We can probably all agree that no one wants to experience an acute medical event. However, they’re simply a part of life — particularly for seniors who often live with multiple chronic medical conditions, which can, from time-to-time, escalate into an acute situation needing immediate medical attention. Unfortunately, seniors are not only more likely to experience acute medical events, they are also particularly vulnerable when they happen. The traditional care pathway for acute situations is to call 911, go to the Emergency Department (ED), and then get admitted to the hospital. This traditional care pathway has important and unintended consequences for seniors related to health outcomes, experience of care, and costs. First, older adults are more likely than non-seniors to be admitted to the hospital through the ED. Once in the hospital, they are particularly susceptible to hospital-acquired infections, delirium, and functional decline, which can lead to extended stays and disposition to skilled nursing facilities (SNFs). Second, the traditional acute care pathway often leads to a poor experience for seniors. EDs can be overwhelming, complicated, and inhospitable places for everyone, but particularly for older adults. Hospitals are also suboptimal places to spend extended periods of time: patients often don’t sleep well, they lack privacy and familiarity, and often must follow institutional schedules that may be at odds with their normal routines. Third, ED visits and hospitalizations are expensive. Even with Medicare coverage, seniors pay $1,340 at a minimum for a hospital admission (every 90 days) and they pay copayments and 20 percent coinsurance for ED services and observation stays (when not admitted). Acute care in the home or SNF-type programs can address some of these problems for older adults by facilitating the delivery of acute care where the patients reside, which is often aligned with their wishes, helps avoid hospital-associated risks, and costs less to deliver. At the West Health Institute (WHI), our mission is to enable seniors to successfully age in place, with access to high-quality, affordable health and support services that preserve and protect dignity, quality of life, and independence. To that end, we have been working closely with the Institute for Healthcare Improvement (IHI) to remodel the care seniors receive when they experience certain acute medical events to, in effect, trade the original “space” for treating these events (the hospital) for a new space (a senior’s home or SNF). We began this work by exploring five existing programs: We compiled key model features related to operations, reimbursement, and obstacles to implementation. We then selected six Next Generation Accountable Care Organizations (NGACOs) and formed the acute unplanned event Learning and Action Network (LAN). The LAN provides shared learning experiences while several of the NGACOs develop home and community-based alternatives to offer seniors when they experience acute events. Using IHI’s quality improvement methodology, participating NGACOs use shared aims and drivers while they engage in local, individualized testing of new initiatives. There are three specific and measurable aims developed in support of the overall mission: The LAN also established three primary drivers toward its aims. These include aligning incentives for the health systems, establishing alternatives to ED and hospital admission, and engaging patients and caregivers. For example, each of the NGACOs is testing a specific initiative related to patient and caregiver engagement with the goal of leveraging innovative ways to connect with seniors with acute needs in the ED, at home, and in SNFs. One NGACO is implementing a “call first” campaign that gives patients and caregivers a phone number to speak with a clinician who can triage and offer advice when acute events occur. Another NGACO is developing and testing an education program to help patients and their physicians understand the symptoms that might signal the beginning of an acute medical event for which urgent or emergency care is needed. The organizations then use the IHI’s rapid cycle methodology — “Plan-Do-Study-Act” (PDSA) cycles — to test their initiatives. During these tests of change, they capture data and share it with the other members of the LAN. Although they are each testing local initiatives, there are enough similarities between the systems — including their objectives and roadblocks — enabling them to support and learn from one another. At the conclusion of the LAN, in December 2018, we will compile our key learnings about mobilizing acute care resources in patients’ homes, SNFs, and the ED, including payment and reimbursement for such services. We intend to share our lessons learned and develop resources to drive scale and sustainability of these important innovations in health services delivery.
As seniors are more likely to endure an acute medical event , the care they receive for them should be remodeled appropriately . Traditional practice for these events is to call 911 , proceed to the emergency department ( ER ) and be admitted to hospital . However , for seniors this process can often result in worse health outcomes and quality of care while invoking high costs . Older adults are more likely to the ED where they are more susceptible to hospital - acquired infections , delirium , and functional decline , which in turn may extend their stays and disposition to skilled nursing facilities ( SNFs ) . In addition , the hospital environment can be overwhelming , complicated and inhospitable , with older adults often enduring lack of sleep , privacy and schedules with which they are unfamiliar . Finally , cost is also a significant factor . Even with hospital ##ization , the minimum cost of hospital admission is $ 1340 , followed by copayments and 20 percent coinsurance for ED services and observation stays . Conversely , acute care provided in the home or SNF - based programs offer a viable alternative to the hospital for seniors . In these environments the quality of care , along with outcomes and costs are often improved . To this end , the West Health Institute has been working with the Institute for Healthcare Improvement ( IHI ) to remodel the acute medical care seniors receive . Following investigation into five hospital programs , key model features related to operations , reimbursement , and obstacles were compiled . The acute unplanned event Learning and Action Network ( LAN ) was then formed with six Next Generation Accountable Care Organizations ( NGACOs ) developing home and community - based alternatives to offer seniors when they experience acute events . There are three aims developed to support the process . A decrease in the percentage of ED visits ; a decrease in the percentage of hospital admissions following an ED visit ; and the implementation of a program whose cost to operate is directionally neutral or positive . The LAN has established three primary drivers towards the aims , which include aligning incentives within health systems , establishing alternatives to ED admissions and engaging patients and caregivers . In addition , the organizations will use IHI ’s rapid cycle methodology “ Plan - Do - Study - Act ” ( PDSA ) cycles to test their initiatives . The findings will then be compiled at the conclusion of the LAN in December .