Bethesda, MD--Under the Affordable Care Act, the federal government was handed an unprecedented set of tools to forge innovation in health care delivery through the Medicare and Medicaid programs. Now, as the new Center for Medicare and Medicaid Innovation begins its work, the goal is to achieve the vaunted “Triple Aim” of improving individuals’ experience of health care, improving the health of populations, and lowering health care costs.
The March issue of Health Affairs takes a detailed look at health care systems that are already moving ahead with needed innovations in the delivery of care. The issue details how fifteen organizations--ranging from health care systems to health plans and other health initiatives--are working to achieve the Triple Aim.
Profiles of these fifteen innovators, who presented their initiatives at Health Affairs’ Innovations across the Nation in Health Care Delivery conference on December 16, 2010, demonstrate that there are clear commonalities and common-sense strategies underpinning their success. At the same time, it is clear that change is hard and challenges remain. The profiles describe what these innovators have achieved despite myriad constraints, such as fragmented delivery systems and flawed payment structures, and suggest what could be accomplished if these constraints were eliminated.
SNAPSHOT OF PROFILES:
Providing Care to Seniors
- Commonwealth Care Alliance in Boston improved care while cutting hospital use and nursing home stays for the elderly and the physically and mentally disabled. The key innovation: multidisciplinary teams--including primary care, behavioral health, and social support services--working with patients in the home and community. During 2005-09, the rate of nursing home placements for eligible elderly people was 30 percent the rate of comparable seniors in Medicaid fee-for-service.
- Geriatric Resources for Assessment and Care of Elders (GRACE), a model of care for low-income seniors, has helped several health systems across the United States reduce unnecessary emergency department visits, hospitalizations, and readmissions. Savings of $1,500 per patient have been achieved through the use of in-home needs assessments, conducted by a team consisting of a nurse practitioner and a social worker.
- Aurora Health Care in Wisconsin introduced a computerized data tool to provide real-time information on each patient’s health risks. The system also made geriatricians available through teleconferencing to improve care for hospitalized elderly patients.
Treating Children with Asthma
- The American Academy of Pediatrics’ Asthma Pilot Project trained forty-nine pediatric practices on ways to improve asthma care for children. Among the changes: training pediatricians to teach patients and families how to “self-manage” the condition. As a result, the percentage of patients who received optimal care rose from 35 percent to 85 percent by the end of the twelve-month project.
- Cambridge Health Alliance in Massachusetts reduced asthma-related pediatric hospital admissions and emergency department visits by as much as 50 percent. With home visits, the system helped parents reduce or eliminate asthma triggers for their children--a return on investment of $4 for every $1 spent.
Caring for Vulnerable Populations
- Clinica Family Health Services in Colorado retooled operations, offering same-day appointments and group visits to improve access to care. Just 5.3 percent of babies born to mothers enrolled in the clinic’s prenatal care group visit program are low-birth weight babies, compared to a national average of 8.2 percent.
- HealthCare Partners Medical Group instituted two interventions targeting high-needs patients at risk of hospitalization: multidisciplinary teams that care for recently discharged patients, and Homecare Teams to visit homebound patients. Hospital use for patients in the program declined 20 percent, which saved the system $2 million annually for every 1,000 members.
- Mercy Health System in Pennsylvania partnered with Keystone Mercy Health Plan to provide a care manager for patients enrolled in Medicaid in each of its health care settings. The improved care coordination that resulted reduced hospital admissions rates by 17 percent. Hospital length-of-stay fell 37 percent, and the system saved $37.70 per member per month.
- ThedaCare in Wisconsin piloted a new care model in which a physician, a pharmacist, and a registered nurse together visit hospital patients within ninety minutes of admission and devise a care plan. Implementing this “Collaborative Care” model decreased costs per case by 15-28 percent. Average length-of-stay dropped 10-15 percent, and 95 percent of patients rated their satisfaction level as “excellent.”
- The Vermont Blueprint for Health is pairing primary care providers with community health teams, who help patients follow treatment plans, fill out insurance applications, and access care in a timely way. Significant year-over-year decreases in hospital admissions and emergency department visits, as well as better patient and provider satisfaction in three pilot sites, has led to statewide expansion of the program.
Providing Patient-Centered Care
- UPMC Health System in Pennsylvania redesigned health care processes, using the perspective of patients and families, rather than that of providers. For example, target departure times were introduced for surgery patients to reduce the unnecessary time that patients spent in the hospital. The changes led to shorter hospital lengths-of-stay, reduced pain and infection rates, and faster return to mobility for patients, as well as higher patient satisfaction.
- Martin’s Point Health Care in Portland, Maine, reorganized its nine practices into patient-centered “care teams” to better track and anticipate the health needs of patients with chronic disease. The number of patients with controlled high blood pressure went from 55 percent in 2007 to more than 82 percent in 2010.
- Bellin Health in Green Bay, Wisconsin, stresses prevention and easy access to appropriate care at low cost for its patients. Successes include its FastCare Clinics, which deliver care to patients outside regular business hours and have saved the system nearly $53 million in emergency department visit costs.
- Capital District Physicians’ Health Plan in New York worked with three pilot provider practices to establish patient-centered medical homes that would accept capitated payments. Each practice realized savings and made significant improvement on key metrics.
Delivering End-of-Life Care
The December 2010 Innovation Conference and the publication of the follow-up case studies were supported by leading philanthropic and health care organizations. Platinum sponsors were the Peter G. Peterson Foundation and the American Hospital Association. Gold sponsors were the Aetna Foundation, the American Medical Association, Blue Shield of California Foundation, California HealthCare Foundation, The Commonwealth Fund, The John A. Hartford Foundation, Institute for Healthcare Improvement, the Fannie E. Rippel Foundation, The SCAN Foundation, and UnitedHealth Group.
- Sutter Health in California provides home-based transitional and palliative care to patients near the end of life, keeping them out of hospitals and reducing unwanted treatments and resulting costs. The program has reduced hospitalizations and increased hospice use, resulting in average saving of about $2,000 a month per patient.