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Care Connections: How Providers and Advocates in Chicago are using the ACA to Improve Health

Bonnie Ewald
August 22, 2014
Those of us working on health systems transformation understand that for change to occur we need to reevaluate every aspect of how we provide care – from how we train future practitioners, to how and where we treat patients, to how that treatment is funded. A recent article in the Chicago Tribune (8/10/14) spotlights a number of Chicago-area projects—several with Health & Medicine connections—that are transforming health in our community through the Affordable Care Act (ACA).  

The article addresses one important aspect of the ACA: real world research that tests new approaches and payment structures to figure out how to best serve certain populations. These initiatives include the Person-Centered Outcomes Research Institute (PCORI), which funds comparative effectiveness research projects and places a great emphasis on engaging consumers themselves throughout the research process. Other demonstration projects are housed in the Center for Medicare and Medicaid Innovation – initiatives such as the Community-based Care Transitions Program, which tests ways that community-based organizations can partner with hospitals to help discharged patients get settled safely in the community and not readmit to the hospital.
 
The  Tribune article highlights a couple of Chicago-area projects utilizing this funding. One of the highlighted projects is taking place at the University of Chicago’s Center for Health and the Social Sciences. Led by Dr. David Meltzer, this project tests a model called the Comprehensive Care Program, where multidisciplinary teams led by a “comprehensive care physician” care for patients in both outpatient and inpatient settings. These comprehensive care physicians have a lower caseload of patients, enabling them to visit those patients in the hospital if they happen to be hospitalized. This is a shift from care as usual, where oftentimes the primary care provider is not even aware that his/her patient had to be hospitalized. However, the patients they are working with are at high risk for hospitalization. Dr. Meltzer and his team are exploring a number of strategies to better meet the needs of community members, including performing home visits.



Comprehensive care "is not just about prescribing medication and ordering tests," Dr. Krishnamoorthi, a member of the Comprehensive Care Program team, said in the article. "It's about the very practical problems of making sure people can get to their appointments. Do they understand what's happening at the appointment? Do they have behavioral problems or cognitive issues? Are they homebound? Do they have to take three buses in a dangerous community? All these issues affect medical care."

Dr. Meltzer's work also has a Health & Medicine connection. In May 2014, he and his team decided to become trained in the Bridge Model of transitional care, which Health & Medicine, in collaboration with other stakeholders, helped develop. While the Bridge Model focuses on supporting older adults and their caregivers during a transition from one care setting to another (say, from the hospital to home), its structured approach to incorporating psychosocial aspects into healthcare can be applied to primary care. Dr. Meltzer’s team recognizes the need to not just address patients’ medical needs, but to also focus on things like their goals, what their social life is like, and what environmental factors might be impacting them; in addition to the comprehensive care physician, a social worker also plays an important part in their care team.

In a neat twist that shows just how interconnected the world of activists and providers working to create a more just and functional health system is, Dr. Krishnamoorthi is also the alumni of one of Health & Medicine’s longstanding Chicago Area Schweitzer Fellows Program. The Schweitzer Fellows program supports graduate students as they design and implement service projects, with the aim that they will become leaders in service and will continue to work to reduce health inequities in their future. Dr. Krishnamoorthi was a Schweitzer Fellow in 2001-2002, during his time as a joint medical and public health student at Northwestern University. Completing his residency in internal medicine at Loyola University, Dr. Krishnamoorthi is now working with individuals at high risk for hospitalization as a member of the Comprehensive Care Program team at the University of Chicago.

The Center for Medicare and Medicaid Innovation has a number of exciting projects like this around the country that are testing ways to provide better care to those who need it, while also aiming to reduce overall costs. For our part, we’ll keep looking for innovative ways to improve care in Illinois—from the Schweitzer Program, to the Bridge Model, to our health policy research. And we’re excited to see how these efforts will continue to impact healthcare on the ground through the work of people like Dr. Meltzer and Dr. Krishnamoorthi and the many other providers, students, and community members impacted by these projects.