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Vanderbilt University Medical Center Reporter

ROUNDS: A message from the Vice Chancellor for Health Affairs

Posted on Thursday, Sep. 6, 2012 — 10:39 AM

The goal of this column is to dialogue with you in a meaningful way, about both the present and what we see in our future.

Jeff Balser, M.D. Ph.D. vice chancellor for Health Affairs and dean of Vanderbilt University School of Medicine

As we look toward the future of health care, it is increasingly clear that the entire model for care delivery must change. What we now do — head to the doctor’s office or the ED when we become sick — is inefficient and so costly it is bankrupting the country. We know our “current model” doesn’t provide people with the best possible health care.

How many times have we seen ideas come full circle?  Remember the days when doctors made house calls? In the future, many of us believe that health care of all sizes and flavors will increasingly be moved out of hospitals, even out of clinics, and into the daily lives and homes of our patients.

Even if provider systems are slow to appreciate the benefits of a new, lifestyle-friendly model for patients, the evolution we are now seeing in reimbursement models for hospitals and physicians will push us in this direction. “Global Payment” strategies, often discussed in the lay press, increasingly reward health systems and clinicians for optimizing the overall health of patients — as opposed to just paying us for the brief windows of interaction patients have with us in our hospitals and clinics.

At Vanderbilt, we are fortunate to be not only a user, but an innovator and discovery engine for the very resources — the tools, people and programs — required to lead the way in this revolution.

During a recent rounding visit I met with Laura Beth Brown, R.N., president of Vanderbilt Home Care Services, and her incredible staff. Not only is Home Care one of our best kept secrets, the program already plays a central role in our mission to move a broad array of Vanderbilt-quality services into patients’ homes. And we have the only program of this kind in our region.

Our program has nearly 200 staff possessing an average of 17 years experience. With an average census of 500 patients each day throughout Davidson and surrounding counties, this “virtual hospital” drives a combined 60,000 miles each month to provide this care. They will soon pass 1 million miles a year. And they are recognized as Best-in-Class by Home Care Elite as one of the nation’s finest home health agencies.

Through a unique partnership with Walgreens, we have been providing cost-effective home infusions of drugs, such as chemotherapy, durable medical equipment, and respiratory care services since 2009. And our strength in information technology allows our Home Care Services team to utilize patients’ health records while employing other important tools such as digital photo wound management and Blue-Tooth wireless telemonitoring in patients’ homes to help prevent unnecessary clinic visits and hospital admissions.

Beyond care for those who require home visits, one of our most important innovations to help patients and providers effectively manage their health in their routine of daily living remains MyHealth at Vanderbilt.

MyHealth is our innovative and evolving portal for patients and providers to actively partner in health management by being able to communicate directly and securely, share laboratory results, radiology reports, make appointments, pay bills and share the latest information on specific health conditions. Now entering its 10th year, MyHealth remains at the forefront of patient Web-based portals developed and used by academic medical centers. I believe those of you already using MyHealth will agree this has transformed the provider and patient relationship.

MyHealth now has nearly a quarter-million users, and 3,500 new users sign up each month. On peak days more than 5,000 patients access the site. Think about this — the number of patients who log into MyHealth each day is approximately the same as the number of clinic visits in the entire Vanderbilt health system each day. Could we have imagined such a remarkable transformation in the model of care even a decade ago?

Finally, in partnership with our new affiliate hospitals — Cookeville Regional Medical Center, Maury Regional Medical Center, NorthCrest Medical Center and Williamson Medical Center — we are poised to lead the way in bringing health care services into the home to dramatically improve the quality of care for chronic diseases that are difficult to treat. Patients suffering from high blood pressure, heart failure and diabetes have some of the highest rates of hospital admission, and the most to lose from a “status quo” approach to health care.

With the help of a Centers for Medicare and Medicaid Services (CMS) Innovation grant of $18.8 million, one of the largest grants ever awarded to VUMC in support of clinical innovation, we will be putting in place a new team-based model that leverages our expertise in informatics to streamline surveillance and provide our patients tailored, evidence-based care right in their homes.

Through this team-based, continuous approach to care, we will help patients develop a greater sense of control over their own health — through managing their own blood pressures and blood glucose levels — with the goal of reducing costly hospital admissions and Emergency Department visits. Our investigators anticipate health care savings that approach $40 million over the three-year study period.

Through these advancements and countless other creative and exciting programs, Vanderbilt seeks to lead the country in turning health care upside down — by moving our care to the patient, instead of waiting for the patient to find care. Doesn’t that kind of innovation express our own values as a caring organization?




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