Perspectives: Tools to Make the Business Case for Person-Centered Care


As Medicare moves away from fee-for-service and utilization-based managed care to value-based purchasing, addressing older adults’ health in light of functional needs is becoming a business necessity. In this Perspectives, Dr. Chernof recognizes delivery systems that champion person-centered care as the practical way of the future and introduces two resources to help health systems leaders justify and ramp up greater adoption of person-centered care models.

Date Updated: 06/20/2016

We all want a high quality, technically correct health care experience. From a population perspective, unnecessary variations in care must be diminished. However, what drives so much of the health care utilization for vulnerable older adults is not a technical failure, nor unnecessary variations. Instead it is the health system’s failure to fully understand and address the uniqueness in older adults’ needs – whether these are functional, behavioral, and/or environmental – coupled with the person’s medical profile.

It turns out that helping older people thrive in homes and communities of their choosing is a major key to controlling health care expenditures for “high cost, high needs” individuals. The data are not new. The costliest 5 percent of Medicare beneficiaries account for almost 40 percent of annual spending, and older adults with functional needs and chronic health conditions cost roughly twice as much as those with chronic conditions alone. How a person lives every day in light of their health status – particularly their ability or inability to achieve security and stability in the community – matters. As Medicare moves away from fee-for service and utilization-based managed care to value-based purchasing, addressing health in light of daily living needs is not simply a “nice to have” programmatic add-on, but a business necessity…

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High quality, cost effective health care delivery is all about targeting – the right care, by the right provider, at the right time, in the right place, and for the right cost. It sounds straightforward, almost easy. The challenge to getting it right is understanding the range of variables in a person’s life that drive health care use and costs. Find out more in this week’s Perspectives.

In this brief, the California Medicaid Research Institute documents its process to acquire and link all the data sources necessary to evaluate long-term care services utilization, costs, and outcomes in California. This provides useful information about how data currently flows in the state and how system transformation can be supported.

Chances are you know and love an older person with needs. Maybe it’s that neighbor of yours whose trash cans you help bring in once a week. Perhaps it’s your grandparent or even a parent who needs help understanding the bills or getting the groceries up the stairs. The reality is the population of older adults in this country is growing rapidly due in large part to the aging of baby boomers – a demographic shift that affects us all. Advancements in health care and technology have also spurred this phenomenon, yet we know that a longer life also brings a greater likelihood of facing multiple chronic health conditions and possibly needing help with everyday activities.