Through its Transforming Clinical Practice Initiative (TCPI), the federal government seeks to move practices from a fee-for-service model that reimburses caregivers for dispensing treatment at episodic visits to what is known as a “value-based” care system that compensates them for keeping their patients well through ongoing, evidence-based disease management.
The program is aimed in particular at the sickest patients with complex conditions such as diabetes and cardiovascular disease who often cycle in and out of emergency rooms, as well as have longer hospital stays.
Rowan Medicine, with more than 150 physicians and health care professionals providing clinical services throughout Southern New Jersey, is the first large-scale clinical enterprise to partner with NJII on this initiative.
The network of providers will engage with more than 500,000 chronically ill patients to manage the care those patients receive to keep them healthier.
Keeping chronically ill patients healthier and, thus, decreasing their hospital admissions or visits to emergency rooms could generate a potential savings of $250 million in claims to government health programs such as Medicare, Medicaid and the Children’s Health Insurance Program.
Reducing the rate of hospital readmissions is a top priority in New Jersey, which last year had the highest proportion among the 50 states of hospitals penalized by government insurance programs for readmitting patients within 30 days of their discharge, said Tomas Gregorio, NJII’s senior executive director of health care delivery systems, in citing a recent report based on government data.
“One of the programs we will implement is transition-of-care management, making sure patients are referred electronically to caregivers in the community while leaving the hospital,” said Gregorio.
“Upon discharge, a nurse will submit a clinical profile of the patient to the appropriate provider, who will see the patient in the office within 7 to 14 days from the discharge date,” Gregorio added. “The doctor will, in turn, be reimbursed for that service, creating an incentive to care for these patients.”
“Health care costs consume more than one-quarter of the entire federal budget,” said Dr. Kenneth Blank, the Senior Vice President for health sciences at Rowan University. “This partnership is an exciting opportunity to be part of a monumental shift that could finally bend the cost of health care downward.”
Under the program, a team of NJII experts will consult with the Rowan Medicine practices to evaluate current practices, establish a baseline of care patients currently receive and provide training on evidence-based care and monitoring practices to meet health outcome targets.
Adult smoking rate reduction, controlling high blood pressure, reducing blood sugar levels and conducting tests for symptoms of kidney disease among diabetic patients are among the 16 quality care metrics that will be monitored under the program.
“As a multidisciplinary practice plan with a strong emphasis on primary care and disease prevention, Rowan Medicine is uniquely qualified to participate in a project of this scope,” said Dr. Thomas Cavalieri, dean of the Rowan University School of Osteopathic Medicine, noting that the school’s faculty practice plan is responsible for more than 250,000 patient visits per year.
The NJII program is the second largest of the 39 projects nationwide that are sharing in $685 million allotted by the Center for Medicare and Medicaid Services (CMS) to transform health care delivery from the traditional fee-for-service approach to one that rewards providers for keeping their patients healthy.
Through the initiative, CMS aims to improve health outcomes for the five million beneficiaries in Medicare, Medicaid and Children’s Health Insurance Program (CHIP).
The agency has set a goal of moving at least 75 percent of Medicare, Medicaid and CHIP providers that complete the Transforming Clinical Practice Initiative to participate in incentive programs and practice models that reward value.
The agency projects that it will save money over the next four years through reduced expenditures and believes it likely that commercial payers will see some savings as well.
About Rowan University
Rowan University offers bachelor’s through doctoral programs to 16,100 students through its campuses in Glassboro, Camden and Stratford, New Jersey. In the past four years, Rowan created a School of Biomedical Sciences & Health Professions; opened the Camden-based Cooper Medical School of Rowan University; and incorporated the School of Osteopathic Medicine and the Graduate School of Biomedical Sciences, making Rowan only the second university in the nation to grant both M.D. and D.O. medical degrees.
Rowan is collaborating with Rutgers-Camden to create degree programs to meet the growing need for medical services in the City of Camden. One of only three state-designated public research institutions in New Jersey, Rowan comprises the University's William G. Rohrer College of Business, the Henry M. Rowan College of Engineering and colleges of Communication & Creative Arts, Education, Humanities & Social Sciences, Performing Arts, and Science & Mathematics and the Division of Global Learning & Partnerships, as well as the medical schools.