Eskenazi cuts hospitalizations, saves millions of dollars with ‘wraparound’ services

Can a hospital that offers on-site nutrition counseling, social work, patient navigation and other non-medical “wraparound services” see patient outcomes improve? Or are these extra services just an added cost?

At Eskenazi Health, offering those services actually reduced hospitalizations and visits to the emergency room, saving the system millions of dollars, a study published in the October issue of the journal Health Affairs concluded.

Researchers at Eskenazi Health and the Richard M. Fairbanks School of Public Health at IUPUI estimated that the benefits from those wraparound services saved up to $8.2 million between 2011 and 2016, based on median hospital costs. That estimate represents an average of $1.4 million to $2.4 million in savings a year.

Finding ways to cut costs while improving patient outcomes is something of the holy grail in the American health system. Payers are putting increasing pressure on providers to trim costs at every opportunity, from medical procedures to back-office functions such as billing and collecting.

On top of that, they are holding providers financially accountable for their patients’ health, and penalizing hospitals with poor outcomes or too many readmissions.

In the traditional fee-for-service reimbursement model, hospitals that use wraparound services can hurt their bottom line, because patients don’t need as much expensive medical care.

But in the value-based payment, which many hospitals are now adopting under pressure from payers, wraparound services can make financial sense, because the hospitals have financial incentives to improve outcomes, not just provide a list of expensive services.

“Providing nonmedical wraparound services in conjunction with primary care is one strategy to improve patient outcomes and reduce overall health care spending,” said Joshua R. Vest, the lead author of the paper and an associate professor of health policy and management at Fairbanks School of Public Health.

Eskenazi Health serves mostly uninsured and under-insured patients, many of whom have poor eating habits and chronic diseases, from diabetes to heart disease.

So the hospital has rolled out numerous programs to provide betting food choices. For example, it opened a small fresh-food grocery to help patients and guests who live in food deserts. It started a “Fresh Veggie Friday” to highlight produce grown on its 5,000-square-foot rooftop, Sky Garden.

It also offers programs for addictions and other behavioral problems, which often contribute to poor health.

Counseling from a dietitian was the most common wraparound service, at 49 percent, followed by consultation with a social worker at 29 percent and behavioral health at 10 percent.

Those wraparound services were offered at the main, 315-bed hospital in Indianapolis and numerous outpatient clinics.

Researchers wanted to know if those programs helped patient outcomes by reducing hospitalizations.

So they studied 11 years of data from Eskenazi Health’s electronic health record system, which contained information on visits, diagnoses and treatments. They also pulled information from the Indiana Network for Patient Care, the oldest and largest health information exchange in the nation, which allows for tracking of patients across different providers.

The study looked at 14,094 adults who received care at Eskenazi between 2006 and 2016, and who had at least one primary care visit before and one visit after 2011. All patients in the study sample had at least one wraparound service.

Eskenazi found that by providing wraparound services, they saw a 5 percent reduction in the number of emergency department visits. They also saw few hospitalizations, saving the system millions of dollars a year.

“We know, based on our research, that our best opportunity to improve the lives of our patients, and by extension, the health and vitality of our community, lies in helping individuals stay well,” said Dr. Lisa Harris, CEO of Eskenazi Health and one of the study’s researchers.

Health Affairs is a national journal focusing on health policy and research on health reform, health care costs, and health system innovations.