The unprecedented changes happening in the American healthcare system have many on high alert as they try to anticipate legislative actions. Significant efforts to move from volume to value, along with changing incentives and alternative payment models, will affect practice and the health system budget. In tandem, growth in the population aged 65 and older is celebratory and daunting. The John A. Hartford Foundation is partnering with the Institute for Healthcare Improvement to envision an age-friendly health system of the future. Our current prototyping for new ways of addressing the complex and interrelated needs of older adults provides great promise for a more-effective, patient-directed, safer healthcare system. Proactive models that address potential health needs, prevent avoidable harms, and improve care of people with complex needs are essential. The robust engagement of family caregivers, along with an appreciation for the value of excellent communication across care settings, is at the heart of our work. Five early-adopter health systems are testing the prototypes with continuous improvement efforts that will streamline and enhance our approach to geriatric care. J Am Geriatr Soc 66:22-24, 2018.Key words: health system; care models; improvement science W e are in the midst of unprecedented change in the American healthcare system. There are significant efforts to move from volume to value, with changing incentives and alternative payment models that have left healthcare delivery precariously straddling two worlds. As we write this, there are those who would repeal the Affordable Care Act 1 and others who assert its salutary effects. Large hospitals and health systems continue to grow larger and consolidate, whereas the number of nursing home beds has declined over the past decade.2 Larger primary care practices are acquiring smaller practices, leaving independent physicians or nurse practitioners who care for families over the life course largely a thing of the past.As the market changes so does demand. Baby Boomers are beginning to demand different types of long-term services and supports than their parents have. It is highly unlikely that the Boomers, weaned on technology and social networks, will tolerate a disjointed, noncommunicating health system.What better time to encourage Congress and the administration to seriously examine what an age-friendly health system might look like? With more than 55 million older adults, $500 billion in annual Medicare spending, and nearly 10 million older adults who are dually eligible for Medicare and Medicaid, it is time for today's healthcare systems that largely care for older adults to improve continuity, decrease waste, and prevent needless harm.Among the stories we heard that have shaped our thinking about the design of the age-friendly health system initiative was this one:My father, an 88-year-old fiercely independent man of Irish descent, still driving his car to the village three miles from his home, was losing weight and, more worrisome, his memory. My ...
This Viewpoint proposes expanding the quadruple aim (improving population health, enhancing the care experience, reducing costs, and addressing clinician burnout) to the quintuple aim, adding a fifth aim of advancing health equity.
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