Health Care Home Outcomes

Courage Center Health Care Home Outcomes 2012

Courage Center’s primary care clinic, a health care home, is a unique approach to providing care to clients with disabilities who have complex medical needs. Courage Center’s Health Care Home (HCH) provides primary medical care and is co-located with rehabilitation and psychiatric services. The clinic strives to provide advanced medical coordination to improve the health of our clients and their health care experience. The goal of the HCH is to partner with the client to keep them as healthy and independent as possible.

Courage Center’s HCH provides

• Comprehensive primary care with coordination of services  
• Improved coordination with sub-specialists; coordination of services provided by medical and community resources
• Preventive and wellness care
• Ongoing care coordination support, designed to increase client engagement

Demographics

At the end of 2011, Courage Center has served 206 clients in HCH.

• 79% Caucasian, 11% African American and the remaining 12% are other ethnic minorities.
• 65% are Male and 35% are Female
• 46% have incomes below the federal poverty guideline, 21% have incomes between 100% to 200% of poverty, and 33% are above 200% poverty. 
• 96% speak English as their primary language.
• Clients’ ages spread evenly from 26-65 years old with few under 25 and over 66.
• The two most common diagnoses are brain injury (37%) and spinal cord injury (36%).

Outcome measures collected within the HCH program at Courage Center include: healthy days, depression, the number and severity of secondary conditions, and the number of Emergency Department (ED) or hospitalizations visits.

Surveys

The measures being used to determine the impact that HCH is having on our clients are:

• Healthy Days: clients identify the number of healthy days they have had in the last month.
• PHQ-9: identifies depression.
• Secondary Conditions Surveillance Instrument (SCSI): determines the number and severity of secondary conditions.

• Patient Activation Measure: measure of patient’s knowledge, competence and confidence in taking an active role in maintaining their health.

Healthy Days

• Clients reported an increase in healthy days after participating in HCH for at least 11 months. On average they reported 10.9 healthy days a month initially and 15.9 days after 11 months or more.

Depression

• 88% have some symptoms of depression
• 37% report minimal depression
• 26% report moderate to severe depression

Secondary Conditions

The number and severity of 26 common secondary conditions is collected from Courage Center’s HCH clients. The average number of health conditions among our HCH clients is eight and ranged from zero to 21. The most common conditions identified by our patients are pain (56%), spasticity (54%), joint pain (52%), and depression (51%), with fully a third of our clients identifying that they have sleep, pain and depression.

The five most common conditions are:

• Pain
• Spasticity
• Joint Pain
• Depression
• Fatigue

When the number of secondary conditions are collected through a chart review, our clients have an average of 13 health conditions. 

Cost Savings

Courage Center is demonstrating that excellent primary care can improve our clients’ health, decrease overall health care costs and improve the client’s health care experience.  As one example, we are tracking the cost of hospitalizations and ED visits prior to enrollment and the period since enrollment in our HCH.  The Minnesota Department of Human Services has been sharing their hospitalization data with us to perform this task.  At the end of 2011, 206 clients had been treated in our HCH. Of these 206, health care utilization data was collected from the 133 clients on their symptoms.

At the end of 2011, the hospitalization rate was:

• 11.16 days per year PRIOR to Health Care Home
• 2.4 days per year AFTER Health Care Home

This 80% reduction in hospital days translates into significant cost savings. At the 2007 rate of reimbursement by the Minnesota Department of Human Services, this reduction in hospitalization rates yields a significant savings in hospitalizations of $2.38 million over the time the clinic has been open, or $2.56 million per year for the 133 Medical Assistance patients currently enrolled.