Health AGEnda

Chris Langston

About Chris Langston

Christopher A. Langston, PhD, is the Program Director of the John A. Hartford Foundation, and is responsible for the Foundation’s grantmaking in support of its mission to improve the health of older Americans.

Public Reporting Alone Will Not Fix Nursing Home Problems

NYT_Capture_NursingHomes400Yesterday, the New York Times had an interesting piece looking at the star rating system that Medicare has been using to evaluate long-term care facilities.

Coincidentally, I was moved to learn that a family friend, my “Aunt Betsy,” has been in an institution for going on 10 years, exceeding almost every expectation for longevity in advanced dementia.

The Times writer, Katie Thomas, observes that much of the data that drives this public reporting system, Nursing Home Compare,  of “hotel-like,” 1- to 5-star ratings comes from institutional self-report and seems susceptible to gaming—including staffing up for the critical two weeks that are the basis of reporting for the year’s rating, and then letting the staff go immediately afterward. Sort of the way that television shows pump up their ratings with guest stars during sweeps week and then fall back to meh afterwards.

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Poll Briefing Makes Voices of Older Americans Heard in DC

From left, featured experts Peggy O'Kane, Robert Berenson, and Caroline Blaum listen intently.

From left, featured experts Peggy O’Kane, Robert Berenson, and Caroline Blaum listen intently.

Like so many stakeholders in health care, we at the John A. Hartford Foundation  have many of our hopes pinned on enhanced primary care as a way of improving health outcomes, particularly for older Americans who face multiple chronic conditions.

Primary care providers will need more skills, more teammates, community partners, and, of course, more money, to live up to these hopes. But we believe that better primary care can prevent some of the acute and expensive events such as hospitalizations that they experience, and thereby also lower total costs of health care.

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Equality Does Not Equal Lowering Health Care Standards for the Poor

FrenchRevolution_177737175July is an important month in history, with Bastille Day, on July 14, coming just 10 days after our own 4th of July. So what better time to consider issues of justice and equality?

There are lots of different ways to interpret equality: equality of outcomes, equality of opportunity, or perhaps—as an even more complex relative equality—matching of resources to individuals’ needs.

In the context of improving health care delivery to older adults, there are several important examples of these principles of equality in what is called “risk adjustment.” And I find myself with very different reactions to the different kinds.

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Coming to Terms with the Concept of Population Health

Crowd_481008763_400Like a lot of new concepts, population health seems to be on everyone’s lips and there seems to be a lot of excitement to “do” population health. It sure sounds good and yet I am entirely unclear about the specifics and I’m pretty sure that everyone is feeling a different part of the elephant.

Unfortunately, a recent paper published on BMJ Open suggests that these divergent views are common.

We can all understand the goals of the triple aim: better care—higher quality health care with fewer defects; better health—a related but independent goal that the population at large is actually healthier; and lower cost, at least on a per capita basis—reducing total costs of care.

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New Grants Target Policy and Practice Change

One of the Hartford Foundation's new grants will support an additional 44 Health and Policy Fellows over the next three years who will bring geriatric expertise to policymakers and in turn receive intensive training in policymaking through placements at key agencies and offices in the federal government.

One of the Hartford Foundation’s new grants will support an additional 44 Health and Policy Fellows over the next three years.

While the two new grants approved by the John A. Hartford Foundation Board of Trustees last week continue to move us forward in our new strategic direction, which includes a focus on health policy and practice change, they also build on partnerships and successful work we have engaged in for years.

The grants totaling $2.13 million will support an additional 44 Health and Aging Policy Fellows (HAPF) over the next three years and help co-support a new Institute of Medicine (IOM) study on family caregiving of older adults. Both projects also offer great opportunities for our new Hartford Change AGEnts to bring their talents, expertise, and skills to bear on important issues related to creating policy and practice change that improves the health of older Americans.

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AGS Annual Meeting Revitalizes Commitment to Improving Care for Older Adults

Jennie Chin Hansen, CEO of AGS, left, with Cory Rieder, the Hartford Foundation's executive director and treasurer.

