Ambulances used to make frequent trips to the Morris H. Blum Senior Apartments, a subsidized low-income housing facility in downtown Annapolis, Md., whose residents would be transported to the emergency department of the nearby Anne Arundel Medical Center.
To reduce those ED visits, in October 2013 the hospital opened a one-doctor clinic inside the apartment building, based on the patient-centered medical home model. It focuses on proactively helping patients manage their own health.
“We realized a high number of frequently admitted patients were coming from the same address,” said Victoria Bayless, Anne Arundel's CEO. “We found a residence in our own backyard whose main access to primary care was calling 911.”
The hospital spent about $185,000 to build the clinic, receiving an $800,000 state grant to help with operations. It serves residents with chronic conditions such as congestive heart failure, diabetes, chronic obstructive pulmonary disease and end-stage renal disease. Up to 20 patients visit the clinic each day, and the staff also makes house calls inside the building.
During those calls, clinic staffers can determine whether patients' back pain is caused by a bad mattress, check the refrigerator and make suggestions to improve patients' diets, and see what medications patients are taking and whether they are at risk for harmful interactions.
In the first year of operation, medical 911 calls fell 13% and ED visits dropped 8%. “We expect it to drop again,” Bayless said. “We're finding a lot of illness and disease that has gone untreated.”
The new clinic is one example of innovative strategies Maryland hospitals are employing to improve population health and reduce costs under their state's unique new global budget revenue, or GBR, program. State officials negotiated the program with the CMS Innovation Center and launched it last January, moving the state toward paying healthcare providers based on improving population health rather than on volume of services. Other hospitals are launching similar initiatives to keep their patient populations healthier.