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Advisory Council April 2019 Meeting Presentation: Driving Change

Monday, April 29, 2019

Printer Friendly Version in PDF Format (8 PDF pages)

 

Driving Change: The Why and How of Advancing Person-Centered Outcome Measurement

Gretchen E. Alkema, Ph.D.
Vice President, Policy & Communications

Consumer's Vision of Success

  1. Ability to live life at the highest functional level possible with least intervention
  2. Needs met in a timely, organized, and convenient manner by competent providers
  3. Confidence in navigating care system by self or with support when needed

Sources of High-Cost Variation

Four squares: Medical, Social, Behavioral, Environmental

Where Function Exists...

Four squares: Medical, Social, Behavioral, Environmental. A circle covers the joining corners: Function.

Functional Impairment Associated withHigh Medical Spending...

Bar Chart: No FI ($7,664), Mild FI ($16,436), Moderate FI ($22,877), Severe FI ($28,027). $10,507 = Full Medicare FFS population.
Source: Anne Tumlinson Innovations analysis of the 2015 Medicare Current Beneficiary Survey. Data is limited to fee-for-service Medicare beneficiaries living in the community and excludes long-stay nursing home residents. Functional impairment in this display is measured at the "moderate" level. https://annetumlinsoninnovations.com/

Particularly True for Those with 3+ Chronic Conditions

Average Per Capita Medicare Spending, 2015
Bar chart: 0-2 Chronic Conditions--No Functional Impairment ($5,467), Functional Impairment ($12,831). 3+ Chronic Conditions--No Functional Impairment ($11,584), Functional Impairment ($26,972).
Source: Anne Tumlinson Innovations analysis of the 2015 Medicare Current Beneficiary Survey linked to Claims. Data is limited to fee-for-service Medicare beneficiaries living in the community; excludes long-stay nursing home residents. Functional impairment in this display is measured at the "moderate" level. https://annetumlinsoninnovations.com/

Policy driving the change...

Area chart showing Risk for Outcomes, Risk for Services, Traditional FFS.

Business Case for Person-Centered Care

Equation stating that Value = Quality / Cost.

What Is Person-Centered Care?

A person's preferences and values guide all aspects of health care and support realistic health and life goals.

Key Characteristics

  • Care Supported by One Team with the PERSON AT THE CENTER
  • Personalized Care Plan and Regular Review of Goals
  • Single Point of Contact
  • Care Coordination with Continual Information Sharing
  • Education and Training
  • Ongoing Feedback for Care Improvement

NCQA Quality Framework

FIGURE 3. Framework for Quality in Integrated Care
Screening and Assessment, Coordinated Service Delivery, Individualized Shared Care Plan, Beneficiary Engagement and Rights, Population Management and Health Information Technology, Quality Improvement Systems -- leads to Healthy People, Health Communities, Better Care, Affordable Care.
Source: NCQA. Integrated Care for People with Medicare and Medicaid: A Roadmap for Quality. 2013

Better Care Playbook

Screen shot of Better Care Playbook Home Page
http://www.bettercareplaybook.org/

Roadblocks & Paths Forward

  • Old Paradigm
    • What's the matter with you?
    • Single provider focus & approach
    • Provider action
  • New Paradigm
    • What matters to you?
    • Customer service approach
    • Consumer confidence & functional outcomes

The SCAN Foundation

  • Our Vision: A society where older adults can access health and supportive services of their choosing to meet their needs.
  • Our Mission: To advance a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence.
  • Sign up for email alerts at https://www.thescanfoundation.org/
  • Follow us on Twitter @TheSCANFndtn
  • Find us on Facebook The SCAN Foundation