1. Caring for the expanding patient population Gero-Friendly Clinic Redesign Project Prepared for The Power of Community Health 15 th Annual Health Care Symposium April 1, 2016 Prepared by: Katheryn Howell, Project Director

2. Setting the stage for change The surge in the aging population coupled with the shortage of geriatrics-trained providers in community health centers (CHCs) may threaten the quality of care for older adults, particularly in the safety net. CHCs have traditionally focused on care for Medicaid beneficiaries, but payment reform under the Affordable Care Act incentivizes CHCs to care for Medicare beneficiaries.

3. The 65+ population will have grown by over 100% in the three decades since 2000 Source: https://www.urmc.rochester.edu/aging-research-health-services/about-us/caring-challenges- opportunities.aspx Last accessed 3.21.16https://www.urmc.rochester.edu/aging-research-health-services/about-us/caring-challenges- opportunities.aspx

4. Where are the Geriatricians? By 2030, roughly 31 million Americans will be older than 75, the largest such population in American history Approximately 7,000 geriatricians are in practice today To meet demand, medical schools would have to train at least 6,250 additional geriatricians between now and 2030, or about 450 more a year than the current ratemedical schools See: KATIE HAFNER As Population Ages, Where Are the Geriatricians? The New York Times Jan 25, 2016 http://www.nytimes.com/2016/01/26/health/where-are-the-geriatricians.html?_r=0 Last accessed 3.21.16KATIE HAFNER http://www.nytimes.com/2016/01/26/health/where-are-the-geriatricians.html?_r=0

5. The Gero-Friendly clinic is an enhanced model for an older adult population of patients ages 65 and over that promotes quality care by design (including access, clinical practices and more).

6. Pilot Site Testimonial: “We brought our clinic staff together around the issue of geriatric care for the first time. This pilot is a great way to catalyze your clinic's awareness of geriatric care and how it is, or is not being provided to your patients. It prompts a close inspection of current processes and highlights deficiencies, allowing for discussion of next steps.” -MD & Director of Primary Care & Gero – Friendly Clinic Champion

7. Gero-Friendly Clinic Project Tools: 1.Geriatric Knowledge Network 2.Readiness Assessment Tool 3.Gero-Friendly Clinic Report 4.Operational Assessment Tool 5.Practice Facilitation

8. The Geriatric Knowledge Network  Evidence-based, best practice guidance from geriatric specialists. Project ECHO L.A.™ is based on the acclaimed Project ECHO™ begun by Dr. Sanjeev Arora a the University of New Mexico  Live Q and A regarding your own geriatric patient cases and their conditions. Create a case based learning loop and a community of practice  Opportunity to translate new knowledge into practice to improve patient outcomes for chronic conditions commonly seen by primary providers  Didactic presentations from faculty and specialists, offering opportunity for “One-on-One Training” with local and highly trained geriatric specialists

9. Providers can expect mentor-led sessions in these core areas:  Approach to the older adult  Care Systems  Syndromes  Psychiatry  Disease and Disorders  In addition, mentor led modules address areas requested in feedback surveys, including fitness/exercise and decision-making regarding surgery, tests, and treatments for older adults. Next Session: April 13th : Diabetes Management in Older Adults * Bring your own geriatric case to submit for the mentor review

10. The Readiness Assessment The Gero-Friendly clinic is an enhanced model or setting for an older adult population of patients ages 65 and over that promotes quality care by design (including access, clinical practices and more).  Evaluate a provider’s current level of Gero-friendliness and help determine which best practices one may have already adopted and identify those your care team may wish to add.  Assess current state of readiness and envision the future state of their clinic when Gero-Friendly best practices are in use.  Takes 15 minutes to complete.  Five distinct domains: Access and Continuity, Care Management and Clinical Practices, General/Leadership, Patient Support and Community Resources and QI/Performance Measurement.

11. The Gero-Friendly Clinic Report  Gives the Care Team feedback summarizing the teams answers to the Readiness Assessment.  Care Teams can choose those areas to pursue change.

12. The Operational Assessment Tool  Action items are grouped to the domains provided in the Gero-Friendly Readiness Assessment Tool.  A clinic's quality improvement team are asked to choose items that are actionable and that would address any issues or problems that have been identified.  Clinics can start with any domain that is of most interest to their team and that the items therein are suggestions toward Gero-Friendliness.  Teams can choose to select a few simple items to work on as a starting point, and add more as is appropriate.

13. Practice Facilitation ii. Primary Care Practice Facilitation Curriculum MODULE 18 https://pcmh.ahrq.gov/sites/default/files/attachments/pcpf-module-18-assessing-readiness.pdf

14. Interested? We have something for everyone!  Register as part of the Geriatric Knowledge Network. It’s easy and CMEs are made available through AAFP and CEUs are pending approval with NASW.  Invite Partners Gero-Friendly project team to your next all-staff or provider meeting.  Have a Gero-Friendly Champion? GREAT! We are scheduling pilot sites NOW!

15. - Questions - Katheryn Howell Project Director Partners in Care Foundation 818.837.3775 ext: 115 Khowell@picf.org The Gero-Friendly Clinic project is made possible with the generous support of the Kaiser Foundation Hospitals