Today Baystate Franklin Medical Center hosted a gathering of healthcare providers, government and state health officials, and community partners to celebrate the hospital’s receipt of a $1.8 million grant from the Massachusetts Health Policy Commission to strengthen the support system for patients with complex medical, behavioral and social needs in Franklin County, and reduce potentially avoidable hospital visits and admissions.
The grant is part of the state’s Community Hospital Acceleration, Revitalization and Transformation (CHART) Investment Program, a two-year initiative aiming to improve the effectiveness and efficiency of healthcare services throughout parts of the Commonwealth served by community hospitals.
“The CHART funding we’ve received is helping us take a truly innovative approach to addressing some of our most difficult challenges in improving the health of our community,” said Dr. Thomas Higgins, interim president of Baystate Franklin Medical Center (BFMC). “By adapting our resources to help our patients stay out of the hospital and get on track for sustainable long-term health, we and our partners are recognizing the needs of our patients and leading important changes in how we provide care.”
The Health Policy Commission’s executive director, David Seltz, attended the event.
“CHART hospitals were issued a challenge: propose initiatives that will put you on a path of transformation, while meeting the critical health care needs of your community,” said David Seltz, executive director of the HPC. “Today, I’m pleased to report that Baystate Franklin Medical Center exceeded that challenge. We look forward to continuing to partner with Baystate Franklin Medical Center and the communities it serves to build a more coordinated and affordable health care system.”
The specific goal of the CHART project at BFMC is to reduce repeated visits to the hospital’s Emergency Department, and readmissions to the hospital, among a population of patients that is identified to be frequent users of those services, especially in relatively small periods of time. The project is funding and establishing a team of care providers who can connect with these patients both inside and outside the hospital to help them manage their health and avoid hospital visits when possible.
Repeated hospital visits are bad for a patient's health; expensive for hospitals, insurance companies, and patients; and burdensome for caregivers and families. In order to reduce re-admissions, hospitals must work with local organizations, patients, and families to support patients. Patients more likely to be admitted multiple times may include those with chronic diseases, a lack of continued outside support (services or family), insufficient transitional care, a lack of knowledge about health or nutrition, and those without primary or specialty providers.
The CHART team at BFMC will include a program manager, a licensed social worker, a medical nurse practitioner and behavioral health nurse practitioner employed by BFMC, and community health workers employed by two community partners, Franklin County Home Care Corporation and Clinical & Support Options (CSO). Funding for those positions will come from the grant, as well as from the resources of BFMC.
“Assembling these resources to help our patients stay out of the hospital wouldn’t be possible under the existing model in which healthcare is financed and delivered,” said Leesa-Lee Keith, RN, chief nursing officer of BFMC and a member of the hospital’s CHART steering committee. “It’s a big change in the way we look at health and healthcare—and a positive one.”
Under the new model, if a patient comes to the hospital and care providers determine—via secure and confidential medical records—that the patient has been there a lot in the recent past, the CHART team will be activated to assess whether the patient might benefit from additional help in managing health challenges. The patient would then be offered appropriate resources, both inside and outside the hospital, to get on track to better health. That could include referrals to other services or programs, mental health or addiction services, or even a primary care provider.
The project was available to patients beginning in December 2015.