They make up a small fraction of hospitalized patients, but account for a disproportionately large amount of health care costs: the so-called “super-utilizers.” The costly repeat patients often grapple with social, economic and mental health challenges that exacerbate their health problems and impede their follow-up care. With those needs in mind, nonprofit leaders this week advanced a foundation-backed effort to spur innovative models for tackling Pittsburgh's super-utilizer dilemma. The project, called iCount, calls on the about 1,000 behavioral health and social service agencies in the greater Pittsburgh region to consider teaming with a primary care provider to become one of three to five “community clusters” in iCount's three-year pilot program. “It's meant to break down the silos and tap existing agencies for the benefit of patients,” said Kate Dewey, president of The Forbes Funds, a Downtown-based organization that advises nonprofits and has been planning iCount for two years. The clusters will focus on the “golden three weeks” following a hospitalization by making daily patient contact and ensuring patients get the wraparound services they need: from transportation to child care to help in understanding medication regimens. Each cluster of up to 15 agencies, centered on a health care provider, will target a geographic area and a high-risk medical need, such as congestive heart failure or diabetes.
The goal is twofold: Improve the quality of life for would-be super-utilizers while lowering costs for everybody. Super-utilizers — patients who return to the hospital five or more times in a year — tend to be low income, seniors or people with disabilities, which means taxpayers pick up their medical tabs.
The clusters will establish close relationships with local hospitals, which have an incentive to participate. The Affordable Care Act of 2010 included a provision that fines hospitals for high readmission rates. “Now really for the first time ever, hospitals are being given very strong incentives to follow the patient beyond their own doctors out into the community to ensure that care continues in an uninterrupted fashion,” said Michael Blackwell, iCount's lead planning consultant and former CEO of insurers Health America and Gateway Health Plan. Eighteen months into iCount, organizers plan to begin negotiating with hospitals and insurers for potential revenue-sharing options, in hopes that if iCount proves it can reduce costs for providers and lower risks for insurers, those companies will pump money back into iCount. “
The Forbes Funds will take a back seat once it establishes iCount as a nonprofit 501(c)3 organization this fall.
Natasha Lindstrom - Trib Total Media. March 22, 2015
The Department of Veterans Affairs (VA) announced a new 11-member Special Medical Advisory Group (SMAG) composed of leading medical experts to assist the Department in delivering health care to the 9 million Veterans enrolled in the Veterans Health Administration. The SMAG is a reconstituted federally-chartered committee that advises the Secretary of Veterans Affairs, through the Under Secretary for Health, on matters related to health care delivery, research, education, training of health care staff and planning on shared care issues facing VA and the Department of Defense.
“The appointment of the new members of the SMAG comes at a time when VA is experiencing increased demand for its health care services. Nationally, VA completed more than 51 million appointments between May 1, 2014, and March 31, 2015. This represents an increase of 2.4 million more completed appointments than during the same time period in 2013-2014. In March 2015, VA completed 97 percent of appointments within 30 days of the Veteran’s preferred date.