How to Improve Care for Older Americans

Quality Matters caught up with Christopher A. Langston, PhD, Program Director of the John A. Hartford Foundation. Dr. Langston was the program officer for the largest study of depression in older adults and helped develop a geriatrics curriculum that is in use at dozens of medical schools.

NCQA: Any advice for health plans looking to improve geriatric care?

ChrisLangstonLangston: [What] percentage of your provider panel is certified in geriatrics? Nationally there are about 7,000 certified MD geriatricians; only about 2 percent of nurses are certified in geriatrics. That’s not sufficient and the problem is going to get worse as the population ages.

NCQA: Why should improving care be a priority?

Langston: Older adults are high users of medical care. According to AHRQ, they are more than twice as likely to be readmitted to the hospital [than] younger populations. About 80 percent have two or more conditions. Appropriately managing them can avoid hospitalizations.

NCQA: What keeps older Americans in the hospital?

Langston: In a fee-for-service system, there’s no incentive not to readmit. Hospitals and doctors get paid for tests, retests, hospital stays. That’s not true in a medical home or ACO. New care models will push us in the right direction.

NCQA: Research highlights you’d like to share?

Langston: There’s good work on care transitions, which are a big deal—it’s not uncommon for patients to get lost in the system when moving from one care setting to another. Dr. Eric Coleman’s Care Transitions Intervention model significantly reduce[s] readmissions and is cost effective.

NCQA: How can medical homes help improve care?

Langston: The model turns the incentive system on its head—instead of paying for each episode of care, we’re paying for health. When care teams know their patients, it improve[s] care and services.

NCQA: Anything else you’d like our readers to know?

Langston: With depression treatment, it’s impossible to tell which is going to work. The trick is follow-up: who’s getting better with a drug or therapy. For those who aren’t, try something else. Chronic disease care takes a team. To make real progress, follow up.

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