Health Care Innovation Awards Round Two: Detroit Medical Center, Vanguard Health Systems Project Profile

Project Title: "Gateway to Health: An Innovative Model for Primary Care Expansion in Detroit"
Geographic Reach: Michigan
Estimated Funding Amount: $9,966,608

Summary:

Detroit Medical Center is receiving an award to test a proposal that would make primary care immediately available to individuals who arrive at 4 major inner city Emergency Departments for non-urgent care by establishing adjacent patient-centered medical home clinics. The initial focus will be on improving the care provided to patients with diabetes or asthma, and Emergency Department "super-utilizers" who have 10 or more visits annually. Medicaid fee-for-service beneficiaries will be the dominant target population. The program will expand to include patients with hypertension, congestive heart failure, chronic obstructive pulmonary disease, HIV, and depression. The design is based on the Nuka model in Alaska.

Team-based interaction with the patient will consist of face-to-face visits, telephone contact, and texting. Services will include an initial assessment of patient expectations, screening for depression, and active engagement of patients in their disease management. Coaches and navigators are essential to the model and are expected to have the greatest impact. The ultimate objective is patient wellness through self-management.

The goals of the project are to reduce emergency room service costs for the subset of emergency room patients with non-urgent care needs while concomitantly increasing access to patient-centered medical homes.  Detroit Medical Center also hopes to minimize the potential impact that Medicaid expansion under the Affordable Care Act may have on emergency room utilization.

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