Pilot program care model reduces hospitalizations

Indiana seniors are making fewer trips to the hospital, thanks to a pilot program at some skilled nursing facilities (SNF).

The pilot program, OPTIMISTIC, is a quality improvement project created at Indiana University through the Centers for Medicare & Medicaid Services Innovation Center. The OPTIMSITIC model of care embeds a collaborative clinical team in SNFs to improve chronic disease management, reduce unnecessary hospitalizations and help residents develop and meet their goals of care.

It’s working. RTI International, an independent nonprofit research institute, compared data from 19 participating facilities with a control group. RTI found residents at participating facilities saw a 25 percent reduction in all-cause hospitalizations and a 40 percent reduction in potentially avoidable hospitalizations in 2015 compared to the control. Their evaluation was published in the journal Health Affairs.

“We have worked with the nursing facilities to fine tune and develop this care model,” said OPTIMISTIC director Kathleen T. Unroe, MD, MHA, in a press release. “Their feedback is absolutely integral.”

Phase one of OPTIMISTIC launched in spring 2013. Phase two of the project, which combines the clinical model with a payment model, is underway at 44 facilities through fall 2020.

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Topics: Clinical