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HealthTech Launches Effort to Demonstrate Ability of Ambulatory Intensive Caring Units to Generate Savings and Insurance Options for Lower Income Individuals With High Cost Medical Conditions

Posted on: Friday, 9 June 2006, 15:00 CDT

HealthTech, the nonprofit center for technology and innovation in healthcare, has launched a national project to demonstrate that a redesigned primary care delivery system for lower-income individuals with very high health risks can lead to affordable health insurance options. The new primary care delivery approach -- known as an Ambulatory Intensive Caring Unit (A-ICU) -- is designed to trim healthcare costs for this group by 30 to 40 percent or more while improving quality of care.

The A-ICU model was designed by a national team funded by a California HealthCare Foundation grant to Mercer Health & Benefits. Design team members and peer reviewers included over 20 clinicians and others specializing in primary care redesign.

Because of the high costs associated with treating chronic conditions in a traditional delivery system, health insurers avoid these individuals and coverage is often unaffordable for lower-income individuals. By some estimates, the sickest 10 percent of the population -- the majority of whom have one or more chronic conditions -- account for approximately 60 to 70 percent of all healthcare costs.

"Our nation's primary care delivery system is inefficient and doesn't serve the needs of lower-income persons with chronic conditions," said Molly Coye, M.D., founder and CEO of HealthTech. "As a result, millions are left with little or no insurance coverage. Hospital emergency departments, ICUs and other services are flooded with patients who have nowhere else to seek care," she said.

A-ICU savings of 30 percent or more would permit substantial reductions in insurance premiums and out-of-pocket costs for consumers, according to Dr. Coye.

The A-ICU project seeks to:

-- Improve the affordability of health care by better supporting patient self-management, streamlining primary care physician visits, and more carefully selecting specialists and hospitals;

-- Maintain or improve quality of care and patient experience;

-- Target the highest cost patients: lower-income, chronically ill or other high risk workers and dependents without Medicaid or Medicare coverage;

-- Stimulate payer-provider partnerships to reduce costs and share savings.

Seven of HealthTech's Partner organizations are developing plans for one or more A-ICU pilots. These healthcare systems are:

-- AtlantiCare (New Jersey)

-- Bon Secours Hampton Roads Health Care System (Virginia)

-- CHRISTUS Health (U.S., Mexico)

-- Group Health Cooperative (Washington)

-- HCA (U.S., England, Switzerland)

-- St. Luke's Hospital/Sutter (California)

-- Santa Clara Valley Medical Center (California)

The Partners have formed a collaborative to share learnings and experiences and accelerate the development of A-ICU clinics. The collaborative is led by HealthTech and supported by Mercer's A-ICU development team: Arnold Milstein, M.D., national thought leader for Mercer Health & Benefits; Rushika Fernandopulle, M.D., founder of Renaissance Health; Tom Bodenheimer, M.D., primary care redesign specialist; and Paul Plsek, M.S., engineering and care innovation consultant. Each participating organization will adapt the A-ICU model to their unique circumstances and most will focus on care for a defined lower-income population from 1,000 to 6,000 patients that does not have health insurance or struggles to afford it.

Partial funding for the design phase of the project was obtained from the Blue Shield of California Foundation. After design is completed in the next few months, the implementation phase is expected to last from Sept. 2006 - Sept. 2007. Participants themselves fund implementation.

"The A-ICU model lowers expected costs by better engaging patients in self-management efforts and by referrals to specialists and hospitals with a track record for outstanding cost-efficiency at above average levels of quality," said Dr. Milstein. "The A-ICU is designed as a partnership with patients to enable more affordable health insurance and higher quality of care. It is an integration of the prior work of many health services researchers and pioneers in redesign of primary care for high risk patients."

According to Milstein, the three "floors" of the A-ICU model adapt designed-for-purpose principles from other industries to assure efficient use of internal resources and partnership with high performing clinical "suppliers."

More information about the A-ICU collaborative is available from Dr. Coye at mcoye@healthtech.org. Information about the A-ICU research sponsored by the California HealthCare Foundation is available from Mayumi Nakajima, mayumi.nakajima@mercer.com.

HealthTech is a nonprofit research and education organization that develops objective forecasts, innovative decision-making tools, and facilitates a learning network of experts for the benefit of healthcare systems, hospitals, safety-net providers, government agencies, and others facing critical decisions on emerging healthcare technologies. For more information visit healthtech.org

Source: Business Wire

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