Innovation won't wait

HHS announced the first grantees in a nearly $1 billion initiative under the healthcare reform law last week and showed again that uncertainty surrounding the act's future won't stop the Obama administration from funding the law's many programs.

Unveiled last November, the Health Care Innovation awards from the CMS Innovation Center will fund up to $1 billion in grants to applicants who design and implement creative care models for patients enrolled in Medicare, Medicaid and the Children's Health Insurance Program. Six months and more than 2,000 applications later, HHS selected 26 grantees nationwide to receive a total of $122.6 million for three years. The agency expects these programs to affect nearly 750,000 patients and lower healthcare spending by about $254 million during this period.

“Our hope is that the most successful projects will become models for the rest of the country,” HHS Secretary Kathleen Sebelius told reporters during a conference call May 8.

That is the same goal of the physicians who designed the North Georgia Critical Care Collaborative, which will receive a $10.7 million award from the CMS to build a network that supports intensive-care units to improve critical care for patients in rural and underserved areas.

For the project, Emory Healthcare will work with Northeast Georgia Health System (Gainesville), St. Joseph's Health System (Atlanta), Southern Regional Medical Center (Atlanta) and telemedicine provider Philips Healthcare. The participants will train nurse practitioners and physician assistants as critical-care specialists, and integrate telemedicine ICU services at community hospitals that will provide support and supervision by critical care doctors and nurses remotely.

The project—which is expected to save about $18 million—will serve about 10,000 federal beneficiaries in Medicare, Medicaid and CHIP in the first three years. That figure represents about half of all the patients who are estimated to benefit from the program, said Dr. Timothy Buchman, the director of the Emory Center for Critical Care and chief designer of the North Georgia Critical Care Collaborative.

Buchman said the collaborative will train about 20 nurse practitioners and physician assistants and also hire a number of critical-care physicians and nurses to work in the telehealth ICU. That “e-ICU” will serve as a command center for doctors and nurses to help manage situations from a distance, said Dr. James Bailey, chief medical informatics officer and chief quality officer at the Northeast Georgia Medical Center, who co-directs the collaborative with Buchman.

While the concept of e-ICUs has been around for about 15 years, Bailey said, it's the six-month training program in critical care for affiliate providers (as the two physicians refer to nurse practitioners and physician assistants) that will be a major focus of this particular program.

“Our goal is to establish a credible model that could be used throughout the country,” said Bailey, who added that it is an “absolute plan” for the collaborative to continue after the funding period ends.

In Boston, clinicians at Beth Israel Deaconess Medical Center will build on the efforts of a six-month pilot project to improve patient outcomes and lower hospital readmissions.

The CMS has awarded Beth Israel Deaconess $4.9 million for the Post-Acute Care Transitions, or PACT, program, which will prospectively enroll all Medicare patients at the hospital through referrals from any one of six affiliated primary-care practices, including one community health center.

At the heart of the project is a care transition specialist who will build strong relationships with the hospital and primary-care site to provide better treatment for the patients, said Dr. Julius Yang, director of inpatient quality at Beth Israel Deaconess. Another important component is the presence of a pharmacist who will work in concert with the care transitions specialist to help patients manage their medications.

In the three-year period, the initiative is expected to affect 8,000 patient discharges, train 11 healthcare workers and yield nearly $13 million in savings.

“The landscape is changing rapidly in Massachusetts,” Yang said, adding that he doesn't know what the healthcare system will look like after the three-year funding period has ended. (See related story: "Tweaking the system") “If we can prove this improves outcomes and reduces costs, the system will find a way to pay for it,” he said, adding that two possible funding sources could be health plans or one of the five accountable care organizations in eastern Massachusetts participating in the Innovation Center's Pioneer ACO Model.

Yang said a care transition specialist is “your travel agent for discharge,” likening these specialists to travel agents 30 years ago, when these professionals were in high demand to manage trips for travelers. Today, travelers book their own trips and manage their own itineraries, making the need for travel agents unnecessary.

“If those two worlds—the outpatient practice and the hospital—become integrated enough, then eventually you don't need that,” he said, referring to the care transitions specialist. “That's another way this program phases out: You solve the problems as you go.”

HHS will announce the second and last set of innovation grants in June.