By Jesse Floyd
Memory care providers are shifting to a managed care model, seeking to forestall expensive medical crises in favor of working to keep residents as healthy as possible for longer.
Residents living with dementia go to the emergency room more than 1.4 million times per year, but such visits are potentially confusing or even scary for the resident, not to mention expensive. And many trips may be unnecessary at the end of the day. Memory care operators often must balance efforts to find the best possible medical outcome for residents with the need to improve their quality of life. That’s where managed care comes in. By building into their operations better supports and ways to keep residents well, operators can keep them out of the emergency room, according to Alan Fairbanks, president of the Value Based Care Alliance at Serviam.
“It is better outcomes for a resident and a model of care that produces better outcomes, keeping resident’s care and services where they are, keeping them out of the hospital, keeping them out of the emergency room and then as operators getting paid for the outcomes that we produced,” said Fairbanks, who previously was executive vice president with senior living operator Bickford Senior Living.
The goal, Fairbanks said, is for senior living companies to act rather than react to a patient’s needs. At the end of the day that benefits the patient and the bottom line, he said. But it also helps the industry move away from what Fairbanks has previously termed a “sick care system.”
In general, managed care is a component of the shift to value-based care, which incentivizes senior living companies to demonstrate their ability to keep residents feeling well for longer.
“If we were to think about it differently and look at that from a more proactive approach and said, what if we’d have done something to prevent that event from happening or delay that event from happening, get ahead of that fall, get ahead of that UTI, use data and technology to be more proactive, what would happen then?,” he said.
‘Huge difference in the end’
Other senior care and memory care professionals are taking a managed care approach with residents, including by shar.
In Minnesota, memory care operator Lifespark has been using a managed care approach for more than two decades, meaning the methods have had time to mature, said Molly Toulouse, who is the operator’s senior vice president of senior living.
Lifespark’s assisted living settings include a number of memory care residents, and the company has designed a program relying on creation of a single point of contact on any of their needs. That contact coordinates the patients’ care with other members of the team, which can include nurse practitioners, doctors, home health professionals — anyone who has contact with the patient.
“That really makes a huge difference in the end to how each member meets those health and life goals. So it’s not just medical, it’s everything a person needs to, what we say, age magnificently because a lot of that really isn’t covered by traditional services,” said Meaghan Puglisi, director of marketing and communications at Lifespark.
Anne Campbell, national director of special projects at Juniper Communities in Pennsylvania, agreed that creating a coordinated, patient-focused care plan improves outcomes at the same time saving costs.
“Having one person that is responsible for that communication really ensures that we have a good flow. We have workflows that it could be from anything to a new move in and the workflow that goes into that to somebody being sent to the hospital, an acute change of condition, certain workflows in place and when to call a provider, when to call the insurance company, when to speak with family about things,” she said.
According to Campbell, the model has removed some important barriers to good patient care. Having a single point of contact means the patients needs are met, and that everyone involved in the patient care has the same information, which helps avoid issues such as duplicate testing, she said.
She emphasized that anyone who has contact with a resident can help manage their care. For example, the housekeeper who sees the patient every day might notice that person is not themselves and report that observation to a single person overseeing the patient’s care.
“When it comes to how we care for these folks, it is not just provider-driven, it is more kind of cyclical with all of the folks that touch that person each day,” Campbell said.
The goal of any managed care program is to improve patient outcomes. In an age where analytics and data is king, it can sometimes be difficult to find hard, empirical numbers supporting the value of a managed care model.
Toulouse pointed to anecdotal evidence that keeping people out of hospitals has improved their health outcomes. But patient confidentiality precludes them from seeing outcomes on patients outside their Lifespark program, so for now, the data remains anecdotal.
Pulglisi pointed to a study done on Lifespark residents showing 37%fewer hospitalizations for residents who are enrolled in the company’s comprehensive care model .
But managed care, and value-based care to boot, will be the future for many seniors and memory care patients, according to Fairbanks.
The Centers for Medicare and Medicaid Services (CMS) has set a goal to move traditional Medicare beneficiaries and “the vast majority of Medicaid beneficiaries” in accountable care relationships by 2030. It’s only seven years away, but he sees it as a real and achievable goal for senior living operators to achieve, considering the number of people he hears talking about it in 2023.
“When you go and go to any senior living conference, they’re talking about value-based care and this move to value based care and the opportunities that exist within value based care,” he said.
Between 50% and 60% of health care spending in the United States goes to 15% of the population – mostly seniors, Fairbanks said. If there is a place on the balance sheet to improve cost savings in health care at the same time improving outcomes, it is within that population.
“We are reducing cost by improving outcomes,” said Campbell. “The biggest cost is going to be somebody going to the hospital, typically. If we can improve outcomes and keep people out of the hospital and drive costs down, that’s kind of a win-win on both ends.”
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