Health Care Innovation Awards: Wisconsin
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.
CHILDREN’S HOSPITAL AND HEALTH SYSTEM, INC
Project Title: “CCHP Advanced Wrap Network”
Geographic Reach: Wisconsin
Funding Amount: $2,796,255
Estimated 3-Year Savings: $2,851,266
Summary: The Children’s Hospital and Health System, Inc., partnering with Children’s Hospital of Wisconsin, Aurora Healthcare, and Wheaton Franciscan Healthcare, is receiving an award to create an Advanced Wrap Network Model (AWN) of culturally sensitive professional, clinical, and social resources to educate Children’s Community Health Plan (CCHP) members on how to effectively navigate the health care system. This intervention, targeted at Medicaid and CHIP beneficiaries in southeastern Wisconsin, will deploy Nurse Navigators and Community Health Navigators to increase use of primary care health homes and reduce emergency room visits and inpatient hospital admissions for beneficiaries. As a result, the program will achieve cost savings, while continuing to improve on HEDIS quality metrics for immunizations, diabetes, asthma, and lead testing.
Over a three-year period, the Children’s Hospital and Health System, Inc., will create an estimated nine jobs, hiring a program manager, nurse navigators, and community health navigators.
INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT
Project Title: "Care management of mental and physical co-morbidities: a TripleAim bulls-eye"
Geographic Reach: California, Colorado, Iowa, Massachusetts, Michigan, Minnesota, Pennsylvania, Washington, Wisconsin
Funding Amount: $17,999,635
Estimated 3-Year Savings: $27,693,046
Summary: The Institute for Clinical Systems Improvement (ICSI) of Bloomington, Minnesota is receiving an award to improve care delivery and outcomes for high-risk adult patients with Medicare or Medicaid coverage who have depression plus diabetes or cardiovascular disease. The program will use care managers and health care teams to assess condition severity, monitor care through a computerized registry, provide relapse and exacerbation prevention, intensify or change treatment as warranted, and transition beneficiaries to self-management. The partnering care systems include clinics in ICSI, Mayo Clinic Health System, Kaiser Permanente in Colorado and Southern California, Community Health Plan of Washington, Pittsburgh Regional Health Initiative, Michigan Center for Clinical Systems Improvement, and Mount Auburn Cambridge Independent Practice Association with support from HealthPartners Research Foundation and AIMS (Advancing Integrated Mental Health Solutions).
Over a three-year period, ICSI and its partners will train the approximately 80+ care managers needed for this new model.
PHARMACY SOCIETY OF WISCONSIN
Project title: “Retooling the pharmacist’s role in improving health outcomes and reducing health care costs”
Geographic Reach: Wisconsin
Funding Amount: $4,165,191
Estimated 3-Year Savings: $20,448,864
Summary: The Pharmacy Society of Wisconsin is receiving an award to better integrate pharmacists into clinical care teams. This project, expanding the successful Wisconsin Pharmacy Quality Collaborative (WPQC), will transform the pharmacist’s role from drug dispensers to drug therapy coordinator and manager. Participating pharmacists will work collaboratively with physicians and other prescribers to revise prescription drug therapies in accord with evidence-based standards of care, targeting participants with diabetes, chronic heart failure, asthma, and geriatric syndromes. These patients are typically prescribed numerous medications, change locations of care, and/or are non-adherent to evidence-based therapies prescribed for them. The result of the intervention will be better medication adherence, better medication therapy management, and better health, with a decrease in adverse events and complications and more appropriate, evidence-based medication therapy.
Over a three-year period, the Pharmacy Society of Wisconsin’s program will train an estimated 1,200 workers and will create an estimated 7 jobs. Regional implementation specialists and clinical pharmacists will train community pharmacists across the state.
TransforMED
Project Title: “Multi-community partnership between TransforMED, hospitals in the VHA system and a technology/data analytics company to support transformation to PCMH of practices connected with the hospitals and development of “Medical Neighborhood”
Geographic Reach: Alabama, Connecticut, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Mississippi, Nebraska, Oklahoma, West Virginia, Wisconsin
Funding Amount: $20,750,000
Estimated 3-Year Savings: $52,824,000
Summary: TransforMED, in partnership with 12 VHA-affiliated hospitals throughout the county, is receiving an award for a primary care redesign project to support care coordination among Patient-Centered Medical Homes (PCMH), specialty practices, and hospitals, creating “medical neighborhoods.” The project will use a sophisticated analytics engine to identify high risk patients and coordinate care across the medical neighborhood while driving PCMH transformation in a number of primary care practices in each community. Truly comprehensive care will improve care transitions and reduce unnecessary testing, leading to lower costs with better outcomes.
Over a three-year period, TransforMED’s program will train an estimated 3,024 workers and create an estimated 22 jobs. The new workers will include an innovation project manager, project control specialists, project managers, an implementation team, a project team, an integration architect, an application trainer, and a population health management advisor.
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.