Flip the Nursing Home: Planning for Senior Care 2020

A Healthcare.mn http://www.meetup.com/healthcaremn “Senior Care Ideathon” meetup in Minneapolis brought together providers, entrepreneurs, advocates and healthcare business professionals to address specific issues facing the American healthcare system in the next decade. The goal of this “Flip the Nursing Home” exercise was to bring ideas from multiple sectors to mash up ideas about how technology can be used to deliver safer, more efficient care to patients in their homes.

The perfect storm. A “senior care crisis” is predicted because a looming healthcare worker shortage is coming at the same time as baby boomers enter their older years. This means it’s urgent that new ways to care for seniors be created.1 Already nursing homes and home care agencies have difficulty recruiting and retaining nurses and other support staff. Because of this shortage, 1,500 nursing facility admissions were denied in 2014, and 12% of nursing facilities reported shutting off admissions for a period of time in 2015.2 These statistics brought together representatives from several Minnesota long-term care providers to talk about ways technology can assist seniors and their families efficiently and effectively support provision of care for those seniors who need it.

Brainstorming solutions. After describing the problem and the imperative to find better solutions, the audience split into work groups to discuss possible solutions to six specific problems. The groups came up with lists of thoughts and suggestions and later shared them with the entire group. The next week, the facilitators shared the slides and aggregated suggestions with participants and suggested meeting again in the future to build on this initial work.

Other solutions from outside and inside the U.S. In recent years it’s become all the rage to look at how other countries manage their healthcare systems. Other developed countries face the same if not more imminent demographic realities. They are also likely to have centrally managed healthcare – either directly reimbursed by the government or a more regulated insurance system where the government is involved in setting benefits and payment levels. As in the U.S. they are looking for better ways to coordinate and deliver care outside institutions. To our north, Ontario has been working to deliver services to patients at home, with Community Care Access Centres (CCACs) http://www.health.gov.on.ca/en/public/contact/ccac/ responsible for managing delivery of physical therapy, nursing care and other services to patients’ homes. After studies highlighted their inefficiencies, Ontario plans to eliminate the CCACs and expand the role of the Local Health Integration Networks https://ontario.cmha.ca/public-policy/context/health-transformation/local-health-integration-networks-lhins/". In addition, Ontario plans to change to the way primary care is delivered in an attempt to control costs and reduce emergency room and after-hours non-emergent care.3

Also in Ontario, McMaster University’s Aging Community and Health Research Unit (ACHRU) https://achru.mcmaster.ca/ has been developing tools to enable patient/clinician collaboration.4 They use user-centered design to make sure their digital tools are as effective as possible.5 With these projects, they are making progress understanding what’s needed to support patients and family caregivers at home and avoid unnecessary hospitalizations. With these initiatives, Ontario is looking for ways to utilize technology and adjust the delivery systems to save costs and improve care.

In the U.S., innovation is happening on two fronts. More complex care coordination is being pursued, but digital health systems are often not adequate to support it. In addition, more attention is given to providing better, more effective and efficient care for patients with serious ongoing health problems by changing payment methods to cover multiple providers in a single Accountable Care Organization or giving a single payment for specific issue, such as an elective surgery or diabetes care. Serious illnesses, such as cancer, are increasingly treated by providers accredited by organizations like the American College of Surgeons’ Commission on Cancer.6 Organizations such as the American Society of Clinical Oncology [ASCO] http://www.asco.org/ are supporting research that informs patients and clinicians about the value of treatments by reporting clinical benefit, toxicity and cost. Likewise, other cancer organizations are conducting similar analyses with the goal “to address the challenge of mushrooming cancer-drug costs by providing cost-benefit analyses in a format that enables a conversation between the patient and physician that incorporates consideration of costs.”7 The costs of drugs used for treatment of cancer and some other serious diseases can be high, but costs of treating the drug’s side effects and complications of care can be reduced with better coordination and communication. Also, selecting the most effective drug and treatment plan for each patient will reduce overall healthcare costs.

Innovations are also coming from new primary care models. Iora http://www.iorahealth.com/ started with employers and now is offered to Medicare Advantage beneficiaries in some states as well. It is a model based on team care with its own health IT to support its care teams, including health coaches, and patient forums. A new health plan built on another innovative primary care model is ZOOM+Performance Health Insurance, https://www.zoomcare.com/health-insurance/ which is now offered on the Oregon public health insurance exchange. Its low cost and superior patient experience are being noticed, as well as its new approach to better lifestyle support that includes teaching ways to prepare healthy foods. They, too, have developed their own technology that is designed to support optimal user experience for patients and clinicians, including its own programs for self-care, crowd-care and instacare.8

Solving Minnesota’s “senior care crisis” and healthcare worker shortage may involve technology and payment innovations modeled on others’ experience and others that are created right here in the state. The incentives for provider organizations, payers, old and young consumers are apparent because we all will suffer the consequences of keeping the status quo. I, for one, look forward to further thought-provoking meetings to sort through these difficult issues, and commend healthcare.mn leadership for supporting this effort.

[1]Other factors include seniors’ desire to age in place; multiple chronic conditions/ADL limitations; government cost of caring for seniors; fewer informal caregivers; declining care center beds/occupancy; insufficient retirement assets. A discussion about the Senior Care Crisis can be found in: BA Bowser, Why Long-Term Care for U.S. Seniors is Headed for ‘Crisis’. PBS NEWSHOUR: The Rundown (March 20, 2013). Accessed at http://www.pbs.org/newshour/rundown/americas-looming-long-term-care-crisis-and-what-can-be-done/ .
[2]Long-Term Care Workforce in Crisis. The Long-Term Care Imperative: A Minnesota Collaboration for Changes in Older Adult Services (March 2015). Accessed at https://www.careproviders.org/members/2015/imperativekeyslidesfromlegsurvey2015.pdf .
[3]E Church, Ontario plans to target home care in overhaul of health care system. The Globe and Mail (November 23, 2015). Accessed at http://www.theglobeandmail.com/news/national/ontario-government-to-overhaul-health-care-services/article27447577/ . [4]J Ploeg, et al. Working Together to Manage Multiple Chronic Conditions (MCC). Aging, Community and Health Research Unit (ACHRU), McMaster University (2015). Accessed at https://achru.mcmaster.ca/sites/achru.mcmaster.ca/files/Study%201%20Infographic_caregivers.pdf . [5]Designing and Developing a Mobile Health Application to Support Community-Based Stroke Rehabilitation: My Stroke Team (MYST). Aging, Community and Health Research Unit (ACHRU), McMaster University (2015). Accessed at https://achru.mcmaster.ca/sites/achru.mcmaster.ca/files/Study%204%20Infographic.pdf . [6]Commission on Cancer, Cancer Program Standards 2012: Ensuring Patient-Centered Care (updated). American College of Surgeons (January 21, 2014). Available at https://www.facs.org/~/media/files/quality%20programs/cancer/coc/programstandards2012.ashx . [7]RC Young, Value-Based Cancer Care. NEJM.org online first (November 18, 2015). Access at http://www.nejm.org/doi/full/10.1056/NEJMp1508387#t=article .
[8]D Chase, I’ve Seen The Future Of Healthcare. I Like What I See. Forbes (November 23, 2015). Accessed at http://www.forbes.com/sites/davechase/2015/11/23/ive-seen-the-future-of-american-healthcare-i-like-what-i-see/ .