A Place for Mom is proud to announce the winning essays of our annual $1,000 scholarship for the advancement in the field of gerontology. 10 finalists were narrowed down to 5 winners whom are being awarded with a financial donation. Applicants were required to write a compelling essay about senior care innovation in preparing for America’s “Silver Tsunami” of aging Baby Boomers.
Congratulations to Deepa Shah, 2014 Senior Care Innovation Scholarship Winner! We invite you to read Deepa’s essay below and comment with your thoughts.
There are countless statistics to cite when making the case that we need to prepare our health care system for America’s quickly approaching “Silver Tsunami.” To me, the most frightening are not the statistics that estimate the sheer volume of 65 and older Americans in our population in 10 years, but the ones that describe this group’s state of health. 3 of every 4 Americans aged 65 and older are living with more than one chronic disease. Adults living with chronic conditions are three times more likely to be depressed, to be inactive, to experience a lower quality of life, or to have a disability or mobility impairment than their healthier contemporaries. Caring for chronic conditions is also expensive, for all of us. It accounts for 75% of what we spend as a nation on health care. Breaking this down further, about 61% of that care is spent on hospital services to manage exacerbations or episodes resulting from chronic conditions (for example, a heart attack or stroke). And the worst part is, chronic conditions, and exacerbations resulting from them, are mostly preventable. All of this means that we are spending about $4,000-6,450 per person per year because we’re not preventing ourselves from developing chronic conditions, or, once we do develop them, we are not preventing ourselves from getting worse.
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The change that needs to happen in the senior care industry is the same one that needs to happen for all patients — healthcare organizations need to invest in new operations, technology, and organizational cultures that move our system away from acute episode management to holistic care focused on prevention. I assert that there are three imperatives in moving our healthcare system towards true preventive care for seniors:
Operations innovations to improve senior care should focus on promoting team-based care in new ways. Team-based care makes primary care excellence possible. When a single physician is responsible for everything her patients need (note, the average primary care panel size is 2,000-2,500 patients), it’s no wonder that patients fall through the cracks. For example, a single physician may know who of her patients is diabetic, but she very likely doesn’t know how many of her diabetic patients are up-to-date on their blood sugar testing or adherent to their insulin therapy. A single physician assumes nothing is wrong until the patient takes the step to schedule an appointment when he is not feeling well. For many patients, deterioration to the worst outcomes is likely before they receive adequate primary care management. This problem becomes compounded in senior patients, who often remember a “body” or state of health that is likely declining more rapidly than it was in the past.
Now imagine that every senior patient is managed by a physician as well as a physician assistant, nurse, or pharmacist. With two people on the patient’s care team, division of labor becomes possible. The physician can focus on in-person examinations, new diagnoses, or coaching patients towards new ways to manage their diseases when the first line of treatment is no longer working. Non-physician clinical partners, in turn, can focus on watching the rest of the panel — the patients who aren’t necessarily coming in for appointments, but who are missing a critical component of their care and need a reminder ( “Hi Mr. Jones, I noticed you haven’t taken a blood sugar test in 6 months. I work with Dr. Smith, and she’d really like to check on your blood sugar to make sure our diabetes therapy is working. Would you be able to go to the lab this week?”).
As new types of clinicians become legally entitled to deliver an expanded scope of clinical services (for example, as of October 2013, pharmacists in California can start, stop, and adjust medications), healthcare organizations need to adjust their operations to enable non-physicians to deliver care. They need to invest in hiring complementary staff; they need to offer specialized training programs to empower non-physician staff in managing senior care; and they need to invest in the design of new care protocols and accountability structures to make both physicians and non-physicians comfortable in team-based care approaches.
As critical as it is to move towards team-based care through operations innovations, it is equally important to invest in new technologies that can enable senior patients’ care teams to focus on the right patient needs at the right time. New technologies are needed at both the enterprise (hospital and clinic) level and in a patient’s home.
At the enterprise level, innovation and design thinking should be applied to the adoption of electronic medical records (EMR). Too many EMR systems are simply a new, electronic interface to paper charts, and just like paper charts, these systems are not “smart,” and I believe this is grossly under-leveraging the power of technology. Rich decision support and alerts can be built into smarter electronic medical record systems, where information from a past visit or a visit with another clinician can be used to direct attention to a care issue today, without the patient having to report symptoms or wait for some other adverse outcome in his health.
