Enhancing Medicare Patients’ Quality of Life

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Chronic Care Management Makes Graceful Aging Possible

Susan Widmar – content writer

Some say aging isn’t for sissies. At her 100th birthday party, the celebrant answered what it was like to be 100, “Don’t work for it, honey.”

Dan Buettner’s Blue Zone1 studies have made healthy aging part of our daily lexicon. He offers step-by-step ways to improve life and longevity. 

  • Who is he speaking to?
  • What of those age 65+ who have chronic conditions?
  • Can patients enhance their quality of life—even in the face of chronic diseases?
  • Can physicians support a Medicare patient with chronic conditions?

Medicare patients with two or more chronic conditions depend on their primary care provider to lead them to their best health and quality of life. Medicare is now fine-tuning its medical reimbursement models to the quality of care for each patient. MIPS (Merit-based Incentive Payment System) calculates rewards for medical practices, hospitals, and Accountable Care Organizations through multiple criteria. Payment adjustments are measured on these criteria and against peer performance. 

The pharmaceutical industry wants support to develop medications that can address additional conditions of aging. Vaccinations and treatments already in the development pipeline could advance faster with an infusion of government money.  

The current administration sees merit in the approach. It proposes a department within the National Institutes of Health (NIH) to authorize development projects much like the Defense Advanced Research Projects Agency (DARPA) at the Department of Defense (DOD). For more than 60 years, the DOD has been allowed to be agile and flexible and even to fail.2

  • This approach may be a burden to physicians and a polypharmacy nightmare for patients.
  • Physicians will have to balance the burden of additional medications to prescribe against worldwide health illiteracy. 
  • In addition, the CDC says, Boomers are notorious rule-breakers and will do as they please.

A study from Mahatma Gandhi University, India,3 concluded that 

  • 21.1% of their targeted study group, age 60+, have access to health literacy skills. 
  • The majority had limited access through non-formal and informal communications about health issues. 
  • Only 6% have a regular program to update their health literacy skills. 
  • Of the studied group, 80.8% show no use of learned health literacy skills to maintain health. 

Medicare’s reimbursement for chronic care older adults depends on developing a patient’s self-knowledge and self-care. Medical providers in the US can ease the burden of adapting to the incentives and disincentives of the reimbursement program by recognizing where the majority of issues lie with patients with multiple chronic conditions. 

  • Adverse drug events (ADE) account for prolonged hospital length-of-stay by nearly 2-5 days. 
  • In outpatient settings, an estimated 1 million visits are due to ADEs.  

Care coordinators, by many definitions, develop relationships with patients to monitor their adherence to health management. The patient-care coordinator interactions now are billable with specific codes that reimburse for the additional time spent through telehealth. Physicians are well aware of the annual changes and increasingly stringent penalties–sometimes at the expense of knowing how to bend the arc in favor of the medical practice. 

PharmD Live uses clinical pharmacists as care coordinators. There is an opportunity for patients to build health literacy skills and a relationship with the pharmacist-coordinator, who can recognize the potential for ADEs. The knowledge and experience of a clinical pharmacist available 24/7/365 give patients access to a trusted health care coordinator for information when it is needed.  

Patients get advice from a care coordinator with whom they’ve developed a personal relationship—and one who has a direct relationship with the patient’s primary care provider. 

Patients engaged in their healthcare can live well with chronic conditions, and medical practices that engage appropriate care coordinators to intervene before ADEs are an issue can help. Combined with coding and reporting that eases the staff burden of the medical practice, PharmD Live also contributes to the health of the business of medicine.

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Susan Widmar, content writer, PharmD Live – Ms. Widmar has nearly two decades of experience writing healthcare marketing and communications for one of Minnesota’s largest healthcare organizations. Four of those years she worked with senior defined populations in health, housing and long-term care.

References

  1. Dan Buettner –  https://www.bluezones.com/live-longer-better/
  1. Scientists are demystifying aging — funding could add decades to our lives https://thehill.com/opinion/healthcare/563337-scientists-are-demystifying-aging-funding-could-add-decades-to-our-lives – Matt Kaeberlein, contributor, 07/16/21
  1. Access and Contribution of Health Literacy toward Healthy Aging – https://www.indianjournals.com/ijor.aspx?target=ijor:ijpss&volume=5&issue=10&article=027  Feyisa Reta Melaku, Department of Development Studies, Mahatma Gandhi University, Kottayam, Kerala, India. Dr. Sabukuttan K., Head and Director Department of Lifelong Learning and Extension. Mahatma Gandhi University, Kottayam, Kerala, India. Published online 24 February 2016
  1. Life course vaccination and healthy aging – https://link.springer.com/article/10.1007/BF03324907 Article Michael K. Gusmano PhD & Jean-Pierre MichelPublished: 26 July 2013

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