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NWX-BPHCModerator: Matt Burke
5-24-12/1:00 pm CTConfirmation # 7818495
Page 1
NWX-BPHC
Moderator: Matt BurkeMay 24, 20121:00 pm CT
Coordinator: Welcome and thank you for standing by. At this time all participants will be in
a listen-only mode until the question-and-answer session. To ask a question at
that time, please press star 1. Today’s conference is being recorded. If you
have any objections, you may disconnect at this time. I would now like to turn
the call over to Matt Burke. Sir, you may begin.
Matt Burke: Great, thank you very much and welcome, everyone. Good afternoon and it
may still be morning for some of you dialing-in from the West Coast and
we’re very excited to have you with us today.
Today’s session is serving an aging population 65 and older in the health
centers and this is another in a series of monthly technical assistance
enrichment sessions presented by the Bureau of Primary Health Care to our
grantees out there in the field and this comes to you from the Office of
Training and Technical Assistance and Coordination which we like to call
OTTAC here.
My name is Matt Burke. I’m a family physician and I am a Senior Clinical
Advisor here in the Bureau specifically in the Office of Quality and Data
which manages the uniform data system and some of the medical home
initiatives here in the Bureau and it’s a great pleasure and honor to speak with
you on today’s call.
NWX-BPHCModerator: Matt Burke
5-24-12/1:00 pm CTConfirmation # 7818495
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We have a couple of great speakers lined-up for you and a particularly salient
topic given sort of the changing demographics of the United States population.
Aging is increasingly prevalent in today’s healthcare environment and the
population of Americans aged 65 and older is rapidly increasing.
It currently stands at about 13% of the U.S. population and by 2030 it’s
estimated that that may be as high as 20% which ranks in the tens of millions
in terms of Americans.
And as many of you may know, aging comes with a whole host of medical
and healthcare issues that are unique to that part of the life cycle and thinking
about how to best care for those persons and think about them within the
healthcare environment particularly given the underserved population that we
primarily see in the health centers is going to be the focus of today’s call
which is extremely, extremely valuable.
The purpose of today’s grant TTA enrichment call will provide you then with
a review of key demographic trends of the 65 and older population. We will
discuss key issues and services involving caring for the aging population and
furthermore provide examples from the field from several grantees who’ve
been met with success with this and our clinical leaders in this area.
We have three grantees speaking today in addition to a colleague of ours from
the Administration on Community Living. We really hope you find this call
informative and enlightening and we encourage participation.
We will have two speakers and then a question-and-answer section and then
our latter two groups of speakers followed by another question-and-answer
session which we hope will be very lively. If you have any concerns or need
NWX-BPHCModerator: Matt Burke
5-24-12/1:00 pm CTConfirmation # 7818495
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additional information, please go to bphc.hrsa.gov/technicalassistance - all
one word - /trainings - plural - to ask any additional questions.
So without further ado let’s move to our first presenter who is Bob Hornyak,
the Director of the Office of Performance and Evaluation inside the
Administration for Community Living which was formerly known as the
Administration on Aging.
All of our participants can follow along with today’s session by using the
slides on the BPHC technical assistance Website. Additionally you will find
today’s agenda and bios for each of the speakers posted on that same Website
and therefore, I would like to turn it over to Bob. Please take it away.
Bob Hornyak: Matt, thank you very much and good afternoon or good morning to everyone
joining us on this call today. I’m very, very excited about joining you all and
to tell you something about the Administration for Community Living as well
as some of the demographics of older Americans so next slide, please. Thank
you. Yes, that’s good, thank you.
So I did want to spend just a minute talking about the Administration for
Community Living. As we understand it, this is the first new operating
division within HHS in about 20 years so we’re still looking at the guidebook
on all those operations but it is a new agency that Secretary Kathleen Sebelius
announced on April 16th in 2012.
And this single agency brings together the Administration on Aging, the
Office on Disability and the Administration on Developmental Disabilities.
This is really being charged to develop policies and improve the supports and
services for older adults as well as people with disabilities. Next slide, please.
NWX-BPHCModerator: Matt Burke
5-24-12/1:00 pm CTConfirmation # 7818495
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And this slide is our newer organizational chart and again just want to
emphasize because we receive numerous questions about this. Please think
about the Administration for Community Living as the umbrella agency that is
really working with these other agencies that still exist.
The Administration on Aging as you can see on this organizational chart still
is a line of business if you will within ACL. The Administration on
Intellectual and Developmental Disabilities still exists. Both of those still have
their federal legislation and their leadership intact. For the Administration for
Community Living, Kathy Greenlee has a dual role.
She is still the Assistant Secretary for Aging because that is a Senate-
confirmed position but she is also the Administrator for the Administration for
Community Living. Henry Claypool is the Principal Deputy Assistant
Secretary for the Administration for Community Living and the Principal
Deputy Administrator for ACL.
We still have our regional office presence across the country. In the center of
that IA work-in is the Center for Disability and Aging Policy. We’re very
excited about this new opportunity to really enhance our ability to serve older
adults which we’ve been doing since 1965 but also expanding our reach into
the intellectual and developmental disabilities as well as physical disability
populations. Next slide, please.
So want to begin, we work very closely with the U.S. Census Bureau to
produce a profile of older Americans every year and as Matt indicated, the
older population certainly makes up about 40 million people. This is in 2010
and most of these statistics really come from the American Community
Survey or the Census Survey.
NWX-BPHCModerator: Matt Burke
5-24-12/1:00 pm CTConfirmation # 7818495
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That we’re going to see this increase of about 15% since 2000 and we know
that life expectancy due to great medical advances and other technology has
been increasing certainly for females and males, more for females as you can
see from this chart.
One of the avenues that we pay close attention to is what is often termed the
oldest old. That is the population of 85 years and above that we can see in
2010 is about five-and-a-half million individuals but we also know that the
population of 65-plus is going to increase rather rapidly.
By 2030 this population is expected to grow to over 19% of the U.S.
population with the 85 population projected to increase to 6.6 million or about
a 19% increase by 2020. Next slide, please.
When we look at the marital status on the older men, much more likely to be
married than older women primarily because older women outlast or have
greater longevity than men but about 40% of older women aged 65 and above
did not have spouses at that age.
The living arrangements, I’m going to tie these stats to some services later in
my presentation because it is important to look at the living arrangements that
about 47% - almost half of these older women aged 75 and above - live alone.
We also know that almost a half a million grandparents aged 65 and above
had the primary responsibility for their grandchildren who do live in them and
our national family caregiver support program helps support specifically some
of those grandparents who are raising their grandchildren. Next slide, please.
We also know that the income of these individuals has adjusted for inflation
headed by these people has fell somewhat from 2009 to 2010. We know that
NWX-BPHCModerator: Matt Burke
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males still have a higher income primarily due to some of their pension and
other income factors.
The main sources of income solely for this population have been Social
Security overwhelming, income from assets, private pensions which are
significantly changing as well as the other sources of income that you can see.
Next slide, please. In terms of poverty about 9% of the older population were
below the poverty level in 2010 and that really hasn’t changed in the last year.
