Institute of Medicine Committee on Geographic Variation in Health Care Spending Larry Minnix LeadingAge

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(No Transcript)
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Institute of MedicineCommittee on Geographic
Variation in Health Care SpendingLarry
MinnixLeadingAge
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The overall aim

• Better quality at lower cost that is
  person-centered, evidence based, that can be
  applied to large and diverse populations can best
  be accomplished through

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Stewardship

• Where stewardship is defined as the intersection
  of
• Values and Value
• as evidenced by Medicare and Medicaid cost
  reductions while measurably improving quality of
  life for consumers who use those programs.

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Long-term services and supports can best
contribute to stewardship that

• Prevents or delays health events
• Helps consumers and their loved ones navigate
  crisis scenarios
• Uses programs and protocols that are proven to
  work effectively on an individual and large-scale
  basis regardless of the living venue
• Employs a community-wide scope and network of
  services

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• Stewardship must be organized around five
  inter-related dynamics called
• The Five Big Ideas

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Quality That People Can Trust

• Belief Good quality is less expensive than bad
  quality.
• Stewardship activities
• Advancing Excellence in Americas Nursing Homes
• Continuous Quality Improvement
• Culture transformation
• Small Houses, Green Houses
• Housing with Services (including AoA and HUD)

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Transitions Management/Interested Communities

• Belief Fragmentation is public enemy 1 to the
  quality-cost problem
• Stewardship activities
• Long-Term Quality Alliance
• PACE, SOURCE, Evercare, Senior Independence
• North Carolina, Vermont (Cathedral Square),
  Detroit (Presbyterian Villages, Ohio (NCR),
  California (Mercy), Oregon (Jewish Care)
• Post-acute bundling connected to non-acute
  service packages

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Talent/Workforce

• Belief Competent, enlightened, paid, family and
  volunteer caregivers are the best proxy for
  quality.
• Stewardship activities
• Culture transformation
• Team empowerment
• Educated consumers/families
• Coaching and guiding through GNPs at critical
  points of transition

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Finance

• Belief Public program relief can come only
  through consumer financial investment in
  self-insurance while preventing unnecessary
  crises.
• Stewardship activities
• CLASS
• Bundling
• Incentives for outcomes not srevices or compliance

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Technology

• Belief Technology is an accelerator/catalyst for
  all other Big Ideas
• Stewardship activities
• Personal health record
• Interoperability from home setting to physicians
  office
• Consumer gadgets that help monitor

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Is it possible to achieve better quality at lower
costs? Yes!
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In fact

• Models of long-term services and supports are
  already demonstrating that effective stewardship
  is possible, and
• Value-based health cannot be achieved without
  long-term services and supports.