Predictive Modeling And Team Care For High-Need Patients At HealthCare Partners

• Published in: Health Affairs 2011-03, Vol.30 (3), p.416-418
• Main Author: Feder, J Lester
• Format: Article
• Language: English
• Subjects: Accountable care organizations; California; Capitation; Chief executive officers; Chronic illnesses; Chronic obstructive pulmonary disease; Community support; Continuity of care; Corporate profiles; Cost control; Doctors; Electronic health records; Health care; Health care expenditures; Health care policy; Health maintenance organizations; Health policy; Heart failure; HMOs; Hospitalization; Hospitals; Independent practice associations; Innovations; Interventions; Medical service; Medicare; Multidisciplinary teams; Nevada; Patient care; Patient satisfaction; Patients; Physicians; Population; Primary care; Risk; Social workers; Success; Teams
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2011.0080

HealthCare Partners Medical Group, which cares for one million patients in California, Nevada, and Florida. Roughly half of these patients are treated by the 1,000 physicians who are employed in a staff-model health maintenance organization; the rest are cared for by affiliated physicians in independent practice associations. HealthCare Partners instituted two interventions targeting high-need patients at risk of hospitalization. At five Comprehensive Care Centers, multidisciplinary teams care for patients who have just been discharged from a hospital or who have conditions such as chronic obstructive pulmonary disease or congestive heart failure. Homecare Teams of physicians, social workers, and case managers visit homebound patients. The goals are to control conditions and return patients to care with their primary care physicians and free up resources for other high-need patients. Reduced hospital use has saved the system $2 million annually for every 1,000 members. For patients in the high-risk program, hospital use has declined 20 percent over the two years of the program. Identifying where resources can best be used to improve care quality and reduce high-cost interventions. A new payment model is also needed to replace fee-for-service, to encourage the provision of this "high-value" care. HealthCare Partners aspires to be a Medicare accountable care organization that takes partial or full risk for patient care. Adapted from the source document.