Notes and Disclaimers:
- Projects shown may have also operated in other states (see the Geographic Reach)
- Descriptions and project data (e.g. gross savings estimates, population served, etc.) are 3 year estimates provided by each organization and are based on budget submissions required by the Health Care Innovation Awards application process.
- While all projects were expected to produce cost savings beyond the 3 year grant award, some may not achieve net cost savings until after the initial 3-year period due to start-up-costs, change in care patterns and intervention effect on health status.
Project Title: "Patient-centered medical home for mental health services in Wyoming and Montana"
Geographic Reach: California, Montana, Washington, Wyoming
Funding Amount: $7,718,636
Estimated 3-Year Savings: $8,100,000
Summary: HealthLinkNow Inc, partnering with a number of local provider groups and health networks in Montana and Wyoming, is received an award to provide a Patient Centered Medical Home Program (PCMH) with mental health and substance abuse services in areas where geography and lack of psychiatrists and psychologists complicate access. This model will offer videoconferencing between local patients and HealthLinkNow psychiatrists; instant messaging, email, and telephone calls via HealthLinkNow between providers and patients; and a HealthLinkNow IT platform that allows billing, e-prescribing, and practice management. The program will improve access to psychiatric consultations, therapy, and long-term mental health case management. Lower costs through reduced hospital admissions and emergency room visits are anticipated. Over a three-year period, HealthLinkNow will hire 24 health care providers, including both psychiatrists and therapists.
INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT
Project Title: "Care management of mental and physical co-morbidities: a TripleAim bulls-eye"
Geographic Reach: California, Colorado, Massachusetts, Michigan, Minnesota, Pennsylvania, Washington, Wisconsin
Funding Amount: $17,999,635
Estimated 3-Year Savings: $27,693,046
Summary: The Institute for Clinical Systems Improvement (ICSI) of Bloomington, Minnesota received an award to improve care delivery and outcomes for high-risk adult patients with Medicare or Medicaid coverage who have depression plus diabetes or cardiovascular disease. The program will use care managers and health care teams to assess condition severity, monitor care through a computerized registry, provide relapse and exacerbation prevention, intensify or change treatment as warranted, and transition beneficiaries to self-management. The partnering care systems include clinics in ICSI, Mayo Clinic Health System, Kaiser Permanente in Colorado and Southern California, Community Health Plan of Washington, Pittsburgh Regional Health Initiative, Michigan Center for Clinical Systems Improvement, and Mount Auburn Cambridge Independent Practice Association with support from HealthPartners Research Foundation and AIMS (Advancing Integrated Mental Health Solutions). Over a three-year period, ICSI and its partners will train the approximately 80+ care managers needed for this new model.
KITSAP MENTAL HEALTH SERVICES
Project Title: “Race to health: coordination, integration, and innovations in care”
Geographic Reach: Washington
Funding Amount: $1,858,437
Estimated 3-Year Savings: $5,800,000
Summary: Kitsap Mental Health Services of Kitsap County, Washington received an award to coordinate and integrate care for one thousand severely mentally ill adults and 100 severely emotionally disturbed children with at least one co-morbidity almost all of them Medicaid, Medicare, and/or CHIP beneficiaries. Research shows health care for the severely mentally ill/severely emotionally disturbed population is often fragmented, ineffective, and inefficient, resulting in poor health and premature death. Through multi-disciplinary care coordination teams providing integrated behavioral health (mental health and co-occurring substance use disorder) management, tighter care coordination with primary care, and a bi-directional model supporting community-based primary care providers with psychiatric consultation, training, and brief interventions, the project is expected to improve beneficiary health and reduce avoidable emergency room visits and hospitalizations with an estimated savings of approximately $1.7 million. Over the three-year period, KMHS will train an estimated 130 health care workers, generate an estimated 11.5 new jobs, and create a transformed health care workforce cross-trained in behavioral and physical health disciplines.
MEDEXPERT INTERNATIONAL, INC
Project Title: "MedExpert International: Quality Medical Management System (QMMS)"
Geographic Reach: California, Idaho, Texas, Washington
Funding Amount: $9,332,545
Estimated 3-Year Savings: $50,410,304
Summary: MedExpert International received an award to test its Quality Medical Management System (QMMS) in comparison to a control group. QMMS is a shared decision-making system that provides consumers with access to world-expert physician advice, educational materials, and assistance with interpreting benefits and treatment options using Medical Information Coordinators and staff Physicians. QMMS will be available in selected geographic markets across the country to serve approximately 180,000 Medicare beneficiaries. The goal is to improve quality of care, reduce costs, increase transparency, achieve high utilization and satisfaction, and demonstrate model viability. Over a three-year period, MedExpert International will train and hire approximately 38 health care workers, including medical information coordinators, a medical information coordinator supervisor, a project manager, a senior executive manager, information technology and data engineers, senior engineers, and physicians.
