Lifespark and North Memorial Health (NMH) have partnered to deepen their senior strategy giving older adults access to a more comprehensive, easier health and wellbeing product to improve customer experience, improve health outcomes, and reduce total cost of care.
The backbone of this strategy is our Life Experience Alternative Delivery System (LEADS), the first of its kind client-centered program in the US, integrating community-based primary care services with ongoing life care services from a trusted advisor to provide a comprehensive proactive whole person model of care. A highly critical piece of this partnership is a value-based payment arrangement targeting more than 5,000 seniors who have a UCare Medicare plan and choose NMH or Lifespark Health as their primary care clinic.
Our initial focus has been meeting with the highest risk seniors through outreach and engagement efforts to coordinate face-to-face meetings with a Life Manager, a registered nurse, who will better understand their health care situation and coordinate the best services to keep them living a sparked life. “It’s true anticipatory guidance for our senior population,” said Dr. Carolyn Ogland, Chief Medical Officer for North Memorial Health (NMH). “This is one quite frankly, I’ve never seen before – it’s very comprehensive.”
While ‘client-centered alternative delivery system’ seems like a mouthful, it’s really about thinking differently how ‘care’ is delivered throughout a hospital continuum – consider this an alternative to how it’s always been done. Backed by technology, LEADS looks at a senior’s whole life, including all phases of their health care journey – tracking hospitalizations, improvements in overall wellness, and addressing social determinants of health – to serve them intelligently with community-based initiatives.
Think about the seniors you work with as they are discharged from the hospital and sent home. Do you often wonder about home and safety concerns, can the family caregiver really help, will the senior follow-through with discharge plans, can they nutritionally feed themselves well, or are their appliances working? These are actual situations that could potentially send a person back to the ER if not addressed before someone transitions home. Yet often the ‘what if’ situations that can occur once they leave the hospital are not fully considered.
“It actually happened for one of our clients. Thankfully though, the Life Manager anticipated fall risks before the client transitioned home,” explained Dr. Ogland. “She went to the client’s home to take inventory of any potential risks and saw that the railing was rickety and in need of repair. She immediately had it fixed in time before the client discharged home to prevent any falls. It’s these little details that mean a great deal to safely transitioning clients home.”
In another story, one senior just needed guidance on dealing with a chronic urinary tract infection. She had seen urologists with many treatment approaches and diet adjustments, but no lasting relief. Her last primary care physician told her it wasn’t another UTI, just normal aging. The senior felt there was nothing she could do anymore, nowhere for her to turn. In her 80s, she was exhausted trying to make her symptoms heard. So many seniors assume this is just how it is when you age.
But when she connected with Lifespark, they listened. They put her in touch with a specific NMH geriatric specialist who sat down with her and listened, talking through several options using a holistic approach.
Often specialists look through a narrow lens – what’s the issue and how can I solve it medically based on my specific expertise – not a larger holistic lens that’s client-centered. This senior was in tears as she described her experience of how our team followed up with her, saying it was unlike any other experience she’s ever head – she ‘felt heard for the first time.’ The doctor she met with had found an infection and prescribed antibiotics, run tests, and scheduled a follow up. Today, she is doing much better and went out of her way to call and thank her Lifespark Life Advisor repeatedly. Since connecting with Lifespark she has had no hospitalizations and zero ER visits but was connected with the NMH system for the right reasons and is happy with her healthcare experience.
The key component of LEADS, as it always has been with Lifespark, is the Life Manager role which we know plays a powerful role in helping people age magnificently. Life Managers focus solely on care management for the high to medium risk clients while Life Advisors focus on proactively guiding the low to no risk clients and escalating the need for access to other service lines as needs change. “It’s about empowering seniors to achieve their best health both in the hospital and in the community where they live and play,” said Joel Theisen, CEO of Lifespark. “Seeing a person’s entire ecosystem is critical if we want to help them live well.”
“We have an under-and over-served growing senior population in Minnesota and at the same time we have a sick and broken healthcare system nationwide,” added Joel. “This partnership is really about addressing that growing crisis and creating ‘clients for life,’ improving customer engagement, addressing social determinants of health, and creating a wellness platform within the community. Seniors need a place to turn with a system that addresses their entire eco-system, this does that.”
For more information about this partnership, read the full news release on our News page.