December 2, 2016 at 5:00 am ET
When a person becomes a patient because of health issues, they want a high-quality health care experience that puts his or her needs and preferences front and center. Every family caregiver also wants to know that their loved one is cared for in a way that honors choice, dignity and independence. However, most of us experience the seemingly great divide between how the medical system sets goals for people and what that person seeks in daily life.
The medical system typically measures success as decreasing the negative effects of disease, but individuals focus more on when and how they can get back to their daily routines. Sometimes these goals match up; often they don’t. Ask any person what “being well” looks like and they’re likely to talk about being able to function in spite of disease, rather than how they are dealing with symptoms or side effects of multiple treatments. This difference is especially stark for older adults with complex health problems, who often have a limited say in how they are treated by a network of well-meaning primary care clinicians, specialists, hospitalists, and family members pushing their own points of view about “success.”
For the health systems that serve them, effectively treating older patients’ functional, behavioral, and environmental needs can be a sizeable challenge from both clinical and financial perspectives. Increasingly, however, health systems are adapting emerging care models that help “high-cost, high-need” Americans thrive in their homes and communities, and ultimately reduce costly admissions to the hospital and avoid unnecessary readmissions.
It turns out that helping older people flourish in homes and communities of their choosing is a major key to controlling health care expenditures for these adults with complex care needs. The data are not new. The costliest 5 percent of Medicare beneficiaries account for almost 40 percent of annual spending, and older adults with functional needs and chronic health conditions cost roughly twice as much as those with chronic conditions alone. How a person lives every day in light of their health status — particularly their ability or inability to achieve security and stability in their community — matters.
Medicare has been moving away from fee-for-service and utilization-based managed care toward value-based payment based on outcomes over the past six years. CMS recently set an ambitious goal that 50 percent of Medicare payments will go to alternative payment models at the same time they are restructuring the physician payment system to be anchored in quality outcomes. Taken together, this major initiative shows that addressing health in light of daily living needs is no longer a “nice to have” programmatic add-on; it is now a business imperative.
So how do we better connect with each patient as a person within the realities of our current health care system?
Ideas from Sens. Orrin Hatch and Ron Wyden through their Chronic Care Workgroup call for enhancing team-based coordination so that older Americans with major health needs and their families can get back to the business of living. Similarly, the American Geriatrics Society defines person-centered care as an arrangement where providers ask for individuals’ values and preferences and use this information to guide all aspects of their care, supporting their realistic health and life goals. Under this model, a person’s values and preferences are understood at the onset of diagnosis and treatment, and goals are regularly reviewed to align care and living needs. These models recognize that older adults with complex needs require coordination and support from a wide variety of providers in order to live a life of their choosing.
Furthermore, aging is everybody’s business — affecting nearly all Cabinet-level departments including Commerce and the Veterans Affairs. The incoming administration is inheriting a nation with a crumbling infrastructure — not worthy of the honor and respect aging Americans deserve. Visible federal leadership is vital to prioritize issues affecting older Americans and family caregivers and to strengthen our crumbling health and social service infrastructure. While the health care community often encounters older Americans when they are lying in hospital beds or sitting in waiting rooms, fundamentally these are people who aspire to live well in the place they call home. By embracing a person-centered approach, health systems, health plans, and payers can deliver on an excellent care experience, improved population health, and lower costs. We hope that the Trump administration will champion person-centered care models and payment reforms in order to make America great for its older citizens.
Bruce Chernof, M.D., is president and CEO of The SCAN Foundation, whose mission is to advance a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence.
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