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  • MediCaring4LIFE: Making Local Improvement for Frail Elders – MediCaring.org
    evidence based improvement activities that assure comprehensive assessment and individualized planning ready availability of critical services at home including medical nursing home modifications transportation caregiver support and nutrition and reliable services organized by an individually negotiated care plan that guides care across all settings Financing of services will be through existing programs where appropriate primarily Medicare and Medicaid accompanied by adjustments of certain rules to permit more flexibility as well as coverage for currently non covered services with the supplemental award funding In the third year the project s financial experience and evidence will anchor specification of a shared savings model for the targeted population frail elderly people in a particular geographic area using a modified Accountable Care Organization model as the financing design for serving the needs of elders living in the four communities The MediCaring approach aims to save at least 20 from medical costs and 5 from long term care costs in the first three years By providing much more coherent care planning that is accessible to all service providers and which reflects strong input from elders and family members the choices afforded to frail elderly people with serious disabilities and coming to the end of life will expand to allow those who wish to do so to forego aggressive and burdensome medical treatments that have little chance of meaningful gains Many may instead choose services that allow them to live as well as possible in the time remaining buoyed with good symptom relief strategies that limit the effects of disabilities support for caregivers and fewer disruptions To achieve this the supportive services must be reliable and prompt so that elderly persons and their families feel confident that they can stay at home rather than resorting to the hospital at the first sign of trouble This also means that the care system must provide around the clock back up by phone and have the capability to have the appropriate service or expert go to the home promptly Both routine and urgent medical care and social supports must be available in the elderly person s residence e g home nursing home assisted living facility Frailty is a very high cost part of our lives the per person per month costs regularly top 5 000 for an average of three years before death Yet the home based primary care program for veterans has cut hospitalization by more than half and nursing home use by more than 80 If MediCaring4LIFE reduces hospital use by just 25 and reduces net long term care costs by 5 the investment of about 1 000 per person per year will yield returns of more than twice the investment Average costs per person per month will come down by about 20 and these are conservative estimates We have recorded a webinar to provide an overview of the spreadsheet calculations behind these estimates on YouTube http www youtube com watch v LaeHLhqDfUw The potential for improving life experience while saving money is feasible but it requires

    Original URL path: http://medicaring.org/2013/08/20/medicaring4life/ (2016-04-30)
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  • Joanne Lynn, MD, speaks at the 2013 Bioethics Symposium – MediCaring.org
    q cite s strike strong Name required E mail required URI Shining Stars Webinar June 27 to Learn from Leaders in Improving Care Transitions Infographic of Nursing Home Care Statistics on Costs Usage and Challenges MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel as president CEO Bureau County Republican April 29 2016 College baseball Weekend Preview April 29 May 1 NCAA com April 29 2016 AbbVie Doubles Down on M A Bloomberg April 29 2016 Aspen Valley Hospital reaps awards for patient experience Aspen Times April 29 2016 Optimizing care transitions the role of the community pharmacist Dove Medical Press April 26 2016 3 lessons to improve patient care transitions FierceHealthcare April 21 2016 Dave Alfano Launches Caring Transitions of Central Connecticut PR Web press release April 19 2016 Older adults with dementia face increased mortality risk due to care transitions Bel Marra Health April 14 2016 Central Wyoming Caring Transitions Owners Recognized for Pioneer

