When health policy researcher Eric Coleman recently received telephone call, saying he had won a MacArthur Grant, he thought it was a prank. “The person kept saying this is not a prank, apparently reading my mind,” Coleman, head of health policy research at the University of Colorado Medical School, recalls. “There’s this whole sense of disbelief. It all feels like some kind of dream.”
The MacArthur Foundation awarded one of its $500,000 “genius grants” to Coleman for his work on health care transitions. Those are the hand-off moments, when a patient may move from a hospital to nursing home, or possibly back home.
It was a weird moment for Coleman, receiving a MacArthur for pursuing the research that he’s repeatedly been counseled against doing. “I was taking this high risk path knowing it easily could have gone wrong,” says . “I was pulled aside multiple times and told why don’t you try something else?”
The reason: Care transitions tend to be some of the most vexing moments in health care, where medical errors are frequent as patients change places and providers. Coleman’s own research has found that one in seven seniors transferred out of the hospital have at least one medical discrepancy in their care, directives to conflicting treatments that could cause harm.
Coleman has spent his entire 23-year career working on how to reduce those medical discrepancies, improving the quality of care while also reducing costs from costly complications. He became interested in that research area during his 18 years as a primary care doctor, and kept seeing patients who were stuck in a fragmented care system.
“It’s a fleeting time period when professionals are actually there,” Coleman says. “I’d walk into the exam room feeling like, ‘okay, I’m this person’s doctor. And then my jaw would just be hitting the floor as they told me about this epic odyssey they’ve been on, from the hospital to the nursing home to the rehab facility. That whole time I was not there.”
That got Coleman interested in the idea of not necessarily teaching doctors how to better handle transitions, but working ensuring that patients had the skills they need to navigate moving from one health-care setting to another.
The model Coleman thought up works like this: After a care transition, the patient receives an hour-long visit from a Transition Coach. The goal of that meeting is to figure out how well the patients are doing at managing their own care - and equip them with the tools they might need to improve.
“Instead of coming in and bringing this long list of discharge medicines, transition coaches would say something like, ‘I’d like to know what medicines you’re taking and how you take them,” Coleman explains. “And they’re saying there is no one right answer, that the patient might be sharing medications or going to Canada or Mexico to buy them.”
There are then three follow-up phone calls, all aimed at “skill transfer:” ensuring that the individuals have the skills they need to know when to call a doctor or how to manage follow-up appointments
The model is, admittedly, a pretty simple one. “It’s one home visit and three phone calls,” as Coleman puts it. But that small intervention has proved incredibly successful in reducing health spending by preventing costly complications down the line. When Medicare piloted Coleman’s model in 14 cities, it saved $100 million.
His home state of Colorado, where Denver was one of the pilot cities, saw a 9.3 percent reduction in readmissions among 89,000 patients.
“It’s the whole idea of teaching a man to fish, rather than just giving him a fish,” Coleman says. “Physicians in the hospitals and clinics have been very supportive of that. I’ve heard a number of transition coaches say this is the reason I went into medicine. This is actually helping people.”
Coleman’s Transitions Care model is now used at over 700 sites across the country and was even incorporated into the health care law, which includes funding for Community-Based Care Transition programs.
Figuring out the best way to move patients through the health care system is challenging. But Coleman says he’s optimistic about the direction that providers are now moving in.
“I’m a cup half full guy,” he says. “There are a lot exciting opportunities, with value-based purchasing, Accountable Care Organizations and bundled payments. We’re starting to see a remarkable shift, away from paying each provider separately and to putting those payments in a common pool.”
He thinks about his own experience managing care transitions, and how he’s run around the hospital trying to find a taxi voucher for a patient headed home.
“I’ve spent countless hours trying to get cab vouchers to make sure a patient isn’t transferring from bus to bus to get home,” he says. “Now let’s say you fast forward to an Accountable Care Organization and the average cost of a readmission is $9,600. In that case it seems pretty silly to worry about a $30 voucher when it could prevent a readmission. I’m not a super smart MBA, but it seems like having a big stack of cab vouchers, in that new system, starts to make a lot of sense.”
Coleman still hasn't figured out what exactly he'll do with his MacArthur money; he says it's still sinking in that he actually won this award.
"I'm certainly working on figuring that out," he told me, when I asked about his plans. "When you work a university and go from one grant to the next, you don't have time to stop and imagine pursuing something outside of that. I think what the MacArthur award presents is some freedom to do that. There certainly are a lot of opportunities to improve care transitions that I'll be interested in working on."