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empathy 2I'm a little grumpy today. It was one of those days in clinic. Since it was the day after New Year's most specialty clinics were closed. Our office was open, so patients who had various symptoms and conditions managed by specialists were directed to our office. Our schedule maker forgot to schedule me a lunch break. The nurse's forwarded me messages that did not indicate a lot of critical thinking on their part. One patient who was fired by her psychiatrist informed me that both the psychiatrist's office and my office said that I would be able to take over prescribing her various controlled substances. It was the kind of day that made me wonder why anyone in their right mind would go into primary care.

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The number of seniors in the United States is projected to nearly double over the next 34 years—from 43 million in 2012 to nearly 84 million by 2050. During that time period, the number of seniors 85 and older is expected to jump from nearly 6 million to 19 million.

oct 04“Our Parents, Ourselves: Health Care for an Aging Population,” a report issued by the Dartmouth Atlas Project, a program of The Dartmouth Institute for Health Policy and Clinical Practice, also reveals that the number of seniors in Medicare private health plans such as Medicare Advantage increased from 6.4 million beneficiaries in 1999 to nearly 12 million in 2011—and that number continues to rise.

Because seniors are likely to experience frequent, complex interactions across many providers in the healthcare system, often there’s no single healthcare provider coordinating all of their care, according to the report, which was released in early 2016.

In addition, the American Geriatrics Society’s Choosing Wisely guidelines, which were released in 2013 and updated in 2015, provide geriatrics-specific recommendations to the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The campaign advances a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.

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Rising drug costs are a big problem at St. Louis, Missouri-based Ascension, the largest nonprofit health system in the United States. Despite efforts to monitor the drugs used by the health system, the cost of many older generic drugs has increased by as much as 10.5% in the last year, says Roy Guharoy, PharmD, vice president and chief pharmacy officer for The Resource Group at Ascension. This cost increase, which only includes older generics, cost the health system as much as $70 million between May 2015 and May 2016.

sept 04These and other drug price increases are untenable, especially in the midst of the transition from fee-for-service to value-based care, he says. And it’s particularly challenging, given that Ascension is a faith-based healthcare organization that provided approximately $1.8 billion in charity care in 2015.

Ascension monitors price changes in as close to real time as possible, so that leadership can take immediate action, such as switching to generic drugs or another drug at a better price, says Guharoy. Integral to this process is having physician leaders and specialists in the field review the literature to look at the efficacy of certain drugs to determine their appropriate usage for Ascension’s patients.

Once a particular drug is approved for use across the health system, physicians have 90 days to implement the medication change. Ascension then tracks the implementation at each hospital.

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The evolution of sophisticated technology has the opportunity to offer many benefits to both care providers and patients, especially when it comes to population health. But this high-tech capability can be daunting and confusing for some people, especially those who are older, have chronic conditions, or encounter social determinants such as socioeconomic conditions or logistical issues in regard to health. However, a “high-tech, high-touch” care approach using navigators can help empower patients.

august 05“There is a lot of patient-focused software out there, but it can be difficult for patients to adopt this for themselves. This approach is actually patient-centric,” said Merrily Evdokimoff, RN, PhD, an adjunct professor of community health nursing at the University of Massachusetts-Boston and a consultant for IT/ software provider Kinergy Health. Evdokimoff presented a session on patient activation using technology-supported navigators at the Healthcare Information and Management Systems Society (HIMSS) conference in Las Vegas.

The high-tech component of this model includes a HIPAA-compliant extension to the existing EHR to facilitate communication with patients, and the high-touch component consists of trained patient advisors – “navigators” – who address non-clinical issues. “I love the name navigators, because that’s really what this is about. This is about helping patients get through and understand the system,” Evdokimoff said. Navigators work particularly well in certified home health agencies, physicians’ offices with chronic care management, call centers and in hospital case management.