The Michigan Value Collaborative

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

Tag: quality (page 1 of 3)

Reshaping Care Delivery: Using Models of Care to Understand Patient Engagement

Abeer Yassine

Abeer is the MVC Hospital Engagement Associate

Patient engagement is frequently cited by health systems as a root cause for sub-optimal outcomes. Studies have supported the importance of understanding individual and population behavioral trends to increase patient engagement and improve outcomes. To improve patient engagement outside of a procedural setting, hospitals such as Massachusetts General Hospital (MGH) are seeking non-conventional methods to better address the needs of a specific population.

Upon receiving the results from a community needs assessment, MGH’s Substance Use Disorder (SUD) population was determined to be a primary focus for intervention to improve patient engagement, coordination, and outcomes. This population includes patients with an alcohol use disorder, opioid use disorder, or other drug/alcohol use disorders.1 By engaging this population in different hospital-led interventions, MGH has seen significant outcome improvements related to readmissions while helping physicians gain a deeper understanding of SUD in general.

To strategically address this population’s needs, MGH launched a multi-faceted Institutional SUD intervention. This institutional intervention includes a variety of features such as an inpatient consulting team, recovery coaching, and primary care support. To provide for a more personalized patient experience, recovery coaches include individuals who are in SUD recovery as well. These coaches provide an additional layer of support by assisting SUD patients in navigating the health system for appropriate care. 1

A study analyzing the impact of the program found the inpatient consulting teams have helped improve physician attitudes and preparedness when treating SUD patients.1 This was evidenced through a physician survey in which 66% of the respondents who had encountered clinical components of the initiative demonstrated positive attitude changes related to caring for SUD patients.1 This emphasizes the impact of an institutional approach to address a patient population.

Another intriguing feature of the SUD intervention is a post-discharge “Bridge” Clinic. This unique transitional clinic helps address the “What happens to the patient after discharge?” question that clinicians long to answer. The outpatient clinic serves patients who have been discharged from the emergency department and have not received follow-up care. The clinic accepts walk-ins, and provides a variety of clinical and social services to holistically treat the SUD patient population. There are no barriers for individuals accessing the clinic, helping them receive appropriate care. Not all services at the clinic are billed (e.g.: resource specialists, clinical pharmacist, etc.) by the hospital; as this is MGH’s method of contributing to the reduction of costs related to avoidable readmissions. More specifically, patients who have sought care at the clinic were readmitted 7.5% less frequently compared to those who did not receive interventional services.2 More information about this program can be found here.

Nonetheless, health systems across the country are exploring unique models of care to help improve patient coordination and engagement. Features of MGH’s non-traditional, yet effective, model of care helps address a main concern for various different populations: lack of access to services. By connecting patients with timely post-discharge care, MGH’s Bridge Clinic helps coordinate with patients during a critical, yet often overlooked, time period.

Questions or feedback for future posts? Feel free to reach out to Abeer (abeery@med.umich.edu)!

Wakeman SE, Kanter GP, Donelan K. Institutional Substance Use Disorder Intervention Improves General Internist Preparedness, Attitudes, and Clinical Practice. (July 2017)

2 Common Wealth Fund Feature, September 2017 and MGH SUDs Initiative

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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