The US is getting old. By 2030, about one in five people will be older than 65—and that age group makes up a big chunk of healthcare utilization.
Adults 65 and older account for more than 40% of hospital admissions and tend to stay in the hospital longer than younger age groups. That means geriatric care will be an increasingly important part of the healthcare system in the coming years. But there aren’t nearly enough geriatricians to care for the aging population—the Department of Health and Human Services estimates the US will be short almost 27,000 geriatricians by 2025.
To help fill in the care gap, Mount Sinai, one of the largest health systems in New York City, started a program in 2016 called Align, which stands for “aging, life innovations, goals, and needs.”
“The US healthcare system is too slow to adapt to the much-needed changes in our rapidly aging population, and we therefore need to create innovative models of care to address these healthcare gaps,” Stephanie Chow, a Mount Sinai geriatrician who serves as director of the Align program, told Healthcare Brew.
How it works
The program is meant to reduce geriatric admissions to emergency departments and take some of the burden of caring for the aging population off primary care teams, according to Mount Sinai’s website.
Through Align, patients over the age of 65 are paired with a care team designed to support patients with complex medical and social needs, according to Chow. The team consists of two geriatricians, a nurse practitioner, a geriatric social worker, a care coordinator, and an administrative assistant.
To qualify, patients must be at high risk for hospitalization and have a record of declining health and frequent doctor visits, according to Fiorella Perez, a geriatrician at Mount Sinai who works as lead physician for the Align program.
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“These are the most vulnerable, frail, older patients for whom the typical medical care—15-minute office visits every four to six months, limited social work, no care coordinator—does not suffice,” Chow said.
So far, around 400 patients have gone through the Align program, according to Perez.
Patients are typically enrolled in the program for three to six months, but enrollment can be extended depending on their needs, Perez said. The idea is to address the most pressing challenges affecting the health of patients, then transition them back into the care of their primary care doctors, according to Chow.
The program runs out of two Mount Sinai locations: the Martha Stewart Center for Living and Mount Sinai Morningside, both of which are in Manhattan.
The Align team is tracking readmissions, length of hospitalization, number of emergency room visits, and patient and provider satisfaction to measure success, Chow said. The team is aiming to publish data on the program’s success in September, she added.
Perez said future goals for Align include further increasing communication and coordination with primary care teams to create long-term care plans for patients.
“We are actively building a curriculum for our geriatric fellows that rotate through Align to show them the importance of learning how to manage high-risk patients and understanding the healthcare system and resources needed to help patients avoid hospital admissions,” Perez said. “We hope training our future workforce in this innovative model of care will increase the number of geriatric providers that can manage high-risk patients and be motivated to dive into Align-type patients rather than be intimidated by them.”