Nonprofit plans expansion
| By TED GRIGGS The Advocate Published: Dec 27, 2009 At right: Chris Williams, of eQHealth Solutions, left, shows Dr. Gregory Ward how an electronic medical records system works. |
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and efficiency.
“I think we’re on a trajectory to be a $125 million to $150 million company in somewhere between 15 and 17 years,” Chief Executive Officer Gary Curtis said.
The firm plans to push all of its expertise — successful programs include reducing limb amputation among diabetics and Medicaid fraud —- into care coordination, Curtis said.
The nonprofit will work with patients, health-care providers
such as hospitals and physicians, hospital associations,
consumers and consumer advocacy groups.
Health industry members say that by coordinating the different
aspects of patient care, providers will improve the
quality of care while better controlling costs.
“The problems with the lack of care coordination are now
becoming so pronounced and so self-evident that more and
more states are looking to put together a response that they
can afford,” Curtis said.
There are around 40 Quality Improvement Organizations
nationwide, Curtis said. The groups help providers improve
care and patient safety.
The federal Centers for Medicare & Medicaid Services
spends roughly $367 million each year on the QIO program,
said Peter Ashkenaz, spokesman for the agency.
CMS supports the increase of competition among the Quality
Improvement Organizations as much as is possible.
Curtis said eQHealth hopes to capitalize on that competition
for contracts. By 2025 or so, eQHealth expects to have
offices in six to eight states, he added.
In addition to its offices in Louisiana, eQHealth has offices
in Illinois and Mississippi, Curtis said.
In Louisiana, eQHealth works for Medicare, the federal
program for seniors. In Mississippi and Illinois, eQHealth
works for Medicaid, the state program that helps poorer
residents get health care.
The company’s contracts cover everything from home
health and long-term care to inpatient and outpatient hospital
services, Curtis said. eQHealth has also done work in
Texas and Arkansas and is targeting contracts in Missouri,
Kentucky and Florida.
“Ours is pretty much a slow-growth strategy. We’ve added
big new pieces of work about every five years,” Curtis said.
The company tends to work very closely with clients and
has to understand what it takes to get the job done in their
state under their political situation, Curtis said. eQHealth
also has to understand what is driving the costs for a particular
problem and how quickly the state can address the
problem.
The company really has to understand not only what its clients
think they need but what they really need, Curtis said.
He compared it to a home repair contractor who’s called in
for one job but quickly realizes that a leaky roof will eventually
lead to much larger problems.
“We build the relationships that they can count on us to fix
the problems they know about and identify the ones they
don’t,” Curtis said. “And that just takes a certain amount of
time.”
In addition, the speed of eQHealth’s expansion is limited by
its nonprofit status, Curtis said. Basically, the company is
not allowed to raise money.
That restriction prevented eQHealth from bidding on a
contract with Georgia earlier this year, Curtis said. The contract
basically required the company to put up $10 million,
which would have taken all of its working capital.
On the positive side, eQHealth doesn’t pay taxes on the
money it makes, so it can plow everything in excess of revenue
and expenses back into the business, Curtis said.
The other major limitation is that eQHealth has a finite
number of workers and time available.
“We have a cadre of talented people, and we can grab a
certain amount of work and then we have to wrestle it to
the ground,” Curtis said.
Still, the company’s strategy has allowed it to successfully
secure a good percentage of the state and federal contracts
it pursues, Curtis said. This year the company looked at
roughly 30 potential contracts, made proposals on eight and
won four of them.
Curtis said he considers three things in pursuing a contract:
■ Does the project offer the chance to work on a part
of the health-care system he knows is broken?
■ Are there known solutions to the problem?
■ If the fix is made, will it affect costs?
Curtis said most of the efforts being made now to fix health
care at the national level are affecting insurance — who
insures whom and for what.
“It doesn’t do much to actually restructure the health-care
system in a way that improves quality at the same time it
drives down cost,” Curtis said. “I think it’s urgent that we
find things that not only improve quality but in a very direct
way can show a return on investment.”
Curtis points to the Care Transitions Project as an example
of that.
eQHealth worked with local hospitals and providers to
slash the number of seniors readmitted to hospitals from
around 19 percent to 5 percent.* eQHealth officials estimate
the program, if implemented nationwide, could save
Medicare around $12 billion a year.
Curtis said the hospital discharge planning process is typically
pretty flawed.
Although the hospital staff does its best to explain to a
patient the warning signs of a chronic condition, such as
congestive heart failure, many times the patient has a hard
time understanding, Curtis said. The result is that patients
often have a hard time explaining what’s going on to their
doctor’s office and rather than wait a few weeks for an appointment,
they end up in the emergency room and back in
the hospital.
The Care Transitions program coaches patients during the
discharge process, teaching them how to manage their care
and how to get the help they need should a problem arise,
Curtis said.
* LHCR reports that only four patients have been readmitted to the hospital
within 30 days of discharge within the group of 93 hospital patients
who were coached in the Care Transitions Project thru May 31st, 2009.
This represents a 4.3 percent readmission rate.
Results are preliminary and it is not intended that the reader should
assume that the information is official or final. The results are subject
to change as additional patients enter the project. Final results will be
published at the completion of the three-year pilot.
CMS Program Progress Report, baseline measurement period 10/07
– 03/08; unadjusted readmission rate for Acute Myocardial Infarction
20.9%, Congestive Heart Failure 22.4%, and Pneumonia 18.9%.
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