Post Acute Care & the Silver Tsunami
Post-acute care is a hot mess: what’s to blame, who pays?
Post-acute care (PAC) management has emerged as one of the most complicated and costly areas across the health care industry. Much has been written about why it feels so fragmented from various perspectives.
From the PAC providers’ viewpoint, and when asked what their most pressing issues were, some broad themes were outlined in a recent survey:
- Declining reimbursements
- Value-based accountable post-acute care
- Denials / RCM
- Lack of information technology
- Lack of data sharing/HIE/interoperability
- Lack of care coordination or quality reporting
Want a take a guess at the one item that landed in every respondent group’s Top Three?
The lack of data sharing or interoperability. Not the lack of data, or even lack of care coordination, but the fact that post-acute is simply too silo’d with its use of data.
Who is most affected by this, other than providers? Thanks to changes over the last decade in Medicare policy and with reimbursement models, payers also have considerable “skin in the game.” But ultimately, it’s patients who are paying for lack of interoperability in post-acute care. And the consequences can be dire.
Patients who are discharged too quickly and without clear education and communication for follow-up treatment are subject to a litany of possible negative consequences, not the least of which are preventable readmissions and an increased risk of mortality.
WHAT IS POST-ACUTE CARE?
Acute conditions (sudden and severe, as opposed to chronic conditions) could range from strokes or heart attacks, to broken bones, or even something more easily treated like an asthma attack. These are the types of incidents that land you in the ER at a hospital, an urgent care clinic, or similar. Everything that happens to these patients afterwards — what their post-discharge care plan looks like or how they eventually navigate the path back to wellness or healing, if that exists for their situation — this is, broadly, post-acute care (PAC). Care settings can include but are not limited to home care, outpatient therapy, in-patient rehab facility, assisted living or personal care facility, long-term care (LTC), nursing home care, and hospice.
In medical circles, the idea of PAC may be referred to as “clinical handover,” literally the transfer of a patient’s care from one provider to another. But the World Health Organization recognizes the need to also encompass the patient’s experience, preferring “transitions of care” instead.
What does the post-acute care patient look like?
In thought leadership pieces about how to improve the landscape for post-acute care, the patient demographic is often described as “frail,” mostly older adults, and their conditions as “debilitating,” often requiring a host of sub-specialty providers. Partly, because we get sicker and have to manage more chronic conditions as we get older. But also because the propensity for acute setbacks is heightened as a result.
When you consider that over 54 million people will turn 65 over the next 15 years, it’s understandable why many business industry leaders in general, but particularly those in health care, have been referring to the aging patient demographic as the “Silver Tsunami.” How the shifting patient demographic will contribute to explosive growth within the post-acute care space, and what it means for health care reform in general, has been a hot topic at conferences in recent years.
PointClickCare, the EHR software vendor who owns the largest market share of the long-term and post-acute care (LTPAC) industry, opened their 2018 summit by saying that organizations needed to brace for the Silver Tsunami — asserting that the “national health care spend doesn’t measure up to the increase in demand” which is headed our way via the population shift. We need to get our acts together, basically.
And CEO of HiMSS, Hal Wolf, delivered a similar edict at Health 2.0 when he warned that the “confluence of an aging population” and more educated consumers means transformational health care industry change is needed. And quickly.
As a sidenote, Ashton Applewhite, activist against ageism and author of “This Chair Rocks: A Manifesto Against Aging,” is at odds with the “silver tsunami” term. As though baby boomers, in tsunami-like fashion, are going to “strike without warning” and “suck all our resources out with them.” She suggests our aging population is actually more of a well-documented “phenomenon” that is “washing gently across a flood plain.” Because it’s not entirely accurate to generalize an entire generation’s behaviors.
THE TIMES, THEY ARE A-CHANGIN’
Whatever you prefer to call the aging patient demographic most referenced with post-acute care, there are several other important factors to consider when framing solutions:
- The U.S. Census, in its 2017 National Population Projections, says that by the year 2030, all baby boomers will be older than 65. This means one out of every five Americans will be of retirement age, and that older people could outnumber children for the first time in U.S. history.
- Grown children have been identified as the single greatest source of care for aging Americans by the AARP.
- However, baby boomers have fewer children than the generations before them.
- In fact, caregiver ratios may be cut in half between now and 2030 (seven potential caregivers for each person 80+ will become closer to four).
- And, boomers live farther apart from their children than did previous generations.
- More boomers are also living alone, thanks to divorce rates.
The data around our aging population’s evolving ecosystem is practically screaming how imperative it is for health care IT to design solutions that will actually work for seniors. How can we put our best foot forward in the modified landscape that is emerging? And how can we provide seniors with the tools to feel more empowered and in control of their own destinies when it comes to managing their health care?
We already have health care IT data — lots and lots of clinical and non-clinical data. The health care industry just isn’t sharing and utilizing it efficiently enough yet. HiMSS CEO Hal Wolf agrees: “Data is fundamentally useless until you turn it into information.” And we also have to make data more actionable, accessible and engaging to consumers.
Contrary to what pop culture would have us believe, there are some straight-up myths to debunk about seniors’ independent abilities to use technology to this end.
While wearables or AI haven’t fully resonated with seniors yet, there are some interesting products starting to bubble up, like Pillo, the robot which uses facial recognition, machine learning and video to remind about, dispense and reorder meds, and Elliq, the part-robot companion that encourages seniors to “get moving” through online games, with other content and functionality that engages family and friends in the caregiver process.
Time is of the essence
The Society for Post-Acute and Long-Term Care Medicine tells us that not only will one-fifth of the U.S. population soon be 65 or older, but that more than half of these persons are plagued with three or more medical problems. Let’s layer in the fact that four million U.S. adults are homebound, many of whom cannot access primary care — these patients account for around half of the costliest 5 percent of patients — and are therefore more likely to be treated for an acute condition.
Now, whether you view the silver tsunami as a tidal wave force that will necessitate massive health care reform, or more of the gentle wash against a flood plain that Applewhite describes, depends on your perspective. But the path toward solutions seems more clear: we have to address data interoperability, specifically, at an unprecedented pace. And tech tools at the patient level seem to wield tremendous potential for closing the dreaded communication gaps.
Because those riding in on the silver wave are a lot cooler than you may have thought.