Mar 4, 2024
In this podcast, Dr. Nick Schneeman, a geriatrican and the Chief Medical Officer for LifeSpark, brings his passion and expertise to discuss the state of care in geriatrics, along with how current delivery in care and payment models effect the geriatric population.
Disclosure note: Dr. Nick Schneeman , speaker for this educational event, has no relevant financial relationship(s) with ineligible companies to disclose.
Enjoy the podcast.
Objectives:
Upon completion of this podcast,
participants should be able to:
This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.
CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org.
Click the link below, to complete the activity's evaluation.
(**If you are listening to
the podcasts through iTunes on your laptop or desktop, it is not
possible to link directly with the CME Evaluation for unclear
reasons. We are trying to remedy this. You can, however, link to
the survey through the Podcasts app on your Apple and other smart
devices, as well as through Spotify, Stitcher and other podcast
directory apps and on your computer browser at these websites. We
apologize for the inconvenience.)
DISCLOSURE ANNOUNCEMENT
The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview. Any re-reproduction of any of the materials presented would be infringement of copyright laws.
It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.
None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. All of the relevant financial relationships for the individuals listed above have been mitigated.
Thank-you for listening to the podcast.
SHOW NOTES:
*See the attachment for additional
information.
PODCAST OVERVIEW
- Geriatric
care delivery and quality has not evolved significiantly.
- Pockets of excellence exist in academic centers.
- Social support systems is integral, but lacking in many parts of
the country.
- Fee for service (FFS) system is not a sustainable model per Dr.
Schneeman for complex senior patients.
- Training and exposure to the 'business platforms' in medicine is
lacking with providers
- FFS = paying for a specific service, procedure, treatment,
etc.
Value Based Care
(VBC)
- Value based care = outcomes/cost
- Clinical outcomes
- Experience outcomes of patient/family
and caregiving team
- How is VBC measured?
- Medical loss ratio (cost
containment)
- How does VBC work?
- Organization contracts with payor
- VBC organization takes on risk
- Money savings opportunity
- Half of seniors in USA are already in a VBC model
- Medicare (CMS)
- ACO (group of doctors, health care
organization, etc.)
- Medicare advantage (CMS product that
insurance companies contract with federal government)
- Cost Product (Medicare advantage product)
- Introduced in MN with assumption that
this state will do such a good job with cost containment, but this
wasn't how it worked out.
- For-profits don't participate in
Medicare advantage products which keep the non-profits more
accountable, although there are also disadvantages with for-profit
programs.
- How does the care delivery work in VBC organizations (Nick's
viewpoint)?
- Step 1: Journey from simple problems
into complexity
- Step 2: What is the current reality
and quality of life? (When people hear you restating their
story, trust goes up immensily.)
- Step 3: What are you hoping for?
(patient, family, etc.)
- Step 4: Acute care planning
- Step 5: Chronic care planning
- Outcomes: POLST (physician
orders for life-sustaining treatment) form that is
comprehensive;
Chronic care plans that
are clear and purposeful and match goals of care
- Well done POLST forms require intential discussion with patient
and advocates who have decision making capacity and understanding
of the patient's reality and values
Palliative Care
-
How it's integrated and its controversy
- All practitioners should be able to make palliative decisions
with and for their patients who they know intimately
- Palliative care as a specialty exists largely due to a FFS
model
- Often this is a clinican the patient has never met before and is
a one time consult
- Private equity had created palliative care 'cold call' business
models in recent years
Value Based
Care (VBC) - continued
- How does a
practitioner go about doing this?
- Make sure the organization you join actually values the primacy
of primary care
- Clinicians need TIME with their complex patients and to be paid
for this time
- FFS can work well for simple problems
- Who does this well? Small pockets, mostly senior care (i.e.
clinic-based, homebased healthcare etc.)
- Nurse, APP, physician - are assigned to each patient and continue
to follow their care, avoid overprescribing, inappropriate abx
- Private equity and Big insurance is getting into the game, but
their approaches tend to be siloed and perhaps less humanistic
- Recruiting quality providers to this care delivery model is
imperative
- Improved patient outcomes and costs exisst (i.e. geriatric
assessment before cancer care)
- Value Based Care really has to be an "all in" experience for a
clinic or organization for it to
work
Training
-
Training typically happens in house, as opposed to a training
program or course
- Subspecialists will still be very much part of the care team,
although decision making about proceeding with advanced therapies
will be oriented around the VBC medical home team
- Pharmacy is a valuable team member as well, especially if part of
the "goals of care" as opposed to merely looking up medications
- Challenge: SNFs and long term care facilities often have
significant staff turnover, care quality issues, and these can lead
to unnecessary care, ED visits and
hospitalizations
Evidence Based Moment
(EBM)
Resources
Magill MK. Time to Do the Right Thing:
End Fee-for-Service for Primary Care. Ann Fam Med. 2016
Sep;14(5):400-1. doi: 10.1370/afm.1977. PMID: 27621155; PMCID:
PMC5394371.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394371/pdf/0140400.pdf
Basu S, Phillips RS, Song Z, Landon BE, Bitton
A. Effects of New Funding Models for Patient-Centered Medical Homes
on Primary Care Practice Finances and Services: Results of a
Microsimulation Model. Ann Fam Med. 2016 Sep;14(5):404-14. doi:
10.1370/afm.1960. PMID: 27621156; PMCID: PMC5394379.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.annfammed.org/content/annalsfm/14/5/404.full.pdf
Thanks to Dr. Nick Schneeman for his expert knowledge and
contribution to this podcast.