Getting Real about Senior Health Care

Polls and pundits, for the most part, got it wrong in their predictions for the outcome of the presidential election. Fake news is in the news. No one knows what the next four years have in store for us — and the future of health care is no exception.

With 20 years of my career in health care leadership, one thing I know for sure, it’s time for a reality check when it comes to caring for our oldest patients. Our nation is aging, and this demographic phenomenon will continue to put pressure on both our ability to care for these neediest members of our community and health care costs. Like global warming, ignoring the problem or “kicking the proverbial can down the road” will not make it go away.

Between 2010 and 2050 the population 80 and older is expected to triple—the population 90 and older will quadruple. This reality has important implications for Medicare because beneficiaries age 80 and older account for a disproportionate share of Medicare expenditures, which currently represent 15% of the federal budget.

During the past 20 years, I’ve seen how different reimbursement models can shape care delivery. One model that clearly doesn’t work is fee-for-service—what many call the “sick care” model, where providers are primarily compensated when people get sick or injured.

Let me give you an example. When I became president of Hebrew SeniorLife, which provides post-acute care services among other things, my new colleagues asked who our primary post-acute care providers were when I was EVP and COO at North Shore Medical Center. My answer — we didn’t really know because the care provided after us was not on our radar. Our financial health depended on a steady stream of sick patients, and there was no real financial incentive to work with rehab facilities or home health care services to reduce re-hospitalization. I don’t think many would argue that this was not in our patients’ best interest, but we had many improvement goals and finite financial and human resources, so it was challenging to decide to invest time and money in programs that were going to reduce our already insufficient revenue.

The Affordable Care Act may not be perfect, but we’d be foolish to abandon the parts that are clearly working, among them payment reform. As examples, Accountable Care Organizations and Bundled Payment models in which HSL participates address fragmentation within our health care system, encouraging and rewarding providers to deliver care in the most effective and efficient way possible.

To control health care costs while improving outcomes, health care leaders and policy makers must continue to focus on:

• Developing integrated models of care,
   
• Determining optimal clinical pathways that can be delivered in the most effective settings,
   
• Improving care coordination among providers across the continuum, including home and community-based service providers,
   
• Enhancing information transfer between these providers to improve quality, cost effectiveness, and care transitions, and
   
• Including both medical and behavioral health in these collaborations.

I’ve been named to head the Massachusetts Health and Hospital Association Continuum of Care Council – a group that will include provider groups from across the health care continuum. I look forward to working with other health care leaders to make sure we don’t halt the progress that’s been made to design a system that focuses on the health of our patients and their families. We at Hebrew SeniorLife are also actively involved in this topic with our Representatives and Senators; are you?