The American Hospital Association Committee on Research each year conducts an in-depth examination of a topic to provide the hospital field with relevant recommendations for advancing health care. In 2011, the committee elected to examine emerging hospital-centered practices for effective care coordination for vulnerable populations. Since the breadth of the vulnerable population is large, the committee focused its initial efforts on the unique "dual eligible" population as a subset.
Approximately 9.2 million Medicaid beneficiaries are dual eligibles — low-income seniors and younger persons with disabilities who are enrolled in both the Medicare and Medicaid programs. Dual eligibles are among the sickest and poorest individuals, and they must navigate both government programs to access necessary services, relying on Medicaid to pay Medicare premiums and cost sharing to cover critical benefits not covered by Medicare.
Currently, care for dual eligibles is fragmented, unmanaged and uncoordinated at the program level, based on an inefficient fee-for-service provider payment system. Different eligibility and coverage rules in Medicare and Medicaid contribute to these difficulties. The current system lacks sufficient care coordination for the comprehensive services this population needs, which inhibits access to critical services and encourages cost shifting between providers and payers. While the alignment of financial incentives to provide care to this population will evolve at the federal, state and local policy levels, hospitals are in the unique position to address the system, provider and patient barriers impeding high quality care.
To that end, we recently shared with the hospital field the result of the committee's work, "Caring for Vulnerable Populations." This report, which can be accessed along with the appendices and presentation materials at www.aha.org/caring, summarizes the literature, highlights best practices and makes recommendations for the field on important elements that should be included in any organized program to coordinate care for the dual-eligible or any other vulnerable population.
We hope you will find this report valuable in planning and implementing future care coordination programs for dual eligibles and other vulnerable populations within your organization.
However, this report is only the beginning of the AHA's discussion on improving care for the most vulnerable populations. The association will hold a special executive briefing on this topic on May 7 at the 2012 AHA Annual Membership Meeting in Washington, D.C. For details about the session and the Annual Membership Meeting in general, visit www.aha.org.
We also will highlight additional examples of care planning for vulnerable populations through case studies and reports available on AHA's Hospitals in Pursuit of Excellence website, and we would like to hear more about what your organization is doing. To submit a case study, please go to www.hpoe.org/case-studies/submit. You can also visit www.hpoe.org to find a growing list of best practices from hospitals.
Teri Fontenot, president and CEO of Woman's Hospital in Baton Rouge, La., is chair of the AHA Board of Trustees. Contact her at teri.fontenot@womans.org. Al Stubblefield is president of Baptist Health Care in Pensacola, Fla. They served as the 2011 co-chairs of the AHA Committee on Research. Contact him at astubble@bhcpns.org.
NEWS FROM THE AHA...
• Program will prepare minority leaders for executive positions
The Institute for Diversity in Health Management will present "Preparing Emerging Minority Leaders in Health Care for the CEO & C-Level Roles" April 25-26 in Chicago. For more information, visit www.diversityconnection.org.
• Advice on owning medical practices and employing docs
In Owning Medical Practices: Best Practices for Sustainable Results from AHA Press, Marc D. Halley, president and CEO of the Halley Consulting Group, offers advice on planning, organizing and overseeing the management of hospital-owned medical practices; managing multiple groups of practices; and running a medical office. Visit www.healthforum.com and click on Books at the bottom of the page.
• Board role in quality oversight
In a monograph from the Center for Healthcare Governance, Christine Izui, executive director of quality at the Blue Cross and Blue Shield Association, examines the hospital board's role in improving quality and patient safety, how boards can foster a culture for improved performance and the shift by insurers from payment for reporting on performance to paying for performance. Visit www.americangovernance.com.
• Tune in to what's up in D.C.
AHA members can stay up to date on what's happening on the legislative and regulatory fronts in Washington, D.C., by tuning into the association's Town Hall webcasts once or twice every month. A replay option lets executives use the webcasts in board and staff meetings. The next three webcasts are April 24, May 22 and June 6. Visit www.aha.org/townhall.
• Safety research grants
The AHA's American Society for Healthcare Risk Management is accepting proposals for grants that study high-reliability organizations, serious safety events and root cause analysis. The grants are for up to $100,000 and last one year. Visit http://www.ashrm.org.
