A healthcare collaboration in one of the most populated counties in the country yielded big savings for hospitals and better health for residents, according to a new study in the September edition of Health Affairs.
Be There San Diego is a regional healthcare collaborative effort born out of the California Department of Managed Health Care and the Right Care Initiative of the University of California. BTSB seeks to reduce preventable morbidity and hospitalization related to heart attacks and heart disease through better identification and changing of risk factors, better clinical care and the implementation of best practices. Medical leaders from healthcare organizations, San Diego County, and several health plans that serve the county's 3.3 million residents lead the initiative and participation is voluntary.
The activities include clinical improvements in the management of hypertension, lipid levels, and blood sugar via "a simplified approach to hypertension treatment." It also includes the distribution of a medication bundle to lower the risk of cardiovascular events among at-risk patients or those with diabetes and improving medication adherence. There is a wider use of health coaches within the physician and staff patient care teams. Community action builds strong partnerships with African American faith-based organizations and connections between clinicians, pharmacists and health workers. There are recommendations for healthcare organizations on addressing hypertension and other healthcare issues.
Planning for the group started in 2010 and actual action commenced in 2011. San Diego County boasts the second highest population of California counties and the fifth highest county population in the country.
"This work is facilitated through monthly meetings, at which best practices are shared among collaborators and transmitted to other clinicians and community partners, and key clinical metrics are reviewed and discussed by leaders from participating health care organizations," Health Affairs said.
Using hospital discharge data for the period 2007–16, which covers a pre-BTSD period and post-BTSB period, researchers compared heart attack hospitalization rates in San Diego County against the rest of the state before and after the BTSD project started. Results showed a 22 percent decrease in San Diego County from the pre-period to the early post period, compared to an 8 percent drop for the rest of the state.
San Diego's heart attack hospitalization rate of 137 per 100,000 residents was significantly lower than the rest of California, which showed a rate of 164 per 100,000 residents during the early post period. Although both areas saw a slowdown during the late post period, there was still a gap of 30 heart attack hospitalizations per 100,000 residents between San Diego County and the rest of California.
Without the BTSD work, San Diego rates were two AMI hospitalizations per 100,000 residents below rates in the rest of the state, researchers said there would have been an average age-adjusted rate of 162 rather than 136 hospitalizations per 100,000 people during the post period. That means the BTSD project yielded 3,826 heart attack hospitalizations that were avoided for the entire post period and a savings of $85.8 million in care costs.
"To put this into context, if the rest of California had had trends in AMI hospitalization rates similar to those in San Diego County during the post period, then its average age-adjusted AMI hospitalization rate would have been 138 rather than 164 per 100,000 residents, and nearly 42,000 AMI hospitalizations and $935 million in hospital costs might have been avoided," the researchers said.
Additionally, steady improvement was made from 2013 to 2017 in blood pressure control for diabetes and hypertension patients in the Data for Quality project for which San Diego health care organizations report . Among the roughly 200,000 people with hypertension, blood pressure control rates improved from from 72 percent to 80 percent. Rates for the nearly 100,000 patients with diabetes improved from 71 percent to 82 percent.
Researchers noted that BTSD leaders and participants worked directly and indirectly with other initiatives as well, so there may have been some overlap in impact from those other efforts. Changes to guidelines and quality measures may have also played a role.
With an increased focus on population health and social determinants of health, the study certainly makes a case for investing in preventative measures and the potential impact such a collaborative could have on any community, if there is a wide swath of key stakeholders engaged and relationships with the community are a part of the effort. The financial benefits of preventing costly and physically traumatic episodes of care like heart attacks are self-evident as expenses continue to climb for hospitals as revenue stagnates and margins constrict.
"Although this type of collaborative might be more challenging to execute in geographic areas that have larger populations, or are more spread out with a greater number of healthcare systems than is the case in San Diego County, the basic organization and implementation of BTSD should be generally applicable elsewhere. The benefits of using evidence-based approaches should accrue to all similar patients," researchers said.