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The Hospital at Home Model: Bringing Hospital-Level Care to the Patient

August 18, 2016

Presbyterian's Hospital at Home program, launched in 2008, is based on a model developed in the mid-1990s by Bruce Leff, M.D., a geriatrician and health services researcher at Johns Hopkins University, who noticed that many of his patients suffered poor outcomes after hospital stays.1 At Johns Hopkins, teams of physicians, nurses, and other clinical staff make house calls to treat elderly patients, many of whom either refuse to go to the hospital or are at such high risk for adverse events that physicians prefer not to admit them. For select patients, this approach produces superior outcomes at a lower cost than hospital care (see Results).The Hospital at Home model has struggled to gain traction elsewhere in the United States, however, in part because Medicare's fee-for-service program will not pay for its services. Presbyterian is able to secure reimbursement from its health plan, which covers 470,000 Medicare Advantage, Medicaid, and commercially insured members throughout the state and has incentives to reduce costs and improve care.Presbyterian's program fits within a suite of services designed to deliver care in the home. These include home-based primary care, home health, hospice, and Complete Care, a care management program designed to improve coordination of services for patients with advanced illness and, when desired, avoid unwanted aggressive care at the end of life.

Aging Gracefully: The PACE Approach to Caring for Frail Elders in the Community

August 11, 2016

Mountain Empire is one of the newest of more than 100 independent PACE organizations across the nation that serve both as health plans and as medical and long-term service providers to elders—offering meals, checkups, rehabilitation services, home visits, and many other supports that enable enrollees to preserve their independence. The model for PACE dates back to 1971, when a public health dentist and social worker from the San Francisco Public Health Department working in Chinatown-North Beach noticed that as their clients aged, many needed extra support but dreaded moving into nursing homes. They founded On Lok Senior Health Services as an alternative to institutional care that would allow elders to "age in place" in their homes; on lokis Cantonese for "peaceful, happy abode."On Lok's founders were particularly concerned about elderly clients who suffered when their various clinicians failed to work together, sometimes leading to complications that necessitated moves into institutional care. They designed On Lok to promote what was then an innovative approach: coordinating care from an interdisciplinary team of professionals who provide all primary care services and oversee specialists' services.A Medicare-funded demonstration spanning 1979 to 1983 found this approach had many benefits. Care teams were able to prevent or quickly address problems, resulting in better health and quality of life and producing 15 percent lower costs than traditional Medicare. In the decades since, the model has spread slowly, though enrollment has grown nearly 40 percent in the past three years. As of January 2016, there were 118 PACE organizations in 31 states serving some 39,000 elders.

Bringing Primary Care Home: The Medical House Call Program at MedStar Washington Hospital Center

July 26, 2016

MedStar's program offers round-the-clock access to a care team comprising a geriatrician, nurse practitioner, and social worker. The house calls reveal and address problems that are missed when care is poorly coordinated, enabling team members to identify social supports for patients that can improve quality of life, reduce the burden on caregivers, and head off problems that can lead to high-cost institutional care.Based on the cost savings it achieved, the program became one of the models for the federal Center for Medicare and Medicaid Innovation's Independence at Home Demonstration, which is testing whether providing primary care at home to frail elderly patients with multiple chronic conditions or advanced illnesses improves outcomes and lowers health care spending. MedStar participates in the demonstration as part of a consortium that includes Virginia Commonwealth University and University of Pennsylvania Health System, both of which are implementing an approach similar to MedStar's. The consortium is one of nine participating groups to earn a share of the savings they produced for Medicare.

Findings from a Survey of Health Care Delivery Innovation Centers

April 28, 2015

Health care innovation centers around the country are working to discover, develop, test, and spread new models of care delivery--in hospitals, clinics, and patients' homes. Between November 2014 and January 2015, The Commonwealth Fund conducted an online survey of innovation centers affiliated with health care organizations to learn about their potential role in promoting health system transformation.Survey findings presented in this chartpack reveal how innovation centers define innovation, what factors into investment decisions, which technologies are most commonly used, and much more. While innovation centers have the potential to contribute to health system transformation, it appears that to succeed they will need sustainable funding and greater integration with clinical enterprises. The survey also reveals that innovation centers may benefit from collaboration to identify solutions to common problems and develop a mechanism for spreading their work.

Taking Digital Health to the Next Level: Promoting Technologies That Empower Consumers and Drive Health System Transformation

October 1, 2014

Digital health technologies offer the potential to transform health care by making it more responsive to consumers' needs, convenient for patients to access, and efficient and satisfying for providers to deliver. Yet there are significant barriers to the adoption of such technologies, including a dearth of evidence of their impact on cost and outcomes and a lack of collaboration between clinicians and technologists in product development. In this report, we draw on the views and experiences of experts and innovators in the field to make recommendations for overcoming such barriers. These include: defining opportunities to focus on the country's greatest health and delivery system problems; closing knowledge gaps among consumers, technology developers, entrepreneurs, health care executives, and investors; creating test beds in care settings; enabling consumer-centered design and valuations of new technologies; and addressing operational factors and challenges related to an evolving reimbursement and policy landscape.

A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System

October 1, 2014

Digital technologies that serve as a communication bridge between providers and consumers have the potential to disrupt the U.S. health care system by enabling consumers to get care and support when and where they need it, while also making their needs and preferences known. This report describes early efforts to use digital technologies—ranging from remote monitoring devices and teleconferencing devices for virtual office visits to data mining tools—to redesign care models around the common needs of discrete patient populations. The approaches described, including those designed to increase patient engagement and close communication gaps, focus on the needs of patients with complex and costly medical and behavioral health conditions as these efforts may present the greatest opportunity for simultaneously improving care and reducing costs.