Members of the High Value Healthcare Collaborative will share in a $26 million Innovation Grant announced Friday by the Center for Medicare and Medicaid Innovation (CMMI).
The grant will fund a program to engage patients and implement shared decision making for patients facing hip, knee or spine surgery, and for patients with diabetes or congestive heart failure. The 16 members of the HVHC collectively serve 50 million patients in health systems across the United States.
According to the CMMI announcement, the project will result in savings of $64 million over three years, largely due to reduced utilization and costs that have been shown to occur when patients are engaged and empowered to make health care decisions based on their own values and preferences.
Dr. James N. Weinstein, CEO and President of the Dartmouth-Hitchcock health system, will serve as the Principal Investigator for the grant. Dr. Weinstein started the first-in-the-nation Center for Shared Decision-Making at Dartmouth-Hitchcock Medical Center (DHMC) and conducted the first large-scale clinical trial to incorporate the concept. Shared decision making is a key component of patient care at D-H.
"We know from our experience at D-H that involving patients and families in their treatment decisions, with evidence-based, objective information, results in higher patient satisfaction, superior clinical outcomes, and often, lower costs," said Weinstein. "When patients are well-informed about the risks and benefits of a test, procedure, or treatment, they have more confidence in their decisions and are more satisfied with their outcomes. Our studies have shown that the process also greatly reduces the decisional regret that can occur when patients make treatment choices without good information."
The bulk of the funding will be used to hire and train Patient and Family Activators (PFAs) at the 15 member organizations of the HVHC. Over the three-year grant period, 1,845 health care workers will be trained and an estimated 48 PFA positions will be created.
According to the CMMI grant announcement, "The PFAs will be trained to engage in shared decision making with patients and their families, focusing on preferences and supplying sensitive care choices... It is anticipated that this intervention will lead to a reduction in utilization and costs and provide invaluable data on patient engagement processes and effective decision making – leading to new outcomes measures for patient and family engagement in shared decision making."
Weinstein said the project is particularly significant because of the population it will reach: "The greatest beneficiaries of this project will be high-cost patients with multiple chronic conditions who have been disenfranchised because of poor health literacy, poverty, minority status, or poorly managed care. Through patient engagement and activation and use of decision aids, HVHC members will ensure that these patients are partners in their care decisions."
The CMMI Innovation Awards were issued through a highly competitive process, with more than 3,000 proposals submitted. At $26.1 million, the Dartmouth/HVHC award was the second highest to be made across the 107 Innovation Grant recipients.
Members of the HVHC include Baylor Health Care System, Beaumont Health System, Beth Israel Deaconess Medical Center, Dartmouth-Hitchcock, Denver Health, Intermountain Healthcare, Mayo Clinic, North Shore–LIJ Health System, MaineHealth, Providence Health and Services, Scott and White Healthcare, Sutter Health, UCLA Health System, University of Iowa Health Care, and Virginia Mason Medical Center. The Dartmouth Institute for Health Policy and Clinical Practice serves as the facilitator and data convener for HVHC.
The Collaborative was founded in 2010 and identified nine high volume, high cost, high variation clinical areas to focus on, with the goal of improving care and outcomes, reducing variation, and lowering costs. The aims of the HVHC are to identify best practices and subsequently move them out to other health care institutions so that all providers and patients can benefit from this work.
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