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Can Health Care Point to True North?

Posted in category Care Models, Foundation Partners, Grant Programs, Uncategorized

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Gary Oftedahl, MD, Chief Knowledge Officer for the Institute for Clinical Systems Improvement, speaks at the CaRe Align initiative launch in Dallas.

Gary Oftedahl, MD, Chief Knowledge Officer for the Institute for Clinical Systems Improvement, speaks at the CaRe Align initiative launch in Dallas.

Older adults who typically live with many chronic conditions see, on average, two primary care providers and five specialists per year in four different medical practices. Such fragmentation and logistical complexities are problematic for providers and patients.

For a hypothetical primary care practice consisting of 30 percent Medicare patients, each of whom has four or more chronic conditions, the physician must coordinate with 86 other providers in 36 practices over a year’s time.

That’s a lot of cooks in the kitchen.

Different referral processes and incompatible electronic health record systems present a burden for both patients and providers that cause important communication gaps, duplication of testing, treatments, and confusion about clinical decision-making and accountability. Without clarity regarding communication and coordination responsibilities among health care professionals, patients and families/caregivers often have insufficient information to decide if treatment is consistent with their care preferences.

For medically complex older adults, treatments and medications are superimposed on people already being treated for a host of other conditions. Care given by each individual health care provider may be at cross purposes. One treatment can undo the good of another, or worse, cause injury. According to safety experts, older adults are the most vulnerable to needless harm or death when treatments conflict.

Whose goals and values should serve as true north for care and treatment decisions?

Increasingly, health care delivery is recognizing that the arbiter of true north is the patient. Person-defined goals are a way to align primary and specialty care to focus on what matters most to the people we serve. Patients are far more activated and engaged in their care when it focuses on achieving what matters most to them.

Whose goals and values should serve as true north for care and treatment decisions?

This may be less about particular clinical outcomes (e.g., lowering one’s blood sugar level) and more about living life the way they want (e.g., being able to garden). And the evidence bears out that activated patients have better health outcomes and lower health care costs.

Despite the challenges of primary-specialty-person-centered care coordination, this intersection represents a significant opportunity for improvement in the care of complex elders. To address these challenges and improve the value of health care for older adults, the John A. Hartford Foundation and the Patient-Centered Outcomes Research Institute (PCORI) have launched the CaRe Align initiative.

About 50 health care leaders from around the country gathered for the CaRe Align launch.

About 50 health care leaders from around the country gathered for the CaRe Align launch.

The 18-month planning grant aims to develop a feasible, sustainable, model that re-aligns primary and specialty care to meet the patient-defined goals of older adults with complex chronic conditions. The Hartford Foundation plans to test this new approach to care in the next phase of this initiative.

Key stakeholders—including providers, payers, patients, and families—are involved in the redesign. The team will:

  • articulate a set of modifiable problems that influence quality, health outcomes, and health care costs for complex older adults; and
  • determine the approach and corresponding evaluation plan aimed at improving care of complex elders through primary care/specialty care redesign.

The effort is co-led by Mary Tinetti, MD, director of the Hartford Center of Excellence in Geriatric Medicine at Yale University and co-led by Caroline Blaum, MD, chief of geriatrics at New York University School of Medicine.

Can Health Care Point to True North? At the recent launch of the CaRe Align initiative in Dallas, more than 50 leaders from around the country resoundingly answered, “Yes!”

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5 thoughts on “Can Health Care Point to True North?

  1. Thanks Amy. The CaRe-Align collaboration hopes to define what healthcare should look like if it aligned primary and specialty care to focus on what matters most to older adults with health conditions. We had a great launch last week in Dallas with great input from a highly engaged group of patients, caregivers, clinicians, and others.

  2. Thanks, Amy for a thoughtful summary of the problems that patients, caregivers and providers face every day in our fragmented healthcare system. The CaRe-Align collaboration is drawing together an amazing group of committed patients, caregivers, providers, policymakers and researchers to help plan care approaches driven by patient goals, and that can address some of these issues. The project launch in Dallas last week was exciting and energizing for all of us.

  3. Once again, Amy has wonderfully and succinctly summarized both the problem and the opportunity. It was indeed my pleasure to have a small role in helping guide the conversation at the meeting in Dallas, which was both inspirational and hopeful. Mary, Caroline, and their team have engaged a “team” which is beyond anything I’ve seen in providing expertise, perspective, and passion to an important area of focus, but one which has not been addressed.

    Spending the time to plan, and engage a broad set of perspectives presents a unique opportunity to move beyond the uncoordinated care too often seen today. My personal thanks for allowing me to be a part of this unique and exciting effort.

  4. Thank you, Amy for your articulating the work of the CaRe-Align Team in Dallas. I am confidant that the diversity of the Team will be reflected in the design of a model that is grounded in authentic engagement of patients and their families. I am grateful for the opportunity to participate.

  5. “Older adults who typically live with many chronic conditions …”, “For medically complex older adults, treatments and medications are superimposed on people already being treated for a host of other conditions.” … “… the arbiter of true north is the patient …”. I doubt that these conflicting statements can truly ever be aligned. In nutrition, the consumer is true north and he/she consumes a lot of unhealthy things that land these “older” with manifold conditions. These are not “typical”, they have been acquired over a lifetime. The only sustainable (!) solution to health care and its true “true north” is when people have to pay for what they sowed. Everything so far goes in the other direction by providing a free-for-all menu of medical cocktails. Hell, if you can’t afford anything, go to emergency care, they’ll give it to you free. The current system is so corrupted that it will have to break down completely before it can ever be reformed.

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