MI partnership creates new transition model

Physicians and hospitals work together

A new care transition partnership might one day be an important model for hospitals as the new health care legislation nudges providers in the direction of reducing hospital readmissions.

The University of Michigan in Ann Arbor, Blue Cross Blue Shield (BCBS) of Michigan, and 15 Michigan hospitals and physician care sites have teamed up to produce a hospital transition model that could reduce readmissions and improve care.

"In health care reform, a major area of focus is going to be improving care transitions and hand-offs of patients between different care providers," says Scott Flanders, MD, SFHM, director of hospital medicine at the University of Michigan in Ann Arbor. Flanders also is the president of the Society of Hospital Medicine (SHM) in Philadelphia.

"This is in part to avoid potentially preventable hospital readmissions, which cost billions of dollars nationally each year," Flanders says. "Our hope is on a case-by-case, hospital-by-hospital basis, to solve this problem."

The initiative kicked off on Jan. 1, 2010, as part of BCBS of Michigan's valued partners program, says Tom Leyden, manager with clinical programs at BCBS of Michigan.

"We have quite a few collaborations like this, and each is a statewide collaboration of doctors, nurses, and a variety of organizations," Leyden says. "The University of Michigan serves as a coordinating center for the organization."

The initiative has a physician leader, a nurse leader, and an analyst.

"Our intent is to have an objective third-party organization to work with providers, brainstorming, and serving as a resource for physician organizations, as well as for hospitals," Leyden says. "We will help them begin or continue down the path of reducing avoidable readmissions."

Hospital providers can accomplish more through this type of collaborative when their hospital leadership is fully behind the effort.

"We certainly have major support from our hospitalist director, who is Scott Flanders, and from our CEO's office," says Christopher Kim, MD, MBA, an assistant professor of internal medicine in pediatrics and an assistant medical director for the faculty group practice at the University of Michigan Health System in Ann Arbor. Kim, who is closely involved in the care transition project, also is an assistant chief of staff for the office of clinical affairs at the health system.

Before the project began, the health system tried to make sure that key constituents that are critical to any chance of success were engaged in implementing this initiative, Kim adds.

Providers involved in the initiative will use tools from SHM's Project BOOST (Better Outcomes for Older adults through Safe Transitions) for all adults in primary care settings, as well as hospital settings, he adds.

"We need to target all hospitalized patients, because many who are not older adults also are at risk of being rehospitalized," Flanders says. "Project BOOST, while initially focusing on older adults, has been implemented around the country to focus on all readmissions, and not just on the elderly."

The hospitals involved in the partnership are as varied as the state of Michigan: They include rural, urban, teaching, non-teaching, large, and small hospitals, says Della Rees, PhD, senior health care analyst with BCBS of Michigan.

"No matter what your hospital is, the program should be accommodating," Rees says.

Each hospital has autonomy to set up its own protocols and processes to work toward the goals. However, they'll collect the same quality initiative data regarding their patient readmissions within 30 days.

BCBS of Michigan provides funding for the coordinating center, a kick-off meeting, forums, and some tools that will assist hospitals and providers in making the necessary changes and improvements.

"They can use the money in any way they choose," Rees says. "The key is collaboration among groups and analyzing current processes."

Hospital discharge leaders and others are expected to share best practices and discuss their care transition strategies at the collaboration forums.

"We provide them with the setting, the funding for a coordinating center, funding participants, some compensation to help defray costs of participation, and providing them with dashboard data, so they can drill down to investigate what their current readmissions look like," Rees explains. "It's funded through the physician incentive program, and the funding goes through physician programs."

Ideally, providers will use the funds to invest in infrastructure improvements that would have a long-term impact on care transition, Flanders says.

"The amount of resources that each physician organization will receive will not allow for large-scale projects, but it clearly will support pilot testing," Flanders says. "They'll implement these systems, and we'll see what works and what doesn't work."

Each physician organization will develop a different system by which patients are bridged from inpatient to the outpatient setting, he adds.

Discharge planners and others will collect key clinical information about patients, including their medications, diagnoses, lab tests post-discharge, etc.

"Another aspect is that hospitals will reach out to particularly high-risk patients after discharge, usually within 72 hours, to assess how things are going," Flanders says. "They'll troubleshoot particular problems and identify solutions that will be initiated on the hospital side."

There is more power in combining information and resources.

"When an individual hospital or physician organization looks at their patients, they're only looking at a small subset," Leyden says. "When you combine data with other organizations, you start to see very clear trends emerge."

BCBS has a goal of building a groundswell of activity and synergy by pulling so many providers together in one state, he adds.

"It takes a unique partnership of folks to make this work, and we find that having well-engaged physician leaders, who are well-regarded in the state of Michigan, leads to greater receptivity to what is presented," Leyden says.

These solutions likely will include a team that has physicians, nurses, social workers, pharmacists, and discharge planners working together.

"It takes a team of people working together to make this transition seamless and safe," Flanders says.

For the first part of the project, providers will collect baseline data, and they'll present this information at the initiative's kick-off meeting in mid-May, Rees says.

Society of Hospital Medicine mentors, University of Michigan experts, as well as representatives from the 15 provider groups, will attend the meeting to see which projects they'll want to tackle first.

The idea is for each hospital-physician group to select one process improvement, make that change, and follow up to assess its impact. If the process improvement works, then they'll find a way to expand its reach.

"We'll give providers an expectation of what their commitment might be, but the way each hospital operates is up to them," Leyden says. "We find we get the best results that way, because they can come back and tell others about what works."

For example, some of these types of collaborations have resulted in cost savings and outcomes improvements in transitions of care, Leyden notes.

BCBS of Michigan's data show that 10.2% of the insurer's health plan members had rehospitalizations within 30 days, Leyden says.

Of these, 63% were preventable readmissions, which amounts to $75 million in unnecessary health care costs, he adds.

"We also estimated the per patient spend for potentially preventable readmissions is $11,490," Leyden says. "That's the area we are expecting physician organizations and hospitals to address."

BCBS has other projects addressing lowering readmission rates, but this provider-insurer collaborative definitely is the future, Rees notes.

"I think this will lead to improved patient care and improved patient safety," she says. "It's not about how many dollars we save with rehospitalizations; it's about what is happening to these patients who are getting rehospitalized and fixing the cracks in the system."


For more information, contact:

• Scott Flanders, MD, SFHM, President, Society of Hospital Medicine, Philadelphia, PA; Professor, Internal Medicine, University of Michigan Medical School; Director of Hospital Medicine, University of Michigan Health System, 3119 Taubman Center, Ann Arbor, MI 48109-5376. Telephone: (734) 647-2892.

• Christopher Kim, MD, MBA, Assistant Professor, Internal Medicine, Pediatrics; Assistant Medical Director, Faculty Group Practice, Assistant Chief of Staff, Office of Clinical Affairs, University of Michigan Health System, 3119 Taubman Center, Ann Arbor, MI 48109-5376. Telephone: (734) 615-3036. Email: seoungk@umich.edu.

• Tom Leyden, Manager with Clinical Programs, Blue Cross Blue Shield of Michigan. Corporate Communications: (313) 225-9499. Email: newsroom@bcbsm.com.

• Della Rees, PhD, Senior Health Care Analyst, Blue Cross Blue Shield of Michigan. Corporate Communications: (313) 225-9499. Email: newsroom@bcbsm.com.