Care Transformation Center Blog

How England's complex care hub cut length of stay by 46%

by Tomi Ogundimu

This is the first blog in a series about care transformation around the globe, where we look at successful population health managers outside the United States. In this post, we highlight the successes of the Symphony Programme, a UK population health management initiative.

Increasingly limited resources and sicker patients have spurred health care innovation and integration across the globe. Countries like Australia, the United Kingdom, Germany, Spain, and the Netherlands are all building upon the successes of early adopters. Throughout 2017, we'll be sharing their stories and lessons for care transformation from international population health managers.

Our first case takes us to the Somerset region of England. In 2011, the local health payer commissioned an extensive analysis to determine which groups of patients were most costly to the system and would benefit from better coordinated care. A local university analyzed a year's worth of anonymized data from 115,000 patients, specifically with the goal of understanding how these patients were using health and social care.

What they found surprised them. The researchers expected to see that costs were primarily associated with age—with older people experiencing higher costs. Instead, they found that costs were explained more by a patient's number of chronic comorbidities.

Researchers then used cost data to identify the most expensive combinations of specific chronic conditions. Using analyses like the spider web graphic below, the researchers ultimately determined that costs were driven as much by patients' number of comorbidities as by their type of comorbidities. For example, they found that those with hypertension and more than three chronic conditions accrued the highest cost, where as those with asthma and no chronic conditions accrued the lowest cost.

Given these findings, local health care strategy shifted to focus on improving care quality and access for multi-morbid patients rather than the elderly specifically, which eventually led to the development of an accountable care delivery model: The Symphony Programme. The program is a partnership between South Somerset's hospital, a local payer, a PCP federation, and a county council.

Community-based multidisciplinary care hub key to program's success

While the Symphony Programme includes a range of population health initiatives, their complex care hub is a key part of their work.

Led by an extensivist, the hub team—which includes a PCP, care coordinators, support staff, specialists, social workers, and a shared group offering advanced diagnostics and urgent care—provides care coordination, medical input, and a single personalized care plan co-developed with patients for multi-morbid patients.

Patients receive specialist care as well as education and preventive services. In between visits, patient conditions are remotely monitored through a web platform where the hub team and patients can connect and view the care plan.

Initially, the complex care team was located within the hospital. PCPs would refer their patients to the hub, which would then completely assume care of the patient. Symphony has since adjusted the model so that the hub integrates into primary care—with each care team supporting three to four practices. Today, PCPs remain in charge of addressing patients' everyday needs, while the complex care team provides supportive wraparound services.

Between 2014 and 2015, the hub helped reduce ED admissions by 33%, reduce inpatient visits by 29%, and lower length of stay by 46%.



Finding cost savings with improved patient observation

Observation use has become increasingly common, growing over 96% since 2006. A large portion of those stays are CV-related, which presents CV service lines with an excellent opportunity for savings.

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