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Our Take: Johns Hopkins care management program saves millions, improves outcomes

Nov 19, 2018

A Johns Hopkins community intervention is associated with reductions in admissions, readmissions and emergency department visits, netting $113.3 million in savings, according to new research in JAMA Network Open.

Our Take: We know that most of you won’t want to wade into the research, so we’re doing it for you. The lessons that can be gleaned from this project are important.

The Johns Hopkins Community Health Partnership (J-CHiP) was created to improve health outcomes through better care coordination in East Baltimore, Md. The JAMA study that reviewed J-CHiP included results from 2012 to 2016 following two types of interventions: nonrandomized acute care intervention (ACI) and community intervention (CI) for Medicare and Medicaid beneficiaries.

Of note, J-CHiP was implemented for all payers, but the analysis only includes Medicare and Medicaid beneficiaries because of data limitations for other payers. About 2,100 East Baltimore residents participated in the initiative.

Here’s what they did. In the ACI group, practitioners focused on improving transition planning following a hospital discharge. They employed six strategies (the list is nearly verbatim from the study; bolded text is ours):

  • Early screen for discharge planning to predict service needs following discharge
  • Daily multidisciplinary unit-based rounds to review goals and priorities of care
  • Patient education using tablet-based modules
  • Enhanced medication management, including the option of medications in hand at the time of discharge
  • Telephone follow-up after discharge by nurses staffing a patient-access line
  • Skilled home care, remote patient monitoring and/or a skilled nurse transition guide for high-risk patients
In the CI group, they integrated behavioral health care services at eight ambulatory sites and used predictive modeling to determine which patients were at greatest risk for hospitalization. They then deployed interdisciplinary teams of care coordinators and community-based health workers in East Baltimore, working in close collaboration with primary care practitioners. The teams homed in on patients who had barriers to accessing care—often meeting them in their homes. Behavioral health specialists looked for substance abuse or other psychiatric disorders.

To avoid getting into the statistical weeds here, we’ll keep this simple. The researchers arrived at their results by comparing expenses for the patient population for about 18 months prior to the intervention versus expenses incurred during the study period.

By any measure, J-CHiP was remarkably successful. The grant used to pay for the program, including an investment from Johns Hopkins, was $19.9 million. At the start of the program, J-CHiP leadership estimated that they would save $52.6 million—less than half the $113.3 million that was actually saved. That’s more than a 5:1 return on investment.

Researchers also surveyed patients to assess satisfaction using a modified version of the Consumer Assessment of Healthcare Providers and Systems. All but one of the satisfaction measures met or exceeded 94 percent. And overall, J-CHiP patients rated their health care practitioner an average of 8.9 (on a 10-point scale) and rated their trust of their care team an average of 9.1, with 92 percent of respondents saying they would recommend their care team to their family and friends.

“The evaluation of the J-CHiP program suggests that a care coordination model that includes separate but complementary bundles of intervention strategies in an urban academic environment can be associated with dramatic improvements in many key utilization and cost indices,” the researchers wrote. “However, it is worth noting that the size of the effect is likely not wholly generalizable, as other efforts to implement such care delivery transformations will reflect investments made by the organizations, baseline health and utilization of patients served, and the communities in which they reside.”

We were so struck by the results that we felt it merited this week’s lead write-up. To be fair, as the study authors point out, such an expansive program isn’t for everyone. J-CHiP was instituted in a very specific patient population in an urban, academic setting. The costs of implementing this kind of community-based initiative might be prohibitive for, say, your average ACO or health system.

That said, it’s worth noting that Johns Hopkins instituted “nearly all aspects” of the program in its JHM accountable care organization, the Johns Hopkins HealthCare Medicaid managed care plan, and other state initiatives related to the Maryland All-Payer Model.

Access the full article here.

Editor’s Note: Due to the Thanksgiving holiday, Our Take will return on December 4.

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