Population health management
We are zeroed in on the end goals: improving the patient experience, improving health outcomes and reducing costs.
As more Americans are gaining access to health insurance through the Affordable Care Act, VCU Medical Center has the opportunity to examine how to provide the best care possible for different groups of patients defined by geography, clinical diagnosis or socioeconomic class.
In stratifying the population and concentrating on certain segments, we are able to identify common problems and find solutions that will benefit the collective group. This approach also allows us to more effectively align our resources, as we look to combine a variety of individual, organizational and societal interventions.
Our population health management initiative focuses on the Institute of Healthcare Improvement’s Triple Aim:
- Improving the patient experience of care (including quality and satisfaction);
- Improving the health of populations; and
- Reducing the per capita cost of health care.
Contact the Office of Health Innovation
Watch how the Complex Care Clinic transform lives.
Giving the sickest patients a shot at life through team-based care
In 2011, VCU Health’s Virginia Coordinated Care program established the Complex Care Clinic to improve the quality of care and decrease the costs associated with the sickest patients — those with six or more chronic illnesses who tend to get their health care by visiting the emergency room, sometimes several times a month. They also often have financial, social and other barriers to accessing care.
Complex Care Clinic staff members take a holistic approach, bringing together a team of professionals from across the health care spectrum to create a circle of support around each patient. The intensely collaborative visit looks at the entire patient and takes into account the barriers to care in order to connect the patient to the right resources and services.
The clinic’s model, based on providing the needed expertise in a single location, engages the patient in their care and builds a relationship of trust. The gained trust becomes critical for driving the behavioral changes necessary to increase patient compliance with the treatment plan, avoid unnecessary Emergency Department visits, improve health and decrease costs.
In its first year, the Complex Care Clinic achieved:
- 44 percent decline in inpatient admissions
- 38 percent decrease in Emergency Department use
- 49 percent reduction in total hospital costs
- Average annual cost savings of $10,769 per patient
- Total cost savings of $4 million
Want to learn more about VCC or the Complex Care Center?
Contact: Arline Bohannon, M.D., medical director
Student-led initiatives help underserved patients
VCU students have joined with the VCU Office of Health Innovation, other VCU units and community partners to make a difference in the lives of our patients and our city.
- With help from a $41,000 grant from the VCU Quest Innovation Fund, pre-med students worked with VCU partners, including the Office of Health Innovation, and the Daily Planet to develop and implement a program called the Health Education Literacy Program for underserved patients. Students working with patients in both the Complex Care Clinic and the Daily Planet received training in how to guide the patients in managing their diet and medications.
- The VCU Division of Community Engagement provided grant funding for a student initiative to educate the community on the appropriate use of the Emergency Department. Targeting frequent users of the Emergency Department who may not have a medical home, the students worked to share a message on alternative resources for care — allowing patients to receive the best care possible, while reserving the Emergency Department for true emergencies.
Want to learn more about our student-led initiatives?
Contact: Kim Lewis, VCC program coordinator