DorlandHealth

Richard Scott

A new program in its third year of testing shows promising patient improvement rates for two segments of the population that together incur the bulk of health care spending—the elderly and those with multiple chronic conditions.

The Guided Care program, established at Johns Hopkins University in Baltimore, Md., is now running in pilot programs in seven Washington, D.C., and Baltimore-area community-based primary care practices, and its early adoptees have witnessed reduced admission rates, lower costs and increased patient satisfaction with the “frail elderly” population it serves.

“Guided Care takes the patient and the patient’s preferences and goals into account,” says Carol Groves, the director of senior services with Kaiser Permanente Mid-Atlantic States, where three pilot programs have recently passed an 18-month testing threshold. With a patient-centered focus and regular intervention by a specially trained nurse, Kaiser’s Guided Care implementation has resulted in reduced hospital admissions and hospital days and, more significantly, a “huge difference” in the utilization of skilled nursing facilities. “It seems that patients have the confidence to go home from the hospital vs. being admitted to a skilled nursing facility,” says Groves.

Richard Scott

More areas of the country are being served by fewer insurers this year, according to the American Medical Association.

The trend toward limited options for the average insurance purchaser in many areas has escalated to a state of quashed competition. In 24 of 43 states studied, at least 70 percent of the market was controlled by the two largest local insurers. The previous year saw 18 of 42 states with the same percentage of dual market presence.

AMA’s new study, “Competitions in Health Insurance: A Comprehensive Study of U.S. Markets,” looked at more than 300 metropolitan regions and found that nearly all—99 percent—are “highly concentrated,” resulting in a situation “where insurer consolidation may have harmful effects on patients, physicians, employers and the economy.” The study analyzed patient use of private insurers like health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

Notes from the 10th Annual Population Health and Disease Management Colloquium

Richard Scott

This year, the leading population health and disease management conference continues its close relationship with two other top health care summits, operating in the same location as conference on retail clinics and another on the medical home model. The 10th annual Population Health and Disease Management Colloquium, sponsored by Philadelphia’s Jefferson Medical College, runs through Tuesday, March 2, and its shared quarters speak to growing trends in care delivery and adherence.

Taking place among the backdrop of the national debate on health care reform, the population health conference assessed the climate of many top reform points of address, such as chronic disease, preventive medicine, wellness, health promotion and comparative effectiveness research, among a panoply of other targeted areas. Monday’s morning sessions focused largely on that term close to case managers and related medical management professionals: care coordination.

Dr. Richard Wender, chair of Jefferson’s Department of Family Medicine, opened the sessions with a keynote address touching on the well-known burden of chronic disease in our country. “Our nation’s health is unconscionably poor,” he said.

Notes from the 10th Annual Population Health and Disease Management Colloquium

Richard Scott

Dr. Thomas Wilson, founder of the Population Health Impact Institute, also spoke during the morning session. His presentation focused on transitions of care and, like Dr. Wender’s exploration of the medical home model, Dr. Wilson explored the areas of health reform that, despite the proceedings on Capitol Hill, can be addressed without formal legislation.

He also addressed the need for transparency in wellness and population health programs, and the PHI Institute will host a free Webinar on March 11 at 1:00 p.m. to explore this issue. The Webinar, “The Value of Transparency for the Evaluation of Wellness and other Population Health Programs,” will be moderated by Ford’s corporate medical officer, Dr. Walter Talamonti.

Most of the initiatives being sculpted and the areas being addressed in Washington focus on the “demand” side of the health care equation. That is, they revolve around the patient, the patient’s needs, and the organizations and systems that a patient “uses.” Transitions of care, however, sit on the “supply” side of health care; they are part of—and can be addressed by—the various providers of care. Dr. Wilson, who refers to transitions as the “white space” that drifts unacknowledged by any health care provider, stresses the importance of accountability and attribution when it comes to transitions—of both people and information.

Unnecessary hospital readmissions are not just a substantial cost burden, but they can carry with them markers of inadequate quality and represent a rupture of care at some point along the patient’s intake-stay-discharge experience.

Reducing avoidable readmissions has become a viable object of study itself, evidenced by the pioneering work of projects like Eric Coleman’s Care Transitions Program at the University of Colorado and Mary Naylor’s Center for Transitions and Health at the University of Pennsylvania. The innovators of both programs, along with another two dozen related experts, brought their ideas together at the behest of the Health Research & Educational Trust, which published in January a compendium of their analyses in an instructional guide called Health Care Leaders Action Guide to Reduce Avoidable Readmissions.

The action guide collects the working—and effective—aspects of the various models, measures them out, and boils them down to create a “starting point” from which not only hospital leaders but health care practitioners in many roles can establish and implement practical changes within their own organizations and practices.