SAN DIEGO – In Messaging New Directions we relayed the general theme for the NIC 2016 National conference – that cost, value and messaging need data, analysis and connections if a clear narrative is to emerge for Senior Living. As expected, there was a newly crafted narrative shared at this year’s NIC 2017 Spring Forum and it was informed by the confluence of data, analysis and some new connections. NIC engaged Anne Tumlinson to research the Board inspired thesis of creating value by intentionally coordinating bricks and mortar with emerging soft resources coined as “Enablers.” These findings became the framework for the NIC 2017 Spring Forum entitled “Unlocking New Value Through Senior Care Collaboration.”
Innovating Senior Care
The following NIC webinar provides a comprehensive introduction to many of the talking points that were expanded upon at the NIC Spring Conference:
Of note, Bob Kramer, CEO of NIC summarizes that, “Healthcare providers and payers are beginning to realize that if you are serious about delivering better health outcomes and controlling costs, housing as well as socialization matters, and in fact, without them you won’t achieve good outcomes.” There is a symbiotic opportunity represented by coupling asset-based providers with the care capabilities of so-called “enablers” and the captive customers they already represent – and can share strategically – in order to scale together. Kramer noted a remark from CEO of Kaiser, Bernard Tyson at the J.P. Morgan healthcare conference, that “40% of an individual’s health is driven by personal behaviors outside of the healthcare environment”. Recognizing the influence that non-real estate based providers of technology and services will have on the Senior Living sector is the first step toward breaking down silos of care.
Enabling by Example
Kelsey Mellard represented Honor at the event where they were the unofficial poster children for the disruptive (enabling) innovation our industry is being charged to embrace. Co-founder Sandy Jen’s brief TEDMED talk below captures their view on the impact non-medical caregiving can have on the cost and value of healthcare:
Jen describes how “unskilled home-care has always orbited outside of the traditional healthcare system of nurses doctors and hospitals and more and more, people are realizing that the home part of hospital to home is crucial.” She adds that it (home-care) can (1) reduce readmission rates, (2) increase quality of life for patients after discharge and (3) reduce the cost of provider health care to an aging population estimated to reach 84 million by 2050. In a recent Argentum post titled, “7 Innovations Changing the Aging Experience” Aging 2.0 Co-founder Stephen Johnston relayed that, “Emerging technologies have the potential to disrupt the senior healthcare market and thereby nudge service providers to improve their offerings.” If advice from NIC and their expert panels take root, it is likely that we will start to see a groundswell in active partnerships and collaborations.
The New World of Senior Care Collaboration
The Value Based Care (VBC) Revolution
The shift from volume to value in Post-Acute Care (PAC) is not going to be possible outside the broader framework that is mandating a transition from treatment of sickness to promotion of health. It is no longer sufficient to care for someone only when they are under your roof! When you recognize this, it becomes clear why an active focus on population health and wellness is critical. As tools and services that exist in the community become more sophisticated (and even ubiquitous) to consumers of all ages, it is imperative that senior living providers not fall behind. In the Forum’s opening session, leadership from Jupiter Communities, naviHEALTH and Optum relayed the following three key takeaways for success in seniors housing:
Provide evidence-based care and show strong outcomes
Educate both payers and traditional clinical providers that they (you) are a meaningful part of the solution
Collaborate rather than compete with other providers
Referring to the “right” PAC setting will be a critical strategy for VBC since “43% of Medicare patients utilize post-acute care after discharge and there is wide variation in costs across each setting.” As stated previously, 84 million people will be 65 years old or older in the United States alone by 2050. Beth Mace, NIC Chief Economist and Director of Outreach, contextualizes that datapoint further by reminding us that today’s 82 year old resident was born in 1934 and is part of the Silent Generation. With all of the age wave and silver tsunami buzz continuing over the past few years, we are still years shy of the crest that boomers will represent for providers of housing, care and tech-enabled services. Now is the time to begin preparing for that certain demographic future.
Tweeting advice to the Industry
Thursday’s luncheon featured a panel discussion with Senators Tom Daschle and Bill Frist, M.D.
