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  • Identifying Communities with Potential for Pioneering MediCaring—Suggest Yours! – MediCaring.org
    organizational features The important thing is that it would help guide providers in the local system toward achieving and maintaining high value care For example the Community Board would work with health care public health and social services providers to monitor performance metrics that reflect the priorities of frail elders in the area including the preferences of individuals and help decide on priorities for investments and improvements Where would funding for investment and system management come from The funding would come from savings arising from much improved coordinated services that are adapted appropriately for the population of frail elderly Medicare beneficiaries follow their preferences and adhere to the principles of geriatrics and that reduce overutilized low value services in Medicare The potential for savings varies but an average of about 30 is plausible for almost any MediCaring Community program Even saving 10 would enhance the ability of communities to make supportive services that are needed by elders and which are the mainstay of long term care much more available A program could be built on a managed care platform or on an Accountable Care Organization arrangement but either strategy will require partnering with the Centers for Medicare and Medicaid Services CMS That s where your help is needed The time has come to ask CMS to take up the challenge of working with willing applicants starting by opening the door to allow pioneer MediCaring Community programs to move ahead CMS will need to adjust certain regulations and allow for more flexibility in operations to allow savings to be reinvested in long term care and support services and to enhance operational efficiency in the programs Here s what we have found likely to be important in the first set of communities enabling them to lead in building reliable sustainable services for frail elders in the MediCaring Communities model A history of cooperation in the public interest Implementation of some improvements already in frail elder care such as some experience with models like PACE GRACE INTERACT local support of nutrition and transportation services age friendly environments or similar models and programs Leaders who are concerned about the future effects of increases in the numbers of persons needing daily help in old age Enough frail elders to field a convincing project but still small enough to be able to make improvements quickly perhaps 500 10 000 is a reasonable range and frail elders are about one tenth of all persons older than 65 Reasonably self contained area with boundaries that are well known that is the health care and supportive services to people who live in the area are generally provided by services anchored in the area There will be other considerations but none are as important as commitment and leadership We invite you to think on it and talk it over with others and if building the elder care system of the future is plausible and appealing in your community city or county please let us know We are planning some webinars

    Original URL path: http://medicaring.org/2015/04/17/identifying-communities/?pfstyle=wp (2016-04-30)
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  • MediCaring.org – Page 3 – Making It Safe to Grow Old
    senioralert takes the preventive care of every individual patient and inputs the data outcomes in a quality dashboard for each municipality accessible to doctors patients and the public The civic leader Protecting Hospitals That Improve Population Health Posted by Les Morgan on December 16 2014 No Responses Tagged with best practices hospital readmissions Medicare Medicare Readmission Reduction Program MRRP public policy quality improvement readmissions rehospitalization Dec 16 2014 by Stephen F Jencks M D M P H Also see companion post by Joanne Lynn M D Issue The Medicare Readmission Reduction Program MRRP encourages hospitals to reduce readmissions within 30 days of discharge by imposing substantial financial penalties on hospitals with more readmissions than would be expected if the same patients were discharged from an average hospital 1 The Evidence That the Readmissions Rate Readmissions Hospital Discharges Is Malfunctioning as a Performance Measure Posted by Les Morgan on December 8 2014 3 Responses Tagged with hospital readmissions Medicare public policy quality improvement readmissions rehospitalization Dec 08 2014 By Joanne Lynn M D Also see companion post by Stephen F Jencks M D M P H Care transitions improvement programs have been effective in helping the health care system both become more effective in serving people living with serious chronic conditions and reduce costs However the key metric used to measure performance is seriously malfunctioning in at IMPACT s Impact on Quality Measurement for Frail Elders Posted by Dr Joanne Lynn on October 28 2014 2 Responses Tagged with IMPACT measurement quality improvement Oct 28 2014 By Joanne Lynn What matters in the lives of frail elders centers on function and understanding an elderly person s course over time requires that everyone involved learn to measure functioning in the same way That s the core of the new Improved Medicare Post Acute Care Transformation IMPACT Act passed by Congress in September 2014 Within IOM Supports Strengthening Social Services near EOL Posted by Les Morgan on September 23 2014 No Responses Tagged with advance care planning caregiving end of life end of life care end of iife care frail elders iom public policy Sep 23 2014 The Institute of Medicine IOM report Dying in America issued September 17 concludes that public and private insurance programs should integrate medical and social services in order to provide care consistent with people s individual values goals and preferences as they approach the end of life The IOM report underscores that as currently configured gaps in A Dangerous Malfunction in the Measure of Readmission Reduction Posted by Les Morgan on August 26 2014 No Responses Tagged with Affordable Care Act CCTP CMS measurement metrics readmissions rehospitalization Aug 26 2014 By Joanne Lynn and Steve Jencks Work to reduce readmissions has started to yield remarkable improvements in integration of care for frail elderly people by prompting hospital personnel to talk with community based service providers by teaching patients and families how to manage conditions and navigate the health care system more easily and by paying Include Family

