Preparing for Tomorrow
Regardless of the outcome of government-driven health care reform, the debate has focused the nation on the need to “bend the cost curve,” improve access and outcomes, and enable consumers to purchase on the basis of value. Throughout 2009, URMC leaders monitored and participated in the dialogue, and they launched a number of initiatives that will enable URMC to take the lead in reshaping tomorrow’s health care system.
Patient-Centered Medical Home
Health care reformers know that the secret to success begins with primary care. Attracting more physicians to practice primary care and more patients into practices instead of emergency departments for non-acute treatment is key to improving quality and cost efficiency. Insurers, employers, and health care providers are collaborating on one of the newest care models – the patient-centered medical home – an experiment that tests ways to lower costs, enhance patient care, and give primary care physicians more time to devote their patients.
Several Center for Primary Care physicians at Strong and Highland are participating in a pilot program sponsored by Excellus Blue Cross/Blue Shield and MVP Health Care. In this model, the primary care practice is the “medical home” for patients, and each physician gives comprehensive, ongoing care to those with chronic conditions or illnesses while also serving as the leader of the “practice team.” Physician time is devoted to treating the patient while a care manager helps patients comply with treatment plans and coordinates with other professionals involved in their care via electronic medical records.
The demonstration project allows URMC and its partners to test better ways to deliver and finance health care. It’s also an important step in enticing the best and brightest medical school graduates to choose to practice primary care. By enabling physicians to spend more time with patients, they report higher job satisfaction.
In the quest to improve efficiency, it’s been noted that as many as 18 percent of Medicare admissions to hospitals are readmissions, instances in which patients return to the hospital for a condition or treatment linked to their initial stay. Although URMC has always used readmissions as a proxy for efficiency and quality, a recent report by the Centers for Medicare and Medicaid ranked the nation’s hospitals on readmission rates for heart disease, heart failure, and pneumonia – enabling URMC to see its own performance in an industry context. With these helpful benchmarks, URMC affiliates redoubled the focus on avoiding readmissions whenever possible.
- At VNS, a telehealth program known as “Health Buddy” proved its effectiveness in reducing hospitalizations. One hundred patients with diabetes, heart failure or pulmonary disorders are now using the wireless devices to transmit their vital signs to VNS staff who adjust treatments or visitation plans and communicate with physicians. By enabling health professionals to intervene before the patient requires an ED visit, Health Buddy is showing a 25-49 percent reduction in acute care hospitalizations, depending on diagnosis. At the same time, patients are reporting 100 percent overall satisfaction with the ease of use, and 97 percent say they would use the device again if needed. VNS’ telehealth program is one of the top reasons that its re-hospitalization rate eclipses the national average. Among peers, VNS ranks in the top 20 percent for effectively preventing re-hospitalizations, beating local competitors as well as state and national benchmarks for both acute care admissions and ED use. It is perhaps the single most important measure of effectiveness for home health agencies.
- At Strong Memorial, leaders are not content with the hospital’s 5.5 percent readmission rate, which puts it in the middle of the pack among hospitals. Instead, readmission teams are working throughout the hospital to whittle that rate by 15 percent over the next two years, a rate that would earn a spot as a “top 10” performer among UHC’s academic medical centers. Now, we begin planning for discharge at the time of admission, more carefully evaluate patients’ readiness for discharge, and encourage patients to make prompt follow-up appointments with their primary care physicians or specialists. Physicians within the Center for Primary Care have made it a priority to see these patients within a week and are often able to intercept problems before the patient’s condition deteriorates. Discharge service teams are also routinely making follow-up phone calls to ensure that patients are able to comply with discharge instructions, and are coordinating with physicians to guide patients to recovery.
- At The Living Center at The Highlands at Pittsford, caregivers adopted a new preemptive approach that requires closer clinical collaboration among attending physicians, nurse practitioners, and nurse managers to avoid the need for residents to be re-hospitalized. Not only does this mean better care for residents, it prepares URMC’s health system for the impact of health reform proposals that penalize institutions for unnecessary readmissions.
URMC’s largest single investment to-date toward improving quality/safety/service is a $49 million commitment to an inpatient electronic medical record (EMR). A pillar in the federal government’s plan to overhaul health care’s effectiveness and affordability, EMRs allow quick and accurate communication across every setting in which a patient receives care. Along with reams of paper charts, EMRs can eliminate the redundancies that can cost consumers precious time and money.
URMC’s eRecord project introduces a single, shared inpatient electronic medical record that will serve both Strong and Highland hospitals – improving communication between doctors and our hospitals, and eventually streamlining information exchanges with other institutions. No longer will caregivers have to log onto multiple systems; eRecord will make each patient’s information available with the ease of a single sign-on. It will also lay the foundation for a rich repository of aggregated data through which researchers can better understand disease patterns and further improve care.
Already, more than 300 clinicians and staff are involved in training and certification to learn the workings of eRecord or to review and refine the vendor’s standard system components. By January of 2011, the deployment team expects to begin training 7,500 faculty and staff at Strong Memorial Hospital. eRecord is expected to launch in March 2011 at Strong; an October “go-live” date is tentatively planned for Highland Hospital.