BW/F Expands on Care Management Program
For patients enrolled in the Care Management Program at BW/F, their electronic medical records will feature a CMP icon that providers can click to e-mail or page that patient’s nurse care coordinator.
Brigham and Women’s/Faulkner Hospitals and the Brigham and Women’s Physicians Organization in February expanded an innovative health care cost and quality improvement program initially launched at BWH’s sister institution, MGH.
The Care Management Program, a demonstration project of the Centers for Medicare and Medicaid Services (CMS), explores an alternative care delivery model for high-risk Medicare patients. CMS will identify and invite 1,000 patients from 11 BW/F primary care practices to enroll in this three-year program. A nurse care coordinator will work in partnership with the patient’s primary care physician (PCP) to manage proactively the care of each patient.
“This is a new way to coordinate care for our sickest and most complex patients with added resources for primary care in a way that will help our patients, families and providers,” said Rebecca Cunningham, MD, medical director for the Care Management Program at BW/F and a primary care physician at Brigham Internal Medical Associates (BIMA).
In August 2006, the CMS funded the MGH and Massachusetts General Physicians Organization to launch the Care Management Program at MGH, one of just six programs nationwide, in an effort to reduce fee-for-service costs for the most complex patients. Favorable preliminary results, including positive feedback from MGH patients and providers, paved the way to expand the program within Partners HealthCare. In addition to Brigham and Women’s and Faulkner hospitals, the program pilot is expanding to North Shore Medical Center, too.
The pilot is intended to address the fact that 15 percent of Medicare fee-for-service patients are responsible for approximately 75 percent of total Medicare health care costs. The overarching goal is to improve care for patients while controlling the cost of that care. CMS aims to learn how much primary care practices can reduce overall costs of care of the sickest patients by employing nurse care coordinators.
Each of the five nurse care coordinators will serve as an integral part of the primary care team. Working with the program’s larger multidisciplinary team and an array of community resources, the nurse care coordinator will ensure that the medical and psychosocial needs of the patient are met efficiently and effectively. PCPs and nurse care coordinators will collaborate with other providers and connect patients with enhanced services, including mental health, social work, pharmacy, community-based resources and other services, as appropriate.
In advance of the program launch, BW/F nurse care coordinators trained with their counterparts at MGH, where the program has been in operation for three years. “MGH care managers precepted with each of us,” said Connie McManus, MBA, BSN, RN, CPHM, the care coordinator for the Faulkner Community Physicians practice in West Roxbury.
“When one of our patients is admitted, perhaps through the ED, we will make sure to assist with that, work with the inpatient care team during their stay and follow up after their discharge to home or to a sub-acute care facility,” McManus said.
Communication with and visibility among specialists is one key to the project’s success. The records for patients enrolled in this project feature a Care Management Program (CMP) icon, in the LMR, for example, so providers can e-mail or page that patient’s care coordinator. Case management software enables care coordinators and project administrators to monitor utilization trends from month to month, too.
BW/F and the BWPO are assuming limited risk to participate in this CMS demonstration project. The management cost would have to be paid back to CMS if specific savings goals are not met. MGH data showed improved clinical performance after 27 months, and as of August 2009, MGH absorbed the care management costs and saved an additional 2.5 percent from expected fee-for-services costs.
MGH data also shows reductions in admissions, ED visits and length of stay for patient enrolled in the Care Management Program. There was a reduction of more than 25 percent in annual admissions and nearly a 10 percent reduction in ED visits for every 1,000 CMP patients when compared to a comparison group comprised of equally high-risk Medicare patients. There were similar reductions in average length of stay and 15-day and 31-day readmission rates between August 2006 and October 2008.
“These data support our contention that intensive care management of these high-acuity patients is a true win-win in reducing costs for the payer and improving care, our ultimate goal, for our patients and families,” Cunningham said.
Additionally, PCPs who are participating in the MGH pilot have given the program high marks. In a follow-up survey, 88 percent of PCPs said the pilot has had a positive impact on patient care, and 85 percent of PCPs said they would recommend the program to other physicians. More than half of participating PCPs said the program saved up to 30 minutes daily.
“It has been very empowering to see how these changes have had an impact on the system,” said Eric Weil, MD, medical director of the MGH Care Management Program. “We had a good start, and now Brigham and Women’s/Faulkner Hospitals and North Shore Medical Center can expand this across the system and make improvements in it along the way.”
Care Management Program
Primary Care Practices
Brigham Internal Medicine Associates (BIMA)
Brigham and Women’s Physicians Organization (BPG)
Brigham and Women’s Primary Care Associates at Brookline
Faulkner Community Practices (FCP)
Southern Jamaica Plain Health Center (SJP)
Brookside Health Center (Brookside)
Brigham Primary Care Physicians at Faulkner (BPP)
Brigham Circle Medical Associates (BCMA)
Women’s Health at the Fish Center
Brigham and Women’s at Newton Corner
Brigham and Women’s at Foxborough