A primary care collaborative in the Cleveland area uses best practices to avert nearly 6,000 hospitalizations over five years, with cost savings estimated at about $40 million.
The Better Health Partnership, a primary care-led regional health improvement collaborative operating in the Cleveland area since 2007, identifies and shares best practices for patients with chronic conditions such as hypertension, heart failure and diabetes.
A study in Health Affairs estimated that the collaborative saw 5,746 fewer hospitalizations for ambulatory care-sensitive conditions from 2009-14, and generated savings of nearly $40 million.
Study co-author Randall Cebul, MD, an internist affiliated with MetroHealth Medical Center, and a member of the collaborative, spoke with HealthLeaders Media about the findings. The following is a lightly edited transcript.
HLM: Why does primary care lead the collaborative?
Cebul: When the opportunity came about through for a national foundation grant, it was primary care physicians who signed up. That’s how it's grown from reporting 34 clinics and 26,000 diabetics in 2008 to now we are reporting those conditions plus some pediatric conditions plus colorectal cancer screening, which we don't report on here, on more than 400,000 patients, in more than 100 practices, and more than 1,000 docs.
Part of the secret sauce has to do with physicians taking ownership of the care of their patients and if that requires engagement of services that are outside the community health center that's what we recommend. We are using the data to document the best practices. The positive deviance approach we use identifies who does best, and if we can determine that there is something replicable, that is presented at twice-yearly annual meetings and we provide either consultation or coaching to practices.
HLM: How did the collaborative save $40 million?
Cebul: It's all reductions in hospitalization costs for cardiovascular conditions; diabetes and diabetes complications, high-blood pressure and heart failure. Heart failure is not the most prevalent but it clearly saw the most cost-savings for hospitalizations. About $20 million was the heart failure part of the $40 million and the other savings were related to diabetes. Hypertension, even though it is very common, doesn’t require hospitalizations that often.
HLM: Why did you target these chronic conditions?
Cebul: We chose these prevention quality indicators from the ambulatory care-sensitive conditions compiled by the Agency for Healthcare Research and Quality. There are a lot of conditions that, given proper outpatient care, should avoid hospitalizations.
Our collaborative was founded in 2007 and immediately chose to use diabetes as one of our conditions and use clinical measures that are familiar to all doctors for the care and the outcomes of patients with diabetes. That was vetted by the clinical advisory committee, which established the measures we should use. Heart failure hypertension followed on the tail of that.
HLM: Is there potential for more savings if you target other chronic conditions?
Cebul: Of course! You'll see that you’ve got chronic obstructive lung disease, and cancer and other chronic diseases that are costly in and of themselves.
This is also cost and not charges. We were able to identify the charges for hospitalizations and then reduce the costs multiplying the ratio of costs to charges.
John Commins is a senior editor at HealthLeaders.