On Oct. 30, Shawn Miyake gave a presentation, translated into Japanese by Takeshi Oishi, to Keiro Retirement Home residents and volunteers about the impacts of health care reform.
On Oct. 30, Shawn Miyake gave a presentation, translated into Japanese by Takeshi Oishi, to Keiro Retirement Home residents and volunteers about the impacts of health care reform.

By SHAWN MIYAKE, President and CEO, Keiro Senior HealthCare

The following article is the third in a three-part series on the changing landscape of health care and its impact on our community.

In the first two articles of this series, we looked at the sweeping changes taking place in our nation’s health care system and the impact of the Patient Protection and Affordable Health Care Act (ACA) of 2010. We reviewed the new direction in health care delivery and financing, including the integration of services and coordination of care among providers such as hospitals, physicians, nursing homes, and community-based service providers, to reduce costs to the government and improve the care and health of a population, and the challenges this system presents to providers like Keiro Senior HealthCare and its residents.

In this article, we examine how decreased health care reimbursement and other health reform initiatives challenge Keiro’s traditional model of providing care, necessitating an assessment of how we serve our community in this changing and uncertain health care future. We also explore how Keiro has been preparing for the future and options for continuing Keiro’s mission of enhancing the quality of senior life in our community.

Preparing for Change

Since 2006, Keiro’s management and Board of Directors have actively monitored the evolving needs and shifting preferences of the Japanese American community, while assessing external forces in a changed health care environment.  These factors combined have created new and growing challenges for operating Keiro in the traditional way.

The implementation of ACA in 2010 accelerated the need for all health care providers, like Keiro, to prepare for a dramatic shift in how health care is delivered and paid for in the future.

After extensive deliberation and evaluation, which included convening a Healthy Aging Summit in 2011 in partnership with the University of Southern California Davis School of Gerontology and the Japan Ministry of Health, Labor and Welfare, and talking with health care experts, the Keiro leadership has been exploring the range of options available to ensure the ongoing provision of culturally sensitive care.

Positioning the Facilities for Continuation

One of the options that Keiro currently is actively engaged in is contracting with insurance plans to continue providing facility-based care within the new health care model. As explained in Part 2 of this series, the consequences of this activity will result in Keiro becoming a more mainstream provider, accepting all residents referred by the health plan, who typically reflect the geographic area surrounding the facility.

Additionally, because of its relatively small size (four facilities compared to organizations with 50 or 100 facilities), Keiro may not be able to secure favorable contracts. Given current contracting rates, Keiro anticipates projected annual shortfalls and severe financial challenges ahead, likely to impact the quality of care for which we are known. Even with increased fundraising, we would not be able to sustain the facilities as they are today.

At a time of great change and consolidation in the health care industry, which many of us have experienced or become aware of, a second option that Keiro is testing is whether it makes sense for the facilities to be acquired by a larger health care organization that will respect our cultural focus and has the necessary scale to efficiently operate on razor-thin margins. This would essentially extend the culturally sensitive services of the facilities into the future.

Keeping the Community Informed

Over the past year, Keiro has been informing the community about anticipated impacts of health care reform on providers like Keiro. Keiro has presented 26 sessions to date, many in conjunction with partner organizations, and provided health resources and information, as well as engaged community members in dialogues on the needs and priorities of the Japanese American community. More recently, as the specific implications of health care reform have become more evident, we have communicated with those directly impacted: our residents, their families, volunteers, supporters, and our staff.

Keiro will continue to keep the community informed with what we know, as information becomes available.

Positioning Keiro for the Future

While health reform initiatives challenge Keiro’s traditional model of facility-based care, it also provides opportunities to reach new generations and the 96% of people 65 and over who are aging at home, rather than in a nursing facility.

Keiro’s ongoing assessments of demographics and senior care preferences over the past decade reveal that the majority of older adults increasingly desire to remain at home for as long as possible. These findings have necessitated changes in how Keiro delivers on its mission, “enhancing the quality of senior life in our community,” with a growing emphasis on community-based services for seniors and their families, wellness, and healthy aging programs, where we now serve twice as many older adults as we do in our facilities.

Meeting the Evolving Needs of Our Community

Today, Keiro partners with national senior-focused and health care organizations, veteran’s associations, and over 80 community organizations through its Nikkei Senior Network to bring educational programs directly to members of our community. It also supports caregivers through conferences, how-to videos, and online fact sheets at www.keiro.org.

Through Keiro’s MedCHAT, a hands-on learning experience about Medicare with 20 other senior services organizations in California, is partnering with the Center for Health Care Decisions and Leading Age California to provide input about the future design of the Medicare program. This is part of Keiro’s Health Literacy Project (HeLP), which helps individuals and community groups navigate the new world of health care.

Keiro’s 50-year legacy is a solid foundation upon which to build the future of Keiro to meet the ever-changing needs of current and future generations. And with over a decade of experience in delivering wellness-focused programs in our community, Keiro is well positioned to continue its mission of enhancing the quality of senior life in our community, addressing current needs while adapting to health care reform challenges.

Commenting on Keiro’s community outreach efforts, Carolyn Sanwo, attendee at several Keiro community seminars remarked, “The more I attend, the more grateful I am for Keiro’s role in our community. The education Keiro provides helps enable each of us to make healthy lifestyle decisions. Our community is very fortunate.”

What We’ve Learned

According to a 2010 poll by Lakeview Research Partners and American Viewpoint, 71% of California voters 40 and older express concern about losing their independence as they get older. Keiro empowers individuals of all ages to regain responsibility and control of their own health and wellness. Through lifelong learning courses, fitness walks and events, the Genki Woman blog at www.genkiwoman.org, and online resources, Keiro helps our community to be informed and stay in front of issues such as memory loss, diabetes, heart disease, osteoporosis, cancer, and more.

Keiro’s wellness efforts appeal to the changing preferences in our community, better serve a geographically dispersed community, improve access to information and resources for overburdened family caregivers, and allow Keiro to remain relevant to our increasingly diverse community.

For more information and videos about health care reform and its impact on Keiro, visit www.keiro.org/health-care-reform-2013.

Ninety-six percent of people age 65 and older are aging at home versus aging in a nursing facility.
Ninety-six percent of people age 65 and older are aging at home versus aging in a nursing facility.

About Keiro Senior HealthCare

For over 50 years, Keiro Senior HealthCare has been committed to its mission of enhancing the quality of senior life in our community. The founders established Keiro to meet the specific needs of the Issei pioneers, and since that time Keiro has been developing and offering new programs and services in response to the changing needs in the community. For over a decade, this has included a variety of community-based education programs like our well known caregiver’s conferences and the establishment of The Institute for Healthy Aging at Keiro to support people to age in place at home, while preventing and managing chronic health conditions.

As the community continues to evolve and faces new challenges like health care reform, Keiro will always be there to help our community make sense of the changes and live with vitality.

Shawn Miyake is president and chief executive officer of Keiro Senior HealthCare in Los Angeles, and has served in this position for the past 19 years. He holds an MBA from California Lutheran University and a master’s degree in occupational therapy from the University of Southern California. His 30+ years of health care experience include administrative positions in a variety of settings from hospitals to nursing homes and community-based care alternatives, giving him a unique perspective on the impact of public policy on care delivery. He has written numerous articles on clinical topics ranging from innovative practices to application of cross-industry concepts in the health care arena. He volunteers for a number of community-based organizations, consulting on capacity building and strategic planning.

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