AtlantiCare - Special Care Center

Overview

AtlantiCare is an integrated system of services designed to help people achieve optimal health. It includes AtlantiCare Regional Medical Center (ARMC), AtlantiCare Health Engagement, the AtlantiCare Foundation, and AtlantiCare Health Services. Its nearly 5,300 employees and 600 physicians serve the community in more than 60 locations. A 2009 Malcolm Baldrige Award winner, AtlantiCare was also included in Modern Healthcare’s Best Places to Work in Healthcare in 2010. ARMC became the 105th hospital in the nation to attain status as a Magnet™ designated hospital in March 2004 and was redesignated a Magnet hospital in 2008.

Faced with escalating care costs, especially for employees with chronic conditions, AtlantiCare opened the doors of its first Special Care Center (SCC) in summer 2007 and its second office in winter 2010. A primary care medical home practice designed to care exclusively for patients with chronic conditions, the SCC charges payers or employers a flat monthly fee or a share of the operating cost. In addition, insurance benefit design is adjusted to remove barriers to patient adherence and provide participation incentives (waiver of visit and pharmacy co-pays).

The SCC Team delivers intensive primary care and care management services to members with complex medical needs and/or chronic conditions with the potential for high medical costs. A physician and health coach lead the team that works with patients to develop a customized care plan, reviewing and revising the plan as needed. Each patient receives a variety of ongoing care and care management support as dictated by the care plan, including regular phone and e-mail communications from the health coach, hospital and home visits, group wellness sessions, and other support. Consistent communication across providers and a patient registry support the effort. The SCC was designed in collaboration with AtlantiCare’s largest partner, who continues to contribute to oversight and data analysis.

Impact

The SCC has achieved greater than 90th percentile performance on chronic condition clinical outcomes and customer satisfaction. The program has seen decreased hospitalizations and emergency department visits, leading to significant reductions in overall spending on these patients (offset in part by increased intensity of outpatient care and medication use). Additionally, the SCC has improved self-management behaviors related to smoking and medication compliance. Patients enrolled in the program for at least six months experienced significant improvements in clinical outcomes related to hypertension, cholesterol, and blood glucose management. Survey data shows increases in satisfaction among those enrolled in the program (as compared with their health care-provider experiences before their use of the SCC), with gains of 30 to 40 percentage points on questions related to access and timeliness of care, respect for the patient, time spent with the provider, communication, and coordination of care between the primary care team and specialists. Results have been cited in numerous articles and publications. This model has been rolled out to seven other sites nationally, including centers in New York City, Seattle, Las Vegas, and Boston.

Challenges/success factors

In response to the Affordable Care Act, AtlantiCare established a new business line called Health Solutions. It is an accountable care organization that has numerous accounts including the Medicare Shared Services Program. AtlantiCare is replicating this innovative model for groups of people through their network of medical homes and focus on care integration and coordination. They are beginning this work with their own employees and their dependents because they believe they can positively impact their health and the sustainability of our organization.

Future direction/sustainability

Future plans involve integrating the SCC’s best practices into the enterprise’s expanding primary care offices to benefit from learned system improvements and savings in an accountable care environment.

Advice to others

Embrace change in an ever-changing health care environment. Strategic innovation with proven results is sustainable and necessary to capture and deliver population health outcomes.

Contact: Sandy Festa
Administrative Director
Telephone: 609-572-6051
E-mail: sandy.festa@atlanticare.org