The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

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Innovative Home Visit Models Reduce Admissions and Emergency Department Use

Shiyuan Yin

Shiyuan Yin is the MVC Research Associate.

Innovative home visit programs are exploring affordable ways to provide quality, rapid care at home while maintaining a tight connection to patients’ primary care providers. A home visit program based in California, DASH (Doctors Assisting Seniors at Home), works to better provide care to patients outside of the emergency department (ED). Patients aged 18 and above who might be too weak to commute to an ED and wait for services now have the option to give DASH a call (DASH, n. d.). Upon calling, skilled nurses and health providers will arrive where the patient resides within an hour. For those residents who live in low-income housing or receive Medi-Cal, this conveniently helpful service is free.

As the population ages it becomes increasingly important, yet challenging, to provide quality of care for older adults. Numerous studies have shown physician-provided home care is effective in saving costs and reducing unnecessary admissions, but little is known regarding whether home-based care delivered by practice-extender teams—such as teams led by registered nurses or lay health workers—can achieve similar results. A study led by researchers from the University of Chicago and Centers for Medicare and Medicare Services examines the effectiveness of five home visit models for older adults and finds compelling results. While DASH is one of the models studied, four other home visit models are also mentioned:

  1. ABC (Aging Brain Care) which focuses on providing care for those with depression or dementia;
  2. CAPABLE (Community Aging in Place, Advancing Better Living for Elders) which offers visits not only from occupational therapists and nurses but also handymen to help maintain seniors living at home;
  3. Stroke Mobile, a mobile stroke unit complete with CT scanner that allows for rapid on the spot treatment of stroke victims; and
  4. AIM (Advanced Illness Management) which aims to improve quality of care and care coordination in those with advanced illness.

Research findings suggest that four of the five models are associated with reduced total Medicare expenditures or utilization. Further analyses show cost savings for CAPABLE and AIM, significant reduction in ED visits for DASH, and decreased hospitalizations for Stroke Mobile, DASH, and AIM (Ruiz et al., 2017). After DASH enrolled 2,000 people in the Santa Barbara area, there was a 38% drop in visits to the emergency room and a 41% reduction in hospitalizations (DASH, n. d.). Home visit programs also have additional advantages, allowing hospitals to “reach high-risk, high-needs patients before a change in condition necessitates a higher level of care and mitigate access barriers such as lack of transportation or limited mobility” (Ruiz et al., 2017). Due to the effort in care coordination and patient/consumer engagement, these five home visit models show improved quality of care despite differences in design and diversity in patient population. Although it is important for hospitals to develop a model that fits their own conditions, the value of having practice extenders provide home visits is significant and translatable to health providers in other regions.

Furthermore, the overall improvement in quality of care for each model is summarized in the table below:

Source: Ruiz et al. (2017) analysis of information gathered by NORC from site visits, interviews, and program materials, as of December 2015, page 431.

 

References:

DASH. (n. d.). Retrieved September 28, 2017 from DASH: http://www.dashsb.com/

Ruiz, S., Snyder, L. P., Rotondo, C., Cross-Barnet, C., Colligan, E. M., & Giuriceo, K. (2017). Innovative home visit models associated with reductions in costs, hospitalizations, and emergency department use. Health Affairs, 36(3), 425–432. https://doi.org/10.1377/hlthaff.2016.1305

Potthoff, G. (2014, December 27). Santa Barbara seniors find peace of mind with DASH medical care program. Noozhawk. Retrieved from: https://www.noozhawk.com/article/santa_barbara_seniors_peace_of_mind_dash_medical_care_program_20141227%20

Transitions of Care Enhanced by I-MPACT, a BCBSM CQI

Pam James

Pam James, MS is the I-MPACT Program Manager

The Integrated Michigan Patient Centered Alliance in Care Transitions Collaborative (I-MPACT) is a Blue Cross Blue Shield Value Partnership collaborative quality initiative (CQI) which was established in 2015 and formally launched with an inaugural kick-off for cohort one in April 2016. This CQI has several aspects that make its approach to quality improvement unique. Hospitals and physician organizations (PO) are required to partner with each other to better coordinate care and ultimately improve patient outcomes and experiences; that partnership is called a “cluster”. Another unique feature of I-MPACT is the incorporation of patient or caregiver advisors on each cluster team. These patient advisors are an integral part of the team and, to encourage continued participation and ensure the patient’s voice is heard, the clusters have to provide information to I-MPACT how the patients are integrated into and utilized on any projects or initiatives. Lastly, each cluster is evaluated as one entity for the Pay for Performance Index (P4P) to encourage collaboration, equity and inclusion between them. The entire cluster, both hospitals and POs, can earn additional dollars based on their cluster’s score on the P4P.

The ultimate goal for I-MPACT is to help improve care transitions for patients. I-MPACT strives to accomplish this goal by focusing on three key areas:

  1. Increasing the frequency with which patients are seen by a provider within 7 days of discharge,
  2. Working on reducing readmissions,
  3. Working on reducing Emergency Department visits.

I-MPACT currently has 20 hospital and PO clusters which are divided into 4 groups or cohorts. Data extraction centers around key documents in the care transition process including the discharge summary, patient summary/after visit summary and the admitting history and physical. The goal is to understand more about processes and communication during the care transition and gain a better understanding of where gaps and challenges are occurring.

I-MPACT focuses on five specific patient populations which were strategically chosen to align with other collaboratives and Center for Medicare & Medicaid Services (CMS) initiatives. The five conditions are:

  1. Acute Myocardial Infarction (AMI),
  2. Congestive Heart Failure (CHF),
  3. Pneumonia,
  4. Chronic Obstructive Pulmonary Disease (COPD),
  5. Patients transitioning from hospital to a skilled nursing facility (SNF).

I-MPACT helps their members understand the care transition process, especially from a patient perspective by performing an on-site observation of a patient’s discharge process and mapping the data gathered in a document called “the patient journey”.

Upon joining I-MPACT each new cluster, along with their patient advisors, attend a day long kick off where they work through mapping out a transition process, identifying gaps and challenges in their organizations’ care transitions and brain storming interventions aimed at addressing those gaps and challenges.

If you would like more information about I-MPACT check out their website at http://www.impactcqi.org/, contact Pamela James,  the Project Manager at  I-MPACTCC@med.umich.edu or contact the MVC Coordinating Center through Abeer Yassine (abeery@med.umich.edu ) or Deb Evans (debevans@med.umich.edu)

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