A Solution to the Whack-a-Mole Style of Management
By Margherita Labson, CHAP Strategic Advisor
If you’ve worked in home-based care, there’s a chance you’ve felt like you are playing a game of whack-a-mole operations and management. Meaning every time you turn your attention to one metric or KPI, others break while you focus on that one. Sound all too familiar?
- You work on lowering your rehospitalization rate and your pharmacy per day and Physician costs go out of WHACK.
- You streamline clinician routing to reduce windshield time and your availability for new admissions tanks and referrals drop.
- You adopt a revised cardiac protocol to improve functional mobility outcomes and your therapy referrals double but so do your patient complaints because home health aides aren’t able to get to their assigned patients before therapy arrives.
WHACK-A-MOLE! As a clinical or operations leader – giving balanced and efficient guidance can sometimes prove to be more difficult than it should be. A framework like the 4M’s of age friendly care create that balanced approach to patient care and management. The 4M’s Framework helps providers improve the experience and satisfaction of both the patient and the clinician simultaneously.
Hospitals and health systems have been seeing improved results from the Age-Friendly approach, and now in-home care providers can now join the movement and reap the benefits of the quadruple aim: Enhancing the Patient Experience, Improving Population Health, Reducing Cost of Care and Improving Provider Satisfaction.
The Problem Facing Many Agencies
Many agencies and smaller home care providers are challenged to maintain reliable operations, assure clinical excellence and grow the business without another problem arising. Age-Friendly Care addresses and solves many of these issues.
According to the US Census Bureau, the US population aged 65+ years is expected to nearly double over the next 30 years, from 43.1 million in 2012 to an estimated 83.7 million in 2050. These demographic advances, however extraordinary, have left our health systems behind as they struggle to reliably provide evidence-based practice to every older adult at every care interaction.
Most healthcare providers struggle to serve the aging population’s evolving needs and expectations. The Age-Friendly Care framework delivers robust insight into those key areas where providers should focus their efforts towards delivering a reliable contemporary set of interventions. In other words, this framework calls on providers to select the evidence-based practices that are best determined to meet the needs of the older populations that they serve.
Your Whack-a-Mole Solution
Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association and the Catholic Health Association of the United States (CHA). The initial goal was to rapidly spread the 4Ms Framework [link] to 20% of U.S. hospitals and medical practices by 2020.
This initiative exceeded its original goal, and more than 1,950 health care organizations joined the movement by the end of 2020. More than 2,800 health care organizations in the U.S. are now part of the Age-Friendly Health Systems movement.
Age-Friendly Care helps achieve: 
- Better healthcare outcomes for this population
- Reduced waste associate with inferior quality of services not properly designed
- Increased utilization of cost-effective services for older adults
- Improved reputation and market share to handle the increase in aging populations
Improved patient experience translates to a richer relationship and increases opportunities for patient engagement and self-care. In turn, the opportunities for employees to experience a professionally satisfying work experience enables organizations to develop strong rates of retention and improved work-life balance for all staff. Everyone involved benefits when an organization develops, as a standard way of working, those evidence-based approaches that have been determined to be reliable and the most appropriate for the populations served. When staff begin with determining “What matters most” to the patient, the individualized plan of care becomes truly patient-centric plan. Using What Matters Most” creates the opportunity for patient and clinicians to meaningfully co-create the experience so that the emphasis is no longer on a medical diagnosis but rather on engaging as an equal partner in his/her care choices and activities. Collectively the patient receives safe, reliable care, and clinicians organize their practice, priorities, and approach ensuring they are prepared for meeting the patient’s needs.
What CHAP is Doing to Help Agencies
The problem that still exists is bridging the Age-Friendly Care gap between those being released from the hospital to home care or hospice. We can assist homecare providers with the tools necessary to make financial returns on their investment of becoming AFC in the Home Certified. The following tools can be broken down as: 
- Adopt a Perspective
- Determine Additional Costs
- Estimate Financial Benefits
- Estimate ROI
- Compare ROI and Hurdle Rate
- Conduct Sensitivity Analysis
Factors that tend to further strengthen the case for providing AFC through a favorable ROI 
- High Baseline Medical Utilization
- Expensive Medical Events
- More Effective Age-Friendly Health System Program
- Lower Implementation Costs of an Age-Friendly Health System Program
- Ability of the Investing Party to Capture the Financial Returns
- Potential for the Age-Friendly Health System to Generate Additional Revenues
 Age-Friendly Health Systems: A Guide to Using the 4Ms While Caring for Older Adults