Next slide, please and the minority population, you know, it’s up from 5.7
million in 2000 to about eight million in 2010 or about 20% of the elderly and
in this profile of older Americans in 2011, overwhelming it is a white
population followed by African-Americans, Hispanic origin, etcetera.
Now we’re going to see that I believe in the next slide change significantly as
we look into the future as we - thank you - with this future growth of minority
populations, we’re going to see significant growth most specifically in persons
of Hispanic origin.
So we know that this demographic is going to change and change fairly
rapidly from 2010 to 2030 and that was one of the avenues that we hope to
partner certainly with a number of different groups including the health
centers in preparing for this change. Next slide, please.
So I just want to say a little bit about the Administration on Aging and its
services since AoA still exists. We serve about 11 million seniors per year and
their caregivers through our state units on aging, the 629 area agencies and
256 tribal organizations and many, many volunteers and service providers.
NWX-BPHCModerator: Matt Burke
5-24-12/1:00 pm CTConfirmation # 7818495
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You can see the millions of meals that are provided each year and rides to
physicians’ offices, clinics, senior centers, the amount of personal care, 35
million hours of personal care provided to these seniors and the number of
caregivers who do assist their care recipients and the respite hours that are
critically needed for caregivers of older adults or of grandparents raising
grandchildren to allow them to provide that care longer. Next slide, please.
As we were talking about the statistics previously in terms of poverty and
other demographics, the Older Americans Act does serve a population of 60
and above. That’s why this is somewhat different from the other slides of 65
and above and we know there’s almost 58 million individuals in this country
aged 60 and above.
Our clientele represents about 11 million of those or about one in five older
adults. When we look at our services, while about 9% of the U.S. population
of elderly live in poverty.
Our clientele represents about 30% of those individuals who are in poverty
and when we look at the near-poor, certainly almost between 73 and 85%
depending on just which services meet that classification of near-poor being
defined as below 150% of poverty. Next slide, please.
And (unintelligible) vulnerable, as we indicated before about the population
who live alone primarily women, again when we look at our clientele between
55 and 69% of our clients live alone, again depending on types of services,
higher rate of diabetes than the U.S. population in general, higher rate of near-
poor, higher rate of minority receiving services and certainly a large rural
population - over a third of our in-home service clients - live in rural areas.
NWX-BPHCModerator: Matt Burke
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The next slide, please, so one of the issues I think we should always look at
and one of the areas that the aging network as we call it, the state units on
aging and our area agencies and ADRCs is to partner.
We look forward to partnering with health centers and to find the area agency
in your agency, the Eldercare locator at this location is an easy way to find
those individuals and the services and next slide, please.
We wanted to include some data resource links to the American Community
Survey demographic data at this site, agednet.org. We also work with the
Census Bureau to do a special tabulation on aging for that 60-plus population
and on a number of other special demographics so that we can do better
planning at the local community level as well as at the state level.
The rest of these resources are certainly available through the Web links and
next slide, please. This is my contact information. I look forward to having
other contacts with participants on today’s call and look forward to questions
and Matt at that point I’m going to turn it back to you.
Matt Burke: Bob, I can’t thank you enough. This is really fantastic and I hope folks are
taking away sort of the magnitude of this issue that these folks, these
Americans are going to occupy a very large slice of our population pie and I
think you did a really excellent job framing the issue and so thank you very
much, that was perfect.
I’d like to move now to our next presenter, Dr. Marty Lynch. He is the
Executive Director of Lifelong Medical Care, a health center in Berkeley,
California and as we’re staring down the pipe of 90-degree weather that’s
humid here in Washington this weekend, that sounds like a very lovely place
to be so without further ado, Marty, you are on.
NWX-BPHCModerator: Matt Burke
5-24-12/1:00 pm CTConfirmation # 7818495
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Marty Lynch: Thanks, Matt. Yes, it’s beautiful out here right now. It is today. Welcome to
everybody. I also want to comment before I start that congratulations to Bob
on the new Administration for Community Living. From our point of view it
makes so much sense to tie the issues of aging and disability together and
work on those together so congratulations, Bob.
Well, let me start by saying just a minute about Lifelong. The thing I want to
say to all of you is that we’re one of those health centers that actually started
with an elderly population. We were founded by the Gray Panthers who were
a senior advocacy group as the over-60 health center many years ago back in
the 1970s.
And over the years we’ve gone to serving all ages but we still have a special
place in our heart and in our mission to serving elderly and disabled as well so
that’s just a touch about us.
The twist just reviewing for the health center perspective that these numbers
that Bob talked about are big and are important but one thing we know about
health center numbers is there’s also a lot of folks right behind these elders in
our health centers as our own populations age.
So that that 45 to 64-year-old group is the biggest bubble in the health center
world so maybe, you know, many of us may be baby boomers and heading
that way but our populations of patients that we serve and the populations in
our communities have a big bubble there that’s going to be coming our way.
And then I would just reiterate that this over-65 population is going to double
and that over-85 population is probably going to grow even more and within
those populations I think probably everybody knows it but it’s worth saying
NWX-BPHCModerator: Matt Burke
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that most people prefer to stay in the community if at all possible and that
nursing homes are not an option that most people prefer to choose. Next slide,
please.
This is just a visual representation of the numbers and the growth of the 65-
plus population. Next slide, please, so I think the takeaways for us are that our
existing patient populations in our communities are aging and that in our
populations in health centers, we’re going to see more poverty.
Bob talked about the near-poor. The poverty level is at 9.3% of elderly are not
so high but if you look at the number of elders between 100% and 200% of
the poverty level, you get really big numbers because a lot of elders are living
on fixed incomes where Social Security might get you out of poverty but
doesn’t necessarily get you to any kind of a comfortable life.
Also more disability as we age and I think again would be common sense but
it’s a good reminder and as you get up into those 75-plus that we call the old-
old or the 85-plus that we call the oldest old, those disability numbers really
go up fast and health centers that are working with the population have to be
ready to deal with it. Okay, let’s move, next slide.
I also just want to give a nod to some of our special populations that we serve
in health centers. I know in the San Francisco Bay area, the homeless
population and remember most of us are healthcare for the homeless grantees
of one sort or another, we serve that population, that population on average is
going up as well.
And when you get a homeless population that’s moving up towards an
average age of 55, many of the homeless researchers would say that person
looks like a 70-year-old in the rest of the population because they have a lot of
NWX-BPHCModerator: Matt Burke
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road miles on them if you want to think of it that way; lot of stress in their life,
lot of health problems.
And I think the you know, you got to say these mental health, substance abuse
and housing issues are in fact important and then I would say on the disabled
side just to say that the independent living centers that maybe we’ve worked
with our communities, their population’s aging, the HIV and AIDS population
is aging as well. Next slide, please.
What we know about the health center population specifically if you look at
national UDS data, we’d say that 7% of our population are over 65 and that
varies by state of course. A state like California is only 5% but the hard
numbers have gone up close to 50% in the last 10 years so that today more
than a million elders are served by health centers and that number I mentioned
a minute ago about the bubble behind them is really moving on us.
