In a recent USA Today article called, Nation’s Sickest Seniors Reshape Health Care, they demonstrated with numerous statistics and figures how 15% of seniors account for nearly half of Medicare spending. It’s no wonder baby boomers are driving big changes in healthcare. We’ll summarize their findings and offer our take on this key aspect of healthcare reform.
With more than 10,000 baby boomers turning 65 each day, it is clear their state of health has an impact on us all. According to the USA Today article, two-thirds of traditional Medicare beneficiaries older than 65 have multiple chronic conditions, and about 15% have at least six long-term ailments, accounting for more than 41% of the $324 billion spent on traditional Medicare.
To make matters even worse, baby boomers are sicker than previous generations, but they are living longer, which means they are struggling with chronic conditions like diabetes, high blood pressure, high cholesterol, heart disease, arthritis, Alzheimer’s, depression and more for decades.
More than 94% of Medicare fee-for-service money spent on seniors is on patients with at least two chronic conditions. That means the sickest people are driving the healthcare costs.
Healthcare spending on a person with one chronic disease is nearly three times as expensive as those without such conditions, and healthcare spending on someone with five or more chronic conditions costs about 15 times as much.
The healthcare system is at a crossroads. It’s being challenged to overcome these issues, and while an evolution of America’s healthcare system is imminent, it will cause tremendous disruption in the first few years. The outcome, however, will be a system that provides us with better care and better health at a better price.
The statistics listed above prove the need for a change to an integrated healthcare model. With so many seniors living with multiple chronic conditions for so many years, it is essential that doctors and specialists get on the same page when it comes to medications, treatments and care plans. Moving forward, it is all about communication, collaboration and teamwork, and addressing the issue of chronic conditions is of the utmost importance.
Below is an outline of the changes that are taking place and why:
A Change in Reimbursements
Fee-for-service is the way we have handled reimbursements up to this point. In other words, the more episodic health services that were performed, the more healthcare providers were reimbursed for providing those services. This has led to care that is more based on sick-care and disease management instead of well-care and disease prevention. We are at a point now when we must focus on the whole patient and on keeping them well because the healthcare system cannot manage the care of such a large number of baby boomer’s chronic conditions.
A value-based payment model is what we must move towards because it rewards healthcare providers for the health outcomes of their patients instead of the services provided. It will transform our healthcare system into one that focuses on prevention and wellness.
In order for healthcare to be effective as we move forward, healthcare providers will need to work together in an effort to better care for their patients and keep them well. It’s no longer about keeping services separated, and is now about a team of physicians and providers working together to improve population health outcomes.
Risks are higher when communication between healthcare providers is poor. With the average senior taking 10-25 prescriptions prescribed by multiple doctors, medication interactions and health concerns pose too great of a risk.
Medicare now compensates healthcare providers for care coordination and management, opening up a whole new service that is an integral part of ensuring patients get the care they need and that providers are working together to provide the best care for the patients.
Less Patients/Better Care
Physicians are starting to move away from serving large numbers of patients that they barely know, and are instead moving to a model where they can spend more time with their patients. This creates a trusted relationship between the primary care physician and the patient. It allows for a more personalized approach to care that leads to better health outcomes.
Keeping People at Home
With the Affordable Care Act instating penalties for hospital readmissions, the emphasis is now on keeping people well at home instead of admitting them to a hospital or care facility. Home care aides and nurses are key in helping people with chronic diseases or disabilities stay well at home.
Sharing of Data
Data and analytics are paramount in an improved healthcare system. The only way we can predict and prevent chronic disease is to understand those diseases and what has caused them in the past. With the stratification of genes and the study of genomics, huge advancements will take place in these areas that will allow us to prevent disease and better manage our risks, and it all starts with the sharing of data.
Technology & Innovation
Technological innovations will make all of this possible. Technology will store and analyze all of the data that will make disease prevention possible. It will make the integration of healthcare providers possible, allowing a network of providers to work together toward the best outcomes of the patients.
Prevention & Healthy Lifestyle Habits
Healthy lifestyle changes have been shown to greatly reduce the risk of chronic disease. It is important for individuals to participate in their health, and incentives that reward people for taking control of their health are being made available. Healthy lifestyle products and services, as well as consumer education will assist with this effort.
CarpeVITA is making all of this possible through our CarpeVITA Health Networks, our CarpeVITA Circle of Care software, and our portfolio of companies, including: CarpeVITA Care Management and CarpeVITA Genomics, CarpeVITA Home Care.