Detroit Medical Center's accountable care organization, Michigan Pioneer ACO, includes Hospice of Michigan that helps it identify terminally ill patients in the ACO that require customized care beyond normal primary care office visits and provides medical care at home. That is not a typical ACO path and could signal the emergence of other innovative care partnerships.
Set on a tiered approach to care management, Michigan Pioneer ACO sees the first tier as prevention and wellness, including flu vaccines and annual checkups, according to Michigan Pioneer's President Carrie Harris-Muller. The other tiers are patients with multiple conditions and the terminally ill patients with less than 24 months to live.
"The very ill need a lot of support in the home," Hospice of Michigan CEO Dottie Deremo said in a Crain's Detroit Business article. "(People) can have two to 10 crises in the last 24 months of life. The options have been to go to the ER or hospital. We can reduce this with personalized programs."
Identifying the patients for the Personalized Care at Home program may take up to nine months, as hospice looks at 200 to 300 patients at a time to determine if the patients are at end-stage illness. Hospice of Michigan research indicates its special program for end-stage illness patients saves 36 percent in medical costs, while providing higher quality care and reducing stress for caregivers during patients' last 24 months of life, Deremo said.
Michigan Pioneer ACO is one of the 32 Pioneer ACOs in the nation, which aims to save Medicare up to $1.1 billion over five years.
I would contend that just as positioning the nursing home / rehabilitation provider as the partner of choice for a hospital in an ACO, it will be equally important to start looking at other elements in the continuum of care as partners as well.
As quality becomes more transparent, one way a hospice might start to strategically position itself, is to consider your quality data. The National Quality Forum recently endorsed palliative and end-of-life measures. In addition, hospice providers will be required to submit a "Quality Data Submission Form" to report quality data pertaining to at least three quality indicators related to patient care. Hospices failing to report quality data in 2013 will have their market basket update reduced by 2% in fiscal year 2014. As these evolve, as with other quality measures, they will be part of the "shopping list" that consumers and referral sources research so getting ahead of quality and incorporating quality messages into conversations now could be beneficial.
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