Chloe Slocum, MD, MPH

2016-2017
Staff Physiatrist, Spaulding Rehabilitation Hospital and Spaulding Hospital for Continuing Medical Care, Cambridge, MA; Instructor in Physical Medicine & Rehabilitation, Harvard Medical School

Dr. Chloe Slocum most recently completed a Spinal Cord Injury Medicine Fellowship at Harvard Medical School Department of Physical Medicine and Rehabilitation/Spaulding Rehabilitation Hospital/VA Boston.  She is most concerned with the intersection of patients’ complex health needs, population health management at a systems level, and health care policy.  Dr. Slocum is passionate about health promotion for adults and children with disabilities and health equity in post-acute care.  Dr. Slocum received her medical degree from Columbia University College of Physicians & Surgeons, New York, NY in 2011.  She completed her Physical Medicine and Rehabilitation residency at Spaulding Rehabilitation Hospital/Harvard Medical School in 2015 and served as Chief Resident from 2014-2015.

Transitions of Care in an Accountable Care Model for Dually Eligible Medicare-Medicaid Enrollees

Transitions of Care in an Accountable Care Model for Dually Eligible Medicare-Medicaid Enrollees

Objectives:
 
The OneCare demonstration was launched in Massachusetts in 2013 to promote coordinated and accountable care for dually eligible individuals aged 21-64, most of whom have a significant disability. In 2016, Commonwealth Care Alliance, a participating plan in the OneCare demonstration, launched a transitions of care initiative aimed at improving care coordination for members and reducing hospital admissions and cost.
 
Background:
 
Individuals with disabilities comprise a significant minority of the United States population and were named a critical area of health disparity by the Centers for Disease Control (CDC) in 2012. Disability-associated health care spending accounts for an estimated 26.7% of all health care expenditures and varies widely by state. In addition, few quality outcome metrics exist to assess care provided for people with disabilities. 
 
Methods:
 
A literature review of best practices for transitions of care in adults with complex medical needs was conducted, comprising more than 70 publications spanning academic publications and gray literature. Key informant interviews were conducted to assess program design for optimizing transitions of care with six executive and administrative leaders for health systems and health plans in three geographic regions of the United States, each with distinct health care delivery market factors. Participation in eight field visits to clinical as well as community sites and planning meetings, along with a review of selected program evaluation and financial analysis of the OneCare program, supplemented findings from interviews and the literature review.
 
Results:
 
Published research and program literature revealed the themes of intensive care coordination, standardized communication protocols, and empowerment of patients and caregivers through education as strategies to manage care transitions. Multiple interviews with key informants highlighted the predominant role of hospitals and specialty clinics for individuals with complex care needs in developing and implementing transitions of care interventions aimed at reducing hospital admissions and cost containment. It was uncommon for transitions of care programs to extend across an entire health system or to incorporate in-person visits to post-acute care settings. Field visits demonstrated investments in collaboration with community-based organizations.
 
Future Directions:
 
In order to continue sustainably and grow, the transitions of care intervention must evaluate which program components provide essential value. Operations mapping of care pathways for different disability categories may help to design effective interventions tailored to members’ specific needs. Reporting of OneCare outcomes data by disability category would help determine any disparities that may exist by disability type or severity. Measures of function and community participation should be explored as outcomes in addition to hospital admissions as metrics of quality. Accountable care models for Medicaid enrollees will expand under the current Massachusetts 1115 waiver and lessons from the OneCare demonstration may be used to inform planning.  
 
Preceptor: Toyin Ajayi, MD, MPhil, Commonwealth Care Alliance