So yes, we have a history as a movement of serving moms and kids in many
community health centers but that is going to be changing and then just
acknowledge there are some health centers and maybe they’re the ones on the
line today who really do a lot of work already with the elderly and for them
it’s just really an expanding population. Next slide.
So a little bit on differences. I always say that if you’re 65 years old and
healthy and I hope this is true because I’m not very far away that your needs
are similar to an adult population and that hopefully you can advocate for
yourself. You can get through our health center systems but of course most
people will have Medicare at 65 but that as the population ages further or is a
complex population, then you do have these functional disabilities, more
dementia and more comorbid chronic medical problems. Next slide, please.
NWX-BPHCModerator: Matt Burke
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I just listed for you in case you weren’t familiar with the AVL, the Activities
of Value Living. In the aging world, a lot of us use these to measure disability,
functional disability so these are basic things. Next slide, and then the
instrumental activities which of course also are got to get done if you’re going
to live successfully in the community. Next slide, please.
I think the note about some of those is for people who have those daily living
problems, they become just as important and probably more important in day-
to-day life than the medical care that we’re providing at our health centers so
that our medical care can’t really be effective unless we also deal with
disability and some of the psychosocial issues that the population is
experiencing.
And you know, quite frankly many health centers are not as familiar with the
ranging disability care as we might want to be and that includes even our type
of health center that’s specialized, we have a lot to learn so next slide.
The - I do want to mention briefly a quick story from one of our Gray Panther
founders on this kind of community psychosocial issue, it’s not really a
functional issue - but she always used to say to me Marty, do you think Mrs.
Jones is going to pay attention to her blood pressure meds if the gas and
electric company is turning off her utilities? You know, you’ve got to deal
with that stuff if you want the person to pay attention.
So then from there clearly primary medical care is important and provided by
physicians and mid-levels and all of us in health centers have worked hard on
best practice. Chronic disease care, that’s important for this population.
Medication management, because if people have complex problems, they’re
probably taking numerous meds. They may be going to specialists and
NWX-BPHCModerator: Matt Burke
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remember if they’re on Medicare, they probably have better access to
specialists than our uninsured population does.
So they’re getting medications from a variety of sources, very important to
take the time to review with our patients on a regular basis. Have them bring
them in in a shopping bag and then the other thing to say really is I think the
multidisciplinary team for the elderly population is just key.
Whether that’s in hallway consults between a social worker or a health
worker, you know, community health worker or whether it be in team
meetings where we talk about our most complex patients. Next slide, please,
so a little bit on that.
I think we count on a type of case management that both deals uses nurses to
deal with medical case management, education, triage, ordering durable
medical equipment, that sort of thing but also we count on the psychosocial
service side to setup a lot of the community services and deal with the family
issues and such and work very closely with our docs.
And then of course we add-on and think it’s important to add-on dental.
Podiatry particularly for this population because mobility is so important.
Mental health, lots of depression, people with severe mental illness aging into
this population and then of course if you can find a way to do it for people
who have cognitive problems neuro-psych testing.
Usually using a clinical psychologist, Ph.D. level clinical psychologist is
important. Next slide, please. We use internists often but I know we have a
family practitioner on the line who is part of our speaking panel and we have
used family practitioners.
NWX-BPHCModerator: Matt Burke
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We actually do have some folks who are sub-boarded in geriatrics but they are
hard to come by. More important is simply - what’s the right way to say it -
more important is that interest in working with older people. Whatever your
training is, if you have that interest and ability to work with people, you’ll be
okay.
Obviously longer visit times for the population, lots of that chronic disease
management we talked about and motivational interviewing to find out what
the patient actually wants to work on and then tying-in these functional and
maybe cognitive dementia issue that may interact with the medical problems.
And we know depression, isolation, substance abuse whether it be alcohol or
something harder are all issues. Next, please, so I mentioned a little bit about
this a second ago so I think I’m going to skip it.
But just to say you can’t, you know, we can’t skip that, social work,
psychosocial, whatever kind of person we use to do that part of the case
management, very important part of the team and obviously getting more
attention nowadays in the patient-centered medical home or health home
approach.
Next slide. We also think that you can do this job with trained community
health workers and that there’s a real place for peers in this process. Many of
you may use peers for things like diabetes groups or maybe centering
pregnancy type of services for younger populations.
But we think there’s work for peers in terms of supporting elders as well
whether it be on community living issues or whether it be on depression
support or whether it’d simply be on dealing with all these variety of medical
and disability problems.
NWX-BPHCModerator: Matt Burke
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The team meeting I would just say the focus that I think are the very complex
patients. You’re not going to talk about all your patients in a team meeting but
regularly review people that are in the hospital, how are they transitioning out,
who are the folks that really need a brainstorm amongst the different providers
on our team who would be the nurses the doctors, the social workers, that
range of staff.
How do you, you know, how do you deal with the most complex problems,
getting that person into their homes, keeping them into their home, dealing
with the dog with fleas, you know, dealing with the housing situation, dealing
with family members wanting one thing and the patient wanting another.
Those are all issues that can be dealt with in team for the folks who need it.
Next. I think the men should care once you get into that 80-85 population, you
know, some numbers say as much as half the population will have some type
of dementia.
Now that may be overstated but nonetheless it’s clear that this is a serious
issue and somehow your providers have to get training and be familiar and
ready to deal with patients and their family members in this area.
We also have found that just the fact in an elderly clientele of people being at
the end of their life having their own end-of-life issues is a big part of our
practice and we try to think okay, how do we interact with hospice better?
How do we do enough (palutive) care in our own settings and what does that
look like for our different populations so that’s, you know, that’s a key issue.
Advance directives, you know, maybe got called death panels and, you know,
in the latest health reform discussion but in fact people do what to have some
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control of what the end of their life is going to look like and want their wishes
to be noted so we have to help them.
Mental health just to mention the warm handoff, we know that from our other
populations and finally on this slide this dignity-driven decision-making is just
all about respect and involving people in their own care. That’s what that
one’s about. Next slide.
Okay, so that’s the respect where capital letters R-E-S-P-E-C-T, we need it.
Over the years what I’ve seen is the dear and honey doesn’t cut it and
obviously, you know, as our population ages expectations change cohort-to-
cohort but I think you can never go wrong with respect so that’s I think the
basic communication and respect are key issues here.
That’s also an issue in terms of how we do customer service from the front
desk on up so that bone issues for an 80-plus population if you’re asking
people to use an auto-attendant, that can be a problem. If you can get them a
voice on the other end of the phone and a person to deal with, it works better.
Next slide.
The people ask me always, do we need a separate clinic for the elderly, you
know, how does that work with older people being in with the kids and all
that? I think it really depends on your population and on the preferences of the
elderly.
But I do think there’s some physical issues and people by the way accomplish
this in all kinds of different ways, an afternoon clinic or a morning clinic or an
actual facility if they want to do something separate but certainly there’s a
slower pace.
NWX-BPHCModerator: Matt Burke
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There’s more space needed for folks to move around with walkers and
wheelchairs and that sort of thing and some, you know, some ADA disability
act system applications that can be helpful.
The, you know, accessibility is an important issue when dealing with this
population. I think certainly security concerns you all know. People want to
come in during the daylight in this population even more so. Next.
