As a health care enterprise that combines both care and coverage, we have important advantages that benefit our patients and purchasers. We know that when we leverage care and financing in smart ways, we can produce better care and better health at more affordable rates. Now, more than ever, we are showing that it can be done.

Appropriate utilization—serving people in the best possible setting for their health situation—is a really big part of the equation.

We know that when members get the right care, in the right place, at the right time, they fare better and their costs are less. We’ve based two major initiatives on this principle: Medical Home and our Emergency Department/Hospital Inpatient (EDHI) work.

Both Medical Home and EDHI have brought enterprise-wide changes in the way we deliver care. They involve staff and leaders from throughout Group Health, and significant collaboration across our enterprise. I’m sure they would not be nearly as successful in a different business model.

With our two-year Medical Home pilot at Factoria Medical Center, and with EDHI, we asked:

• How can we give better quality of care at lower costs?
• Can we enhance care so people with non-emergency needs don’t worsen and become hospitalized?
• And when patients do need to be hospitalized, what can our teams do better so patients aren’t unnecessarily re-admitted? 

Achieving just one of these is a tall order in today’s complex health care world, yet we’re doing all three.

Work like medical home and EDHI are changing health care for the better. As you’ll read in the following stories, we now have fresh data and exciting new national validation of this from the journal Health Affairs.

Your hard work and collaboration are making these initiatives successful. Together we are consistently improving quality while reducing costs, and are truly a model for the country.

 

Group Health’s Emergency Department /Hospital Inpatient initiative (EDHI) has strengthened the care patterns we provide members in our hospitals and emergency rooms. From intake to discharge, this system brings specialists, nurses, hospitalists, and care managers into more tightly coordinated planning modes.

In short, this has been another strong example of our cross-divisional work—a notable collaboration between delivery system and health plan.

A more coordinated hospital experience for patients
Whether someone is going home to recover or moving to a different facility, EDHI systems and training make transitions smoother, especially for patients with complex conditions. Thorough discharge planning—among hospitalist teams, care managers, nurses, providers and patients—ensures that the right medications and follow-up instructions go with patients and their families.

Dr. Rafi Hovsepian leads the hospitalist team at Virginia Mason Medical Center. He says the physician and discharge planning staff are more intentional about patients’ planning needs. Care Management Liaison Nurses thoroughly review red-flag issues, medications, discharge instructions and follow-up plans, and make a 48-hour phone call to make sure patients are progressing.

“We’re also gaining earlier understanding of patients’ wishes for life-sustaining treatments and end-of-life options,” notes Amanda Lee, MD, service line chief for hospitalists in six of Group Health’s seven contracted hospitals. “On the front lines we’re also seeing more patients arrive with their documents in place, because Medical Home prioritizes this planning in primary care,” she says.

The EDHI difference: patient satisfaction up, readmissions down
Group Health began implementing EDHI systems and training in late 2009 and early returns on our efforts are very promising. According to Brenda Bruns, MD, executive medical director for the Health Plan Division, readmission rates and hospital bed days per 1000 members are rapidly moving toward our targets for 2010.

“The national benchmark is the Medicare 30-day readmission rate, at about 20 percent,” explains Bruns. “Group Health already had a below-average readmission rate of 15.7 percent, and after the EDHI rollout, we lowered this by another percentage point very quickly. This trend represents a significant projected savings over time.”

Another indicator of success: Group Health inpatient satisfaction scores during care at Virginia Mason Medical Center are on the rise. In the last two months, our patients’ satisfaction with our physicians there has passed the 90th percentile when compared with national rankings. This is up from 60 percent in 2008 and 78 percent in 2009.

What’s driving this change at Virginia Mason? It’s likely a combination of factors. Our EDHI work has focused attention on planning and preparation. And Kate Brostoff, MD, medical director for clinical support, thinks communication skills practiced in some end-of-life training may have helped our hospitalists to better connect with patients.

