STEPS To Value: Episode #21: The Value of “People” vs. “Patients”: Understanding Long-Term, Post-Acute Care (LTPAC)

STEPS to value host, Rod Piechowski, had the opportunity to interview Chuck Czarnik, Vice President of Strategic Planning at Brookdale Senior Living, the leading operator of senior living communities throughout the US, about the need for healthcare organizations to have a more holistic perspective on the people to whom they are providing care, seeing them more as people than patients. Here are some excerpts from their conversation:

Listen to Chuck’s complete interview here

Rod Piechowski: Chuck, thank you so much for joining us today.

Chuck Czarnik: Thanks, I'm glad to be here today.

Rod: Patients are moving back and forth all the time between acute and long term or post‑acute care settings. This happens quite frequently unfortunately. You run into this over and over again. What's important for patients to understand as it relates to what you're trying to do and the policies and the technology that you need in order to make a better connection between those worlds?

Chuck: That's a great question. When we think about the engagement point, we also, as post‑acute players, would like to be engaged in the care of our resident as they transition back into "big healthcare." I would come back to my description of the nature of that relationship that we have. If we've been caring for someone for weeks, months, years, we know something about that patient, about their needs, their wants, their desires. It may or may not be aligned with the goals that are set out in big healthcare, palliative care for example. I'm looking for policies and technologies that allow us to capture those goals and those needs of the resident patient in the LTPAC (long term post acute care) setting and pass them back to our upstream caregivers so that we're all playing from the same playbook.

Today, most of the technologies, the standards policies that have been developed, are focused on very discrete, sterile, clinical elements, medication lists, vitals, the demographics, basic ADT type information. That's all very important information, but there's a lot that we know about these residents that, if we had a means to communicate those in a structured, meaningful way back up the chain as the residents move throughout the healthcare continuum, I think our segment of the industry could definitely add value.

Rod: Is there information that you have that you know is important that isn't making its way upstream back to the big healthcare environment for example? Are there systems incapable of containing this kind of information? Are your systems unique in that you have that information? What's the disconnect on the content side?

Chuck: I think it's about the nature of the data that we capture in post‑acute care. This lifestyle data, the resident goals and needs, is not something that's easily captured in an electronic medical record. The structured versus unstructured problem, narrative form data is very difficult to translate into something that can be quantified at an EMR. I think that's a problem that we need to work on both in post‑acute and in acute care in capturing narratives and being able to do something with it. That's an EMR problem.

The second is a transport problem. Once we figure out how we can make this data actionable, we need to figure out the facilities to transfer it. I don't know that it easily fits into the current interoperability frameworks that we have that are focused on very sterile clinical data in my opinion, medication lists, diagnosis, demographic ADT data, names of physicians, that sort of thing. There's so much more that we know about our resident that, frankly, we can't quantify today. We know that, but we'd like to figure out how to quantify that and then communicate it up the chain to our healthcare partners as our residents transition throughout the healthcare spectrum.

Rod: Can you give us a quick example of the kind of information you're talking about?

Chuck: Goals would be a resident wants to become functionally capable to attend her great‑granddaughter's wedding, simple stuff like that that I think we miss the big picture understanding those needs and wants of that resident. It may not be a blood pressure reduction protocol or stroke program. It might as simple as let's figure out what we can do to get her to that wedding three weeks from now.

Rod: The goal here for you and Brookdale is to not dehumanize the patient.

Chuck: Absolutely.

Rod: They're people more than patients.

Chuck: Absolutely. We have been entrusted with an incredible responsibility in post‑acute care. The residents that have chosen to move into our care settings have entrusted us with the last chapter of their lives in many cases. We owe them something special. I think we can also add value to healthcare if we can figure out how to capture what it is special, structure it, and share that among the broader group of providers that are responsible for caring for that resident patient.