The Health and Aging Policy Fellowship, supported by The Atlantic Philanthropies, is a national program that seeks to provide professionals working in health and aging with the experience and skills necessary to make a positive contribution to the development and implementation of health policies that affect older Americans.
As Health and Aging Policy Fellows, we have the opportunity to learn about health and aging policy issues from government and foundation representatives during several meetings. By writing here, we hope to make some of that knowledge more widely available. The theme of our most recent meeting in May 2012 was “Consumer Engagement in Policy: What Are the Key Policy Issues?”
Engaging Consumers through Health IT
To begin, Dr. Terry Keenan of AARP discussed highlights from an AARP survey showing that two-thirds of older adults use personal computers to communicate with family and friends and that half search for health information online. Despite this widespread use of technology among older adults, barriers remain, particularly related to cost and concerns about privacy. Jodi Daniel, Director in the HHS Office of the National Coordinator for Health Information Technology (ONC), provided an overview of ONC’s efforts to engage consumers with health information based on a framework of access (increasing access to information), attitude (changing expectations to empower consumers), and action (increasing usability of information so that consumers can use health information to make good health decisions). Discussion centered on the ability of health IT to reach different types of consumers, including consumers with disabilities and different cultural backgrounds, as well as the role of health IT in improving health care quality.
Reauthorizing the Older Americans Act (OAA)
The second session focused on the process, challenges, and opportunities created by efforts to reauthorize the Older Americans Act. The legislation funds many programs that support older adults in the community, including well-known ones such as Meals-on-Wheels and Adult Protective Services. It is critical, noted Terri Lynch, Director of the Area Agency on Aging (AAA) in Arlington, Virginia, in supporting Area Agencies on Aging throughout the country. Panel participants Sophie Kasimow, from the Senate HELP Committee’s Subcommittee on Primary Health and Aging chaired by Senator Bernie Sanders (I-VT), and Bill Benson, from Health Benefits ABCs, discussed issues surrounding the bill’s upcoming reauthorization. Kasimow shared Senator Sanders’ priorities, which include increasing funding for meals, SCSEP, and other OAA programs.
Howard Bedlin and Michelle Rodriguez from the National Council On Aging (NCOA) discussed NCOA’s One Away campaign, which shares videos featuring older adults to engage consumers and legislators in the importance of reauthorizing the OAA. The lively question and answer period that followed highlighted the contrast between when the OAA enjoyed bipartisan support to today, when its reauthorization and perhaps more importantly, appropriations, require a concerted effort and engagement of consumers, advocates, and healthcare professionals.
Improving the Quality of Nursing Home Care
While nursing home care is a major expense for our country, the quality of care in many nursing homes has room for improvement. This workshop considered three policy questions:
- What payment models might achieve improvements in the quality of nursing home care at lower cost to both Medicare and Medicaid?
- What models can prevent unnecessary hospitalizations of nursing home residents and promote a higher quality of care in the nursing facility?
- What nursing home perspectives should we keep in mind when developing policies that shift acute care responsibilities from hospitals to nursing facilities?
Three presenters addressed these important questions. Dr. Josh Wiener from RTI International discussed Value-Based Purchasing and Pay-for-Performance models, which are currently being tested with a three-state demonstration. Rather than use regulatory approaches to nursing home quality, these models offer a new approach with a market orientation. Evan Shulman from the Medicare-Medicaid Coordination Office shifted to the potential for quality improvement by Medicare Advantage “Special Needs Plans” serving institutionalized individuals (I-SNPs). Studies indicate substantial reductions (up to 50%) in hospitalizations among beneficiaries enrolled in I-SNPs. Separate from ISNPs, the Center for Medicare & Medicaid Innovation recently issued an “Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents” to test innovative models to improve quality of care.
To conclude, Dr. David Gifford of the American Healthcare Association shared the perspectives of the nursing home industry, who prefer to be partners in quality improvement but believe they are often simply perceived as vendors. A key challenge for the industry is the fact that the major payors, Medicare and Medicaid, often work at odds with each other. Audience members then questioned how patients and families will perceive these initiatives if they believe that the hospital is or should be the place to go when sick. Including these stakeholders as partners will be key to gaining acceptance and more broad dissemination of these innovative initiatives.
Using Patient-Reported Quality Measures
Patient experience measures are taking on a more prominent role in quality reporting. In the final session, we discussed how health care providers and systems might use patient-reported measures to improve health care for an aging and changing population. Current Fellow Julie Bynum led off the session by discussing how the focus on patient-centered care has heightened interest in the use of patient-experience measures. Patient experience measures reflect not simply how satisfied a patient is with care, but how s/he rates specific aspects of care, such as communication, assessment of patient preferences, and timeliness. The Consumer Assessment of Healthcare Providers and Systems (CAPHS) has developed such instruments for use in physician offices that are set to be more widely used in the ambulatory setting.
Christopher Langston of the Hartford Foundation shared insights from the Foundation’s recent nationally representative survey of people over the age of 65. Respondents indicated a very high level of satisfaction with their primary care physicians, but the responses also indicated low rates of receipt of services and assessments that are often considered the backbone of quality in geriatric care. This survey unmasks the disconnect between generic measures of “satisfaction” as compared to “evidence-based quality metrics.”
Kalahn Taylor-Clark from the National Partnership for Women and Families discussed this disconnect further with special emphasis on how seemingly paradoxical responses can occur when one considers how specific ethnic groups, for example, might differ in what they are seeking in a clinician. Michael Fosina, current Health and Aging Policy Fellow and Executive Director of an urban hospital, concurred. He reported that generally low survey response rates at hospitals like his own have been particularly problematic.
During the discussion, experts in the audience suggested several different uses for patient-reported quality measures, including helping consumers choose a doctor and evaluating physician performance, potentially tied to reimbursement. While it is clear how these measures could be used for the latter, the discussion group suggested that getting people/consumers/families (especially older adults) more engaged in using the reported measures to drive informed choices about their healthcare providers may be challenging. Yet they may be necessary to drive the meaningful change toward patient-centered care for older adults that we seek.
As Health and Aging Policy Fellows, we will be on the front lines of change as we continue to work to move health policy in a direction that benefits older adults. We are grateful for the opportunity to learn as much as possible about key policy issues, and are happy to share that information with others who are deeply committed to improving health care outcomes.
This post was authored by the 2011-12 Health and Aging Policy Fellows.
2011-2012 Health and Aging Policy Fellows
G. Adriana Perez
Dawn Alley (not pictured)