    Original URL path: http://medicaring.org/page/3/ (2016-04-30)
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  • An Eye to 2020: Where Will Health Care Reform Lead? – MediCaring.org
    are Accountable Care Organizations bundled payments or global capitation whatever mix is fine he said At the same time Emanuel acknowledged that success won t happen overnight and a lot of different payment models will need to be tried The problem is that fee for service and delivery system changes do not line up Emanuel said For example marketing and advertising for costly procedures and treatments influence patient decision making More important he observed health care providers many of whom are not primarily focused on delivering the best possible care for the most efficient price follow entrenched patterns of practice The result is that rising health care costs are threatening wage growth and all of the other things we human beings care about Despite the large challenges inherent in bending the health care cost growth curve Emanuel does not advocate abandoning U S social insurance programs Instead he advocates serial systemic reforms For example he notes that although we don t have a good alternative to peer review which some critics call a bottleneck to rapid reform he believes it is feasible and imperative to develop new protocols for more rapid testing and dissemination of pilots demonstrations and other types of initiatives We need a frame shift to look at multiple factors at the same time he said We need to evaluate differently with different standards and perhaps larger numbers It is within this broader measurement context that Zeke Emanuel believes transparency will be an essential driver of change Doctors are highly competitive Emanuel told the crowd of Disruptive Women They are trained to want to be number one The current dilemma he says is that the driven nature inherent in training physicians goes out the window when they start practicing But as quality measures increasingly become public spotlighting how good processes of care and delivery are along with patient outcomes and patient experience the big push for change will come from providers he predicted Emanuel also acknowledged that the quest to coordinate services and drive down costs must involve and engage individual patients Right now patients are not focused on costs he said They are not going through websites to compare the costs of various procedures and treatments But if metrics of cost and quality can be arrayed in a simple way and if a selection among them can be developed to include price this could help to drive costs to a more reasonable level he said To that end Emanuel is currently writing a concept paper on shared savings that discusses the possibility of sharing savings not only between health care providers but also with patients If there is a choice between treatments that are clinically equivalent he reasoned why shouldn t patients get part of the savings Why not indeed Anne Montgomery is a Senior Policy Analyst for the Center for Elder Care and Advanced Illness at Altarum Institute Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes

