A nursing home demonstration project in Indiana has reduced avoidable hospitalizations among residents by a third, according to a recently released independent evaluation of OPTIMISTIC, (Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care).
OPTIMISTIC is a Centers for Medicare and Medicaid (CMS) demonstration program designed to improve chronic disease management and boost staff education and training.
Tim Darragh has written a “How I did It“ essay on his yearlong project looking at a community-wide effort to reduce hospitalization and ER use among a group of “superusers,” people who have complex medical conditions and use a whole lot of very expensive health care. Many have multiple medical problems, often including mental illness or other behavioral issues. We also wrote about his work a few weeks ago.
Darragh looked at a specific program financed under the Affordable Care Act in the Allentown, Pa., area. (He was at The Morning Call at the time. He recently moved to New Jersey Advance Media, which publishes The Star-Ledger and NJ.com.) But hospitals and health care systems across the country are looking at ways to reduce avoidable hospitalizations and rehospitalizations; the incentives are part of the ACA, and insurers are also demanding this to reduce costs. Addressing these patients’ needs before they become a crisis that lands them in the ER isn’t just a money-saver. It’s also better health. Continue reading
The Centers for Medicare & Medicaid Services (CMS) released interim financial results for its various ACO and bundled payment initiatives today which show savings in excess of $488 million.* These included cost savings analyses for Medicare Accountable Care Organizations, Pioneer ACOs, the Physician Group Practice demonstration and expanded participation in the Bundled Payments for Care Improvement Initiative. Many of those programs are discussed in detail in the AHCJ tip sheet “Latest innovations in Medicare.”
“These innovative programs are showing encouraging initial results, while providing valuable lessons as we strive to improve our nation’s health care delivery system,” HHS Secretary Kathleen Sebelius said in a statement. “Today’s findings demonstrate that organizations of various sizes and structures across the country are working with their physicians and engaging with patients to better coordinate and deliver high quality care while reducing expenditure growth.”
CMS said that In their first 12 months, nearly half (54 out of 114) of the ACOs that started program operations in 2012 already had lower expenditures than projected. Of the 54 ACOs that exceeded their benchmarks in the first year, 29 generated shared savings totaling more than $126 million. These ACOs generated a total of $128 million in net savings for the Medicare Trust Funds. Medicare shares in any ACO savings generated from lowering the growth in health costs while meeting high quality care standards.
Final performance year-one results will be released later this year. Continue reading
Many of you probably saw the recent Sunday New York Times Magazine story about home- and community-based health care, called “What Can Mississippi Learn From Iran.” Basically, it describes a still rudimentary and not fully funded vision of creating “health homes” using community health workers to reach the medically underserved in the Mississippi Delta, particularly those with chronic diseases. The idea is based on a similar program in Iran.
So the points I raise below aren’t because I think the article was bad – as I said, I liked it. Rather it’s because I wanted to draw out a few points that will help you as health journalists read it a little more critically and then think a little harder about what’s going on in your own states or communities.There’s a lot I liked in this article by Suzy Hansen. The author is an American living in Turkey and she’s not a health care writer. She came to the subject – and to the Mississippi Delta – with fresh perspective. I liked her focus on chronic disease, disparities (black/white, rich/poor, rural/urban), prevention and wellness, the need for more and better primary care, the lack of care coordination and the rationale for more integrated delivery systems with primary care at its core. She did that well. Hansen also did include some context (I would have preferred a bit more) about some of the other delivery system changes unfolding through the Affordable Care Act, changes in the delivery of health care that my posts here often urge you to report on.
Hansen said in an interview that she first got intrigued about the Mississippi initiative after seeing an earlier report on it in 2010 AARP Bulletin. When I went back and read the 2010 article, and then re-read the Times piece several times I wasn’t really clear on how much the “health homes” had achieved in the two intervening years. I emailed her and she said, “It’s all moving slowly. They have implemented the HealthConnect program, they have trained community health workers, they have designed the health worker certificate program at Jackson State, and opened clinics in some of the schools. They are trying to demonstrate various aspects of the model in order to convince people to fund them.” But the to-do list is still long.
Given all the attention right now on changing health care to achieve precisely the goals that the Mississippi group is trying to achieve (wellness not sickness, better care coordination, fewer hospitalizations, reducing disparities, etc). I was left wondering what’s stuck here – why isn’t this program accomplishing more. (It might have to do with Mississippi and local politics and personalities – not purely “health.”) Continue reading