Monday, October 7, 2013

Improving Health Care, Controlling Costs – Rutgers Launches New Initiative

One key factor sets Robert Wood Johnson Partners apart from other attempts at reform – the Accountable Care Organization has the power of a major research university behind it
Dr. Alfred Tallia examines Barbara Carcich
Credit: Nick Romanenko
Nurse Donna Bonavitacola assists as Alfred Tallia examines Barbara Carcich.
'This is one of the first tangible benefits of how the new Rutgers is going to serve the state of New Jersey in health care. This was not possible before. Now we have all the pieces under one roof.' – Alfred Tallia

Meet the some of the collaborators and researchers behind Robert Wood Johnson Partners:
Lynn Clemow, a clinical associate professor in the RWJMS Department of Family Medicine and Community Health, coordinates a program to place graduate students from the Department of Psychology and the Graduate School of Applied and Professional Psychology at the Monument Square primary care practice. The graduate students work with patients to quit smoking, take their medicine and on more traditional mental health issues. "Mental health services are a nightmare of poor reimbursement and poor access,'' Clemow said. "This cuts through the stigma of seeking out services and having to call an 800 number, talk to a clerk about your issues and get a list of providers, many of whom arent taking patients or on the plan anymore, Clemow said. About 15 percent of patients recommended for mental health services outside the office make an appointment, but closer to 90 percent of patients do in an integrated system, she said. "Depressed people don't take as good care of themselves, they don't take their medications because they don't seem to have the energy to do that, Clemow said. "If you treat the depression, everything works better.''
Xiaomu Zhou, an assistant professor in the School of Communication and Information, wants to study how access to information through the patient portal can improve communication between patients and doctors. "I want to understand how information technology can be designed to provide more information access to patients, facilitate communication and lead to better health outcomes,'' Zhou said.
Professors Kang Li and Susan Albin, in the School of Engineering, will use mathematical modeling and statistical analysis to study workflow in the primary care office and define the role of a patient care coordinator. "The availability of services from a patient care coordinator could reduce patients frustration obtaining care, fulfill doctors’ plans for how best to help the patient, and reduce the cost burden on the whole community with fewer emergency room visits and hospital admissions,'' said Albin, a professor in the Department of Industrial and Systems Engineering.

