While still shrouded in mist, the path to transforming our health care system is becoming more clear.
While the view is still hazy, last week the Centers for Medicare and Medicaid Services (CMS) took a major step to clarify how it will address the major challenge facing Medicare (and therefore our health care system): transforming an episodic, acute-care dominated, fee-for-service system into one that can meet the challenge of complex chronic care, improving the health of older people while reducing spending.
This is the challenge our new “downstream” grantmaking strategy is designed to address, making CMS’s proposal both very welcome and a high-stakes opportunity to advance our hopes.
Greetings from New Orleans and the 2013 Gerontological Society of America (GSA) meeting. As usual, many John A. Hartford Foundation staff are at the meeting to learn from the experts in the field, to work with our grantees, and to answer questions from anyone interested in improving the care of older adults.
We are particularly excited about the launch of our new Change AGEnts program. Anyone ever associated with a Hartford-funded project is invited to join us at the Change AGEnts Initiative launch event on Friday, Nov. 22, from 6:30-8p.m. (Sheraton Hotel, Grand Ballroom C). Visit our Change AGEnts page to RSVP and learn more!
Of course, we are also very proud of the accomplishments of our current grantees and friends. I’d like to recognize several who are being honored here this week.
If you can stay calm while others all about you lose their heads, sometimes it means you just don’t understand the problem.
Click on document to read the full Department of Justice press release.
Most of the time, being reasonable and understanding and putting yourself in the other fellow’s shoes is the right thing to do. But sometimes being reasonable and understanding just supports an unjust status quo, reduces any sense of urgency to action, and makes one complicit.
Dr. Amy S. Kelley
In recent weeks on Health AGEnda, we have presented our five new program strategies: Leadership in Action, Linking Education to Practice, Developing and Disseminating Models of Care, Tools and Measures for Quality Care, and—last but not least—Public Policy and Communications. Paired with each strategy description, we have also presented an interview with a John A. Hartford Foundation grantee who is already doing the work, showing the potential value of the strategy.
If our shift in strategy moves our focus from “upstream” academic capacity building to a “downstream” emphasis on the determinants of practice, these vanguard leaders are shooting the rapids and teaching us what can be done with geriatric expertise.
Last month, The Journal of the American Medical Association (JAMA) published a major report on the State of U.S. Health 1990-2010 as part of the Global Burden of Disease project funded by the National Institutes of Health, the National Institute of Environmental Health Sciences, and the Bill and Melinda Gates Foundation.
There’s a ton of information on changes in life expectancy and healthy life expectancy at birth over this 20-year span and all the usual international comparisons. Probably most people have heard the good news/bad news parts of the report: Both life expectancy and healthy life expectancy have increased in the U.S. (+3.0 and +2.3 years, respectively), but we continue to lose ground in comparison to other Organisation for Economic Co-operation and Development (OECD) nations, falling to 27th and 26th from 20th and 14th out of the 34 countries in the group.
But what interested me most is the change in the impact of Alzheimer’s disease in the U.S. Between 1990 and 2010, the rate of death due to Alzheimer’s increased by 524 percent, the most of any of 30 diseases and injuries contributing to reduced life. Even the rate of years of life lost (YLL), which takes into account the shorter life expectancy of people affected by a disease of aging, shows an increase of 391 percent.
Dr. Tracy Lustig testified in August before the Commission on Long-Term Care.
One of my biggest surprises in the passage of the Patient Protection and Affordable Care Act (PPACA) was the inclusion of title VIII, the CLASS ACT, which created the possibility of a national, voluntary, premium-financed, and federally administered long-term care insurance program.
While the benefits might have been small and delivered through our only marginally adequate long-term care system, at least it was a start and a step toward recognizing the serious long-term care needs of our aging population.
Graffitti by the street artist Banksy.
“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”—Margaret Mead
Our mission at the John A. Hartford Foundation is to change the health of older Americans for the better. And despite the national investment in health care and the excitement of research, I don’t think we are alone in seeing this as a long, slow road.
I have a confession to make: Despite painful experience, I am a serial optimist. Over the past several years, I have gotten very excited about new benefits added to the Medicare program as ways to support high-quality geriatric care.
Now, a new Complex Chronic Care Management Services benefit has been proposed by the Centers for Medicare and Medicaid Services (CMS). It would address the long-standing concerns that good care to chronically ill older people is discouraged by the focus in the Medicare payment system on face-to-face patient interaction without adequate support for planning, communicating with other providers, and other services outside the exam room.
It could be a really good thing, but it also has many seemingly arbitrary or unclear features. That’s where all of us who work in this field come in. CMS is seeking comments from the public on the new rule.
In mid-May, I was at the Social Impact Exchange (SIE) meeting, thinking about the relationship between our work and what I was hearing from other funders and non-profits. I was struck by how much of the “problem” that others were describing had to do with too many funder dollars chasing the same non-profits and too many non-profits working on the same social issue (e.g., to improve the education of at-risk youth).
It made me feel very lonely. With the coming spend-down of The Atlantic Philanthropies and the Donald W. Reynolds Foundation, two of our biggest colleagues are exiting the field. Not only will we miss their money helping to advance the care of older adults, but we will also miss the expertise and shared knowledge of our peers. Of course, there are new funders emerging, such as the Margaret A. Cargill Foundation who have an aging focus, but, given the growth of the population, it just doesn’t feel like enough.
One thing that one hears at the SIE meeting is a lot of succinct case statements describing the rationale for an area of funding. For example, the poverty rate for children in America was reported this week to have reached 23 percent. And of those low-income children, fewer than half will graduate from high school. It isn’t unusual when the wasted lives are described to see stern professional program officers get a bit teary.
Last Friday I was at a session of the National Health Policy Forum (NHPF) in Washington D.C. focused on Medicare’s readmission reduction program The program, authorized under section 3025 of the Patient Protection and Affordable Care Act (PPACA), is the “stick” to section 3026′s “carrot.”
Section 3026 authorizes the $500 million Community-based Care Transitions Program that will pay partnerships of community-based organizations and hospitals to offer evidence-based, post-discharge services to reduce readmissions. Section 3025, in effect since October 2012, dropped the other shoe and requires the Centers for Medicare and Medicaid Services (CMS) to reduce payment for Medicare services to hospitals whose patients have higher than expected rates of rehospitalization within 30 days of discharge. (For more background, watch this Modern Health interview with longtime John A. Hartford Foundation grantee Eric Coleman, MD, read this recent Reuters article featuring Coleman, and this post I wrote on Health AGEna in December 2010.
Clearly the audience at the session was very concerned about the program and seemed sure that it should changed, if not abandoned (See my response to a Wall Street Journal op-ed last month.). I see the matter very differently and I’d like to explain why. NHPF Sessions are off the record, so I won’t use any quotes or attribution.