In­no­va­tion awards spur high hopes

De­spite law’s un­cer­tainty, CMS awards grants

Modern Healthcare - - FRONT PAGE - Jes­sica Zig­mond

HHS an­nounced the first grantees in a nearly $1 bil­lion ini­tia­tive un­der the health­care re­form law last week and showed again that un­cer­tainty sur­round­ing the act’s fu­ture won’t stop the Obama ad­min­is­tra­tion from fund­ing the law’s many pro­grams.

Un­veiled last Novem­ber, the Health Care In­no­va­tion awards from the CMS In­no­va­tion Cen­ter will fund up to $1 bil­lion in grants to ap­pli­cants who de­sign and im­ple­ment creative care mod­els for pa­tients en­rolled in Medi­care, Med­i­caid and the Chil­dren’s Health In­sur­ance Pro­gram. Six months and more than 2,000 ap­pli­ca­tions later, HHS se­lected 26 grantees na­tion­wide to re­ceive a to­tal of $122.6 mil­lion for three years. The agency ex­pects these pro­grams to af­fect nearly 750,000 pa­tients and lower health­care spend­ing by about $254 mil­lion dur­ing this pe­riod.

“Our hope is that the most suc­cess­ful projects will be­come mod­els for the rest of the coun­try,” HHS Sec­re­tary Kath­leen Se­be­lius told re­porters dur­ing a con­fer­ence call May 8.

That is the same goal of the physi­cians who de­signed the North Ge­or­gia Crit­i­cal Care Col­lab­o­ra­tive, which will re­ceive a $10.7 mil­lion award from the CMS to build a net­work that sup­ports in­ten­sive-care units to im­prove crit­i­cal care for pa­tients in ru­ral and un­der­served ar­eas.

For the project, Emory Health­care will work with North­east Ge­or­gia Health Sys­tem (Gainesville), St. Joseph’s Health Sys­tem (At­lanta), South­ern Re­gional Med­i­cal Cen­ter (At­lanta) and telemedicine provider Philips Health­care. The par­tic­i­pants will train nurse prac­ti­tion­ers and physi­cian as­sis­tants as crit­i­cal-care spe­cial­ists, and in­te­grate telemedicine ICU ser­vices at com­mu­nity hos­pi­tals that will pro­vide sup­port and su­per­vi­sion by crit­i­cal care doc­tors and nurses re­motely.

The project—which is ex­pected to save about $18 mil­lion—will serve about 10,000 fed­eral ben­e­fi­cia­ries in Medi­care, Med­i­caid and CHIP in the first three years. That fig­ure rep­re­sents about half of all the pa­tients who are es­ti­mated to ben­e­fit from the pro­gram, said Dr. Ti­mothy Buch­man, the di­rec­tor of the Emory Cen­ter for Crit­i­cal Care and chief de­signer of the North Ge­or­gia Crit­i­cal Care Col­lab­o­ra­tive.

Buch­man said the col­lab­o­ra­tive will train about 20 nurse prac­ti­tion­ers and physi­cian as­sis­tants and also hire a num­ber of crit­i­cal­care physi­cians and nurses to work in the tele­health ICU. That “E-ICU” will serve as a com­mand cen­ter for doc­tors and nurses to help man­age sit­u­a­tions from a dis­tance, said Dr. James Bai­ley, chief med­i­cal in­for­mat­ics of­fi­cer and chief qual­ity of­fi­cer at the North­east Ge­or­gia Med­i­cal Cen­ter, who co-di­rects the col­lab­o­ra­tive with Buch­man.

While the con­cept of E-ICUS has been around for about 15 years, Bai­ley said, it’s the six-month train­ing pro­gram in crit­i­cal care for af­fil­i­ate providers (as the two physi­cians re­fer to nurse prac­ti­tion­ers and physi­cian as­sis­tants) that will be a ma­jor fo­cus of this par­tic­u­lar pro­gram.

“Our goal is to es­tab­lish a cred­i­ble model that could be used through­out the coun­try,” said Bai­ley, who added that it is an “ab­so­lute plan” for the col­lab­o­ra­tive to con­tinue af­ter the fund­ing pe­riod ends.

In Bos­ton, clin­i­cians at Beth Is­rael Dea­coness Med­i­cal Cen­ter will build on the ef­forts of a six-month pi­lot project to im­prove pa­tient out­comes and lower hospi­tal read­mis­sions.

The CMS has awarded Beth Is­rael Dea­coness $4.9 mil­lion for the Post-acute Care Tran­si­tions, or PACT, pro­gram, which will prospec­tively en­roll all Medi­care pa­tients at the hospi­tal through re­fer­rals from any one of six af­fil­i­ated pri­mary-care prac­tices, in­clud­ing one com­mu­nity health cen­ter.

At the heart of the project is a care tran­si­tion spe­cial­ist who will build strong re­la­tion­ships with the hospi­tal and pri­mary-care site to pro­vide bet­ter treat­ment for the pa­tients, said Dr. Julius Yang, di­rec­tor of in­pa­tient qual­ity at Beth Is­rael Dea­coness. An­other im­por­tant com­po­nent is the pres­ence of a phar­ma­cist who will work in con­cert with the care tran­si­tions spe­cial­ist to help pa­tients man­age their med­i­ca­tions.

In the three-year pe­riod, the ini­tia­tive is ex­pected to af­fect 8,000 pa­tient dis­charges, train 11 health­care work­ers and yield nearly $13 mil­lion in sav­ings.

“The land­scape is chang­ing rapidly in Mas­sachusetts,” Yang said, adding that he doesn’t know what the health­care sys­tem will look like af­ter the three-year fund­ing pe­riod has ended (See story, p. 10). “If we can prove this im­proves out­comes and re­duces costs, the sys­tem will find a way to pay for it,” he said, adding that two pos­si­ble fund­ing sources could be health plans or one of the five ac­count­able care or­ga­ni­za­tions in east­ern Mas­sachusetts par­tic­i­pat­ing in the In­no­va­tion Cen­ter’s Pioneer ACO Model.

Yang said a care tran­si­tion spe­cial­ist is “your travel agent for dis­charge,” liken­ing these spe­cial­ists to travel agents 30 years ago, when these pro­fes­sion­als were in high de­mand to man­age trips for trav­el­ers. To­day, trav­el­ers book their own trips and man­age their own itin­er­ar­ies, mak­ing the need for travel agents un­nec­es­sary.

“If those two worlds—the out­pa­tient prac­tice and the hospi­tal—be­come in­te­grated enough, then even­tu­ally you don’t need that,” he said, re­fer­ring to the care tran­si­tions spe­cial­ist. “That’s an­other way this pro­gram phases out: You solve the prob­lems as you go.”

HHS will an­nounce the sec­ond and last set of in­no­va­tion grants in June.

JACK KEARSE, EMORY UNIVER­SITY

Emory, and its neuro-crit­i­cal-care unit, is part of the North Ge­or­gia Crit­i­cal Care Col­lab­o­ra­tive.

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