Integrating Care

Case Study: Dignity Health

At Dignity Health the integration of community benefit in strategic planning and operations most recently involved an initiative to reduce readmissions for ambulatory care sensitive conditions and has been successfully completed. Costs for treating these conditions across a network of 40 hospitals were more than 4261 million in FY2010, representing more than 29,000 hospitalizations and more than 120,000 inpatient days. From 2008-2010, its hospitals invested $5.7 million in preventive and disease management programs for patients deemed at risk for hospitalization for asthma, diabetes, or congestive heart failure. This resulted in 8,917 individuals participating in disease self-management programs, and 86& were not seen in the emergency department or hospital within the six months post intervention.

Moving into full implementation of the Patient Protection and Affordable Care Act, the goal of Dignity Health hospitals is to institutionalize evidence-based chronic disease self-management programs as an essential component of a broader disease management strategy. With a focus on disproportionate unmet health-related need populations, these programs will help Dignity Health confront the challenges of continuing to care for the uninsured/underinsured populations in an era of health care reform.

Strategy: Offer evidence-based chronic disease self-management programs to help avoid hospital admissions for two of the most prevalent ambulatory sensitive conditions, as identified by community needs assessments and hospital utilization data. We expect at least 50% of participants to avoid admission to a hospital or emergency department for six months following their participation.

1. Each facility/service area will:

• Identify and engage a clinical champion,
• Engage clinical health professionals in the development and implementation of the program.

1. The intervention strategy may include home health, outpatient case management and/or evidence-based education programs.
2. The primary, but not exclusive, focus will be on the uninsured and populations covered by Medicaid, Medicare/Medicaid, or other means-tested government programs.
3. Where appropriate, strategies should seek to place patients in the community clinic/FQHC system or other community health care providers, including medical home models, so that long-term coordination of care can be managed in a primary care setting.

Challenges: Besides identifying the most appropriate staff member to lead an evidence-based program, and to commit to non-productive time to plan, implement and evaluate the program, thoughtful planning and budgeting is required to ensure allocation of adequate resources. Here the key is understanding that such a program is needed, and that there will be a return on the investment. this has meant ongoing education of leadership and the sharing of hospital-specific data to establish a business case in support of the strategy. One of the many lessons learned is the importance of including physicians in the planning of this kind of intervention strategy, their support being vital to ongoing referrals of participants for the program.

Performance: In FY2011, more than 5,400 persons were served by our disease management programs with an average admission rate of only 7% among those participants.