By Dr. Bruce Chernof
(Next Avenue invited our 2016 Influencers in Aging to write essays about the one thing they would like to change about aging in America. This is the latest submission.)
It is time to modernize our ideas and actions toward aging and health care so older Americans can get the right care at the right time for the right cost. Therefore, I challenge the health care industrial complex and most particularly its leaders — those that design, regulate, pay for and provide services — to deliver on the promise, not just the provision, of better health and health care.
I call on these leaders to move beyond incremental thinking that pervades most health care “innovation” and shift boldly toward a more person-centered, value-driven and outcomes-oriented delivery model. I encourage all of us, whether we are providing care and support to a loved one or are actively using the health care system ourselves to expect our goals to drive how health care is organized and define what outcomes count.
Big Changes Needed
Despite lots of tinkering around the edges, the way we pay for and provide health care for older adults has not kept pace with the rest of the American innovation explosion. It’s still operating as an acute care-centric, bricks and mortar-driven, episodic service system. Yet life expectancy in the United States has increased by 10 years and people are for more likely to live with chronic medical conditions and some level of functional challenge for a long time than in the past.
Adults with complex needs want to live with dignity and independence in the communities of their choice, with most wanting to live at home for as long as possible. Thus, health care needs to transform and work in service of these life choices.
This is a high hurdle.
‘Indignities and Challenges’
Health care is purpose-built to meet the needs of those who pay for it and those who provide it — not those who use it. Had any luck lately finding and contacting someone after 5 p.m. who knows about your health care and can help with your problem? Ever received a prescription for an urgent medication that was not on your insurer’s formulary? Have you brought a loved one home from the hospital only to find that the discharge supplies did not actually get delivered?
These indignities and challenges are problem enough when you are perfectly healthy; they are magnified exponentially as we age. It is time for the locus of control to swing back toward people, toward an approach that rewards providers for individuals’ quality of life outcomes, not just the technical quality of medicine.
Focusing on the Person
I believe a person-centered health care system is a necessity. Please do not misunderstand me — I love being a physician. Yet I know to my core that organized health care beats disorganized care, and person-centered care easily outdoes “patient-centeredness.”
Patient-centered care starts with a vaguely paternalistic view that the health care system is the source of all solutions, when, in fact ,it creates many of the problems that erode people’s quality of life — the risks of poly-pharmacy [multiple medications] and use of low-value treatments are a few examples.
Finally, hospitals can be dangerous places for older people, even when used for all the right reasons. We know that older adults often lose substantial function and mobility when hospitalized that they never regain when they get home. Person-centered care explores how we can use the health care system and tailor it to each individual to achieve their goals — big and small — whether they are age 55, 75 or 95.
Time to Build It and Pay for It
We all deserve a health system that starts with “what matters to you” and not “what is the matter with you.” It is time to stop treating the implementation of a better model of care as some randomized drug trial (does it work or not?) and get on with actually building and paying for it. To use the parlance of health care, we need some “rapid cycle quality improvement” here.
I guarantee you that if health insurers’ and providers’ reimbursement was tied to three simple questions, the system would change dramatically:
- Is my health care plan built to help me achieve my goals?
- Is there a specific person I can call in the health care system if I have a problem or a question who would know me and be prepared to help me?
- How likely is it that I can reach that person on the first call?
These are tough words and questions for a field that I love and to which I have devoted my entire professional life. Candidly, selfishly, this reimagined system is what I want for myself and my family.
My hunch is this is what all of you reading this want for your lives, too.