Skip to main content
SpringerLink
Log in

Targeting Interventions and Populations

  • Chapter
  • First Online:
Book cover Healthcare Changes and the Affordable Care Act

  • 892 Accesses

Abstract

The delivery of health care is undergoing dramatic changes. Important drivers for these changes include the increasing complexity of modern medicine, advancements in health information technology, and the shift in the delivery of care from the hospital to other care settings. As a result, physicians are now more specialized in the services that they provide and are more likely to focus their efforts either in a hospital, outpatient, or long-term care setting. At the same time, an increasing number of eligible older adults and an escalating average cost per beneficiary will make Medicare financially unsustainable. State Medicaid programs are also undergoing rapid changes. Many face potential increases in their financial obligations under the Patient Protection and Affordability Care Act (ACA) and an increasing population of indigent older adults in need of long-term care services. Complex geriatric care is needed to address these healthcare system changes. We will describe the most prevalent and important care models for complex patients. Additionally we will detail efforts to target these interventions to appropriate populations. Finally we will review what is currently known about the quality metrics and outcome measures that have been applied to these models.

Disclosure

Drs. Golden and Wan received support from the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number U24MD006954. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Golden AG, Mintzer MJ, Silverman MA. Uncovering a “new” clinical niche for the geriatrician. Ann Long-Term Care Clin Care Aging. 2013;21(6):21–2.

    Google Scholar 

  2. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118(3):219–23.

    Article  PubMed  CAS  Google Scholar 

  3. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization associated disability: “she was probably able to ambulate, but I’m not sure”. JAMA. 2011;306(16):1782–93.

    Article  PubMed  CAS  Google Scholar 

  4. Wan TTH, Breen JM, Zhang NJ, Unruh L. Improving the quality of care in nursing homes. Baltimore: Johns Hopkins University Press; 2010.

    Google Scholar 

  5. Kane RL, Ouslander JG, Abrass IB, Resnick B. The geriatric patient: demography, epidemiology, and health services utilization. In: Essentials of clinical geriatrics. 7th ed. New York: McGraw Hill; 2013.

    Google Scholar 

  6. Cigolle CT, Langa KM, Kabeto MV, Tian Z, Blaum CS. Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med. 2007;147(3):156–64.

    Article  PubMed  Google Scholar 

  7. Dobson A, DaVanzo JE, Heath S, Shimer M, Berger G, Pick A, et al. Medicare payment bundling: insights from claims data and policy implications. American Hospital Association and Association of American Medical Colleges. 2012. http://www.aha.org/content/12/ahaaamcbundlingreport.pdf

  8. Gillick MR. When frail elderly adults get sick: alternatives to hospitalization. Ann Intern Med. 2014;160(3):201–2.

    Article  PubMed  Google Scholar 

  9. Congressional Budget Office. Dual-eligible beneficiaries of Medicare and Medicaid: characteristics, health care spending and evolving policies [Internet]. 2013. http://www.cbo.gov/sites/default/files/cbofiles/attachments/44308_DualEligibles.pdf. [Cited January 18, 2014].

  10. Lyons B, Watts MO. Health reform opportunities: improving policy for dual eligible [Internet]. Washington, DC: Kaiser Family Foundation; 2009. http://www.kff.org/medicaid/upload/7957.pdf

  11. Wallace E, Hinchey T, Dimitrov BD, Bennett K, Fahey T, Smith SM. A systematic review of the probability of repeated admission score in community-dwelling adults. J Am Geriatr Soc. 2013;61(3):357–64.

    Article  PubMed  Google Scholar 

  12. Herr M, Ankri J. A critical review of the use of telephone tests to identify cognitive impairment in epidemiology and clinical research. J Telemed Telecare. 2013;19(1):45–54.

    Article  PubMed  Google Scholar 

  13. Wang L, Porter B, Maynard C, Evans G, Bryson C, Sun H, Gupta I, Lowy E, McDonell M, Frisbee K, Nielson C, Kirland F, Fihn SD. Predicting risk of hospitalization or death among patients receiving primary car in the Veterans Health Administration. Med Care. 2013;51(4):368–73.

    Article  PubMed  Google Scholar 

  14. Albada M, Cha SS, Takahashi PY. The elders risk assessment index, an electronic administrative database-derived frailty index, can identify risk of hip fracture in a cohort of community-dwelling adults. Mayo Clin Proc. 2012;87(7):652–8.

