Advisory Council April 2019 Meeting Presentation: View from the Clinic

Monday, April 29, 2019

Printer Friendly Version in PDF Format (4 PDF pages)

Person Centered Care Planning: A View from the Clinic

Soo Borson MD
Dementia Care Research and Consulting
Professor Emerita, University of Washington School of Medicine
Affiliate Professor, School of Nursing

Person Centered Care for Dementia: Principles and Process

Person > disease(s)
Key friends and family
Clinician roles = consultant, technician, container of uncertainty
- Eliciting concerns, understanding, priorities
- Advising from evidence + judgment
- Integrating complexity
- Negotiating goals
- Evaluating goal attainment
- Adjusting and revising
- Anticipating and counseling
- Mitigating risk

Person-Centered Dementia Care: 5 Domains

Pie chart: Cognition; (1)Mental and (2)emotional health; (1)Physical health; (1)Key friends and family; (1)Social determinants.

Modified from Borson & Chodosh, Clin Geri Med 30; 395-420 (2014)

CMS Cognitive Impairment Care Planning Code 1.0 -- Alzheimer's Association Workgroup

Interprofessional collaboration
Goals
- Explain in plain language - purpose and elements of CPT 99483
- Encourage uptake in primary care
  - Illustrate simple ways to meet required 9 elements
- Identify gaps -- the evidence of collective experience
- Anticipate potential barriers to use

Borson, Chodosh, Cordell et al. Alz Dementia 13: 1168-1173 (2017)

Key innovations

Acknowledges complexity (9 elements)
Explicitly includes caregivers
Requires written, shared care plan
Offers good value for providers and health systems
Allows combination with other select codes -- reflects realities of 'care on the ground'...and the phone...and when patient is not present...and...

CPT 99483 vs. Person-Centered Care Planning

Pie chart: Cognition/function--History, objective measure, staging, impact on function, Ability to make own decisions; (1)Mental and (2)emotional health--Neuropsychiatric symptoms, Potential causes/care; (1)Physical health, risks--Safety, Med reconciliation, Advance care plan, Treatment and prognosis; (1)Key friends and family--Willingness/ability to care, Stress, depression, cognitive impairment, frailty, knowledge and skills; (1)Social determinants--Resources, access, continuity of care.

Person-Centered Care Planning 2.0: Putting It into Practice

What providers need in order to change their practice
Person-centered measures, e.g. Managing Your Loved One's Health
Payment incentives for comprehensive dementia care (already in CPC+ models of primary care)
Systems of care
- Dementia care teams - adapting local resources
- Standardized documentation and care plan templates
- Electronic accountability and referral tools
- Population and outcome research management