Of Force Multipliers and Hot Spotting: RWJF-Supported Initiatives Bring Forth Innovation

May 16, 2012, 4:14 AM, Posted by John R. Lumpkin

John Lumpkin John Lumpkin

Innovation – the process of applying new thinking to old problems – is critical to improving our health care system.

On May 8, the Department of Health and Human Services (HHS) announced its first round of Health Care Innovation Award grants to 26 organizations nationwide, including two groundbreaking initiatives that have been supported by the Robert Wood Johnson Foundation (RWJF). Together, Project ECHO and the Camden Coalition of Healthcare Providers funded through Cooper University Hospital will receive three-year HHS grants totaling more than $11 million to amplify their efforts to improve both the quality and affordability of health care.

HHS Secretary Kathleen Sebelius noted that the awards will “provide our most creative minds … with the backing they need to build the strong, effective, affordable health care system of the future.”

In the case of both Project ECHO and the Camden Coalition, these words could not be truer.

Project ECHO: Expanding Treatment Capacity by Sharing Medical Knowledge

Project ECHO, the transformative model of medical education and health care delivery led by social innovator Sanjeev Arora, MD, of the University of New Mexico Health Sciences Center in Albuquerque, brings high-quality, complex care to very sick patients wherever they live. The ECHO model teams community-based providers with specialists at university medical centers to manage patients with complex chronic conditions. Through real-time virtual clinics conducted weekly in the manner of grand rounds, Project ECHO shares medical knowledge to expand treatment capacity, producing what Dr. Arora calls a “force multiplier effect.”

RWJF is supporting Project ECHO with a three-year, $5 million grant, and believes that one day the ECHO model will be the new norm for a systems approach to delivering high-quality care. We see in ECHO the potential to save and improve millions of lives.

The model started in New Mexico and is spreading quickly, with replications in Washington state and Chicago. Government agencies, academic medical centers, health care systems, health plans, and others are also adopting the ECHO model.

With a Health Care Innovation Award grant of nearly $8.5 million, Project ECHO will significantly step up its operations in New Mexico and Washington state, training an additional 150 to 300 primary care professionals, including physicians, nurses, physician assistants, nurse assistants, and community health workers, to provide care for patients with complex, chronic diseases ranging from hepatitis C to rheumatoid arthritis to mental illness.

These newly trained “primary care intensivists” will treat 5,000 high-cost, high-utilization patients with high levels of disease severity, at an estimated savings of $11 million over the three-year grant period.

While savings are important, the notion of bringing high-quality care to an additional 5,000 high-need patients is exhilarating. It’s also the tip of the iceberg in terms of what the ECHO model can achieve for our health care system.

Camden Initiative Transforms Health Through “Hot Spotting”

Cooper University Hospital, of Camden, N.J., will receive a nearly $2.8 million Health Care Innovation Award to support its work with the nonprofit Camden Coalition of Healthcare Providers to identify and track patients with frequent emergency department visits and repeat hospitalizations and provide them with coordinated medical and social services. This practice, known as “hot spotting,” was pioneered by Jeffrey Brenner, MD, who directs the Camden Coalition and is head of the hospital’s Urban Health Institute.

The Camden Coalition began hot spotting in 2002, collecting and using data from public and private insurance claims to identify which patients were using the most expensive services and mapping where they lived. In addition, the Coalition worked with social service providers to ensure that patients got the support they needed to manage their conditions—such as transportation to their medical appointments—as well as clear discharge plans, so that they didn’t fall through the cracks after hospital stays and end up in the emergency room.

Hot spotting provides important clues for how the health care system can improve the health of its sickest patients and keep them out of hospitals and emergency rooms. This is huge. Research shows that the sickest 5 percent of patients account for more than half of U.S. health care costs. Improving the health and outcomes of these 5 percent would free up health care resources tremendously. The Camden model will soon be tested in several communities with RWJF support.

With the Health Care Innovation Award, the Camden Coalition will use the hot-spotting model to identify and coordinate care for an additional 1,200 high-use, high-cost patients, at an estimated savings of approximately $6.1 million over the three-year period. In addition, the program will create and provide training for 14 new staff to help expand a multidisciplinary team that will support care coordination activities.

The Robert Wood Johnson Foundation is committed to supporting game-changing innovation that can dramatically improve the health and health care of all Americans. On behalf of the RWJF, I congratulate Dr. Arora, Dr. Brenner, and their colleagues – not only for receiving these very significant awards, but also for the wonderful and important work that they do.

This commentary originally appeared on the RWJF Pioneering Ideas blog.