Playing the population health game in long-term care
Marty Stempniak, Staff Writer
In my former life as a hospital reporter, I think just about every other word out of someone's mouth had something to do with “value” or “population health.”
If I had to hear the analogy one more time that we have “one foot on the dock” that is fee-for-service medicine, and “one foot in the boat” that's the new model of value-based care, I think I would have screamed and started pulling my hair out.
So, it's with some relief that I've entered the world of long-term care, with plenty of new acronyms, jargon and foot-on-the-dock clichés to start picking up on. But I'm curious how much those lines are blending nowadays, and whether the hospitals' hackneyed phrases of yesterday are becoming skilled nursing's own today.
You are already thinking in this value-based, preventative fashion when it comes to readmissions back to the hospital. It seems like every other day we get another announcement of a partnership between a SNF and a consulting firm or a tech company to harness something or other to keep residents out of the hospital. Just on Tuesday, McKnight's wrote about how senior services organizations in Maryland are working with a company to get real-time clinical alerts and recommendations out to facilities so that providers can respond quickly before a condition worsens — hopefully preventing any of those unnecessary trips to the hospital, of course.
But what about going even further upstream to provide better care for your residents? Along with these announcements of tech partnerships, we're also getting plenty of alerts about studies tied to the risk factors associated with dementia incidence. Last week, there was this one out of Boston University's School of Medicine, exploring whether age, marital status, body mass index and sleep are associated with a greater risk of developing dementia later in life.
As researchers noted, dementia is the leading cause of dependence and disability in the U.S. elderly population. This study from the RAND Corp. back in 2013, pegged the annual tab for caring for these individuals at upward of $215 billion, with the greatest share of the pie coming from institutional- and home-based long-term care settings. There's no medication for dementia, as the Boston folks note, so they think it is keenly important to target those modifiable factors to prevent dementia later in life.
“Demographic and lifestyle factors that are non-invasive and inexpensive to implement can be assessed in midlife and used to potentially modify the risk of dementia in late adulthood" the study states. In other words, better habits can help.
Another analysis, out of University College London this week, found that being poor later in life could boost the chance of developing dementia by 50%. Their thought is that having a wealth of socioeconomic resources gives older adults greater access to mentally stimulating environments.
The authors argue that there is clearly a need for public health strategies to prevent dementia by targeting socioeconomic gaps, reducing health disparities and protecting those who are disadvantaged.
Other recent studies from the past few months also link alcohol use as a risk factor for dementia, while yet another says older adults who have slower walking speeds may have a higher risk of developing it.
What role should long-term care play in pursuing these sorts of public health, population-based strategies to try and move upstream, ahead of dementia? Are these the sorts of questions your institution is already asking, and does this sort of work fall in the lap of long-term care (and not just something that primary care docs or hospital leaders should be thinking about?) If any of your answers is yes, shouldn't you want a seat at that table?
This is certainly something that CEOs like Randy Oostra of health system ProMedica are thinking about. Last fall, the Toledo-based operator announced that it was putting some $50 million toward tackling the social determinants of health. Those dollars aren't going toward building new hospital beds but rather, addressing education, food, employment and housing — issues that have not typically been under the purview of the hospital. Nonetheless, they help exacerbate health problems and land patients in the emergency department eventually.
And, oh, by the way, that's the same ProMedica that just announced it is planning to acquire HCR ManorCare, the nation's second largest provider of long-term care and post-acute services. You can bet that Oostra and his organization are thinking about some of the same sorts of strategic maneuvers to move upstream and address the social determinants of eldercare, before they snowball.
“We want to take down the wall between traditional hospital and post-acute care services in an effort to enhance the health and well-being of our aging population,” Oostra said in April. “The lines are blurring between where healthcare begins and stops. This acquisition provides us the platform to think differently about health and aging.”
So, get your nursing home's feet off the dock, and maybe think about taking a boat ride upstream. The water is warm and I can guarantee it will be crowded soon.
Follow Staff Writer Marty Stempniak @mstempniak.