Meet Robert
Q&A with Robert J. Schreiber MD from Hebrew SeniorLife in Boston, MA.
“It is important to celebrate your victories and successes and not discount the work you are doing....you all are leaders that are making daily differences in people’s lives and make certain you take time to reflect on this.”
Q: How long have you been a GSA member? Why did you become a member of GSA?
A: I have been a GSA member for a total of five years and have become more engaged as a member recently due to the need for supporting new interdisciplinary approaches leading toward new innovations for improving the system of care for aging adults of diverse backgrounds in microsystems, mesosystems and macrosystems of care. I have become more involved with the Society since it is an “incubator” that fosters collaboration between scientist, multidisciplinary health professionals, policymakers, behavioral health and social science professional in a manner that is improving the care and understanding of our aging population. The work I am now doing involves interdisciplinary engagement and new approaches to providing better care to various older adult populations with multiple chronic conditions and being a member of GSA has allowed for my learning and sharing with other colleagues these new approaches to health and care delivery.
This work is also connected to policy change. GSA has provided me with information, knowledge and opportunities to work with people on policy issues that impact my current work of integrating Long Term Service Support care into medical care delivery systems. This also allows for the spreading of new innovations across disciplines and like minded colleagues with a goal of promoting healthy aging in person with multiple morbidities in a sustainable manner. It is important as a practicing clinician to get involved with policy change in order to ensure the innovative work we do can be sustained over time.
Q: You are a Hartford Change AGEnt. What is your Hartford affiliation and what was that project?
A: My Hartford affiliation is three fold at the present time. I am presently a Senior Leader for Practice Change Leaders Program which is a national program to develop, support and expand the influence of organizational leaders who are committed to achieving transformative improvements in care for older adults. The Practice Change Leaders Program and its predecessor program, the Practice Change Fellows are jointly supported by the John A Hartford Foundation and the Atlantic Philanthropies.
I am also part of the Patient Centered Medical Home Network that is part of the Change Agents Program. The Patient-Centered Medical Home (PCMH) Network will transform PCMH and similar initiatives to recognize, facilitate, encourage, and ultimately reward doing the right thing for older adults and their caregivers. The vision of the Network is to transform PCMHs to recognize, facilitate, encourage, and ultimately improve the care of older adults and their caregivers. We also propose to enhance their connection to relevant resources, including family caregivers and community-based resources. A large thrust of the Network will be to identify ways to improve the skills of PCMH who may not have formal geriatric training, at both patient and population level.
Last but not least, I am involved with a John A. Hartford Foundation grant to develop two large-scale, prototype networks that link community-based, social service agencies to the health care sector, with the goal of establishing an integrated health care and social services delivery system in California and Massachusetts. The Partners in Care Foundation, of San Fernando, CA is building a regional network in Southern California, with Elder Services of Merrimack Valley and Hebrew SeniorLife collaborating to develop a Massachusetts prototype. My role in the Massachusetts Collaborative is as Medical Director.
Q: How did you become interested in the field of aging?
A: I had the opportunity after residency to work in a federally funded Health Center for Older Adults in Connecticut after my internal medicine residency. I had a chance of caring for very medically and behavioral complex older adults and by focusing on geriatric principles of care such as function and the individual’s goals, we were able to make a dramatic difference in our patients’ lives as well as those of their family. In addition, I learned that these individuals had incredible wisdom and lessons to share. I realized that the return I received was much greater than what the care we provided for these patients.
I had the chance of working under mentors including GSA Fellows Richard Besdine, MD and Ian Lawson, MD and this greatly encouraged my work in geriatrics.
Q: What practice change initiatives/projects are you currently working on and what are your intended outcomes?
A: The practice change initiatives I am working on include t he following
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As Medical Director of the Massachusetts Healthy Living Center of Excellence I am helping to integrated the Stanford chronic disease self management programs, Matter of Balance fall prevention programs into Patient Centered Medical Homes and Accountable Care Organizations in Massachusetts. We have three accountable care organizations in Boston using these programs in the Boston area as well as other medical systems across our state. In addition, we have one dual eligible insurance company now paying for these programs with at least one other insurer looking to do the same.
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I am working with the National Council on Aging to advocate for policy changes to make self management programs a covered patient benefit. There is bipartisan legislation being proposed by US Senate Finance Committee for Improving Chronic Disease management. I have been working with legislative aides from the chairs of the bipartisan committee and will continue to advocate for inclusion of these programs as a patient benefit in all insurance programs including Medicare and Medicaid.