So just a nod to the fact that health centers across the country do many special
services outside of their clinics and this slide just gives a nod to what some of
those are and lots of different partnerships and lots of approaches. Next slide.
So I think we ought to mention business and policy issues because folks want
to know are we going to lose money if we take a Medicare-only population
and, you know, what’s that look like and we have to acknowledge that the
Medicare payment system for FQHCs looks different than Medicaid.
And that the rate is actually capped. The numbers are a little different for
urban and rural areas but in fact we know that Medicare does not pay our full
FQHC costs and in most states the Medicaid FQHC PPSs from a Perspective
Payment System typically does pay us at cost.
So if a person only has Medicare versus being a dual-eligible, it is possible
that you’ll be getting a little bit lower rate than your Medicare rate. On the
other hand it’s also possible that that’s a much better rate than you’re getting
for an uninsured or a commercial population.
Right now CMS is re-looking and looking at re-basing the rate and they’re
gathering data from our coding in health centers to help decide what that’s
going to be.
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NACHC the National Association is on top of that but we’ll see in the next
couple of years where that goes, just a reminder of how important it is even in
our system to code accurately what you’re doing because it is going to help set
that base. Next slide and of course there’s a time issue. You’re not going to hit
the old 4200 number that I know doesn’t really get used anymore.
You’re not going to hit that for an elderly population. I haven’t found out
what for full-time provider staff, I haven’t found out if their - over many years
working in this area - I’ve never had a hard number but I think for myself
3500 for full-time provider may be reasonable. The case management that’s so
required for this care can be hard to pay for.
Some states allow it as part of your Medicaid cost, others don’t. Some place
sometimes you’ll be paying for it yourself, sometimes you’ll be paying for it
with grant monies, maybe Older Americans Act monies but it’s not easy to
support and finally as your patients age, we think aggressive health plans will
compete for them so just keep that in mind. You want to keep them.
Next slide, so big market for us so and our communities are aging and
remember, rural markets and inner-city areas where we live and where we
work, they are definitely aging and we have those fixed-income elders and we
have complex problems that we’re a little more used to working with than
many of the private sector docs.
The health home I think that Medicare is pushing now becomes another
opportunity and health centers are also pushing becomes another way to
position us better for elder care. Let’s go to the next slide, please.
NWX-BPHCModerator: Matt Burke
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Also the - what’s the right way to think about it - I think there’s more talk and
more demos around the country that are really looking at case management
and disease management fees separate from a PPS structure so I think they
become another option.
I also think as we move more older people into managed care type of
arrangement, there’s more opportunities for health centers to negotiate shared
savings or bonuses that also fall outside of the standard FQHC PPS
reimbursement system so some financial opportunities as well. Next slide.
On the other hand, stuff we don’t know basically. We don’t really know how
many health center patients are dual-eligibles which now are getting a lot of
attention from CMS, the Center for Medicare and Medicaid Services in terms
of improving care and where we have I think tremendous opportunities to do a
good job that improves quality and improves patient experience and saves
money.
The ADL functional disability measures, again not such good data on what
our health center population looks like. Also we claim in the health center
world that we save money in the big picture and we get good quality
outcomes, I don’t know that we have the data that says that about this
population per se.
We’re going to need that data, not just on the family population as well so
we’re really talking about, you know, both paradigm shift in terms of where
our services and our populations are going but also a data need shift. Next,
please.
I think also some special things to mention. Again I sort of referred to it but
let’s mention PACE at least because some health centers choose to sponsor
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program of all-inclusive care for the elderly which is managed care program
for very, very disabled elders who would otherwise be nursing home-eligible.
Some health centers make that a part of their package of care and it’s complex
but some of the best integrated care around for very needy older folks. I
mentioned the Medicare advantage and duals program. I just think got to
concentrate, got to think about them in your area and pay attention to what’s
going on.
And just because you’re in a rural area doesn’t mean that this stuff may not be
coming to your community sometime in the next few years and then of course
the state-based demonstrations but let’s not say more about that. Next slide,
please so it is timely to think about health reform.
Yes, we’re all waiting with bated breath for what happens with the Supreme
Court decision and the next election in terms of the future of health reform but
again CMS is pushing innovative programs. They’re pushing duals plans.
They’re pushing other ways to bundle services and payment for the Medicare
population including the so-called accountable care organizations including
payment tied to discharge and readmission that pushes hospitals to think about
partnering better with community partners so some real possibilities there,
also the technology that helps care for people is growing. Next slide, please.
So a few recommendations. We just think it’s wise to plan for this population.
It may be a no-brainer but let’s say it and to use that patient-centered medical
home tool. We’re going to have these folks so, you know, let’s plan for it and
let’s do a great job in our community for this population.
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Case management is critical, got to find a way to pay for it but it’s critical.
Other services like adult day healthcare or some of these others we’ve
mentioned can be an important part and it may vary by your state and what the
opportunities are there. Next slide.
Bob being on the phone earlier was really helpful I think in terms of planning
to partnership possibilities. I think all those aging service providers out there
that we may or may not have partnered with in our community are sources of
referrals and sources of extra services for our folks.
We can’t do it all and we also don’t know everybody so those kinds of
partnerships I think are going to be important for us. I think the duals
population will drive how much you do that you have in your health center.
And will drive how much you do in terms of contracting either with a
Medicare special needs plan which is a type of Medicare HMO that
concentrates usually on the duals or with a state-level or CMS-sponsored
duals pilot but what I would say is demand a share of any savings you produce
if you contract with those kinds of entities.
Don’t just get paid on a fee-for-service basis or a primary care cap basis and
then, you know, I think the PACE program is a tremendous opportunity but
you got to be sophisticated. It take start-up costs. It’s not an easy program to
run so for some who have high volume might be appropriate. Next slide,
please.
So here is my contact information. I look forward to a few questions later on
and happy to contact or be responsive to any of you by e-mail as well. Matt,
back over to you.
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Matt Burke: Marty, that was fantastic. I loved it. I think you did a really nice job framing a
bunch of the issues in terms of what elder care needs might be, how you go
about thinking about structurally how to set some of that up in your own clinic
as well as thinking about sort of all-important payment policy and how that
might affect your ability to develop and sustain these programs.
So I think that was very, very well done. At this time we’d like to spend 10
minutes and take maybe three to five questions from folks on the line directed
towards Bob and Marty here so operator if you don’t mind opening the call up
to questions for people on the phone.
Coordinator: Thank you. To ask a question at this time, please press star 1. You will be
prompted to record your name. It is required to introduce your question. You
may withdraw your question by pressing star 2. Once again to ask a question,
please press star 1. One moment, please. One moment. We have a question
from Mr. (Jimenez). Your line is open.
(Ricardo Jimenez): Yes, this is Dr. (Ricardo Jimenez). I am the Medical Director of consumer
community health centers, one of the largest CHCs in the State of Washington
and I’m a family physician as well.
One of the things that I am intrigued by Marty’s presentation is I think it was
outside the slides but productivity-wise it seems we’re being always
constantly reminded of the 4200, the magic 4200 number which basically
technically impair us to develop a format, a structured visit for the elderly.
