To address health care cost growth, BWHC is redesigning care to provide more value to patients, including improved outcomes, higher-quality care and lower costs. BWPO Chief Medical Officer and BWHC Vice President of Care Redesign Jessica Dudley, MD, led a Quality Rounds presentation last month to share the various BWPO projects that are doing just this—from Partners eCare and the integrated Care Management Program (iCMP) to projects that facilitate patient engagement and more.
“While national and state governments are very focused on identifying approaches to controlling health care costs, we as providers are uniquely positioned to identify opportunities to improve efficiencies and outcomes for patient care,” said Dudley. “Through our efforts in population health management, we have been investing in the infrastructure and developing programs to improve outcomes while also reducing medical expense trend.”
Rebecca Cunningham, MD, iCMP medical director, provided an update about the program, which is a key strategy of population health management that focuses on BWHC’s highest-risk patients. As part of the program, nurse care coordinators collaborate with patients’ primary care teams to help manage every aspect of their care.
The result is a nurse-led multidisciplinary care team that provides better care coordination for patients in order to improve health outcomes and reduce preventable hospital admissions. So far, more than 3,000 patients have been engaged in the program, which is supported by a multidisciplinary team of nurses, social workers, psychiatrists, pharmacists and community resource specialists. The program is measuring health care utilization and costs, as well as patient and provider experience. With the support of this enhanced care team, hospital admission rates for iCMP patients decreased by 18 percent from 2013 to 2014.
During the presentation, Adam Licurse, MD, MHS, BWPO assistant medical director and a primary care physician at Brigham and Women’s Advanced Primary Care Associates, South Huntington, also spoke about the medical neighborhood, which links primary care, specialists and other providers into one coordinated team. The defining features of the medical neighborhood are eReferral and Team Care. The first is a web portal in which primary care physicians can send referrals to any ambulatory BWH specialist—an effort to ensure the patient is seen by the right specialist in a timely manner and prevent patients from leaving the BWHC family for specialty care. Until eReferral, there hadn’t been a standardized hospital-wide system that coordinated referrals.
Similarly, Team Care provides physicians with a portal to ask each other questions about a patient’s care before a referral is made, potentially avoiding unnecessary referrals.
Satisfaction about the referral process jumped from 21 percent to 69 percent from 2013 to 2014 among the specialties piloting eReferral and Team Care, which includes Orthopedics, Gastroenterology, Neurology and others.
Licurse also shared some of the ways BWHC is improving patient engagement, leading to improved decision-making and increased self-care at home. BWHC has been a leader in the collection of PROMs, or patient-reported outcome measures, in which patients answer a series of questions using an iPad in the waiting room and then receive follow-up questionnaires. In addition to engaging patients in their care, this helps BWHC collect data about quality outcomes that matter to patients, provides new insights into patient behavior and allows for better tailoring of care to specific patient groups.
Additionally, an online video software program called Vidscrips allows clinicians and other staff to easily record short informative video “prescriptions” that are specific to certain diseases or patient populations. Patients are able to watch the videos whenever they have questions related to their condition or information their clinician has shared. Vidscrips, along with virtual video visits, which the BWPO is also piloting across a number of departments, may allow for improved patient self-management in between care episodes and higher patient satisfaction.
Karl Laskowski, MD, MBA, BWPO assistant medical director, shared an update on the BWPO Care Redesign and Incubator Startup Program (BCRISP), an initiative established in 2013 in which teams of frontline clinicians submit proposals for projects that improve quality of care and reduce health care costs. BCRISP projects have focused on a variety of topics, including bedside medication delivery, Emergency Department observation of atrial fibrillation and innovative clinical pathways in lung cancer. More than 100 proposals and 16 project pilots later, BCRISP has led to $1.2 million in total medical expense savings.
Read more about the latest round of BCRISP projects in BWH Bulletin later this month.