Will Trump's election affect value-based care efforts?
How will Donald J. Trump's election to the nation's highest office affect senior care providers that are operating under Affordable Care Act provisions that incentivize value-based care over volume-based care? After all, Trump has vowed to repeal and replace the ACA, although the specifics of his plans are vague.
Lynne Katzmann, Ph.D., the founder and president of Juniper Communities, which has integrated the provision of medical care into assisted living rather than sticking to a strict hospitality model, shared her thoughts the day after making a presentation about the company's efforts in the current healthcare environment at the PointClickCare Summit in Orlando.
“The drive to control costs while enhancing personal responsibility for health is, in my opinion, something that may fly below the political radar screen,” she told McKnight's Senior Living. “Quality measures and reduced cost, particularly for those with chronic illness — the old and frail — may be one of the few survivors come January.”
More likely, Katzmann speculated, the government's mandate that all eligible individuals enroll in a health insurance plan or pay a penalty will be the first ACA requirement to go.
Tuesday, before results of the presidential election were known, she shared with PointClickCare Summit attendees three keys needed for senior care providers to continue to serve individuals as they move along the continuum of care in the current era of value-based care and health promotion: information technology through which data can be shared; a human navigator who acts as a point person for residents and others; and communication protocols that determine how information is collected and used as well as when and with whom information is shared.
The knowledge comes via Juniper's Connect4Life program, she said, which has brought primary care, rehabilitation, home health, pharmacy and laboratory services on-site at all 18 of its communities, through partnerships and alliances. The company has integrated those services into an electronic health record and operating system so that it can produce data on rehospitalizations among community residents, for instance, to present to potential hospital partners and others. Readmission penalties, Katzmann said Wednesday, are “the reason we are now talking about and implementing coordinated care.”
Having ancillary services on-site enables the community to intervene early and keep residents out of the hospital, Katzmann told PointClickcCare session attendees. “If you have just one more extra month from every person in your building,” she said, “there's a definite return on investment.”
Of the ancillary services, the most important is primary care, Katzmann said. “Primary care is the connector between acute care and care in the community, and that's really critical,” she said. “So primary care is the key thing you need to have if you're going to build a continuum of care.” Having primary care on the premises also opens up a new funding source for some of the things communities already are undertaking, Katzmann said.
To make the most of partnerships to deliver services and care, Katzmann said that EHR interoperability is needed, as are common standards and metrics across the care continuum, and patient engagement.
“It's been proven that the life enrichment piece is really key,” she said. “How you spend your time. How you connect, how you deal with depression, how you deal with all of those feelings coming from dealing with chronic illness make a difference.”
The ACA incentivizes entities that work together to address residents' medical and social needs, Katzmann noted, and also incentivizes wellness-focused care and services.
Even if the ACA is repealed, however, senior care providers may have reasons to continue their efforts to reduce hospital readmissions, according to one panelist at the PointClickCare session.
In Canada, the government has not implemented financial penalties related to readmission, said Bill Dillane, president of Responsive Group, which manages 18 retirement communities and 14 long-term care homes in Ontario. Taking steps to reduce readmissions anyway can result in an improved reputation for a community and a better position among peer organizations, he said.
“It's still a competitive landscape. Individuals get to choose which long-term care home they want to go to if they're in the hospital or if they're waiting for long-term care in the community,” Dillane said of the Canadian healthcare system. “Our sensibility is that if an individual in the community post-surgery or post-episodic care and acute care has come to us from a transitional care unit and is going back to the community, it's highly probable, particularly if they're managing a chronic disease, that they're going to be back in the healthcare system again. … We want people to talk about how well they were cared about.”
Although the Canadian health system doesn't offer an economic incentive to reduce readmissions, Dillane said that local health authorities are looking to track hospital readmissions on a home-by-home basis.