As the clip above reflects, we need to engage in a more active national conversation about our social contracts and the role our government should play in health care. Interestingly, Sen Bill Frist made multiple passive references to the role quality food and nutrition has to play in improving health and reducing the cost of care. Did anyone else hear this? Or was it just wishful thinking on our part? If we want to prove that we believe in breaking down silos, we might consider a 2018 NIC Spring Forum focused on the economic development and health impacts of advancing and deploying local food systems!
Takeaway from a Taxi ride…
Providence offered a clear metaphor for reinforcing the value of collaboration in the experience of my brief taxi ride to the San Diego International Airport. As I stepped onto the Bayfront Hotel porte cochere, I could see that there was a single taxi waiting. The attendant escorted a woman into the back seat and then quickly turned to me and summoned the next car in line. Asking if I was headed to the airport, I confirmed that we both were. Our two, four-door, five passenger taxi sedans began to travel down Harbor Drive on parallel tracks together yet alone. We arrived at the same gate, at the same time, and we both presumably paid the same twenty-dollar fare.
The over-consumption model that this story captures mirrors many of our contemporary business relationships and transactions. In this example, some outreach and collaboration would have created immediate value for the two of us. Moreover, who knows what we might have discussed and explored through the connection of common interests. Do we really choose to consume alone or have we been artfully conditioned to relinquish our collective buying power? We should not consider ourselves to be victims of a broken system – we are active players that can influence the rules of the game.
Interestingly, our industry predicament seemingly proves a microcosm of our world at large. Our communities, industries and nations need to honor a simpler mandate – we must always demand and promote more collective EFFICIENCY every-where and for every-one. These are habits that must be formed and refined if they are to take up permanent residence in our collective psyche. If we identify and optimize what is wrong in these daily details, the broader canvas just might correct itself. There is a clear opportunity attendant to the messages that NIC and others are developing for us. The challenge is to expand the scope of our inquiry and recognize through our actions not just that silos represent lost opportunities for added value creation – but that all of our silos are nested one inside of the other. When we celebrate acceptance of an expanded and more inclusive perspective, we must remind ourselves that their is an ever-widening circle to be informed by. As in our own business practice, “Combining Capital with Care” seems like the formulary for success.
We recently attended The Erickson School’s 5th Annual Memory Care Summit in Orlando, Florida. The Coronado Springs Resort at Disney World proved to be a symbolic venue represented by engaged staff who reminded us in real-time what the ideal customer experience feels like. What better way to explore the facets of Memory Care – and its growing significance for an evolving Senior Living Industry – than with the timeless nature of a Disney “theatre” as backdrop.
SETTING THE STAGE
Best practices proffered by the Walt Disney Company about employee training and brand management almost felt unrealistic. The competitive advantage of being part of a “magical kingdom” seemingly anchors them in a winner’s circle far removed from our own care industry. In the days that followed, it became clear that this apparent advantage just MIGHT be attainable for all. Is it possible that success is as simple as telling stories with lessons that can be shared, recalled and channeled – to inform the moments we create with residents, staff and families? It is our ideal nature to care and to be cared for. If we don’t seize opportunities to create meaningful relationships that extend beyond routine tasks; we are losing more than just a bottom line.
Employee Engagement is the key
The Program launched with a 90 minute presentation by Mark Matheis of the Disney Institute. Sponsored by Integrace and entitled “Disney’s Approach to Employee Engagement,” Mark portrayed Disney’s management excellence while sharing the underpinning of a customer service philosophy where everyone is special and everyone contributes.
Validated by his own 27 year career recall with Disney, his engaging stories exhibited the “real deal” that constitutes and carries the Disney culture. Like our own business, it’s the genuine caring for both employees and customers that fuels success. There is at lease one key attribute required of every Disney employee – you’ve got to be genuinely “nice” to join the team.
