Evaluation of the Hospital-Setting Health Care Innovation Awards (HCIA)
- CMS sought to improve the quality and efficiency of care delivered to patients in hospital settings.
- Abt evaluated 10 innovation awards from the Centers for Medicare and Medicaid Services.
- We estimated that Emory’s program saved $1,486 per episode of care; other programs’ savings were inconsistent.
Abt Associates evaluated programs from 10 of the Centers for Medicare and Medicaid Innovation (CMMI) Health Care Innovation Awards (HCIA) recipients, who sought to improve the way care is delivered to patients in hospital settings. The innovations included:
- Tele-health Intensive Care Unit (ICU);
- Sepsis screening and treatment protocols;
- Hospital-associated delirium, screening and prevention;
- Early mobility for ICU patients;
- Geriatric emergency medicine; and
- Screening to identify and address high-risk conditions in hospital and nursing home inpatients.
To assess each program’s impact, Abt developed a mixed-methods evaluation design that included surveys of both patients and clinicians, semi-structured interviews and focus groups with program leaders and frontline staff, and analyses of Medicare claims to assess program impact on key patient outcomes, including:
- Admission and readmission rates;
- Emergency department visits;
- Length of hospital stay;
- Discharge destination, such as to home, or to a step-down or intermediate care facility; and
- Total Medicare spending per episode.
Abt, with partners General Dynamics Information Technology and Telligen, evaluated how the 10 hospital-based HCIAs innovations were implemented, and which resulted in better care at a lower cost. Among the programs that stood out was Emory’s Rapid Development and Deployment of Non-Physician Providers in Critical Care program, also known as the Emory tele-ICU. The program reduced readmission rates for critical care patients and reduced costs, on average saving $1,486 per Medicare patient per episode of care, or $4.6 million over 15 months. Patients were also discharged from the hospital in better health, and more were able to go straight home rather than requiring institutional post-acute care.
The other evaluated programs showed mixed results, which may have been in part due to small sample sizes. Complete analyses of each of the programs are available in the final, third annual report on the CMS website.