Jewish Healthcare Foundation approves more than $1.5 million in funding
December 17, 2007
The Jewish Healthcare Foundation's board has approved $1.5 million in grants, including $200,000 for the first stage of a three-year project to redesign care for patients whose chronic illnesses are complicated by substance abuse.
The substance abuse project is expected to incorporate promising new screening tools and to emphasize the use of "medical homes" for improving diagnosis and treatment of substance abuse in patients with illnesses such as diabetes, chronic obstructive lung disease, high blood pressure and congestive heart failure.
The goal is to reduce emergency room visits, hospitalizations and recurrent detoxifications through better screening, office-based treatment and follow-up of patients with substance use problems that put them at risk for addiction or complications of other medical conditions.
Of the 23 million Americans who meet diagnostic criteria for substance abuse only 17 percent receive ongoing professional or recovery-support services. Roughly 30 percent don't seek treatment. Another 53 percent seek help but do not receive continuing care. Many millions more who are attempting to manage chronic health conditions complicate that care through problematic drinking or drug use.
The JHF project is timely for several reasons. First, treatment in medical homes—where one physician practice provides or coordinates all of a patient's medical and behavioral care— is viewed as the new frontier for primary care and fertile ground for testing changes in current healthcare reimbursement methods. Leading professional organizations, such as the American College of Physicians, the American Academy of Family Physicians and others have endorsed the concept.
In addition, the JHF demonstration would make use of new screening and brief-intervention tools that researchers and clinicians working under a federal grant in Pennsylvania and seven other states have piloted, along with appropriate follow-up care.
Use of these brief screens with appropriate treatment and follow-up shows promise of improving health while dramatically reducing health costs and substance abuse, including among those whose habits put them at risk but don't yet meet diagnostic criteria for addiction, said Michael Flaherty, PhD, Executive Director of the Pittsburgh-based Institute for Research and Training in Addictions (IRETA). IRETA is expected to be a partner in the JHF project, along with the University of Pennsylvania's Treatment Research Institute (TRI) and its affiliate, the Center for Organization and Management in Addiction Treatment (COMAT).
"This is the future," Dr. Flaherty said. "In our life time, you'll see more and more of these brief screens for other illnesses because this is the model for improving chronic care."
Tackling addictions or addictive behavior in medical homes also is expected to improve care, said A. Thomas McLellan, PhD, Chief Executive Officer of TRI. "The largest substance use problems in our society are cigarettes and alcohol. Over 70 percent of individuals with these problems are employed and insured. Less than 10 percent of them receive any kind of treatment," he noted. "One reason for the failure to address these problems is that 'addiction' is treated in specialty programs and there has been very little involvement of primary care, especially for those who may not be 'addicted,' but may be drinking too much."
The JHF demonstration also will test payment methods needed to support screening and early intervention in primary care practices that serve as medical homes.
JHF and the Pittsburgh Regional Health Initiative, one of the Foundation's operating arms, have been actively supporting development or deployment of new models for treating chronic diseases such as diabetes for a number of years and also began working recently on a demonstration to reduce hospitalizations and ER visits associated chronic obstructive pulmonary disease. Additionally, JHF and PRHI have been planning demonstrations aimed at aligning reimbursements with the best practices of care.
"In conversations related to those initiatives, our region's hospitals have indicated they are concerned about the high level of readmissions among patients with co-existing chronic disease and substance abuse diagnoses," said Karen Wolk Feinstein, PhD, President and Chief Executive Officer of JHF and PRHI.
"Substance abuse is itself now recognized as chronic illness and can severely limit the ability to treat co-morbid chronic conditions like COPD," added Dr. Feinstein, who serves on the executive committee of Governor Rendell's Chronic Care Management, Reimbursement and Cost Reduction Commission and co-chairs the Commission's subcommittee on aligning incentives. "But there's a significant problem in that the substance abuse either goes undiagnosed or is treated once, like an acute illness, only to be followed by chronic relapses because there was no referral for appropriate office treatment or follow-up."
Along with the addictions grant, JHF's board also approved:
- $25,000 for a needs assessment that the Pittsburgh AIDS Task Force plans as a step toward bringing patients who are HIV positive, but not in care, into treatment and ensuring that more people at risk for AIDS get testing for their HIV status; JHF serves as the state's fiscal agent for distributing funds among the organizations that provide services to the HIV/AIDS population.
- $20,000 for the Carnegie Science Center to devote segments of its SciTech initiative to health careers. SciTech offers interactive experiences to acquaint students with the science-related growth sectors of the region's economy. To showcase health care, SciTech will incorporate a career fair, featuring health professionals, and an opportunity to view surgery in real time via distance learning technology.
- $80,000 over two years for the University Of Pittsburgh School Of Education to continue developing radio broadcasts that stimulate greater public awareness about health-related issues. Under the grant, the JHF-supported Psychology Minute series of radio broadcasts on KQV will be replaced with a Healthcare Quality Minute series.
- $40,000 over two years for Friendship Circle of Pittsburgh to help establish programs that pair Jewish student volunteers with children who have special needs for recreational and social support.
The $1.5 million in grants that JHF's board approved earlier this month also included a $900,000 annual grant to the United Jewish Federation of Greater Pittsburgh, a $55,000 award to United Way's Impact Fund and a previously announced $250,000 grant for the first year of a two-year project to establish a web platform that provides online research, education and training resources for healthcare professionals engaged in process improvement work.