University HealthCare Alliance

July 27, 2020

Three Approaches Could Lower Health Care Spending While Improving Late-Life Care

Francesca Rinaldo, MD, PhD, became interested in the plight of older adults during a rotation in the intensive care unit at Stanford Hospital. She noticed how often elderly patients were admitted after sustaining rib fractures, head gashes and other injuries from falls at home, and she wondered what could be done to keep them safer. 

Rinaldo decided to put her surgical residency training on hold to accept a yearlong fellowship at Stanford’s Clinical Excellence Research Center, where clinicians and researchers use scientific evidence to design less costly approaches to providing high-quality health care. She was assigned to a team investigating late-life care, and she wasn’t surprised by her initial research. She found that for older people, health care costs are high, and satisfaction is low.

“Most older adults value their independence,” Rinaldo said. “They want to age in place. They want to remain functionally independent. They don’t want to be a burden on their families —  either for their daily living or financially, as we all know that health care’s very expensive. And they don’t want to burden loved ones with end-of-life care decisions. Unfortunately, the reality right now is pretty much exactly the opposite of that.”

Rinaldo and her colleagues synthesized information from site visits, peer-reviewed literature and interviews with more than 50 national experts. Eventually, they zeroed in on three approaches, based on programs from around the country, that showed promise in improving the well-being of older adults while also reducing health spending.

The approaches include peer support, occupational therapy, home repairs, and telephone conversations about health care goals — services that fall outside the traditional definition of medical care. With recent changes to government rules, however, these benefits are now covered by private Medicare Advantage plans, making these strategies feasible on a broad level.

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