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Trading patient-centered care for person-centered living

March 29th, 2012

by Anthony Cirillo

There is a high likelihood that hospital utilization will decline precipitously over the next five to 10 years. And because of that, as a recent presentation at The Governance Institute noted, "it is now a 'cost game' and a 'care organization game (for hospitals).'"

From what I see, that is partially right. Hospitals are trying to become as efficient as possible and ring out every conceivable cost. And at the same time, they are trying to improve quality at every turn. Both are laudable.

But...

It seems hospitals want to become masters of their domain: That is, they want to be absolutely great at hospital care. And we will need hospitals. Yet this silo approach ignores the growing reality that care will extend much more beyond the hospital walls.

[More:]

And beyond the nursing home walls.

And beyond the assisted living facility walls.

There is a continuum of care that is blurring. And even with a population that ignores self-responsibility, the technology is such that more care is, can and will be moving into the home. Sure, hospitals offer home health to an extent, most paying lip service to it.

Many hospitals talk about this continuum and acknowledge it, but few seem to want to embrace it. The "care organization game" is more about organizing the existing care they provide than extending that care. Yet it would seem the ideas of wellness, population health, chronic disease management and bundled payments eventually will move the care and the incentives outside the walls. But hospitals continue to build their "hotel-like" structures. Will they be left behind?

Some, like Highmark Blue Cross, get it. While many have sneered at its purchase of a hospital, the insurer realized that owning more of the continuum makes sense. Just as United Healthcare realized when it purchased physician organizations. And while I don't suggest ownership is virtuous, it acknowledges that owning the continuum is not only good for business but also assures continuity of care, a consistent culture, and with data at their disposal, a clear focus on improved outcomes, quality and a true understanding of what a person needs to enjoy a quality of life.

Note I said person not patient. Treating the whole person throughout the continuum of care and the entirety of their life is what we should be charged with doing. Yet we say adios to most after they exit the doors.

This idea of person-centered living is one I have come to embrace. And I have done so through the Consumer Consortium for Advancing Person Centered Living (CCAL) of which I am on the board.

CCAL coined the term person-centered living (PCL) as a reminder that as people grow older or have disabilities they should not experience a loss of humanity. PCL means living as one chooses to live. If support is needed, support is centered on personal preferences and values that stress dignity, choice, self-determination, respect, privacy and individuality. PCL means being kind, respectful and sensitive to those being served and honoring their right to make their own choices, regardless of the setting.

Emphasis--regardless of the setting.

And while some may say this is a shameless plug, well maybe it is. I believe in it. Because as someone who moves across the continuum of care in my work, I see the disconnect. PCL can be a connector. Hospitals have a great opportunity to be the connectors of care, though many seem to be cocooning into their safe and comfortable environments. And right now, nothing is safe or comfortable in healthcare.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities. He also is the expert guide in Assisted Living for About.com and Healthcare Channel Partner for CEO².

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