Concentrated efforts improve care coordination

January 1, 2014

URAC recognizes best practices

As healthcare becomes increasingly complex and competitive, organizations are turning to creative solutions to improve care, reduce costs and engage consumers to take charge of their health.

URAC, a healthcare accreditation and education organization, honored 21 organizations in 2013 with Best Practices Awards in recognition of their efforts to advance consumer engagement and protection in measurable and reproducible ways.

Kaiser Permanente Northern California

Reduction of hospital-acquired Clostridium difficile infection

As hospitals across the country grapple with hospital-acquired Clostridium difficile infections, Kaiser Permanente Northern California developed a plan for its 21 hospitals, where rates had doubled from 2006 to 2008. 

The program has five components: standardized hospital room cleaning and disinfection protocols; immediate isolation of infected patients and precaution to prevent spread of bacteria by contact; hand-hygiene protocols; proactive stewardship of antimicrobial medications; and reduction in usage of acid-suppressing gastric medication. The last item reflected a growing body of evidence that suppressing gastric acid increases risk of infection, so the system began to restrict use of proton-pump inhibitors outside the intensive-care unit, says Alan Whippy, MD.

A system also was developed for cleaning rooms in a specific manner, and employees were educated to understand their role in saving lives.

“In very short order we were able to show we had a very significant reduction in germs on surfaces in patient rooms,” Dr. Whippy says.

Employees were trained in “deliberate practice sessions” to walk through the hand-washing protocols.

“To say everyone should wash hands before going in and out of patient rooms is easy, but it turns out there are some practices that make it quite difficult,” she says. “If your arms are full of medications or you’re rolling carts around, when does hand washing happen?”

The biggest hurdle has been creating a culture of good hand hygiene. Recent “secret shopper” results show 80% compliance-up from about 20% at the program’s outset.

Since 2010, Kaiser Permanente Northern California has reduced the incidence of Clostridium difficile infection by 62%, prevented more than 2,855 cases and 485 deaths, and reduced hospital stays by 28,551 patient days.

“None of these strategies takes a lot of additional equipment or is hugely expensive,” says Barbara Crawford, vice president for quality and regulatory services. “It really requires leadership being clear and precise about what you want people to do.”

 

Robert Young Center and Community Health Care

Coordination of care for severe mental illness 

Mentally ill patients often fail to receive the physical care they require before their health becomes critical, leading them to incur a disproportionate amount of healthcare expenses. Although 11% of the Medicaid population suffers a major mental illness, they are responsible for 39% of healthcare expenditures, says David L. Deopere, PhD, president of UnityPoint Health’s Robert Young Center (RYC) in Moline, Ill.

“Behavioral co-morbidity is a big deal in cost savings and a big deal in quality outcomes,” he says.

The center partnered with Community Health Care (CHC) to establish a primary clinic at the RYC Community Support Program, creating healthcare homes for 385 people. RYC provided a mental health clinician, and the center hired 2.5 care coordinators who were “compassionate yet persistent and aggressive” to ensure patients stayed on track, Dr. Deopere says.

In about two years, the model led to a 46% decrease in emergency room visits; a 65% decrease in payments for ER visits; a 50% decrease in psychiatric admissions per quarter; a 16.9% decrease in medical admissions per quarter; an 80% decrease in payments for medical admissions; and a 131% improvement in quality of life scores-while saving $8 million.

“The bottom line is, they are happier, they are healthier, and they’re not spending as much money,” Dr. Deopere says.

Family Health Network and Sinai Urban Health Institute

Improving asthma control 

Economically stressed communities in the Greater Chicago area had an above-average number of Medicaid recipients with asthma, with some areas rising as high as 17%. Family Health Network partnered with Sinai Urban Health Institute to expand an existing program, training five community health workers to identify patients who needed extra help getting their asthma under control.

Since August 2011, more than 427 patients were referred to the program, which provided a series of visits in the home over 12 to 18 months. Community health workers were trained in interviewing techniques, engaging the child and adult, evaluating the home situation and giving them ways to control their asthma, says Barbara Hay, chief operating officer of Family Health Network.

The visits gave workers a chance to assess the potential triggers-such as dust in the home. In one case, a community health worker helped a family relocate.

“You have to be able to speak with them and educate them in a non-threatening environment,” says Hay.

The program was able to reduce emergency department visits by 75%, with 91.4% fewer hospitalizations, 96% fewer hospital days and 50% fewer missed days at work and school, says Keith Kudla, president and CEO of Family Health Network. A similar program is in the works for diabetics.

“Supporting health through education and empowerment makes medical and economic sense and can result in a dramatic improvement in health outcomes,” Kudla says. 

“There’s a big difference between transparency and clarity,” -Robin Gelburd

FAIR Health

Empowering consumers to understand their medical expenses 

Born in 2009 from a settlement agreement, FAIR Health was established to construct a transparent, objective database and related methods for determining out-of-network reimbursement. It holds a repository of more than16 billion health claims records for 129 million lives nationwide, and it is used by health plans, consumers and researchers.

According to Robin Gelburd, president, consumers can use the website to determine their out-of-pocket costs for decision-making.

“There’s a big difference between transparency and clarity,” she says. “What we try to do is take all that data and create some order and some sense to it.”

Unlike some cost calculators, FAIR Health’s tool takes certain procedures, such as arthroscopy, and adds related procedures that will be needed, such as anesthesia.

“Consumers need to know all elements involving their care, including the cost, which was previously not a big part of the conversation,” Gelburd says. “To really interface with the consumer, you have to approach that role very responsibly; you can’t just push data out into the marketplace.”

ActiveHealth Management

Member engagement

Conscious of the complexity of managing multiple chronic conditions and coordinating treatment by various physicians, ActiveHealth Management developed the CareEngine to identify gaps in care and alert members and physicians to opportunities to improve treatment plans. Using more than 1,300 algorithms, the organization studied the member claims, pharmacy and lab data for a client company with more than 350,000 members. ActiveHealth sent more than 196,000 letters to members and physicians to alert them to potential gaps in care, and followed up with automated calls.

Nurses, clinicians, wellness coaches and others were trained in soft phone skills to connect with members on individual health needs, scheduling appointments and following up on missed appointments. Each member was scored by risk to receive four to 12 contacts a year.

More than 200,000 members completed health assessments-compared with 20,000 who had done so prior to the program’s roll out, says Wadida Murib-Holmes, ActiveHealth’s executive director.

“We’ve never seen numbers like this before,” Murib-Holmes adds.

ActiveHealth saw improvement in 22 of 28 measures, and members indicated a 93% satisfaction rate.