Enter the age of the age-friendly health system
The future of the United States is old. And this old future isn’t that far off. By 2026, the majority of baby boomers, the most populated generation in our nation’s history, will be in their 80s. Twenty-four years on, 20 percent of the U.S. population will be older than 65. 

For the Triple Aim goal to be met, IHI had to confirm the best ways to provide care. “We studied all of the major successful, evidence-based interventions for older adults,” Mate says. And what they found were the 4Ms — what matters to the patient, medications, mobility and mentation or mental activity. “The 4Ms were considered the absolute most important, most-evidenced and most impactful changes that could be made for improving the lives of older adults,” he says.

Mate admits that the 4Ms are not “terribly surprising or particularly innovative,” but they are what works. Simplicity is often the best course to take and Fulmer says medical providers love the reductionism of four elements. “We don’t want to add work,” she says. “We want [clinicians] to measure these elements and put in place common-sense best practices that move care in the right direction.”

The way they do this is through bundles — strategies used to ensure reliable implementation of, and attention to, the 4Ms. Rather than have a standard set of procedures for treatment, as is the case in the volume-based structure, bundles incentivize physicians to compile approaches and treatments that are necessary and sufficient for that patient and their condition, putting the focus on quality, not quantity. That’s why providers working at ACOs and alternative payment model care systems often find it much easier to follow the 4Ms, especially what matters. When put into action like this, wasteful costs that may come from repeated and unnecessary tests and hospital readmissions are reduced. What’s more is that the patient often experiences a faster and more complete recovery.

“ We have to make sure this work translates into streamlining what [hospitals and health systems] are already doing. As we shift from fee-to-service to value-based payments, health services will shift. This is a new day and we have to make sure we are using all the talent we have and releasing all the waste we can. ” Terry Fulmer, President, The John A. Hartford Foundation





The 4Ms translate to the patient’s understanding, too. “I [used the 4Ms] this morning,” Fulmer says. “The patient I saw has been post-operative for several days, has a colostomy and a number of other problems with that. She’s not giving up. She wants to go home and go back to dog walking.” When you think about what’s best for her, what matters most to her, you can tailor her care to best meet her goals, Fulmer says.

By focusing on the 4Ms, hospitals and health systems can begin reducing the amount of money that is wasted through inefficient care. An estimated one-third of what the U.S. spends on health care each year is wasteful, according to Fulmer. When adopted, the 4Ms can free up that waste so it can be put toward more useful avenues. This translates to better care at home, better attention to related services, better communication throughout the health care system and ultimately, a reduction in repeat hospital visits. Although the focus of the AFHS initiative is on the aging population, a reduction in wasteful health care spending saves money for every population.

Putting the initiative to work

U.S. health care costs account for 17 percent of our GDP, and that number is expected to rise to 20 percent in the next three years. At the same time, the Foundation and IHI are geared up to have the AFHS initiative in 20 percent of U.S. hospitals and health systems — that’s roughly 1,000 hospitals across 40 states — by 2020. Today, The John A. Hartford Foundation and IHI partner with five health systems, Anne Arundel Health System, Ascension, Kaiser Permanente, Providence St. Joseph Health and Trinity Health, on creating age-friendly health systems.

Fulmer says that 20 percent is an audacious goal.