The way people now live during their last decade is quite different from the way they did 35 years ago, when Medicare was first established. Now, most of us can expect to live to be 70 or 80, with our last years marked by one or more disabilities caused by chronic illness.
Our health care services were not established with such needs in mind, and researchers at the Center to Improve Care of the Dying (CICD) at RAND Corporation are working to test a more appropriate package of services, and to determine the financial effect of such a restructuring. At the March Lunch Bunch meeting, two CICD researchers, Anne Wilkinson, Ph.D., and Joanne Lynn, M.D. discussed this work, also known as ‘MediCaring.’
Wilkinson opened the discussion by noting that there are many systems that currently do a wonderful job of providing quality care for individuals with serious and complex illness: both hospice and the Veterans Administration are committed to quality care for this population. She explained that MediCaring and related efforts are not intended to replace these gem programs, but to explore the potential of other modes of care delivery and financing.
Wilkinson gave an overview of the MediCaring project along with background on a closely related endeavor—the Institute for Healthcare Improvement’s (IHI) Breakthrough Series on Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD). Wilkinson described how every organizations had committed to making some improvement for its CHF/COPD patients. One example of such a change was the distribution of medication kits to patients and families to be used in the home when exacerbations occurred. This change, although minor, made a significant difference in patient confidence as well as in the institution’s ability to ensure prompt care in emergency situations.
Wilkinson also described the project’s focus on improving on transitions of care across what she termed “silos,” in which care is provided only with the care site in mind. For example, hospital staff do not routinely provide patient follow-up once the patient has been transferred to a skilled nursing facility.
When asked about the financial impact of such restructuring, Wilkinson noted that costs are still being determined. Predictions are that patients will fare better with more supportive services—and that costs will be lower. Finally, Wilkinson shared with the attendees the “promises” or elements of system performance that have served as the backbone for this restructuring:
Lynn explained that the current health care system is driven by risk adjusters that relate to disease type rather than—what she proposed as an alternative—disease severity. Lynn said that “severity-specific” risk adjustment in Medicare+Choice plans could also tie this enhanced payment to continuity and outcome measures. Lynn emphasized that she and other researchers welcome comments on such ideas, as well as information about other innovative methods.
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