A federally funded, hospital-based pilot project created by Emory University successfully expanded access to critical care services while reducing readmission rates and costs, according to an Abt Associates evaluation.
In recent years, the Centers for Medicare & Medicaid Services (CMS) chose dozens of organizations to receive Health Care Innovation Awards, ranging from $1 million to $30 million over three years.
Ten hospital-based organizations received Health Care Innovation Awards (HCIAs). The funding was to support innovations to reduce health care expenditures, improve health care delivery and outcomes, and reduce readmissions for people enrolled in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) – particularly those with the highest health care needs.
Evaluating Hospital-Based Innovations
Abt Associates – in partnership with General Dynamics Information Technology and Telligen – conducted mixed-methods evaluations of the 10 hospital-based HCIAs to determine what innovations worked and why. Each of the 10 awardees implemented different experimental models, including ways to improve intensive care and emergency department care, screen for acute conditions in hospital and nursing home patients, and improve team-based inpatient and outpatient services for high-risk patients.
The evaluations focused on how the programs were implemented and their impact on patients, service delivery, and cost. The evaluations also identified key lessons about implementation and sustainability, to help other organizations replicate promising programs.
A Critical Care Program that Saved Millions
While all 10 programs shared the goal of delivering more efficient and effective care, Emory University was a clear standout. The Emory Rapid Development and Deployment of Non-Physician Providers in Critical Care program, also known as Emory tele-ICU, was designed to address a shortage of critical care physicians while expanding access to critical care services.
The Emory program had two components: (1) a residency training program for affiliate providers – nurse practitioners and physicians assistants – in critical care; and (2) a tele-ICU program to support the affiliate providers with real-time, continuous telemetric monitoring. Intensivist, critical care physicians also provided remote oversight and support to the affiliate providers during nights and weekend shifts, when physicians are often are not present in intensive care units.
Overall, the Emory tele-ICU program reduced readmission rates for critical care patients and reduced costs. On average, the program saved $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, requiring less institutional post-acute care and instead going straight home.
Employees in the eICU control room on Emory Saint Joseph’s campus monitor critical care patients at Emory hospitals and a community hospital, when ICU physicians are not present. An Abt Associates evaluation of an Emory pilot project to train physician assistants and nurse practitioners found that, on average, the program saved $1,486 per Medicare patient per episode of care, or $4.6 million over 15 months.
Photo credit: Jack Kearse, Emory University “Emory’s program was larger than most and we could measure impact quarter after quarter,” said Andrea Hassol, project director of the evaluation and a principal associate at Abt. “It was not just about the technology of the tele-ICU and monitoring, but also the staff training. It clearly changed patterns of care and patterns of cost.”
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 report.
The Hunt for Better, Lower-Cost Care Continues
Now that funding for the HCIAs has ended, Hassol anticipates that Emory and other health care systems will look to health insurance companies to support this demonstrably effective program and others like it.
Abt continues to support CMS and other clients in developing responsive evaluations that deliver rigorous results. Hassol also leads an oncology care model evaluation that is examining whether payment and quality incentives can lead to better cancer care.
Read the final HCIA evaluation report.
Read more about the HCIA project.