Michigan project aims to coordinate doctor, hospital care

Patient-centered care

A pilot program scheduled to begin in Michigan next year will link physicians and hospitals with social service organizations to better coordinate care for patients.

Michigan’s Blueprint for Health Innovation is funded by the Affordable Care Act and a $70 million state innovation model grant to the state’s Department of Health and Human Services, according to a report by Crain’s Detroit Business. In the first year of the three-year project, the initiative will focus on reducing patient visits to the emergency room.

The pilot will start in January in five regions in Michigan, each of which will have a coordinating agency responsible for managing the project that will link medical practices certified as patient-centered medical homes, participating hospitals in accountable care systems, payers and social service organizations that range from mental health providers to housing agencies, the publication said.

In its first year, the program will target high and unnecessary use of emergency department services. The following year the five regions will choose additional goals, such as reducing obesity, depression, infant mortality, high-cost healthcare users, and individuals with multiple chronic diseases, the report said. The goal is for providers to eventually use the program to coordinate care for all patients with acute care needs and chronic diseases.

Patients who frequently use the emergency room often have untreated medical conditions, don’t have a regular primary care doctor and generate high costs for the healthcare system, Paul Valenstein, M.D., co-chairman of the working group for Washtenaw and Livingston counties, told the publication. Positive results could lead to expansion throughout the state, Valenstein said.

A key to success will be developing payment incentives and collecting and sharing data. The project will also rely on providers at medical practices and hospital emergency departments to refer patients to appropriate social services organizations to address problems such as mental health issues, substance abuse, poor housing, lack of nutrition and inability to pay for medications.

Michigan currently has 400 certified patient-centered medical homes, which the initiative hopes to more than double to 1,000 by 2020. It also plans to ensure patients have a primary care doctor. One way to reduce the number of patients who seek care in the emergency department for minor problems is to keep primary care practices open for more hours on nights and weekends.