CMS chooses 73 pro­fes­sion­als to help lead in­no­va­tion ef­forts

CMS gives groups $20,000 to test in­no­va­tions

Modern Healthcare - - EDITORIAL MODERN HEALTHCARE - Jes­sica Zig­mond

The CMS has named 73 pro­fes­sion­als who will par­tic­i­pate in the agency’s In­no­va­tion Ad­vi­sors Pro­gram, a $6 mil­lion ini­tia­tive to test new mod­els of pay­ment and health­care de­liv­ery. Each home or­ga­ni­za­tion will re­ceive $20,000—funded through the Pa­tient Pro­tec­tion and Af­ford­able Care Act—to sup­port its rep­re­sen­ta­tive, who is ex­pected to work 10 hours a week on the pro­gram. The idea is for these trained lead­ers to re­turn to their or­ga­ni­za­tions with new skills and re­sources in health­care eco­nomics and fi­nance, pop­u­la­tion health, sys­tems anal­y­sis and op­er­a­tions and re­search (Nov. 7, p. 6). To see the full list an­nounced last week, visit in­no­va­tions.cms.gov.

Here are four of the cho­sen in­no­va­tors from dif­fer­ent re­gions of the coun­try, who of­fer a glimpse of the lead­ers and projects the pro­gram seeks to de­velop.

Gary Chris­tensen

Im­prov­ing Rhode Is­land’s poor hos­pi­tal read­mis­sion rate is the prima- ry fo­cus for Gary Chris­tensen, the chief op­er­at­ing of­fi­cer and chief in­for­ma­tion of­fi­cer of the Rhode Is­land Qual­ity In­sti­tute in Prov­i­dence, who en­tered the health­care field from the fi­nan­cial ser­vices in­dus­try. His project will be an ex­ten­sion of a ser­vice the in­sti­tute has de­vel­oped in which providers are no­ti­fied au­to­mat­i­cally when one of their pa­tients is ad­mit­ted or dis­charged from a hos­pi­tal. Data for this are col­lected through Cur­rent­care, a health in­for­ma­tion ex­change that be­gan in April 2011. The in­sti­tute’s goal is to re­duce hos­pi­tal read­mis­sions in the state by 12% over three years, Chris­tensen said, and the In­no­va­tion Ad­vi­sors pro­gram may help the in­sti­tute learn how to scale the ser­vice across the state.

“I will ab­so­lutely hone my change­m­an­age­ment skills,” Chris­tensen said about par­tic­i­pat­ing in the pro­gram, which kicks off this month in Bal­ti­more. He added that pre­vi­ously he fo­cused his work on pri­vate pay­ers and will gain in­sight into Medi­care and Med­i­caid. The best thing about the CMS pro­gram, he said, is the op­por­tu­nity “to learn about and steal from other re­ally good ideas from the other par­tic­i­pants so we can launch projects we haven’t even thought of yet.”

Kathy Scott

Kathy Scott, who holds a PH.D. in or­ga­ni­za­tional sys­tems, was ex­cited by Pro­health Care’s sys­tem of hos­pi­tals, re­ha­bil­i­ta­tion cen­ters, hospice and ex­tended care pro­grams when she be­came the chief in­no­va­tion of­fi­cer there more than a year ago. As she sees it, Pro­Health Care’s sys­tem, based in Wauke­sha, Wis., is the “per­fect set-up for learn­ing and trans­form­ing health­care,” which she hopes it will do, in part, through her project. That ini­tia­tive will ex­am­ine how to man­age chronic care across the full con­tin­uum with an ACO that is com­posed of em­ployed and independent physi­cians. (Pro­health Care’s ACO was es­tab­lished in Jan­uary 2011 and the in­ten­tion is for it to be a part of the Medi­care Shared Sav­ings Pro­gram, ac­cord­ing to Scott.)

Pro­health Care has some of the project pieces in place

al­ready. For in­stance, it re­cently im­ple­mented an elec­tronic med­i­cal-record sys­tem in its acute or­ga­ni­za­tion and its em­ployed physi­cian or­ga­ni­za­tions. And it has some hos­pi­tal-based chronic-care pro­grams in an out­pa­tient set­ting that it will use in the process. But what Scott says the project needs—and what she hopes to learn from the In­no­va­tion Ad­vi­sors pro­gram—is how to make a seam­less chron­ic­care pro­gram last over time.

