CMSA Today - Issue 4, 2015 - (Page 17)

The Future of Care Coordination Cleveland Clinic Integrated Care Model Value-Based, Patient-Centered Model of Care BY MARY MCLAuGHLiN DAviS, DNP, MSN, APRN, ACNS-BC, CCM, and LiNDA O'DONNELL, RN, CMAC, BS, MHA C leveland Clinic is on the cutting edge of the future of care coordination. Anchored by its 1,250-bed main campus, Cleveland Clinic Health System integrates care across eight community hospitals, 16 family health centers, a Northeast Ohio multi-county skilled home care program, in-hospital acute rehabilitation, and skilled care units. Historically there has been a wide variation of definitions and model components of care coordination. Within the Cleveland Clinic Health System, there have been over nine models, including management of disease and populations, utilization, physician patient groups, and payer groups. The Case Management Society of America defines care coordination as: The deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health services. Organizing care involves the marshaling of personnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care (CMSA, 2010). There is reason to change models now based on the alarming trends of high dollar and relatively low-value care transitions. National health care spending continues to rise, but growth has slowed for four years (Table 1). The Centers for Medicare and Medicaid (CMS) attributes this decrease in growth to greater availability of lower-cost generic prescription drugs and deceleration of spending on nursing home care and prescription drugs. However, spending on hospital and physician care continued to grow in 2012 (Advisory Board, 2014). In 2013, CMS introduced the concept of value-based purchasing, and in that same year the penalties for unnecessary readmissions became a reality. The move to decrease inpatient beds across the country and the emergence of high deductible insurance plans spurred Cleveland Clinic as well as many other health care systems to plan for this payment restructure. Cleveland Clinic first focused on the management of chronic disease, notably congestive heart failure (ChF), since the CMS cost of ChF inpatient management is $17 billion annually. The rate of exacerbations and readmissions to acute care for individuals with ChF is 22 percent (Akshary, Stevenson,2012; Yale, 2014). Readmissions for all causes are 17.6 percent, resulting in an additional $15 billion in spending (Report to Congress, 2007). Of all hospitalizations, 20 percent are re-hospitalizations within 30 days of discharge, with an estimated cost per readmission of $7,338 (Brewer & vavricek, 2012). One-third of chronically ill adults do not use medications due to cost and do not tell their clinicians. These patients do not comply with medication plans through under-adherence (31 percent) or over-adherence (18 percent). They understand the rationale to take medication but choose not to follow advice, or do not know or understand their medication plan. The failure to teach medication management to hospital patients and provide a safe transition home contributes to these adverse drug reactions and unnecessary readmissions (Goulding, 2004; Gray, Mahoney & Blough, 2001; Moore, Wisnivesky, Williams, & McGinn, 2003). These figures represent a high and unnecessary financial burden on the health care system, as well as untold suffering for patients with a multi-organ disease. Clearly patients with one or more chronic disease are the highest utilizers of health care (Jonas, Chernyak, Lin, Lumbert, Noormohamed, 2012). Table 1: Health Spending In response to these alarming trends, a multi-disciplinary team of experts designed a patient-centered continuum of care. Prior to 2010, and before the passing of the Affordable Health Care Act, Cleveland Clinic enhanced its focus on health and wellness. Its preliminary mission - to provide better care for its sickest patients, investigate their problems, and further educate those who serve them - began an aggressive campaign to teach patients how to self-manage their chronic disease. Issue 4 * 2015 CMSA TODAY 17

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2015

Integrating Behavioral Health Services into Mainstream Medicine
Cleveland Clinic Integrated Care Model
The Importance of Collaboration
Adult and Pediatric Integrated Case Management
Corporate Collaboration

CMSA Today - Issue 4, 2015