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ACA’s Innovation Center spurs testing of new health care models

ACA’s Innovation Center spurs testing of new health care models

Picture of Kellie  Schmitt

One of the lesser-known provisions of the Affordable Care Act is the creation of the Center for Medicare and Medicaid’s Innovation Center, a program designed to test out new, more efficient ways of delivering health care. Throughout the country, hundreds of organizations are experimenting with ways to reduce spending, improve patient outcomes and strengthen the health care workforce.

Jay Hancock of Kaiser Health News recently explained what the center and its 10-year, $10-billion budget hopes to achieve: “In several states the office is working to overhaul medicine for nearly all residents — not just those with government Medicare and Medicaid coverage. … Backers compare it to a venture-capital fund that can finance the next big idea or Lockheed Martin’s ‘skunk works’ for developing advanced jets.”

But, as Hancock points out, the programs are experimental by nature, and critics question whether the results will justify the billions spent. After a several-year test period, CMS contractors will monitor the programs and see if the successes can be expanded. The Center for Medicare and Medicaid Innovation published a framework (PDF) last month for measuring and evaluating project performance.

There are innovations being tested in every state, which can be seen on this interactive map. Many initiatives are using new models to better coordinate care for frequent health care users, such as the elderly, those with chronic conditions and people with mental and physical disabilities. Others try to bridge communication and education gaps that could be keeping patients from accessing and understanding their health care options.

More than a dozen projects are targeting California patients alone, including one that’s  expanding the role of pharmacists in managing chronically ill patients. Below, you’ll find a brief sampling of a few others. In the future, this Affordable Care blog will spotlight some of the California projects and take a closer look at how they are faring.

Asian Americans for Community Involvement (AACI)

Funding amount: $2.7 million (2012)

This project, called the “Patient Navigation Center,” is designed to help people who face language and cultural barriers to accessing health services. The program is training Asian and Hispanic youth as well as veteran case managers as patient navigators. These navigators will help with translation, appointment scheduling, referrals, transportation, and application help for social services.

“Patient navigators build AACI’s capacity to improve access to care, disease screening, diagnosis time, and medication adherence, while reducing patient anxiety and avoidable ER visits,” the group said. AACI estimates this effort will save about $3.4 million over a three-year period.

California Long-Term Care Education Center (CLTCEC)

Funding amount: $11.8 million (2012)

This project aims to integrate in-home supportive services for seniors and people with disabilities into the health care system. The idea is that these in-home caregivers aren’t currently a part of their client’s care team. Steve Decker, CLTCEC’s executive director, described the program here: "By giving caregivers the training necessary and making them part of their client's health care team, they'll be able to act as a bridge to their client's multiple doctors and ensure that the care being provided at home aligns with the care directives of their client's physicians."

Grant funds will be used to train about 6,900 in-home caregivers in Los Angeles, San Mateo and Contra Costa counties. CLTCEC predicts the coordinated model will reduce ER visits by 23 percent and reduce the average length of stay in a nursing home by 10 percent – cuts that, over three years, could result in $25 million in savings.

Felton Institute (formerly Family Service Agency of San Francisco)

Funding amount: $4.7 million (2012)

This mental health project focuses on prevention and recovery from early psychosis in two low-income, largely Latino counties in Central and Northern California. The grant is being used to train health care providers and create jobs for social workers, nurse practitioners, vocational counselors and peer and family aides – all of whom will work to prevent the onset of full psychosis. Full psychosis occurs when patients lose touch with reality.

This San Francisco-based organization is known its approach to treating schizophrenics, which is “built on the premise that early intervention can dramatically change the trajectory for young individuals diagnosed with or at risk of schizophrenia,” according to a description of the program in Mental Health Weekly (PDF).

Without some kind of intervention, as many as 90 percent of these patients could be Supplemental Security Income or Medicare recipients by their 30s, according to the award summary. The group predicts that reducing that figure could save $4.2 million over three years.

University of California, Los Angeles

Funding amount: $3.2 million (2012)

The goal of this project, which targets the western area of Los Angeles County, is to improve health care for patients with Alzheimer’s and dementia, and lower the cost of their care in the process. The program combines a dementia registry, assessments of patients and caregivers, creation of individualized care plans, and 24/7 access to assistance and advice.

The UCLA project is working with several community-based organizations that serve dementia patients and hiring three geriatric nurse practitioners who will help with the care plans. Along with improving overall care, the program hopes to reduce hospitalizations and ER visits, and shorten hospital stays – creating an estimated savings of almost $7 million.

Cropped photo by Boegh via Flickr.

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