4 Strategies to Bring Population Health to Your Food and Nutrition Services Program<p><img src="/Breaking-News/PublishingImages/headshots/LisaRoberson.jpg" alt="Lisa Roberson" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />​It’s not enough to just care for patients inside our facilities. We must think bigger these days—for the good of the patient, community, and our organization. That’s where population health comes in. It has long been a buzzword, but as an industry, we have an opportunity to bring the concept to life. Skilled nursing and long term care facilities can learn from other areas of the health care industry to fully integrate population health programs into their food and nutrition services.</p><p>Population health initiatives are an important factor in caring for an entire community, but they also can have a tangible impact on a long term care or skilled nursing facility’s finances by controlling costs, improving outcomes and increasing patient satisfaction scores. Here are four key points to drive success through integrating population health within food and nutrition services.<br></p><h3>1. Invest in a sustainable supply chain.</h3><p>Where our food comes from matters. It matters from a freshness and taste perspective. It matters from a health perspective. And it certainly matters from a sustainability perspective, which recently came to light during COVID when our supply chains were strained.</p><p>Food travels an average of 1,500 miles to get from the farm to your plate. That leaves a significant carbon footprint. In all, food production is responsible for a fourth of the world’s greenhouse gas emissions. That is not sustainable.</p><p>We need to create a cleaner, greener supply chain. That journey starts with sustainability of logistics, produce sourcing, and packaging. By purchasing locally, long term care facilities can source produce that is picked and eaten at the peak of ripeness, which means it is denser in nutrients and, thus, more nutritious. This leads to a sustainable sourcing model as well as a successful business infrastructure in the community. In addition, diversifying suppliers through both number of sources and social backgrounds has proven to be a successful approach to promote sustainability.</p><p>A sustainable supply chain is more than just an environmental initiative or way to promote goodwill in the community. It is a smart business move. It is caring for the population as a whole and creating channels to get the critical resources you need to care for patients.</p><h3>2. Rethink menus.</h3><p>Creating healthier populations from a food and nutrition services perspective starts with our first touchpoint—patient dining. We need to create healthy options that foster wellness. That means no antibiotics or growth hormones, while encouraging fresh produce and low-fat proteins. All this needs to be done while maintaining delicious flavors. Menu creation can be the first step in a population health strategy.</p><p>One area where I’m seeing significant growth is with plant-based diets. Studies have shown the advantages of a diet rich with plant-based food, including lower abdominal fat, cholesterol, blood sugar, and BMI compared to study participants consuming a diet of predominantly animal protein. And 58 percent of consumers say they want to increase their plant-based protein consumption.</p><p>Rethinking our menus and taking particular care to craft dishes focused on fitness can lead to both immediate and long term improvements in patient wellness. It’s about showing them healthier options outside of their current diet. Patient dining is the first opportunity to start that conversation.</p><h3>3. Think beyond the four walls of your facility.</h3><p>We have an opportunity to impact community wellness long past a patient’s stay. That means thinking beyond the four walls of the facility and getting facts about nutrition and its impact on wellbeing to the community. The first step of this is to change patient perceptions about healthy eating, which can have a trickledown effect on others in the household. </p><p>It can be intimidating trying to cook healthy food. Facilities have an opportunity to teach the community about the benefits of healthy eating and how to bring it to life. Setting up a teaching kitchen with your onsite dietitians or culinary staff can provide confidence for in-home cooks and empower them to live healthier lives. Some hospitals have taken this to the digital space with instructional cooking videos that are featured on social media or local news.</p><p>Even armed with the right information, there are barriers to living a healthy lifestyle. Too often underserved communities do not have access to the nutritious food that is critical to establish long term healthy habits. A programmatic approach from the facility can be expensive, but it doesn’t have to entirely come out of your already thin margins. For example, I have seen facilities invest in mobile grocery stores that are funded through grants and community fundraising. These grocery stores-on-wheels provide fresh ingredients to areas that otherwise would not have access to them, helping to eliminate food deserts.