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.
While progress has been made (see some examples below), health care is still too dangerous for older Americans and their families. It is too often neither fiscally responsible nor humane. That’s why the Hartford Foundation will continue to invest in Models of Care as we implement our new strategic plan and funding areas.
In recent weeks on the Health AGEnda blog, my colleagues Rachael Watman and Nora OBrien-Suric have written about our new Current Strategies and the new funding portfolios they oversee—Leadership in Action and Education to Practice.
My “new” funding portfolio—Developing and Disseminating Models of Care—will continue and greatly expand work we have engaged in for the past two decades.
In our new strategic plan, we chose to double down on Models of Care for three reasons: 1) the demographic shift, 2) the opportunities to significantly improve care, cost, and quality and 3) our history of impact through care redesign efforts.
As many of you know, the demographic shift in the United States presents unprecedented challenges, as an astounding 10,000 older adults turn 65 each day. Our current health care spending is untenable and nearing a stranglehold on the economy. Within the morass of health care expenditures, it is the older adult population that bears a disproportionate share of avoidable health care spending. Those with multiple chronic conditions coupled with cognitive and/or functional deficits represent the highest costs with lowest quality outcomes.
Indicators of poor value abound. Avoidable hospital readmissions for older adults are estimated to exceed $17 billion annually. There are more than 1.5 million adverse drug events annually, disproportionately occurring in older adults. One contributing factor is poor care. Older adults receive about half of the recommended care suggested by clinical guidelines.
Through the years, the Hartford Foundation has supported Models of Care that address these and other serious shortcomings in our current health care system. Examples include:
- Care Transitions Intervention, led by Eric Coleman, University of Colorado. The Care Transitions Intervention was developed with support from the Hartford Foundation beginning in 2000. In this proven model of care, a “transition coach” helps patients and family caregivers gain self-management skills to ensure that their needs are met during the transition from hospital to home. Patients who received the intervention were significantly less likely to be readmitted to the hospital. To date, more than 700 institutions and medical plans are using the Care Transitions Intervention in 39 states. We are working to make this best practice a common practice.
- Center to Advance Palliative Care, led by Diane Meier, Mount Sinai in New York City. Palliative Care serves as an extra layer of support to people experiencing serious illness by focusing on the management of pain and symptoms. Many think of palliative care at the end of life. But it is also important to manage pain and symptoms with certain chronic diseases or to mediate the effects of life-saving treatments like chemotherapy. Today there are more than 1,600 hospitals providing palliative care—two-thirds of all hospitals. Yet, palliative care should be available in the community and in nursing homes in order to prevent needless hospitalizations. We support efforts to expand the quality and availability of palliative care services.
- IMPACT Evidence-based Depression Care, led by Jurgen Unutzer, University of Washington. IMPACT utilizes a team approach to depression treatment under the direction of a patient’s primary care physician. Care is augmented by a depression care manager who supports pharmaceutical therapy and counseling delivery. The model shows compelling health outcomes, roughly doubling the effectiveness of usual care for depression in the elderly. Through an innovative public-private partnership with the federal government and the University of Washington, the Foundation is supporting the expansion of IMPACT in Washington, Wyoming, Montana, Idaho and Alaska through a Social Innovation Fund award.
- HomeMeds Medication Management, led by June Simmons, Partners in Care Foundation. HomeMeds is a technology-assisted medication management program for frail older adults who live independently at home. This effort targets high-risk problems such as drug duplications and incompatibilities that can be life-threatening for older adults. The intervention takes advantage of a key opportunity—social workers already go into the home and collect the medication data needed to identify potential errors, but previously did not have any means of analysis.
Hartford’s grants support the development, testing, and spread of proven innovations like the above that respond to the current failings of health care delivery. Our investments in Models of Care leverage the Foundation’s core beliefs that:
- Provision of quality care for complex elders recognizes the values and goals of older people and the needs of their family caregivers.
- Financial models that realign health care incentives offer fertile ground to test innovative approaches across settings and providers of care.
- Medical care must better integrate social services into the care of older adults.
- Health care providers may lack competence in geriatrics; retraining plays a significant role in successful redesign.
- Success will only be achieved through partnerships with philanthropy, payers, policymakers, providers, researchers, and older adults and their families.
Let this blog serve as both an invitation and a forum. I sincerely hope you will consider sharing your thoughts in the Comments section below about issues and innovations that may have the greatest impact on the health of older adults. The needs are great and our aging demographic has arrived.
This is the third in a series of Health AGEnda posts on the Hartford Foundation’s new funding strategies. Read the previous posts:
What the Heck Are Hartford’s New Funding Areas? Part Two: Education to Practice
What the Heck Are Hartford’s New Funding Areas? Part One: Leadership in Action