Helping Safety-Net Providers Improve Care for Medicaid Patients at the End of Life

    • August 1, 2000

The Institute for Healthcare Improvement (IHI), Boston, undertook a project to include 10 safety-net health care providers in its Breakthrough Series Collaborative on Improving Care at the End of Life.

IHI is an organization that works to accelerate improvement in health care systems in the United States, Canada, and Europe by fostering collaboration, rather than competition, among health care organizations.

Seven organizations (four public hospitals, two Veterans Administration [VA] hospitals, and one home care agency) that were deemed "safety net" according to the percentage of patients insured by Medicaid and the income profile of these patients' surrounding communities joined 40 other organizations in the collaborative.

Time constraints prevented the grantee from finding a 10th safety-net organization. The safety net health care providers did not have to pay the entire $12,000 enrollment fee usually required of participants.

Key Findings

The collaborative evaluated the teams' work in order to determine the extent to which they met their goals. They reported the following findings:

  • The safety-net organizations showed a normal distribution of achievement, with three demonstrating outstanding improvement.

  • The organizations that showed the least improvement may have been hindered by a lack of commitment at the leadership level.

  • It may have been more effective to make a stronger effort to contact senior leaders and teach them how to help their teams, given that their attention and energy was less focused on improving end-of-life care than that of many of the participants who had paid the $12,000 enrollment fee.

  • Work on maintaining continuity of care during patient transfers between health facilities improved the least, which was typical of all organizations in the Collaborative, including those that were not safety-net.

  • Despite the constraints and concerns of hospitals with very few resources, the teams from safety-net organizations had some opportunities that non-safety-net organizations did not have.

    Free of some of the perpetual worries about making a profit, they could devote themselves to their mission-oriented effort without being confined by concerns about the bottom line.