Nov 122013

The new theme issue of JAMA (Journal of the American Medical Association) features a dozen opinion pieces that address critical issues in US health care,  including “Reliable and Sustainable Comprehensive Care for Frail Elderly People,” by Dr. Joanne Lynn, director of the Center for Elder Care and Advanced Illness [now the Program to Improve Eldercare] at Altarum.  In her “Viewpoint” essay, Lynn describes the MediCaring model for improving care for frail older adults by integrating health and social services, with monitoring and management by local communities.  Today, she joined JAMA editor-in-chief , Howard Bachner, M.D., Hamilton Moses III, M.D., Ezekiel Emanuel, M.D., and Ph.D., Joshua Sharfstein, M.D., for a  briefing at the National Press Club in Washington, D.C. (Dr. Lynn is among the audience in the cover art, included here.)

This article is article are available on the JAMA web site.

You can watch a 35-minute video of Joanne Lynn’s remarks via the YouTube video shown below. You also can download the PowerPoint presentation that she speaks about in the video.

You can also view a YouTube video of the entire press conference:

Lynn said, “We almost all get to grow old; it’s the terrific success of modern medicine.” Indeed, she noted that  those lucky enough to grow old—including millions of Boomers now on their way—face a health care system not designed or equipped to meet the essential needs of very old people for continuity of care, community-based services, access to nutrition and transportation, and help for family caregivers. Lynn writes that requiring a comprehensive, realistic assessment of each frail elderly person’s situation and development of a shared plan of care,  is the keystone of highly reliable, effective and affordable care. These care plans would inform and direct a person’s care,  and build the delivery system we need in advanced old age. Anchoring the effort in the communities where people live will make them more effective and will allow savings from more efficient medical care to be used to support social services, a plan that Dr. Lynn calls “MediCaring ACOs.”

Lynn concluded today’s remarks with a sense of urgency, and a call to action. “It’s not a hotshot pill anymore, it’s how people are going to live with these conditions,” she said. “We have about a decade to get it right.”

key words: Joanne Lynn, JAMA, MediCaring

Jan 232013

By Dr. Joanne Lynn

The latest issue of JAMA features our paper describing   an exciting and successful initiative from the Centers for Medicare and Medicaid Services (CMS) and fourteen of its quality improvement organizations (QIOs).  Grounded in quality improvement methodology—plan-do-study-act–this unusual project offers many insights for those aiming to reduce avoidable readmissions.  And its raises a number of important question about how we measure progress in reducing readmissions. (For more on that topic, see our earlier MediCaring blog, )

A Medicare patient’s ability to receive successful treatment during care transitions from one setting to another has a crucial effect on the overall cost and efficiency of the Medicare system. Errors in information transfer, care planning or community support can cause hospitalizations, rehospitalizations and unnecessary costs to the Medicare program.

This project involved a three-year, community-based effort to improve the care transition process for fee-for-service Medicare beneficiaries. Participating QIOs facilitated cooperation among providers, health care facilities, and social services programs, such as Area Agencies on Aging. They centered their efforts around each community’s unique needs.   QIOs worked with communities to understand their own particular causes of readmissions, and to implement appropriate, evidence-based models to address them.  Communities analyzed results of the intervention along the way, and changed course to stick with interventions most likely to work.

The results, when compared to 50 comparison communities, showed significant reductions in hospitalizations and rehospitalizations, both by an almost 6% average, saving Medicare $3 million in hospitalization costs per average community per year.

This correlation has already led to new national efforts such as Partnership for Patients and the Community-based Care Transitions Program. In addition, in the 10th Scope of Work, all 53 QIOs are leading community projects nationwide (so far, in more than 400 communities).

This paper may be the first time one of America’s leading medical journals has published a report based on QI methods. Doing so represents a profound change in the openness of American medicine to learn not only what works for a patient, but works for the delivery system, too.

key words: quality improvement, care transitions, CMS, CFMC, Joanne Lynn, readmissions, community coalitions, JAMA