Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? Issue Brief – The Commonwealth Fund – 7 August 2014
“Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target “high-need, high-cost” patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts.”
Toward Increased Adoption of Complex Care Management – NEJM – 7 August 2014Read Full Post | Make a Comment ( Comments Off on Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? Issue Brief – The Commonwealth Fund – 7 August 2014 )
What is the evidence on the economic impacts of integrated care? – European Observatory on Health Systems and Policies (EOHSP) – 6 June 2014
“This new policy summary reviews the existing evidence on the economic impact of integrated care approaches. Whereas it is generally accepted that integrated care models have a positive effect on the quality of care, health outcomes and patient satisfaction, it is less clear how cost effective they are. As the evidence-base in this field is rather weak, the authors suggest that we may have to revisit our understanding of the concept and our expectations in terms of its assessment.
Integrated care should rather be seen as a complex strategy to innovate and implement long-lasting change in the way services in the health and social-care sectors are delivered.
This policy summary (number 11) is based on a report for the European Commission to inform the discussions of the EU’s Reflection process on modern, responsive and sustainable health systems on the objective of integrated care models and better hospital management. Both authors are affiliated to RAND Europe.”Read Full Post | Make a Comment ( Comments Off on What is the evidence on the economic impacts of integrated care? – European Observatory on Health Systems and Policies (EOHSP) – 6 June 2014 )
Behavioral Health Integration Capacity Assessment Tool – Institute for Healthcare Improvement – 2014
“The purpose of the Behavioral Health Integration Capacity Assessment (BHICA) is to assist behavioral health organizations in evaluating their ability to implement integrated care. The BHICA enables behavioral health organizations to evaluate their processes related to three approaches to integrated care: coordinate care, co-locate care, or build primary care capacity in-house. It also allows organizations to assess their existing operational and cultural infrastructure to support greater integration. The BHICA was developed by IHI and the Lewin Group under a contract from the CMS Medicare-Medicaid Coordination Office.”Read Full Post | Make a Comment ( Comments Off on Behavioral Health Integration Capacity Assessment Tool – Institute for Healthcare Improvement – 2014 )
by Nick Goodwin, Anna Dixon, Geoff Anderson, Walter Wodchis
“Lessons from seven international case studies
Around the world, rapidly ageing populations are resulting in increased demand for health and social care services, which presents significant challenges for national health and care systems. Many have adopted an integrated care approach to meet the needs of older people with chronic or multiple conditions. This approach often involves a single point of entry – designating a care manager to help with assessing needs, sharing information, and co-ordinating care delivery by multiple caregivers (formal and informal).
This report synthesises evidence from seven case studies covering Australia, Canada, the Netherlands, New Zealand, Sweden, the United Kingdom and the United States. It considers similarities and differences of programmes that are successfully delivering integrated care, and identifies lessons for policy-makers and service providers to help them address the challenges ahead.”Read Full Post | Make a Comment ( Comments Off on Providing integrated care for older people with complex needs – King’s Fund – 30 January 2014 )
Integrated care value case toolkit – Local Government Association [UK] – 17 January 2014
“The LGA has partnered with NHS England, The Association of Directors of Adult Social Services (ADASS), The Association of Directors of Children’s Services (ADCS), Monitor, NHS Confederation and the Department of Health (DH) to deliver a programme of work carried out by Integrating Care.
The toolkit should enable Health and Wellbeing Boards and local partners to understand the evidence and impact of different integrated care models on service users, as well as the associated impact on activity and cost to different parts of the health and care system.”Read Full Post | Make a Comment ( Comments Off on Integrated care value case toolkit – Local Government Association [UK] – 17 January 2014 )
Public Health England and NHS Improving Quality announce changes to the End of Life Care Co-ordination Information Standard – 10 January 2014
“The standard specifies the core content to be held in Electronic Palliative Care Co-ordination Systems (EPaCCS), or paper-based care co-ordination systems. Evidence is emerging that the standard improves care co-ordination, supporting more people to die in their place of choice (What we know now 2013, PHE National End of Life Care Intelligence Network).
