National Health Policy Forum Hosts Guided Care Site Visits
On August 7th , 2009, the National Health Policy Forum hosted a site visit to Johns Hopkins University in Baltimore, Maryland, for more than 40 senior staff members of numerous federal executive and legislative agencies. It was titled Coordinating Care for Persons with Multiple Chronic Conditions: the Guided Care Model and Other Innovative Approaches. This was the second Guided Care site visit by policymakers, with the first having been oversubscribed.
Chad Boult, MD, MPH, MBA, Director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health and the Principal Investigator of the randomized control trial of Guided Care, described the key components of Guided Care and presented the preliminary results from the RCT to the visitors: improved quality of patients’ care, reduced use and cost of expensive services, reduced caregiver strain, and improved physician satisfaction with chronic care.
“Guided Care is the first form of comprehensive health care for high-risk Americans that a rigorous scientific study has shown to be cost-effective,” said Dr. Boult.
Participants included representatives from the Congressional Budget Office, the Congressional Research Service, the Office of Management and Budget, the U.S. Department of Health and Human Services, the U.S. Department of Veterans Affairs, the U.S. Government Accountability Office, the U.S. House of Representatives, the U.S. Senate, and the John A. Hartford Foundation, one of the funders of the recently completed, three-year, multi-site randomized controlled trial (RCT) of Guided Care.
Others involved in Guided Care were on hand to share their experiences. Three Guided Care nurses described their role and how they interact with physicians, patients, family caregivers, and other health care providers. One nurse explained what is involved in initial home assessments and how she works with her physician partners, using health information technology, to develop evidence-based “Care Guides” and patient-friendly “Action Plans” for her patients. Another nurse described how she helps patients make smooth transitions from hospitals to home.
For the family caregiver, who cares for her elderly mother-in-law, the Guided Care nurse has been a critical asset in getting timely answers to questions and dealing with emergencies, especially when they surface while she is at work. When a meeting participant asked if the panel members felt Guided Care helped to avoid the need to go to the ER, all the members emphatically answered “yes.”
The lunch discussion featured three primary care physicians who explained the challenges they face when dealing with patients with multiple chronic conditions. They described how Guided Care helped improve patient care and how they work with the Guided Care nurse. “Guided Care is a model that will attract physicians into primary care in the future,” said a physician.
The meeting concluded with a discussion of the policy issues that affect the delivery and financing of chronic care. For Guided Care to be disseminated widely, Dr. Boult proposed that insurers support Guided Care physicians with monthly care management fee, plus performance bonuses that focuses on the quality of care.
As a concluding remark, one participant said, “There is broad demand for a model like Guided Care, and the patients we heard from today are so passionate. As a nation, can we afford to wait?”
The John A. Hartford Foundation thanks the National Health Policy Forum for sharing Guided Care with these audiences and for creating a platform for discussing the widespread adoption of Guided Care and other innovative models of care for older adults with complex conditions.
