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Coordination lowers costs, increases quality

The patient was a typical one for Lifetime Medical Group’s Care Connection.

  With congestive heart failure, diabetes and chronic obstructive pulmonary disease, the patient had been in the emergency room twice and hospitalized once in the past year, and the visits were costly from both the hospital’s and patient’s perspective. Because a mix of providers worked with the patient, medication changes were frequent.

  After a nurse with Care Connection worked with the patient and providers to come up with a single medication list, the patient’s symptoms improved and further hospitalizations were not required.

  That exemplifies the mission of Care Connection, a group of nurse care coordinators who connect patients to their primary-care doctors, specialists and community health resources to manage and understand their medical needs better. Case managers follow up with patients at regular intervals, giving them higher-quality, more focused care and reducing medical expenses.

  "The cost of health care is monumental, and when we can save on each patient, it adds up and can be quite considerable," says Karen Feigel, director of marketing and public relations for Lifetime Medical Group. The program benefits not just the patients but everyone, she says: "With a lower cost of health care as a whole, the community makes out as well as the health care provider on expenses that don’t need to happen."

  The care coordinators use electronic medical records and clinical information systems-things like predictive modeling and disease registries-to get a full picture of the patient’s condition. Nurses then make recommendations intended to improve the quality and reduce the cost of care, like identifying potentially dangerous drug interactions or coordinating follow-up visits to primary-care providers.

  "It’s just good patient care," Feigel says. "We develop a rapport, keep connections with the patient to make sure their problems don’t exacerbate. If they have a problem they truly don’t need to go to the emergency room for, we keep them out of there. It can be a stressful situation for them and often a long wait, and there is no need to put the patient through that if they don’t need it."

  Efforts focus on a small part of the population with higher medical needs. When program administrators began looking at the general patient population at the end of 2008, they found that roughly 12,000 patients had $65 million in expenses.

  "That’s a big chunk for a small population, so it got us looking into ways to reduce those medical expenses," says Julie Grossman, the program’s coordinator.

  Grossman hired a team of registered nurses who started calling emergency room patients within 72 hours of their discharge. The nurses went through the discharge instructions with them to make sure the patients understood. They also gave tips on symptoms to watch for that might require thepatients to see their doctors again.

  The program focuses on four areas to reduce medical expenses-hospital inpatient admissions, emergency room visits, pharmacy costs and referrals to specialists. Analysis has shown savings to the tune of $2,800 per patient over a three-month period following the initial contact.

  Compliance rates among patients also increased: 77 percent of patients contacted by Care Connection came in for their return visits after emergency room care, and 88 percent came for their return visits after being discharged from a hospital. Over a one-year period, hospital admission rates for these patients decreased 10 percent and readmission rates dropped 19 percent.

  While there have not yet been any formal surveys of patients, case managers often hear stories of grateful patients, Grossman says. But she has another measure of success-their own involvement in the program.

  "I think the greatest way for us to measure that patients are paying attention is when they call us," she says. "We always tell them if they have any questions to call, so when I hear the phone ring and it’s a patient, I know we’re getting through to them."        

3/18/11 (c) 2011 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or e-mail [email protected].

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