    Original URL path: http://medicaring.org/2013/04/18/an-eye-to-2020-where-will-health-care-reform-lead/ (2016-04-30)
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  • bending the cost curve – MediCaring.org
    health care system get off fee for service medicine and chart a course toward other delivery system reforms and payment reforms Whether these are Accountable Care Organizations bundled payments or global capitation whatever mix is fine he said At the same time Emanuel acknowledged that success won t happen overnight and a lot of different payment models will need to be tried The problem is that fee for service and delivery system changes do not line up Emanuel said For example marketing and advertising for costly procedures and treatments influence patient decision making More important he observed health care providers many of whom are not primarily focused on delivering the best possible care for the most efficient price follow entrenched patterns of practice The result is that rising health care costs are threatening wage growth and all of the other things we human beings care about Despite the large challenges inherent in bending the health care cost growth curve Emanuel does not advocate abandoning U S social insurance programs Instead he advocates serial systemic reforms For example he notes that although we don t have a good alternative to peer review which some critics call a bottleneck to rapid reform he believes it is feasible and imperative to develop new protocols for more rapid testing and dissemination of pilots demonstrations and other types of initiatives We need a frame shift to look at multiple factors at the same time he said We need to evaluate differently with different standards and perhaps larger numbers It is within this broader measurement context that Zeke Emanuel believes transparency will be an essential driver of change Doctors are highly competitive Emanuel told the crowd of Disruptive Women They are trained to want to be number one The current dilemma he says is that the driven nature inherent in training physicians goes out the window when they start practicing But as quality measures increasingly become public spotlighting how good processes of care and delivery are along with patient outcomes and patient experience the big push for change will come from providers he predicted Emanuel also acknowledged that the quest to coordinate services and drive down costs must involve and engage individual patients Right now patients are not focused on costs he said They are not going through websites to compare the costs of various procedures and treatments But if metrics of cost and quality can be arrayed in a simple way and if a selection among them can be developed to include price this could help to drive costs to a more reasonable level he said To that end Emanuel is currently writing a concept paper on shared savings that discusses the possibility of sharing savings not only between health care providers but also with patients If there is a choice between treatments that are clinically equivalent he reasoned why shouldn t patients get part of the savings Why not indeed Anne Montgomery is a Senior Policy Analyst for the Center for Elder Care and

    Original URL path: http://medicaring.org/tag/bending-the-cost-curve/ (2016-04-30)
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  • health care reform – MediCaring.org
    Elder Care and Advanced Illness at Altarum Institute Response to Howard Gleckman s article in Forbes Online Long Term Care a Forgotten Issue in the Presidential Campaign Posted by Janice Lynch Schuster on October 25 2012 No Responses Tagged with eldercare health care reform Medicare public policy Oct 25 2012 by Judith Peres LCSW Howard Gleckman in Forbes online http www forbes com sites howardgleckman 2012 10 24 long term care a forgotten issue in the presidential campaign rightly states that long term care and the needs of citizens with serious chronic conditions and functional limitations are not part of our current Presidential debate There are an estimated 10 million Americans with long term care needs The amount and quality of long term care palliative care hospice received through their illness trajectories varies tremendously as do their unmet needs near the end of life Studies consistently demonstrate that patients with advanced illness and functional decline experience untreated pain and other symptoms lengthy hospitalizations involving unwanted often low yield and costly medical treatments and low overall family satisfaction The current national dialogue about the need to reform the health care system includes recognition that the population is aging a changing trajectory of illness for Medicare beneficiaries advancements in high tech life support systems limitations in health care resources and issues surrounding patient autonomy and the right to a dignified death However for the most part the development of the new chronic condition models tend to overmedicalize the services delivered and do not acknowledge the knowledge base developed over three decades of long term care and palliative care research on how to manage this population Recent studies suggest that medical care for patients with serious illness is characterized by inadequately treated physical distress fragmented care systems poor communication between doctors patients and families and enormous strains on family caregiver and support systems Although most of the years after age 65 are a time of good health independence and integration of a life s work and experience eventually most adults will develop one or more chronic illnesses with which they will live for years before death These years are characterized by physical and psychological symptom distress progressive functional dependence and frailty and high family support needs What exactly do we need More than anything we need programs that support family caregivers those individuals who provide an estimated 450 billion dollars worth of care for older adults We need hospice like wraparound services that would help people from the time they are seriously ill or disabled and that offer home care services respite for our caregivers and supports for what we can no longer manage or cope with on our own We need social structures and public policies that support families as they live through years in which they simply cannot piece it together on their own As a country we ve done a remarkable job of creating a health care system that does well at treating acute problems and curing much of what

