Health Forward Foundation

Truman Medical Centers Embrace Change

Through a federally funded program, TMC examines ways to teach "super-users" of hospitals to manage their health care in other ways
Dr. Jeff Brenner

KANSAS CITY, Mo. – Truman Medical Centers stand out for their willingness to embrace the changes unfolding in the health care system, according to a New Jersey physician who specializes in improving care for low-income patients who are chronic users of hospital services.

Dr. Jeff Brenner, founder and executive director of the Camden Coalition of Healthcare Providers, visited Truman this week. The coalition and Truman are part of a federally funded project led by the Center for State Health Policy (CSHP) at Rutgers University.

Under the $14.3 million grant, awarded last year by the Medicare & Medicaid Innovation Center, Truman and three other sites around the country will work with project leaders in New Jersey to help teach “super users” of hospital services how to manage their care differently.

Approximately 2,300 patients will take part at the four sites through the three-year grant, said CSHP Director Joel Cantor.

The project is expected to save the health care system $67.7 million.

The challenge, said Truman CEO John Bluford, would be moving to a system focused on keeping people healthy and managing their conditions outside the hospital though hospital revenues remain largely based on inpatient stays and medical procedures.

For the past three years, Dr. Shauna Roberts and her team at Truman have been working with high-utilization patients through their Guided Chronic Care and Passport to Wellnessprograms. Roberts is Truman’s corporate quality director.

“I love what she is doing,” Bluford said. “My CFO (chief financial officer) does not like what she is doing.”

Brenner said Bluford and Truman seemed “really aligned” to the kind of work the grant is funding.

“This is classic disruptive innovation,” he said, “and a smart institution, and a smart company and CEO, will allow its business model to be disrupted so they can get the next business model.”

Fewer admissions and shorter hospital stays haven’t helped the bottom line, he said.

Roberts’ work has already led to changes at Truman, such as open scheduling at clinics that preserve slots for same-day appointments.

Roberts said that working with Brenner and his colleagues in New Jersey should help her team improve its ability to assess its results.

At Truman, she said, they have already refined their initial information gathering tool from one that was so onerous “that patients could hardly stand to talk to us.”

She was also interested in comments from the New Jersey experts about not being overbearing on patients that don’t take to the model right away.

“So, I can see we will be learning from them how to do that,” she said, “how to back off and then maybe that patient will come back to us, or there will be another time they will be more ready.”

For his part, Brenner said he liked how Truman focuses on small wins for patients, such as applauding them for making a doctor’s appointment or taking care of their own prescriptions.

As part of the grant, the participating sites are expected to test the “sustainable high-utilization team model” by including nurses, social workers, and community health workers on care-management teams that will assist patients with everything from applying for health coverage or disability benefits to finding adequate housing.

The hope is that the patients then could more easily transition to less costly care in primary care medical homes.

“Right now, you know,” Brenner said, “we can separate Siamese twins, we can operate on people’s brains, but we actually don’t know how to save money in health care.”

The challenge, Cantor said, would be to prove that the wrap-around services, which are not cheap either, actually pay off in reduced costs for the health care system.

In Camden, the highest-cost patient they encountered had racked up about $3.5 million in medical charges over time.

So, Cantor said, it would be a win to reduce that bill to $2 million and redirect the savings into effective care management.

By the time the grant ends, Bluford said, Truman would be a changed institution.

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