Health Care Innovation Awards Round Two: Iowa

Notes and Disclaimers:

• Projects shown may also be operating in other states (see the Geographic Reach)

ASSOCIATION OF AMERICAN MEDICAL COLLEGES

Project Title: "eConsults/eReferrals: Controlling Costs and Improving Quality at the Interface of Primary Care and Specialty Care"
Geographic Reach: California, Iowa, New Hampshire, Virginia, Wisconsin
Estimated Funding Amount: $7,125,770

Summary: The Association of American Medical Colleges project will test the scalability of an eConsult/eReferral model for implementation in five partner academic medical centers.  The eConsults model, developed by the University of California San Francisco (UCSF), is an electronic consultation and referral (eCR) platform for access to specialty input to address several well-documented gaps in primary care-specialty care communication and coordination and provide a foundation for non-face-to-face, asynchronous electronic consultation.  The proposed model has two components, both fully integrated into the Epic electronic health record.  The first being implementation of a standardized set of condition-specific referral templates across 12 medical specialties, with additional surgical specialties nearing completion. These templates, developed at UCSF and refined at each academic medical center by a consensus of primary care/specialist clinicians, provide immediate decision support to the primary care provider (appropriateness of referral, recommended pre-referral tests, etc.) and ensure that all necessary information is provided to the appropriate specialist. The second component of the model is the eConsult, an asynchronous exchange initiated by the primary care provider to seek guidance from the specialist, who is expected to respond in less than 72 hours. eConsults are completed in lieu of an in-person specialist visit, though the specialist can convert an eConsult to a referral if the situation warrants and the patients will still have the option to seek care with that specialist, if desired. The eConsult system integrates into current care-delivery practices and supports the work of both the primary care provider and the specialist involved in an eConsult exchange.

AVERA HEALTH

Project Title: "Avera Virtual Care Center: Improving Care & Reducing Costs for the Vulnerable Elderly Population"
Geographic Reach: Iowa, Minnesota, Nebraska, South Dakota
Estimated Funding Amount: $8,827,573

Summary: The Avera Virtual Care Center project will test the virtual wrapping of a set of comprehensive, resident-centered, geriatric care services around the long term care population. The project will operate in facilities located in South Dakota, Minnesota, Iowa and Nebraska. The three primary drivers of this project include: building the assessment capability and toolkits of the long term care team of care providers; providing long term care facility residents with routine and early access to appropriate goal-directed care; and improving management of care transitions. A Virtual Care Team will host INTERACT II training sessions and skill building workshops for long term care staff and will facilitate widespread implementation of INTERACT II tools and treatment algorithms to support earlier identification of urgent issues. The INTERACT II implementation will be further supported by high-quality care planning resources and training to promote alignment of resident care goals and treatment plans. To address the geriatric care access gap, the Virtual Care Team will offer daily rounds, comprehensive geriatric assessments and urgent care visits to address resident health needs in a timely manner. These services will be provided out of a centrally staffed telemedicine hub, spreading the expertise of one team over 30 long term care centers. To maximize safety and continuity across transitional points in care, the Virtual Care Center team will promote the adoption of standardized tools and processes.

CATHOLIC HEALTH INITIATIVES IOWA CORP., DBA MERCY MEDICAL CENTER DES MOINES

Project Title: "Transitioning a Rural Health Network to Value-Based Care"
Geographic Reach: Iowa, Nebraska
Estimated Funding Amount: $10,171,220

Summary: Catholic Health Initiatives Iowa Corporation is receiving an award to test a model to transition a network of rural critical access hospitals to value-based care through improved chronic disease management, increased clinical-community integration and 'lean' process improvement initiatives. Once the value-based care infrastructure has been established, the 25 critical access hospitals, including their 73 primary care clinics, will be enrolled in Mercy's Accountable Care Organization (ACO) and benefit from shared savings, resulting in model sustainability. The model is based on the approach of the Mercy ACO, which has used a similar model in its urban clinics and has achieved successful outcomes. This model includes public and private payers, rural leadership, expertise in barriers to quality care in rural communities, and utilizes Mercy's evidence-based chronic care health coach and disease registry that aim to improve care and reduce costs.

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