Partners Healthcare

The big question on everyone’s minds these days is whether hospitals can reduce costs and improve quality at the same time.  At Partners HealthCare, we would say we can, and a Medicare demonstration project at one of our founding hospitals — Massachusetts General Hospital (MGH) — is one example which holds great promise for patients in Boston and throughout the country.

In August, 2006, the U.S. Centers for Medicare and Medicaid (CMS) funded the MGH and the hospital’s physician organization to launch the Care Management Program at MGH, one of six demonstration projects nationwide. During the three-year demonstration, the MGH developed new strategies to improve the way health care is delivered to its most vulnerable high risk patients — those with multiple health conditions and chronic disease.

The program integrates nurse care coordinators into primary care practices to coordinate each patient’s medical and psychosocial needs. Care managers identify gaps in care and tackle every aspect of their patient’s illness, including helping patients and their families manage a discharge from the hospital, coordinating multiple medications, ensuring patients have adequate food and nutrition, and keeping patients active and engaged in their community. At the MGH, 2,500 Medicare patients were enrolled in the program. On average, these patients take more than 12 medications and are hospitalized more than three times each year.

Why focus on the sickest patients? Because 10 percent of Medicare patients represent nearly 70 percent of Medicare spending. By coordinating all of the care that some of our sickest patients require, we are able to improve the quality of care — and reduce cost.

Here’s what happened at the MGH: Hospital readmissions dropped 20 percent, and emergency room visits dropped 13 percent for patients enrolled in the program. Patients and caregivers alike are extremely satisfied with the program. And the cost savings? Annual net savings of 7 percent among enrolled patients after accounting for the management fee paid by CMS to MGH. Over the first three years, MGH invested more than $8 million to operate the program, but the return on investment is high; for every dollar spent, the program saved $2.65 in health care costs. The e-Care Management blog called it a “Home Run.”

In 2009, CMS renewed the MGH program for another three years (only three of the original demonstration projects were renewed) and expanded it to two more Partners hospitals, Brigham and Women’s and North Shore Medical Center. To date, the Care Management Program has enrolled almost 5,000 patients and is expected to involve more than 8,000 total patients over the next few years.