Are we doing something at the central level Marty if I may somebody is
giving feedback to HRSA that, you know, they at least need to balance that
expectation 4200 patients per one FTE family physician because that really
impairs the clinical side of a CHC to successfully lobby for the
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implementation of an elderly visit as much as we have a prenatal visit, an
AIDS visit, the chronic diabetic visit and so forth.
And so Marty I don’t know if you have any input in that regard.
Marty Lynch: Well I will tell you, thank you, it’s a really good question, I will tell you that
at the National Association of Community Health Centers has an elderly
subcommittee. We have talked about this issue over the years and I know
NACHC has talked to HRSA about it.
My understanding is that from a HRSA point of view that’s not an official
application of this standard that maybe Matt or somebody will speak to that
but I want to tell you that there’s still a risk with it though because I think it’s
in people’s mind as a general standard, Number 1.
And Number 2 what we’re seeing is states in Medicaid rate setting trying to
apply that kind of standard so and then discounting your rate if you’re not
reaching 4200 so clearly that’s a disincentive to serve the elderly, the disabled,
any complex population, the homeless, you know, that are going to take a lot
of time.
So it’s a really important question and I think we do need to do more work on
clear guidance not just from HRSA but probably from CMS because of course
the states really rely on CMS more than HRSA for guidance on how they run
their Medicaid programs. Matt, do you want to say anything about that?
Matt Burke: I do and that’s great. That’s actually very well answered Marty and Dr.
Jimenez it’s a really important question and I don’t want to punt to CMS
necessarily but in terms of payment policy, it’s a little bit more in their real
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house than ours. Marty is correct that that is not an official HRSA
requirement.
I don’t have the institutional knowledge but it is my understanding that many
years ago that may have been more formally codified but is no longer and
would not necessarily for an individual provider or a group of providers to fail
to reach that productivity threshold, there would be no punitive action taken to
service area competition applications or grant renewal funding or opportunity
to be part of other HRSA-based demonstrations.
I think it has persisted over the years as a loose HRSA guideline because folks
that meet that productivity threshold like Marty said will just naturally by
consequence fall into the favorable zone with respect to state payment reform
and payment policy.
But none of that is mediated through HRSA here so people can see fewer
visits and be totally fine from a HRSA compliance and a HRSA grant
perspective.
You do raise a really good question about it being, you know, as we continue
to build-out constructs like medical homes and patient care particularly as the
population ages and becomes more comorbid over time, longer visits are
going to be important for quality.
And that level of thinking is good and sound and I think national payment
policy is the thing that hasn’t caught up to it yet and that might be an area with
NACHC or with HRSA representation to help you contact CMS.
We might be able to lobby for that a little bit better but for right now, I think
the larger answer to your question would be to build-out the systems that are
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appropriate for your patients and get them paid-for within your state
regulatory environments and then we’ll move forward from there.
Coordinator: Once again to ask a question, press star 1. One moment. (Mehandalen), your
line is open.
(Mehandalen): Hi. I’m looking at Slide 31 and 38 Marty and really appreciate your
presentation. We’re in a colony in an area where the proportion of seniors is
21% already and so what I’m asking is how do we care for this population
when we’re getting 30% lower reimbursements in our costs?
And secondly how do the 75% of health centers that are receiving more than
the cap, how do they do that and is the rest of our 25% of health centers
eligible for that same enhanced reimbursement?
Marty Lynch: Well, thank you again. Really serious question. Let me clarify the slide first of
all and my numbers on my printed version - oh here it is, up on the screen, on
38 - so the 75% number just says it’s says it the other way. Basically 75% of
health centers have actual costs that are higher than the cap so they’re not
getting paid their costs just like you aren’t.
(Mehandalen): Okay.
Marty Lynch: Okay, so that’s a clarification on that. Then I would say a couple of things, a
couple of strategies. Number 1 is we believe in the health center population
there is a lot of opportunity for qualified people for Medicaid as dual-eligible
coverage as a supplemental coverage to Medicare.
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Depending on your state policy, many, many, many states then do wrap-
around Medicare payment up to the full amount, not all so I don’t know what
your state does but many, many, many states do.
So one strategy both for the patient because remember if the patient qualifies
for Medicaid, then the state pays their Part B - that’s B and in Boy - their
outpatient Medicare premium that otherwise would come out of their Social
Security check, that’s almost 100 bucks a month so it’s good for the patient
that way.
And it’s good for the health center in terms of getting that Medicaid rate so
you don’t have that gap. The only other things we’ve seen particularly is this
issue of if you’re in an area that does have managed care contracting to see if
there’s some shared savings, bonus payments for quality, case management
fees that can be negotiated.
Otherwise I don’t think there’s a magic answer to this. Maybe if somebody
else, you know, if somebody else later in the speakers is going to answer or ha
thoughts on it, I’d appreciate it but it is a challenge.
(Mehandalen): Thank you.
Matt Burke: All right. I’m getting prompted here from this end that for the interest of
everyone’s time we would like to move forward. Luckily contact information
for our speakers is available. If folks would like to reach out to them
afterwards, that would be great.
But I think we’re going to move forward with the presentation.
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It is sad but I think we have to say goodbye to Bob Hornyak at this time, our
colleague from the Administration on Community Living who has to sign-off
but as I just mentioned, his contact information is available and he can be
reached if folks have questions or follow-up afterwards so thanks so much for
your time, Bob.
Bob Hornyak: Thank you very much, Matt.
Matt Burke: Have a good afternoon. Okay. In moving on, we would now like the
perspectives from the field from two health center grantees. Our next
presenters are from Hudson River Health Care, a health center in New York
State’s Hudson River Valley. Allison Dubois is the Chief Operations Officer
and Elizabeth Phillips is the Director of Health Education Services at Hudson
River and at this point I would like to turn the conference over to them.
Allison Dubois: Great, thanks so much. This is Allison and we’re hopeful just to be able to
share some experiences that we’ve had in terms of serving the senior
population and talk about what the challenges have been and our lessons
learned so next slide.
Just a little bit of background information about Hudson River Health Care.
We are a federally-qualified community health center and we were founded in
the early ’70s by four founding mothers who really struggled with access
issues and the ability to find services that were cost-effective, culturally
appropriate and in the home community.
And so since that time we have really worked with additional communities in
the surrounding area to bring our services to those communities. Our mission
is to increase access to comprehensive primary and preventive healthcare and
to improve the health status of the community. Next slide.
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This is a map of our service area so if you’re familiar with New York. One of
the issues that we have at the health center is the geographic spread of our
community but this gives you an indication of the area that we’re serving.
Next slide, please.
As I mentioned, the health center does have 22 locations. We’re serving
80,000 patients with increasing numbers of under and uninsured as a part of
our service area. We have seen significant growth and has grown by 80%
since 2006. Next slide.
So I’m grateful to have the opportunity to talk about our WISE program,
Wellness Information for Senior Empowerment which is both the umbrella
name of our program as well as the specific program title that we share in the
community and it includes specifically a program that serves seniors in two
housing complexes but also welcomes community members and seniors from
the community to participate.
