As seniors are more likely to endure an acute medical event, the care they receive for them should be remodeled appropriately. The American Geriatrics Society is a nonprofit organization dedicated to advancing health and well-being of older adults. 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 ED 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 Medicare coverage, 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-type programs offer a viable alternative to the ED for seniors. In these environments the quality of care, along with outcomes and costs are often improved. 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. 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.
As seniors are more likely to endure an acute medical event, the care they receive for them should be remodeled appropriately. The American Geriatrics Society is a nonprofit organization dedicated to advancing health and well-being of older adults. 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 ED 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 Medicare coverage, 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-type programs offer a viable alternative to the ED 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.