Green Side Up
Mark amplified one experience in the opening of Disney World’s Orlando Resort that captured the role storytelling can play in our education, training and engagement activities. Amidst the chaos surrounding opening day, it was the President of Disney who detected that a critical item had been overlooked. The Resort’s Grand Floridian Hotel did not have its grass sod laid – though it was neatly stacked on-site. He immediately dispatched a message to his entire team. All those not engaged in critical business were to report directly to the Floridian for priority assistance required. In the meantime, the President loosened his tie, rolled up his sleeves and began to unload and place squares of sod in front of the building. With beads of sweat emerging, a senior team member approached the President in response to his appeal. With some reservation, the executive, accompanied by others, expressed that he had never done this kind of work and questioned the skill-set required. The President offered a simple response, “It’s easy. Green Side Up.” And so it was that all joined in and the job was done. To this day, every employee knows the mantra of “Green Side Up”. It is a powerful metaphor that informs desired behavior. We work together toward the common goal of delivering a unique customer experience; irrespective of formal titles or job descriptions.
Overmanage for Sustained Results
Mark also relayed that “Disney’s consistent business results are driven by “overmanaging” certain things that most companies undermanage or ignore – and that is a key source of what differentiates us.” In simple terms, they “have learned to be intentional where others are unintentional.”
The example of an intentional act was captured by the deconstruction of a wave from a Disney Princess. The mechanical formulary of “wash the window, wash the window, missed a spot, missed a spot” captures the spirit of how designed experiences that have been broken up into meaningful elemental actions that can be easily shared and sustained as a desired behavior. It is not a huge leap for Animators to dissect micro-motions like this but that is the point of integrative thinking; to seek constantly to reframe problems and opportunities from alternative perspectives that capture every detail. If you do not create a script for your operation, how can you effectively train your team and deliver your brand’s promise?
Our second day began with a presentation from James Hendrix, the Director of Global Science Initiatives at the Alzheimer’s Association, where we were reminded of their three-pronged mission to eliminate the disease through (1) the advancement of research; (2) enhanced care support and (3) the reduction of risk for all dementia sufferers through the promotion of “brain health.”
What is the scope of the problem? 5.4 million Americans of ALL ages will have Alzheimer’s in 2016 at total cost of care of $236 Billion according to the CDC! Interestingly, in a supplemental peer-reviewed journal entry, we learned that “…the Association also believes there is sufficiently strong evidence, from a population-based perspective, to conclude: (1) regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking, and hypertension) have been shown to reduce the risk of cognitive decline and may reduce the risk of dementia; and (2) a healthy diet and lifelong learning/cognitive training may also reduce the risk of cognitive
What’s the take-away? In spite of the millions of dollars (and human hours) spent yearly, we are not any closer to a meaningful cure BUT we have evolved considerably on the care front through the medium of Culture Change and Person-Centered Care (PCC) language and practice. Perhaps more importantly, a groundswell of professionals actively recognize that the “job” of Memory Care is not to heal or repair the disease; because we can’t (yet). Rather, our role as caregivers and family members is to relate and under-stand behavior so that we can be more supportive of individual needs as they struggle to mitigate the threat of a changing connection to self.
Ann Wyatt, Manager of Palliative and Residential Care at CaringKind relays that “Behavior is communication: it is not the dementia that causes the behavior, it is the dementia which prevents the person from expressing the cause of their distress.”
This change of perspective is transformative. It is conventional to bundle disease with symptoms in a cause and effect fashion but when you separate the two you become empowered to make a difference. In viewing behavior as form of communication, you are invited to listen more contextually and establish communication based on validation and empathy. This relational strategy is summarized by Validation Therapy’s founder Naomi Feil’s in her TEDx Talk at Amsterdam Women:
BRINGING IT HOME
Without question, the most moving part of this year’s program was the concluding morning presentations of day three. This segment is quickly becoming a promised experience delivered by the Erickson School’s Memory Care Summit; to conclude the series with human narratives that highlight the critical nature of the work we are all doing. Here we witnessed highly personal stories of two individuals confronted with life altering memory care circumstances. These interview presentations were moderated by Dr. Peter Rabins who consistently echoed the truism that our professional credentials do not fully prepare any of us to process the weight of memory loss among our peers and loved ones.
