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• W3023938519 abstract "New models of care are challenging the way practitioners work, but they also present welcoming opportunities for physicians and others to use their clinical knowledge, experience, and skills. In many ways, this is the game post-acute and long-term care practitioners have been training for their whole careers, and many are eager to take the field. In a session at the recent American Health Care Association/National Center for Assisted Living Population Health Summit, Richard Feifer, MD, MPH, FACP, and Angela Norman, DNP, GNP, ACNP, talked about how practitioners can lead the way in new models such as institutional special needs plans (I-SNPs) and accountable care organizations (ACOs). Dr. Norman, director of the Donald W. Reynolds Institute on Aging at the University of Arkansas for Medical Sciences, observed that it’s easy to be overwhelmed when thinking about implementing a new care model. However, she asked, “How is this really different than what we are already supposed to be doing?” Looking at the “why” of the new models, she said, is the answer to achieving better outcomes. Medical directors and other clinical leaders play a key role in changing their teams’ mindsets and attitudes about new models of care. “A good leader starts with now. You have to make sure everyone understands what you’re doing and why,” Dr. Norman said, adding, “You can’t just run out there and start with what you want to do.” Dr. Feifer, chief medical officer at Genesis HealthCare and president of Genesis Physician Services, agreed: “There is a lot of variability out there among practitioners. You can’t assume automatically that everyone understands these new models and is on board. It’s important to realize nursing leadership and others on the team need to pivot as well.” In I-SNPs and other new care models, said Dr. Feifer, “the medical director has a huge opportunity to make an impact. This is the person most likely to have a background in population, longitudinal, preventive health. Those are components of physician training and experience.” However, he stressed, “This can’t happen without nursing and facility leadership buy-in. Everyone needs to elevate their game.” He observed that “we need to get out of ‘check the box’ exercises. We need to have meaningful conversations with patients and families about goals of care. We all need to be thinking differently.” There is so much happening at once and so many pressures and pulls on administrators, directors of nursing, and others. How do we get them all focused? Dr. Feifer said, “When you are trying to focus people on something new, it is helpful to attach it to something they are already doing.” For instance, he suggested, “Everyone is focused on 30-day readmission, so one solution is to start talking about population health as an expansion of 30-day readmission management.” He added, “Change the language and change the dialogue to get people to think differently.”“The medical director has a huge opportunity to make an impact [in implementing new models]. This can’t happen without nursing and facility leadership buy-in. Everyone needs to elevate their game.” Dr. Norman suggested a few assessment-related activities: reviewing all hospitalizations and emergency department (ED) visits identified (e.g., as causes of avoidable 30-day readmission), referrals, and services used within the facility. She said, “Look at root causes behind hospitalizations to see how you function as a group. Identify what your issues are with providers.” This will help identify problems such as weekend physicians who send everyone to the ED and may need geriatrics training. However, before any training or education takes place, it is essential to identify gaps in knowledge and skills. “When staff can’t get good information clinically, it is hard to make decisions,” said Dr. Norman. It is essential to address condition changes early on and communicate this information back to practitioners, she noted. The good news is that this has received increased attention in PALTC in recent years. Tools such as INTERACT and AMDA’s Know-It-All™ Before You Call data collection system offer resources and support for these efforts. There also needs to be better communication between care settings as silos break down. “Transitions into and out of nursing facilities still haven’t received as much attention as they should. We see fabulous examples of warm handoffs, but they aren’t the norm. We need handoffs that involve all members of the care team and utilize everyone’s expertise,” said Dr. Feifer. All of this loops back to education. As Dr. Norman said, “All practitioners have been educated in general practice, but they’re not taught palliative care and advance care planning or issues such as behavioral management in dementia. They need geriatrics training and education.” As practitioners move into I-SNPs and other population health models, they need to embrace and promote transparency. This presents an opportunity for medical directors and other practitioners to lead and be accountable for decision-making and outcomes. An important starting point is improving the quality and efficiency of care delivery. Dr. Feifer recommends these key tactics:•On-site nurse practitioners (NPs) and physician assistants (PAs)•Narrowed physician panels•Clinical decision support embedded in the electronic health record at the point of care•Rewarding value not volume•Robust analytics and benchmarking of provider performance•Heightened expectations of medical director leadership•Aligned incentives across the care team with center/facility operators The shift from fee-for-service to value-based models involves a profound change in thinking, culture, strategy, and actions, Dr. Feifer stressed. He said that to move forward in this new world, practitioners need to ask themselves if they are eager and willing to change the care process. “Not surprisingly, doing the same thing you’ve always done will only yield the same results. Decisions about how to evaluate patients in the facility versus [ED] visits, change of condition management, and transitions from the hospital and to the community all need to be revisited.” He concluded, “This is a great time in health care for practitioners who want to be rewarded for doing the right thing and doing what they went into medicine to achieve in the first place. These new payment models reward outcomes over volume, and that’s a good thing.” Senior contributing writer Joanne Kaldy is a freelance writer in Harrisburg, PA, and a communications consultant for the Society and other organizations." @default.
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• W3023938519 date "2020-05-01" @default.
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• W3023938519 title "PALTC Practitioners Hit the Field on Population Health" @default.
• W3023938519 doi "https://doi.org/10.1016/j.carage.2020.04.020" @default.
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