Institute of Medicine Committee on Geographic Variation in Health Care Spending Larry Minnix LeadingAge

The overall aim: Better quality at lower cost that is person- centered, evidence based, that can be applied to large and diverse populations can best be accomplished through…

Stewardship Where stewardship is defined as the intersection of… Values and Value as evidenced by Medicare and Medicaid cost reductions while measurably improving quality of life for consumers who use those programs.

Long-term services and supports can best contribute to stewardship that Prevents or delays health events Helps consumers and their loved ones navigate crisis scenarios Uses programs and protocols that are proven to work effectively on an individual and large-scale basis regardless of the living venue Employs a community-wide scope and network of services

Stewardship must be organized around five inter-related dynamics called: The Five Big Ideas

Quality That People Can Trust Belief: Good quality is less expensive than bad quality. Stewardship activities: –Advancing Excellence in America’s Nursing Homes –Continuous Quality Improvement –Culture transformation –Small Houses, Green Houses –Housing with Services (including AoA and HUD)

Transitions Management/ Interested Communities Belief: Fragmentation is public enemy #1 to the quality-cost problem Stewardship activities: –Long-Term Quality Alliance –PACE, SOURCE, Evercare, Senior Independence –North Carolina, Vermont (Cathedral Square), Detroit (Presbyterian Villages, Ohio (NCR), California (Mercy), Oregon (Jewish Care) –Post-acute bundling connected to non-acute service packages

Talent/Workforce Belief: Competent, enlightened, paid, family and volunteer caregivers are the best proxy for quality. Stewardship activities –Culture transformation –Team empowerment –Educated consumers/families –Coaching and guiding through GNPs at critical points of transition

Finance Belief: Public program relief can come only through consumer financial investment in self-insurance while preventing unnecessary crises. Stewardship activities: –CLASS –Bundling –Incentives for outcomes not srevices or compliance

Technology Belief: Technology is an accelerator/catalyst for all other Big Ideas Stewardship activities: –Personal health record –Interoperability from home setting to physician’s office –Consumer gadgets that help monitor

Is it possible to achieve better quality at lower costs? Yes!

In fact… Models of long-term services and supports are already demonstrating that effective stewardship is possible, and… Value-based health cannot be achieved without long-term services and supports.