GRAPEVINE, TEXAS — The field of post-acute and long-term care is “at the edge of a transformational cliff,” keynote speaker Cheryl Phillips, MD, CMDR, president and chief executive officer of the Special Needs Plans Alliance, told her audience at AMDA – the Society for Post-Acute and Long-Term Care’s Annual Conference. “The earth underneath us is shifting, and ignoring change will have its own consequences.” The field is very different today than it was 20 years ago, and it continues to evolve, Dr. Phillips said, noting the move from traditional fee-for-service to care models that focus on value, costs, and documentation of quality. These alone present challenges for practitioners working as clinicians and advocates for the patients they serve. Among the challenges practitioners face moving forward, Dr. Phillips said, are: •An increasing number of higher-cost, dual-eligible (Medicare/Medicaid) patients with greater functional needs.•A growing population, along with an increasing number of people with dementia.•More patients with mental illness, a population who are living longer and entering PA/LTC in large numbers. These patients are not only expensive to care for but present unique behavioral and other challenges.•Physician and other practitioner shortages, making technology such as telehealth increasingly important.•An increase in senior homelessness — dramatically so in some states — and a lack of affordable housing. Where there are challenges, said Dr. Phillips, a past president of the Society, there are opportunities. “We just have to be able to separate true innovation from the noise,” she said. “As I look at the future of long-term care, you are truly the leadership we need.” One concern is a pushback from some housing providers who say society doesn’t need nursing homes anymore. Some services will indeed shift to other settings, Dr. Phillips said, but there will still be a role for nursing homes. Although some innovative community programs such as Chefs for Seniors, in which chefs go into older people’s homes to cook meals, may help support these individuals, they are not a panacea. “It’s one thing to send a patient home after a hip fracture when that person has lots of family support,” Dr. Phillips said. However, someone who has no family support, no access to transportation, and some cognitive issues will not be safe without significant supports, and will be at greater risk for readmission. “We need to look at how we determine who needs what services and supports to keep them safe and in the right setting to get what they need,” she said. Many states — 22 to date — have moved to Medicaid Managed Care as a solution to balancing costs with quality care. There are other new types of managed care plans, such as Special Needs Plans (SNPs), which are a type of Medicare Advantage plan with membership limited to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Plans such as this, Dr. Phillips said, “are a huge opportunity for our leadership.” Institutional Special Needs Plans (I-SNPs) are another opportunity for clinical leaders. I-SNPs restrict enrollment to Medicare Advantage–eligible individuals for 90 days or longer who require or are expected to need the level of services provided in a nursing home or skilled nursing facility, an intermediate care facility, or an assisted living facility. “I-SNPs will need clinical leadership looking to transform care and provide guidelines/pathways that make sense for these communities,” Dr. Phillips said. PA/LTC practitioners have an important leadership role to play in this changing landscape, Dr. Phillips said. “We are the most passionate voice for our patients, families, and staff. We can’t be passive about this,” she said. “[The Society] is a powerful voice nationally, but we need to be powerful voices in our states as well.” PA/LTC practitioners no longer function in silos. “We work in systems of care, and we need to know how the pieces fit together,” Dr. Phillips said. “We are the voice of integration and person-centered care. This is the essence of care — getting the patients’ voice in their care plans.” Physicians and others need to track outcomes and prove the value of their work. Toward this end, Dr. Phillips advised, “Know your data. Know what’s being collected. Use it to tell your story.” Dr. Phillips expressed confidence that her Society colleagues can do what needs to be done to meet these challenges head-on. “We will not let others transform long-term care. We are the leaders we’ve been waiting for.” Senior contributing writer Joanne Kaldy is a freelance writer in Harrisburg, PA, and a communications consultant for the Society and other organizations.
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Jan 23, 2023
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