The pursuit of high-quality and technically sound healthcare is a universal goal. Reducing unnecessary variations in care is crucial for population health. However, for vulnerable older adults, a significant driver of healthcare utilization isn’t technical errors or inconsistencies. It’s often the healthcare system’s failure to fully grasp and address the unique blend of functional, behavioral, and environmental needs alongside an individual’s medical profile.
It turns out that empowering older individuals to thrive in their chosen homes and communities is a critical element in managing healthcare costs, particularly for those categorized as “high cost, high needs.” This isn’t a novel concept. Data consistently reveals that the most expensive 5% of Medicare beneficiaries account for nearly 40% of annual expenditure. Older adults facing functional challenges and chronic health conditions incur roughly double the costs compared to those managing chronic conditions alone. The daily living context of an individual’s health status—specifically their ability to achieve security and stability within their community—profoundly matters. As healthcare systems, particularly Medicare, transition from fee-for-service and utilization-based managed care towards value-based purchasing models, addressing health in the context of daily living becomes not just a desirable program enhancement, but a fundamental business imperative.
So, what can propel this essential paradigm shift?
Championing Person-Centered Care within Delivery Systems
A pivotal step forward is the adoption of person-centered care models by healthcare delivery systems. In a significant move in December, the American Geriatrics Society (AGS) published a groundbreaking national consensus definition for person-centered care. This expert-backed definition emphasizes that person-centered care is about actively seeking and honoring individuals’ values and preferences. Once articulated, these preferences should guide every facet of their healthcare journey, aligning with their realistic health and life aspirations. This approach thoughtfully incorporates input from family and caregivers, respecting the individual’s wishes. AGS meticulously outlined eight essential characteristics for establishing successful person-centered care programs, encompassing everything from crafting goal-oriented care plans to implementing performance measurements that incorporate feedback from individuals and their families.
To accelerate the broader implementation of person-centered care models, The SCAN Foundation is providing vital resources to assist healthcare delivery systems in building sustainable programs and constructing a compelling “Scan Foundation Business Case For Person Centered Care”. The first key resource is a comprehensive Business Case report. This report meticulously details the value proposition and potential economic returns associated with person-centered care models. It offers a realistic assessment of the economic benefits, demonstrating that person-centered care programs yield value that extends beyond simple cost avoidance. These benefits can encompass higher premium revenues, improved reimbursement rates within pay-for-performance frameworks, enhanced staff morale and reduced turnover, and, most importantly, improved quality outcomes for older adults with complex needs.
Complementing the Business Case report is an interactive Return On Investment (ROI) Calculator. This tool is designed to empower healthcare organizations to develop robust and sustainable person-centered care programs. It facilitates a deeper understanding of program costs, enables the analysis of trade-offs in program design choices, and allows for the tracking of variances over time. The ROI Calculator is designed for customization, enabling organizations to input their own data and generate results that are precisely tailored to their specific program models. For any new program, a credible ROI analysis is crucial for securing buy-in from executive and administrative leadership, who are responsible for both the organization’s financial stability and the maintenance of high-quality care.
Our current healthcare system, while effective in many ways, was historically structured around the convenience of providers, regulators, and payers. However, healthcare professionals are fundamentally aware that older individuals are only “patients” during brief periods within clinical settings. Outside of those moments, they are individuals with lives, goals, aspirations, and the desire to live well in their homes and communities. Developing person-centered care models that embrace the whole person, beyond just their medical diagnoses, is the crucial element in achieving the “Triple Aim” of healthcare improvement: enhancing patient experience, improving population health, and reducing per capita cost. The resources offered by The SCAN Foundation demonstrate that this approach is not only achievable but also sustainable, making a strong scan foundation business case for person centered care.