Some changes have been made to the standard following feedback from implementers and key stakeholders and these have recently been published by the Information Standards Board for Health and Social Care. They include:
new data item to record consent status
data item to record actual place of death moved to core data set
data item to record date of death
subset of codes now specified for the disability data item
additional codes for the data item on informal carer, prescription of palliative care medication and formal carers involved in care
data item for main informal carer to be mandatory for completion
removal of non-specific codes for primary end of life care diagnosis
removal of Liverpool Care Pathway (LCP) from the data item that records ‘End of Life Care Tools in Use’ ”
… continues on the siteRead Full Post | Make a Comment ( Comments Off on Public Health England and NHS Improving Quality announce changes to the End of Life Care Co-ordination Information Standard – 10 January 2014 )
Measuring people’s experiences of integrated care; an options appraisal and a recommended set of questions – Picker Institute Europe – 8 January 2014Read Full Post | Make a Comment ( Comments Off on Measuring people’s experiences of integrated care; an options appraisal and a recommended set of questions – Picker Institute Europe – 8 January 2014 )
Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis – NHS National Institute for Health Research – November 2013
Lewis GH, Georghiou T, Steventon A, Vaithianathan R, Chitnis X, et al. Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis. Final report. NIHR Service Delivery and Organisation programme; 2013.
Extract from the executive summary
Health care systems in many developed countries are currently under financial strain because of ageing populations, the rising prevalence of various chronic diseases, and budgetary constraints resulting from the global economic downturn.
The costs of providing health care are highly skewed across the population, with a small number of patients accounting for a large proportion of expenditure. Since unplanned hospital admissions account for a high proportion of costs, considerable resources could potentially be invested in providing preventive care for a relatively small number of costly patients and yet still potentially yield net savings overall from averted future hospital costs. In practice, however, such savings have been difficult or impossible to demonstrate.
One reason why preventive interventions may be unsuccessful at reducing demand is if they are offered to patients who are at insufficiently high risk of future unplanned hospital admission. In 2005, the Department of Health commissioned two “case finding” tools for improving the identification of high-risk patients in England. Known as “PARR” and the “Combined Model”, these predictive risk tools are now used in many parts of the country to select which high-risk patients should be offered a hospital-avoidance intervention.
One such intervention is the “virtual ward”. This model of care uses the staffing, systems and daily routines of a hospital ward to deliver preventive care to patients in their own homes in the aim of mitigating their risk of unplanned hospitalisation. Whilst virtual wards have been introduced in many parts of the UK and overseas, their efficacy and cost-effectiveness has yet to be determined.”
Related Article from the International Journal of Integrated CareRead Full Post | Make a Comment ( Comments Off on Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis – NHS National Institute for Health Research – November 2013 )
Safety in Canadian health care organizations: A focus on transitions in care and Required Organizational Practices – Canadian Health Accreditation Report – 21 October 2013
Accreditation Canada. (2013). Safety in Canadian health care organizations: A focus on transitions in care and Required Organizational Practices. Ottawa, ON: Accreditation Canada.
“The Accreditation Canada standards and patient safety goals—the Required Organizational Practices—identify the importance of communication and transfer of information. This year’s Canadian Health Accreditation Report highlights how Canadian health care organizations are performing relative to care transitions—handovers at shift changes, client transfers, discharges, and referrals to other health services providers—which play a critical role in providing safe and quality health care. The second part of this year’s report showcases areas of excellence achieved by Canadian health care organizations and opportunities for improvement relative to the Accreditation Canada Required Organizational Practices—over the past years and moving forward.”
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“The costs of caring for people with age-related chronic and complex medical conditions are high and will continue to rise with population ageing. Yet people with multiple health and social care needs often receive a very fragmented service, resulting in less than optimal care experiences, outcomes and costs. Many countries have developed strategies to improve care co-ordination, but these have often failed to achieve their objectives. There is also a general lack of knowledge about how best to apply (and combine), in practice, the various strategies and approaches to care co-ordination.
