A group of doctors in Anchorage hopes to do a better job caring for some of the sickest patients in the city. It may cost more money initially, but in the long run, the goal is also to save health care dollars. The new group is called Alaska Innovative Medicine and the idea is based on a kidney dialysis clinic.
Cesar Jose spends 12 hours each week sitting in the same brown recliner at Liberty Dialysis in South Anchorage. On a recent morning, he settles in with slippers, a blanket and breakfast – a donut and cranberry juice.
After a weight and blood pressure check, a technician hooks Jose up to the dialysis machine. A small tube will serve as his kidney for the next four hours.
Jose is 67 years old and has kidney failure. But he laughs as he explains his labs are perfect.
“That’s why Dr. Gitomer told me, ‘Oh you’re boring because every month it’s the same… Oh Cesar, you’re boring!’ ”
Boring is exactly what Dr. Jeremy Gitomer is hoping for. To get to boring Jose has a team of providers – a doctor, a nurse practitioner, a nutritionist, a primary nurse, a technician and a social worker. They work together to make sure Jose stays as healthy as possible. It sounds simple, but Gitomer – who co-owns the clinic – says it is a long way from the standard in dialysis care when he came to Alaska about a decade ago:
“The death rate for dialysis patients was 25 percent (every year), which is terrible. And the patients really didn’t have close supervision. In fact, it was kind of a survival of the fittest.”
Gitomer does things differently. Cesar Jose’s team understands his basic health stats, like his potassium level. But they also know Jose has a weakness for hamburgers, that he wants to visit his four kids and 11 grand kids in the Philippines and that his wife lost her job recently. To get that kind of information, the whole team sits around a sprawling conference room table with patients and their families four times a year.
Six months ago, Gitomer says he had a patient who kept telling him, ‘I’m fine.’
“I didn’t realize that her husband was dying of Alzheimers. There was a tremendous strain on her and her family who were caring for her and her husband. We were able during that family meeting to hear all of this information and get him plugged into many Alzheimers resources, remove the burden from the family and now she’s not just doing fine, she’s doing great. She’s thrived and it’s really been one of those simple things that we never would have done in the past, because we never would have figured it out.”
Gitomer estimates it costs his clinic at least 50 percent more to care for patients compared to more typical dialysis centers in Alaska.
In the long run though, he’s convinced his patients save substantial health care dollars. And data from Medicare back him up. His clinic has one of the lowest hospital admissions rates in the country.
A few years ago he started wondering if a similar model could work for other chronically ill patients in Anchorage. Gitomer began talking to other doctors about setting up a group that would coordinate care for some of the sickest patients in the city. Dr. Terry Lester was on board from the beginning:
“I think this can have dramatic impacts,” Lester says. “I think this can be very big. We have the ability to truly reset the thinking of healthcare in Alaska.”
The group Lester and Gitomer came up with is called Alaska Innovative Medicine – or AIM. A health insurance company, Premera Blue Cross Blue Shield of Alaska is providing the initial funding. Premera won’t disclose how much, but describes the investment as ‘substantial.’ Starting in January, AIM will take Premera’s sickest patients and focus on doing a better job transitioning them from the hospital to home and providing more of their care at home. After a decade of working as a hospitalist in Anchorage, Lester has a long list of things he can’t wait to do differently.
“Physicians as a whole have not been very involved throughout a lot of reform in healthcare and I think that’s one of the biggest problems. We’re the ones who every day we see where things fall through the cracks, we see where the inefficiencies are, where the problems are, how we could do it better.”
Lester gives the example of a patient with a complicated case who is discharged from the hospital on a Friday afternoon. Home health services may not be available until Monday, which means the patient is on their own at a time when they’re at high risk for being readmitted to the hospital. AIM will have a case manager and a social worker to make sure the patient has help in those critical hours. They’ll also coordinate with the patient’s primary care doctor and specialists. Gitomer says one thing the doctors won’t do is focus on cost:
“Premera has guaranteed any home care that we have recommended for the first 30 days after hospitalization no questions asked, which is amazing when you think about that.”
Home care is not cheap. But it is a lot less expensive than a hospital. And long term, AIM’s goal is to save money… maybe a lot of it. The group wants to reduce hospital readmissions for their patients by 25 percent by the end of the three year demonstration project. They want to reduce ER visits by 6 percent. Gitomer thinks it’s going to work for one simple reason.
“We’re allowed to basically care for patients like we’d want to care for patients.”
If it is successful, AIM wants to use the same model to help the state’s Medicaid population. Gitomer says that’s where the group can have the most impact on the overall health of Alaskans and on the price tag of one of the biggest drivers of the state budget.
This story is part of a partnership between APRN, NPR and Kaiser Health News.