iCount project to target Pittsburgh's repeat health care patients
They make up a small fraction of hospitalized patients but account for a disproportionately large amount of health care costs: the so-called “super-utilizers.”
The costly repeat patients often grapple with social, economic and mental health challenges that exacerbate their health problems and impede their follow-up care.
With those needs in mind, nonprofit leaders this week advanced a foundation-backed effort to spur innovative models for tackling Pittsburgh's super-utilizer dilemma.
The project, called iCount, calls on the about 1,000 behavioral health and social service agencies in the greater Pittsburgh region to consider teaming with a primary care provider to become one of three to five “community clusters” in iCount's three-year pilot program.
“It's meant to break down the silos and tap existing agencies for the benefit of patients,” said Kate Dewey, president of The Forbes Funds, a Downtown-based organization that advises nonprofits and has been planning iCount for two years.
The clusters will focus on the “golden three weeks” following a hospitalization by making daily patient contact and ensuring patients get the wraparound services they need: from transportation to child care to help in understanding medication regimens.
Each cluster of up to 15 agencies, centered on a health care provider, will target a geographic area and a high-risk medical need, such as congestive heart failure or diabetes.
“The point is you're going to build services around the patient,” said Karen Feinstein, CEO of the Jewish Healthcare Foundation and its operating arm, the Pittsburgh Regional Health Initiative, which has helped fund and plan the iCount project.
The goal is twofold: Improve the quality of life for would-be super-utilizers while lowering costs for everybody.
Super-utilizers — patients who return to the hospital five or more times in a year — tend to be low-income, seniors or people with disabilities, which means taxpayers pick up their medical tabs.
Pennsylvania's roughly 84,000 super-utilizers rack up about $760 million annually in Medicare and Medicaid costs for inpatient hospital stays, data from the Pennsylvania Health care Cost Containment Council show. That means 3 percent of hospitalized patients contribute to about 15 percent of the state's federally subsidized hospital bills.
The clusters will have to establish close relationships with local hospitals, which have an incentive to participate. The Affordable Care Act of 2010 included a provision that fines hospitals for high readmission rates.
“Now really for the first time ever, hospitals are being given very strong incentives to follow the patient beyond their own doctors out into the community to ensure that care continues in an uninterrupted fashion,” said Michael Blackwell, iCount's lead planning consultant and former CEO of insurers Health America and Gateway Health Plan.
Eighteen months into iCount, organizers plan to begin negotiating with hospitals and insurers for potential revenue-sharing options, in hopes that if iCount proves it can reduce costs for providers and lower risks for insurers, those companies will pump money back into iCount.
“We know we have to prove our case,” Blackwood said. “They're not going to do it out of the kindness of their hearts — they want to see hard evidence.”
The concept drew inspiration from the Camden Coalition of Healthcare Providers, which has had success addressing super-utilizers in New Jersey. Dr. Jeffrey Brenner, the coalition's executive director, said his nonprofit is all about rethinking the “obsolete, broken and poorly structured models” that persist in most health care systems.
The Forbes Funds will take a back seat once it establishes iCount as a nonprofit 501(c)3 organization this fall. The new nonprofit will likely start out with about 10 employees and will serve as the administrative hub for the community clusters.
The target is to be serving more than 3,000 patients by the third year.
The Forbes Funds put out a request for proposals this week seeking applicants with the goal of choosing finalists in mid-May and obtaining the finalists' detailed plans by mid-September.
“One thing we're very candid about is this is an experiment,” Feinstein said, “and agencies have to give up a certain amount of autonomy and work out the financial details and the sharing of records.”
She added, “Our goal right now is to unleash creativity.”
Natasha Lindstrom is a staff writer for Trib Total Media. She can be reached at 412-380-8514 or firstname.lastname@example.org.