The Michigan Value Collaborative

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

Tag: CHF (page 1 of 5)

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)

Hospitals in Michigan: Growing a Palliative Care Program

Melinda Gruber

Melinda Gruber MBA, PhD, is the Chief Executive Officer for Caring Circles.

Palliative care provides a number of benefits for patients of all diagnoses including Congestive Heart Failure (CHF). During the CHF workgroups a topic for discussion was how palliative care programs can reduce readmissions and the MVC Hospital Engagement team found out more about some palliative care programs here in Michigan.

BACKGROUND

Lakeland Hospital started their palliative care program in the outpatient sector through a local independent hospice after recognizing that patients would benefit from improved symptom and pain management along with advanced care planning. By 2008, Lakeland realized they needed to engage a physician champion who was both well-known and accepted throughout the community with a vision for both inpatient and outpatient palliative care. In 2012, the outpatient hospice program joined Lakeland and a business plan was proposed to add an inpatient program. This program has grown and received positive feedback, and Lakeland now has a Hospice and Palliative Medicine Fellowship. Recently they have worked with home care and have started to provide a palliative home care service that is actively growing. As the program evolves, Lakeland continuously assesses the needs of the program to determine where to best allocate resources.

BENEFITS

The benefits of the palliative care program at Lakeland include an added layer of support for both patients and their families. Additionally, examples show reduced readmissions, better pain and symptom management, increased support for the family, and patients meeting their goals in end of life care surrounded by family who have been prepared.

While partnering with other outpatient and inpatient palliative care programs throughout the area, Lakeland is learning the strengths of each to provide for the varying needs of the patients.

CHALLENGES

One of the challenges Lakeland faces is an ongoing lack of understanding about palliative care and its true value to the patient. There is also the challenge to convince the provider that the palliative care team is there to assist with the patient’s needs and not completely take over care of the patient. To address these challenges, the palliative care program at Lakeland takes on the responsibility of educating and coaching staff to provide them with a minimum foundational skill to deliver palliative care and explain how and why the palliative care approach was taken. This helps those involved in patient care understand the different approaches to care given, and how the palliative care program works.

Other challenges being faced by Lakeland are identifying what the optimal approach for palliative care is, staffing needed to provide palliative care and setting expectations to deliver consistent care.

LIAISONS

Lakeland partners with Agency on Aging which includes an interdisciplinary team that goes to a patient’s home and provides dietary and medication advice. Lakeland’s palliative care program also has relationships with primary care for the homebound, nursing homes, hospitalists, hospices, intensivists, and consultation programs for all-inclusive care.

EDUCATION

Lakeland stresses the importance of palliative care education and provides opportunities for growth in learning such as:

  • Huddles with the hospitalists and working more with the residents;
  • Lunch and learns for CME credits; and
  • A patient care summit on the benefits of palliative care

NEXT STEPS

As the palliative care program at Lakeland continues to grow, the palliative care team perform needs assessments to ensure the program is meeting the needs of the patient and the health system. They also utilize data in a simplistic understandable way to demonstrate the value of the program to high level leadership. Moving forward, they have scheduled to attend meetings at provider offices to build relationships and provide educational opportunities to clinicians.

ADVICE

Lakeland advises other hospitals to recognize that there is not one set way to provide palliative care. They recommend setting expectations up front, developing objectives to meet the needs of both the patient and the health system, and finding “champions” and get them engaged in palliative care initiatives.

Lakeland is also seeking advice for how clinicians can be consulted ahead of a patient “crisis”. Team members are currently on call 24/7 but they would like to find ways that the team can be more consistent with providing consults especially in the off shifts.

If you would like to learn more about the palliative care program at Lakeland Hospital, please contact Doris Glowacki at dglowacki@Caring-Circles.org or the MVC Coordinating Center.

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