Advanced Illness: Revolutionizing the Care Value Proposition

Care Transitions, Advance Directives, Hospice All Need to Be Part of Solution

More and more care is moving to the home. Getty Images

Advanced Illness: Revolutionizing the Care Value Proposition was the topic of a panel at the World Health Car Congress featuring Mitchell Daitz, CEO, Vital Decisions; Kenneth Doka, Professor of Gerontology, Graduate School of the College of New Rochelle; Colleen Marshall, Chief Operating Officer, Vital Decisions; Richard Payne, M.D., Professor of Medicine, Duke University; and former HHS Secretary and Chairman and CEO of Thompson Holdings, Tommy Thompson.

Tommy Thompson started the 50,000 foot discussion. The unanticipated deficits of the Medicaid and Medicare programs is between $40-$70 trillion. We are going to have to come together with the private sector and the government to bring new solutions to the table to reduce costs.

Of course these statistics will increase with an aging population. Consider the following.

• There are 65.7 million caregivers; 29% of the U.S. adult population

• 43.5 million caregivers care for someone 50+ years of age; 14.9 million with Alzheimer's disease or other dementia.

• 66% of caregivers are female.

• Half perform medical & nursing tasks.

• The average age of caregiver is 48.0 years.

• Caring for someone 50+, the average age is between 50-64.

• Caring for someone 65+, the average age is 63 years.

•  70% of the caregivers between the ages of 50 and 64 care for someone 85+.

Home Health

While SNF populations have held steady, the need for home health in the home is acutely increasing.

One third of Medicaid is being devoted to elder care.

Dr. Payne delved deeper into elder care, noting the chronic nature and disjointed delivery system. He alluded to the still small numbers of people using hospice care in a fee for service environment where the medical establishment continues to prolong life instead of considering quality of life at the end of life.

He then spoke about Palliative Care as a way to broaden reach, touching not only end of life patients but others in need.

He suggested that Advanced Illness Management presents a new value proposition. And it starts with things we have covered here before.

Better transitions in care - we know the hand offs between providers is poor at best and when that happens people get sick and then readmitted. So concepts such as transition teams, care managers, and care liaisons supported by tele-support and electronic medical records will help keep people in a quality of life in their home. The technology alone is not enough. That is why the care team is important.

Doka took the end of life discussion deeper suggesting that advanced directives, while good, are not enough because how we feel about our wishes when we fill these out in our 30's may be drastically different when we are in our 50's or in the moment of our own health care crisis, facing our own mortality. It certainly does speak to reviewing these documents periodically.

But it is more than a document and more of a family conversation that needs to take place.

Where all of this was going of course was to a solution that the next presenter outlined.

Marshall of Vital Decisions outlined "Kim's" story. Kim had leukemia. Her wish was to do everything so she could see her grandchildren.

As the conversation grew to another level they discovered that what Kim wanted was to to be aware and involved in her grand children's lives. If she could not have that, she wanted no heroic measures. Unfortunately after Kim's second bone marrow transplant, she could no longer speak for herself but her family knew what she wanted and they let her pass on.

That is the essence of person-centered experiences.

The experience of care is the marketing. Because people talk about experiences. And as you know they talk about negative experiences to more people than they do about positive experiences. No amount of marketing can combat bad word of mouth. Every employee has a brand personality. And they must realize they are both chief experience officer and chief marketing officer. They are on the front lines. So make sure you take care of your employees' health and well being too because great patient and resident experiences start with great employee experiences.

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