    Article  Google Scholar 

  15. Higgins S, Chawla R, Colombo C, Snyder R, Nigam S. Medical homes and cost and utilization among high-risk patients. Am J Manag Care. 2014;20(3):e61–71.

    PubMed  Google Scholar 

  16. Edmans JA, Gladman JRF, Havard D. Umbrella review of tools to assess risk of poor outcome in older people attending acute medical units. Medical crises in older people discussion paper series. Issue 11 2012. http://www.nottingham.ac.uk/mcop/documents/papers/issue11-mcop-issn2044-4230.pdf

  17. Bixby MB, Naylor MD. The Transitional Care Model (TCM): hospital discharge screening criteria for high risk older adults. Try this: best practices in nursing care to older patients. Issue 26, 2009. http://consultgerirn.org/uploads/File/trythis/try_this_26.pdf

  18. Wenger NS, Roth CP, Shekelle P, ACOVE Investigators. Introduction to assessing care of vulnerable elders-3 quality indicators measurement set. J Am Geriatr Soc. 2007;55:S247–52.

    Article  PubMed  Google Scholar 

  19. Grabowski DC. The cost-effectiveness of noninstitutional long-term care services: review and synthesis of the most recent evidence. Med Care Res Rev. 2006;63(1):3–28.

    Article  PubMed  Google Scholar 

  20. Ouwens M, Wollersheim H, Hermens R, et al. Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care. 2005;17(2):141–6.

    Google Scholar 

  21. Chiu WK, Newcomer R. A systematic review of nurse-assisted case management to improve hospital discharge transition outcomes for the elderly. Prof Case Manag. 2007;12(6):330–6.

    Article  PubMed  Google Scholar 

  22. Hansen LO, Young RS, Hinami K, et al. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155(8):520–8.

    Article  PubMed  Google Scholar 

  23. Golden AG, Martin S, da Silva M, Roos BA. Care management and the transition of older adults from a skilled nursing facility back into the community. Care Manag J. 2011;12(2):54–9.

    Article  PubMed  Google Scholar 

  24. Golden AG, Tewary S, Dang S, Roos RA. Care management challenges and opportunities to reduce the rapid rehospitalization of frail community-dwelling older adults. Gerontologist. 2010;50(4):451–8.

    Article  PubMed  Google Scholar 

  25. Jones SS, Rudin RS, Perry T, Shekelle PG. Health information technology: an updated systematic review with a focus on meaningful use. Ann Intern Med. 2014;160:48–54.

    Article  PubMed  Google Scholar 

  26. Campbell KR. What are the biggest issues with EMR today? [Internet]. 2012. http://www.kevinmd.com/blog/2012/11/biggest-issue-emr-today.html. [Cited November 4, 2013].

  27. Alder-Milstein J, Salzberg C, Franz C, Orav J, Newhouse JP. Effect of electronic health records on health care costs: longitudinal comparative evidence from community practice. Ann Intern Med. 2013;159(2):97–104.

    Article  Google Scholar 

  28. Kaushal R. Reducing the costs of U.S. health care: the role of electronic health records. Ann Intern Med. 2013;159(2):151–2.

    Article  PubMed  Google Scholar 

  29. Wang CJ. Medical documentation in the electronic era. JAMA. 2012;308(20):2091–2.

    Article  PubMed  CAS  Google Scholar 

  30. Golden AG, Silverman MA, Wan TTH. Electronic health records: an awkward third wheel. South Med J. 2014;107(6):380.

    Article  PubMed  Google Scholar 

  31. Wilson SR, Cram P. Another sobering result for home telehealth- and where we might go next. Arch Intern Med. 2012;172(10):779–80.

    Article  PubMed  Google Scholar 

  32. Dang S, Golden AG, Cheung HS, Roos BA. Telemedicine applications in geriatrics. In: Fillit HM, Rockwood K, Woodhouse K, editors. JC Brocklehurst textbook of geriatric medicine and gerontology. 7th ed. London: Churchill Livingstone; 2010. p. 1064–9.

    Chapter  Google Scholar 

  33. Takahashi PY, Pecina JL, Upatising B, et al. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Arch Intern Med. 2012;172(11):773–9.

    PubMed  PubMed Central  Google Scholar 

  34. Golden AG, Silverman MA, Mintzer MJ. Is geriatric medicine terminally ill? Ann Intern Med. 2012;156(9):654–6.

    Article  PubMed  Google Scholar 

  35. Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy RC, Hsieh F, Phibbs C, Lavori P. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002;346:905–12.

