By Eve Gelb
Much has been written in recent years about the aging of our society and about how the increased number of older Americans is placing new challenges on our nation’s infrastructure. Such institutions as housing, transportation, communication and healthcare are undergoing significant transformations and are causing those in leadership positions – in both the private and public sectors – to rethink their roles and responsibilities. They know that the new era is not just coming; it is already here.
Nowhere is this truer than in the world of Medicare Advantage health plans. Throughout its history, these plans have helped lead the industry when it comes to innovations in healthcare delivery, care coordination, and effective disease management. As a result, nearly 17 million Americans now receive high-quality affordable coverage through Medicare Advantage plans with the number of enrollees swelling every year.
As their popularity grows Medicare Advantage plans need to find new ways to deliver true value to their members if they are not only to remain competitive but help shape the future of care for all seniors. In this regard plans must continually look for solutions that improve health status, lessen gaps in care, reduce hospital stays, and increase provider and patient satisfaction. In many cases smart innovation is the key to making all of this possible.
Smart innovation in healthcare today is driven by the three goals in the Triple Aim, a term coined by Don Berwick, M.D., a former head of CMS. The Aims include: improving the patient experience of care (both quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare —all of which are embraced by MA plans’ philosophy and services.
At SCAN our person-centered approach to innovation and service is built around listening to our members, aligning care goals between all participants in the healthcare process and effectively leveraging systems, data and resources to drive better outcomes and enhanced satisfaction. By understanding the unique needs of each member as well as the differences between the various populations SCAN serves, we are able to generate and – along with our provider partners – test and refine new programs that deliver true value to beneficiaries.
One such program is “Connecting Provider to Home,” which SCAN is currently piloting with several of the largest provider groups in California. This program extends the physician’s team into the home through a social worker and community health worker. They become the eyes and ears for the physician and reduce the need for acute or long-term care by providing or coordinating non-medical, in-home and community-based support. In addition to serving the member, this program generates employment opportunities for lower skill workers and helps them develop the skills they need to advance to nursing or other higher skilled positions.
Another area where fresh thinking is needed relates to transitions of care and finding new ways to assure that seniors being discharged from a hospital or skilled nursing facility arrive home safely and avoid unnecessary readmissions. Here increased attention needs to be placed on the power of electronic health records to communicate information to primary and specialist physicians. There also needs to be a focused reconciliation of pre- and post-hospital medications and assurances that the older person and their caregiver fully understand what is involved with post-discharge care.
Innovative approaches are needed as well in the area of medication management. Wondrous new drugs are allowing people to live longer and healthier lives than ever before, but with these advances come new challenges for Medicare Advantage plans who must concern themselves with not only the costs of these new drugs but with managing the complex medication regimens of their members. Evidence has shown that an enhanced focus in this area can have a positive impact on medication adherence, which can, in turn, improve health outcomes. This is particularly true for those Medicare beneficiaries with chronic conditions such as diabetes, high blood pressure or high cholesterol. As such members considered high risk for medication issues need special attention to address such common concerns as health literacy, potential mismatches between drugs and diagnoses, and the use of non-geriatric recommended medications. Here, too, creative thinking can play a part. SCAN’s pharmacy department, for example, has co-branded a program with Express Scripts that encourages pharmacists to take a more active role with Medicare Advantage members as a way to enrich the member experience, improve medication safety, and enhance quality of care.
Fresh thinking and smart innovation in healthcare benefits everyone – from the youngest and healthiest Medicare Advantage member to the oldest and most frail. Now, more than ever, such thinking is needed.
Eve Gelb is senior vice president of healthcare services for SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans currently serving approximately 170,000 members throughout California.
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