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White paper: Transforming value-based care as America ages

A key demographic in the United States is growing: adults over the age of 75. This comes as the result of medical advances that help us live longer healthier lives. But how will our healthcare system care for the needs of this growing population?

This white paper ‒ authored by Eric Cahow, Ph.D., vice president of Government Markets Performance, and Heidi Syropoulos, M.D., FACP, medical director of Government Markets ‒ offers an in-depth look at this situation as well as a strategy and proposal for how to address it. We believe that expanding the older adult care measures in the Medicare Advantage Quality Bonus Payment (Stars) program to include palliative care and management of geriatric syndromes will advance health equity and improve access to affordable quality care.

The current situation

The U.S. has a rapidly growing population of older adults living past the age of 75.

22 million seniors are over the age of 75

The problem

The current health care system is not prepared to address the needs of this growing population.

Increased age = increased need

The opportunity

Now is the time to take on the challenge of caring for our aging population.

To respond to these realities, our public-private partnerships between health plans, providers, and CMS need to drive structural change in how older adult care is delivered and measured. We believe CMS leadership on this front will empower health plans and providers to coalesce around a new framework for an age-friendly health system. Here are the next steps that can be taken: 

  • Create a new model for older adult quality care to deliver the broad structural changes needed. 
  • Close gaps in care for older adults experiencing more complex care needs. 

Our strategy

Collaborate with CMS to enhance the Medicare Advantage (MA) Quality Bonus Payment (Stars) program incentives.

Today, quality metrics in geriatric care are largely absent from the MA Stars program. We believe expanding the older adult care measures to include palliative care and management of geriatric syndromes will advance health equity and improve access to affordable quality care. 

Missing measures include: 

  • Advanced care planning 
  • Cognitive impairment and dementia 
  • Patient Experience 
  • Disability and activity of daily living limitations 
  • Addressing harmful drug interactions

Current MA Stars measures for adults 75+

Our proposal

We recommend that CMS enhance the Stars measure set to incentivize high-quality care for adults 75+ and create a working group of stakeholders to develop additional solutions.

1. The 4Ms AFHS Framework was created in collaboration between the John A. Hartford Foundation and the Institute for Healthcare Improvement:

What Matters:

Honoring patient goals and care preferences 

Medications:

Resolving the often adverse interactions of the many prescriptions that medically complex individuals may take 

Mobility:

Ensuring older adults move safely every day to maintain function 

Mentation:

Screening and addressing delirium, depression, and dementia 

2. Create a multi-stakeholder workgroup to focus on issues of older adult health care and provide continuous updates and improvements to the Stars measure set, such as a new focus on advanced care planning.