Hospitalizations reduced by regional collaboration in Ohio

The establishment of a primary care-led regional health improvement collaboration in the Cleveland area reduced hospitalizations attributed to conditions like heart failure and bacterial pneumonia, saving nearly $40 million, according to a study published in the February 2017 issue of Health Affairs.

The Better Health Partnership (BHP) was established in 2007 among providers in Cuyahoga County, Ohio, which contains Cleveland and most of its suburbs. The collaboration has involved reporting on outpatient care across payer sources and socioeconomic groups for conditions considered “ambulatory care-sensitive.” The study, led by Case Western Reserve University MD-PhD student Joseph Tanenbaum, compared rates of hospitalizations related to heart failure, hypertension, diabetes and bacterial pneumonia in the period before (2003-2008) and after (2009-2014) the BHP was implemented.

Rates of hospitalization for those conditions had been falling in Cuyahoga and other counties before the BHP was in place. What Tanenbaum and his coauthors found is once it was implemented, there was a steeper decline in Cuyahoga. From 2009 to 2011, the hospitalization rate for those conditions was 106 fewer hospitalizations per 100,000 adults than in comparison counties. The difference was smaller (91 fewer hospitalization per 100,000 adults) in the later part of the study period from 2012 to 2014.

Overall, the study estimated 5,764 hospitalizations for ambulatory care-sensitive conditions were averted between 2009 and 2014, yielding an estimated $39.7 million in savings. More than half of those savings ($20.2 million) could be attributed to averted hospitalizations for congestive heart failure.

“These population-level improvements were associated with the establishment of a strong primary care provider integrator organization that was committed to and catalyzed primary care transformation and the public reporting of health care quality metrics in a relatively small well-defined geographic area,” Tanenbaum and his coauthors wrote.

The study authors noted that unlike other regional improvement initiatives, BHP adopted data from electronic health records data for measuring outcomes. This allowed best practices to be identified and adopted more quickly compared to other programs relying on insurance claims data.

The results, they said, should encourage other states to pursue more primary care-led programs through Section 1115 Medicaid waivers or other “state innovation models.”

“Our findings support the premise that primary care–focused quality improvement initiatives that emphasize disseminating best practices within a region can avert preventable hospitalizations for ambulatory care–sensitive conditions and may lead to substantial cost savings for the health care system,” Tanenbaum and his coauthors concluded.