Taking Care of the Most Vulnerable
When you have a chance, please take a moment to read this tender New York Times story, “Fighting to Honor a Father’s Last Wish: To Die at Home,” by reporter Nina Bernstein, about a man named Joseph Andrey and his desire to end his days with dignity in his own home. The article, as well as the accompanying “Care at Life’s End” graphic, demonstrates how cost-effective and more humane it is to Age in Home than moving from institution to institution during the most fragile of years. One of the benefits of new digital technologies is how it can empower people to do many things that were not previously be possible. In particular, they can allow for a greater level of personalization in care assessment, management and delivery. But while patient engagement, connectivity and electronic health records have become current buzzwords, we must remember that the dignity of the patient should always be paramount. For all of the buzzwords, none will have as much impact on bending the health care cost curve or improving care if technology is not accessible to help the costliest, neediest, most vulnerable users in the system. A systemic cost impact requires an ability to access and generate communications, interactions and responses for the most vulnerable and underserved populations. A systemic solution is critical to any genuine success in reducing overall US health care costs and enhancing lives through better care quality. It is essential, on an organizational level, for plans, payers and agencies that are exposed to the risks of their costs under capitated rate programs, and versions thereof, such as value-based payments, bundled payments and shared risk programs, to reach the costliest and neediest patients in our system. We need to focus on the means to generate useful information from homes that are otherwise unconnected and badly underserved, which in turn will enable rapid, timely interventions to minimize problems, optimize treatment cost effectiveness and better manage overall care. That accessibility will be a meaningful new strength to the extent that it can be accessed by all, including people such as Mr. Andrey and their families and caregivers.