You may have noticed that the Centers for Medicare & Medicaid Services has introduced some new accountable care organization models that take into account social health-related needs such as food insecurity or unstable housing, and it wants to see whether addressing these needs can help improve health outcomes and reduce costs. It’s as they say, a good start. 
The reason I say it’s a good start is because the CMS model will not pay directly or indirectly for any community services received by patients. Providers must use their award monies to connect people with those offering such community services. So it is really more about awareness and navigation than about providing the services. In some respects, it is another carrot and stick, check-it-off-the-list item. And there have been more and more of these cropping up. Annual wellness visit, end-of-life talk--check and check.
The real consequences happen when a person leaves the physician office or hospital. Unless someone is actually advocating for patients--in some respects holding their hands to make sure they not only connect with but also receive services--health outcomes will not improve. And let’s face it; if your organization does not already know the community services available and have relationships with those organizations, well, you shouldn’t be in business. And if there are service gaps, you should be developing programs to fill those, too. So maybe all CMS is doing is encouraging a little more effort in addressing this in the office or at discharge. Heck, if you’re going to pay us to do it, sure why not?
I think providers have to look beyond the immediate carrots and sticks to understand that when they actually address societal issues, they improve health outcomes--and that does impact the bottom line in areas where the hospital is being assessed and rewarded or punished. Addressing these issues results in an overall more satisfied patient (HCAHPS scores). It reduces admissions (30-day readmission penalties). It reduces hospital-acquired infections, etc.
That is why some savvy providers are actually putting physicians in senior communities. That is addressing the issue head on. There is a cost-benefit ratio to that, and providers know that a physician on site can address problems early.
In my white paper, 'Dementia Friendly as a Strategic Business Imperative for Hospitals & Health Care Providers," I suggest that “Future success of providers hinges on an understanding that societal health is more than just about population health and that ACO players are not just other hospitals, physicians and long-term care entities. Rather, employers, banks, supermarkets, in short the community, all play a role when it comes to understanding dementia, including Alzheimer’s. Caring for family caregivers in the workplace and creating dementia friendly communities are key issues that society has to address together.”
It takes a forward-looking visionary leader to embrace interventions that you are not directly getting paid for but which you know intuitively will benefit the health of the population.
Take Anna Roth, CEO of Contra Costa Regional Medical Center and Health Centers, a large publicly funded health system in the San Francisco Bay Area. Roth's organization has partnered with Health Leads to direct patients to resources that affect health, including food and housing.
Anna says: “It is time we look beyond the four walls of our institutions and see how we can partner with those who have already mastered things like housing and employment. There are expert agencies. ... We should learn how to work with them. If these networks and organizations are not as strong as we would like them to be, maybe the role we can play is to be strong partners for them so they can strengthen themselves.”
Exactly!
Since the senior population is my focus and probably the majority of your patients, I further suggest that providers look at new roles in the organizations that can better address the intent of what CMS is trying to accomplish and will inherently inspire more real partnership (not referral) programs such as what Contra Costa has done.
Many healthcare providers have care coordinators who work in service-line specific environments. Often providers lament that they need a coordinator for the coordinators. In the United Kingdom, certain hospitals in the NIH have implemented a role, dementia coordinator, to service this specific patient population across diagnoses. It is critically important in light of the following:
- Nearly half of all individuals on antipsychotics in nursing facilities were admitted with a prescription for these medications already in place. The majority of nursing home admissions come directly from the hospital. Make the connection.
- Nearly 45 percent of hospitalizations among nursing home residents enrolled in Medicare or Medicaid are avoidable. People with dementia are far more likely to be hospitalized than their peers without impaired brain function. About two-thirds of the hospitalizations that occur in people with dementia are for potentially preventable illnesses.
The role is designed to support patients admitted with a known diagnosis of dementia or cognitive impairment. The coordinator is a dementia champion, assisting in reducing the stigma attached to dementia patients. The coordinator is also responsible for helping family caregivers and patients fully understand their discharge instructions, appropriately follows up and assures smooth transitions to other care environments and home.
I applaud CMS for helping us start the conversation, but we have a long way to go to make the intent of the new ACO models something that results in true improvement of health outcomes in the community.
Anthony Cirillo, F.A.C.H.E., is president of the Aging Experience, which specializes in experience management and strategic marketing across the continuum of care. Anthony is a monthly contributor on The Charlotte Today program, the about.com expert in senior Ccare, an executive board member of CCAL and a member of the Dementia Action Alliance.