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HHS Awards First Health Care Innovation Awards

Transplant surgery (NIH)

(National Institutes of Health)

The U.S. Department of Health and Human Services revealed the first group of universities, companies, and medical centers to receive Health Care Innovation awards. The three-year cooperative agreements, authorized by the Affordable Care Act, total $122.6 million and are administered through HHS’s Center for Medicare and Medicaid Innovation.

The department says the 26 awardees were selected for offering innovative solutions to health care challenges facing their communities and a focus on creating a well-trained health care workforce. The awarded projects expect to reduce health spending by as much as $254 million over the next three years.

The awardees are:

– Beth Israel Deaconess Medical Center in Boston, Massachusetts, for its Post-Acute Care Transition Program to improve care and reduce hospital readmissions for Medicare and beneficiaries dually eligible for Medicare and Medicaid who represent more than 8,000 discharges for conditions such as congestive heart failure, heart attacks, and pneumonia

– Center for Health Care Services in San Antonio, Texas, to integrate behavioral care and health care for a group of 260 homeless adults in San Antonio with severe mental illness or co-occurring mental illness and substance abuse disorders

– Cooper University Hospital, serving Camden, New Jersey, and adjoining areas, to better serve over 1,200 patients with complex medical needs who have relied on emergency rooms and hospital admissions for care

– Courage Center in Minneapolis – St. Paul metropolitan area, to test a community-based medical home model to serve 300 adults with disabilities and complex health conditions, particularly complex neurological conditions

– Delta Dental Plan in South Dakota, to improve oral health and health care for American Indian mothers, their young children, and American Indian people with diabetes

– A consortium led by Duke University, for its plan to reduce death and disability from Type 2 diabetes mellitus among 57,000 people in four Southeastern counties, using informatics systems that stratify patients and neighborhoods by risk, target communities in need of higher-intensity interventions, and enable decision support and real-time monitoring of interventions

– Emory University, in partnership with Philips Company (a tele-intensive care unit contractor) and several medical centers to hire more than 40 critical care professionals, including 20 nurse practitioners and physician assistants who will be deployed to undeserved and rural hospitals in Northern Georgia, and for support of nurses and allied health personnel to reach an additional 400 clinical, technical and administrative support professionals who form the local hospital critical care teams

– Finity Communications Inc., to use health information technology to track and monitor over 120,000 at-risk patients in greater Philadelphia, create a participant engagement program, develop integrated health profiles and care management plans, and evaluate and reassess treatment on a continuing basis

– George Washington University, to improve care for about 300 patients on peritoneal dialysis in Washington, D.C., and eventually in Philadelphia and Southern Maryland, with a dialysis nurse workforce trained in prevention, care coordination, team-based care, telemedicine, and the use of remote patient data to guide treatment for co-morbid, complex patients

– Health Resources in Action, for its New England Asthma Innovations Collaborative to create a new type of workforce and service delivery model that targets cost-effective and culturally competent care, which features patient self-management education, environmental interventions, and long-term sustainability payment mechanisms of these services

– Joslin Diabetes Center Inc., to expand a program for diabetes education, field testing, and risk assessment that sends community health workers into community settings to help approximately 3,000 Medicare and Medicaid beneficiaries and low income/uninsured populations in New Mexico, Pennsylvania, and Washington, D.C. understand their risks and improve health habits for the prevention and management of diabetes

– Kitsap Mental Health Services of Kitsap County, Washington, to integrate care for 1,000 severely mentally ill or severely emotionally disturbed adults and children, many of them Medicare, Medicaid, and/or CHIP beneficiaries, with at least one co-morbidity

–  LifeLong Medical Care, to integrate care and encourage healthy behavior, and reduce excessive emergency room and hospital visits among the disabled among 9,750 disabled, homeless, and mentally ill Medicaid and beneficiaries in California, dually eligible for Medicare and Medicaid to reduce excessive emergency room and hospital visits

– Mountain Area Health Education Center, serving 16 counties in Western North Carolina, to test team-based enhanced primary care for some 2,000 patients with chronic pain, whose treatment can be both costly and avoidably frequent

– National Health Care for the Homeless Council, to serve ten communities across various regions in the U.S. — New Hampshire, Texas, Nebraska, Massachusetts, Illinois, Florida, North Carolina, and California — to reduce the number of emergency department visits and lack of primacy care services for more than 1,700 homeless individuals

– Ochsner Clinic Foundation to better serve almost 1,000 acute care stroke patients in Jefferson and St. Tammany parishes in Louisiana through a telemedicine system that enables care providers to monitor patients, evaluate outcomes, and check on medication and treatment adherence on a real time basis

– Pittsburgh Regional Health Initiative, to create specialized support centers, staffed by nurse care managers and pharmacists, to help small primary care practices offer more integrated care within the service areas of seven regional hospitals in Western Pennsylvania

– University of California, Los Angeles, to expand a new program that provides coordinated, comprehensive, patient and family-centered, and efficient care for about 1,000 Medicare and Medicaid beneficiaries with Alzheimer’s disease or other forms of dementia

– A consortium led by South County Community Health Center to create a health disparities collaborative for over 19,000 people with diabetes in a multi-cultural, high-risk, high-cost population in southeast San Mateo County, California

– A consortium led by University of Chicago Urban Health Initiative, to develop the CommunityRx system, a continuously updated electronic database of community health resources that will be linked to the electronic health records of local safety net providers

– University (at Buffalo) Emergency Medical Services, to deploy community health workers in emergency departments to identify high-risk patients and link them to primary care, social and health services, education, and health coaching

– University Hospitals (UH) of Cleveland and Children’s Hospital at UH Case Medical Center, to improve care for some 65,000 children with Medicaid with high rates of emergency room visits, complex chronic conditions, and significant behavioral health problems in several counties across northeastern Ohio

– The University of New Mexico Health Sciences Center for its ECHO Project, to identify 5,000 high cost, high-utilization, high-severity patients in New Mexico and Washington State, and uses a team of primary care “intensivists” trained in care for complex patients with multiple chronic diseases, working with area managed care organizations and care providers

– The Upper San Juan Health Service District, to expand access to specialists and improve the quality of acute stroke and cardiac care in rural and remote areas of southwestern Colorado

– Vanderbilt University Medical Center, with National HealthCare Corporation, to reduce inpatient re-hospitalization by 17 percent and improve patient experiences for some 27,000 Medicare and beneficiaries dually eligible for Medicare and Medicaid in 10 Tennessee counties

– Women and Infants Hospital of Rhode Island, to improve services for about 2,400 mothers in Rhode Island who have pre-term babies, including the hiring, training, and deploying of family care teams to offer education and support and monitor infants’ growth and development

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