Dr. Timothy W. Farrell, right, from the video series depicting a patient undergoing transitions of care across different locations of care.
It happens all too often: Older adults “fall through the cracks” of the health care system. They fall victim to bad transitions of care due to a host of issues, including poor communication, a lack of geriatrics expertise on the part of the health care provider, and a dysfunctional or non-existent team.
As a result, older adults are rehospitalized, frequently move across sites of care, and receive suboptimal and, too often, harmful services.
Our most recent annual report celebrated the John A. Hartford Foundation’s 30-year commitment to improving the health of older adults. As part of the online, interactive version of the report, we asked some of our long-time grantees to help us tell the Foundation’s story by sharing short and sweet video messages about our past successes, our current projects, and our new directions.
We want to highlight a few of these brief video clips, each only about one minute long, and invite you to browse and share the other messages in our dynamic online annual report.
In this first video, David Reuben, director of the Multicampus Program in Geriatric Medicine and Gerontology and director of the Hartford Center of Excellence in Geriatric Medicine at UCLA, points out the changes he’s seen over the past three decades in how geriatrics is incorporated into medical student education. Dr. Reuben was a beneficiary of the 1983 Hartford Geriatrics Faculty Development Awards, Hartford’s earliest program to build up the field of geriatrics.
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.
What is the best way to sell umbrellas? We have tons of street vendors in New York who know the secret. Is it to have the best-made, reasonably priced umbrella on the block? That’s a good starting point.
Do you need an attractive sign or an attention-getting catchphrase? Good advertising certainly helps. But if you really want to sell your umbrellas, there is one sure-fire way to have them fly off your cart. You guessed it.
Jürgen Unützer, MD, brings the IMPACT model of depression care to Casper, Wy.
Given the John A. Hartford Foundation’s focus on improving the health of older Americans, it should come as no surprise that the Foundation has looked for opportunities to create a more comprehensive, coordinated and continuous health care delivery system.
Since the 1990s, we’ve done this by investing in the development, testing, and spread of effective and affordable Models of Care to address barriers to the provision of high-quality, cost-effective care for elders.
In recent months, the debate over how best to reduce avoidable hospital readmissions has become a hot topic in the national media. While many are just now joining the fray, the John A. Hartford Foundation has been working on this issue for years.
It also has been a topic we have written about extensively on our Health AGEnda blog as we seek to help shape the public debate about an issue that is at the very core of real and sustainable health care reform and of critical importance to older adults.
Last Friday I was at a session of the National Health Policy Forum (NHPF) in Washington D.C. focused on Medicare’s readmission reduction program The program, authorized under section 3025 of the Patient Protection and Affordable Care Act (PPACA), is the “stick” to section 3026′s “carrot.”
Section 3026 authorizes the $500 million Community-based Care Transitions Program that will pay partnerships of community-based organizations and hospitals to offer evidence-based, post-discharge services to reduce readmissions. Section 3025, in effect since October 2012, dropped the other shoe and requires the Centers for Medicare and Medicaid Services (CMS) to reduce payment for Medicare services to hospitals whose patients have higher than expected rates of rehospitalization within 30 days of discharge. (For more background, watch this Modern Health interview with longtime John A. Hartford Foundation grantee Eric Coleman, MD, read this recent Reuters article featuring Coleman, and this post I wrote on Health AGEna in December 2010.
Clearly the audience at the session was very concerned about the program and seemed sure that it should changed, if not abandoned (See my response to a Wall Street Journal op-ed last month.). I see the matter very differently and I’d like to explain why. NHPF Sessions are off the record, so I won’t use any quotes or attribution.
At the American Geriatrics Society meeting a few weeks ago, I—along with most of the attendees—was spellbound by Dr. Diane Meier‘s Henderson Award lecture on the issues confronting geriatrics and palliative care and our profound failure to deliver useful care to those with incurable serious illnesses.
To outsiders, Washington D.C. is a mysterious place filled with smart and hardworking people. But it is very hard to know who has influence, whose opinion is respected, and where to start. It’s also a place where young staffers have incredible responsibilities to carry out the ideas and intentions of their elected bosses, but not a lot of background or time to master issues.
Who would have guessed six or seven years ago that the young staffers of the junior senator from Illinois would have been elevated to positions of enormous influence by their boss’s election to President? For us at the John A. Hartford Foundation, one way to help navigate these mysteries and to be sure that the issues and work of the grantees we support are communicated to policymakers is our relationship with the National Health Policy Forum.
Over the years—31, to be exact—the Hartford Foundation has funded 10 grants totaling more than $6.4 million to the National Health Policy Forum (NHPF or “the Forum”), located at George Washington University in Washington, D.C., and headed by its founding director, Judith Miller Jones. In the early days, the Hartford Foundation funded Judy and the NHPF to further the foundation’s work under its short-lived Health Care Cost & Quality initiative. A few years after that initiative ended, Hartford again commissioned Judy and the NHPF to further the Foundation’s current mission and work in aging and health care issues, which it has been doing since 1997 with six grants worth more than $5.7 million.
There is a yawning chasm between the health care system we want and what we have. Crossing that gorge will be a messy and inconvenient process—but necessary.
While many of us in the geriatrics community were wending our ways home from the 2013 American Geriatrics Society conference in Dallas with dreams of improved care for older adults dancing in our heads, respected health services researchers Stephen Soumerai and Ross Koppel published a Wall Street Journal opinion piece with a stinging attack on Medicare’s new hospital readmissions penalty program.