Where will the Rubber Meet the Road?

Responsibility.

People often ask me how we will pay for Aging in Place 2.0? I reply that it will come from savings. Once a truly comprehensive, dynamic and coordinated well managed system is available the savings will start to flow. Until the whole system is available it is hard to judge savings. Cracks in a system cost money. My view about what is needed is not changing. I have new ideas about where the money to get started will come from.

Until you can run the things well for a while it is too hard to price out lots of well but if? Like…”Our trip was good, everything went like clock work except we had to change a tire once in the rain and wait 1/2  day for a tow truck and then parts for a day. Needless to say we were not right on time…but without those problems we would have been on time.” Too hard to judge how much time each systems failure cost.

The cost of caring for someone in their own home with well managed services is less than caring for them in senior housing facilities. The best demonstrations so far are the Veterans Administration and the PACE program. Those two groups are responsible for their populations. Once you take responsibility you care about the big picture outcome. That makes them look at systems and prevention, and once they investigate, they build the systems.

PACE (Program for All-Inclusive Care for the Elderly) takes payment for medicaid patients by the person not illness, procedure or incident. PACE pioneered preventative measures for a long time. That is how they are able to do a better job with their resources. (This doesn’t mean it is so good those of us with other resources hope to be destitute, but there is an irony that the most comprehensive system is only available to those who are impoverished.) The VA, recognizing both quality and economy with very well managed home care for clients with multiple chronic conditions built a team approach of very well managed care in people’s homes. Both models are directed at clients with severe needs- nursing home level for PACE and similar for VA. It stands to reason that what saves money for those with severe needs will work as well or better for those whose needs are less severe. This is especially true when the pool is inclusive- the payer is responsible. This is a foundation of AiP2.0, and a basic building block of health care reform.

So where will the next early adopters come from? It will not be the mass of us relying on medicare because huge government bureaucracy is too filled with rules, inflexibility and fraud. It will not be those of us on private pay programs that fight not to pay for anything. That is the opposite of responsibility.

I am learning the next round of innovation will come from smaller populations where responsibility is a value…groups where ‘we’ is the standard of language. I am speaking of member organizations- unions, pensioners, service organizations and faith based groups. Until recently I expected entrepreneurs, business interests and established providers to lead innovation. Now I see that group buying power and responsibility may demand innovation.

I am talking with a few organizations developing programs to take care of their members, take care of each other. This is innovative, though not extreme. People power is strong. Group clients negotiate products and deals.  These are the models where education, self management and prevention will be encouraged before things get real bad. That is where the savings will come from. That is where the rubber meets the road. Responsibility.