I’m not an enormous football enthusiast, but watching a game yesterday led to a clarifying moment — let’s fix healthcare by hiring Vince Lombardi (as a euphemism for team-oriented leadership).
Imagine a football team where every player functions in their little bubble (their specialty), unaware of their teammates’ strategies (operational and financial), not passing the ball (I own the patient), or even clashing on the field (we’re in different networks and environments). The true quarterback (the patient and family) doesn’t know where the receivers are, and the linemen (the full range of providers) have no clue which way the running back is headed. This would be painful to watch, and this lack of coordination would undoubtedly lead the team to lose.
If you are wondering, “What does football have to do with the care of older adults?” you have not helped a parent or grandparent through the health system, nor do you work within the healthcare system. So let me help — the lack of coordination can be as disastrous as a disjointed football team but with far greater impact.
Historically, various participants in the care journey, including the patient, family, informal caregivers, community-based organizations, and the formal health system, have functioned in silos¹. These separate, isolated entities rarely communicate or coordinate, frequently leading to fragmented care.
Healthcare (viewed to include health, wellness, and the social determinants of health) may be the most important aspect of our lives. How could this “system” be so bad when we spend so much and the providers are so good (at least for a population segment)?
Structural Barriers: A primary structural barrier is the historical development of specialized sectors, like acute care, long-term care, and home care. While specialization can be suitable for targeting specific needs, when they don’t communicate, and the broad care team does not have a joint strategy, the outcome is suboptimal².
Payment Models: Fee-for-service payment models, which reward volume over value, have inadvertently encouraged siloed care. It’s like paying a wide receiver for each sprint, regardless of whether he catches the ball or not³. While well-intentioned, human nature incentivizes almost all of us to work based on the goals associated with our performance — not the greater good of the team.
Societal Impediments: Our society tends to undervalue the role of the patient, family, informal caregivers, and community-based organizations. In addition, there tends to be a focus on the outcomes we deem appropriate, as opposed to the needs and objectives of the patient — even if their preferences differ from ours. This is akin to disregarding the crucial roles of coaches, cheerleaders, fans, or even Taylor Swift, who, while not playing directly on the field, significantly influence the game⁴.
Better Quality of Care: When care is coordinated around the patient, healthcare outcomes dramatically improve. Like a football team that’s in sync (rarely the Jets), they score touchdowns more often⁵.
Cost Savings: Research shows that coordinated care reduces unnecessary hospital readmissions, leading to significant cost savings⁶.
Holistic Approach: Involving family and informal caregivers leads to a more complete understanding of the patient’s needs. It’s like a quarterback understanding the entire field and making better passes⁷.
Luckily, the market recognizes these challenges and is continuing to shift.
Value-Based Care: Emerging models, like bundled payments and accountable care organizations, reward outcomes and encourage providers to work together. These changes are proving to be game-changers, much like when a football team finds a star player who elevates the entire team (and does not get injured in the first five minutes of the season)⁸. While many of these concepts make sense, aligning interests and evolving the market is a slow process.
Technological Platforms: Digital platforms are beginning to connect providers, patients, and caregivers in previously unthinkable ways. While early in the process, it’s like a football team using advanced tech to strategize and communicate in real-time — it makes a difference⁹.
Empowering the Community: There’s a renewed focus on involving community-based organizations and understanding their value in providing high-quality, culturally sensitive care¹⁰. Community health workers and community-based organizations maintain trusted relationships, which can influence patient relationships far more than many others in the healthcare system.
So, while the challenges in coordinating care for older adults remain significant, the movement toward integration and coordination is promising. Like a football team that learns to play in harmony, the future of elder care is on a trajectory toward better care. And just as a coordinated football team generates points and is fun to watch, a coordinated care approach means a better quality of life for our aging loved ones and improved outcomes.
¹ Smith, M., & O’Hanlon, C. (2020). “The Fragmented Care Conundrum”. Journal of Geriatric Medicine.
² White, A. (2021). “Structural Barriers in Holistic Care”. Health Systems Review.
³ Patel, R., & Grey, M. (2021). “The Pitfalls of Fee-for-Service Models”. Medical Finance Quarterly.
⁴ Liu, F., & Zhang, T. (2022). “Recognizing The Unrecognized: The Value of Informal Care”. Journal of Community Health.
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