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I have always contended that the experience of care is the total experience, and I go out of my way in my keynotes to look at how the experience impacts everything--billing, patient safety and quality, discharge and transitions. Yet HCAHPS only looks at a small slice of this, if any at all.
I also spend a lot of time talking about family caregivers. Just one in three physicians ask for their input into a loved one’s care, and only one in six physicians ask the caregiver themselves how they are doing. My doctor, on the other hand, called me back four months after my annual physical because he was concerned about my stress level as a family caregiver to my 94-year-old mom.
Consider further that according to an Experience Innovation Network (EIN) study only 13 percent of organizations were giving top priority to patient and family voice in 2015. And a Beryl Institute benchmark report showed slightly better scores with 37 percent of responders committed to giving priority to patient and family engagement. This further reflects in other EIN data that shows very little patient and family caregiver engagement in discovery and data gathering, implementation, testing, process mapping. And of course, family voice is not measured by HCHAPS.
The once in a decade (really, once every 10 years) White House Conference on Aging held in July had some highlights worth talking about--such as Uber playing a prominent role as it continues to expand UberASSIST, its senior transportation option. Transportation is a huge issue with seniors and very much a part of any discussion about creating dementia-friendly communities.
Which brings me to another initiative launched at the conference, Dementia Friendly America (DFA). According to the newly launched website, “The Dementia Friendly America initiative, a multi-sector, national collaborative, is on a mission to foster communities that are equipped to support people with dementia and their family and friend caregivers by becoming ‘dementia friendly.’”
Dementia friendly is definitely not something achieved in a silo. A compelling graphic on the DFA website lists the components to achieve a dementia-friendly community. Frankly, the United Kingdom equivalent is a little more robust. Consider the following from a white paper from the Alzheimer’s Society in the UK. Dementia friendly includes the following 10 priorities:
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?
Ask most healthcare CEOs the utilization rate for the Medicare Annual Wellness Visit (AWV) and they will probably not know it. While it is reimbursable, the cost/benefit ratio favors practices sticking to what makes them money. They need to see the bigger picture.
The AWV reimburses on average $117 per visit, and to capture all of the documentation necessary to financially benefit the practice, it requires approximately 45 minutes. And if you don’t code properly, well, that’s another story.
Most find the AWV time-consuming, tedious and a financial burden.
There is a marketing term called loss leader. It’s the idea that you provide a product or service that is an enticement to help grow the number of customers you have. You may break even or lose money. But that is the cost to introduce new people to you.
For healthcare organizations, the gamble is that once they have experienced the care you offer they will come back and tell others.
There were many presentations at the March conference of the American College of Healthcare Executives regarding population health management. With value-based purchasing heating up, accountable care organizations forming fast, and readmissions a big hot button, it's only natural that keeping people well and out of the hospital would be a part of the conversation.
I am not a clinician, but I know enough to understand that population health management has been focused on the chronic conditions that eat up cost, challenge access and could be controlled--heart disease, diabetes or cancer, for example.
But is dementia, including Alzheimer's, really being addressed in current population health management models? I would contend no.
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