Wednesday, June 25, 2014
In the United States, 5 percent of the population accounts for almost half of total health care expenses. That’s according to a report from the Agency for Healthcare Research and Quality. In the world of health policy and health reform, identifying those super-utilizing patients is sometimes called “hot spotting,” and it could be a key to controlling health care costs in the future.
A five-student interprofessional team from Virginia Commonwealth University is one of 10 chosen for a six-month learning collaborative to explore the root causes that lead to repeat visits to the hospital and drive up health care costs.
The team will be led by the Eveline Chu and Tricia Olaes. Both are medical students in the school’s International/Inner City/Rural Preceptorship program who will use the experience as their capstone project. Other participants include Emily Pratt, a graduate student in the School of Social Work; Andrea Ramos, a student in the School of Nursing; and Aziza Dang, a student in the School of Pharmacy.
The team’s faculty adviser is family medicine physician Katherine Neuhausen, M.D., who practices at VCU’s Hayes E. Willis Health Center, a primary care clinic serving primarily uninsured and Medicaid patients. The team will work with Neuhausen to select up to five clinic patients who are super-utilizers of hospital resources. They’ll look for patients with at least three inpatient admissions over the past 18 months who have uncontrolled chronic physical diseases, behavioral health conditions and social needs driving their high utilization.
To get started, the students will meet with patients in their homes to complete a needs assessment and action plan that will take into account such issues as the patients’ chronic medical diseases, health literacy, mental illness, substance abuse and social needs. They will also identify barriers to patients accessing health care and will accompany patients on doctors’ visits, even assisting with transportation or helping to obtain health insurance, as needed. If a patient is hospitalized, a team member will visit them in the hospital to determine if the action plan should be modified.
The students will draw on Neuhausen’s experience at the Centers for Medicare and Medicaid Services where she conducted case studies of super-utilizers programs as a Robert Wood Johnson Foundation clinical scholar. In addition to her position as assistant clinical professor in the Department of Family Medicine and Population Health, Neuhausen also serves as the director of delivery system transformation in the VCU Office of Innovation.
The students also will call on a policy advisory team of VCU faculty members for help in analyzing overarching patterns in patients’ experiences, including the role of social determinants of health, and identifying wider policy changes necessary to improve care for these patients. The interprofessional faculty team includes family medicine and internal medicine physicians, a medical anthropologist, a pharmacist, a clinical social worker and a gerontological nurse practitioner.
Over the course of the six-month program, the VCU students will participate in monthly case conferences and topical webinars with family physician and 2013 MacArthur Fellow Jeffrey Brenner, M.D.
Brenner is the executive director of the Camden Coalition of Healthcare Providers, which is organizing the project along with Primary Care Progress and the Association of American Medical Colleges. Each of the 10 student teams have been awarded a $700 grant to support patient needs such as bus passes, phone cards and canes. The students will also attend a hot spotter conference this winter hosted by Camden Coalition for students from all 10 sites to share their work.
The 10 academic health centers selected for the learning collaborative are:
· Jefferson Medical College
· Johns Hopkins School of Medicine
· LSU New Orleans School of Medicine / Tulane School of Medicine
· Penn State College of Medicine
· The Ohio State University College of Medicine
· University of Rochester School of Medicine & Dentistry
· University of Washington School of Medicine
· UNC School of Medicine/ Duke University School of Medicine
· Vanderbilt University School of Medicine
· Virginia Commonwealth University School of Medicine
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