    Article  PubMed  Google Scholar 

  36. Ellis G, Whitehead MA, O’Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to the hospital. Cochrane Database Syst Rev. 2011;7:CD006211.

    PubMed  Google Scholar 

  37. Fox MT, Persaud M, Maimets I, O’Brien K, Brooks D, Tregunno D, Schaa E. Effectiveness of acute geriatric unit care using actue care for elders components: a systematic review and meta-analysis. J Am Geriatr Soc. 2012;60(12):2237–45.

    Article  PubMed  PubMed Central  Google Scholar 

  38. D’Souza S, Guptha S. Preventing admission of older people to hospital. BMJ. 2013;346:f30186.

    Google Scholar 

  39. Epstein AM, Jha AK, Orav EJ, Liebman DL, Audet AM, Zezza MA, Guterman S. Analysis of early accountable care organizations defines patient, structural, cost and quality-of-care characteristics. Health Aff. 2014;33(1):95–102.

    Article  Google Scholar 

  40. Centers for Medicare and Medicaid Services. Pioneer accountable care organizations succeed in improving care, lowering costs [Internet]. 2013. www.cms.gov/newsroom. [Cited January 8, 2014].

  41. Correia EW. Accountable care organizations: the proposed regulations and the prospects for success. Am J Manag Care. 2011;17(8):560–8.

    PubMed  Google Scholar 

  42. Burns LR, Pauly MV. Accountable care organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s. Health Aff. 2012;31(11):2407–16.

    Article  Google Scholar 

  43. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association Joint Principles of the Patient-Centered Medical Home. 2007. http://www.acponline.org/running_practice/delivery_and_payment_models/pcmh/demonstrations/jointprinc_05_17.pdf

  44. Maeng DD, Graham J, Graf TR, et al. Reducing long-term cost by transforming primary care: evidence from Geisinger’s medical home mode. Am J Manag Care. 2012;18(3):149–55.

    PubMed  Google Scholar 

  45. Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization and costs of care. JAMA. 2014;311(8):815–25.

    Article  PubMed  CAS  Google Scholar 

  46. United States Congress. The Better Care Lower Cost Act of 2014. http://beta.congress.gov/bill/113th/senate-bill/1932

  47. Institute of Medicine. New models of care. In: Retooling for an Aging America: building the health care workforce. Washington, DC: National Academies Press; 2008, pp. 75–122. http://www.nap.edu/catalog/12089.html

  48. Meret-Haneke LA. Effects of the program of all-inclusive care for the elderly on hospital use. Gerontologist. 2011;51:774–85.

    Article  Google Scholar 

  49. Golden AG, Ortiz J, Wan TT. Transitional care: looking for the right shoes to fit older adult patients? Care Manag J. 2013;14(2):78–83.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Department of Elder Affairs, State of Florida. Program of all-inclusive care for the elderly & statewide medicaid managed care long-term care program comparison report 2014. 2014. http://elderaffairs.state.fl.us/doea/Evaluation/PACE_Evaluation_2014.pdf

  51. Counsell SR, Callahan CM, Clark DO, Tu W, Buttar AB, Stump TE, Ricketts GD. Geriatric care management for low-income seniors: a randomized controlled trial. JAMA. 2007;298(22): 2623–33.

    Article  PubMed  CAS  Google Scholar 

  52. Counsell SR, Callahan CM, Tu W, Stump TE, Arling GW. Cost analysis of the geriatric resources for assessment and care of elders care management intervention. J Am Geriatr Soc. 2009;57(8):1420–6.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Medicare Payment Advisory Commission. Report to the Congress-Medicare Payment Policy. 2012. http://www.medpac.gov/documents/Mar12_EntireReport.pdf. Accessed 5 June 2012.

  54. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy. Washington, DC: MedPAC; 2009. http://www.medpac.gov/documents/Mar09_March%20report%20testimony_WM%20FINAL.pdf. Accessed 12 Aug 2012.

  55. Aldridge MD, Schlesinger M, Barry CL, Morrison RS, McCorkle R, Hürzeler R, Bradley EH. National hospice survey results: for-profit status, community engagement, and survey. JAMA Intern Med. 2014;174(4):500–506.

    Google Scholar 

  56. Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005;330(7498):1007–11.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ. 2000;320(7233):469–72.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  58. Lamont EB, Christakis NA. Prognostic disclosures to patients with cancer near the end of life. Ann Intern Med. 2001;134(12):1096–105.