That program is hosted by a social worker and meets weekly, provides a
healthy snack, provides information about health issues, often times focusing
on chronic conditions which tends to be the focus area of the individual tour
member of the group.
And really while it includes, you know, significant and comprehensive health
education really addresses - focus as another component of it - looking at
social isolation and so the group provides us an opportunity to engage with
seniors, to have them spend some time with a social worker and with their
peers and then also can be used as a setting for group visits.
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So that has been a really great opportunity for us to really maximize the group
dynamic as well as ensuring that we’re getting folks in for preventive health
services as well. Next slide, please.
So some of the challenges of that model in terms of working with the group is
the diversity of the group and so there are individuals who are both, you
know, anywhere from 65 to 85. We have a number of different cultures. We
have some who have English as a second language, both men and women and
so it’s often challenging to find activities that are really appropriate and
engaging for a group that is as diverse as that.
And, you know, there’s some real practical challenges in terms of
demonstrating healthy food choices on limited and fixed budgets and doing
that while you’re still addressing, you know, some of the disabilities and
issues around teeth and chewing.
So some of those things have been challenging as well physical limitations
which have limited some of the other activities outside of the public housing
and senior housing settings where we have often wanted to do activities. Next
slide.
So some of the approaches that we’ve had in terms of looking at overcoming
those challenges is to really take the time and talk with the participants about
their interests and their concerns so that we can develop programming that’s
responsive.
We are, you know, certainly trying to focus activities that use a little bit less
fine motor skills. While we do have a diverse age group, the majority of the
participants do tend to be I think as Marty defined them the old-old, not the
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oldest-old but and so, you know, really just trying to be responsive to those
needs and to work within the diversity. Next slide.
That program has dovetailed really nicely with a program that we call HUGS
which is Health Unites Generations and that’s an inter-generational program
that links a youth from the community to the seniors who are in the program
and other seniors as well and again as a way that we have looked to address
the social isolation of residents and has provided just a really rich experience
for both generations to share their experiences, to share their preconceived
notions, to do some activities and programming together.
You know, the youth have received a small stipend which has been focused on
helping to promote positive youth development and honestly to be frank,
that’s the way that we’ve funded some of this program is to focus on the youth
enhancements of it and get some grant dollars to do that.
But at the same time tap-in to the senior population which, you know, is really
was in need of some additional programming. Next slide. Of course, this
presents the challenge of dealing with even greater diversity so this group
setting brings that challenge, addressing group stereotypes.
This program is housed in Peekskill which is more of an urban center and so
there’s a lot of stereotypes and preconceived notions about young people and
safety concerns and whether that was an issue for seniors, that the young
people would be in the building and so we had to work through a lot of that in
order to really get the full benefit of the program. Next slide.
And I think I really talked about this and I think one of the most exciting
things is to see some of the joint programming that has come forward in terms
of looking at cultural celebrations and joint journaling projects that the seniors
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and the youth have done together to really be wonderful examples of working
through some of the stereotypes and finding warm relationships between them
on the other side which has been really wonderful. Next slide.
I’m going to introduce Liz Phillips who is our Director of Health Education is
going to talk about another specific program, the CDSMP program which has
been really valuable for us as well as an organization.
Elizabeth Phillips: Yes, thank you and I am excited to share about our entrée into the Chronic
Disease Self-Management Program. In essence it’s an evidence-based
program that was developed by Stanford University.
In essence it’s a workshop that’s given two-and-a-half hours for once a week
for six weeks and it’s conducted in community setting such as senior centers,
churches, libraries, very portable program and it’s really designed for adults
ages 18 and up.
However, we’re focusing on working with our older adult population as well
as the general public and the principles of the program focus on self-
management and what’s rather unique is that this is made available to any
person with a chronic condition or their caregiver or their significant other.
So at Hudson River Health Care we simply refer to this as the healthy choices
program. Next slide, so in terms of offering this program, we actually do this
in partnership with our local healthy aging organizations such as our
Department of Senior Services and what our approach has been to train our
staff.
We really wanted to have a rather, you know, interdisciplinary group of staff
involved in this first phase and as you can see, we’re looking at both our
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registered dietitians. We have clinical assistants, we have social workers, case
managers, and health educators that have been a part of the training.
They basically serve as peer leaders. The program is really designed to be led
by the health leaders. Ideally they are either a person who has a chronic
disease themselves or they themselves are a caregiver, some of them with a
chronic condition. Next slide, please.
So in terms of our program startup, we began with a rather successful startup.
We were able to use some funding from one of our HIV capacity grants that
actually allowed us to obtain a license which is really required for any
organization that’s looking to be authorized to offer the CDSMP program.
And when we first began our, you know, our initiation into the program, just
in the last six to seven months staff were able to deliver seven workshops
again in various locations. We reached a total of about 80 participants, the
majority being adults who are ages 55 and up and of which 75% actually
attended at least four sessions or more.
Kind of looking ahead, our organizational goal is to be able to deliver at least
two to three workshops per year and for us because we have a wide network
of about - we are located in about 10 counties and 23 health centers - we’re
really looking to be a little bit more strategic in terms of how we offer this
program to our communities where we have a presence as well as our health
center patients. Next slide, please.
So as I mentioned, you know, there’s certainly some investment in terms of
starting-up with the program aside from the training and the licensing but it
also gave supervisors a really great opportunity to look at the collaborations
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that we have, those existing relationships with other healthy aging providers
and other community-based organizations. Next.
So while we really enjoyed a great, you know, startup, we also recognized that
there have been, you know, some challenges and one of the things that we
have to look to is how we can build our cadre of peer leaders because it
certainly has - there’s a time commitment - and in addition to staff we would
like to be able to involve community health workers as well as AmeriCorps
members
So that’s an ongoing effort that we need to look at in terms of developing our
peer leaders. The program itself because it is new it’s a new program for us
although it’s been around the country and in the state for a couple of years, we
do need to look at marketing.
We need to make sure that people are aware that this is something that’s being
made available and in terms of locations, as you can imagine we’re looking at
space whether again it’s through house of worship or senior center so we need
to again reach out to those partners for them to be able to consider being a
host site and so those are some of the things that we have to continue to look
at. Next slide.
So I think I would also just, you know, highlight the fact that, you know, one
of our strategies in terms of reaching out to the community is by hosting what
we call an open house and that really allows us to share how the health choice
program works.
It allows us to introduce it to staff as well as residents and also to other
providers and one of the things that we’ve realized for example in working
with the senior nutrition centers, they have a very full schedule.
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So quite often we need to be flexible to try to, you know, work within their
existing calendars but nonetheless they really received the program because
it’s considered like an enrichment in terms of health and wellness.
You know, the program itself is very different in that it complements any
health education program that may be existing at your health center site or
within your community but with the CDSMP program we really focus on the
process.
The participants are able to experience such techniques as problem solving,
how to deal with fatigue and pain. They also are taught in terms of how they
can, you know, look at what we call action plans so they can figure out the
things that they want to do.