Jennie Chin Hansen, CEO of AGS, left, with Cory Rieder, the Hartford Foundation’s executive director and treasurer.

In honor of the American Geriatrics Society’s (AGS) annual meeting opening today in Orlando, we want to reflect on the key role this partner organization has played in our joint efforts to improve the health of older Americans.

Over the years, AGS has been one of our largest and most frequent grantees, leading a diverse array of projects. Many grants have aimed at strengthening the field of geriatrics, such as the leadership development award through the AGS affiliate organization, the Association of Directors of Geriatric Academic Programs (ADGAP)  or the Health Outcomes Research Scholars through another affiliate, the Foundation for Health in Aging.

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Toward a More Effective CMMI

CMIinnovationlogofinal1Last week on Health AGEnda, I stuck up for  the Center for Medicare and Medicaid Innovation (CMMI) in the face of what seemed to me fairly unrealistic criticism from a Wall Street Journal op-ed.

I approached the issue from my perspective as a funder and as a very, very, much smaller player in the reform of the health care delivery system than CMMI. It got me thinking that, while I have offered advice directly to the Centers for Medicare and Medicaid Services (CMS) and CMMI staff and mentioned various concerns here on the blog in passing, I haven’t really tried to think through what our experience at Hartford suggests might help CMMI be as effective as possible.

CMMI is the big player in health care delivery reform—the changes to culture, training, regulation, payment, and organization in health care that we all hope will lead to higher quality care, a healthier public, and lower costs of care per capita.

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Debate Role of CMMI? Absolutely. Abolish it? No

WSJCapture400When I first saw the Wall Street Journal op-ed attacking the Center for Medicare and Medicaid Innovation (CMMI) for many purported sins, my first thought was that I should just congratulate CMMI for having arrived. After all, in our hyper-partisan environment, you aren’t anybody unless you are considered worth bashing by someone.

CMMI was set up and funded as part of the Affordable Care Act under section 3021of Title III, the hitherto relatively noncontroversial part of the law aimed at “IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE.” The agency’s goal is one that the John A. Hartford Foundation  has pursued on behalf of older Americans for 30 years and one that we feel passionate about:

The purpose of the CMI is to test innovative payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care furnished to individuals under such titles. In selecting such models, the Secretary shall give preference to models that also improve the coordination, quality, and efficiency of health care services furnished to applicable individuals defined in paragraph (4)(A).

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On Each Other’s Team: What We Can Learn By Listening to Older Adults

poll_satisfaction350If our work at the John A. Hartford Foundation has taught us one thing, it’s this: In the quest to transform primary care for older adults, a huge part of the answer is deploying more geriatrically expert primary care teams that can coordinate and deliver care designed around the patient’s needs. You could call this the low-hanging fruit of health care reform, because, if there is a population in which we have the biggest opportunity to see improvements in both cost and quality of care outcomes, it is older Americans.

The debate on how best to deliver effective primary care has gone on a long time, sometimes frustratingly so, but it has almost never included a crucial constituency: older adults. Today we are pleased to help change that.

We believe that listening to older adults is essential if we are ever going to transform our primary care system so it can and does deliver well-coordinated, comprehensive, accessible care centered on their needs and goals. This belief has already led the Hartford Foundation to conduct two previous public opinion polls, focused exclusively on adults 65 and older, examining serious gaps in geriatric primary care and mental health care.

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Does Geriatrics Expertise Matter? Prove It!

votingOnce again I want to call the Hartford community (all of the grantees, fellows, scholars, alums, and friends) to respond to an opportunity to put geriatrics expertise to work.

The Centers for Medicare and Medicaid Services (CMS), the 900-pound gorilla with a checkbook whose actions shape so much of health care for older adults, and its relatively new transformation arm the Center for Medicare and Medicaid Innovation (CMMI), are requesting input from the public on how to achieve large scale transformation of clinician practices.  This input will help guide CMS’s policy considerations and potentially lead to the testing of new payment and service delivery models.

Sometime early in March (I almost missed it), CMMI issued a Request for Information (RFI) on Transforming Clinical Practice in which they ask for advice on the processes needed to make truly radical change in health care.  The deadline for submitting comments is April 8.

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