A few weeks into his tenure as the new president and CEO of the VNA Health Group, Dr. Steven Landers digested the Supreme Court's ruling on the Patient Protection and Affordable Care Act with the rest of the New Jersey health care community. To Landers, implementing reform may be less of a challenge than adapting to his new home state.
The 37-year-old father of three jokes that includes finding which Dunkin' Donuts and Italian restaurant to frequent near the Red Bank headquarters. Landers has spent his entire career and the bulk of his education in Cleveland, attending Case Western Reserve University School of Medicine, and serving as director at the Center for Home Care and Community Rehabilitation for the Cleveland Clinic. For him, it was the Visiting Nurses Association, not the pizza, that attracted him to New Jersey.
"I'm here because of the organization and the opportunity that's presented," said Landers, the first physician to take on the role. "You've got one of the most substantive public health organizations in the country at a time where the country needs more of what we've got."
Home care is being eyed as a key component of implementing successful health care reform. Landers said one of the ways he hopes the VNA will improve outcomes in New Jersey will be keeping more of the vulnerable population at home, instead of nursing homes. David Knowlton, CEO of the New Jersey Health Care Quality Institute, said he sees this philosophy getting growing attention from the baby boom generation.
"They don't want to be at the hospital, and they don't want to be in a nursing home or a step-down unit," Knowlton said. "They would love to receive their care continually in the home, and sometimes that's not safe. VNA provides the alternative."
Landers said he believes that, through implementing technology, the VNA can become more efficient at providing safe, cost-effective home care. For instance, he said, the app "Hospice in a Minute" can serve as a mobile reference for families and caretakers discussing end-of-life issues.
"Technology offers hope that we can truly improve care while reducing costs" through better point-of-care educational tools and logistics tools, Landers said. "We're going to find ways here at Visiting Nurse Association to use that in a way not to where technology becomes a barrier to humanism and caring, but where it elevates humanism and caring."
The ability to look beyond the traditional tools of home care is something Landers credits to his education; as part of a Robert Wood Johnson Foundation program, Landers took a year off of medical school to attend the Johns Hopkins Bloomberg School of Public Health to earn a master's degree in public health.
"Sometimes, when you see things in health that aren't going well — poor outcomes or frustration of providers or a lot of people having the same problem — it's frustrating," Landers said. "A public health framework provides you a model for thinking about how to measure that and how to improve things, and that's empowering."
Dr. George Rhoads, interim dean of the School of Public Health at the University of Medicine and Dentistry of New Jersey, said a degree in public health offers a "population perspective" on health issues.
"A typical physician is focused on individual patients, and you don't really learn in medical school very much about the way health care is organized in the country … how you actually persuade patients to live healthier lives," Rhoads said.
Landers said he realized the power home care could have to fix the health system when he started making house calls as a geriatrician.
"One of the things you find that's sort of humbling as a physician is that, if somebody had a stroke and they can't lift their hand to feed themselves, there's not a lot a doctor can do to improve that person's health if they don't have somebody who can help them with the basics of life," Landers said. "I want that perspective to be heard in the health policy world and the payers, because there's a big difference that can be made."
That perspective is important, Knowlton said, since community-based care will be "so important in the Accountable Care Act."
"I think it's not just seeing home-health care as a supplementary to physician's care, but seeing it as an active part of fixing things," he said. "I was impressed with him."
Critical to the VNA's mission will be improving end-of-life care, an area where New Jersey providers are ranked far below other states. According to a study released by Healthcare Quality Strategies Inc. in July, New Jersey's hospital readmission rate for Medicare patients 30 days after discharge at the end of 2011 was 20.68 percent — one of the highest in the nation, despite spending the most on Medicare patients in the country.
Landers said discussion is the key way to move forward on end-of-life care, as is better training for the physicians and nurses who ask the difficult questions.
"This isn't about taking anything away or stopping treatment. For many, many people, it's just about making sure they're comfortable, making sure their nutrition is addressed, making sure their family has the support they need … so really the whole person is taken care of," Landers said. "It's about every day, the doctors, nurses, patients, families having better, more meaningful discussions."
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