Executive Update
January 16, 2019

A Message from Peter Embi, CEO: Regenstrief Makes Its Mark on Wide-Ranging Issues

Dr. Peter J. Embi

Regenstrief’s mission is to improve health around the world, and, while asking the right questions, conducting the research and implementation are important, the mission of the institute also requires thought leadership. Our investigators are making their mark on a national scale, influencing policy and pushing for changes to enhance the way healthcare is delivered.

Below are just a few examples of how we’ve collaborated and counseled policymakers here in Indiana, nationally, and even internationally.

A recent article in Health Affairs by Malaz Boustani, M.D., MPH, is serving as a rallying cry for the creation of a new Medicare reimbursement model for individuals with Alzheimer’s disease and related dementias, as well as their caregivers. He and his colleagues are calling for increased payment for services offered by collaborative care models that would benefit the patient and the caregiver.

Collaborative Care Models are a team-based model that focus on the coordination of care. They offer services such as medication management, care navigation and dementia care, that provide holistic care for the patient.

We’ve seen the impact of this model in our own backyard. Dr. Boustani and his team have implemented a highly effective Collaborative Care Model called the Aging Brain Care model for nearly 10 years at Eskenazi, and it’s proven to save Eskenazi thousands of dollars per patient, per year. What’s more, the model has drastically improved the lives of caregivers.

In addition, informal caregivers, who serve as an integral part of our healthcare delivery system, are typically underserved by health networks. They often report high stress, and when they enter the Medicare system themselves, they do so at a health deficit in comparison to their peers.

If Dr. Boustani’s proposed changes are enacted, Medicare reimbursement could bring about higher quality care to seniors with Alzheimer’s and related dementia in every state, and much needed support for their caregivers.

The OPTIMISTIC project led by Kathleen Tschantz Unroe, M.D., MHA, has sounded a similar clarion call. Over the past seven years, OPTIMISTIC has shown the benefit of its model, reducing avoidable hospitalizations and saving costs for Medicare by respecting patients’ wishes and, when possible, treating patients for conditions in their nursing homes to avoid complications caused by transfers in care. She’s achieved these goals by building an impressive coalition, seating healthcare academics alongside state policymakers, business owners, and more.

Her coalition’s work in proving the efficacy of this model has already had an impact in Indiana’s state policies and, I’m excited to see its impact grow as she launches the Care Revolution, Inc., a business that is a continuation of this project.

Joshua Vest, PhD, MPH, and his team, consisting of leaders from Eskenazi Health, Regenstrief, and the Richard M. Fairbanks School of Public Health at IUPUI, have been hard at work proving the benefit of wraparound services. Their work, published in Health Affairs in October, found that wraparound services provided by Eskenazi Health were associated with reduced hospitalizations and emergency department visits.

Multiple current U.S. policies require healthcare organizations to become more attentive to patient risk factors and behaviors outside the medical system. While wraparound services may seem counterintuitive financially, this work proved that, under value-based payment, wraparound services may be one aspect of a larger strategy to address the factors that drive poor patient health and, by addressing those needs, can save a health system millions each year in avoided hospitalization costs alone.

Kurt Kroenke, M.D., MACP, participated in a review about implementing measurement-based care in behavioral health. The review, published in JAMA Psychiatry last month, offers a 10-point research agenda to improve the integration of measurement-based care (MBC) into practice. MBC is the systematic evaluation of patient symptoms before or during a health encounter to inform behavioral treatment. The method has demonstrated the ability to enhance care, but is underutilized.

The review looked at the barriers to implementing this type of care. Using implementation science, Dr. Kroenke and his co-authors offered strategies to address the barriers to using MBC, which include measures such as making evidence-based policy decisions and aligning reimbursement structures.

We’ve benefited greatly from the work of Nir Menachemi, PhD, M.S., and his colleagues, who, in recent years have published a review of the literature on high deductible healthcare plans. They’ve cautioned us that while these plans save the healthcare system dollars due to the reduction of utilization, they do so by reducing the use of all services, including the use of beneficial preventive health services that could help avoid the use of costlier health services in the future.

In addition, I co-authored a paper from the American Medical Informatics Association (AMIA) suggesting new policies to help the U.S. accelerate efforts to better align clinical research and clinical care to optimize our national investment in health information technology. The paper makes more than a dozen recommendations for public policies to facilitate the generation of medical evidence now that the adoption of electronic health records (EHR) is widespread.

The nation has made a large investment in health IT and a great amount of health data exists, but the ability to leverage this data to increase our knowledge of health and disease and drive improvements in care remain overwhelmingly under realized. That must change.

The public policy recommendations are divided into three parts: policies needed to facilitate evidence generation at the local level, policies needed to facilitate clinical research across organizations, and policies needed to maintain a national research ecosystem.

Again, these are just a few examples of Regenstrief’s involvement in the policy arena, however, they serve as excellent signposts for the expanded impact that our work as academics can have when we advocate for policy based on sound evidence.

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