A new Health Affairs study links nearly $40 million in savings over six years to the work of Better Health Partnership, a Cleveland-based regional health care improvement collaboration of primary care providers and other stakeholders.
The savings come from avoided hospitalizations by providing better care to primary care patients with diabetes, high blood pressure and heart failure, according to the study published in the February issue of Health Affairs and conducted by researchers at the Case Western Reserve University-MetroHealth System Center for Health Care Research and Policy.
"You take good care of them in the outpatient setting, and it's (a) much lower likelihood that they would need hospitalization for, for example, amputation in diabetes or kidney failure or recurrence of heart failure," said Dr. Randall Cebul, an emeritus professor of medicine and of population and quantitative health sciences in CWRU School of Medicine.
Cebul — an author on the study and founder and original CEO of the partnership that was formerly called Better Health Greater Cleveland — said the results were more dramatic than had been expected.
Better Health Partnership's membership includes general internists, family physicians, geriatricians, medicine-pediatrics specialists and advanced practice nurses. The partnership assesses members' performance across nationally endorsed quality measures, and also collects data on patients' social determinants of health, according to the study.
In an effort to disseminate observed best practices, Better Health uses these data for three types of quality improvement: twice-yearly public reports that enable members to compare their quality measures to others in the region; twice-yearly learning collaborative summits to share best practices; guidance for practice coaches in their support of quality improvement. Coaching focuses on workflow redesign, the meaningful use of electronic health records and recognition as patient-centered medical homes, according to the study.
The study compares Cuyahoga County to other large, urban Ohio counties: Hamilton, Franklin, Lucas, Montgomery and Summit counties. If trends in Cuyahoga had followed those in the comparative counties, it would have seen an estimated 5,746 more hospitalizations for ambulatory-care sensitive conditions between 2009 and 2014.
The study — funded by the National Heart, Lung and Blood Institute of National Institutes of Health — looks at hospitalizations that could have been prevented or avoided with quality primary care for patients with diabetes, high blood pressure, heart failure and pneumonia vaccinations. It compares hospitalization rates for these conditions in Cuyahoga County and the comparative county before (2003-2008) and after (2009-2014) Better Health programs and activities were established.
Although Better Health Partnership was formally founded in 2007, the study uses Jan. 1, 2009 as the starting point for when its work would have taken effect.
Hospitalization rates before that time, between 2003 and 2008 had been declining already for both Cuyahoga County and the comparative counties, said Joseph Tanenbaum, lead author on the study and a M.D./Ph.D. student in the Department of Population and Quantitative Health Sciences in the Case Western Reserve University School of Medicine.
The researchers projected what hospitalizations would have looked like between 2009 and 2014 had the rates followed the declining trend.
"What we found is that (in) Cuyahoga County the hospitalization rates fell more and more quickly in Cuyahoga County relative to the comparative counties after the implementation of Better Health," Tanenbaum said.
The biggest savings that accompanied the averted hospitalizations was for congestive heart failure, saving an estimated $20.2 million over six years. Estimated savings for diabetes-related conditions were $9.2 million; for high blood pressure, $4.4 million; and $8.7 million for pneumonia by increasing vaccination rates. These numbers add up to more than $40 million because they are estimates calculated separately.
"For 11 years, Better Health has routinely documented that collaboration amid competition is possible and productive," Rita Horwitz, president and CEO of Better Health, said in a prepared statement. "Common chronic diseases disproportionately affect disadvantaged populations and consume resources that otherwise might support investments in education, housing, public health and other community needs."
The study, she said, highlights the power of the Better Health Partnership to make a difference in population health and health care quality and costs in the region.
Tanenbaum agreed: "At sort of the 30,000-foot view of this, our results support the idea that provider-led primary care focused collaboratives can improve population health in a meaningful way and have the potential to lead to some cost savings for the broader health care system."
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