So with all of that, you know, we’re recognizing that this program in itself
really supports the health center mission and it’s turned out to be quite an
asset both for our staff professionally and as well for how we’re able to
augment our relationship with other healthy aging providers in the community
so with that I think I would like to just turn it back over to Ally.
Allison Dubois: Great, and I think, you know, one of the things that we are highlighting here in
this conversation is the care management and case management and support
services that wrap around the primary care services that we offer.
We do have a gerontologist on our staff in one of our locations and have in a
number of our health centers up to 11% of our patients who fall into this
category and so the ability to utilize this type of programming to address some
of the ongoing social isolation and care management and chronic disease
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management issues that we’ve been talking about are a priority for the
population.
One of the things that I, you know, we’re just particularly proud of our some
of the warm and fuzzy moments which for example would be the senior prom
which is the culmination of our intergenerational program and turns out to be
a really wonderful community event.
The mayor comes and a number of elected officials and has the young people
and our seniors. I think this might be the Electric Slide that we’re seeing on
the slides right now so, you know, there’s just some really wonderful
opportunities to creatively some of that additional support that our senior
population needs.
So we again thank you for inviting us and we’re happy to answer any other
questions about our programming as we move forward in the call. Thanks so
much.
Matt Burke: Allison and Elizabeth, that’s really exciting stuff and thank you for that great
presentation. I think it shows a lot of creative muscle in terms of developing
programs and finding ways to get them financed and they’re extremely
patient-centric and appear to have very good community purchase also, kind
of that perfect mix of all of those elements that create sustainability and actual
change agency.
So it’s very, very exciting for us to hear on this end and I’m sure everyone is
really pleased to hear this also so thanks so much for your time. We’ll hold
questions until one more session and then you folks in Jackson-Hinds will
take a joint Q&A session right at the end of the call but thank you very much.
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Our next set of presenters as I just alluded to is from Jackson-Hinds
Comprehensive Health Center in Jackson, Mississippi. We have three for this
last section, Dr. Lynda Jackson-Assad, Dr. Ayanna Jenkins and Dr. Bob
Hutchins. Dr. Jackson-Assad is the Medical Director for Jackson-Hinds.
Dr. Ayanna Jenkins is the Clinical Director of the Copiah clinical site and Dr.
Bob Hutchins is a physician in adult medicine department in the Jackson-
Hinds Comprehensive Health Center so after that, I would like to just turn it
over to Dr. Jackson-Assad.
Lynda Jackson-Assad: Yes, thank you. We here at Jackson-Hinds Comprehensive Health
Center are honored to be a part of this information series. On this slide you’ll
see - next slide, please - this is Jackson-Hinds Comprehensive Health Center
and we are under the direction of Dr. Jasmin Chapman, our Chief Executive
Officer. She has been at the community health center for 32 years and our
CEO for 14 years. Next slide, please.
Next slide, please. Some basic information about Jackson-Hinds. Jackson-
Hinds Comprehensive Health Center was established in 1970 and we are the
largest provider of primary healthcare services to the uninsured and
underinsured in Central Mississippi and we are one of the oldest federally-
qualified health centers in the nation.
We are a joint commission-accredited institution. Next slide, please. Jackson-
Hinds Comprehensive Health Center is comprehensive in name and in scope.
Here at Jackson-Hinds we have adult medicine, OB-GYN, optometry.
We are one of two community health centers in this state that has optometric
services on-site. We have dental, pharmacy, pediatrics, WIC and nutrition and
nutrition is important in the elderly population.
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We have diagnostic lab and X-ray. We have EPS CT or Medicaid screening,
transportation which is vitally important to all aspects of community health
center, social services and school-based clinics. We also operate an elderly
housing complex known as Alex Waites. Next slide, please.
Jackson-Hinds Comprehensive Health Center operates 15 clinics and we serve
three counties, Hinds, Warren and Copiah Counties and in that vein we have
freestanding full-based clinics.
We have 17 additional schools that we serve via our two mobile units and we
have dental services are provided via mobile units in our Jackson public
school district which is the largest school district in the state and our
Hazelhurst and Hinds County schools. Next slide, please. I will now turn it
over to Dr. Ayanna Jenkins.
Ayanna Jenkins: Thank you, Dr. Assad. Now we’re actually going to address several
healthcare-related challenges that affect the geriatric population and how
providers and staff here at Jackson-Hinds work together to address these
issues. We’re also going to discuss how important it is to integrate ancillary
enabling services when caring for geriatric patients. Next slide, please.
As you can see here, mostly females comprise the largest population in those
patients over the age of 65 here at Jackson-Hinds. Next slide, please. In our
elderly population, patients are overwhelmingly treated mostly for
hypertension and diabetes. Next slide.
Again this kind of reiterates the fact that we are very good at reaching out to
our female patients but we’ll discuss later on in our presentation how we’re
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going to work to reach out to our male elderly population well. Next slide,
please.
Now we’re going to get pretty much into the meat of our presentation this
evening. We’re going to discuss nine challenges that are certainly not limited
to the geriatric population but they definitely impact how adequately
healthcare is delivered to elderly patients. I’m going to pass the presentation
over to Dr. Bob Hutchins now.
Bob Hutchins: Thank you. To discuss those challenges versus nine as we have noted,
transportation is of course vital to getting the patient to medical care. Many of
our elderly patients have very limited financial resources. They cannot drive
themselves or a family member cannot drive them.
Our solution here at Jackson-Hinds has been to provide a transportation - next
slide, please - provide transportation via van. Patients are contacted the
evening prior to their appointment and the morning of their appointment to
ensure they have adequate time to prepare for pickup and the appointment.
Next slide, please.
Chart Number 2 is the visit itself. Clearly visits for a geriatric patient can be
challenging and they require more time particularly if they are using
wheelchairs and walkers and they may need assistance with registration.
A solution has been to start the preparation for a geriatric appointment by
providing morning appointments, of allowing extended time if deemed
necessary by the provider and our scheduling staff being available to assist
geriatric patients with registration and completion of forms. Next slide, please.
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This up, okay. The third challenge we devised is the medical history and in
elderly patients, obtaining a good medical history self can present a challenge
because of cognitive function and other problems with understanding courses
in giving history.
A solution had been to encourage family members to accompany the patient
or a caregiver who’s knowledgeable about their health issues and concerns or
to provide a written note with those concerns and new problems so they can
be addressed. Next slide, please.
The medical examination itself (provides) a challenge in geriatric patients.
The medical assistants here began the examination process by collecting the
needed data, reviewing health maintenance information, instructing patients
and family members concerning health maintenance issues, i.e., flu,
pneumonia, smoking documentation and need for age and disease-specific
referrals exclusive of podiatry, optometry and dental.
Our solution has been that the medical assistants are assigned to a specific
provider. They get to know those clients that the physician serves. This
promotes familiarity and trust. They may express to the medical assistant
some medical concerns that they may have residents in expressing to the
provider, just open up another avenue of communication with our patients.
That may mean the assistants or the medical assistant, a nurse in transferring
patients from and to and from the exam tables. Nurses provide a role in going
over the medication to reinforce compliance and comprehension of
instructions.
