How an integrated care approach keeps seniors out of the ER

With research suggesting that America’s seniors account for more than 20 million annual ER visits, caregivers are exploring new routes to provide more focused care to the elderly – and produce significant cost savings in the process.
 
Mathew Philip, MD, an internal medicine specialist and Medical Director of Clinical Innovation at DuPage Medical Group in Wheaton, Illinois, recently spoke to MGMA Sr. Editor Daniel Williams on the MGMA Insights podcast about the integrated care approach his 800-physician group is employing to better treat senior patients.
 
Philip said improved communication with patients and their families is critical to circumventing the all-too-familiar pattern of repeat ER visits by seniors, as well as to shifting the focus to preventative outpatient care.
 
“About six years ago, we started our clinics called breakthrough care centers, which are high-risk clinics with more resources for at-risk seniors to try to prevent hospitalizations,” he said. “Part of the reason we did this was we noticed that 20% of the patients account for 80% of all healthcare costs, so we figured we should probably give them more help and services to prevent some of those bad outcomes from happening.”

A proactive approach

Philip explained that with the country’s current general demographic shift, seniors will invariably continue to become a bigger part of the overall healthcare equation. But simply funneling patients to the ER for routine issues, where they are treated by doctors who don’t know their medical or personal backgrounds, providers are simply making the issue worse – and driving up costs in the process.
 
“Our system has been really misaligned,” Philip said. “Historically, it’s been a kind of fee-for-service model, where the more things you do, the more you get compensated. … We’re really trying to take a more proactive, front-footed approach to say, ‘OK, if these seniors were our family members, how do we take care of them? How can we prevent bad things from happening? How can we help them to be independent, healthy?’
 
“And what we’ve seen is a huge reduction in costs and a significant increase in their quality of life and their patient satisfaction.”

Thinking outside the box

Philip said the breakthrough clinics have been especially effective in determining the underlying causes of senior healthcare issues and ER utilization, rather than stick with the industry norm of “trying to fit people in boxes.”
 
“We sought to create these clinics with a variety of different resources, to try to treat the root cause of what was going on – and we found that it was different for everyone,” he said. “We tried to tailor our approach to the individual, whether it be home-care services or counselling. Is depression a cause? Are they isolated? Or did they not have the teaching or education needed to try to prevent those things from happening?”

The full scope

Patients within Philip’s medical group are given a full health-risk assessment, ranging from questions about family or social connections – how often do they leave their homes, for instance – to specifics on medical conditions or recent falls. Philip said this has been a great opportunity to emphasize health literacy with elderly patients, who often misunderstand the full scope of their medical conditions and how those could ultimately create larger issues.
 
“It really comes down to that one-on-one relationship that we’ve developed with our patients,” he said. “We have to have a lot of difficult conversations. We talk about end-of-life planning or what their goals of care are. We have to talk to them about using canes or walkers, not driving anymore or restricting some of the things that they used to do. It can seem like a decrease of independence, but we phrase things that it’s actually meant to prolong their independence and promote their safety, as well as the safety of other people. People are smart, and they can tell if you really care about them or not.”

The more, the merrier

Family members are also a critical part of the equation, and Philip said each clinic’s network of specialists strives to build consensus and make decisions with as many stakeholders as possible.
 
“A lot of times, patients have had a sneaking suspicion that things have been headed in the wrong direction, or family members have definitely noticed it – and they said, ‘I’m so glad you guys picked up on that.’ As we try to make decisions together, I think family members and patients can really see, ‘Hey, you’re saying this because you care about me, and you really want what’s best for me.’”
 
The result of this integrated-care approach, Philip said, has been more than a 50% decrease in emergency room visits, hospitalizations and hospital readmissions throughout his medical group. By partnering with Medicare Advantage plans, the patient-focused care system is able to track patient data and is seeing much broader patient satisfaction – he said his group is in the top 1% both nationally and regionally – as well.
 
“You can have patients that are happier and healthier while dramatically decreasing costs,” Philip said. “It seems like a win-win situation for both the patients and our healthcare system. A lot of times, patients haven’t seen something like this before, and so when they first come here, they’re sometimes a little skeptical and confused. But really quickly, they fall in love with the model. Oftentimes, we hear, ‘Why aren’t other clinics doing this? People should know about this, so that this can be done more often.’”

Hear more from Dr. Mathew Philip on his medical group's integrated approach to senior care in this episode of the MGMA Insights podcast

• "A third of practices adopt team-based care in the past year" (MGMA Stat)
• "Embracing risk to succeed in value-based care" (MGMA Insight Article)
• "How to Succeed as a Clinically Integrated Network in Value-Based Care" (MGMA Webinar)