Our methods as a model
Group Health intends EDHI to be an open resource for other medical groups to use. Bruns says this will be important as Medicare prepares to stop paying for hospital re-admissions. “We’re freely letting the medical community know what we’re doing and they are readily adopting it,” she says. 

Group Health financial analyst Casey Keenan recalls her recent conversation with a nurse at St. Joseph Hospital in Bellingham: “The nurse said she used to hate Group Health, and had a really low opinion of us. However, her elderly aunt and uncle had care recently at Virginia Mason, and Group Health has this wonderful new team approach in the hospital. She said ‘I want that—how can we do it at St. Joe's?’ and ‘Once other places catch on, they will want to do it too.’ She loved how coordinated the care was.”

“It was nice to see how a hospital experience can change someone's mind, adds Keenan. "Especially a St. Joe's hospital employee!”

 

This week the prestigious health policy journal Health Affairs reports on the results of Group Health’s Medical Home pilot at Factoria Medical Center. In just two years, Group Health recouped its investment and achieved a 50 percent return on this patient-centered model. The Medical Home pilot produced faster-than-expected improvements where it matters most: quality of care, patient experience, and costs.

Factoria Medical Center’s two-year results: Health Affairs, May 2010 Patient experience in our Medical Home: Health Affairs, April 2010 Group Health’s Medical Home featured on CNN's “American Morning"

 As our Medical Home model gained momentum from an initial spark of an idea in 2006 to a full-fledged pilot by 2007, its champions dug into the challenge of proving its worth. Results were so strong that in 2009, the model was rolled out to 26 primary care clinics.

Over the last two years, Group Health Research Institute (GHRI) investigators have tracked the

impact of medical home on health outcomes, patient experience, provider burnout, and costs of care. This included scientifically valid before-and-after evaluations of the pilot at Factoria, comparing specific measures against 19 other Group Health clinics. The study tracked change components at the beginning of the pilot, at 12 months, and during the second year.

Significant results from the two-year medical home pilot:

• Medical home patients at the Factoria clinic had 29 percent fewer emergency room visits and 6 percent fewer hospitalizations than in the 19 comparison clinics.
• Hospitalization costs were approximately $14 lower per member per month compared with the control group.  
• After nearly two years, continuously enrolled patients at Factoria had costs approximately $10 less per member per month compared to the other clinics.
• After two years, staff burnout continued to be lower at Factoria compared with the other clinics.  
• The Factoria clinic reported significantly higher patient experience scores than comparison clinics after both years 1 and 2.

“Nationally, the patient-centered medical home is emerging as a key way to improve health care and control costs,” says evaluation leader Robert J. Reid, MD, PhD, an associate investigator at GHRI and Group Health's associate medical director for preventive care. “Our findings strongly support this model and its ability to address these concerns. The medical home is here to stay.”

President and Chief Medical Director Michael Soman, MD led the implementation of the pilot. “We have followed our passion in creating an innovative care delivery model that counts on our people and our organization to give the right care in the right way, then passes on higher quality, better satisfaction, and appropriate utilization to our patients,” says Soman. “It is wonderful to be recognized by Health Affairs for these efforts. Our work makes a difference.”

 

Group Health is proud to honor the dedicated, around-the-clock work of nearly 3.1 million registered nurses nationwide. Our nurses play a critical role in improving members’ health, staying vigilant about their safety, and in educating members and their families.

May 6 is a day of special recognition for nurses everywhere, kicking off national nurses’ week through May 12. The American Nurses Association’s 2010 theme is Nurses: Caring Today for a Healthier Tomorrow.

Barbara Trehearne, Executive Director for Nursing Operations, Group Health

Barbara Trehearne, Executive Director for Nursing Operations, believes that there is no better time to be a nurse. “We have a story to tell—that our work as nurses is about outcomes. We are finally seeing growing, definitive, and convincing evidence that nursing care makes a difference: in patient safety, in health improvement, in costs of care, and in the satisfaction of both nurses and their patients.”

