Employers are the primary way Americans under age 65 obtain health insurance coverage, so partnering with employers is key to improving the quality of care. However, there has been some resistance among employers to adopt new payment models and programs. Wisconsin AF4Q has made working with employers a priority.

 

Since 2010, The Wisconsin Collaborative for Healthcare Quality (WCHQ) and the Partnership for Healthcare Payment Reform (PHPR) have worked with other organizations in Wisconsin to support providers and health plans in experimenting with innovative payment models. As part of that work, PHPR created two pilot projects: a bundled payment for total knee replacement and a shared savings project for adults living with diabetes.

Fragmentation in care can increase the odds of rehospitalization. Partnership between providers can lead to greater communication that can ultimately help minimize fragmentation in care and reduce readmissions.

 

Statistics show that more than 17 percent of Medicare beneficiaries are re-hospitalized within 30 days of discharge, and the Medicare Payment Advisory Commission estimates that up to 76 percent of these readmissions might be preventable. Not surprisingly, 64 percent receive no post-acute care between discharge and readmission.

 

To address this issue, the Centers for Medicare and Medicaid Services (CMS)approved a two-year, community-based care transitions program in which 30 communities across the country participated. Western NY AF4Q was one of the 30 selected communities and worked with P2 Collaborators in Western New York, seven of the region's eight counties, the state's Medicare Quality Improvement Organization (IPRO), area hospitals, nursing facilities, community organizations and other regional stakeholders. These various groups focused not only on reducing readmissions but also on building up patients' self-management skills and improving their access to existing programs.

Empowering patients and helping them take better care of themselves means understanding the patients' environment. But when the average visit to the primary care physician lasts less than 20 minutes, getting the big picture about patients' home and work environments and how those environments affect their choices and health can be difficult.

 

Eighty-five percent of primary care physicians feel that to achieve the best possible health outcomes, doctors need to address patients' resources and barriers--social, financial, and physical. The current medical system does not give physicians much time to discuss with patients how they live, work, and spend their leisure time. AF4Q talks about how partnerships between primary care practices and community organizations may help fill this gap in patient care and forge the building blocks needed to create sustainable, successful, community-based partnerships.