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Johns Hopkins Medicine Alliance for Patients Achieves Outstanding Quality Score in 2015

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Johns Hopkins Medicine Alliance for Patients Achieves Outstanding Quality Score in 2015

Johns Hopkins Medicine Alliance for Patients Achieves Outstanding Quality Score in 2015

Date: 11/01/2016

Intensive care coordination and quality improvement efforts have made a significant difference in the lives of thousands of individuals — and helped the Johns Hopkins Medicine Alliance for Patients (JMAP) achieve a 96.2 percent quality score and reduce rates of hospital admissions and emergency department visits by 2 percent from 2014 to 2015. Its quality performance places JMAP among the top quarter nationally and among the top three in Maryland for accountable care organizations (ACOs) that had a quality score in 2015.

Urgent specialty access and population-based pharmacy review were additional efforts likely contributing to JMAP’s achievements, says Scott Berkowitz, senior medical director of accountable care in the Office of Johns Hopkins Physicians and executive director of JMAP.

Launched in January 2014, JMAP is a Medicare Shared Savings Program ACO comprising the Johns Hopkins University School of Medicine, Johns Hopkins Community Physicians (JHCP), the five Maryland and D.C. Johns Hopkins Medicine (JHM) hospitals, Columbia Medical Practice, Potomac Physician Associates and Cardiovascular Specialists of Central Maryland. In all, some 2,900 providers care for 38,000 fee-for-service Medicare beneficiaries.

When a Medicare Shared Savings ACO reaches a savings threshold while attaining a number of quality targets, such as controlling high blood pressure or screening for fall risk, it shares in the savings generated. In 2015, only about a quarter of ACOs nationwide qualified for shared savings.

“Despite its excellent quality performance and improvement in key utilization measures, JMAP, unfortunately, did not achieve shared savings in 2015, but there is much to be proud of in these efforts, which involve the active collaboration of dozens throughout the enterprise, prepare JHM for the future and optimize care for our patients,” says Berkowitz.

“We are very pleased with the progress made so far,” says DeWayne Oberlander, chief executive officer of Columbia Medical Practice, an independent primary care practice in Howard County. “We have been a partner in JMAP since its inception and look forward to continuing to improve the quality and value of its care.”

Care Coordination and Better Access to Specialty Care

In collaboration with Johns Hopkins HealthCare, one way that JMAP is working to improve care quality and value is by having care coordinators work with JMAP’s most medically complex patients, helping them stay healthy and out of the emergency department or hospital. The JMAP website features a number of patient testimonials about the value that care coordinators have brought to their lives. The help they lend might include assisting an elderly patient with getting set up with Meals on Wheels, helping a patient with procuring a nighttime breathing machine or facilitating a patient’s move into a rehabilitation center after a hospital stay.

Another way that JMAP has improved care quality for its patients is by expanding the Specialty Urgent Same-Day Response, or SUSDR, service. Fifteen specialty departments now participate, says John Flynn, vice president in the Office of Johns Hopkins Physicians and chief medical officer for JMAP. Phone calls are triaged by a clinical specialist, who responds to the urgent nature of the patient concern from the referring physician by notifying the specialty department for expedited scheduling of an appointment. The SUSDR line then follows up with referring physicians to confirm that an urgent appointment has been set up. “In the past, JMAP patients could not always be seen by our specialists quickly. SUSDR benefits patients who need to see a specialist in the next two or three days, who prior to SUSDR may have been referred to the ED as the only recourse,” says Flynn.

Pharmacy Review

Pharmacists are key contributors to JMAP’s achieving important quality targets. They review the electronic medical record for the use of medicines tied to those targets. For instance, patients with certain conditions are to be on beta blockers, says Scott Feeser, office medical director for JHCP and medical director for JMAP. “Our pharmacists will give the physician a heads-up that the patient isn’t on them and they may want them to be, but the decision remains in the hands of the physician.”

Pharmacists, if requested, can also do a polypharmacy review to see if the list of medications that a patient is on could be narrowed, helping the patient by reducing potential side effects and saving the cost of unnecessary prescriptions.

Other Innovations

JMAP has recently expanded behavioral health care for its patients, building on the success that the Johns Hopkins Community Health Partnership (J-CHiP) had using licensed clinical social workers to counsel patients with anxiety or depression, for instance, and help them more fully engage in their care. A palliative care program is rolling out now, says Feeser. This will educate patients about advance directives and encourage them to create one for themselves.

Advancing integration among Johns Hopkins-employed physicians and those who are not is an ongoing endeavor. “We’re talking with regional physicians about how we can collaborate more closely in terms of sharing information to support shared goals in caring for patients with a mix of Hopkins and non-Hopkins providers,” says Berkowitz.

Says Steve Schwartz, a JMAP board member, the medical director of Potomac Physician Associates and its chief information officer: “We signed on with JMAP for many reasons, but one was the we recognized that partnering with Johns Hopkins Medicine would give us the opportunity to build IT and process infrastructure to measure and improve quality for our patients.”

Partnering with non-Hopkins entities is a key innovation for JMAP. “As the U.S. health care system moves to a population-based model, integration among health care providers will be critical,” says Berkowitz. “Our partners are highly valued team members who have been with us since the beginning and are integral to improving care quality, value, access and reach for our patients.”