Project Title: "Integrating industrial and system engineering (ISE) methods into healthcare improvement"
Geographic Reach: Massachusetts, North Carolina, Washington
Funding Amount: $8,000,002
Estimated 3-Year Savings: $60,780,907
Summary: The Healthcare Systems Engineering Institute at Northeastern University received an award to conduct a National Demonstration Project of the value that the systems engineering methods used in other complex industries can also be used to reduce healthcare costs, improve quality and safety, reduce waits and delays, and improve clinical outcomes and overall population health. Under this award, Northeastern will create a model regional healthcare systems engineering extension center that partners with several local healthcare systems, applies systems engineering methods to targeted common problems to significantly impact the goals of better outcomes, better health, and at lower costs, and develops an implementation plan for national spread. This award funds the first phase of a larger scale 10-year project to establish a national network of similar healthcare systems engineering regional extension centers across the U.S. that develop and embed regional industrial and systems engineering improvement science academic departments and other resources into their local healthcare systems, saving billions annually while training a targeted future workforce of 15,000 healthcare systems engineers.
PACIFIC BUSINESS GROUP ON HEALTH
Project Title: “Intensive outpatient care program”
Geographic Reach: Arizona, California, Washington
Funding Amount: $19,139,861
Estimated 3-Year Savings: $25,280,570
Summary: The Pacific Business Group on Health received its award to partner with provider groups in Arizona, California and Washington for the Intensive Outpatient Care Program (IOCP). Care managers embedded in primary care practices provide psychosocial and medical support for 27,000 predicted high-risk patients with chronic illness. The program aims to improve patient experience and clinical outcomes, reduce avoidable emergency room visits and hospitalizations, and spread best practices across a wide network of partners and, ultimately, other providers. Over a three-year period, Pacific Business Group on Health’s program will train over 410 people to spread best practices across a wide network, while creating an estimated 211 jobs for Care Coordinators and project staff.
PROSSER PUBLIC HOSPITAL DISTRICT
Project Title: “Prosser Washington Community Paramedics Program”
Geographic Reach: Washington
Funding Amount: $1,470,017
Estimated 3-Year Savings: $1,855,400
Summary: Prosser Public Hospital District of Benton County, serving a large, rural area in Washington State, received an award for a program through which physicians can send a community paramedic (CP) to visit patients of concern. The CPs provide reinforcement of discharge instructions, disease process education, post-abdominal surgery follow-up, medication clarification and social service referrals. The area has high rates of obesity, high cholesterol, diabetes, heart attacks/coronary disease, and angina/stroke. Emergency room visits and readmissions are high and preventive care is limited, with poor follow-up care for chronic illnesses and frequent missed appointments. By expanding the role of the emergency medical services, CPs are increasing access to primary and preventive care, providing wellness interventions, decreasing emergency room utilization, and improving outcomes. Over a three-year period, Prosser Public Hospital District's program will train an estimated 10 community paramedic workers.
TRUSTEES OF DARTMOUTH COLLEGE
Project Title: “Engaging patients through shared decision making: using patient and family activators to meet the triple aim”
Geographic Reach: California, Colorado, Idaho, Iowa, Maine, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New York, Oregon, Texas, Utah, Vermont, Washington
Funding Amount: $26,172,439
Estimated 3-Year Savings: $63,798,577
The High Value Healthcare Collaborative (HVHC) received an award led by The Trustees of Dartmouth College to implement patient engagement and shared decision making processes and tools across its 15 member organizations for patients considering hip, knee, or spine surgery and complex patients with diabetes or congestive heart failure. The program will hire and train 48 health coaches across the 15 member organizations to engage patients and their families in their health care and health decisions.
High Value Healthcare Collaborative (HVHC) is implementing a bundle of services related to the care of sepsis patients across 13 health care systems around the country. The overall goal of this project is to utilize process improvement strategies to implement specific services at 3- and 6-hours post diagnosis as defined by the Surviving Sepsis Campaign (SSC) and National Quality Forum (NQF) guidelines for the care of severe sepsis or septic shock. Over three years, this intervention aims to improve optimal adherence to sepsis bundled care by 5%, reduce the burden of chronic morbidity from sepsis-associated chronic organ dysfunction, and achieve a 5% relative rate reduction in the number of patients with sepsis requiring long-term acute care or sub-acute nursing care after an incident episode of severe sepsis.