By 2030, the economically influential generation known as the Baby Boomers, will have turned 65 and become eligible for Medicare – catapulting enrollment to over 80 million beneficiaries. While the sheer volume of this group alone will impact our nation’s healthcare system, this new generation will ultimately reshape traditional long-term and post-acute care delivery models.
Leading the consumerization of healthcare, these Baby Boomers grew up during a time of significant technological advancements and are accustomed to obtaining information and making their own healthcare decisions with a click of a button. Unlike the generation before them, these new beneficiaries are well informed, well engaged, and living longer. Yet they also present more complex health needs. According to the National Council on Aging, 80% of older adults have one chronic illness while nearly 70% have two or more – meaning this new generation will rely more heavily on post-acute and long-term care than ever before.
As Medicare enrollment continues to increase and the demand for more personalized informed care grows – how can health plans begin to prepare for the impending influx of beneficiaries who are waiting on their doorstep?
Data Transparency is Leading the Consumerization of Healthcare
In preparing for the healthcare needs of Baby Boomers, providing consumerization within a PAC setting is one component in which health plans can begin to appropriately prepare for this impending wave of Medicare participants. Recognizing that the patients, even those participating in Medicare, have the ultimate choice of the care they want to receive, they will decide on the type of PAC they want and how it will be delivered. Because of this, it is essential that health plans begin to establish a high-performing post-acute network (PAN) where they can obtain post-acute data transparency to help provide the participants with real-time data to make informed care decisions.
Understanding what this population requires at an individual level while encompassing a wide range of services with a large emphasis on healthcare consumerization is vital. The need for a detailed treatment plan of care for this population is imperative to maintaining the expected level of personalized service. As this generation is accustomed to playing an active role in their health care choices, particularly when it comes PAC, the need for involvement and transparency in care options is pivotal. Data transparency (without the redundancy) is key, with access to information across differing electronic health record (EHRs) as this generation is expecting to play an active role in the decision-making process relating to their healthcare choices.
Preparing For a Shift in Long-Term and Post-Acute Care
Unlike their predecessors, many baby boomers desire to age in place from the comfort of their own home. While understanding the desire to age how they choose, the need for PAC remains and will continue to play an integral role in this generations’ care. As baby boomers continue to present more complex health needs, PAC will be needed now more than ever. Based on this desire to age in place, it is imperative that PAC be adaptive in the platforms it can encompass, as well as the accessibility to high performing PANs. Although, the way PAC will be administered in the coming years will continue to evolve, data transparency will be instrumental in adapting to any unforeseen changes. Health plans need to be able to connect to any post-acute setting and need to begin to develop high-performing PANs NOW!
Through collaboration and preparation, health plans and their post-acute partners can better prepare for this generation and the demands that will come with it. For this generation, who want to age in place, it is imperative through changes in long-term care that health plan providers are collaborating with home and community-based services and working towards providing these services on an individualized level. With the continuing development of PAC delivery, baby boomers will be able to age in place on their terms while not diminishing the quality of their care.
A Data Driven, Analytic Approach to Chronic Disease Management
Due to the prolonged onset of the baby boomer generation, most are entering the Medicare system with a minimum of 1-2 chronic diseases. Chronic diseases have become more prevalent and due to these circumstances baby boomers suffering from multiple chronic conditions are often either re-admitted to a healthcare facility or treated for another issue within the same visit if their health plan is not being properly managed. Having clear line of sight into the patient’s EHR data and following their chronic disease management will aid in reducing readmissions and improving quality of care. Due to the inherent risk of chronic diseases, it is imperative to be able to access data from any post-acute setting, regardless of EHR platform. By implementing data-driven, standardized care pathways for specific diagnoses, health plans can reduce treatment variability and prioritize the amount and type of care needed for members with chronic disease and code accordingly.
Although, there are a host of solutions available to streamline the care process, it is important to realize that diversity in care options does not mean the quality of care should be diminished, nor the necessity of transparency into the healthcare system. With the right preparation, health plans can better prepare for the largest generation of Medicare beneficiaries and begin to develop a wide variety of high-performing post-acute networks.
Learn how Real Time Medical Systems Interventional Analytics is helping health plans access live clinical data from the post-acute EHR to proactively manage care for chronically ill, high-needs members, reduce rehospitalizations, and impact total cost of care. Click here to get started today!
ABOUT THE AUTHOR
With over thirty-five years of health care experience in acute care, ambulatory care, and post-acute care, Phyllis Wojtusik has led the development of post-acute networks, participated in the Medicare Shared Savings Program and other value-based contract programs. Prior to joining Real Time Medical Systems, Phyllis led the development of a preferred provider SNF network for PENN Medicine Lancaster General Health. In this network she developed and implemented strategies that reduced total cost of care and readmissions while improving quality measures and patient outcomes. She utilized system approaches, clinical standards, and care management tactics to improve coordination and transition of care while reducing post-acute length of stay in a network of non-owned SNFs.