Population health overdue

funded through CMS’ innovation center, such as a reimbursement plan that gives hospitals a set amount for, say, a knee replacement. They get more if they treat the patient for less and lose money if it costs more.

The ACA also prompted hospitals and doctors to work together in what are known as “accountable care organizations” that share in any savings they bring to the Medicare system.

As the fate of the ACA — and CMS’ Center for Medicare and Medicaid Innovation — becomes increasingly uncertain, Christiana CEO Janice Nevin said she’s apprehensive about what will happen to the funding. But she’s convinced it’s still the best way to practice health care.

“We’re used to dealing with lots of change and certainly the uncertainty now is a challenge,” said Nevin. “But all of the work we are currently doing is work we need to be doing to (stay) focused on health and affordability.”

The money has sure helped, though.

Christiana has seen a 20 percent drop in patients being readmitted after 30 days as part of its overall “bundled” payment plan for heart failure. For hip and knee replacement, readmissions are down 25 percent 30 days after they are released. “Without the funding we got through CMMI, it’s hard to imagine we’d be in the position we’re in today,” said Nevin. “I would strongly urge that we keep the commitment to CMMI (because) you have to innovate to learn.”

Population health, which can involve a set number of patients in an area or with a certain condition, is “long overdue in this country,” said Leah Binder, CEO of the Leapfrog Group, which rates hospitals on quality and safety.

Binder, whose group was started by employers and insurers hoping to bring health costs down, said the changes in how hospitals are paid drive the focus and she hopes it will accelerate in the Trump administration. The push, she said, “forced hospitals to think about what happens after patients are discharged.”

“What ties this all together is the laser focus on the well being of the patient,” said Binder, a former hospital administrator. “Even though that sounds like the most obvious thing in the world, that has never been business as usual in healthcare.”

In a typical hospital, the 5 percent of patients

Few have more chronic conditions than Tramonte. He developed Type 2 diabetes while in his 20s and it “attacked all of his organs,” said his wife. After spending 36 years working for the U.S. Postal Service, he started working for the armored car company Brinks and retired five years ago. It hasn’t exactly been peaceful, but it’s been better than it would have been without his care team, the couple said.

Christiana helps Phyllis Tramonte “put things