Michigan BOOST program aims to improve discharge transitions

ANN ARBOR-Blue Cross Blue Shield of Michigan and 15 hospitals will embark on a statewide project in May to cut the millions of dollars spent on preventable hospital readmissions.

Project BOOST (Better Outcomes for Older Adults through Safer Transitions) is a transitional care coordination model created by the Society of Hospital Medicine, launched last year at six pilot sites around the country. Using hospitalists, BOOST aims to reduce hospital readmissions with patient education, better communication between inpatient and outpatient providers and timely follow-up visits.

Blue Cross Blue Shield of Michigan (BCBSMI), with 4.7 million members in the state, and the University of Michigan will manage the program.

The initiative includes the Physician Group Incentive Program, which rewards physicians with added reimbursement for practice improvements such as transitioning to a patient-centered medical home model. The incentive program includes 80 physician organizations, 8,148 physicians and 2 million members.

"[The initiative] includes the responsibility for care across the continuum," Dr. Share says. "Following patients over time and in different settings of care, not just when they come in the door."

Teams will be assigned a mentor to coach them through the process of planning, implementing, and evaluating Project BOOST at their site. Program participants will receive face-to-face training, monthly coaching sessions with their mentors, and a toolkit to implement Project BOOST. Sites also participate in an online peer learning and collaboration network. BCBSMI will pay for the physicians' mentor training.

STRUCTURE USES EXISTING TOOLS

Physicians and hospitals will share patient and discharge data using methods and existing technology already available within their community or physician organization.

"What we expect is they will figure out how they will communicate between the hospital and outpatient setting, what tools they use and how they could augment those tools," Dr. Share says. "If it's posted on an electronic record, or they're using some kind of Web portal, which some do, or Pony Express, or fax, it's up to them."

Performance metrics have yet to be determined, he says, but they will likely involve proof of medication reconciliation, patient education, timely information transmission to the office, and confirmation of outpatient office appointment after discharge.

The April 2009 New England Journal of Medicine shows one in five hospitalized patients is readmitted to the hospital within a month of their discharge. The estimated cost of unplanned hospital readmissions in 2004 accounted for $17.4 billion of the $102.6 billion total hospital payments made by Medicare that same year, according to the study.