</p><h3>4. Create programs to reduce waste.</h3><p>Food waste is everywhere in the U.S. with approximately 40 percent of food produced ultimately being wasted. Health care leaders sit in a prime position to make a quantifiable impact on the industry and community. Controlling food waste makes you a better steward of your resources and helps to manage your business in a sustainable way.</p><p>While we can’t eliminate food waste entirely, we can minimize it and turn waste into community benefit. Many hospitals partner with local organizations to donate excess food. They set up composting sites to better utilize the existing waste and repurpose that waste through gardens that provide produce for patients. Additionally, being mindful of ingredients and how they are prepared impacts waste. I love to see facilities adopt a “root to stem” strategy to use the entirety of their ingredients instead of throwing out large portions of useable produce. </p><p>New technology features can be used to drive waste reduction. Through enhanced analytics, we can better track and record food waste types, amounts, and ultimate destinations (e.g., donation, composting, landfill). Through this data, facilities receive valuable insights to create new strategies to address food waste at the source. Some have been able to decrease their food waste by nearly 50 percent by utilizing technology to make better, more informed decisions.</p><p>Food and nutrition services can drive a new, healthier perspective for the community because it takes more than just a clinical approach to care for a population. The foodservice team plays an important role in supporting and assisting long term care and skilled nursing facilities to establish and expand population health programs that have many far reaching and sustained benefits for patients and communities.<br><br><em>Lisa Roberson, RDN, LD, is national director of wellness &amp; sustainability at Morrison Healthcare. She is a registered dietitian with 20 plus years of experience in nutrition leadership.</em></p>2022-11-15T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/food.jpg" style="BORDER&#58;0px solid;" />Population Health ManagementLisa Roberson, RDNSkilled nursing and long term care facilities can learn from other areas of the health care industry to fully integrate population health programs into their food and nutrition services.
Population Health Management Summit Offers Assisted Living Education Opportunities<p>​<img src="/Monthly-Issue/2022/SeptOct/PublishingImages/LaShuanBethea.jpg" alt="LaShuan Bethea" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;169px;height&#58;212px;" />The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) will host its 2022 <a href="https&#58;//www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" target="_blank">Population Health Management Summit</a> December 7-8 at the Gaylord National Harbor in Maryland. This event has grown each year, as value based care and risk-based models move into the forefront of how long term care communities—including assisted living (AL)—continue to deliver quality care and improve the lives of residents.</p><p>You may <a href="/Monthly-Issue/2022/SeptOct/Pages/Celebrating-Joyful-Moments-%26-the-Future-of-Assisted-Living.aspx" target="_blank">recall</a> that population health management (PHM) is the process of improving the health and quality of life for groups of residents. It focuses on wellness, prevention, and proactive care coordination/management. PHM models help achieve the triple aim—the right care, at the right time, in the right place. Although still a fairly new concept within AL, PHM is something that you not only need to understand but also be able to evaluate employing within your communities in order to improve quality outcomes for your residents, position yourself well in the market, and manage risk within communities.</p><p><strong>That is why it is so important for AL providers to </strong><a href="https&#58;//www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" target="_blank"><strong>attend</strong></a><strong> this year's PHM Summit. </strong>This event features an AL-specific track with sessions that will cover the why, what, and how to help you stay ahead of the curve.</p><p>Highlights include&#58;</p><p><strong>Wednesday, Dec. 7</strong><br></p><ul><li><em>Opening keynote speaker Mark McClellan, M.D., Ph.D., Director at the Margolis Center for Health Policy at Duke University</em>&#58; McClellan is a physician-economist who focuses on quality and value in health care, including payment reform, real-world evidence, and more effective drug and device innovation. He is former administrator of the Centers for Medicare and Medicaid Services (CMS) and former commissioner of the U.S. Food and Drug Administration where he developed and implemented major reforms in health policy.</li><li><em>Healthcare Transformation&#58; Why Should Assisted Living Providers Care?</em> Value based care, population health, I-SNPs, the alphabet soup continues; what does this mean for AL providers and why should they pay attention? Whether you know it or not, payors and referral sources are tracking your outcomes. What are the implications and what can you do?