Rapid Reengineering Of Acute Medical Care For Medicare Beneficiaries: The Medicare Innovations Collaborative

Abstract

In 2009 we described a geriatric service line or "portfolio" model of acute care-based models to improve care and reduce costs for high-cost Medicare beneficiaries with multiple chronic conditions. In this article we report the early results of the Medicare Innovations Collaborative, a collaborative program of technical assistance and peer-to-peer exchange to promote the simultaneous adoption of multiple complex care models by hospitals and health systems. We found that organizations did in fact adopt and implement multiple complex care models simultaneously; that these care models were appropriately integrated and adapted so as to enhance their adoptability within the hospital or health care system; and that these processes occurred rapidly, in less than one year. Members indicated that the perceived prestige of participation in the collaborative helped create incentives for change among their systems' leaders and was one of the top two reasons for success. The Medicare Innovations Collaborative approach can serve as a model for health service delivery change, ultimately expanding beyond the acute care setting and into the community and often neglected postacute and long-term care arenas to redesign care for high-cost Medicare beneficiaries.

Nurses Improving the Care of Healthsystem Elders: Creating a Sustainable Business Model to Improve Care of Hospitalized Older Adults

“…NICHE has the infrastructure to expand beyond its current membership base so that it can partner with other programs that disseminate geriatric models of care. The Medicare Innovations Collaborative (also funded by The Atlantic Philanthropies foundation) pilot tested a geriatric portfolio or service line approach in which several geriatric models are implemented simultaneously but customized to each of the six healthcare organizations' local circumstances . NICHE was the most commonly adopted model and was viewed as foundational for building a hospital's culture of quality and safety .…”

“…35 NICHE was the most commonly adopted model and was viewed as foundational for building a hospital's culture of quality and safety. 35 This makes sense because NICHE principles complement other models and because all of these programs require significant nursing input to provide services or oversee the model and its interdisciplinary team. The next step is a new level of national-level collaboration in which the national groups representing these various geriatric care model programs work together to advance adoption, especially if coupled with clear guidelines for tracking patient and financial outcomes.…”

Implementation of geriatric acute care best practices: Initial results of the NICHE SITE self‐evaluation

“…They include interdisciplinary care provided in specialized units (Counsell et al , 2000; Conroy et al , 2011) or through mobile consultant teams (Conroy et al , 2011; Ellis et al , 2011; Farber et al , 2011) specialized assessment and multi-component interventions (Inouye et al , 1999), and programs of early discharge planning and transitional care (Naylor et al , 2004; Coleman et al , 2006). In addition, Nurses Improving Care for Healthsystem Elders (NICHE) hospitals have embedded infrastructures that support the development, evaluation and sustainability of a geriatric acute care initiative to promote the implementation and sustainability of evidence-based care (Boltz et al , 2008b; Leff et al , 2012). …”

Transforming Nursing Practice: Barriers and Solutions

“…Fragmentation of the health care system is when care is provided in silos in which there is little or no communication between providers within or across patient care settings 4,14 . When vital patient information is not shared among providers, care can be redundant or missed.…”