Setting it up. The Intensive Outpatient Care Program invited Boeing employees with chronic conditions to enroll if they were patients at Everett, Valley Medical Center IPA or Virginia Mason Medical Center clinics. The three physician groups received supplemental monthly per capita fees for each patient in the study. Altogether, 740 chronically ill patients signed up and 224 of them were at Everett.
Starting out. Each patient received a comprehensive intake interview, physical exam and diagnostic testing. Caregivers developed a care plan and communicated frequently with the patient in-person and by telephone, e-mail or a patient portal on the clinic website. At Everett, four primary care physicians dedicated a large part of their work time to the project. They were joined by a nurse case manager, clinical pharmacists and PhD psychologists.
Execution. The Everett team visited the patient, collaborated with the patient’s regular primary care physician, and reviewed patient cases. Team members communicated with each other daily to plan patient interactions and brought in specialists, such as behavioral health professionals, when feasible. Patient visits were longer and team members met with patients in groups to discuss lifestyle modifications, such as how diabetics should take care of themselves to avoid acute episodes. When patients visited the ED or were admitted to the hospital, a hospitalist from Everett would follow them.
Results. The project ended last year. In the first year, the cost of care was reduced by 20 percent compared with a control group who did not get the intervention. The savings came from lower use of the ED and less inpatient care. Results from the last year are not available yet. In addition, quality indicators were higher. Patients surveys for all three sites showed a 17.6 percent increase in care “received as soon as needed” compared to patients not in the project. Patients also reported a 56.5 percent reduction in missed workdays.
Implications. Rather than having to wait for years to see positive results, caregivers saw impressive results in the first year. The program did not require a large, integrated delivery system or costly IT. But it did require leadership of at least one large payor, which could also be Medicare, another large employer or a consortium of employers. Since the project ended, Everett has expanded these techniques to more patient populations.