    Original URL path: http://medicaring.org/2013/07/31/joanne-lynn-md-speaks-at-the-2013-bioethics-symposium/ (2016-04-30)
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  • Joanne Lynn’s Testimony before the Commission on Long-Term Care – MediCaring.org
    have any way to measure the quality of care plans against outcomes even though for frail elderly people this is nearly all that matters are we serving the person s priorities effectively The most important outcome in frail elder persons from their perspective is how you can live in the life remaining Today a physician can order up any treatment or test for a frail elderly patient with virtually no regard to cost Yet we cannot get a home health aide to keep the person clean or a good nutritious meal or a place to live thus saving a huge amount in medical costs down the road unless we place the patient in nursing home facilities and the like This has to be the most expensive scheme for supporting housing food hygiene and personal care that one could imagine and it has been the source of all manner of dysfunction Virtually every other country even underdeveloped ones provide housing and food for its disabled elderly persons but we do not Virtually every other country provides support for family caregiving but we provide so little that you can hardly see it In fact we begrudge providing social support services leaving them as a set of poverty programs that come and go causing service gaps and frustration while we treat medical services as an open ended entitlement This pattern does not match the needs of frail elders now and unless we do something about it the mismatch will become extremely severe and the consequences extremely expensive as the number of frail elder persons in this country rise For those who continue to hope that the family can step in to save the day the facts are against you We will have too few 21st century family caregivers and they will often have to work or will be disabled themselves Similar to the declining ratio of workers to retirees the number and availability of family caregivers will decrease dramatically during the coming age wave The budget focused proposals that are now circulating in Washington seem to presume that the main strategy is to get the financial incentives right in Medicare and Medicaid The prevailing wisdom seems to be that if we can just get the financial incentives right the clinical service array would follow This is implausible both in terms of logistics and cost Instead this Commission must be more direct in working to reshape the existing service delivery system We should talk for example about how we can enable local governments public health offices coalitions of providers and Area Agencies on Aging to take a leading role in measuring and managing the supply and quality of services for all frail elderly residents across each community That care like so much in life is and must be local This type of community based planning could readily be implemented on a broad scale Once we require good care plans for every frail elderly person a local coalition or agency could monitor performance by aggregating and geo mapping the service needs from those care plans This would make it easy to see where the community has undersupply oversupply or poor quality this would pave the way for efficient action to optimize services We would see for example that it is not efficient to have multiple home care agencies traveling across a metropolitan area twice a day to serve clients who live in adjacent apartments At Altarum Institute we are working to establish multi disciplinary networks of providers in urban and rural communities who can follow each frail older person s unique care plan and who will be accountable for meeting quality measures For your consideration we ve developed some achievable policy recommendations I won t go through them now but am happy to take questions now or to have follow up conversations We wish you the greatest success possible in the short time you have and hope you will count on us to serve as full and enthusiastic partners in our mutual quest to improve long term care Thank you Recommendations to the Long Term Care Commission from Altarum Institute s Center for Elder Care and Advanced Illness Recognizing that the Long Term Care Commission is charged with advancing policy recommendations to improve the coordination and quality of care and the competency and quality of the workforce we suggest that the Commission consider making strong recommendations in the following areas 1 Quality coordination of care metrics for physicians should be broadened to incentivize and then require comprehensive care planning for frail elders 2 Direct care workers should be given a fair deal on income access to their own health care services solid baseline training and ongoing opportunities for further education and expansion of skills 3 Family caregivers should be provided with both general guidance and hands on training about how they can if they agree to do so provide supportive services to an ill or disabled loved one and given access to their own respite services 4 Communities should be allowed and enabled to take on some monitoring and management of their elder care system including hospitals housing care at home rehabilitation hospice transportation nutrition and other essential needs To do so requires standardization and availability of some data sets and re examination of the role of geographic concentration and provider competition More specific ideas to achieve the four broad goals outlined above include Quality coordination of care Recommendation to HHS to give higher updates under a reformed Sustainable Growth Rate SGR physician payment system to practitioners who can demonstrate that they 1 have comprehensive care plans for more than 50 of their patients who are over 80 years old or who have disabilities 2 are providing continuity of care across settings to more than 70 of their patients and 3 ensure that an appropriate clinician follows up within 24 hours of when a new issue arises for a disabled patient living at home or in a nursing home Recommendation to the Office of the

    Original URL path: http://medicaring.org/2013/07/17/joanne-lynns-testimony-before-the-commission-on-long-term-care/ (2016-04-30)
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  • QIO Care Transitions in JAMA – MediCaring.org
    acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI Going Home Costs of Care Essay Readmissions frail elders communities So much to learn and know MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel as president CEO Bureau County Republican April 29 2016 College baseball Weekend Preview April 29 May 1 NCAA com April 29 2016 AbbVie Doubles Down on M A Bloomberg April 29 2016 Aspen Valley Hospital reaps awards for patient experience Aspen Times April 29 2016 Optimizing care transitions the role of the community pharmacist Dove Medical Press April 26 2016 3 lessons to improve patient care transitions FierceHealthcare April 21 2016 Dave Alfano Launches Caring Transitions of Central Connecticut PR Web press release April 19 2016 Older adults with dementia face increased mortality risk due to care transitions Bel Marra Health April 14 2016 Central Wyoming Caring Transitions Owners

    Original URL path: http://medicaring.org/2013/02/25/qio-care-transitions-in-jama/ (2016-04-30)
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  • Transition to Better Care Video Contest – MediCaring.org
    need is a video camera and a story to tell Your video should share how you your patient and their family or your colleague s went above and beyond to make certain that a patient making a care transition from the hospital to the home was given and understood comprehensive instructions as well as the necessary support and resources to help ensure that he or she would remain on a path to wellness Entries are welcome from across the patient provider and caregiver communities including but not limited to Nurse practitioners nurse midwives advanced practice nurses clinical nurse leaders care coordinators front line staff in health care settings doctors other hospital staff patients family members of patients caregivers The Robert Wood Johnson Foundation RWJF is sponsoring this video contest as part of its Care About Your Care campaign a national effort to spark conversation and galvanize attention about what people can do to identify and receive better health care Launched in 2011 Care About Your Care is a national effort to spark conversation and galvanize attention about what people can do to identify and receive better health care Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI RARE Campaign Measuring Success One Pillow at a Time IHI Broadcast on Reducing Readmissions MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel

