Dec 222014

By Elizabeth Rolf Take a look at the Swedish national dashboard for eldercare. It’s a great model. An analytics approach that works, Senior Alert ( takes the preventive care of every individual patient and inputs the data outcomes in a quality dashboard for each municipality, accessible to doctors, patients, and the public. The civic leader […]

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Dec 162014
Protecting Hospitals That Improve Population Health

by Stephen F. Jencks, M.D., M.P.H. [Also see companion post by Joanne Lynn, M.D.] Issue. The Medicare Readmission Reduction Program (MRRP) encourages hospitals to reduce readmissions within 30 days of discharge by imposing substantial financial penalties on hospitals with more readmissions than would be expected if the same patients were discharged from an average hospital.[1] […]

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Dec 082014
The Evidence That the Readmissions Rate (Readmissions/Hospital Discharges) Is Malfunctioning as a Performance Measure

By Joanne Lynn M.D. [Also see companion post by Stephen F. Jencks, M.D., M.P.H.] Care transitions improvement programs have been effective in helping the health care system both become more effective in serving people living with serious chronic conditions and reduce costs. However, the key metric used to measure performance is seriously malfunctioning in at […]

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Oct 282014
IMPACT’s Impact on Quality Measurement for Frail Elders

By Joanne Lynn What matters in the lives of frail elders centers on function — and understanding an elderly person’s course, over time, requires that everyone involved learn to measure functioning in the same way. That’s the core of the new Improved Medicare Post-Acute Care Transformation (IMPACT) Act, passed by Congress in September 2014. Within […]

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Sep 232014
IOM Supports Strengthening Social Services near EOL

The Institute of Medicine (IOM) report “Dying in America,” issued September 17, concludes that public and private insurance programs should integrate medical and social services in order to provide care consistent with people’s individual values, goals, and preferences as they approach the end of life. The IOM report underscores that, as currently configured, gaps in […]

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Aug 262014
A Dangerous Malfunction in the Measure of Readmission Reduction

By Joanne Lynn and Steve Jencks Work to reduce readmissions has started to yield remarkable improvements in integration of care for frail elderly people – by prompting hospital personnel to talk with community-based service providers, by teaching patients and families how to manage conditions and navigate the health care system more easily, and by paying […]

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Jul 302014
Include Family Caregiving in the White House Working Families Initiative

by Janice Lynch Schuster Age-related issues, including family caregiving, must become integral to the domestic policy agenda. Until now, they have received lip service. But here’s our opening to push for real conversation: The Obama Administration has declared a domestic policy focus on improving the lives of working families. At a June White House Summit […]

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Jul 092014
The IMPACT Bill, the BACPAC Proposal, and Why It Matters Where PAC Savings Go

by Anne H. Montgomery and Joanne Lynn, MD, MA, MS Congress is gearing up to put a legislative glide path in place that is intended to culminate in major reform of Medicare’s post-acute care (PAC) payment system. Following several months of soliciting and reviewing comments on a discussion draft, the “Improve Medicare Post-Acute Care Transformation […]

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Jun 302014

Closing the Care Gap for Families in the 21st Century In early July, Sen. Bob Casey (D-PA) will introduce a novel policy proposal that could be life changing for the millions of Americans who quietly worry and wonder who they can call on for help and steady companionship when a loved one becomes ill, disabled, […]

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May 282014
Innovation Requires Shedding Established Patterns

While diligently trying to improve care for frail elders, often by filling gaps in the care system, even our most innovative programs tend to work within the constraints that created those gaps in the first place. Dr. Joanne Lynn, Director of the Center for Elder Care and Advanced Illness (CECAI), has been visiting and often […]

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