Continuing the example above, Mr. Jones is a 70-year old diabetic who complains of a bad cough and decides to visit his physician. His physician sees that Mr. Jones’ primary complaint is the cough, and she also sees the medications that Mr. Jones is taking. With most paper or electronic medical charts, this visit would lead to a brief check-in on whether Mr. Jones is taking his medications and whether he is experiencing any side effects, but most of the visit would be dedicated to Mr. Jones’ acute problem — his cough. In a visit powered by smarter technology, however, the doctor may be alerted that Mr. Jones has a diabetes diagnosis on record and the absence of a blood sugar test in 6 months. Without Mr. Jones having to report diabetes symptoms to his doctor, his doctor can spend some appointment time reminding Mr. Jones that it is good diabetes management to check your blood sugar every 3 months to ensure that his medication regimen is controlling his disease. Arguably, the doctor’s time spent reminding Mr. Jones how to best manage his diabetes is likely to prevent the worst outcomes over the long-term, more so than the time spent discussing his cough. Enterprise-level technological investment in smart EMR can power a team-based, total health management approach in senior care.
However, enterprise-level technological investment is only half of the picture. Most seniors living with chronic diseases will still only spend 1-2 hours (4-8 appointments) with their physicians or nurses each year, but they will spend over 5,000 hours with their selves, families, and other “care providers” outside of a hospital or clinic’s four walls. Building technologies that connect patients, caregivers, and their primary care teams through a system of information tracking, information sharing, and alerts will be vital to delivering care to a much larger senior population in the future, largely because this is care seniors may receive while in the convenience of their homes. Not to mention, building technologies that help keep seniors in their homes longer will significantly contribute to senior happiness, quality of life, and in turn, willingness to manage their chronic diseases to prevent the most horrible outcomes.
My last imperative deals with an organizational aspect that is very important to me and often overlooked. In my current work, I’m inspired on days when I work alongside physicians to study variation in clinical outcomes and to identify innovative improvement strategies. I’m also frustrated on days when implementation is slowed by our biases, habits, and structurally-limiting systems. I believe that we, organizations that deliver care, need to embrace change to meet our customers’ demands of rapid change in transparency, efficiency, quality, access, and service.
Despite the pressure for change, I’m not sure that we always identify good solutions. Worse, I am not certain that providers uniformly have the will to adopt solutions that may require radical change. I believe the most challenging issue facing America’s hospitals and health systems, now and in the future, is that there exists a subtle but pervasive culture of resistance to change, and that this culture is reinforced by the way we have organized our operations and our lack of learning from other industries and markets.
This is what healthcare looks like at a very real and operational level: Primary care physicians’ patient panels are expanding and they are working harder than ever, despite the fact that patients feel their doctors are spending less time with them. Technological investment is focused almost exclusively on speedy electronic medical record implementation, without matching investment in designing EMR differently from our old paper-based systems to make EMR “smarter.” Administrative departments are cutting staff to meet cost-savings goals, so project priorities shift to “maintaining business as usual” or “making small tweaks” (vs. introducing big, necessary innovations) when administrators are under-resourced.
In a world like this, it is very difficult to even think about how we will get to a patient-centric model of healthcare delivery for our aging population and all of our patients. However, the fact is we need to get there and we need to get there fast. The first step in this journey is to build a culture of innovation within health organizations by: 1) increasing exposure to outside industries and perspectives, 2) increasing the use of compelling data (not personal influence) in decision-making, and 3) encouraging and enabling all our personnel to try new things.
Building a culture of innovation will not be easy, but it’s this critical need that drives me to work so intensely to improve healthcare. I feel strongly that my background from outside of healthcare was a first step in my journey to change health system culture — I have been able to apply valuable outside strategies and approaches to identify workflow and technology innovations more quickly than my peers. Pursuing an MBA is the next step in my journey to learn from innovators in different industries, to apply new lessons, and to enable progress towards true innovation in healthcare.
My contributions towards the change needed in healthcare operations, technology, and culture are my vision, my commitment to achieving that vision for all patients, and my experience in being a change agent. I come from background where I have been trained to take a step back, frame steps in the context of a bigger picture, and point to a path for change. My skills and experience managing change are my biggest assets, and I have no doubt that I will spend my time at Wharton continuing to bolster my approach and effectiveness in managing innovation. The bottom line is that we are not going to address the needs of our aging population in our current system. We need innovation and change, and innovation and change take a village — or several capable and willing change agents.
View and read all of the 2014 Senior Care Innovation Scholarship finalists and congratulate them on making it closer to the scholarship prize.
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