Formerly IGSW News | VOLUME 23 | WINTER–SPRING 2016

From the Director

Better results at lower cost?

CADER–Massachusetts General Hospital
Partnership Will Evaluate Acute Community Care

By Scott Miyake Geron

ScottFive years after passage of the Affordable Care Act, studies show substantial gains in coverage, quality, and cost control. For example, based on current accrued savings in healthcare spending, it is now projected that Medicare alone will spend $1 trillion less between 2010 and 2020 than was projected before passage of the Act, a new Commonwealth Fund report says.

That's all good. But we who work in aging and disability know that longstanding and new challenges—from population pressures to rising costs of pharmaceuticals—mean we must redouble our efforts if we are to sustain and increase these gains. Here at CADER we are pleased to be joining in partnership with Massachusetts General Hospital to conduct a new study funded by PCORI, the Patient-Centered Outcomes Research Institute. PCORI is at the center of the Affordable Care Act's initiative to improve care and lower costs through research on effectiveness of treatments and care-delivery systems.

The study, Acute Community Care to Avoid Unnecessary Emergency Department Visits, will examine an innovative Massachusetts program in which specially trained and equipped paramedics respond to urgent-care calls to evaluate and treat individual patients within their homes or residential facilities. By avoiding unnecessary costly emergency department visits and, potentially, hospital admissions, the program aims to reduce risks to patients and improve urgent care outcomes. Improving the patient experience with urgent care is also a priority.

The program is a collaboration between an emergency medical services provider, EasCare, and Commonwealth Care Alliance, an integrated healthcare provider that uses an enhanced primary-care model for vulnerable low-income clients who are dually eligible for Medicare and Medicaid. The program was recently initiated in the Boston area, with plans to extend it throughout the state.

Previous research has shown that up to 34 percent of Medicare beneficiaries calling 911 and taken by ambulance to emergency departments could have been safely treated in nonacute settings. Among Common Care Alliance members age 65 and older, some 60 percent of emergency department visits were to address matters that could have been treated effectively at home. For the PCORI evaluation, in addition to participating in measures of cost and outcomes, we will interview patients, families, and service providers, from physicians to social workers and paramedics, about their experiences. We'll keep you posted as the results unfold.

Scott Miyake Geron, Ph.D., is director of CADER and associate professor, School of Social Work, Boston University.

Boston University photo of Scott Miyake Geron

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Copyright © 2016 Trustees of Boston University. All rights reserved. This article may not be duplicated or distributed in any form without written permission from the publisher: Center for Aging & Disability Education & Research, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, U.S.A.; e-mail: