The honor of caregiving

In her book, The Inspired Caregiver, Tia Walker writes, “To care for those who once cared for us is one of the highest honors.”

As our population ages, all of us need to think about caregiving. Most of us, in one way or another, have been affected by it. Who among us hasn’t listened to or advised a friend who’s dealing with an aging parent? Who hasn’t heard the question: How can I keep my loved ones in their home as they get older? Or perhaps we’ve been called upon to assist a relative or neighbor with health issues that have become debilitating or everyday tasks that have become too difficult.

When we’re called upon to help, the first attribute we need is compassion. High-quality care or assistance can’t occur without a willingness to empathize and sacrifice for the benefit of others. But for organizations that serve older adults and people with chronic conditions and disabilities, compassion alone is not enough.

We must also do a better job of connecting the dots across a diverse and often fragmented system. Call it “care coordination” or “integrated care” or perhaps something else. It begins with a strong foundation built from common sense and extensive health and human services expertise. It requires a deep data and technological background and a willingness to try innovative approaches. And perhaps most important, it requires coordinating real-time information and bringing together doctors, families, patients, payers, advocates and other caregivers who are informed by that information. Only then can we deliver the right services and care to the people who need it.

It’s much easier said than done. But when it’s done right, this combination provides a glimpse into the future. In it, there’s a much more effective system of providing care for those who require what’s known as long-term services and supports (LTSS).

Optum prides itself on the ability to offer this combination, and this glimpse, working in close collaboration with our innovative state partners. The progress we’ve made can serve as an example and inspiration across the LTSS spectrum.

For example, in Arkansas, we’ve worked hand-in-glove with the Department of Human Services (DHS) to conduct 66,600 functional assessments, with many more to come. We assessed Medicaid beneficiaries with mental health issues, developmental disabilities and aging/physical disability needs. The assessments help DHS assess who needs what services. DHS considers the assessments critical in its efforts to transform its Medicaid program to offer more services that support the whole person. Ultimately, these services will be more cost-effective and help improve outcomes.

The independent assessments covered a range of categories, many related to an individual’s ability to engage in activities of daily living (ADLs) such as:

  • Eating, bathing, dressing and personal hygiene
  • Preparing meals
  • Managing medications
  • Managing finances
  • Memory and cognition

The results are shared with the state, providers, the individual’s care coordinator and appropriate family members. All work together to develop an appropriate care plan to improve the person’s quality of life. Professionals also use the assessments to determine whether individuals are eligible for Medicaid coverage. Or they use them to determine if individuals are eligible for home- or community-based care versus far more costly institutional settings.

And there’s a back-story that illustrates the kind of thinking we all need to improve LTSS services.

By contract, Optum is obligated to provide:

  • The assessment tool
  • Qualified professionals to objectively administer the tool
  • Underlying technology platform to support the tool and collect and report data
  • Provider training and support

But beyond the contract, Optum and the state worked together to find the innovation to get the job done. That’s sometimes more difficult to define.

As is often the case when a state implements a broad new initiative, the assessment program got off to a slow and sometimes rocky start. Assessors had difficulty scheduling appointments with a Medicaid population that often did not have access to email. They didn’t respond to phone calls and were skeptical of a caller’s motives when they did answer.

Very quickly, Optum worked with the state and providers to implement a plan to remedy the situation. The plan had several components. Most important was the decision to embed assessors at provider sites. That way, they could conduct assessments as part of a patient’s regular visit for an exam, a consultation or to obtain a prescription. They could also conduct assessments at care facilities and institutions.

This embedding approach helped in numerous ways. It placed assessors where the beneficiaries were. It mitigated — and virtually eliminated — the negative “telemarketer effect” that assessors experienced when they called beneficiaries at home. And it engaged providers in the process in a more active way.

Almost immediately, the number of assessments Optum conducted grew exponentially. We went from a low of around 30 per day to more than 500 per day three months later. More than 160 assessors were embedded at provider locations across the state and they “touched” 250 individual provider locations. The innovative approach helped Optum exceed the assessment goal. DHS was so pleased with the results that they shared them with other states at the recent Healthcare IT Connect conference in Baltimore. To learn more about the Arkansas independent assessments read the full case study.

So what’s the bottom line here? As Tia Walker wrote, it’s an honor to care for those who once cared for us. And with that honor comes a responsibility to get it right. To bring together the expertise and a willingness to try new things. To trust our inherent instincts to do good work. When you combine those attributes with compassion, it’s an unbeatable recipe — not just to care for others, but to improve their lives.

And that’s the real honor.

About the Author:

a.cone_img_1616Andrew G. Cone
Sr. Vice President, State Government Solutions

Andrew Cone leads solution and business development / strategy for Optum State Government.  His experience spans the health spectrum, including commercial, government (Medicare and Medicaid), payer, provider and pharmacy benefit services.  A graduate of Hamline University in St. Paul, Minnesota, his 30 + year career includes business and software development, service delivery, and consumer engagement.

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