If 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.
It’s going to take all of us working together to make the changes we need to ensure that older Americans get the quality health care they deserve.
So I’m pleased to share the news that five winning teams have been selected to receive Collaborative Pilot Grants through a joint program between the John A. Hartford Foundation Centers of Excellence in Geriatric Medicine and Psychiatry and the Hartford Change AGEnts.
The five winning teams were chosen from 25 applications received from 15 centers, and were announced by the Hartford Foundation and the American Federation for Aging Research (AFAR).
This week, a RAND research team published a report in the Journal of the American Medical Association (JAMA) on a three-year evaluation of Patient-Centered Medical Homes in Pennsylvania, funded by the Commonwealth Fund and Aetna. Since, like almost everyone else, we believe in the potential benefits of enhanced primary care, this is an important paper.
However, its implications are very complicated. I believe the results confirm concerns I had from the beginning that this kind of project wouldn’t work. Why? Because it wasn’t focused enough on the complexly ill and it didn’t incorporate enough special expertise in their care.
The evaluation was led by Mark Friedberg, MD, and used a pre-post, matched practice/patient design where 32 practices worked to become medical homes. The outcomes of the practices and the patients were tracked over three years. A non-random comparison group was created by looking at other practices and patients followed over the same time period to serve as a contrast group not implementing medical home elements.
Having lived in New York City for many years now, I’ve grown used to the blare of ambulance sirens. Still, when I hear one go by, I sometimes find myself saying a little prayer of hope that the patient onboard makes it OK through the insane city traffic.
These past few weeks, however, ambulances and emergency medical technicians (EMTs) were on my mind even more than usual. First, I received an inquiry from a geriatrician trying to develop an EMT intervention for the care of older adults and looking for the appropriate quality measures to use. I pointed her to Beeson Scholar Manish Shah at the University of Rochester, who has done innovative work in this area.
Then, I attended a meeting of a Community Action Board for a project led by the emergency department at Mount Sinai Medical Center: the GEDI-WISE program. The project aims to improve health and reduce costs for older emergency room patients
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.
As somebody who actually enjoyed studying statistics and quality improvement, the focus of the new funding portfolio I oversee—Tools and Measures for Quality Care—sets my pulse racing.
But I’ve been around enough to know my enthusiasm for constructing statistical measures of performance isn’t universal and that the greater good would be served if I explained our goals and why this initiative means a lot to all of us, whether we’re patients, caregivers, providers, payers, policy wonks, or other stakeholders.
In recent blog posts, my colleagues Rachael Watman , Nora O’Brien Suric, and Amy Berman introduced the John A. Hartford Foundation‘s objectives in developing three of our other new grant portfolios —Leadership in Action, Linking Education to Practice, and Models of Care—and gave examples of how we plan to execute our “downstream” strategy. Next Thursday, Marcus Escobedo will explain the fifth and final new funding area: Policy and Communications.
Sarah Szanton, PhD, CRNP (photo from Johns Hopkins Nursing Magazine)
At the John A. Hartford Foundation, we are well on the path to implementing our new strategic plan focused on putting geriatrics expertise to work in health care delivery and practice change.
As I described in last week’s post introducing one of our new strategic funding areas – Leadership in Action – one of our primary strategies will be to engage the community of experts in geriatric social work, medicine, and nursing that we have supported for more than 20 years. We will now support them to join forces in inter-professional teams to implement evidence-based best practices, change policy that will drive improvements in health care delivery, and take other actions to improve the health of older adults. We will accomplish this in part through one of the Leadership in Action’s primary grant programs, the Change AGEnts initiative, which was just approved by our Trustees.