Health Care Innovation Awards: New Jersey
Notes and Disclaimers:
- Projects shown may also be operating in other states (see the Geographic Reach)
- Descriptions and project data (e.g. gross savings estimates, population served, etc.) are 3 year estimates provided by each organization and are based on budget submissions required by the Health Care Innovation Awards application process.
- While all projects are expected to produce cost savings beyond the 3 year grant award, some may not achieve net cost savings until after the initial 3-year period due to start-up-costs, change in care patterns and intervention effect on health status.
COOPER UNIVERSITY HOSPITAL
Project Title: N/A
Geographic Reach: New Jersey
Funding Amount: $2,788,457
Estimated 3-Year Savings: $6.2 million
Summary: Cooper University Hospital, serving Camden, New Jersey, and adjoining areas, is receiving an award to better serve over 1200 patients with complex medical needs who have relied on emergency rooms and hospital admissions for care. The intervention will use care management and care transition teams to work with these people to reduce avoidable emergency room visits, inpatient hospital admissions, and hospital readmissions and improve their access to primary health care. This approach is expected to result in better health care outcomes and lower cost with estimated savings of approximately $6.1 million. Over the three-year period, Cooper University Hospital’s program will train an estimated 14 health care workers, while creating an estimated 14 new jobs. These workers will include non-clinical staff, like AmeriCorps volunteers and community health workers, who will serve as part of multidisciplinary teams to support care coordination activities.
DEVELOPMENTAL DISABILITIES HEALTH SERVICES
Project Title: “Expanding and testing a Nurse Practitioner-led health home model for individuals with developmental disabilities”
Geographic Reach: Arkansas, New Jersey, New York
Funding Amount: $3,701,528
Estimated 3-Year Savings: $5,374,080
Summary: Developmental Disabilities Health Services is receiving an award to test a developmental disabilities health home model, using care management/primary care teams of nurse practitioners and MDs to improve the health and care of persons with developmental disabilities in important clinical areas. The health homes will serve individuals with intellectual and developmental disabilities who receive Medicaid and/or Medicare benefits in New Jersey, the Bronx, and Little Rock, Arkansas, and are eligible for services in each state's Home and Community-Based Services waiver program, as well as individuals who are commercially insured and uninsured. All of these patients are considered high-risk and many have co-morbidities. By integrating care using nurse practitioners as care coordinators and health care providers, the health homes will improve primary care, mental health care, basic neurological care, and seizure management for these beneficiaries, resulting in reduced emergency room visits and lower out-of home placement and institutionalization.
Over a three-year period, Developmental Disabilities Health Services will retrain and deploy 20 individuals to provide and coordinate primary care and mental health services in health homes for persons with developmental disabilities.
MOUNT SINAI SCHOOL OF MEDICINE
Project Title: "Geriatric emergency department innovations in care through workforce, informatics, and structural enhancements (GEDI WISE)"
Geographic Reach: Illinois, New Jersey, New York
Funding Amount: $12,728,753
Estimated 3-Year Savings: $40,124,805
Summary: Mount Sinai School of Medicine is receiving an award to integrate geriatric care with emergency department (ED) care in three large, urban acute care hospitals in New York, New Jersey, and Illinois. Emergency room use by older adults has doubled in the past decade and is expected to continue to increase. The Mount Sinai care model will use evidence-based geriatric clinical protocols, informatics support for patient monitoring and clinical decision support, and structural enhancements to improve patient safety and satisfaction while decreasing hospitalizations, return ED visits, unnecessary diagnostic and therapeutic services, medication errors, and adverse events, such as falls and avoidable complications.
Over a three-year period, Mount Sinai School of Medicine's GEDI WISE program will train more than 400 current health care workers and create 22 new jobs. The new hires will include nurses, nurse practitioners, physician assistants, pharmacists, physical therapy, project coordinators, research assistants, data analysts and geriatric transitional care managers.
THE TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Project Title: “A rapid cycle approach to improving medication adherence through incentives and remote monitoring for coronary artery disease patients”
Geographic Reach: New Jersey, Pennsylvania
Funding Amount: $4,841,221
Estimated 3-Year Savings: $2,787,030
Summary: The University of Pennsylvania is receiving an award for a program to improve medication adherence and health outcomes in post-discharge patients who are recovering from acute myocardial infarctions in metropolitan Philadelphia and adjoining areas of New Jersey. Such patients typically have high rates of poor medication adherence and hospital readmissions and are costly to monitor through intensive case management. The intervention will increase medication adherence through telemonitoring and a visual and audible “reminder” system. It will also retrain social workers as engagement advisors to monitor adherence, offer incentives, and enlist patient support from family and friends. The result will be improved health outcomes and lower cost. The investments made by this grant are expected to generate cost savings beyond the three year grant period.
Over a three-year period, the Trustees of the University of Pennsylvania’s program will train an estimated 21 workers, while creating an estimated seven jobs for investigators, clinical social workers, clinical nurses, software programmers, project co-directors, and a project director.
TRUSTEES OF DARTMOUTH COLLEGE
Project Title: “Engaging patients through shared decision making: using patient and family activators to meet the triple aim”
Geographic Reach: California, Colorado, Idaho, Iowa, Maine, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New York, Oregon, Texas, Utah, Vermont, Washington
Funding Amount: $26,172,439
Estimated 3-Year Savings: $63,798,577
Summary: The Trustees of Dartmouth College is receiving an award to collaborate with 15 large health care systems around the country to hire Patient and Family Activators (PFAs). The PFAs will be trained to engage in shared decision making with patients and their families, focusing on preferences and supplying sensitive care choices. PFAs may work with patients at a single decision point or over multiple visits for those with chronic conditions. 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.
Over a three-year period, the Trustees of Dartmouth College-sponsored program will train 5,775 health care workers and create 48 positions for patient and family activators.
UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER
Project Title: "Brookdale Senior Living (BSL) Transitions of Care Program"
Geographic Reach: Alabama, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin
Funding Amount: $7,329,714
Estimated 3-Year Savings: $9,729,702
Summary: The University of North Texas Health Science Center (UNTHSC), in partnership with Brookdale Senior Living (BSL), is receiving an award to expand and test the BSL Transitions of Care Program which is based on an evidenced-based assessment tool called Interventions to Reduce Acute Care Transfers (INTERACT) for residents living in independent living, assisted living and dementia specific facilities in Texas and Florida. In addition, community dwelling older adults who receive BSL home health services will be included in the Transitions of Care Program. Over the course of the award the program will expand to other states where BSL communities are located. The program will employ clinical nurse leaders (CNLs) to act as program managers. CNLs will train care transition nurses and other staff on the use of INTERACT and health information technology resources to help them identify, assess, and manage residents' clinical conditions to reduce preventable hospital admissions and readmissions. The goal of the program is to prevent the progress of disease, thereby reducing complications, improving care, and reducing the rate of avoidable hospital admissions for older adults.
Over a three-year period, the University of North Texas Health Science Center's program will train an estimated 10,926 workers and create an estimated 97 jobs for clinical nurse leaders and other health care team members.