This March, we whipped up some friendly competition to improve care with a March Madness-style tournament. The goal was to improve primary care reconnection rates for frequent emergency department users by pitting the primary care practices of our Medicaid Accountable Care Organization (ACO) against each other to see who could achieve the highest seven-day reconnection rate.

Eight teams of primary care practices competed against each other, bracket style, for a gold trophy and $1000 prize to be used for a celebratory team dinner. And just to make sure that teams wouldn’t slack off if they lost the first round, the worst-performing team got what the Camden Coalition’s Clinical Redesign Initiatives (CRI) called the “terrible troll.”

Wilson announces March Madness winner and loser

CRI team member Carter Wilson announces March Madness results, joined by the trophy and the “terrible troll”

The cornerstone of the CRI is the 7-Day Pledge: primary care practices who are part of our Medicaid ACO have pledged to get Medicaid patients in for a primary care visit within seven days of hospital discharge. While practices have made significant progress in connecting with patients who have been discharged from inpatient stays, it has been more difficult to reconnect patients who are frequent utilizers of Camden emergency departments.

The CRI team has found that there are a number of reasons for this disparity. Inpatients can often be engaged at bedside, before discharge, making successful primary care reconnection much more likely. In contrast, patients who are being discharged from an emergency department, in addition to being more difficult to engage at bedside, are more likely to have recently experienced significant trauma, making them less able to follow up with their care, or may have a habit of visiting the ED instead of a primary care provider that can be hard to break.

The CRI team’s challenge was to better target the ED high-utilizer population using their current tools and workflows, and they decided decided to see if generating hype among ACO member practices would help close the gap. The CRI team engaged the practices with a fun video introducing the teams, stat sheets for each matchup, regular updates, and some friendly trash talk. Coalition staff got into the fun too, making detailed brackets that became a parallel competition to see who could best predict the winning and losing teams.

After three weeks of fierce competition, the winners are in. Project H.O.P.E., an organization that provides medical care and social services to the homeless population of Camden, emerged as a clear winner, increasing their percentage of ED high-utilizer patients reconnected to primary care from 20% to 60%. In second place was the combined Cooper Pediatrics and Lourdes Pediatrics team, who increased their ED high-utilizer reconnection rate from 23% to 53%. Across the ACO, the seven-day primary care reconnection rate for ED high-utilizing patients increased from 17% in March 2015 to 32% in March 2016. The chart below shows how the number of primary care visits within seven days has increased across the ACO within the ED high-utilizer population in Camden.

Graph showing 7-day primary care visits for ED High Utilizers between June 2015 and March 2016

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