CAPP Physician Group: EVERETT CLINIC, VIRGINIA MASON MEDICAL GROUP
Project: Boeing Company Intensive Outpatient Care Program

Summary: An innovative pilot program sponsored by Boeing, called the Intensive Outpatient Care Program, brings together the medical groups, insurer, and employer purchaser to identify and manage the health care quality and cost of Boeing patients with complex chronic conditions.

The Boeing Company is sponsoring an innovative pilot, the Intensive Outpatient Care Program (IOCP), to improve health care delivery for employees and family members who need the most complex health support and care. In a unique partnership, Boeing is working with three provider groups in Puget Sound, Washington - The Everett Clinic, Virginia Mason Medical Center, and Valley Medical – to implement the IOCP to provide improved patient experiences and higher quality, more cost-effective care. More broadly, this initiative supports Boeing’s ongoing efforts to positively influence and change the U.S. healthcare system.

The pilot’s goals are to:
• Improve clinical quality, patient satisfaction, and the overall health status of the patients.
• Deliver quality health care, resulting in lower costs for Boeing, its employees and its employees’ family members and improved long-term affordability for all.
• Design a model that can be expanded to other Boeing employees and their family members.
The most complex patients are identified through independent and confidential analysis of past health insurance data and through clinical evaluation by their doctor and enrolled in the program. These individuals often have multiple chronic conditions, involving several specialists, ongoing testing, many medications, frequent ER visits and hospitalizations, all with no single source of support for these complicated needs. The IOCP model provides customized care delivered by a personal advocacy team to help manage their health issues and navigate the system - utilizing evidence-based medicine to provide high quality and efficient care. Participants are invited to join the pilot program by their current health care provider, at no additional cost to the participant.

The IOCP at the clinical sites provides participants with:
• Highly customized clinical care, social support and navigation of the healthcare system
• An intensive intake visit and a customized shared care plan
• A dedicated team supporting each participant
• Access to 24/7 care via email, phone and home visits
• Proactive and reactive evidence-based care deeply integrated with existing providers
• A very high level of customer service to employees and their families

Boeing’s role as a sponsor is to provide financial support to the three medical groups enabling them to invest the time and extra resources necessary to deliver the IOCP. Mercer Human Resources and Renaissance Health provide the on the ground training, consulting and support to Boeing and the three sites during implementation and in the evaluation process. Regence Blue Shield of Washington is the participating health plan.

The IOCP model itself is based on the Ambulatory Intensive Care Unit (AICU) model, developed by a group of healthcare leaders, funded by the California Health Care Foundation in response to the growing urgency for quality and efficiency improvements in the U.S. healthcare system. Analogous to the services of and populations served by hospital ICUs, AICU serves a group of patients who benefit from intensive outpatient care – with customized plans, personal attention, different staffing models and advanced technologies.
• This group represents the most complex and most expensive 10%-20% of a population, and can incur up to 80% of a population’s healthcare spending.
• These patients who utilize the healthcare system the most – those with chronic, complex and costly needs - are the most underserved by the current healthcare system which is often reactive, fragmented, difficult to access and navigate, and expensive.
• This under-managed, complex care leads to further fragmentation of care and drives the rise in healthcare costs to alarming levels, leading to less overall health insurance affordability and increasing numbers of uninsured.

The AICU and the IOCP models are specifically targeted to address the needs of this unique population in order to positively influence health care quality and affordability for all.

For more information about this project, contact Al Fisk, MD (Everett Clinic); Tim Neale (Boeing) at (312)-544-2921; Pranav P. Kothari, MD (Renaissance Health) at (301)848-8412; or Angela Hult (Regence) at (503)412.7902.

Integrating Services for Low-Income Seniors Shows Health Care Benefit, by Claire Sowerbutt, Contributing Writer, MedPage Today, December 11, 2007.

INDIANAPOLIS, Dec. 11 -- For low-income seniors, the likelihood of providing the recommended standard of health care services could be enhanced by integrating home-based and institutional services, found researchers here.

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“From High Tech to Soft Touch: The Everett Clinic uses innovative ways to control health care costs,” by Bryan Corliss, Washington CEO, November 26, 2007.

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“CAPP’s 35 MSMGs [multispecialty medical groups] share a common vision as learning organizations dedicated to the improvement of clinical care. Their features include physician leadership and governance; commitment to evidence-based care management processes; well-developed quality improvement systems; team-based care; the use of advance clinical information technology; and the collection, analysis, and distribution of clinical performance information. These features are congruent with the [Institute of Medicine’s] recommendations on key elements needed to redesign delivery systems.”

From Chapter 5, “Developing the Test Bed—Linking Integrated Service Delivery Systems: Council of Accountable Physician Practices,” by Michael A. Mustile, MD. The Learning Healthcare System: Workshop Summary (IOM Roundtable on Evidence-Based Medicine), edited by LeighAnne Olsen, Dara Aisner, and J. Michael McGinnis, National Academies Press, 2007.

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“A shift from the current care model to a more coordinated care model centered on primary care is one potential way to help stave off the healthcare dilemma.”

“It's too expensive to be a primary-care doctor,” by Debra A. Geihsler, president and CEO of Harvard Vanguard Medical Associates & Atrius Health. Boston Globe, July 25, 2007.

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