One Rutgers, A World of Discovery

The new Rutgers, combining nearly 250 years of academic excellence with a renewed commitment to medical education, is inspiring faculty, students and staff to form innovative partnerships in academic research and public service. In an online series, Rutgers Today examines the new ways that members of the university community are collaborating, across a wide range of disciplines, to better meet the needs of the people of New Jersey and beyond.
– The Editors
During nearly three decades as a primary care physician, Alfred Tallia has identified a daunting list of flaws with the nation’s health care.
Specialists rarely coordinate care for patients with chronic illnesses such as diabetes and high blood pressure – which can lead to repetitive, expensive tests.
In most doctors’ offices, no one is responsible for developing plans with patients to lose weight, exercise and change their diet – or for following up with those patients to help them meet their goals.
But Tallia, chair of the Department of Family Medicine and Community Health at Robert Wood Johnson Medical School – now part of Rutgers – is getting ready to launch a solution he believes will deliver more effective care at a lower cost.  
“The idea of improving quality and controlling costs, that is something here to stay,’’ Tallia said. “We can’t keep spending 18 percent or more of the Gross Domestic Product on health care, not cover everybody and have disappointing outcomes. That is what we have now.’’
Tallia is spearheading the creation of an Accountable Care Organization, called Robert Wood Johnson Partners, that will coordinate treatment among doctors, other health professionals, and hospitals through better use of electronic health records. The project also involves restructuring doctors’ offices to improve communication with patients, and directly involve them in developing plans to benefit their health.
Although similar efforts have been rolled out around the country since health care reform became law in 2010, one key factor sets Tallia’s work apart :
Robert Wood Johnson Partners has the power of a major research university behind it.
Tallia and others in the medical school – in partnership with Robert Wood Johnson University Hospital and Health System – are teaming up with researchers across different disciplines at Rutgers to find the best ways to improve care and curtail costs. This includes the School of Engineering, the Department of Psychology, and the School of Communication and Information.
Alfred Tallia
Credit: Nick Romanenko
Physician Alfred Tallia at Robert Wood Johnson Medical Group’s Family Medicine office at Monument Square.
“The reason for Robert Wood Johnson Medical School and Rutgers to be involved is to answer the many outstanding questions about how a system should work,’’ Tallia said.  “We are in the best position not only to deliver care, but to also do the research to make it better.’’
For example, a professor in the School of Communication and Information plans to study the use of a patient portal, an online information hub that would allow patients to access test results and other health information. The technology will also allow patients to schedule appointments, request or renew prescriptions, pay bills and ask questions about their care.
Graduate students from the Department of Psychology in the School of Arts and Sciences and the Graduate School of Applied and Professional Psychology will work in a primary care practice to help patients quit smoking, improve eating habits and address other behavioral health issues.
And professors in the School of Engineering will use mathematical modeling and statistical analysis to study workflow in the primary care office and define the role of a patient care coordinator. The person in this position would be dedicated to helping patients adhere to plans for their health – which could involve communicating with pharmacies to make sure prescriptions are filled, keeping tabs on exercise plans and coordinating appointments.
“Part of what the engineering department is going to do is help us make our care more efficient so we can spend more time on things that really matter,’’ said Elizabeth C. Clark, an assistant professor in the RWJMS Department of Family Medicine and Community Health.
“If doctors are spending less time doing paperwork they will have more time to spend with patients,’’ Clark said.
The medical schools, nursing, pharmacy, and other professional programs at Rutgers can also build on lessons learned to train a team-based workforce suited to meet the health care needs of the future, Tallia said.
Brian L. Strom, the incoming chancellor of Rutgers Biomedical and Health Sciences who is also a primary care physician, echoed concerns about the health care system and called Tallia a “national leader in this area.’’
“As a nation, we need to move away from an episode-based disease management system,’’ Strom said.
“This will require a multidisciplinary approach to population health, and a multidisciplinary approach to evaluating the new models of care that emerge, like the ACO planned by Dr. Tallia. Rutgers, with its depth and breadth across health and non-health fields, is enormously well positioned to be a leader in this field."
A Timeline for Providing Care
Robert Wood Johnson Partners is seeking approval to start treating Medicare patients early next year. The Affordable Care Act encourages the creation of such Accountable Care Organizations for Medicare patients, but most have been developed around hospital systems.
Rutgers would be one of the first academic institutions to launch such an organization, Tallia said.
Tallia is also talking to some of the state’s major health insurance companies including Horizon Blue Cross Blue Shield and Aetna to expand into a statewide organization next year called Rutgers Health Partners.
In the meantime, the Robert Wood Johnson Partners would be modeled on the restructuring of Rutgers Robert Wood Johnson Medical Group’s Family Medicine office at Monument Square in New Brunswick. The primary care practice, which is part of the Robert Wood Johnson Medical School, has been organized into a “patient-centered medical home,” where medical providers share information and work with patients to closely coordinate care.
Nearly 30 additional primary care practices have signed contracts to participate in the upcoming rollout of Robert Wood Johnson Partners.
The partnership would also include the 500 specialists in the Rutgers Robert Wood Johnson Medical Group along with clinicians on staff at Robert Wood Johnson University Hospital and the other hospitals within Robert Wood Johnson Health System.
Medicare and insurance companies offer financial incentives for such reform efforts that meet benchmarks for improving care while moderating costs. Participating doctors, hospitals, and other providers would receive a share of the savings. And in Robert Wood Johnson Partners, patients may also share in the benefit.
A Difference Patients Will Notice 
What this will mean for patients is seamless care, much like the experience Lou and Barbara Carcich have with the doctors at Monument Square, where some of the changes have already been introduced. When Barbara Carcich went for a follow up visit after a hospital stay, the doctor had all the information about her illness and treatment at his fingertips.
“I didn’t have to go through the whole thing again: why I went in, what happened,’’ said Carcich, of Somerset. “You know the information you usually have to retell, it was all there. My doctors in the hospital communicated and all care was coordinated with Dr. Tallia and his nursing team at Monument Square."
And Lou Carcich finds it reassuring that Tallia and his cardiologist receive the results of his blood work simultaneously. “I feel very confident and comfortable knowing that I have two doctors working for me who are both on the same page," he said.
What the Somerset couple doesn’t see is the coordination behind the scenes. Tallia and the cardiologist both have access to Lou Carcich’s electronic medical records. If there is an issue Tallia wants the cardiologist to look into, he can make a note in the record for the cardiologist.
Tallia and other members of his team are looking forward to forming new partnerships with faculty from other academic units and research institutes at Rutgers – including the College of Nursing, the School of Social Work, the Edward J. Bloustein School of Planning and Public Policy, Rutgers Center for State Health Policy and all the units of the new Rutgers Biomedical and Health Sciences – as Robert Wood Johnson Partners moves ahead.
“This is one of the first tangible benefits of how the new Rutgers is going to serve the state of New Jersey in health care,’’ Tallia said. “This was not possible before. Now we have all the pieces under one roof.’’

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