In the past several decades, our nation has advanced the medical infrastructure we need to treat people with acute illness and serious injuries. Today, we have networks of trauma centers working with air ambulances, highly trained EMTs and other advances in life-support and emergency medicine that are saving lives.
In more recent years, we’ve begun to see the beginnings of another quiet revolution – this one changing the way we treat people with chronic illnesses. And at the New Jersey Health Care Quality Institute, we know that changing the way we treat chronic illness requires changing the way we pay for that treatment.
Consider these two examples:
We pay for a patient with a serious asthma attack to be admitted to the ER and sometimes even the ICU. But we don’t generally invest in home inspections to reduce asthma triggers, and we rarely adequately support comprehensive primary care, education and home visits to prevent future hospitalizations.
A health system can obtain greater reimbursement for intervening in the serious complication of diabetes, such as amputations or dialysis, than for providing preventive services, such as regular primary care visits and follow-up coaching by community health workers.
We’re not saying health systems want to amputate more feet, but the payment system provides few incentives for systems to invest in preventive care.
Thankfully, the system is beginning to change. The federal government has sparked much of the innovation, but private payers are joining in as well. We are beginning to see a shift in resources to put greater focus on community-based care that treats the patient before a chronic illness advances to cause serious problems – or before a chronic disease begins at all. In New Jersey, the Quality Institute has developed programs, such as our Mayors Wellness Campaign and the QI Collaborative, that align with this shift in focus.
Our Mayors Wellness Campaign (MWC) empowers mayors and community leaders by providing them with toolkits of simple, yet effective wellness programs to create more informed health consumers. The campaign supports mayors who may want to create anything from new walking and bike trails to community wide healthy cooking classes. We see the MWC as our grassroots engine serving more than 370 municipalities.
Our QI Collaborative supports Medicaid Accountable Care Organizations (ACOs), which are innovative community-based collaborations that bring together hospitals, mental health organizations, social service professionals and others to better coordinate patients’ health.
A patient with heart disease may reduce visits to the hospital with regular home visits from a nurse – and from a phone number of someone they can call when frightening symptoms arise. Payment changes propel innovation. Once this model is implemented and financially supported, the ACOs could share in savings if Medicaid sees savings in the program.
Right now, ACOs in New Jersey work with vulnerable populations. But similar models can be found across New Jersey for seniors and others struggling with chronic illness. Already, we are seeing improved outcomes and savings from patient-centered medical homes, where a team of caregivers call patients on the telephone, visit them at home, or work to provide education and understanding of their chronic disease.
Changes in how we treat and pay for chronic illness may not seem as exciting as a new advanced life support helicopter or new emergency technology. But at the Quality Institute, we believe these changes will prove just as revolutionary over time.