The Division of Transformation has a lot to do, so they are jumping in with one population to test some ideas. Medicare’s Pioneer Accountable Care Organization was one of the nation’s first, and has been a means for hospitals and health care systems to learn how to work in an “ACO world.” Pioneer includes a specific group of patients who are at higher risk for hospitalization—senior citizens. Medicare has put in place an enhanced menu of resources to help keep these pioneer patients healthier and out of the hospital. So, we’re going to start with a focus on these patients.
Our IS team has developed a way to flag Pioneer patients when they present to us for care, so that we can pay closer attention to additional options for them, like focused care management and care in the home setting, extra support resources to prevent readmissions, among other things. “We’re considering Pioneer to be our first small test of change,” comments Robin Hynds, RN, senior director of care integration and transformation. “We can and need to learn from this work. Eventually, the number of patients who will have access to these enhanced resources will increase and this new model of care will become the standard.”
As the Division of Transformation looks forward, there are several bodies of work they are focused on addressing. “We have designated smaller groups to examine issues and formulate action plans in a number of areas,” comments Pracha Eamranond, MD, Lawrence General’s new chief transformation officer.“ These subgroups are already meeting to look at things like cases going to Boston unnecessarily, potential over use of skilled nursing facilities, physician engagement, and reducing unnecessary admissions.
“Our goal is to provide the right care at the right place and time,” adds Terry Sievers, RN, VP of quality and patient safety. “We are going to target over use, under use and misuse of the services we offer. When we have done that, we will be delivering exactly what the patient needs, when they need it, in the most appropriate, least restrictive setting. That’s great health care!”