Building Innovative Community Programs to Reduce Healthcare Costs

Jul 09, 2014 at 04:29 pm by Staff

Health Council of East Central Florida is developing innovative approaches to adapt to the New Health Economy

OVIEDO—In Brevard County, the Health Council of East Central Florida (HCECF) is working to secure pilot funding for Chronic Care Brevard, a model built around the

Poly-Chronic Care Network (PCCN). It provides communities with a safety net boost for residents with multiple or poly-chronic diseases and represents only one of various HCECF-initiated programs to help communities in its four-county service area – Brevard, Orange, Osceola, and Seminole – adapt to the New Health Economy.

“We’re exploring innovative ways to improve the health of populations and the patient experience of care, all at a reduced per-capita cost as we move along the ecosystem journey,” said HCECF executive director Ken Peach. “For example, we’re working on another program, predicated on one underway at the Satellite Beach Fire Department, where they’ve successfully reduced hip fractures by up to 50 percent. In their community of 12,000, paramedics on the fire department staff follow up with recently hospitalized residents and, with their permission, survey their homes to assess fall risks inside and out. Most women fall inside a home; the majority of men fall outdoors. It’s important to take the entire property into account. Their program has been successful for a number of years.”

Collaborative Innovation

HCECF, Osceola County Health Department, Florida Hospital, and Community Vision are developing a promising, new “Phone to Home” program in Osceola County.

“When appropriate, every time the EMS responds to a call, the paramedics give the person a healthcare guide linking all Osceola County support services,” explained Peach, noting the health council picked Osceola County because of the higher number of incomplete runs. “If a person refuses transport, there’s no reimbursement, so hopefully this can reduce those incomplete runs, and therefore reduce costs.”

In Seminole County, a risk-stratifying program should reduce costs for covering the uninsured.

“The demand of care for the uninsured has increased to the point of funds running short on an annual basis,” said Peach. “We’re working with county officials and providers of safety net organizations on this project, which classifies patients as high-risk (5 percent), rising-risk (15 percent), and low-risk (80 percent).

“High-risk patients will be assigned case managers to watch over their care through local free clinics,” said Peach. “Rising-risk patients will be encouraged to link to a patient-centered medical home available through the federally-qualified health centers in Seminole County. The county can then expand the reach of the program and leverage dollars better for where the greatest needs of the population fall.”

Back to the Chronic Care Brevard program: The HCECF is developing it with the Viera VA Outpatient Clinic, and seeking funding for a one-year pilot.

“We’d work with identified individuals to develop a circle around them of family, friends and neighbors, and link them with an electronic app to have ongoing observation and a support network in place,” said Peach. “The concept is to reduce the likelihood that something’s going to occur to that individual in the time between routine physician visits. Often, without support, these individuals end up in the Emergency Department, the hospital, and then possibly readmission to the hospital. If the program is proven successful in the one-year pilot – if “per-member-per-month” fees cost less than hospital admissions or readmissions – then it’ll be sustained for at least another two years, based on the business plan we developed for this concept.”

Achieving the IHI Triple Aim

Developing innovative programs to help communities reduce healthcare costs is the only solution, said Peach, to achieving the IHI Triple Aim.

“From a health council standpoint, we’re involved as the healthcare navigator in this community, so we’ve been supporting or encouraging the expansion of healthcare coverage – but, we truly believe that’s not going to solve the access issue,” he explained. “For example, in Massachusetts, home of the reformed model that President Obama picked, there’s been something like an 85 percent increase in the delay of time getting to a primary care practice. We had firsthand experience last year, when a nurse stayed with us while visiting her family. She and her husband had very good insurance. But because they’d recently relocated from one neighborhood to another in Boston, they had him call to make an appointment with a new primary care practice so he could be established in the system. When he asked for an appointment, they told him a first visit with a routine physical would be available in a year and nine months. If Obamacare goes into full effect, we can expect the same problem with 80 million baby boomers, now turning 65 at 10,000 a day, and healthcare expenditures closing in at 20 percent of the GDP. It’s not sustainable to meet the growing demand.”

Peach emphasized the IHI Triple Aim framework developed by the Cambridge, Mass.-based Institute for Healthcare Improvement (IHI) under former CMS administrator Donald Berwick, MD. It describes an approach to optimizing health system performance by pursuing three dimensions simultaneously.

“No one is accountable for all three dimensions: population health, patient experience, and reducing per-capita costs,” said Peach, noting the latter is the most difficult dimension to achieve. “We’re already seeing 14 to 15 percent increases in health insurance premiums. Hospitals are having a difficult time with huge deductibles. Some medical groups are asking patients for cash upfront because they can’t be sure they’ll get reimbursed for the patient portion after the care. We’re seeing a tremendous impact there.”

Community Helpers

Peach pointed to the Healthy Communities Institute (HCI), a non-profit company in Berkeley, Calif., comprised of public health professors across the country. HCI provides communities with report cards to help them better track their health-improving performance, and access to a multitude of information to improve community health and statistics to assist with grant proposals.

“We got sponsorship in place for Brevard County, and six months later, we were able to find funding for Osceola and Seminole counties,” said Peach. “We have literally over 100 indicators of health determinants that communities must consider. It gives us access to roughly 2,000 of the best evidence-based or best ideas from programs operating around the country. Many use the HCI system to develop grant applications and peruse various programs to consider implementing in their communities. On a statewide basis, it’s also available in the Miami-Dade area, and seven counties north of us – Volusia up to the Georgia line and northeast Florida. There’s one each in Tampa Bay and the Palm Beach area.”

Peach also pointed to The Creative Destruction of Medicine, written by Eric J. Topol, MD, as a superb resource.

“It’s an excellent compilation of many different approaches being taken to find less expensive ways to deliver quality care and to reach a larger population,” he said.

Editor’s note: The companion article, “Searching for the New Power Players,” in this edition recaps the Health Research Institute’s April-released “Healthcare’s New Entrants: Who will be the industry’s” that Ken Peach references in the article.

Institute for Healthcare Improvement: “Because the IHI Triple Aim entails ambitious improvement at all levels of the system, we advocate a systematic approach to change. Based on six phases of pilot testing with over 100 organizations around the world, IHI recommends a change process that includes identification of target populations; definition of system aims and measures; development of a portfolio of project work that’s sufficiently strong to move system-level results, and rapid testing and scale up that’s adapted to local needs and conditions.”

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