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A Care Manager is the Difference

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care manager is number oneWhat do ObamaCare and geriatric care managers have in common? You probably have heard a whole lot about what is called ObamaCare – more accurately the Affordable Care Act – but you probably have not heard so much about geriatric care managers…let alone geriatric care managers and the Affordable Care Act.
It works like this. The new law that has given more access to more Americans has also worked to have everyone in health care working toward the same goal. Raise your hand if you have ever had an older loved one admitted to a hospital. When that event happened, what you wanted most was to get your loved one safely recovered from what brought them to the hospital and to get them discharged. At the point they were discharged, what you wanted least was to face the prospect of seeing them readmitted to a hospital. Unfortunately for the Medicare-age population, that readmission was happening a lot.
So, ObamaCare built in a program where everyone is working toward keeping older people healthy once they are discharged from the hospital. But let me take you back a number of years. There was a time when all health care providers – including hospitals – were paid fee-for-service. Every office visit, every hospital visit, every procedure was a charge, and the providers were paid more for more volume. Then some of the rules changed so that health care was “managed” by insurers who made more money if they paid providers less. The first system rewarded volume, and the second one rewarded cutting care.
Under the new model, providers and hospitals are rewarded for working together to improve quality and efficiency. And what do the people running these new organizations say is most instrumental in making all this work? In a survey conducted this last year among executives of ACOs, they were asked what was most effective and most important in keeping people healthy and out of hospitals: telemedicine, pharmaceuticals, electronic medical record-keeping, pharmaceuticals, home health care or care managers? It is not computers, it is not the providers, it is not new medicines; it is care managers who are viewed as both more effective and more important. What makes it all work better are the care managers who can assess a person’s health and their home, and then develop a plan to help a person get back on their feet. That same care manager is the one who will advocate on behalf of an older patient to get help at home or to get in to see a doctor to help avoid an unnecessary trip to the hospital. This is not to toot our own horns; we will leave that to the CEOs at the new health plans to do that for us.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.

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