5 ways to deliver reliable age-friendly care

CMS will require hospital attestation to meet age-friendly care measures in 2026 and incorporate age-friendly care performance into the Hospital Value-Based Purchasing (VBP) Program in 2027. The question for hospital leaders has shifted from “Should we do this?” to “How reliably are we doing this today and what variation puts us or the patient at risk?”

Organizations will need to demonstrate consistent delivery of the 4Ms across care settings, supported by policies, workflows, and measurable outcomes.

The importance of the 4Ms         

What matters

What matters conversations clarify goals, preferences, and acceptable trade‑offs. When teams lack a shared understanding of what matters most to the patient, care plans drift from patient priorities, leading to unwanted treatments, prolonged hospitalizations, and discharge plans that collapse once the patient returns home.

To ensure alignment on what matters, organizations should:

• Standardize a brief, structured what matters conversation for all adults 65+.
• Embed documentation fields that surface goals in real time for decision making.
• Integrate social drivers of health into discharge planning workflows.

Medication

Medication is a significant source of preventable harm for older adults. Without structured review, patients may leave the hospital with regimens that are unsafe or unsustainable in the home environment. When medication is not addressed, risk accumulates, falls increase, delirium becomes more likely, and the likelihood of successful discharge to home decreases.

To ensure reduction of preventable harm, organizations should:

• Implement a consistent medication review process for older adults.
• Use pharmacists strategically for high-risk patients or high-risk medications (e.g. Beer's list).
• Align deprescribing with what matters goals to reduce adverse events.

Mentation

When mentation is not assessed reliably, delirium is missed, depression goes untreated, and dementia related needs are unrecognized.

To ensure adequate detection, organizations should:

• Adopt a single delirium screening tool to ensure consistent use.
• Build escalation pathways for positive screens.
• Integrate depression and dementia screening into routine assessments.

Mobility

Mobility is one of the strongest predictors of discharge disposition. Yet when mobility practices depend on staffing, culture, or physical layout, variation becomes inevitable. When mobility is not reliably addressed, patient strength declines, functional reserves erode, and the likelihood of returning home decreases.

To preserve function and enable discharge, organizations should:

• Establish mobility expectations for every shift.
• Use mobility aides and therapy teams to drive early mobilization.
• Document mobility in a way that informs discharge readiness.

5 ways Optum Advisory can make age-friendly care a system capability

CMS is signaling that age-friendly care must become a system capability. Organizations that treat this as a compliance exercise will struggle; those that build reliable infrastructure will see improvements in safety, throughput, and patient experience. Optum Advisory can turn age-friendly care from a set of intentions to a reliable, system-level capability. To build the infrastructure required for CMS attestation and strong VBP performance, Optum Advisory will:

1.       Diagnose variation

A rapid, system-level assessment can show exactly where the 4Ms are reliable, where they break down, and why. We examine workflows, documentation, policies, role clarity, cognitive load, and cross continuum handoffs. Leaders receive a map of unwarranted variation and the operational risks it creates.

2.       Build from strengths

Every organization has bright spots. We identify the units and teams already delivering reliable age-friendly care and use them as the foundation for spread. This strength-based approach accelerates adoption, reduces resistance, and avoids adding new work.

3.       Operationalize the 4Ms

We refine workflows so the 4Ms show up consistently with minimal burden. We clarify roles, streamline steps, and ensure documentation captures the right data at the right time. Escalation pathways are defined, practical, and aligned with real world conditions. The goal is standard work.

4.       Install the infrastructure

We help organizations build the backbone that sustains age-friendly care: aligned policies, optimized EHR fields, real-time dashboards, and education and governance structures that reinforce accountability. This creates a durable system capability rather than a temporary project.

5.       Prepare for CMS

We translate CMS requirements into operational expectations, ensure the right data is captured, and position the organization to perform well in 2027. Leaders gain clarity, confidence, and a roadmap that is both achievable and sustainable.