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|July 26, 2018
NEW SMMC PROGRAM GOALS ESTABLISHED BY AHCA FOR MEDICAID LONG TERM CARE
Medicaid New Five-Year Contract Begins January 1, 2019
Two of these goals have significance to the nursing home community: (1) to reduce potentially preventable hospital events (PPEs) - Admissions, Readmissions, Emergency Department Visits; and (2) to increase the percentage of enrollees receiving long-term care services in their own homes or the community instead of a nursing facility.
If you are interested in reviewing the entire section of this contract to further understand why or to explain to the resident’s family the case manager’s interview requests, please contact me.
If you have questions, please contact Dana McHugh via email or by calling her at (850) 339-2909.
Goals of Care Discussions in Long Term Care
A hot topic in long term care is “person-centered care.” In fact, the latest guidance for managed care plans state that:
“Person-centered care” means that individuals’ values and preferences are elicited and, once expressed, guide all aspects of their health care, supporting their realistic health and life goals.”
A key term in this definition is the addition of life goals to the usual medical discussion. Thus, person-centered care is not just about discussions of end-of-life care, but really about how the person wants to live, regardless of the time left.
What is your understanding of your present situation?
This provides an opportunity to clarify any misunderstandings and offer more information about available choices. This often opens the door to the next question:
What is most important to you in your life right now?
This question often is the first opportunity a resident has been given to talk about his or her goals and can be very meaningful to the resident. After some further clarification of what is important a useful question to elucidate the resident’s goals is:
What would you like to see happen over the next year in your life?
At this point it is important to simply listen attentively, asking probing follow-up questions. If there are scenarios that are unlikely to occur (e.g., “to go back to living in my own home”) it is best to wait until the next conversation to develop a deeper understanding of the resident’s thoughts on this matter. Too early presentations of “reality” will only set the resident up to being in an adversarial position. A better approach is to acknowledge the resident’s concerns and views. A statement like:
I hear what you saying that you would like to see x, y, and z happen in the next year. I look forward to talking more about that with you.
There are other questions that can be used when discussing specific questions such as intensity of care or end-of life decisions. These will be addressed in future articles.
RIPPED FROM THE HEADLINES
Rumored Amazon Pilot Would Target Hospital-to-Home Transitions. Two health systems are reportedly working with Amazon (Nasdaq:AMZN) and a startup called Xealth, with plans to launch a pilot program that could ease patients’ transition between hospital and home. Read more...
Health plan updates
Staywell, WellCare’s Medicaid health plan has provided an updated Florida Medicaid Provider Resource Guide.This guide explains how to access their provider portal and all the capabilities within the portal. Read the Guide...
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