Today’s focus on quality, patient satisfaction, healthier communities and lower costs is leading healthcare entities to “innovate big” or go home.
Across the United States, the effects and expectations of the Affordable Care Act (ACA) continue to drive system improvement and innovation in healthcare. The first nationally standardized survey on healthcare services and satisfaction, known as HCAPS, helps to provide an objective and meaningful comparison of hospitals and related services. To deliver a patient-centric approach to care management, healthcare providers from different disciplines and organizations are working as a team to improve the health of our patients and community.
Embracing the Triple Aim
Developed by the Institute for Healthcare Improvement, the Triple Aim serves as a transformational rationale and framework for improving healthcare, linking together three key expectations. They are: 1) improving the patient experience of care, including both quality and satisfaction; 2) improving the health of populations; and 3) improving the per capita cost of care.
Planning for care needs following a hospital discharge (transitional care) is a common concern for hospitals and patients. Aging seniors, patients with chronic diseases and in-home care can be difficult to coordinate. Often times, services are not available when patients may need them. Without access to care or a plan to coordinate alternative access after-hours, patients or their families may turn to convenient resources that were otherwise designed to manage serious or even life-threatening illnesses or injury.
Emergency Medical Services (EMS) is an important healthcare access point for out-of-hospital emergency care, treatment and transport to a qualified emergency department. Often times, ambulances and emergency departments represent a community’s healthcare safety net when serious gaps in medical care or non-medical needs exist. Ironically, using a single point of contact such as 911 severely limits the care available to patients who do not have a serious medical condition.
A retrospective review of data (2014-2015) regarding 911 emergency medical responses in Peoria County demonstrates some of the dramatic challenges of a community healthcare system. When totaling the number of emergency medical transports provided to the 15 highest users of service, there were 976 visits to area emergency departments. Looking at the same data through a slightly different lens, the top 15 locations to which ambulances were dispatched generated 1,811 transports to area emergency departments. Many of these patients have chronic diseases and are unable or unwilling to access a primary care physician. Sometimes these patients are challenged by the lack of service availability when the patient needs to access care.
The retrospective review provides some insight into the plight of patients with chronic disease management needs. In collaboration with Peoria hospitals, AMT has developed a local program to improve the quality of care and health of patients with chronic diseases such as congestive heart failure, diabetes or chronic obstructive pulmonary disease. Working with OSF’s care managers and physicians, protocols have been submitted for regulatory approval to the Illinois Department of Public Health. The project scope will select patients with a moderate to high risk of readmission following discharge. Altogether, the pilot project embraces the Triple Aim’s trio of outcomes as the desired result.
Coordinated and Mobile
The Institute of Medicine’s groundbreaking 2012 study estimates that $750 billion—or 30 percent of the annual healthcare expenditure in the United States—is wasted on prevention failures, unnecessary services, inefficiency and other non-care related medical expenses. To answer these challenges, a team of professionals representing diverse healthcare and technology disciplines are collaborating to develop mobile integrated healthcare programs (MIHP).
Physicians, case managers, social workers, home healthcare professionals and paramedics are working together to fill the gaps in transitional and post-discharge care to better align patient needs in a coordinated model of care. Mobile integrated health programs are using a team-based approach to delivering patients the right care, at the right time, in the right place and at the right cost. A stronger focus on bringing care to the patient outside the traditional setting is turning ideas and dialogue into action with measurable outcomes. Once begun, the reality of nontraditional approaches seems less “nontraditional” and more appropriate than ever.
Another innovative project underway at AMT-Quad Cities helps demonstrate a nontraditional approach using MIHP in the post-admission discharge plan of care. For the past three years, AMT and UnityPoint have been testing the effectiveness of using EMS technicians as mobile healthcare providers. Developed by a senior team of population health experts, a risk assessment tool (LACE) was developed to measure the potential risk of hospital readmission for patients being discharged. In partnership with Rock Island’s UnityPoint Health – Trinity Medical Center, home health professionals, social workers, EMS and others meet weekly to receive their assigned patients for follow-up care and support. The teams review the objective results of their programs and receive feedback and coaching from the hospital’s case management leadership.
Dispatched by AMT to the patient’s residence, specially trained caregivers strive to see patients within 24 hours of discharge and referral. Enrolled patients receive a home visit and a health assessment using a physician-approved assessment tool. Included in this home visit is a review of their discharge care plan, education about chronic disease management and medication reconciliation. The caregivers use the hospital’s electronic medical records system to document their findings to the patient’s case manager. In the event a patient needs an intervention, AMT notifies the patient’s case manager or primary care physicians immediately and arranges the necessary transportation, if indicated.
The results of the UP-Trinity/AMT mobile integrated healthcare program are promising. During the most recent survey period, AMT was able to document wellness examinations for 72 percent of all assigned cases. Of the patients assessed, only nine percent were readmitted to the hospital within the 30 days following discharge. These outstanding results illustrate the opportunity to transform EMS from a strictly emergency care provider to a value-based mobile healthcare provider, fully integrated within a community healthcare system to improve the health of the population and influence the system’s cost of care.
Keeping patients healthy once seemed like a slogan reserved for wellness gurus. Today, the focus on better quality, higher patient satisfaction, healthier communities and an improved cost of care is leading healthcare CEOs and corporate boards to “innovate big” or go home. iBi