Skip to main content

'One-stop Care' Cuts Costs by Double Digits for Seriously Ill Patients

Analysis  |  By Tinker Ready  
   March 16, 2017

The per-patient cost of hospital care declined 19.4% for aging patients enrolled in a project that provided home-based services. Now an interdisciplinary panel is examining ways to build and pay for a "critical pathway to improved care."

When seriously ill patients seek care at the MedStar Washington Hospital Center, they can expect to get care from the system for the rest of their lives.

Not just health care, but everything required to meet their social and functional needs, says K. Eric De Jonge, MedStar's director of geriatrics.

He calls it "one-stop shopping" and he shared the concept with a panel that met in Cambridge, MA, at the Harvard Law School last week.

De Jonge is involved in an effort by the school's Petrie-Flom Center to address care for people who are seriously ill. The Center is dedicated to the study of health law policy, biotechnology, and bioethics.

It is working with C-TAC, the non-profit Coalition to Transform Advanced Care, to apply an "interdisciplinary analysis to important health law and policy issues raised by the adoption of new person-centered approaches to care for this growing population," according to the center's website.

The panel, which convened last Friday, includes representatives from organizations interested in services for and the needs of the frail, elderly and seriously ill. Panel members were asked to consider a dense draft proposal for "a care model implementation framework" for patients with serious illness.

6 Months to a Framework
The goal is to come up with a framework within six months. The draft document spells out the group's tasks this way:

  • Define the seriously ill
  • Identify promising solutions
  • Examine care outcomes: quality, care experience, and costs
  • Explore implementation
  • Evaluate evidence

One key to the panel's success will be to ensure that its recommendations are simple to understand, yet capture variation of needs at a local level, said Khue Nguyen, the COO of C-TAC Innovations.

The guidelines should also allow researchers and providers to drill down and look for the causes of those variations.

"If we are looking to impact a population that, for example, has a very low health status in terms of overall health, a high functional status, and low coping capability, how do we build a service that matches that population?" she asked.

Members of the panel include providers, payers—costs are on the table—and programs involved in the care of the seriously ill. Home health, palliative care, hospice and primary care were all represented in Cambridge.

Timothy Ferris, MD, came across the river from Partners Healthcare, where he is a vice president for population health management and medical director of Massachusetts General Physicians Organization.

Ferris thinks efforts to address the care of the seriously ill will help with problems such as readmissions and the challenges of providing hospital care to an aging population.

Payment Models Are Considered
An issue that came up at the meeting was a desire to avoid duplicating other efforts.

There are many other programs in place or being tested for care of the seriously ill, but Ferris said the Harvard group could play an important role in finding solutions.

"We have not crossed a tipping point with these programs," he said. "We're all still experimenting and we really have to take it to the next level to figure out what is the best way to do this."

While not discussed last week, payment models are also on the panel's agenda. At MedStar, De Jonge said the system assumes all the risk for some of its patients. That allowed the health system to tap into new payment models that include coverage for services such as home-based primary care.

The MedStar program was part of a Centers for Medicare & Medicaid Services demonstration project called Independence at Home. It identified 15 different services that aging patients may need and MedStar put together a team to make them available.

They were able to reduce readmissions and cut costs for high-risk Medicare patients with programs such as house calls and home-based primary care.

Double-Digit Cost Reductions
The C-TAC effort will explore costs and identify payment reforms to allow reimbursement for such teams.

In a study published in the Journal of the American Geriatrics Society, De Jonge reported that cost-per-Medicare-patient enrolled in the program dropped 12.97% to $44,455 from $50,977.

The per-patient cost of hospital care declined 19.4% to $17,805 from $22,096, and costs declined 20.1% for skilled nursing facility care to $4,821 from $6,098, while home healthcare and hospice care costs grew.

There were no differences in mortality or average time-to-death.

De Jonge said he expects the panel to describe the key elements of a care team for the seriously ill and identify payment reforms to allow reimbursement for that team.

So, the panel will need to find solution not just for the delivery of care, but for how to reimburse for care.

"It is a dead end if you just do the right thing, but you don't have a payment model that supports those services," De Jonge said.

Tinker Ready is a contributing writer at HealthLeaders Media.


Get the latest on healthcare leadership in your inbox.