</li><li><em>Considerations for Assisted Living in Value Based </em><em>Care&#58; </em>Join your peers for an interactive discussion on AL, value based care, and PHM, as well as get a better understanding of the sessions focused on assisted living for the next day.</li></ul><p></p><p><strong>Thursday, Dec. 8</strong><br></p><ul><li><em>Market Strategies for Assisted Living</em>—<em>Experience from the Field</em>&#58; Consumers have always expressed their strong preference to receive care in their homes. The COVID-19 pandemic has accelerated the actualization of care-at-home services with growth in virtual care, emerging technologies, and value based care. Presenters will share models and market strategies to succeed in this changing landscape.</li><li><em>Sorting Through the ACO Maze</em>&#58; Learn about one of the primary trends driving all of health care towards more value based, alternative payment arrangements, accountable care organizations (ACOs). Take a deeper dive into the two main ACO models and gain insight into what you must consider when thinking about ACO partnerships.</li><li><em>Primary Care&#58; Do you Own, Contract, or Partner?</em> Primary care is the building block of PHM models. Given its primacy, how do LTC providers approach engagement with physicians and advance practice professionals? What do you need to consider as you evaluate your options?</li><li><em>Closing keynote speaker Ellen Lukens, Deputy Director of the CMS Innovation Center&#58; </em>Lukens has deep experience both within and outside the government tackling complex health policy issues. Prior to this role, she served as the Group Director of the Policy and Programs Group within the CMS Innovation Center, where she led the team that provides cross-cutting support for Center-wide policy and portfolio management.</li></ul><p></p><p>The time to plan for the future of AL is now—and that includes population health management. This Summit offers an invaluable opportunity to learn more about how to be successful utilizing PHM strategies and models in your communities.</p><p>I look forward to seeing you there!</p><p>Online registration for the Population Health Management Summit is open through November 30.<em> </em><a href="https&#58;//www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" target="_blank"><em>Register today!</em></a></p><p><em>LaShuan Bethea is the executive director of the National Center for Assisted Living (NCAL).</em></p>2022-11-07T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/2022/PHM_2022.jpg" style="BORDER&#58;0px solid;" />Population Health ManagementLaShuan BetheaThis event has grown each year, as value based care and risk-based models move into the forefront of how long term care communities—including assisted living (AL)—continue to deliver quality care and improve the lives of residents.
Be Prepared for the Shift to Population Health<p><img src="/Monthly-Issue/2022/NovDec/PublishingImages/MikeCheek.jpg" alt="Mike Cheek" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;108px;height&#58;135px;" />​Under traditional care arrangements, health care providers are reimbursed for the services provided. It is a patient by patient, treatment-based, reactive approach. For example, skilled nursing facilities are responsible for single-benefit, skilled care under Medicare part A. This is a specific situation where care and therapies are all aimed at rehabilitating the patient to levels of function prior to surgery, an accident, etc. <br></p><p>On the other hand, population health management (PHM) is a data-driven, holistic approach to care delivery and patient outcomes of a group of individuals, whether that cohort be defined based on the setting (i.e., nursing facility or assisted living) or chronic condition (i.e., dementia, COPD, etc.) or other feature. This “managed” care model means that everything from doctor visits to medication to specialty services—and the interactions between them—is governed from a proactive, preventative, and coordinated standpoint. This type of value-based care model rewards operators that improve care and reduce costs. Residents in skilled nursing facilities and long term care facilities receive higher quality, more timely care and a better overall experience, and the government achieves its goal of reducing per capita cost.</p><h3>Moving from Fee-for-Service to PHM </h3><p>The Centers for Medicare &amp; Medicaid Services (CMS) and states are heavily focused on moving from fee-for-service and payment by volume to value-based care and PHM models, thereby also driving health plans, health systems, and physicians groups down this path. Being able to understand and adopt population health approaches is critical if long term care providers want to move upstream in the health care reimbursement food chain. For example, Medicare Advantage in 33 states grew by double digits, and there are states where Medicare fee-for-service is irrelevant. Over the last 20 years, the over-65 population has gradually migrated to managed care.