Project seeks to enhance chronic disease management
Drawing on its strengths in clinical information technology to expand the concept of care beyond the clinic walls, Vanderbilt University Medical Center is setting out to transform outpatient management of three common chronic conditions: hypertension, diabetes and congestive heart failure.
A pilot project is under way in the Adult Primary Care Center and implementation will begin there in July. The project is called My Health Team @ Vanderbilt.
“With My Health Team we're looking at doubling both our quality of care and our capacity,” said Jim Jirjis, M.D., MBA, chief medical information officer and medical director of Adult Primary Care.
“In addition, by optimally keeping these chronic conditions within control, avoiding acute episodes and the need for hospital services, we stand to slash total per-patient costs of care by more than one-quarter.”
From a disease management perspective, patients with hypertension, diabetes and congestive heart failure form assorted sub-groups based on severity and co-morbidity.
• At the sub-group level, clinical information systems will streamline both surveillance and the coordination of tailored, evidence-based care.
• Working as care coordinators, nurses will track, educate and coach patients, with special attention to eliminating any barriers to physiologic control.
• Telemedicine and group visits will substantially supplant traditional clinic visits, freeing physicians to follow many more patients.
• To coordinate care planning, primary care and specialist physicians are developing protocols together. Specialists will routinely provide curbside consults: that is, without actually seeing the patient, they will review records and offer expert guidance.
• For any patients who prove especially difficult to bring within physiologic control, the health team will meet to tailor a strategy.
Leaders speak of the initiative as a forerunner and say its guiding principle is innovation. This year, VUMC introduced innovation as a new core pillar for organizational goal-setting.
“It's innovation because it's trying to put together processes and technology in a way that they've never been assembled, to dramatically change the results by essentially trying to double the quality in ways that actually reduce the cost of the care of the population,” said Bill Stead, M.D., associate vice chancellor and Chief Strategy and Information Officer.
“With this idea of a care coordinator and a coordinated plan and good telecommunication and so forth, we only need to see you when there's something we have to do, and it looks to us like we can double the number of people we can actually handle in the physical clinic space,” Stead said.
“As we move ambulatory care processes outside the exam room and the traditional encounter, we'll be studying the economics and opening talks with payers about alternative systems of payment.” said Dave Posch, CEO of The Vanderbilt Clinic and executive director of Vanderbilt Medical Group.
Today's providers generally aren't reimbursed for measures like telemedicine, intensive outpatient tracking and curbside consults. To cover these new costs, VUMC will need to persuade health plans to apply some of what they'll be saving to fund this new approach.
Just from improved management of hypertension alone, Jirjis has calculated a health care cost savings opportunity of more than $2 million per year in reduced hospital services for heart attack and stroke based on the current population of adult primary care patients at Vanderbilt.