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Partners in Progress
By Maura Keller

More than 10 years ago, Hospice of Michigan and the University of Michigan conducted a study funded by the Robert Wood Johnson Foundation that demonstrated that no matter how informed people were about hospice care, when faced with terminal illness, 60% to 70% did not want it. The majority with a terminal diagnosis wanted to pursue treatment and a possible cure.

“In 2000, with the results in hand, we realized that people who would benefit from comprehensive care were unlikely to receive it,” says Tracy Lark, corporate director of communications at Hospice of Michigan. “They didn’t want hospice care, and there was no comprehensive alternative to hospice. Without comprehensive care, the burdens of the illness and care fall primarily on the patient and the primary caregiver.”

Hospice of Michigan wanted to do something to help patients and caregivers facing this dilemma. “We thought patients and families should have a better option than going it alone, and we worked on a model that answered a lot of the ‘what if’ questions that we had,” Lark says. “We established @HOMe Support in 2000 and took our first patient in 2002.”

At its core, the @HOMe Support model provides comprehensive medical care for the patient’s illness and support to the patient and family. In this model, the caregiver is part of the unit of care. By providing continuous, comprehensive support, the patient’s care is normalized, crises are reduced or eliminated, emergency department (ED) and ambulance use declines, and the patient and family are more prepared to deal with emerging situations and cope with the emotional and spiritual aspects of living with serious illness.

“In addition, we’ve developed proprietary software that sifts patient data to identify patients with advanced illnesses most likely to benefit from the comprehensive care offered by @HOMe Support,” Lark says.

Hospice of Michigan’s first strategic partnership was with The Michigan Pioneer Accountable Care Organization (ACO), which is part of the Detroit Medical Center (DMC) system. After a rigorous review, @HOMe Support was selected to partner with the DMC to enhance care and reduce costs for chronically ill patients in its largely urban, multihospital health system.

Since signing the contract in early 2012, @HOMe Support has gained more than 200 patients for the Michigan Pioneer ACO, and it is expected that more than 400 patients will be served by year’s end, with that number growing in 2013.

“The Michigan Pioneer ACO and the DMC were very excited by the @HOMe Support model because we had research to back up our belief that comprehensive, compassionate care reduces overall costs because the support of a highly trained interdisciplinary team monitoring the patient’s status on an ongoing basis and fine-tuning the care plan eliminates the need for many of the crisis interventions like [ED] visits, ambulance use, and hospitalizations,” Lark says. “They liked what they heard, and they liked the research results. We showed a reduction of costs of more than 33% for patients enrolled in @HOMe Support compared with patients who were not enrolled.”

The @HOMe Support model uses proprietary software to mine patient data from Medicare and Medicaid, helping to identify patients in the Michigan Pioneer ACO most likely to benefit from this supportive model of care.

In addition, the model uses a patient record documentation system that allows for real-time documentation from mobile devices to maximize time with patients and reduce the time to complete administrative tasks and documentation. This software also allows for medication and equipment orders.

According to Lark, since the announcement of the first contract with the Michigan Pioneer ACO in March, @HOMe Support has enrolled more than 200 patients and already seen some of its patients change the way they manage their illness.

“One patient, who is dealing with loneliness and isolation, often relied upon hospitalizations to feel a sense of community,” Lark says. “In addition, a diet that was made up of soda, chili dogs, and hot sauce often had him going to the [ED] believing he was having a heart attack when actually he had indigestion. This patient’s care includes frequent touch bases that demonstrate an interest in him and to educate him on things he can do to enhance his quality of life, including making simple changes to his diet. This is one example of how we can reduce the high cost of [ED] visits, ambulances, and hospitalizations by providing a supportive, comprehensive care plan and staying involved with the patient throughout the illness.”

So how does this project fit into the broad concept of ACOs? As Lark explains, the ACOs have accepted a federal mandate to enhance the quality of care of patients using measurable outcomes while reducing the cost of delivering care.

“If they succeed, they will share in the savings,” Lark says. “If they fail, they must return payments from the federal government. The financial component is an important incentive—it raises the stakes for finding solutions. By offering the Michigan Pioneer ACO a tested model of care that could be immediately implemented, they have had the ability to take action immediately to achieve the objectives set by the federal government. We expect to get them results, and they are counting on us to do so. If we are successful, there is a lot to be shared with other ACOs and we can make a big impact in some key areas of the healthcare system.”

— Maura Keller is a Minneapolis-based writer and editor.