<br></p><p>Adopting a PHM model benefits facilities by capturing more dollars for care, being efficient with those dollars to achieve high-quality outcomes, and allowing a range of risks for costs. There providers can have their own plan or partner on shared savings or other value-based reimbursement arrangements. </p><h3>AHCA/NCAL’s Population Health Summit</h3><p>A key step is understanding the PHM options and potential paths to engagement. AHCA/NCAL’s Population Health Summit will be held on December 7-8, 2022, at the Gaylord National Harbor in Maryland and offers long term care providers further exploration, solutions, and opportunities in PHM. This summit will equip providers with the first steps to move away from the fee-for-service environment and into managing the whole person. <br></p><p>The summit features sessions for providers just entering the space, those well into the space, and those looking to create local and regional relationships. Networking is vital because the regional nature of PHM models relies upon a variety of plan owners, provider networks, and even part owners. Additionally, it is an opportunity for providers to share best practices of managed care to improve quality care and the overall experience for residents. There will be sessions specifically for independent owners and assisted living operators as well.<br></p><p>There will be education on all levels of risk, from launching an institutional special needs plan, being involved in sub-capitation payment plans, or joining a preferred provider contract with an accountable care organization. This will allow attendees to find the right path at the right time for them to take on risk bearing and PHM approaches.<br></p><p>Dr. Mark McClellan, a former CMS administrator, will deliver the opening keynote. His research at Duke University’s Margolis School for Public Health about PHM models has been forward thinking and innovative. The closing keynote will be the deputy director for the Centers for Medicare &amp; Medicaid Innovation, Ellen Lukens, talking about the innovation center’s vision for acute and long term care providers in their approaches to moving away from fee-for-service and to paying for value of care. </p><h3>Don’t Be Left Behind </h3><p>Traditional fee-for-service is largely going to be gone by 2030, replaced by a system that holds providers accountable through partial and total cost of care models for quality and outcomes. If you’ve not started to think through how you will function either as a meaningfully engaged partner in a value-based reimbursement environment or a risk-bearing entity, you’re going to be at a very serious disadvantage. <br><br><em>Mike Cheek is senior vice president for reimbursement and market strategy at AHCA/NCAL. Cheek and the reimbursement team work on traditional Medicare and Medicaid issues as well as with members to move into new, innovative PHM approaches.</em></p>2022-11-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/NovDec/PublishingImages/PHM.jpg" style="BORDER&#58;0px solid;" />Population Health ManagementPHM is a data-driven, holistic approach to care delivery and patient outcomes of a group of individuals.
Where Innovation Meets Data<p>​“The core advantage of data is that it tells you something about the world that you didn’t know before,” said Hilary Mason, a data scientist. <br><br>The American Health Care Association (AHCA)/National Center for Assisted Living (NCAL) is changing the way the long term and post-acute world gathers, analyzes, and shares data through the Long Term Care Data Cooperative. <br></p><p><img src="/Monthly-Issue/2022/NovDec/PublishingImages/LTC%20DataCoop.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;200px;height&#58;121px;" />The Cooperative is the first of its kind in the world. Formed in partnership by AHCA/NCAL and Brown University and funded by the National Institute on Aging, the Cooperative is an effort to improve the quality of care within skilled nursing care centers through a new—and collaborative—approach to gathering and sharing patient data. Both the scale and the methods for aggregating data give the Cooperative its innovative edge. This large-scale effort involves any long term or post-acute care center across the nation that chooses to enroll, and the data are being gathered from multiple electronic medical record (EMR) software vendors into a single repository of information.<br></p><p>“This project was born out of a real need for better data during the pandemic,” said Dr. David Gifford, MD, MPH, chief medical officer and director of the Center for Health Policy Evaluation in Long Term Care at AHCA/NCAL. “It started with an idea of gathering data to truly understand how infection prevention methods were working within centers across the country and to gain better insights into the effectiveness of the vaccines. It grew from there into a look at the effectiveness of practices and the research required to make critical decisions about patient care.”