By Joanne Lynn
The time has come to allow some leading communities to put insights into practice by building the elder care system of the future! We’ve all learned that reliable, effective care for frail elderly people is possible, at a much lower per capita cost than we are now spending. We’ve found that some cities, states, and counties have leaders willing to work on fundamental reforms that make medical care more prudent and buttress food, housing, transportation, personal care, and caregiver supports. The situation is ripe to take action!
Allow Counties and Communities to Manage Elder Care, Using Savings from More Efficient Medicare Spending
Communities across America face challenges with our aging population. Some are ready to develop personal care plans and manage their delivery systems for elders, aiming to increase access to food, housing, transportation, personal care, and medical care at home. The Obama Administration should direct CMMI to let pioneering communities try this “MediCaring Communities” approach in a demonstration, for which CMMI would waive certain rules and monitor quality and for which sustaining funds will mostly come from the savings from spending Medicare dollars more wisely. While health care overspends substantial Medicare funds on inefficient, ineffective services, supportive services are underfunded and often inaccessible. Families are impoverished, and moving to nursing homes becomes necessary.
Why now? First, CMMI has matured to having solid staff and operating processes, but these are at risk when administrations change in a little more than a year. Getting a set of demonstration communities underway before the disruption of personnel change would be prudent. Waiting even a few more years until lines of authority are reestablished means that the period of major increase in the numbers of frail elders is that much closer, and teams eager to be underway are blocked and will lose momentum and commitment.
Second, many communities note the challenges that they will have as the number of persons living with serious chronic conditions grows, the financial and workforce resources needed are not available, and the inherited service delivery system is overwhelmed. Fully half of retirees now have no savings, yet the average duration of self-care disability in old age is more than 2½ years. The mismatch is ominous. How are we to ensure food and housing for so many frail elderly people who have no assets?
Furthermore, we are paying for medical services that are often unreliable, undesired, and ineffective. The examples are rife. Someone once told me that if we paid ministers by the prayer, there would be a lot of prayers said. We do pay doctors for each service, and there are a lot of services provided. That is changing, but some questionable medical services have been substituting for serious shortcomings in supportive services. There needs to be a way to take some of the savings from more prudent medical care to fund better supportive services, still aiming to reduce the overall cost, but with a more balanced approach.
The MediCaring Communities model is a comprehensive approach that makes better medical care, better supportive services, and lower costs all come together. But communities cannot implement it fully without CMMI providing some flexibility in current rules. Communities could use an Accountable Care Organization framework, for example, but then they would need exemption from the restrictions that bar all enrollment, enrollment of only a targeted set of elders, or geographic service delivery. If the community used a Program of All-Inclusive Care for the Elderly (PACE) or Medicare Advantage framework, then they would need to be able to spend on nonmedical items and enroll only the targeted frail elders. In short, we can’t fully implement MediCaring Communities without some partnership with CMMI.
If you have a community that would want to be among the first, let us know at email@example.com.
Let’s build the future together!