First, “Wearing Two Hats: Providing Care at Home and at Work”. This was the story of Teresa Robinson, VP, Clinical Services of Sagepoint Senior Living. Teresa is a caregiver in her organization as well as a caregiver at home as her husband was diagnosed with young onset Alzheimer’s before the age of 50. Second, “I’m Still Carol”. Carol Poole was diagnosed with Mild Cognitive Impairment (MCI) in 2013 and probable Alzheimer’s disease in 2014 at age 65. Remarkably, these two individuals continue to give beyond their personal burdens – sharing their experiences in hopes that it will advance a cause and help others.
To relay these stories further would not do justice to the love, compassion and caring commitment they represent. Suffice to say, these stories were heart wrenching and inspirational
– proving that Emotional Magic can fuel both the purpose and passion for evolving communities of practice around Memory Care. It certainly did for us.
SHARE YOUR STORY
In reflecting upon the Program Experience, the Disney backdrop certainly has relevance to our business models for Memory Care. We too can deliver those magical moments through intentional best management practices that are informed by our own narrative and brand identity. To be successful, we must support and sustain our own business culture that delivers on our promise of Person Centered Care – recognizing that Memory Care is indeed about validation and empathy. Our employees need to be genuinely engaged in a unified and integrated fashion with intentional purpose of enriching lives in the moment. Similarly, our service environments need to deliver the atmosphere and amenities conducive to comfort and care. Above all, our leadership needs to exercise the integrative thinking attributes that ideally empower, align and motivate our collective efforts by sharing stories that bind our thoughts and actions.
Data standards and integrity are arguably the two most critical ingredients when you consider achievement at either the (individual) human or (collective) global scale. There is no causation absent data (information) and there is no consequent execution unless it has been purposefully structured and validated for sharing. Healthcare Reform promises innovation in care delivery by increasing the transparency of data and quality metrics but how can you improve on something that doesn’t ideally exist yet?
When the OIG released its report, The Medicare Payment System for Skilled Nursing Facilities Needs To Be Reevaluated, they noted a 29% margin (overpayment) for therapy service reimbursement. Further, Skilled Nursing Facilities (SNFs) increasingly billed for the highest level of therapy even though key beneficiary characteristics remained largely the same. Achieving information access and coordination throughout the “Continuum of Care” requires a call to action for better interoperability and data management practices if we want to be successful in the future value based / bundled payment systems. Common standards for (1) assessment/documentation, (2) secure exchange of EHR/PHI and (3) compliance/accountability across the Continuum of Care (Hospital to Skilled Nursing & Rehab to Home) need to be pioneered further before they can be adopted and enhanced. The Electronic Health Record (EHR) is arguably at the root of this opportunity but all business information has relevancy.
Introducing The 4th Industrial Revolution
As thought leaders on the world stage prepare us for the Fourth Industrial Revolution and Web 3.0 (The Semantic Web), we are reminded of the inequity gap that exists between enterprise level organizations, technologists and the remaining 99% of data users. That it to say that if best practices in knowledge management trickled down to Healthcare delivery the marketplace could be transformed very quickly. We get a glimpse of the future of work and mobile health when we watch a TED Talk or purchase a personal device with updated features but when will mainstreet be touched by technology that addresses productivity and information sharing in a more meaningful way?
Senior Living – as a subordinated subset of established industry classification(s) represents a now distinct and emerging asset sector, yet uniquely representing a blend of real estate; healthcare services; and hospitality. Everyone chatters about technology, disruption and innovation but we fail to emphasize two clear imperatives;
Simple, shareable language makes everything technically possible.
Business challenges have frequently been met and overcome in adjacent spaces (as the YouTube clip above intimates) if we only had the eyes to see them.
We must look to other industries to inform data initiatives that drive and define our evolving identity and moonshots. Of all the data we amass, what is more relevant to quality and compliance than the MDS? And how does that documentation relate to an EHR or related Protected Health Information (PHI)?
