Rising health care costs, concern about medical errors, and the needs of aging Americans are just a few of the forces pushing health plans and hospitals to re-engineer how health care is delivered.

Recently, 50 leaders in health and managed care gathered at the first Cogent Healthcare Forum, “The Future of Inpatient Care,” to discuss the forces and strategies that can shape hospital and healthcare into this decade, and beyond. The new paradigm outlined in these discussions integrates hospital services with disease management, home care, end-of-life planning, and care delivery in outpatient and sub-acute settings. It also reduces medical errors, supports regulatory compliance, improves outcomes, and increases patient satisfaction.

“The Forum was an incredible success”, says Michael Brouthers, President and CEO of Cogent Healthcare, Inc., “I was amazed to see the energy and hear the positive comments coming from so many hospital and health plan administrators to these concepts. Obviously, the health care system in our country is ready for improvements of this nature.”

The components of the model presented at the Forum include the following tenets:

1. Ensure that each patient is managed as efficiently and effectively as possible on each day of hospitalization and beyond.

2. Decrease the variability and errors occurring in inpatient care, and increase standardization of care through best practice methodologies.

3. Build a network of high quality “physician integrators” focused on delivering inpatient care 24/7 and supported by specially trained clinical care coordinators.

4. Support these “physician integrators” and their clinical teams by a medical informatics and technology infrastructure that measures outcomes and performance, maximizes the efficiency of the workflow, identifies obstacles to efficient care, and works toward the standardization of care and operations across multiple institutions on a daily basis.

5. Early inpatient management programs utilizing hospitalist physicians have demonstrated that initial quality and cost improvement results are not sustainable without appropriate measurement tools and without proper support processes, including people, systems, and continuous quality improvement methods. A program that rests solely on the back of the physician is, in fact, not sustainable.

6. Involve the physician integrators to ensure early and appropriate triage in the emergency room. The availability of a hospitalist physician to rapidly evaluate a patient arriving in the ER will help get that patient directed to the most appropriate care setting for immediate intervention.

7. Extend this inpatient care management process to strategically appropriate outpatient and sub-acute programs, ensuring that patients will be managed as efficiently and effectively as possible in AND outside of the hospital.

8. Employ systems to measure quality and identify inefficiencies. These systems must be capable of identifying the “root cause” of these situations, versus simply uncovering anecdotal information. Instruments must ask the right questions and communicate findings to appropriate parties, who then are charged with developing action plans that can standardize care and operations across multiple institutions.

9. Encompass end-of-life planning in inpatient and outpatient settings. While health plans are required to educate members about advanced directives, most Americans do not have an advanced directive. A JAMA study (March 15, 2000) concludes that increased use of advanced directives reduces utilization without affecting satisfaction or mortality. Medicare patients with advanced directives cost 1/3 that of final hospitalizations for those without them. Hospital costs for nursing home residents with advanced directives was 54% less than for those without such instruments.

10. Deploy both technology and disease management approaches to improve prescription management and compliance with a focus on reduction of medication errors.

11. Target illnesses that require the most frequent hospitalizations for management in inpatient and outpatient settings. It is especially imperative to take a disease management approach in the home care setting, where fragmentation in care management frequently leads to recidivism and re-hospitalization.

12. Analyze and audit how high volume diagnosis are treated and actively address barriers to timely care that are identified in the audit.

13. Assess patient and physician satisfaction with the care system as a part of the care management plan.