She adds that Group Health’s collaborative, enterprise-wide initiatives such as Medical Home, emergency and hospital inpatient improvements, and consultative specialty model line create opportunities for our nurses to do their best, most complex work.

“These initiatives support what we want and expect nurses to do. We are using nursing interventions to reduce readmissions to the hospital, and to smoothly transition patients across care settings. We’re also supporting patients in their self-care by taking time to understand their lifestyles, obstacles, and family involvement,” says Trehearne.

“Studies demonstrate that nursing interventions, along with adequate RN hours of care, result in prevention of pneumonia, reduced rates of GI bleeding, infection, and falls,” she adds. Most recently, The Lewin Group reviewed 28 different studies analyzing the relationship between higher RN staffing and several patient outcomes: reduced hospital deaths, hospital acquired pneumonia, bloodstream infections, and length of stay, among others.

“These studies are good news,” Trehearne says. “They build a strong case for nurses and nursing care. They also help us to educate the public, our colleagues, legislators, and administrators of the value and need for nurses everywhere.”

 

Not a member? Not a problem. Christina Lombardi, Director of Occupational Health Services, says that’s the motto to keep in mind when someone with a workplace-related injury comes to Group Health.

“We can treat people who’ve been hurt on the job at any of our occupational health, urgent care, or primary care clinics, even if the injured person is not a Group Health member,” Lombardi explains.

In fact, nearly one in three of these non-member patients eventually joins Group Health. “People discover the excellence of our care teams, and our emphasis on not just treating, but preventing workplace injuries.”

“Employers really need and appreciate what we have to offer, so we’re helping to grow this area of Group Health by reaching out to them,” adds Jody Mahoney, Associate Director, Employer Health Services. Group Health At Work is our all-in-one workplace health and safety program, staffed with board-certified occupational medicine physicians, and clinicians. 

Occupational Health Services include

• Injured worker care (Washington law allows injured workers to see any provider they choose)
• Screening services
• Monitoring services
• Drug testing
• Employment physicals
• Case management
• Workers' compensation paperwork assistance
• On-site wellness screening
• Health promotion programs
• Access to our 12 occupational medicine locations

“We call Occupational Health Services Group Health’s best kept secret,” says Mahoney, “but our recognition is growing. Our program recently became Washington’s first and only Nationally Certified Occupational Health Program, designated by the National Association of Occupational Health Professionals.”

Getting people back to work quickly and smoothly is important to our state’s overall productivity and economy. The state Department of Labor & Industries handles more than 150,000 workplace-injury and occupational-illness claims every year.

 

Even those of us who enjoy decades of good health can be touched by critical illness eventually, either in our own lives or in those of our loved ones. When this happens, we grapple with serious and often confusing choices about living with serious afflictions.

Group Health’s Senior Caucus presents a community discussion on these issues featuring Robert Martensen, MD, PhD. The free, public events will take place in Seattle on May 5 and in Tacoma on May 6.

Dr. Martensen will provide his perspectives and take audience questions during this interactive forum. Advance registration is required for the Seattle event. See the event page for venues and registration details. 

 

In the March 24 “Open Mike” we shared the story of a patient who lost consciousness in his car in front of Bellevue Medical Center, and the emergency medical team who quickly came to his aid. Folks on the scene offered additional detail about the event.

Dear Michael,
It was nice of you to include mention the Bellevue code in your "Open Mike." The person who did CPR however was not Andrew Cahn but rather Robert Cleaves. He is an EMT in the Urgent Care. Andrew suctioned the patient and administered oxygen.
-Sue Greiling

Andrew Cahn, PA adds:

Dear Michael,
Dr. Susan Eggas and I were the first on the scene, pulling the patient from the car. I initiated and performed CPR for the first several minutes while we established the defibrillator and shocked the patient. Then Robert took over CPR and I worked on the airway. 

It was a team effort throughout.