Fall Prevention Program Helps MD Resident: Philmore’s Story

Maryland programs help prevent falls, address other health-related issues

Philmore White Sr. has limited hearing and vision, which has left the 81-year-old Salisbury, Maryland resident feeling unsteady and falling several times.

In late 2022, he started attending a falls prevention class called Stepping On, one of many programs hosted by Maryland’s Living Well Center of Excellence (LWCE), a division of MAC Inc., a non-profit area agency on aging on Maryland’s Eastern Shore.  The evidence-based falls prevention program consists of seven sessions with rotating experts such as physical therapists, an expert who explains how to set up a house to prevent fall, and a pharmacist to ensure participants’ medications aren’t contributing to their instability. 

“You don’t have your eyesight and you don’t have your hearing – it throws you off so bad,” said White. Stepping On, he said is “a good program. You can learn things that will help you, it teaches you what to do to help yourself.”

According to the Centers for Disease Control and Prevention, more than one out of four older people falls each year, and, in 2015, medical costs associated with injuries from falls totaled more than $50 billion. If a patient who experienced a fall goes to the emergency department at a local hospital system on the Eastern Shore, MAC receives automated alerts via Maryland’s Health Information Exchange and then calls the patient to encourage them to join evidence-based programs, such as the Stepping On class. 

As a community care hub, LWCE works with individual primary care providers under the Maryland Total Cost of Care Model, a Centers for Medicare & Medicaid (CMS) Innovation Center model (pilot program) promoting better health care in the state. LWCE contracts with health care providers and health systems that refer patients who may need other evidence-based programs and/or additional social services. 

LWCE’s falls prevention class and other, related programs are part of a larger strategy to address health for seniors in the region. Under the Maryland model, physician practices can refer patients who may need programs like Community for Life, which offers handyman services, runs errands, and helps with transportation; or PEARLS, a depression-management program offered directly by LWCE.

In September 2021, LWCE was awarded funding from the U.S. Administration for Community Living as one of 12 community care hubs across the country charged with working collaboratively across healthcare and social care to improve access and quality of care for older adults and people with disabilities. A community care hub centralizes administrative functions and operational infrastructure for a network of community-based organizations to allow for more efficient contracting with healthcare organizations. 

LWCE staff also can update patients’ electronic health records, so their medical team can be looped in if LWCE finds the patient is struggling with food insecurity or suffering from depression, for example.  

“Maryland’s value-based care model is what has made us so successful,” said Leigh Ann Eagle, Chief Operating Officer of the LWCE. “We’re never going to move the needle until we marry the clinical side and the community side.”

Eagle said their arrangement with Maryland Primary Care Program practices, under the Maryland Total Cost of Care Model, has allowed them to do innovative things like pay for seniors on Smith Island, an isolated island with only a couple hundred residents, to travel by boat to take a falls prevention class.

In 2022, the Maryland Total Cost of Care Model began Health Equity Advancement Resource and Transformation (HEART) payments for primary care practices to address social determinants of health, such as food insecurity and housing instability. Eagle said they have partnered with Maryland Primary Care Program primary care practices to use the HEART payments to pay for meal delivery, transportation to doctors’ appointments, and in one case, a person’s housing expenses so they wouldn’t be evicted. 

Addressing these health-related issues can help patients become healthier. In turn, they are likely to have fewer emergency department visits or need less intensive health care, which helps to save Medicare dollars. 

White’s wife, Velma Jean White, passed away shortly before he began the Stepping On classes. A car enthusiast with a vintage 1967 Chevy Two, White’s health conditions have also kept him from socializing at car shows. But he said the classes have helped with socialization after the loss and given him more confidence with getting around. He also recently started another program from LWCE to help him manage his diabetes.

“I would recommend it to anybody,” White said of the program. “It can help anybody’s situation.”