AGS Viewpoint: Innovation

Public agencies and private foundations are increasingly promoting innovation in healthcare, encouraging providers to find new ways to improve the quality and cost-effectiveness of care, including in long-term care (LTC). As part of this initiative, these organizations are offering assistance in the form of expert advice, help with start-up costs, incentives for implementing successful changes, or a combination of these measures.

In December 2011, for example, the Centers for Medicare & Medicaid Services (CMS) launched the Independence at Home Demonstration project, which is designed to determine whether providing chronically ill Medicare and Medicaid beneficiaries with comprehensive, coordinated primary care services in their homes will improve outcomes, help prevent hospitalizations and emergency department visits, and save money. Over the course of the project, physicians and nurse practitioners will lead teams of healthcare professionals and coordinate primary home care for these beneficiaries. If successful, the project could enable older adults who have multiple chronic health problems and require LTC services to stay at home. Teams that cut costs to a level at least 5% lower than traditional office- and hospital-based care will be eligible for a share of the savings.

Just a month earlier, in November 2011, CMS’ Innovation Center launched another groundbreaking initiative, the Health Care Innovation Challenge. This program will award grants totaling as much as $1 billion to organizations that “implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and the Children’s Health Insurance Program, particularly those with the highest healthcare needs.” CMS is looking for innovations that can be introduced within 6 months, whether a new approach or an existing approach that can be expanded to include new populations. Care providers, public–private partnerships, local governments, and payers can all apply. “For example, the Health Care Innovation Challenge could support the use of personal and home care aides to help the elderly stay in their homes,” the agency notes in its call for proposals.

Recent initiatives to foster innovation and higher quality, more cost-effective care have also focused on LTC facilities. CMS, for example, recently worked closely with Advanced Healthcare Solutions—a large corporation that manages approximately 40 nursing homes in Texas—to implement innovative changes that have improved care and cut employee turnover and costs. Starting with an initial group of seven facilities, and with support from CMS’ Quality Improvement Organization for Texas, the company made changes that created a more home-like setting in each facility. Among other things, the corporation divided the long hallways in these facilities into smaller, more intimate “neighborhoods,” and gave residents more of a say in what happened in their neighborhood. Residents were encouraged to decorate their neighborhoods and plan activities there. To foster closer relationships between staff and residents, Advanced Healthcare also stopped “rotating” staffers and instead assigned each staff member to a given neighborhood. They also gave staff flexibility in scheduling patient meals, baths, and other activities, based on individual resident preferences. As a result of these measures, staff turnover dropped significantly and satisfaction with care increased, as did operating income. The firm has followed up by introducing similar changes in its 30 other nursing homes.

In the private sector, religious organizations and philanthropies are also supporting innovations in LTC. The Robert Wood Johnson Foundation, for example, is investing in the Green House concept, which supports small home-like LTC facilities that house no more than a dozen residents. Each resident has a private bedroom and bathroom that leads to a common living room and dining–kitchen area, where communal meals are prepared and shared. Staff are assigned to care for specific residents, who make decisions such as when to go to bed and get up. Preliminary findings suggest that, among other things, Green House residents are more satisfied with the care they receive. In addition, it appears these residents also have a lower risk of depression than those residing in traditional nursing homes.

The American Geriatrics Society (AGS) encourages its members and others in the field to make the most of opportunities for innovation. The deadline for applying for funds through the Independence at Home Demonstration project was February 6, and the deadline for the first round of funding for the Health Care Innovation Challenge was January 27. There will, however, be a second round of Health Care Innovation Challenge awards if funds are available after the initial round of awards are allocated. Should funds become available, CMS will release information about the second round of awards before April 2012. AGS will continue to track and report funding opportunities in the field. The society lists key funding opportunities in its weekly listserv, which is e-mailed to all members and also appears on the AGS Website at www.americangeriatrics.org.