Health Care Lessons from the Elderly
Boston Globe Editorial by John Baackes
Imagine a health plan that covers 100 percent of prescription drugs, includes dental, has no co-pays or deductibles, helps with issues like arrangingtransportation to medical appointments, and offers a personal touch that few see from the healthcare system.
This kind of plan already exists in Massachusetts for poor seniors - and it may offer lessons to everyone in healthcare as the industry seeks to stem rising costsand care for the growing elderly population.
Known as Senior Care Options, it combines all the benefits of Medicare and Medicaid into one comprehensive health services package. It was originallydesigned to help seniors stay at home and out of a nursing home by using local agencies that know a community and its residents.
Plan members are delighted with their care. At Senior Whole Health, we have a 99 percent retention rate. Almost 10,000 seniors are enrolled in Senior CareOptions statewide, half of them with Senior Whole Health. In Brockton, 50 percent of the eligible population is participating in Senior Whole Health.
Our success is even more striking, given the target population: More than 40 percent of Senior Whole Health members do not speak English, and 20 percent areilliterate. Most have one or more chronic diseases. The average number of prescriptions is five. This is not a case of saving money by covering a young, healthy population in need of minimal healthcare.
Why has this approach become such a success? Here are some lessons we have learned:
Create one-stop shopping. Navigating the healthcare system is difficult at best. Our members have a nurse care manager who becomes their main contact andchief advocate in arranging the right combination of services. A nurse is available for consultation 24 hours a day. While ensuring that the member receives the appropriate care in a timely way, this approach also averts future complications that can be more costly.
Use a team approach. In addition to having a primary care doctor and an assigned nurse care manager, every member receives a home visit by a geriatricsocial worker from a local elder services agency. Each member receives an individual care plan. Senior Whole Health has just launched a new initiative that expands and strengthens the team by creating a caregiver advocate - someone to link in and support the primary caregiver from the member's family.
Pay for appropriate nonmedical costs. We've found that nonmedical issues can have a significant effect on healthcare. If a patient can't get to the drugstore topick up a prescription, for example, that could lead to serious and expensive consequences down the line. Employing a multilingual staff can avert medical issues that arise from a lack of understanding. We have also expanded our definition of preventive care to cover such nontraditional programs as tai chi to help preventfalls. All of these strategies are a form of prevention, which has been demonstrated to improve health and save money.
Home care works. Supportive care in the home can help reduce the need for even more hospital visits and, in some cases, nursing home placement. Bycombining preventive programs with an emphasis on home care, Senior Whole Health has reduced avoidable hospital admissions by 25 percent for members over the past two years. In particular, re-admissions for the same diagnosis within 30 days of being discharged are being reduced.
The Massachusetts Legislature created the regulatory structure for Senior Care Options, in part, because more than 6 percent of our elderly live in nursinghomes compared with the national average of less than 4 percent. But everyone who cares about healthcare policy should consider the lessons of this successful model for all of the population.
John Baackes is the chief executive of Senior Whole Health.
Last modified: 04/01/2010