AtlantiCare teamed with a local union to create the Special Care Center, which has reduced hospital admissions and ED visits and lowered costs by helping patients better manage their chronic conditions.

The AtlantiCare Special Care Center (SCC) is a primary care center designed for patients with a chronic illness, such as heart disease, diabetes, hypertension, obesity, asthma, or emphysema.

The clinic-which serves about 1,000 patients in the Atlantic City, N.J. area-was created through a partnership between AtlantiCare, the region's largest healthcare provider, and the HEREIU Local 54 Health and Welfare Fund, a large multiemployer trust fund for service workers at hotels, restaurants, and casinos.

Initially funded with costs shared by the health system and trust fund, the risk moved to an adjusted per-member-per-month rate for subsequent payers.

Putting Patients and Their Families First

The SCC puts patients and their families first in total clinic design. The following care coordination practices have improved patient compliance and satisfaction:

  • Each patient is assigned a nonclinical health coach, who makes contact with the patient at least once every two weeks to help him or her proactively manage their care and navigate the health system.
  • New patients receive a one-hour appointment with a physician; existing patients receive 30-minute physician appointments.
  • Each member of the interdisciplinary care team shares 24-hour call coverage so that patients can contact someone at any time when issues arise, and data capabilities allow the team to access patient charts from home and refer patients to the emergency department (ED) if necessary.
  • All patients are guaranteed same-day sick visits.
  • Patients have access to group education on a variety of issues, which are segmented by type of condition and provided in several languages.
  • All patients who need a sick visit will receive a follow-up call from their health coach within 24 hours of leaving the physician's office.
  • Patients have no copayments for physician visits or prescriptions filled at the on-site pharmacy, which encourages patients to use the clinic's pharmacy and allows the care team to monitor adherence.

Reducing Admissions, Improving Outcomes

According to an analysis conducted between 2008 and 2009, patients experienced 41 percent fewer inpatient admissions, 48 percent fewer ED visits, 25 percent fewer surgical procedures, and improved outcomes in pharmaceutical adherence, quality indicators, and generic medication use. Spending on primary care visits, prescription drugs, labs, and testing all increased.

It is assumed that these increases are a result of higher compliance, and the program still produced a first-year savings of 28 percent of total net spending for the highest-risk patients.

This article is excerpted with permission from the following resource: Goburdhun, N., Caring for Vulnerable Populations, American Hospital Association, Chicago, 2011.

See related article: Case Study: Becoming Accountable to Patients



Publication Date: Monday, February 20, 2012