Forum Session

Improving the Quality and Efficiency of Care for Older Adults: Lessons From the Field
September 18, 2015


Sally Coberly, PhD


Observers of the American health care system agree that older adults frequently experience care that is uncoordinated, of poor quality, and too intensive. Such care unnecessarily increases costs for Medicare and Medicaid, as well as for beneficiaries themselves. Redesigning care for older adults to improve both quality and efficiency has proved challenging, however. While a number of efforts supported by Medicare have been successful at maintaining or improving quality, few have been able to achieve cost savings. This may be due, in part, to a failure to target interventions to those most likely to truly benefit; it may also be due to the use of interventions that are too costly on a per-patient basis.

National Health Policy Forum and Health Affairs logosThis session, jointly sponsored by the National Health Policy Forum and Health Affairs, looked at two interventions aimed at improving care and reducing costs. Both have been featured in articles published in Health Affairs. The Geisinger Health System’s ProvenHealth Navigator® is an advanced patient-centered medical home that embeds case managers in clinics. These case managers combine physicians' knowledge of their patients with results from predictive modeling and risk stratification software to identify high-risk older adults likely to benefit from intensive services. The Comprehensive Care Physician model at the University of Chicago Medical Center seeks to avoid the problems created by the lack of coordination and communication between hospitalists and primary care physicians by enabling primary care physicians to care for their patients in both inpatient and outpatient settings. It focuses a physician's practice on patients at high risk for hospitalization so the physician will have "enough hospitalized patients to have a meaningful daily physical presence in the hospital while still allowing them to provide ambulatory care."

In addition to delving into these two models, the session offered commentary on prior initiatives to improve the quality and efficiency of care delivered to older adults, their successes and failures, and the challenges of bringing successful interventions to scale in the Medicare program.


Thomas Graf, MD (bio)
National Director of Population Health Management, The Chartis Group
Former Chief Medical Officer, Population Health and Longitudinal Health Care Services Lines, Geisinger Health System

David O. Meltzer, MD, PhD (bio)
Chief of the Section of Hospital Medicine, Director of the Center for Health and the Social Sciences (CHeSS), Professor in the Departments of Medicine and Economics and the Harris School of Public Policy Studies, University of Chicago

Randall Brown, PhD (bio)
Vice President and Director of Health Research, Mathematica Policy Research

Robert Berenson, MD (bio)
Institute Fellow, The Urban Institute

Related Materials

David O. Meltzer and Gregory W. Ruhnke, "Redesigning Care For Patients At Increased Hospitalization Risk: The Comprehensive Care Physician Model," Health Affairs, 33, No. 5, May 2014, pp. 770-777.

Daniel D. Maeng et al., "Reduced Acute Inpatient Care Was Largest Savings Component of Geisinger Health System's Patient-Centered Medical Home," Health Affairs, 33, No. 4, April 2015, pp. 636-644.

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