“We’ll need to use de­ci­sion-sup­port tools and then all kinds of reengi­neer­ing pro­cesses for hos­pi­tal­ists and nurses to mit­i­gate tran­si­tions of care,” Scott said. “And then we have to de­cide on the care-man­age­ment model that is sus­tain­able in the fu­ture. There is a lot of re­search on chronic-care mod­els, but they haven’t been sus­tain­able.”

Pamela Dun­can

Last July, Pamela Dun­can was hired by Wake For­est Bap­tist Med­i­cal Cen­ter to im­prove post-acute ser­vices and in­te­grate care with so­cial ser­vice agen­cies in an ef­fort to re­duce the sys­tem’s hos­pi­tal read­mis­sion rate. To do this, Dun­can, di­rec­tor of tran­si­tional out­comes at Wake For­est Bap­tist and pro­fes­sor of neu­rol­ogy at Wake For­est School of Medicine, both in Win­ston-salem, N.C., em­pha­sized “break­ing down si­los” to tran­si­tion from health­care to com­mu­nity-based ser­vices.

“It will re­quire that we ex­am­ine how we re­im­burse and how we func­tion as teams,” Dun­can said, adding that some of the fo­cus will be on how in­di­vid­u­als per­form at the top of their game. “For ex­am­ple, phys­i­cal ther­a­pists or nurse prac­ti­tion­ers or physi­cian as­sis­tants can ac­cept a lot of re­spon­si­bil­ity for co­or­di­nat­ing and man­ag­ing care for the pa­tient.”

Dun­can has ded­i­cated her long ca­reer to aca­demic re­search and how to man­age pa­tients in a post-acute set­ting. Now she wants to learn more about eco­nomic in­cen­tives and poli­cies in health­care. In Novem­ber 2010, Dun­can trav­eled to Sin­ga­pore, where she saw how in­di­vid­u­als at the Min­istry of Health were able to in­te­grate care—which caused her to won­der why this isn’t hap­pen­ing in the U.S.

“Every­thing is driven by pol­icy and re­sources and the abil­ity to pro­vide the in­cen­tives and lead­er­ship to in­no­vate,” she said. “You may have it at the fed­eral level and the state level, but as we will demon­strate—it will be a com­mit­ment at the grass­roots level as well.”

Dr. Anna Flat­tau

Dr. Anna Flat­tau, di­rec­tor of the wound heal­ing pro­gram at Mon­te­fiore Med­i­cal Cen­ter in New York, hopes the In­no­va­tion Ad­vi­sors pro­gram will help de­velop her idea of pro­vid­ing home-based ser­vices for pa­tients with pres­sure ul­cers (more com­monly known as bed sores).

Flat­tau’s pro­gram calls for an in­te­grated part­ner­ship among physi­cians, physi­cian as­sis­tants and home nurses to care for pa­tients.

“The goal is to de­velop this as a way that al­lows us to do this of­fi­cially and mea­sure out­comes,” Flat­tau said. “It de­pends on the ap­proval from the hos­pi­tal and it needs to be funded,” she added. “So it’s mak­ing sure a busi­ness plan is ac­cept­able to Mon­te­fiore.”

Flat­tau said she’ll bring back what she learns in a few ways, such as teach­ing oth­ers dur­ing clin­i­cal ro­ta­tions and pub­lish­ing re­sults of out­comes in the fu­ture. She said the pro­gram de­scrip­tion ex­cited her be­cause the pa­tients she sees— those with com­plex dis­eases—need a bet­ter health­care de­liv­ery sys­tem that brings care to them.

“You must have the clin­i­cal knowl­edge, but you need to speak the lan­guage of a busi­ness plan,” Flat­tau said. “And I think there is good rea­son for that—be­cause if you don’t have one, you’re not fi­nan­cially sus­tain­able.”

Scott

Chris­tensen

Flat­tau

Dun­can

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