There will continue to be a lot of talk about the repeal of the Affordable Care Act over the next weeks and months. From my perspective, I am hopeful that the Trump administration and Congress will keep their focus on the payment aspects of the ACA to ensure affordability for those in need.
My health system has been delivering care under a value-based care delivery model for the last six years, and I don’t want to see that care model go away under the repeal of the law. Quite frankly, this approach to care delivery should be the model for the entire nation.
We have been making a difference in the lives of so many through an approach that provides comprehensive, interdependent care to the sickest of the sick. We started with those patients with multiple comorbidities such as heart disease, diabetes, hypertension and COPD. Through our on-campus Center for Clinical Resources, we can now address their care needs simultaneously through the efforts of physicians, nurse practitioners, nurses, pharmacists, respiratory therapists, dieticians, navigators, community health workers and care coordinators.
The model has been so successful that we are now taking the concept out to the community. We identified “hot spots” throughout our service area where patients with the highest utilization of our health system are located. We applied our high-utilizer determination criteria of three or more bedded visits within 12 months, or six or more emergency department visits with a bedded visit and readmission within 12 months, to determine these patients and their locations. We are now delivering care in homeless shelters, with senior housing, low-income housing, senior centers and churches to follow.
Our goal is to disrupt these high utilizers’ cycle of use by providing services before an ED visit becomes necessary; assisting them to address their social determinants; intervening on any behavioral health issues; introducing those in need to a community health worker who can address any ongoing social needs such as transportation to appointments; and setting them up with a primary care provider for their care going forward.
Two years ago, we introduced our first community garden, and last year our gardens grew to five additional gardens serving those in need. We anticipate the same growth with this model of taking care to the community.
If the ACA is repealed and impacts our care delivery model, programs such as these will go away, leaving the most vulnerable once again in need of the most expensive care rather than enabling us to use the Triple Aim-focused approach to their care.