Med-IC aims to improve health care for older adults

The Medicare Innovations Collaborative, or Med-IC, is a pilot program that will put some of the nation’s best ideas for improving health care for older adults into practice at hospitals around the country, Mount Sinai School of Medicine and Johns Hopkins University announced.

“By incorporating these new models into their geriatric programs, hospitals will be able to improve both the care they provide to this growing population and their own financial health as well”

Med-IC aims to effect change in health care policy, both by testing leading geriatric care models in a hospital setting and by demonstrating how these innovative programs can help hospitals remain profitable while providing better, more cost-effective care to their Medicare patients. Med-IC comprises an expert, nationally recognized group of geriatrics leaders, six participating health systems, and the new model developers, made possible by a grant from The Atlantic Philanthropies.

“Caring for older adults is a central challenge facing hospitals today,” said Albert Siu, M.D., principal investigator of Med-IC. Siu is the Ellen and Howard C. Katz Chairman and professor, Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine. “By incorporating these new models into their geriatric programs, hospitals will be able to improve both the care they provide to this growing population and their own financial health as well,” Dr. Siu noted.

“Med-IC offers a unique opportunity for hospitals to put cutting-edge research into practice every day in their own communities,” said Bruce Leff, M.D., co-principal investigator of Med-IC. Dr. Leff is Associate Professor of Medicine at the Johns Hopkins University School of Medicine with a joint appointment in the Department of Health Policy and Management at The Johns Hopkins University Bloomberg School of Public Health. “This allows health systems to bring the benefit of new models to their communities and, at the same time, to contribute to the urgently needed effort to find new and effective ways to care for older patients.”

Six Health Systems Selected to Test New Care Models

Med-IC will work with a group of six competitively selected health systems, each with a track record of excellent geriatric care. Each site will test one or more innovative programs designed to improve care for Medicare patients with multiple chronic conditions. These challenging patients make up an increasingly significant portion of the hospital population, and their care is complex and expensive. The six sites will serve as “learning laboratories,” testing the feasibility of offering patients access to these evidence-based programs in acute-care inpatient hospital situations.

The six sites chosen to participate in the Medicare Innovations Collaborative are:

• Aurora Sinai Medical Center, Milwaukee, WI;
• Carolinas HealthCare System/Mercy Hospital, Charlotte, NC;
• Crouse Hospital, Syracuse, NY;
• Geisinger Health System/Geisinger Clinic, Danville, PA;
• Lehigh Valley Health Network, Allentown, PA;
• University Hospitals Case Medical Center, Cleveland, OH.

Models Address Gaps in All Stages of Geriatric Care

The participating health systems will work together to share their existing best practices and adopt and test a portfolio of one or more new care models at each site. These programs address a range of needs, including keeping older people out of the hospital when they do not need to be admitted, caring effectively for patients in the hospital, and preventing hospital readmissions by helping patients make effective transitions home from the hospital. The six models in the initial portfolio include:

• ACE (Acute Care for Elders), a patient-centered model that combines geriatric assessment and quality improvement, a prepared hospital environment (the ACE Unit), interdisciplinary team rounds, planning to return home, and medical care review.
• NICHE (Nurses Improving Care to Healthsystem Elders), a national program providing clinical and organizational tools to improve hospital care of older adult patients and nurse competence.
• HELP (Hospital Elder Life Program), designed to prevent delirium among hospitalized older patients using trained volunteers and skilled interdisciplinary staff.
• Palliative Care, focusing on relief of pain and other symptoms of serious illness to prevent and ease suffering and to offer patients and their families the best possible quality of life.
• Care Transitions Intervention (CTI), a four-week program for patients with complex care needs and family caregivers that helps them learn self-management skills and meet their needs during the transition from hospital (or short-term rehab stay) to home.
• Hospital at Home, an innovative health care model that provides hospital-level care in a patient's home as a full substitute for acute hospital care.

Policy Feedback and Outreach

Med-IC will review results from each site and publish manuscripts and journal articles identifying challenges at each step, such as policy and payment barriers, and proposing solutions. This policy feedback loop aims to help all hospitals develop a line of geriatric services to fit their own situation, thus making better geriatric care more available and more sustainable everywhere.