Creating the Business Case
Engaging hospital administrators in the Chronic Care Model
approach is important for successfully transforming the health care system. The
University of Cincinnati Academic Health Center and Vanderbilt University Medical Center emphasized the bottom-line benefits to build a convincing business
case for adopting the Chronic Care Model.
Creating the Business Case—University of Cincinnati Academic Health Center
- Uncompensated care is reduced. The University of Cincinnati Academic Health Center's internal
medicine team used hospital and clinic data gathered as a result of plan-do-study-act
(PDSA) projects to demonstrate how the Chronic
Care Model reduces emergency department visits and admissions for uninsured
- The Chronic Care Model aligns with key hospital objectives. Cincinnati Children's Hospital Medical Center has a national reputation for its
improvement work. The Chronic Care Collaborative was well aligned with the
hospital's organizational strategy and viewed as a mechanism for further
improving outpatient care and residency education.
- The Chronic Care Model addresses Accreditation
Council for Graduate Medical Education (ACGME) requirements. Residency programs are working under six ACGME
competencies that include System-Based Practice and Practice-Based Learning and Improvement.
A chronic care collaborative fits well within these aims, and offers a proven
approach for improving resident education.
- Chronic Care Model projects can enhance resident
recruitment. Increasingly, residents are interested in novel,
forward-looking programs that will equip them with skills in leadership and
quality improvement. One resident actively involved at Cincinnati's medicine-pediatrics team reported that her job
interviews went particularly well when she explained her role in a successful
performance improvement initiative.
- Chronic Care Model projects can generate positive public
recognition. Project leaders at the University of Cincinnati Academic Health Center actively promoted their Chronic Care
Model work locally and at national meetings (e.g., an article in the Cincinnati Business Courier focused on the collaborative's approach for teaching
new physicians to improve care).
- The Chronic Care Model develops leadership in health care
change. Administrators at the University of
Cincinnati Academic Health Center went out of their way to support Chronic
Care Model work in part because they wanted to help a group of
passionate residents and their faculty succeed. Presentations from residents
and junior faculty to the senior leadership group helped generate this
collective sense of enthusiasm.
Creating the Business Case—Vanderbilt University Medical Center
The Vanderbilt University Medical Center team also determined
that specific data outcomes of their participation in the collaborative contributed
to making a business case.
Several new resident recruits to Vanderbilt's medicine-pediatric
residency program specifically mentioned the work of the collaborative as a
facet of the program that greatly increased their desire to train at the
- Cost Savings. Data from processes can be used to
illustrate cost savings to payers and administrators. For example, the foot
exam rate improved from 17 percent to 80 percent, thereby reducing amputation
risk. These data can also support the argument that departmental results can be
replicated system-wide, to whole patient populations, and across institutions.
- Marketing. Hospitals can use improved care data to
market services to patients. For example, rates of
blood pressure treated to target (systolic blood pressure less than 130 and diastolic
blood pressure less than 80), low-density lipoprotein to target (less than 100),
and A1c to target (less than 7.0 percent) were all improved in patients at the Vanderbilt
University Medical Center.
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