    Article  PubMed  CAS  Google Scholar 

  59. Edes T. Transforming VA care at the end of life [Internet]. 2010. http://council.brandeis.edu/pdfs/2010/Edes.pdf. [Cited March 10, 2014].

  60. Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL, Schraq D. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012; 367(17):1616–25.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  61. Golden AG, Roos BA, Silverman MA, Beers MH. Home and community-based Medicaid options for dependent older Floridians. J Am Geriatr Soc. 2010;58(2):371–6.

    Article  PubMed  Google Scholar 

  62. Grabowski DC, Cadigan RO, Miller EA, Stevenson DG, Clark M, Mor V. Supporting home and community-based care: views of long-term care specialists. Med Care Res Rev. 2010;67 (4 Suppl):82S–101.

    Article  PubMed  Google Scholar 

  63. Golden AG, Roos BA, Silverman MA, Wan TTH. The challenges measuring the effectiveness of a statewide Medicaid long-term care managed care program: the Florida experience. Int J Public Policy. 2012;8:43–52.

    Article  Google Scholar 

  64. Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health Aff. 2010;29(1):57–64.

    Article  Google Scholar 

  65. Institute of Medicine. Interim report of the committee on geographic variation in health care spending and promotion of high value care: preliminary committee observations. 2013. http://books.nap.edu/openbook.php?record_id = 18308. Accessed 31 Mar 2014.

  66. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–28.

    Article  PubMed  CAS  Google Scholar 

  67. Centers for Medicare and Medicaid Services. Chronic conditions among medicare beneficiaries, chartbook: 2012 Edition. Baltimore, MD. 2012.

    Google Scholar 

  68. Centers for Medicare and Medicaid Services. Community-based care transitions program. http://innovation.cms.gov/initiatives/CCTP/

  69. Naylor MD, Bowles KH, McCauley KM, Maccoy MC, Maislin G, Pauly MV, Krakauer R. High-value transitional care: transition of research into practice. J Eval Clin Pract. 2013; 19(5):727–33.

    PubMed  Google Scholar 

  70. Peikes D, Zutshi A, Genevro JL, et al. Early evaluations of the medical home: building on a promising start. Am J Manag Care. 2012;18(2):105–16.

    PubMed  Google Scholar 

  71. Ouslander JG, Bonner A, Herdon L. The Interventions to Reduce Acute Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care. J Am Med Dir Assoc. 2014;15(3):162–70.

    Article  PubMed  Google Scholar 

  72. Ouslander JG, Lamb G, Tappen R, et al. Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project. J Am Geriatr Soc. 2011;59(4):745–53.

    Article  PubMed  Google Scholar 

  73. Tena-Nelson R, Santos K, Weingast E, et al. Reducing potentially preventable hospital transfers: results from a thirty nursing home collaborative. J Am Med Dir Assoc. 2012;13:651–6.

    Article  PubMed  Google Scholar 

  74. Gill TM, Gahbauer EA, Han L, Allore HG. Functional trajectories in older persons admitted to a nursing home with disability after an acute hospitalization. J Am Geriatr Soc. 2009;57(2): 195–201.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Supreme Court of the United States. Opinion of the court. Olmstead v. L.C. No. 98–536. 1999. http://www.law.cornell.edu/supct/pdf/98-536P.ZO

  76. Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009;301(6):603–18.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Central Florida College of Medicine, Orlando Veterans Affairs Medical Center, 5201 Raymond Street, Orlando, FL, 32803, USA

    Adam G. Golden M.D., M.B.A.

  2. Geriatrics & Extended Care, West Palm Beach Veterans Affairs Medical Center, 7305 North Military Trail, Riviera Beach, FL, 33410-7417, USA

    Michael A. Silverman M.D., M.P.H.

  3. College of Health and Public Affairs, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL, 32816-3680, USA

    Thomas T. H. Wan Ph.D.

Authors
  1. Adam G. Golden M.D., M.B.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael A. Silverman M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas T. H. Wan Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam G. Golden M.D., M.B.A. .

Editor information

Editors and Affiliations

  1. Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    James S. Powers

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Golden, A.G., Silverman, M.A., Wan, T.T.H. (2015). Targeting Interventions and Populations. In: Powers, J. (eds) Healthcare Changes and the Affordable Care Act. Springer, Cham. https://doi.org/10.1007/978-3-319-09510-3_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09510-3_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09509-7

  • Online ISBN: 978-3-319-09510-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation