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Successful Care Coordination and the ACA. Care Coordination for the Chronically Ill Alliance for Health Reform Briefing August 11 th , 2011 Randy Brown. Overview. What do we know about effective care coordination? What ACA provisions are likely to produce savings for Medicare?

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Successful Care Coordination and the ACA


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    Presentation Transcript
    1. Successful Care Coordination and the ACA Care Coordination for the Chronically Ill Alliance for Health Reform Briefing August 11th, 2011 Randy Brown

    2. Overview • What do we know about effective care coordination? • What ACA provisions are likely to produce savings for Medicare? • What can we do to enhance the likelihood of success? • What are the major barriers to success?

    3. The Best Evidence on Effective Care Coordination • Significant favorable effects—only for high risk patients • Transitional care (Naylor, Coleman) • Medicare Coordinated Care Demonstration—4 sites • Care Management Plus model (Dorr; OHSU) • Geriatric Resources for Assessment and Care of Elders (GRACE) model (Counsell) • Mass. General Hospital high cost program • Telephonic disease management programs don’t work

    4. What distinguishes successful interventions? • Face-to-face contact with patients • Frequent face-to-face contact with patients (~1/month) 2. Small enough caseload (e.g., 50-80) • With ongoing training of and feedback to care managers 3.Rapport with physicians • Face-to-fact contact through co-location, regular hospital rounds, accompanying patients on physician visits • Use same care coordinator for all of a physician’s patients 4. Strong patient education • Provide a strong, evidence-based patient education intervention, including how to take RX correctly and adhere to other treatment recommendations

    5. What distinguishes successful interventions? 5. Managing care setting transitions • Have a timely, comprehensiveresponse to care setting transitions (most notably from hospitals) 6. Being a communications hub • Care coordinators playing an active role as a communications hub among providers and between patients and providers 7. Managing medications • Comprehensive Rx management, involving pharmacists and/or physicians 8. Addressing psychosocial issues • Staff with expertise in social supports for patients who need it

    6. Proposed Models in the ACA • 20 models of care suggested in ACA for CMMI to test • Ones that have promise of improved care coordination: • Patient-centered medical homes for high risk patients • Advanced payment ACOs • Geriatric assessment and comprehensive care plans (GRACE) • Care coordination through HIT and telehealth (high risk patients) • Community-based health teams to improve self-management • Fully integrated care for dual eligibles • Home health providers who offer multidisciplinary care teams • Coordinated care demonstration to test replicability of successful programs from MCCD for high risk patients • Success will depend on how implemented • Bundling models have less promise for chronic illness

    7. How Can We Increase Likelihood of Success? • Require key features of successful past programs • Focus on high risk patients • Feed back information to programs and physicians • Build in studies of operational issues • Test dissemination now that core features are known

    8. Potential Barriers to Success • Excessive attention to rapid cycle learning • Quick answers are often wrong answers (e.g., Guided Care, Wash U) • Takes time to learn, train, adapt, build rapport • So use intermediate outcomes and build in tests of program implementation issues (Mahoney) • Don’t sacrifice rigor of evidence for speed • Building on prior successes should shorten time to improvement • Lack of political will • Failure to withstand pressure from special interests (e.g., hospitals, MA plans) will thwart attempt to save • Lack of information and incentives for providers • Physicians need data on quality and efficiency—their own and specialists • Payment to providers should be tied to both factors • Resource use reporting should provide this