This report presents the findings from a two-year research project funded by Aetna and the Aetna Foundation, which aimed to understand the key components of effective strategies employed by studying five UK-based programmes to deliver co-ordinated care for people with long-term and complex needs. It elicits some key lessons and markers for success to help identify how care co-ordination might be transferred from the UK to the US context.”Read Full Post | Make a Comment ( Comments Off on Co-ordinated care for people with complex chronic conditions – King’s Fund – 24 October 2013 )
Integrated Care: Our Shared Committment – Gov.UK – 13 May 2013
“A framework that outlines ways to improve health and social care integration.
This framework document on integration, signed by 12 national partners, sets out how local areas can use existing structures such as Health and Wellbeing Boards to bring together local authorities, the NHS, care and support providers, education, housing services, public health and others to make further steps towards integration.”Read Full Post | Make a Comment ( Comments Off on Integrated Care: Our Shared Committment – Gov.UK – 13 May 2013 )
Findings from 16 integrated care pilot initiatives in EnglandRead Full Post | Make a Comment ( Comments Off on Does integrated care deliver the benefits expected? – RAND – May 2013 )
From vision to action. Making patient-centred care a reality – Richmond Group of Charities [UK] – 2012
Extract from the foreword:
“When our ten leading health and social care charities published our joint view on how high-quality, patient-centred, cost-effective care could be delivered, we were surprised how aligned our thinking was. We agreed five themes on which the post-reform NHS should be based
and within which productivity gains are possible:
• co-ordinated care
• patients engaged in decisions about their care
• supported self-management
• prevention, early diagnosis and intervention
• emotional, psychological and practical support.
Our shared vision has yet to be delivered. The Health Select Committee recently warned the government that if standards of quality and access are to be maintained, system redesign is needed, rather than salami-slicing existing services or incremental improvement (House of Commons Health Committee 2012). We agree.
As leading charities that both advocate for and support the care of people with health and social care needs, we renew our commitment to working with colleagues locally and nationally, in policy and in service delivery, to build a sustainable model for the NHS and its partners.”
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How to deliver high-quality, patient-centred, cost-effective care. Consensus solutions from the voluntary sector – Richmond Group of Charities [UK] – 2010
Extract from the introduction:
“This publication is the collective effort of ten of the leading health and social care organisations in the voluntary sector. Each organisation submitted evidence to The King’s Fund, which independently analysed and assessed each submission and worked with the organisations to establish a common position. Together we have identified the five key themes that the health and social care system must embrace to be sustainable and to ensure quality. The themes are:
•patients engaged in decisions about their care
•prevention, early diagnosis and intervention
•emotional, psychological and practical support”
… continuesRead Full Post | Make a Comment ( Comments Off on How to deliver high-quality, patient-centred, cost-effective care. Consensus solutions from the voluntary sector – Richmond Group of Charities [UK] – 2010 )
by David Squires
“High-quality care for patients with chronic and complex conditions often involves coordinating between multiple providers and sources of care. Fee-for-service payment, which reimburses providers for a particular service, fails to provide incentives to coordinate care and can encourage providers to work in silos. Bundled payments—also known as episode-based payment or case rates—have been proposed as a way to encourage coordination across providers and to promote more efficient care. Under a bundled payment, a single fee is paid for an entire episode of care; for example, a single fee for hip replacement would cover both the procedure itself and the rehabilitation and follow-up treatments. This fee would be divided among the providers along the care pathway, either prospectively or retroactively.
Bundled payments already exist in the U.S. in a number of systems, such as the Geisinger Health System. The Affordable Care Act contains provisions advancing bundled payments in Medicare, including a large-scale pilot scheduled to be rolled out by January 1, 2013. Other countries have also experimented with bundled payments, most notably the Netherlands and Germany. Their experiences can inform U.S. efforts to reform health system payment and drive improvement.”