    Original URL path: http://medicaring.org/2012/09/28/transition-to-better-care-video-contest/ (2016-04-30)
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  • Nominations sought for IOM Committee on Transforming End-of-Life Care – MediCaring.org
    the fields of medicine nursing pharmacy social work health care administration pastoral care and other healthcare fields health care finance palliative and end of life care research communication and media patient advocacy and community based support and care giving health law and biomedical ethics public policy and health education are needed for the committee The overall objective of the project is to advance policies to improve the care that individuals and families receive at the end of life through alignment with individual values and preferences and to stimulate a national conversation with individuals families and communities on improving the way we approach death Specifically the IOM committee will Review progress since the 1997 report assess challenges and opportunities and evaluate strategies to integrate end of life care into a person centered team based framework Demographic and cultural changes will be considered as will advances in technology that affect the provision of care in different settings most notably in the home Families are increasingly recognized as a vital component of the healthcare workforce and the financial and other ramifications for individual families and society will be considered Develop recommendations for changes in policy financing and clinical care that will align care with individual values and preferences and promote high quality cost effective care Design a dissemination and communication strategy to promote public engagement and understanding A prerequisite for progress is public understanding of the realities facing individuals and families at the end of life and the availability and consequences of different choices This strategy will need to consider the fears and anxieties surrounding aging and death and cultural diversity in values and preferences Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite

    Original URL path: http://medicaring.org/2012/09/11/nominations-sought-for-iom-committee-on-transforming-end-of-life-care/ (2016-04-30)
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  • Calculating blended rate for the 3026 application – MediCaring.org
    segments low medium and high risk Assume that as the risk level increases so does the time and cost of your intervention However you have to arrive at a per eligible discharge rate that reflects a fair fee for anyone in any of the three patient segments So taking the above example let us assume the following costs and volume this example uses very high costs just to illustrate the computations Volume Cost of each intervention Total Cost Low risk 80 500 40 000 Medium risk 420 700 294 000 High risk 500 1000 500 000 Blended rate Total Cost Total Volume 834 000 1000 834 For each input that goes into the blended rate you need to make your assumptions and data explicit Let s take the example of the low risk patient population To arrive at the volume you should be able to accurately predict the number of patients who would be 1 eligible for the intervention and 2 would agree to the intervention So the calculation for the volume can be done in the following way for low risk targets Total number of patients eligible for the intervention 1000 Proportion of eligible patients who belong to the low risk pool 40 Proportion of patients from the low risk pool we expect to refuse the intervention 80 Total number of low risk patients who are eligible and will accept the intervention 1000 x 40 x 20 80 A few things to consider when calculating the blended rate Characteristics of the target population Are they low risk or high risk and how this will affect your intervention cost Things that you might consider when calculating the cost of each intervention Personnel salary of time spent on intervention cost of recruitment and turnover etc Expected refusal or acceptance rate for the intervention this can be derived from a previous care transition project Remember to provide explanations or footnotes for any assumptions made As always we are very interested in your experience and thoughts Please respond to this blog or send along info to email protected This information was updated on November 18 please note that IT costs CANNOT be included in your calculation Previous information posted here was incorrect on this point We apologize for that error Key words care transitions blended rate section 3026 hospital readmissions budget worksheet per eligible discharge rate Tweet Pin It One Response to Calculating blended rate for the 3026 application More News on Care Transitions Funding Think Home Care Blog says November 30 2011 at 12 32 pm call a modified Coleman Model The same blog in a slightly earlier post ran an interesting piece on developing a blended per person rate as required by the Section 3026 budget Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI How to Build

    Original URL path: http://medicaring.org/2011/11/03/calculating-blended-rate-for-the-3026-application-2/ (2016-04-30)
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  • Tech challenge seeks to improve care transitions – MediCaring.org
    acquired conditions Nearly one in five patients discharged from a hospital will be readmitted within 30 days A large proportion of readmissions can be prevented by improving communications and coordinating care before and after discharge The Centers for Medicare and Medicaid Services CMS provides a discharge checklist to help patients and their caregivers prepare to leave a hospital nursing home or other care setting Research has shown that empowering patients and caregivers with information and tools to manage the next steps in their care more confidently is a very effective way to reduce errors decrease complications and prevent a return visit to the hospital The ideal application for this tech challenge will Incorporate the content of the CMS Discharge Checklist Help patients and caregivers access the information and materials needed to answer the checklist s questions about their condition their medications and medical equipment and their post discharge plans Share this information with doctors pharmacists nurses and other professionals in their next care setting e g home nursing home hospice Identify community based organizations or others who can provide valuable assistance Leverage and extend NwHIN standards and services including but not limited to transport Direct web services content Transitions of Care CCD CCR and standardized vocabularies Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI CFMC Offers Online Learning Sessions Work with the Experts to Improve Transitions Understanding a Health Care System As a Path to Improving It MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request

    Original URL path: http://medicaring.org/2011/09/25/tech-challenge-seeks-to-improve-care-transitions/ (2016-04-30)
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