President Obama signed the Older Americans Act Reauthorization Act of 2016 into law on April 19, 2016, reaffirming our nation’s commitment to the health and well-being of older adults. What matters most to seniors is the choice and ability to “age in place.” According to the Livable Communities Research conducted by the American Association of Retired Persons, nearly 90 percent of seniors intend to continue living in their current homes for the next five to 10 years. A fundamental concern is how our healthcare system will adapt to meet the needs of seniors to bring this goal to fruition. This year the d.Health Summit set out to address barriers, such as antiquated reimbursement and licensing policies, with global healthcare leaders as their shared their own “disrupting healthcare” stories. On the topic of Successful Aging and Chronic Care, a diverse panel shared their concerns, accomplishments and views on change.
Value-Based Care Keeps Patients at Home in the Netherlands
Dr. Bastiaan “Bas” Bloem is convinced value-based care reimbursement is the way to go. He thinks an integrated system is the only way to finance innovation. As the Medical Director of the Parkinson Centre Nijmegen in the Netherlands, a recognized National Parkinson Foundation center of excellence since 2005, he “owns” the budget and spending. “One thing we just developed and I am really proud is Parkinson TV,” gloated Dr. Bloem. He doesn’t think he would have gotten reimbursement to invest in a studio for the hospital for Parkinson TV but pays for it out of his budget. The program is run by a panel of patients and is broadcast once a month on live TV to patients, spouses, and caregivers at home. “And it’s wonderful,” declared Dr. Bloem, “the patients decide about the topics and instead of transporting patients to the hospitals we transport knowledge from the hospital to the patients’ homes.” The National Parkinson Net concept won best healthcare innovation and was awarded the prestigious Value Based Care Award in 2015. What happens when patients are well informed and stay out of the hospital? Dr. Bloem has proposed a new solution where they experiment with the insurers to reimburse the hospital for every patient who no longer comes to the hospital. He remarked, “That’s why we need this disruption – this little revolution and turn our thinking around, reimbursing for patients who are no longer coming to the hospital. It is a game changer.”
An Unknown Asset: The Role of Caregivers
“Most older adults are accompanied to physician visits by other persons, and yet, there is data that suggests that we rarely know how to engage that person,” stated Dr. Boyd, an Associate Professor of Medicine at Johns Hopkins University of Medicine. Cynthia Boyd MD, MPH research interests specialize in patient-centered care for people with multiple chronic conditions. She received the American Geriatrics Society Award for Outstanding Clinical Investigation in 2010. She feels questions as to “what would a patient want their caregiver to be involved in doing” and “how do we empower the roles of caregivers” remain unaddressed. First, to be part of the long-term planning and thinking is really important, and Dr. Boyd proposes “making sure that we try to figure out how to maximize the value of people who are accompanying older adults to visits across the spectrum.” Second, she thinks there has really been a shift in how we measure caregiving. The way caregivers are traditionally defined compared what people are asked to do know is very different. Today, the role is being the care coordinator of all the care coordinators, in addition to doing all those traditional caregiving tasks. “When we talk about measuring caregiving”, shared Dr. Boyd, “sometimes we don’t even measure those tasks.”
Dr. Landers’ work is in an environment for elder services. Steven Landers, MD, MPH is the President and CEO of the Visiting Nurse Association Health Group, the nation’s largest not-for-profit home health care organization. He believes a missing piece of the puzzle is the knowing the impact a caregiver has on influencing a patient’s outcome. He addressed the audience on these gaps in knowledge, stating that measurement can be a great way to shine a light on things and motivate change. “You can’t look at a Medicare advantage plan, a home health agency a hospital, or physician practice and see the outcomes of family caregivers. I think if we start measuring them. I know scientifically and psychometrically measuring caregivers outcomes, I am sure is a challenge, but we ought to figure out how to start measuring caregiver outcomes. It will start motivating grassroots efforts and local levels to make the lives of caregivers better,” encouragingly spoke Dr. Landers.
Outcomes-Based Philanthropy
“We are doing a really terrific research project on how to empower informal and family caregivers in a really meaningful way because the pressure upon them is like you almost can’t describe it,” enthusiastically proclaimed Shelley Lyford, President, and CEO of the Gary and Mary West Foundation. West Health is advancing innovative healthcare delivery models that enable seniors to age successfully. And in addition to that, shared Ms. Lyford, there is a subset of seniors who don’t even have informal caregivers and that is a group that we are very interested in supporting in San Diego.” At West Health, Ms. Lyford uses philanthropy to kick-start new program models. It was about million dollars that the foundation decided that they were going to deploy to kick start a new model of care to leverage these community organizations in a meaningful way. West Health engages with public-private partnerships and local health and human service agencies on programs that will demonstrate better health outcomes. They have successfully launched a Senior Dental Center for oral health screenings and caregiver-focused research to enhance both caregiver and patient. “We are bound and determined to do it, and with all that data, we are going to the agencies in Washington DC. We hope to influence new payment mechanisms and reform. So we see this as a journey, and we know it’s not going to take a year or two years – it’s a multiyear journey, but the importance of philanthropy kick starting new innovations is really important,” assuringly smiled Ms. Lyford.
The d.Health Summit on Aging took place on May 4 at the New York Academy of Sciences in New York City, you can find more information about the organization and event on their website.