Stepping out of the Sandbox
There are too many languages in the medical community and they often represent overlapping or redundant concepts. Consider this post’s leading sub-title that suggests how innovation is intrinsically connected to interdisciplinary thinking. For example, IF we operate in a SNF setting and have a Medical Director as part of our Quality Assurance and Performance Improvement (QAPI) Committee but don’t understand either (1) the correlation between Quality Measures on Nursing Home Compare and the corresponding fields on each Minimum Data Set submission, or (2) the relationship between those measures and the 254 quality measures that CMS identified for the PQRS in 2015 (mapping to the U.S. National Quality Standard (NQS) health care quality domains), THEN, it is clear in this one trite example that we really need to rely on each other’s knowledge if we are going to make this work. Is it possible that there is a future scenario on the horizon where a more connected and semantic web will learn how to navigate and connect these complexities for us? The question becomes, how much accountability should we have for understanding and correlating all of these terms and frameworks? Leading from behind is not the sustainable solution.
The Need for Interoperability Standards
You are likely consuming this blog entry on a mobile device that is connected to the Web. The internet works because it operates upon open standards that have been established by the World Wide Web Consortium (W3C). If you are a designer or developer, you understand that you cannot create anything successfully without employing these interoperability standards in your own work product. On the other hand, we business consumers remain steeped online and in conferences with little emphasis on the need for knowledge to transfer.
The following clip references a government commissioned the JASON report that identifies what we have been getting wrong in our industry and prescribes an approach for fixing it:
It is clear that brilliant people endeavor to solve our problems beneath the surface-level chatter of our practice and headlines. They need our insight if the solutions they develop are to be (1) fast-tracked and (2) widely distributed. Our more active and collective engagement and collaboration will help make this happen.
The challenges we confront in our sector (and frankly the majority of business industries) are downstream of lacking interoperability standards; inadequate reporting capabilities; and too few safeguards to ensure data integrity. The commodity of business intelligence is the new currency
of sustainable business success.
The call to action is simple. We need to be alert to exhibiting trends and become better data managers. We offer the following recipe for ACTIONS:
A – ssess and appraise current information systems capabilities.
C – orrect conditions of inadequacy, inaccuracy and redundancy of data gathering.
T – ransition reporting capabilities to achieve full integration for all users.
I – nterpret data intelligence routinely to inform best practice management.
O – pen and share data with collaborative partners to promote new prospects.
N – urture systems reporting to foster data integrity and build business bridges.
S – eek outside resources to develop and maintain data integrity.
Providers in our sector who best capture, manage, share and act upon reliable business data will be the survivors and prosper. New standards like FHIR promise to transform the way we conduct business and deliver quality outcomes but they represent future solutions. Data integrity defines not only your business identity, but importantly, your performance history and ratings in the marketplace. The Five Star Rating system in the skilled nursing sector is a good example of how reported data defines a business brand. Take charge of this information flow; ensure its integrity; and manage it to your advantage now before it is too late. That constitutes leading from the front.
Need guidance with your ACTIONS? Contact us to learn how we can help.
The “Seniors Housing & Care” tagline has been seemingly subordinated in a move that exhibits how the industry is being redefined. Although it was not stated explicitly, the original NIC symbol conjured a capital/institutional sentiment with its currency-inspired graphic whereas the new combination mark reflects a sea change that recognizes how data and its interpretative analysis are paramount to the survival of products and services that are now defining a broader sector – one evolving from “need driven” housing & healthcare services for seniors and now extending to “market driven” wellness and lifestyle delivery – ultimately for everyone.
As business and financial advisors focused on supporting regional providers of the industry, we value the NIC Conferences as an opportunity to step away from the trenches and immerse ourselves in ideas and best practices that represent a “collective IQ”. While we foster new messaging for our industry identity, we are reminded that we are all experiencing dramatic and unprecedented change, ripe with opportunity for those alert to exhibiting trends and signals.
As the NIC tagline suggests, data is of little use absent analysis and connections. In his opening remarks, Former Utah Governor Mike Leavitt relays similarly that “information gathering and making sense of weak signals is critical to success.” In this post, we share takeaways from the opening session together with select NIC Talks featuring Ken Dychtwald, Billie Jean King and Joseph Coughlin. When you synthesize the talking points it becomes clear that cost, value and messaging need data, analysis and connections if a clear narrative is to emerge.
