R.I. hospital uses CMS grant to expand medical home model for premature babies

PROVIDENCE, R.I.—Women and Infants Hospital of Rhode Island hopes to expand the care it provides preterm babies and their families with a $3.2 million grant from the Centers for Medicare & Medicaid Services’ (CMS) healthcare innovation awards program. All four of Rhode Island’s congressional lawmakers met with local providers at the hospital on Aug. 15 to hear how the money will help them deliver higher quality care at lower costs.

Preterm births lay a costly burden on the national healthcare system. Approximately one million infants are born prematurely each year at an annual cost of $26 billion, according to Betty R. Vohr, MD, a 38-year veteran of Womens and Infants and director of its neonatal follow-up clinic. In addition to their specific healthcare needs and greater chances for rehospitalization, these patients can exacerbate the social and environmental stresses felt by their families.

To treat preterm babies, Women and Infants implemented the Transition Home Plus program, a medical home model of care administered by a multidisciplinary team that includes not only providers and nurses, but also administrative personnel with personal preterm birth experience. Coordinated care provided to preterm babies in the program includes support for primary care pediatricians, home visits from neonatal intensive care unit nurses, medication management and social service resources.

The program began in 2006 with funds from the White Plains, N.Y.-based nonprofit March of Dimes and treated 50 preterm babies that year. Women & Infants has since contracted with multiple health plans and received donations from CVS Caremark, a pharmacy chain headquartered in Woonsocket, R.I., to continue the program, which now treats approximately 100 of the most extreme preterm cases per year. Women & Infants will be able to expand the program for three years to treat 800 preterm cases annually with the CMS funds, according to Vohr.

The program has produced positive results so far. Women and Infants was able to reduce preterm rehospitalizations within 18 months from 30 percent in 2007 to 22 percent in 2008. The reduction was even more pronounced among preterm babies with public insurance. Rehospitalizations within 18 months for this subgroup dropped from 34 percent in 2007 to 23 percent in 2008. Women and Infants’ staff believes that the CMS funds will help them make even more progress, estimating that the total healthcare costs for preterm babies can be reduced by 20 to 40 percent with savings of up to $1.5 million per year in reduced rehospitalizations alone.

“It’s been really exciting to see this happen because it’s exactly the sort of thing we had in mind when we put together innovation grants and the CMS Innovation Center,” Sen. Sheldon Whitehouse (D-R.I.) said.

The CMS Innovation Center was established by and received funding for its healthcare innovation awards program through the Patient Protection and Affordable Care Act (PPACA). These awards are intended to fund initiatives that propose unique models of care with the potential to improve the quality of and reduce the costs of care provided to the beneficiaries of the federal government’s public health plans. In the first round of funding, only 26 of more than 3,000 applicants received awards. Those numbers indicate just how successful Womens & Infants approach has been, Rep. Jim Langevin (D-R.I.) noted.

While the PPACA relies on payment reform to accomplish its goal of reducing healthcare costs, these reforms don’t simply cut payments; they are incentivizing providers to redesign the way they deliver care to be more effective and efficient. Programs like Transition Home Plus show how it can be done. “There hasn’t been much discussion about this innovation aspect of health reform,” Rep. David Cicilline (D-R.I.) added. “This innovation component speaks to the underlying premise of health reform.”