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
Because I spent nearly 30 years as a flight attendant for a major airline, and I now work for a not-for-profit foundation devoted to improving health care for older people, I often find myself comparing airlines and hospitals.
After someone close to me experienced major problems in a hospital over a weekend stay, it made me think about the difference between airlines and hospitals when it comes to which days you are using the services. It also made me think about safety and how the different industries learn from their mistakes. This is especially concerning for older adults, who are the major users of hospitals where they are at a greater risk of harm than younger people.
Airlines, as we all know, are 24/7, 365 operations. All employees are aware of this before they apply for the job, and are not surprised when called upon to work weekends and holidays. Seniority prevails, and the longer one is around, the better one’s schedule becomes. But by and large, it is not a detriment for passengers to fly on weekends (although flights may be more crowded on Fridays and Sundays). And it will not be unusual to find seasoned flight crews in the cockpit on weekends as well as weekdays.
For 20 years, the Hartford Centers of Excellence (CoE) in Geriatric Medicine have been supporting the development of geriatrician faculty at schools of medicine across the country. These scholars have become researchers, educators, and clinicians, helping transform academic medicine to better prepare the next generation of physicians to care for older adults.
As we forge ahead with our new strategic plan to rapidly change health care practice to improve the health of older adults, our funding for the Centers is winding down. We are now intent on helping current CoE scholars and alumni, in addition to our academic superstars in nursing and social work, utilize their geriatrics expertise to change health care delivery for the benefit of older adults. We believe this is best achieved by helping them to connect and collaborate.
We are pleased that many of our existing grants are aiding in this transition. Funds within the CoE program, administered by our grantee the American Federation for Aging Research (AFAR), have been repurposed to bring together CoE Scholars and support their work to improve care for older adults. In doing so, we are offering five $40,000 grants to fund collaborative pilot projects.
In the world of philanthropy, there are only a handful of foundations focusing on aging and even fewer on aging and health issues.
Five years ago, The SCAN Foundation—an independent private foundation created by, but independent of, The SCAN Health Plan in Long Beach, Calif.,—was born. Over the years, they have been excellent colleagues, co-leaders in Grantmakers in Aging (GIA) and occasional partners on projects. In 2013, the John A. Hartford Foundation and The SCAN Foundation together cofunded an $800,000 grant to the National Committee for Quality Assurance (NCQA) to take on a major challenge: to help develop measures of quality of care for frail and disadvantaged elders that would be based on personalized goals of care and preferences.
In December 2013, Bruce Chernof, MD, president and CEO of The SCAN Foundation, spoke to the Hartford Foundation board about SCAN’s new five-year strategic plan, long-term care reform, and our deepening partnership. We look forward to working with Dr. Chernof and our other colleagues at SCAN over the next five years and beyond.
As we enter 2014, the topic of health care costs continues to be a major topic of conversation in the media and among policy makers. The topic is complex and can be spun in different ways.
You may have seen the recent news about how growth in health care spending in the United States has remained low for four consecutive years, for which the White House would like to take some credit. Or you may have seen news reports about how Medicaid expansion in Oregon led to higher emergency department use (and therefore higher costs), which is used by some to argue against the Affordable Care Act. The bottom line is that understanding health care costs is a complex task.
Clearly, the issue of out-of-control U.S. health care costs is of crucial importance and has been a serious challenge to increasing funding for other needs, such as improving infrastructure and education. It is also one in which the general public, pundits, and politicians look for simple, single reasons and matching solutions, e.g., obesity/calorie designations on menus; malpractice insurance/tort reform, too much government involvement/more private sector competition, etc.
While we can all see problems in the care of older adults all around us in both our personal and professional lives, figuring out how to deliver better care at a lower cost is not easy.
The John A. Hartford Foundation has been working on demonstration programs for many years and while some are great successes, it is not uncommon for even well-designed interventions to increase costs due to the added services being delivered and the discovery of unmet needs.
Even worse, it is also possible for an intervention designed with all the expertise and good will in the world to fail to change health outcomes or even patient satisfaction with care.
Change is hard. It takes leadership to drive change. Robert Jarvik—a former John A. Hartford Foundation grantee and inventor of the artificial heart—once said, “Leaders are visionaries with a poorly developed sense of fear and no concept of the odds against them.”
Today’s successful leaders need that same vision, but they also require a set of skills that go far beyond their clinical training and experience. They need strategies to address policy and payment methodology. They need to engage stakeholders. And they need to measure what matters in terms of cost and quality.
In order to develop this new kind of leadership, people capable of driving health care redesign for vulnerable elders, the Hartford Foundation funds—in partnership with The Atlantic Philanthropies—the Practice Change Leaders Program.