… continues on the site
Bundling Payments for Chronic Conditions in the Netherlands
Integrated Care Contracts in Germany
Connecting Those at Risk to Care: The Quick Start Guide to Developing Community Care Coordination Pathways – AHRQ – 29 February 2012
AHRQ = Agency for Healthcare Research and Quality
“Developed by: Community Care Coordination Learning Network
This quick start guide is a reference and resource for public and private stakeholders engaged in improving the system for identifying and connecting at-risk individuals within a community to appropriate health and social services. The target audience includes all those involved in the design, implementation, and financing of care coordination services. This Quick Start guide complements Connecting Those at Risk to Care: A Guide to Building a Community “HUB” To Promote a System of Collaboration, Accountability, and Improved Outcomes.
Why Create a Community HUB and Pathways?
Reason #1: To Promote the Goals of Health Care Reform
Reason #2: To Close the Nation’s Cost and Quality Gap by Paying for Value, Not Volume
A Quick Guide to Creating and Using a Community HUB and Pathways
Key Elements of an Effective Community HUB
A Step-by-Step Process for Using a Pathway
Examples of Six Core Pathways
Core Pathway 1: Medical Home
Core Pathway 2: Medical Referral
Core Pathway 3: Social Service Referral
Core Pathway 4: Health Insurance
Core Pathway 5: Medication Assessment
Core Pathway 6: Pregnancy
Appendix A: Pathways Compendium
Exhibit A-1: Sample Demographic and Referral Form
Exhibit A-2: Sample Care Planning Checklists
Exhibit A-3: Followup Adult Checklist
Exhibit A-4: Examples of Reports for the Community HUB and Participating Agencies”
Care Coordination Model: Better Care at Lower Cost for People with Multiple Health and Social Needs – Institute for Healthcare Improvement – May 2011
Craig C, Eby D, Whittington J. Care Coordination Model: Better Care at Lower Cost for People with Multiple Health and Social Needs. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011.
“People with multiple health and social needs are high consumers of health care services, and thus drivers of high health care costs. The elevated cost of care in this population offers a tremendous opportunity to understand the individuals and their priorities and needs, and to craft a service delivery plan that meets their needs more effectively at a significantly lower cost.
This white paper outlines methods and opportunities to better coordinate care for people with multiple health and social needs, and reviews ways that organizations have allocated resources to better meet the range of needs in this population. There is special emphasis on the experience of care coordination with populations of people experiencing homelessness.
The framework relies on a methodical approach to delivering coordination services, not just health interventions, to improve health outcomes while ensuring efficient access to the health care system and other needed supports. The role of strong partnerships between health care and community organizations is highlighted and innovative test ideas are included.”Read Full Post | Make a Comment ( None so far )
Where next for integrated care organisations in the English NHS? – Nuffield Trust – 30 March 2010
Author: Richard Q Lewis, Rebecca Rosen, Nick Goodwin & Jennifer Dixon
“Since the 1950s, the NHS has been looking at ways of improving care coordination. Lord Darzi’s NHS Next Stage Review introduced a new concept, that of the integrated care organisation (ICO). Since then, the Government has begun piloting schemes that offer different models of integrated care. This report, published jointly by The Nuffield Trust and The King’s Fund, examines some of these new models. It focuses in particular on organisations that combine commissioner and provider roles. These, the authors suggest, offer the most promise for aligning incentives to produce efficient care across primary, community and acute services.
Where next for integrated care organisations in the English NHS? forms part of work by both The Nuffield Trust and The King’s Fund examining new forms of structuring and delivering care over the coming decade.
This report will be of interest to healthcare policy-makers, senior managers and clinicians, and others involved in commissioning,as well as academics and students in the fields of healthcare and social policy.”
ISBN: 13-978-1-905030-42-2Read Full Post | Make a Comment ( None so far )