</p><h3>Determining Effectiveness of Treatments</h3><p>In the long term care sector, the vast majority of treatments, medications, and practices that are adopted for use within nursing homes are often developed outside of the nursing home environment, explained Gifford. Their effectiveness for this population is unknown. Gaining access to long term care patients and data is complex, and researchers often use settings or younger populations more conducive to testing and data gathering.<br></p><p><img src="/Monthly-Issue/2022/NovDec/PublishingImages/DavidGifford.jpg" alt="David Gifford" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;108px;height&#58;135px;" />“The challenge then is determining what is truly effective and—equally as important—what is not effective specifically in a long term care environment,” said Gifford. “The Co­operative is helping to change this by providing access to real patient data for verified research opportunities.”<br></p><p>Through the Cooperative, vetted federally funded researchers would have access to data in a way that’s never been available before. Nearly 1,000 centers have signed up to participate in the Cooperative completely free of charge. As enrolled providers, these centers will feed real-time data from their EMRs to the Cooperative, where it will be translated into a shared data platform. As more centers participate, more data become available, offering better and more realistic insights into the effectiveness of treatments than have ever before been provided. </p><h3>Providers Led the Effort</h3><p>The benefits to researchers are numerous, but all research will be guided by the decisions of providers. Researchers will need to move through an extensive approval process to gain access to the Long Term Care Data Cooperative, which will include input from participating providers, who will have the opportunity to review each application and decide on appropriate uses of data. <br></p><p><img src="/Monthly-Issue/2022/NovDec/PublishingImages/LonnitaMyles.jpg" alt="Lonnita Myles" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;108px;height&#58;135px;" />“This is, above all, a provider-led effort,” said Lonnita Myles, project director of the Long Term Care Data Cooperative. “We are involving providers every step of the way through town halls, one-to-one interaction, and large-scale feedback reports.” <br></p><p>All participating centers in the Cooperative receive feedback reports, which can greatly influence patient outcomes, explained Myles. The comprehensive collection of data is an ongoing process that will continue for years to come, enabling centers to gain more insights with every new report.<br></p><p>“These feedback reports are a repository of all collected data, and it is an extremely effective roadmap to help providers decide what to do next. They will have the information they need to make important decisions within their own care centers,” said Myles. “The real impact of the Cooperative is the ability to see the effect of decisions as measured through data, thus allowing providers to take informed and educated next-steps in initiatives, procedures, and more.”</p><h3>Connecting EMR Data to CMS Claims</h3><p>In addition to feedback reports, centers are able to view linkage of available EMR data to Medicare claims. The Cooperative’s data-streaming process, which has been pioneered by data science expert Exponent Inc., will merge EMR data with CMS claims data to give centers rapid access to information about critical measures of quality care, such as rehospitalization rates. <br></p><p>Finally, participating centers have direct access to AHCA/NCAL leadership involved in the Cooperative as well as to experts in the industry who are connected to the Cooperative. The barrier to entry is low for centers who are interested in enrolling. In less than 30 minutes, most centers can complete the registration process. Additional introductory calls and information gathering will be coordinated by AHCA/NCAL. The process is completely free for all centers, and centers do not need to be active AHCA/NCAL members to participate. <br></p><p>“The existence of this program means it’s already a success,” said Gifford. “More than a thousand centers have enrolled, we’re receiving applications for research, and word is spreading. This is something that’s never been done before—and we’re proud to be behind it.”<br></p><p>For more information on the Long Term Care Data Cooperative or to enroll, visit <a href="https&#58;//www.ahcancal.org/Data-and-Research/Pages/LTC-Data-Cooperative.aspx" target="_blank">https&#58;//www.ahcancal.org/Data-and-Research/Pages/LTC-Data-Cooperative.aspx</a> or contact <a href="mailto&#58;LTCDataCooperative@AHCA.org" target="_blank">LTCDataCooperative@AHCA.org</a>​​. <br><br><em>Claire Krawsczyn is a freelance writer and creative consultant serving industries such as long term and post-acute care. She can be reached at <a href="mailto&#58;claire@goverano.com" target="_blank">claire@goverano.com</a>. </em></p>2022-11-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/NovDec/PublishingImages/LTC-DC.jpg" style="BORDER&#58;0px solid;" />ManagementClaire KrawsczynAHCA/NCAL is changing the way the long term and post-acute world gathers, analyzes, and shares data through the Long Term Care Data Cooperative.