How ZIP Code 29203 Is Reinventing Healthcare Delivery 

Using principles of community activism, hospital leaders are working with insurance executives, Medicaid officials, church volunteers, and citizens to identify unique approaches to improving population health in ZIP code 29203-one of the poorest areas in South Carolina. About 30,000 uninsured emergency department visits from that single ZIP code rack up $20 million in unreimbursed costs each year.

"I see this initiative as a real opportunity for us hospital CEOs to create a dialogue with different stakeholders in the community about new ways to keep our citizens healthy," says George A. Zara, president and CEO of Providence Hospitals in Columbia, S.C.

After the project launches on March 3, about 300 volunteer organizers will begin helping individuals, groups, and neighborhoods in 29203 develop wellness programs and other health-oriented initiatives.

Meanwhile, payers and providers will be changing the way they interact.  Local physicians will be paid incentives by BlueCross BlueShield of South Carolina if they can demonstrate improved management of patients with chronic diseases. The insurer will also pay providers for new kinds of care, such as pharmacist visits and home visits, that are not typically reimbursed in the traditional payment system.

Decrease in Patient Falls No Fluke at Harborview Medical Center 

In early 2010, the medicine/geriatric unit at Harborview Medical Center, Seattle, had the hospital's highest patient fall rate-more than six falls per 1,000 patient days, versus a hospitalwide average of just under five falls per 1,000 patient days.

A multidisciplinary team launched several fall prevention strategies-including developing a detailed fall risk assessment tool, involving physicians and pharmacists in fall management, and encouraging staff to identify prevention approaches-in an effort to reduce patient falls on the unit by 20 percent during a six-month period.

When the six-month period ended in December 2010, the team had exceeded its goal, reducing falls on the unit by 35 percent-and none of the falls resulted in serious harm. Six months later, patient falls on the unit decreased by another 21 percent, proving that the results were no fluke.

By Eliminating Triage, St. Lucie Reduces ED Waits, Boosts Volumes 

Long emergency department (ED) wait times were a problem at Florida's St. Lucie Medical Center. Patients waited nearly an hour, on average, to be placed in a bed, and they also experienced a lengthy door-to-doctor time of 66 minutes.

St. Lucie embarked on a redesign of its ED processes-which included eliminating triage and implementing bedside registration-to reduce wait times and increase patient throughput. Within a year, St. Lucie was documenting significant improvements-and ED performance metrics have continued to improve. Today, the average ED wait time is down to about nine minutes, door-to-doctor times average about 12 minutes, and patient volumes have increased by 15 percent.

A Joint Effort to Improve Care Coordination for the Chronically Ill 

The Special Care Center (SCC)-created through a partnership between Atlantic City, N.J.-based healthcare provider AtlantiCare and a large union-is a primary care center designed for patients with a chronic illness.

The SCC implemented several care coordination practices that have improved patient compliance and satisfaction. For example, 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.

According to an analysis conducted between 2008 and 2009, patients experienced 41 percent fewer inpatient admissions and 48 percent fewer emergency department visits. Outcomes in pharmaceutical adherence, quality indicators, and generic medication use have improved.


Publication Date: Monday, February 20, 2012