As a generation of aging baby boomers, and a corresponding uptick in chronic illnesses, meets rising medical costs in a perfect storm, the medical and social services communities have to face a critical question: How can we best provide care for our nation’s low-income elderly population?
About 20 percent of the US population is age 65 or older, and as that number continues to grow, the implications for our health care system are great. The “high cost, high need” patients among them, according to a recent New England Journal of Medicine article, make up just five percent of the population but already account for 50 percent of the country’s health care spending.
What’s more, a just-released study by the Commonwealth Fund finds that one in five high-need adults reported having an unmet medical need—defined as having had to forgo or delay needed medical care or prescription medication in the past year. The study also finds that only two in five high-need adults who received care at a doctor’s office or clinic reported having “good” patient-provider communication. Add the fact that nearly three in four older adults suffer from one or more chronic health conditions, and it becomes clear just how important it is for us to figure out a cost-effective way to deliver high quality care, fast. Poor quality of life—human suffering, strains on family and community, increased costs, and lack of proper access to an already-overburdened health care system—will define the future of care for our elderly if we do not work together on solutions today.
The landscape is full of challenges, but also emerging potential solutions and promising examples. Under the Affordable Care Act, federally qualified health centers (FQHCs)— which provide community-based care to uninsured and medically underserved patients—must now treat patients under a pay-for-performance model, rather than the old fee-for-service model. The result is that FQHCs now have real incentives to better manage patient health (including chronic conditions), and to reduce the need for hospitalization and re-admission.
These are good changes, and yet FQHCs are finding themselves burdened in serving growing numbers of our most vulnerable citizens. One possible remedy is to accelerate adoption of “integrated care” models, under which patients receive some or all of their primary medical and dental care, lab services, pharmacy access, mental health care, and social services through one facility with closely coordinated partners. Unlike health delivery services that are fragmented, with patients receiving care at different locations by disconnected providers, integrated services help ensure that individual patients receive holistic treatment and don’t fall through cracks in the system.
LifeLong Medical Care provides a good example. This organization has established partnerships with a local hospital, adult day health centers, independent living centers, and Programs of All-Inclusive Care for the Elderly (PACE) in Oakland and Berkeley, California. On the other side of the country, Piedmont Health SeniorCare in North Carolina—an authorized PACE facility and certified FQHC—is another good example. Piedmont provides each patient with access to a personalized interdisciplinary care team that includes representatives from up to 12 health care disciplines and allows older adults to age at home. And in Carbondale, Illinois, the Shawnee Alliance for Older Adults integrated care model includes comprehensive care coordination, counseling, money management assistance, transitional care, access to a long-term care ombudsman, and elder abuse and neglect protection.
We recognize that pursuing an integrated model raises its own challenges, especially since many FQHCs also operate on very limited funds and in outdated facilities. In today’s challenging economic environment, raising money for capital campaigns takes longer, and foundations and government agencies have smaller endowments and less grant money. Finding the capital necessary to build a new facility, or even expand an existing one, can be overwhelming. Fortunately, solutions for this also exist.
Mission-driven community development financial institutions (CDFIs) such as Capital Impact Partners, where I am CEO, work specifically to ensure that projects that increase high-quality medical access to underserved and low-income individuals receive the financing they need. Where many large financial institutions see only risk, CDFIs see potential. They are driven by the social impact their lending can achieve and often partner with FQHC administration teams early on to understand their needs and work with them to structure loans that are often below existing market rates. That financing effort is often bolstered by policy advocacy and capacity-building efforts that help to strengthen the sector as a whole.
I am proud of the hundreds of FQHCs we have supported to help create health equity for millions of patients without regard to their socio-economic status. I’m also proud of how this effort continues through our Healthier California Fund, launched in partnership with The California Endowment and Age Strong, which we manage with support from the AARP Foundation and Calvert Foundation. These examples show how the medical, social service, government, and nonprofit communities can work together to address the looming “perfect storm” of elderly patient care, share best practices, and create staffing and financial partnerships to deliver quality, integrated care to our seniors and other vulnerable communities.
But we know that financing is not enough. And that is why we are convening a series of roundtables across the country to bring together health care leaders and advocates for the aging. We invite all those who are interested to reach out so we can include you in the ongoing conversation. Only together can we create solutions for the expansion and improvement of community-based FQHCs to better serve our aging population.