One of the most extraordinary demographic shifts in the history of the United States is officially here. Last year, the first of the Baby Boomers — America’s post-World War II generation, born between 1946 and 1964 — turned 65 years old. Many millions are about to follow suit: the number of Americans over 65 is expected to increase 138 percent by 2050, at which point 1 in 5 Americans will be 65 or older.
Health care executives have anticipated this for years, of course. But now that the reality has arrived, and is coupled with shock waves from health care reform, a clearer picture of the problem’s scope is emerging. For example:
- 84 percent of adults over 65 have at least one chronic health care condition;
- One-fifth of older adults in working families were either uninsured or had histories of unstable coverage, according to a Commonwealth Fund survey;
- People aged 65+ have 706 annual ambulatory visits per 100 people, compared to 291 per 100 in those 18-44, according to the Center for Health Workforce Studies at the University of Albany.
The challenge of delivering high-quality care in a coordinated, efficient and age-appropriate manner is a multifaceted problem that involves executives, clinicians, HR departments and the Boomers themselves, who have very high expectations for quality and cost. There’s just no way around it: Geriatric care as we know it must fundamentally shift, and health care organizations are going to have to reorganize, re-train and re-educate their teams along the way.
Many organizations have already factored this new normal into their strategic plans. But actually delivering on the promise of integrated care may prove more difficult.
Here are a few trends indicating how geriatric care is evolving and the ways leaders must step up to ensure that their organizations succeed.
1. Rise of Patient-Centered Medical Homes
Given the high incidence of chronic conditions in the senior population and the new performance-driven CMS mandates, PCMH facilities are a new model for delivering more coordinated and cost-effective care over time to seniors by uniting providers in a single setting.
The Challenge: Cultivating Alignment
By definition, the medical home model connects a very diverse team of providers — from physicians to educators to social workers and of course, executives — either onsite or virtually. These diverse and (in other settings) disconnected providers and managers must be able to efficiently and effectively communicate in order to provide integrated care to the patient — and allow the patient to participate in their own care management.
Leaders are going to need an aligned team that share their vision for integrated, high-quality care if they want to control costs. Individual providers can’t operate in a silo, and they must be prepared to share data and input with leadership — and respond to performance measurements.
2. More Sophisticated Clinical Training
Faced with a diverse, rapidly aging population with high expectations for medical care — many of whom also suffer from chronic illnesses — clinicians are going to experience increased pressure to manage and not just deliver care. Institutions such as the National League of Nursing and Community College of Philadelphia are innovating with new training methods. They’ve developed simulation tools to prepare nurses for the dealing with this particular population.
The Challenge: Establishing Accountability
Leaders can’t just pay lip service to “training” anymore. A Studer Group survey of 17,000 health care leaders found a correlation between a high percentage of low performers and lower HCAHPs results.
To address the performance problem, leaders must implement more robust performance evaluation and hiring methods that emphasize excellence — and enforce excellence as a value through ongoing training and evaluation. With an expected nursing shortage on the horizon, HR will need a competitive strategic plan to attract and retain high performers. In the long term, giving clinicians and their managers the resources they need to keep improving is going to become a critical, ongoing aspect of tomorrow’s health care leadership.
3. Actively Engaging Boomers in Preventive Health Care
Marketing, education and customer service must cater more specifically to Boomers to ensure that the resources health care organizations are investing in preventive care and wellness actually lead to better outcomes. This is a customer service, HR and communications challenge.
The Challenge: Finding New Ways to Communicate
Health care organizations will need to focus on creating educational tools and customer service training initiatives that address Boomers’ specific needs at a time when resources are scarce. To do so, they need to agree on a strategy across multiple departments — and be able to identify gaps in customer service, staffing and communications that are alienating their patients. They’ll also need to embrace technology like social media to better engage and understand patient needs — something health care organizations have been reluctant to do. (Mayo Clinic’s Center For Social Media is a useful resource.)
Of course, these are only a few examples of the challenges facing health care today. How is your organization tackling complex issues like ACOs, wellness for Boomers and advanced clinical training?