By: Peter Slavin, MD, president, Massachusetts General Hospital, and professor of health care policy, Harvard Medical School
In his commentary “Academic Medicine in a Transformational Time,” Senator Thomas Daschle addresses five of the most important, game-changing forces that will affect health care in the coming years. He suggests – and I agree – that the innovative capacity of academic medical centers put these institutions in an advantageous position to address these forces. Indeed, given the heritage of academic medical centers addressing our society’s most important health care challenges, we have an obligation to do so. The brilliance and passion of the individuals at academic medical centers across the nation and the people I have the privilege of working with each day at Massachusetts General Hospital (MGH) have already led us to new and innovative programs shaped, undoubtedly, by our ability and willingness to leverage data, increase transparency, redesign care, maximize scope of practice, and experiment with new payment models.
At MGH, one manifestation of these forces can be seen in our Medicare Demonstration Project first started in 2006, which has involved providing enhanced services to the sickest Medicare patients in an effort to improve care and control costs. Patients in the program represented the 10% of Medicare beneficiaries who consume 70% of Medicare expenditures. These individuals typically have multiple chronic medical conditions and benefit from ongoing management. We tested multiple strategies to improve the coordination of services for this group and saw tremendous success. Improved communication between the patient and care team through care managers was critical to getting information to the right people in a timely manner, resulting in increased satisfaction for both patients and their providing physicians. Effective involvement of advanced practitioners was central to this strategy. Among patients in the program, we saw lower hospitalization rates, emergency department visit rates, and even mortality rates. Clear communication empowers patients and leads to more appropriate care delivered in more appropriate settings. Furthermore, the cost of care was less than that of a similar group of comparison patients. This work continues today across Partners HealthCare as the integrated Care Management Program and has spread to all Medicare patients in our Pioneer ACO and to patients covered by several commercial contracts.
We have also begun to explore ways to improve the health of our community, and one important focus is reducing the toll of substance use disorders. Substance use disorders not only affect the health of millions of Americans but are associated with a complex range of downstream effects. MGH has tackled this ubiquitous problem head on, developing a multipronged disease management approach that involves identification, treatment, prevention and education. More than 2,000 patients with substance use disorders are admitted to MGH annually, and these patients have a longer average length of stay and higher readmission rate. While substance use disorders traditionally have been treated as episodic conditions, our focus is on providing continuous care – like that commonly provided to patients with congestive heart failure or diabetes. One part of the plan is a multidisciplinary inpatient addiction consult team. This group is responsible for comprehensive evaluation, treatment recommendations and connection to community resources prior to discharge. Another important aspect of the plan involves use of recovery coaches — individuals who are peers in recovery and who support those with substance use disorders in the community, connect patients with community resources during the transition from inpatient to outpatient care, and get involved in the development of tailored treatment/wellness plans.
US health care is in the midst of an incredible transformation. I am excited to see how a growing number of academic medical centers are embracing and leading this transformation. We must channel our innovative capacity to redesign care so that ultimately we can create a health care system that provides outstanding and affordable care to the American people.
Editor’s Note: This New Conversations blog post is part of the journal’s ongoing conversation on the present and future impacts of current health care reform efforts on medical education, health care delivery, and research at academic health centers, and the effects such reforms might have on the overall health of communities. To read other New Conversations pieces and to contribute, browse the New Conversations collection on our website, follow the discussion on AM Rounds and Twitter (@AcadMedJournal using #AcMedConversations), and submit manuscripts using the article type “New Conversations” (see Dr. Sklar’s January 2015 editorial for submission instructions and for more information about this feature).