A Different Measure of Success

4/15/2014

Most people wouldn’t consider losing a million in revenue an effective way to run a business. Matt Eisenhower isn’t one of those people. For him and other caregivers at PeaceHealth Ketchikan Medical Center, this is a new way to define success. Matt is Program Manager for the Centers for Medicare & Medicaid Services (CMS) Innovation Grant awarded to PeaceHealth Ketchikan in 2012. His work is part of a dramatic philosophical change in health care delivery that has successfully saved local patients about $1.5 million in the last year and a half. Payments to PeaceHealth are down 14 percent, hospital readmissions between two and four months after discharge are down 65 percent, and there is improvement in patients with chronic conditions like diabetes and high blood pressure.

While at first glance it may look as if Matt’s job is to decrease revenue for PeaceHealth Ketchikan, the real purpose is to find innovative ways to provide better care, which leads to better health, resulting in lower costs.

“Hospital-based health care costs continue to go up, and the way insurance companies and government pays for this care is changing dramatically,” Matt says. “For decades, American health care payment models have been heavily weighted toward fixing problems in the hospital setting. This has been the emphasis of health care, and it’s what primarily drives health care payments now. We are on the cutting edge of developing different models that reward hospitals and clinics for effective preventive care.” 

The centerpiece of the grant is care coordination, which provides ongoing care and contact with patients who have been discharged from the hospital or who live with a chronic disease. New staff has been hired to implement the program. Through the three-year, $3.5. million grant, PeaceHealth Ketchikan has hired three registered nurses, a licensed practical nurse, a social worker, a clinical educator, a nurse practitioner, and a manager. Ten other positions are partially funded through the grant.

Here’s how it works: When patients leave the hospital and return home, a nurse or the social worker calls to talk about the patient’s progress and answer any questions. This care coordinator asks questions too and, most important, listens.

Earlier this year, a patient remarked in conversation that there was some warmth near the surgical site and that the patient planned to tell the surgeon during a follow-up appointment the next week. Instead, because of care coordination, that patient was seen almost immediately, and what could have become a major infection was an easily treatable condition.

In the last quarter of 2013, about 70 percent of the more than 525 patients discharged were contacted. Intervention at that time resulted in an approximate decrease of percent of immediate readmissions.

“What that means,” says Matt, “is that three or four patients every month were not returning to the hospital.”

For people with chronic conditions like diabetes or congestive heart failure, a care coordinator helps monitor their condition, makes appointments, and otherwise helps overcome hurdles to care.

It’s no secret that some people avoid colonoscopies and mammograms. With the encouragement of care coordinators, more people are being reassured that the tests aren’t horrible (they really aren’t) and are being screened for breast cancer and colorectal cancer.

Particularly encouraging is a big uptick in immunizations. From a baseline of 55 percent in November 2012, 85 percent of people now have the appropriate immunizations.

But what about all that lost revenue? Matt has the answer. "This is what we celebrate,” he says. “It’s not about revenue alone, but about healthier people and fewer people in the hospital. This is deep in the DNA of PeaceHealth and the people who work here. This is good medicine, it’s the right thing to do, and ultimately the path toward balancing revenue and costs by reducing unnecessary return trips to the hospital for expensive care.”

PeaceHealth Ketchikan Medical Center CMS Innovation Grant team 2014