Mike Leavitt suggested in his opening remarks that the value-based payment system is one of the most significant changes confronting the US Healthcare system and its future remains uncertain. How can we drive the implementation of these changes more quickly and who will take center stage? Senior care providers can respond in three ways; (1) fight and die; (2) go along and have a chance; or (3) lead and prosper. More specifically, he offered that there is an open opportunity to become what he refers to as a “Strategic Aggregator” in our evolving coordinated network. In simple terms, this role could be understood as the “general contractor for medicine,” someone who is able to crack the code of a fee-for-value service world.
Connection, Purpose and Meaning
“Who are the boomers going to be when they get older? If you get that wrong, you’re out.”
As the Founder and CEO of Age Wave, Ken Dychtwald relays that messaging, marketing and communications provide the largest barrier to our industry and that we will likely be challenged to turn market sentiments around. In sharp contrast to the linear model of aging that we are accustomed to, there is a “longevity bonus” on the horizon and we will need to establish a new narrative for how to keep connection; purpose; and meaning at the center of our offerings. Ken proffers that “if you are building your communities, and your marketing and your intelligence is based on the 20th century notion that people will really want to stop work, separate from society and not do much of anything other than relax and socialize and be called seniors, you are going to fail. I don’t want you to fail.”
What can we do? We need to tell a better story that works to address the core issues of loneliness and peace of mind but emphasizes how we support a reinvention of life so that the prospect of new active aging possibilities are front and center. We need a new narrative that better communicates our offerings – displacing negativity and ignorance about the industry. We need to create on-ramps for reinvented offerings and exit-ramps from the “Fortresses for the Old”.
Relationships, Learning and Problem Solving
Billie Jean King framed her session with recognition that “Sports is a Microcosm of Society.” From an early age she had a purpose and a goal that intentionally leveraged her tennis career to champion social change. As the active aging ambassador for Atria, she shares her insight that inner and outer successes rely upon relationships, learning and problem solving. Atria doesn’t use the word “senior” any longer but Billie highlights the value she has always placed on older people – while admitting that she now feels the influence of ageist stereotypes personally.
Elders are a source of wisdom where we can better tap into and leverage the value of life experiences they offer. Stay active, keep learning and recognize that relationships are everything. Personalized engagement is key to promoting well-being and should be fostered through important opportunities for acts of kindness. “Active is happy.”
Excite and delight
We are reminded by Joseph Coughlin of MIT’s Agelab that it is the convergence of technology and the consumer that bring real innovation into the marketplace. He advises us to focus on what we are trying to accomplish first and then try to find technology that will help to accomplish those goals. Technology is the “tool box”. While musing about the impact of “aging in place” technology, he notes that a tech-enabled service that could keep you in your home for an extra six months could have a $34B impact on the industry.
The major takeaway? Senior providers have the expertise to hop over the fence and develop relationships with people in the community before they even need your services. Building a pipeline into the Home & Community service realm is critical but we must be reminded to “excite and delight” with our offerings. “Generation Expectation” believes that there is a “product, policy or pill that will enable them to live longer and better” and innovators that can answer the call will be well rewarded. New players will be branded by collaboration in a newly defined sharing economy. Life on demand through apps will continue to emerge with a focus on wants as well as needs. Having it all and owning none of it is the value proposition. Above all, you’ll need a good marketing team to get your messaging right.
Where do we go from here?
Recognize that your are missing out on 90% of the market and focus on strategies for minting new customers (and staff) while reinventing and effectively messaging. Don’t try to guess what the whole market wants/needs.
Cultivate your own identity and engage followers wherever they are.
Seize opportunities to augment and or integrate your current offerings with community programs and services that are beyond your walls and intergenerational.
Find ways to incorporate programs for active aging, longevity and wellness.
Promote opportunities for lifelong learning, engagement and problems solving through new relationships and technology that “excites and delights” all ages.
Get your messaging right and get it out there effectively.
This is an important issue because we want to update you on a project that we have been working on for well over a year called Sectour. Issue # 003 will provide you with a quick introduction to the project and also showcase some recommended content (new and old) from CCA and around the web…