Q: What was your inspiration for your practice change initiative/project?
A: I had the opportunity of working with Kate Lorig PhD, RN and learning about these programs going back to 1998. I had the opportunity of seeing directly the benefit the Stanford Chronic Disease Management Program had on my older adults with chronic conditions and the improved outcomes they had when attending these programs. I then had the opportunity of working with Nancy Whitelaw Ph.D, MSW in developing model evidence based self management programs and I was the lead facilitator for the development of the evidence based program Healthy Eating for Successful Living Program, a nutrition program for diverse community-dwelling adults age 60 and older. The overall goal of Healthy Eating is to increase self-efficacy and general well being by improving participants’ knowledge of nutritional choices that focus on heart and bone healthy foods as well as supportive physical activities. Goal setting, problem solving and self-monitoring are used to optimize individual behavior change. http://www.healthyliving4me.org/
Q: What are your key responsibilities at your job?
A: My key responsibilities include the following
1.
As a geriatric consultant working in a Patient Centered Medical Home that is part of an accountable care organization in Boston, Massachusetts, I am helping the practice develop a comprehensive approach to managing older adults with complex behavioral health and/or medical morbidities in the community. This model is now being replicated in another accountable care organization in Boston. I am also collaborating with other geriatric colleagues who are doing a very similar model in two other accountable organizations. This is a model that can be potentially a scalable approach of integrating geriatric care into a patient centered medical home in a manner that will improve the health and quality of care for this population while lowering the cost of care.
2.
I serve as the Medical Director of the Healthy Living Center of Excellence (HLCE) which is a partnership between a medical care provider (Hebrew SeniorLife) and a community-based organization (Elder Services of the Merrimack Valley). The HLCE embraces a diverse community of stakeholders, that allows for an integrated delivery system which leverages the expertise and resources of the community to improve patient activation and achieve better care, better health and lower costs through the dissemination of evidence based self management programs proven to empower older adults become the central managers of their health. As Medical Director, my role is to advocate, support and give guidance to the HLCE to develop and foster partnerships with medical care providers and explore collaborative approaches demonstrating improved outcomes demanded by medical providers to ensure future payment and ongoing sustainability
Q: What has been your most memorable practice change challenge or story?
A: The most memorable practice challenge involves my work in developing a Department of Geriatrics at Lahey Clinic in Burlington, MA. When I joined the Clinic in 1995, there were no geriatricians of a department of Geriatrics. Through leveraging multiple disciplines including the department of internal medicine, several surgical subspecialties, nursing, social workers, administrators and community based organizations including several Area Agencies on Aging and Senior Center, a comprehensive approach to geriatric care was developed in the organization that led to the first new Department (formed in 2004) at the Lahey Clinic in 14 years. This Department achieved national recognition two consecutive years in a row.
Q: Do you have any tips for emerging gerontologists and Change AGEnts?
A: Emerging gerontologists and Change AGEnts are entering a period of time of disruptive health care change and transformation. The timing is ripe for innovative approaches that have a value proposition for improving the quality of care for older adults while lowering costs. In addition, our knowledge is invaluable in helping improve the health of older populations and this will become even more important over the next decade.
My advice is this: We are involved a marathon and not a sprint as our healthcare system transform care delivery. Change AGEnts have to take a long view and not expect that changes will happen immediately. This work is hard and complex so it is important to have a personalized strategic approach and action plan. Developing a group of mentors and peer supports will be very important to sustain ones commitment and passion and validate the work you are doing. It is important to celebrate your victories and successes and not discount the work you are doing. Make time to nourish your physical and mental health and take the time that will allow you to stay connected to the things that are most important to you. You are part of an extraordinary and talented group of people who care about our older adults and want to honor them and their lives. As such, you all are leaders that are making daily differences in people’s lives and make certain you take time to reflect on this.
Q: Have you had an important mentor in your career or benefited from interdisciplinary relationships? If so, how did it make a difference?
A: I have been very blessed to have a number of mentors over my career spanning 30 years, many of which have been interdisciplinary. I have had the honor of being mentored by a dedicated group of nurses, physicians and social workers through the HMO Workgroup on Care Management, the Practice Change Fellows Program and the Practice Change Leaders Program. This has been a group I have known for over 17 years and they have been always there to give me advice, support and “hugs” when needed. They have been also been critical in my decision making of career paths and have been a safety line when I have been presented with challenges.