Two of the projects selected for funding in this competitive process were submitted by UPHS.
Helping Patients Stay Medication Compliant
Almost all people who have had heart attacks will be prescribed several medicines to help prevent them from having another heart attack. But existing research shows that only about half of all patients are still taking their medicines after a year—even after something as important and scary as a heart attack.
Improving medication adherence and health outcomes in these post-discharge patients is one of the Penn projects selected for funding. “We want to find new ways to help people stay on track with their care,” said David Asch, MD, MBA, who submitted one of the selected projects with Kevin Volpp, MD, PhD, both of the Department of Medicine, Leonard Davis Institute and the Penn Medicine Center for Innovation.
Titled “A rapid cycle approach to improving medication adherence through incentives and remote monitoring for coronary artery disease patients,” the project involves monitoring patients from remote locations -- such as their home -- and a visual and audible "reminder" system that prompts patients to take their medications. “We need to find ways to engage our patients outside of the office visits and hospitalizations where we currently see them,” said Asch. “So many of our health outcomes depend on what happens outside of these visits—what we do when we are at home or at work, and whether we take our medications, exercise, and follow healthy diets. “
The project will also retrain social workers as engagement advisors to monitor adherence, offer incentives, and enlist patient support from family and friends. The result will be improved health outcomes and lower cost. The $4.8 million dollar-funded program will train an estimated 21 workers, while creating an estimated seven jobs. The project is estimated to save CMS $2.7 million.
Throughout their illness, many patients with advanced cancer will need a variety of services. Although hospice offers valuable help, it is limited to patients who want to focus on comfort care. In order to better meet the needs of patients with advanced cancer who want to continue receiving cancer treatment, David Casarett, MD, UPHS director of Hospice and Palliative Care, created the CLAIM program (Comprehensive Longitudinal Advanced Illness Management), the second Penn project to receive CMS funding.
CLAIM is designed to provide a comprehensive set of home-care services, enabling patients with cancer to remain in their homes and avoid unnecessary -- and frequently undesired -- hospitalizations. CLAIM services will include a visiting nurse trained in palliative care, social worker, and access to a chaplain and to a home health aid (for practical help around the house). “Patients will also have access to a pharmacist to assist with what are often complicated medication regimens,” he said.
CLAIM’s overarching goal is to improve the quality of care that patients receive and, in doing so, decrease unnecessary hospitalizations. Casarett described an example of a patient with lung cancer who is in severe pain. “She wouldn’t want to go to the hospital if she doesn’t have to but many patients have to go to the emergency room or the hospital because they can’t get the help they need at home,” he said. “With CLAIM, we can send a visiting nurse who can contact the pharmacist and coordinate with the patient’s physician, allowing the patient to receive the pain medication she needs without going to the hospital.”
Casarett said that, while some problems will require a trip to the hospital, “this program will help us resolve problems the patient would rather manage at home.” Patients in the program would still continue treatment, with the same oncologist.
Using the CMS funding, Casarett will test CLAIM for Medicare and/or Medicaid beneficiaries with advanced cancer in five counties in the metropolitan Philadelphia area. The $4.3 million dollar-funded program will create an estimated 16 jobs and train 64 workers. The project is estimated to save CMS over $9.4 million.