Marshfield Clinic

Centers for Medicare & Medicaid Services

Purpose:

To both increase efficiencies and improve quality by supporting patients and families in partnering with their personal physicians

Target Population:

The Marshfield Clinic patient population

Program Goals:

• To improve the quality of life for patients with diabetes, hypertension, heart failure and coronary artery disease
• To save the Medicare program money.

Years in Operation:

2005 – 2008 (three-year Medicare Physician Group Practice [PGP] Demonstration)

Results:

First-year results demonstrated that the Marshfield Clinic improved clinical outcomes and lowered costs for patients with diabetes. Specifically, the number of hospitalizations for any reason among these patients decreased from 350 per 1,000 to 315 per 1,000 during a two-year period of the project. With 17,500 Marshfield Clinic patients with diabetes, an estimated 770 fewer people needed hospitalizations annually.

Funding:

Funds were those provided by a Medicare Demonstration grant, and those received by providing services to patients. Marshfield Clinic funded upgraded technology needs, nurse help lines, and other clinical and administrative supports required.

Key Partners:

Centers for Medicare & Medicaid Services (CMS); participating providers

What Works and Why:

Marshfield sees its success as an accumulation of incremental gains. Success isn't a single act but a multifaceted approach. Marshfield credits the use and accessibility of a common medical record for allowing greater coordination among providers, greater transparency, and the benefit of finding complete patient information easily.

Structure and Operations:

The Medicare PGP Demonstration Project evaluates physician groups against a cumulative set of quality measures in diabetes (year one), heart failure (added year two), and hypertensionand prevention treatment (added year three). Each medical group in the demo has the freedom to structure and design their own chronic care intervention. CMS evaluates whether the medical groups have saved Medicare money compared with other beneficiaries in the region not treated at the medical groups in the demonstration. Groups generating a savings of more than 2 percent share a part of the savings with Medicare.

Marshfield Clinic is composed of more than 40 clinics covering central, northern and western Wisconsin.

Each site has access to the centralized 24/7 nurse line. The nurses have access to the electronic medical records of the patients, the doctors' standing orders for the patient, patient education materials, and approved guidelines for treatment. Marshfield also has telephonic health rograms for dislipidemia and congestive heart failure. These programs provide disease education as well as information about diet needs, and may include daily check-ins with the patient about how he or she is feeling. Depending on the responses, a nurse may call the patient to ollow up and have the patient come into the office to be seen in person.

For the demonstration project, Marshfield accelerated the roll-out of computers to primary care physicians. The programs included chart reminders of recommended care for patients with diseases. Marshfield instituted telephonic programs for heart failure after the demonstration started.

The telephonic programs work as an extension of the physician's practice, not as a replacement. They are designed for patients not meeting clinical goals for managing their condition. Physicians are advised of the programs, and will refer a patient to them at the physicians' discretion. For example, if a patient isn't meeting his lipid goals, he receives education about the importance of meeting his goals, changing his diet, taking his medicine, and making other changes needed. He has his labs checked every eight weeks and is called in for follow-up as needed. Once at goal, he then has regular follow-ups.

The clinic has established metrics for their practice and will alert physicians when there are problems with a patient. The clinic provides tools to help plan the visit in advance. For example, there are alerts when an appointment is needed, and the alerts show what labs are due. That way, labs are scheduled to occur when the patient comes in for the appointment, eliminating the need for a second visit.

Barriers to Success:

Medicare reimbursement levels, upfront investment in technology required, and rewards coming years after program implementation create barriers to making necessary investments to enhance care services and improve outcomes.

More Information:

http://www.marshfieldclinic.org/patients/default.aspx

Download:

Download this program information in PDF format.