While I lamented in an earlier blog that a panel speaking about aging in place in assisted living at the Assisted Living Federation of America conference (ALFA) may have been missing the point about care integration, a panel later the same day gave me hope that some industry pioneers understand the concept.
In the session, Integrating Assistive Living and Local Healthcare Systems, three panelists painted a compelling value proposition for how assisted living can sell themselves to hospitals.
Erik Johnson, senior vice president of Avalere Health, gave a good summary of Accountable Care Organizations (ACO). I won't take up too much space on this as there is plenty of literature to find.
Essentially, we are looking at managed care 2.0 but what might make this work is health information technology that helps to coordinate care; value based purchasing that makes you accountable and rewarded (or not); and evidence based medicine that continues to refine best practice medical care. That is essential if you are going to be paid a bundled payment and be responsible for population health.
The interesting discussion Johnson raised was that while most of the discussion around health care savings has been around controlling chronic conditions, the real efficiencies in health care will come from managing functional impairment.
That gets into activities of daily living and therefore rolls in the assisted living industry. After all, under a bundled payment scenario, a hospital unsure how to handle the functional impairment of a very frail and elderly population will be looking to expert partners to do so. How that payment is made remains to be seen as assisted living is a primarily self-pay model.
He shared that per capita spending on health care is four percent lower in assisted living than nursing homes, clearly another value proposition for assisted living.
Approaching this is a voluntary effort that is more about planning for the future. You have to start showing that the role of the entire continuum is important and that requires education to hospitals on the value you bring.
Francine O'Neill, corporate director of wellness, the Arbor Company, showed how her company has started that education with hospitals by tackling hospital pain points.
Transitions of care are a big issue in health care. When someone transitions from one setting to another, the hand-offs are not always ideal. As O'Neill pointed out, 30 percent of patients have at least one medication discrepancy. The post-discharge doctor appointment is critical but does not always happen. And one in five people discharged to home experience an adverse event.
So her organization positioned itself as a safety net for patients by becoming a transitional care provider to fill a void for ED, SNFs and Hospitals. Brilliant!
Her organization positioned itself with the right services. They provide medical follow up on site from a geriatric physician. They perform medication reconciliation aided by electronic records. They bring in their home health, hospice and rehab partners and have weekly meetings to coordinate care. This of course helps to keep people out of the hospital and increase length of stay in the facility.
Having developed the services they then needed to sell it to hospitals. They started exploratory conversations with hospital CEO's, CFO's and Care Management Staff. They found they had some common language and goals in the area of falls, falls with trauma, wound care, and congestive heart failure and the need for constant blood pressure and weight monitoring. They started to educate hospitals about what assisted living does. And hospitals were surprised.
Tiffany Tomasso, founding partner, Kensington Senior Living, operates a boutique assisted living in key major markets focused on high acuity memory care.
One of these facilities is in NY, a state that allows "Enhanced Assisted Living" that is the facility can provide a SNF level of care.
Tomasso came at the issue from an opposite view, not how can we help the hospital but how can we assist our residents with hospitalization. Still, they followed much of the same protocol as Arbor.
It occurred to me at the end of the session that Assisted Living can do rehabilitation and so much more. While SNFs are positioning themselves around rehabilitation, the role of assisted living as both rehabilitation provider and transitional care expert could be a competitive advantage with hospitals and in the industry.
Learn more ~ or join the conversation!
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@ALFA
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