My colleagues from the National Association of Healthcare Advocacy Consultants (NAHAC) gathered here in Boston last month for our fourth annual conference. The conference was titled “The Leading Edge of Reform” and included a number of engaging speakers discussing the incredible innovations taking place in the way healthcare is delivered.
One strong and persistent theme throughout the conference (and the focus of today’s newsletter!) was the need for “improved coordination of care.”
As a healthcare advisor/advocate – and someone who sees her role as questioning the paradigms, not accepting the status quo and politely pushing the envelope – I am often hindered by a healthcare system that is not always centered around the individual. In this regard, I was encouraged by a number of conference speakers who are already making significant changes from within their own organizations!
Here then, are three wonderful examples:
- In a discussion of The Patient-Centered Medical Home Model, Dr. Maury McGoughdescribed how care mangers, pharmacists, nutritionists and behavioral health specialists are being integrated into primary care physician practices. Known as the Medicare Demonstration Project, this work focuses on the relatively small population of patients who result in a disproportionate share of healthcare costs (e.g., older adults with multiple chronic conditions who flow into and out of the hospital and rehabilitation systems repeatedly).
Thanks to the introduction of a “care manager,” as well as the institution of other innovations,Dr. McGough’s group was able to reduce emergency room admissions, increase patient and physician satisfaction and reduce overall cost. The Medicare Demonstration Projectwas so successful, that it led to expansion of the program and permission to waive the Medicare rule of requiring a three night hospital stay for Medicare to cover skilled nursing care in a rehabilitation facility.
I’ve experienced similar benefits over the past year while working with a care manager to manage the care of an older client currently living at home with her husband. Although this woman did require hospitalization, we averted more admissions by working together to intervene early. When she was hospitalized, the care manger was instrumental in identifying an appropriate rehab setting that enabled continuity of care with her own primary care physician.
- Dr. Rushika Fernandopulle, our keynote speaker, spoke on the topic of “Reinventing Primary Care.” Dr. Fernandopulle is working with large purchasers of healthcare such as employers and unions and, here as well, is attempting to focus care around the overall needs and experiences of the patient, rather than the healthcare institutions themselves.
For example, Dr. Fernandopulle’s practice employs “health coaches” as part of the healthcare team. These folks are involved in brief, daily, all-staff meetings to discuss patients who have been assigned a high “worry score” (i.e., they are in need of attention).
The health coaches then take action as necessary via home visits. Here they get involved in everything from arranging patient transportation to and from medical appointments, to helping patients manage the complicated elements of a drug regimen.
As someone who visits clients in their homes regularly, I was thrilled to hear about a practice that understands the need, at times, to go beyond the accepted paradigm of delivering care in a physician’s office or hospital!
- Dr. Eva Chittendon discussed how palliative care is being integrated proactively into the care of both hospitalized and outpatient individuals – long before such services have traditionally been initiated.
She explained how early discussions often begin with asking questions such as, “What are your goals?”, “What’s important to you?” and “What worries you as you think about the possibility of getting sicker?”
These frank conversations can often lead to a better understanding of a patient’s values and wishes, empowering them to make decisions about the kind of care they want, and to assist them in finding meaning and closure at the end of life.
For example, I recently began working with an 88-year-old woman with severe heart failure who had been hospitalized for several months and was heading home from a rehab facility. When I asked about her goals, she shared a few things that were important to her: living in her own home; getting out a little bit; playing some bridge; and never again returning to the hospital.
Thanks to the involvement of her primary care physician and her children, she now goes out for dinner on occasion, plays bridge once a week and is on Hospice Care at home.
I’m pleased to tell you that by the end of the NAHAC conference, I came away excited and inspired by many of the positive changes I am seeing, and in the move towards more coordinated care and the placement of patients at the center of service delivery.
As someone whose organization was founded on the principles of questioning paradigms, promoting transparency and educating clients, I can tell you that this is a move in the right direction!