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UM Improved Preventive, Chronic Care

Ruzanna Harutyunyan's picture

Medicare patients with heart conditions and diabetes, or who require cancer screenings, are getting better treatment than ever at the University of Michigan Health System and that care is costing less, according to a new report.

These results come from the third year of a five-year national project undertaken by 10 large physician groups, including the U-M Faculty Group Practice.

The results were announced today in Washington, D.C., by the Centers for Medicare and Medicaid Services. CMS oversees the Medicare system and launched this demonstration project to promote investment in care management programs and redesigned care processes that might be used by doctors and hospitals nationwide.

U-M achieved both of the project’s aims: to provide the highest-quality care and reduce health care spending growth for all traditional Medicare patients, including those with costly chronic illnesses.

U-M’s performance was better than the CMS targets for 29 of the 32 quality measures tracked in the third year of the project. The quality measures focused on diabetes, congestive heart failure, coronary artery disease, hypertension, and breast and colorectal cancer screenings.

In addition, U-M provided care for these Medicare patients at a lower cost than the CMS target, saving Medicare $2.9 million that would have otherwise been spent on the care of U-M patients in that year.

This is the third year in a row that U-M has achieved both sizable savings and high scores on health care quality benchmarks as part of the project. Two more years of data remain to be collected and analyzed.

The U-M Faculty Group Practice, part of the U-M Medical School, includes all of the nearly 1,600 U-M faculty physicians who care for patients at the three U-M hospitals and 40 U-M health centers.

Many of the programs and innovations that U-M has put in place for this project involve not only physicians but also pharmacists, nurses, social workers, care managers and others who are involved in the care of Medicare patients at all U-M facilities.

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The report is based on data from 18,000 Medicare participants who received most of their care at U-M during the 12-month period that began April 1, 2007.

It does not include those who were enrolled in a Medicare Advantage plan offered by a private health plan, nor Medicare participants who received only limited care at U-M. But the improvements made for the project are helping other patients as well.

“The U-M Faculty Group Practice invested significant time and resources in this project because it provided the opportunity to develop and test potential interventions that could improve clinical outcomes and reduce costs for patients with chronic disease,” says David Spahlinger, M.D., senior associate dean for clinical affairs. “Our investments have enabled better coordination of care.”

The project’s formal name is the Medicare Physician Group Practice Demonstration Project. It is Medicare’s first Pay-for-Performance Demonstration Project to work directly with physician groups.

It began by focusing on the quality of care of patients with diabetes, but was expanded in its second year to include congestive heart failure and coronary artery disease – both chronic heart conditions that carry a very high risk of emergency hospitalization and other higher-cost care if not managed appropriately. In the third year, the program was further expanded to include hypertension – another high-risk and costly condition – and breast and colorectal cancer screenings.

Project leader Caroline Blaum, M.D. – associate professor of internal medicine, associate chief of geriatric medicine and a research scientist at the VA Ann Arbor Healthcare System – says the project results provide important input for the national debate on health care cost and quality.

“There are plenty of opportunities to squeeze costs out of the system while also improving quality of care. For example, focusing on how patients transition between care settings and proactively reaching out to ensure they understand the information provided and the next steps can make a substantial impact,” she says.

During the three years it has participated in the project, U-M has launched a number of new programs to help improve care for all patients seen at U-M. The U-M Faculty Group Practice was one of the first in the project to implement transitional care programs designed to assist patients with hospital discharge information and follow-up activity.

U-M has also implemented complex care coordination programs designed to reduce unnecessary treatments, readmissions, handoffs and wait times, as well as a medical home program where a patient and his/her personal physician partner to identify, provide, and coordinate all needed services across multiple locations and settings.

U-M’s Faculty Group Practice is the only organization in Michigan taking part in the project. It was chosen for several reasons, including demonstrated success in chronic care management, diabetes quality and organizational structure.