Sometimes these instructions need to be reinforced by being repeated several
times and the team members providing that in a different manner also helps to
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ensure compliance. The geriatric ADLs are noted in the chart in the electronic
health records and they are addressed by the provider. Next slide, please.
Reconciliation on the medication list.
As noted in the geriatric population, this can be a challenge in task because of
comprehension, hearing problems, etcetera. Our solution has been to have
asked of the patient to bring all their medications to each visit. As you know,
geriatric patients sometimes can hoard many medications and we review the
medication list with the actual medications in the patient’s possession.
The discarded - discontinued medications - are discarded. Sometimes patients
refuse to discard their medications and they are taken to prevent inappropriate
use. This ensures compliance and understanding of medications. Patients
provided with the new medication list of any new prescribed medications and
a clinical summary. Next.
Pharmacy can present a challenge as we alluded to earlier in elderly patients
not have transportation or requiring finances that are needed for other things
to go pick the medicine up. They may have no third-party coverage for
medications.
Here at Jackson-Hinds we do participate in the 340B pharmacy program. This
has allowed us to eliminate transportation concerns and costs to the elderly
patient in obtaining medication. It provides the provider with readily-available
informational compliance, availability and coverage on this description of
various prescription plans. Next, please.
Social services. Social services under any medical agreement or environment
is essential but even more so an asset in providing services to the elderly
population.
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At Jackson-Hinds our social workers perform eligibility assessments, assist
patients that cannot afford their medications to obtain them via a prescription
assistance program and elder ancillary prescription programs. Social worker
also provides home visits when a provider deems that there are extenuating
circumstances of concerns. Next. Next slide, please.
Home evaluations are essential in the elderly. Living quarters for the geriatrics
(and some proposed), health and safety risks. These inspections are necessary
to identify the improper lighting, positioning of furniture and rugs that
contribute to injuries.
Home evaluations have a unit life by us as a center utilizing home health
agencies as well as social workers to help identify those risks that are present
in the home. Also involving other agencies that may provide safety
equipment, i.e., bathtubs and shower rails and (style seats). Next, please. Next
slide.
Lastly one of the areas of concern in dealing with the elderly has been durable
medical equipment as requires. While they provide much needed supplies and
equipment and services to our elderly, many of our patients are bombarded
with cold call solicitations for durable medical equipment and DME
equipment.
This results in multiple (forms) being sent to the provider and duplication and
of services with potential for fraud. Our solution has been to ask patients to
bring the forms in to ensure that this is one, a legitimate request and that the
services were initiated or requested by the patient and the company itself is
legit.
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We also encourage them to use well-known national and local vendors or
request referrals from friends and family of vendors with whom they have had
satisfactory services. Now I will turn to the presentation to Dr. Ayanna
Jenkins.
Ayanna Jenkins: Thank you, Dr. Hutchins. Just briefly I want to discuss two issues that we at
Jackson-Hinds readily experience when dealing with Medicare and of course
our elderly patients - I’m sorry, next slide, please, thank you - and of course
our elderly patients primarily utilize Medicare health services.
Basically preferred medication panels change quite frequently and this affects
whether or not the patient can afford their medication. It can confuse the
elderly patient regarding what their appropriate regimen is and it can affect the
improvement or decline of specific medical conditions.
We have begun working with our in-house pharmacy, local pharmacies and
caregivers to ensure that medications have been appropriately reconciled with
the patients and their caregiver.
Also we have issues often times dealing with billing for Medicare but one way
we seek to address this issue is that we will have our medical records and
billing staff to verify the correct Medicare plan that covers the patient prior to
the visit to ensure that our patients are not over or undercharged and now I’ll
turn the presentation over or back to Dr. Lynda Jackson-Assad.
Lynda Jackson-Assad: Next slide, please. Thank you. Here you see our elderly housing
complex which is called Alexander Waites. Next slide, please. Next slide.
Jackson-Hinds under its corporate umbrella operates an elderly housing and
handicapped housing complex and a Jackson-Hinds employee acts as a
facilitator for the residents.
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In 1986 with a grant from HUD we established this complex. More than 70%
of the tenants are 65 years of age or older and approximately 80% of the
tenants use Jackson-Hinds as their primary healthcare provider. Next slide,
please.
We have actually not only do we work with these tenants, we have established
trust with them and that is why they come to us. When necessary the manager
from the elderly housing complex, she keeps the primary care providers
abreast of the resident’s medical condition and we make sure all of this
information is HIPAA-compliant.
The residents are assisted in receiving enabling services such as transportation
to the physician offices as well as other activities in the community. Again the
biggest thing when you operate an elderly housing complex is that you must
have trust.
We also work with different types of community organizations such as Meals
on Wheels to assist the elderly. As we know, they must have proper nutrition
in order to maintain their health.
Other activities that Jackson-Hinds manager helps them with would be
educational presentations within the elderly housing complex and many of our
elderly are very, very religious and we also have Bible studies done on site.
Very, very important is that the manager also inspects the apartments for any
hazards and following HUD guidelines and these things are done regularly.
Now Dr. Jenkins and Dr. Hutchins will also discussed lessons learned and tips
for other health centers.
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Ayanna Jenkins: Thank you, Dr. Assad. This slide briefly summarizes the challenges that we
address in our presentation but they only represent a portion of concerns that
influence adequate healthcare of the elderly population.
It is crucial to focus on those ancillary services as well as quality of medical
care to ensure that the elderly patient as a whole receives the adequate
assistance that they deserve.
Matt Burke: Pardon me, this is Matt. I need to step in and I’m so sorry. I know we are on
your very last slide but I see that we are at time and I wanted to give the
audience a chance to ask one or two questions of the folks at Jackson-Hinds or
Hudson River Health Care because I think that that’s really important and this
is very valuable also but hopefully because all of our contacts are up online,
we can communicate offline with each other as we see fit.
So my deep apologies for that. It was a great presentation, really, really
innovative work going on in Mississippi which as you mentioned has the
oldest health center in the United States dating back to 1964 so the
institutional knowledge and the work that you guys do is fantastic.
So with that, operator, if you could please open us up for just a couple of
questions and then we’ll wish everyone a happy Memorial Day and move on
with our afternoon I think.
Coordinator: Thank you. To ask a question, please press star 1. Be sure to record your name
so I may introduce your question. You may press star 2 to withdraw your
question. Once again to ask a question, press star 1. One moment, please. And
at this time there are no questions.
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Matt Burke: Well in that case I think for the sake of time please I would encourage folks
still on the phone to e-mail the presenters if they have any questions. I would
like to on behalf of HRSA and the team here personally thank all of our
presenters today who did a fantastic job.
I know Marty and Allison and Elizabeth are probably still on the line but also
Ayanna, Lynda and Bob very much thank you as well as our first Bob who
has now left us for other appointments this afternoon.
Please e-mail Stephanie Crist for any logistical considerations. That’s S-C-R-
I-S-T @hrsa.gov and I wish everyone a happy Memorial Day. We shall be in
touch.
Man: Thank you.
Woman: Thank you.
Man: Thank you all.
Woman: Bye bye.
Coordinator: Thank you for participating in today’s conference. You may disconnect at this
time.
END