Editor's note: This popular story from the Daily Briefing's archives was republished on Jan. 24, 2019.
The Better Health Partnership, a health improvement collaborative operating in the Cleveland area, generated almost $40 million in savings and reduced hospitalizations by nearly 6,000 from 2009 to 2014 by focusing on primary care, John Commins writes for HealthLeaders Media.
The Better Health Partnership launched in 2007 with a focus on improving care for patients with diabetes. Over the years, the partnership has expanded to work with more than 100 primary care practices, ranging from large health care systems like the Cleveland Clinic, MetroHealth, and the VA to smaller safety-net and community providers. The partnership also has broadened its focus to include heart failure and hypertension. Today, the collaborative serves more than 400,000 patients.
Randall Cebul, a member of the collaborative and an internist with MetroHealth Medical Center, who co-authored a Health Affairs study that analyzed the collaborative's results, sat down with Commins to discuss the Better Health Partnership's success.
How the collaborative saved money
According to Cebul, the bulk of the partnership's savings resulted from reduced hospitalizations.
"It's all reductions in hospitalization costs for cardiovascular conditions, diabetes and diabetes complications, high-blood pressure, and heart failure," he said. "Heart failure is not the most prevalent, but it clearly saw the most cost-savings for hospitalizations. About $20 million was the heart failure part of the $40 million, and the other savings were related to diabetes." He added that, while hypertension is very common, it doesn't often require hospitalization.
Those lower hospitalizations, according Cebul, were largely realized through the work of primary care physicians. "Part of the secret sauce has to do with physicians taking ownership of the care of their patients, and if that requires engagement of services that are outside the community health center, that's what we recommend," he said.
According to Cebul, the partnership from the start has relied on provider-led initiatives. The partnership tracks those efforts to determine whether an initiative is working and, if so, whether it's replicable in other settings. Approaches that are deemed successful and replicable are presented at the partnership's biannual meetings.
A big commitment
While the partnership has saved nearly $40 million, Cebul said the partnership itself doesn't necessarily reap the financial benefits. "Maybe we will go cap-in-hand and ask for some of that savings," he said.
For hospitals, he said, it's "actually a loss." By reducing hospitalizations, hospitals are "not filling beds" with patients, most of whom have health insurance, he said.
But Cebul said hospitals that participate in the collaborative are "committed to lower costs, population health—the triple aim of better care, better outcomes, and lower costs." He added, "No hospitals that we asked to join us were unable to get the commitment from their visionary leaders."
At the end of the day, Cebul said, the key to creating a successful primary care-focused partnership is involving "people who care." He continued, "We believe that all health care is local. So, being committed to a community is key. There has to be cooperation and leadership within the physician community and a willingness to share data, and we've done that" (Commins, HealthLeaders Media, 3/7).
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