Integrated Care Market in Cleveland Features Unique Partnership

By Kindred Healthcare
 (from left to right): Leslie Vajner, RN, Steve Jakubcanin, Michael Felver, MD, and Brian Newman (from left to right): Leslie Vajner, RN, Steve Jakubcanin, Michael Felver, MD, and Brian Newman

Kindred’s unique relationship with the Cleveland Clinic was the focus of a break-out session this afternoon at the fourth Clinical Impact Symposium – Care Transitions Across the Continuum.

Kindred and the Cleveland Clinic have formed a partnership that has resulted in improved communication between acute and post-acute providers, and the sharing of useful programs that can benefit patients across the continuum of care.

Some unique characteristics of the Cleveland market have facilitated this collaboration: most physicians in the market are employed by two very “healthy and large” hospital systems, with independent physicians in supporting roles, said Steve Jakubcanin, Vice President of Operations for Kindred’s Cleveland Integrated Care Market. Cleveland has a total managed care penetration of 77 percent, and above-average long-term acute care hospital utilization.

Because of the prevalence of the hospital-employed physician model in Cleveland, there was no opportunity to share patients with smaller independent physician practices, Jakubcanin said. In Cleveland, there was a need to look outside the box to achieve continuity across levels of care and the best possible outcomes for patients in the post-acute space.

Enter the three-year-old Kindred-Cleveland Clinic partnership, which has already yielded successful programs and results including:

  • Connecting of electronic medical records between the two organizations, allowing, for example, for post-acute encounters to show up in Cleveland Clinic medical records
  • Creation of an interface for physician notes, so a Cleveland Clinic doctor can enter his or her notes and they will automatically transfer to Kindred’s ProTouch electronic medical record system
  • Kindred implementation of quality of life, functional psychological outcome surveys, based on the Cleveland Clinic model. Patient-reported feedback provides clinical insight and an ability to act early, resulting in enhanced and effective care
  • Telemedicine – Kindred is exploring how we can use technology for patients at high risk for readmission based on Cleveland Clinic’s Heart Care at Home program
  • Participation in a 3-year CMS bundled payment demonstration project

The partnership benefits both entities.

The Cleveland Clinic set out three years ago to reach out into the community and still be able to touch our patients after discharge, without having to manage them, said Michael Felver, MD, Medical Director of the Cleveland Clinic’s Center for Rehabilitation and Medical Director of Kindred’s Transitional Care Unit at the Greens.

“Our patients think of themselves as Cleveland Clinic patients, and they expect that level of care when they move into the post-acute space,” Dr. Felver said.

Though the Kindred-Cleveland Clinic partnership has grown by leaps and bounds, the presenters encouraged participants not to be daunted and to think about what might be possible in their own markets.

“We started by just meeting once a month,” said Jakubcanin.

Additional panelists included Leslie Vajner, District Director for Clinical Integration and Business Development in Kindred’s Cleveland Integrated Care Market, and Brian Newman, District Vice President in the Cleveland Integrated Care Market.

(from left to right): Leslie Vajner, RN, Steve Jakubcanin, Michael Felver, MD, Brian Newman