    Original URL path: http://medicaring.org/tag/health-care-reform/ (2016-04-30)
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  • The Price is Right! Suggestions from current 3026 applicants – MediCaring.org
    previous experience Many programs initially have very high refusal rates but usually you can decrease that over time Although the budget worksheet does not include a place for an acceptance rate you could modify your entry on Row B and then enter the explanation in an accompanying footnote Not to exceed budget is another aspect that might cause some confusion Basically your not to exceed budget is the money CMS will set aside for your entire program Remember that the budget you are proposing is for five years There might be changes in your program over this time period only some of which you could predict For example you might be able to streamline your intervention over the first two years or you might predict an increase in patient volume You could write in these predicted changes with a modification on Row M and then enter the explanation in an accompanying footnote The aim of the program is to be integrated as a permanent part of Medicare and to this end it allows and encourages learning throughout the program However the degree of flexibility is unknown Here is the link to the powerpoint presentation from the meeting on 7 12 11 http medicaring org wp content uploads 2011 07 CCTP Budget Proposal pptx This is a collaborative effort and the above suggestions would not have been available if not for care transitions teams sharing their experience So any comments questions or modifications to our suggestions are encouraged Please send your response to email protected Key words section 3026 applicants Affordable Care Act ACA medicare budget worksheet financing CCTP care transitions patient volume rate per eligible beneficiary IHI Triple Aim ONC Beacon community based organizations Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags

    Original URL path: http://medicaring.org/2011/07/18/the-price-is-right-suggestions-from-current-3026-applicants/ (2016-04-30)
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  • Harshika Satyarthi – MediCaring.org
    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 Spirit PR Web press release April 4 2016 Tags advance care planning Affordable Care Act aging Altarum Institute best practices caregivers caregiving care plans care transitions CCTP CFMC CMS coalition building Coleman Model community based discharge planning elder care eldercare end of iife care end of life end of life care evidence based family

    Original URL path: http://medicaring.org/author/harshikasatyarthi/ (2016-04-30)
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  • Beacon communities – MediCaring.org
    that you did not cover The greater the volume the more spread out your costs will be One way of improving your volume estimate is getting a good approximation for the acceptance rate into the program which can be based on previous experience Many programs initially have very high refusal rates but usually you can decrease that over time Although the budget worksheet does not include a place for an acceptance rate you could modify your entry on Row B and then enter the explanation in an accompanying footnote Not to exceed budget is another aspect that might cause some confusion Basically your not to exceed budget is the money CMS will set aside for your entire program Remember that the budget you are proposing is for five years There might be changes in your program over this time period only some of which you could predict For example you might be able to streamline your intervention over the first two years or you might predict an increase in patient volume You could write in these predicted changes with a modification on Row M and then enter the explanation in an accompanying footnote The aim of the program is to be integrated as a permanent part of Medicare and to this end it allows and encourages learning throughout the program However the degree of flexibility is unknown Here is the link to the powerpoint presentation from the meeting on 7 12 11 http medicaring org wp content uploads 2011 07 CCTP Budget Proposal pptx This is a collaborative effort and the above suggestions would not have been available if not for care transitions teams sharing their experience So any comments questions or modifications to our suggestions are encouraged Please send your response to email protected Key words section 3026 applicants Affordable Care Act ACA medicare budget worksheet financing CCTP care transitions patient volume rate per eligible beneficiary IHI Triple Aim ONC Beacon community based organizations Care Transitions Measurement 101 Posted by Dr Joanne Lynn on May 17 2011 No Responses Tagged with Beacon communities best practices care plans care transitions discharge planning ESRD frail elders measurement Medicare rehospitalization SNF May 17 2011 Many improvement teams have real problems with measuring their progress some never get around to measuring and some never do anything else This presentation was set for the communities funded under the Beacon initiatives that are working to bring information exchange to care transitions but you ll find the pointers applicable to any intervention that your community might try You can download a PowerPoint presentation by clicking the following link caretransitionsmeasuresprimer PowerPoint presentation Keywords Beacon communities care transitions reasonable skeptic test ten units of energy test sure audience test rehospitalization best practices Medicare good care plans near misses targeting nursing home residents mentally ill delirious frail elderly homeless ESRD revolving door patients case reviews Care Transitions Measure avoidable readmission HCAHPS discharge planning denominator problems numerator problems MediCaring is a service of the Center for Elder Care and Advanced

    Original URL path: http://medicaring.org/tag/beacon-communities/ (2016-04-30)
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