Healthcare Innovation Awards: Institute for Clinical Systems Improvement

Publication Year: 2019
Patient Need Addressed: Behavioral health, Care Coordination/Management, Chronic Conditions
Population Focus: Complex care, Medicaid beneficiaries
Demographic Group: Adult
Intervention Type: Service redesign, Staff design and care management
Type of Literature: Grey
link: https://innovation.cms.gov/initiatives/participant/Health-Care-Innovation-Awards/Institute-For-Clinical-Systems-Improvement.html
Abstract

The Institute for Clinical Systems Improvement (ICSI) of Bloomington, Minnesota received an award to improve care delivery and outcomes for high-risk adult patients with Medicare or Medicaid coverage who have depression plus diabetes or cardiovascular disease. The program will use care managers and healthcare teams to assess condition severity, monitor care through a computerized registry, provide relapse and exacerbation prevention, intensify or change treatment as warranted, and transition beneficiaries to self-management. The partnering care systems include clinics in ICSI, Mayo Clinic Health System, Kaiser Permanente in Colorado and Southern California, Community Health Plan of Washington, Pittsburgh Regional Health Initiative, Michigan Center for Clinical Systems Improvement, and Mount Auburn Cambridge Independent Practice Association with support from HealthPartners Research Foundation and AIMS (Advancing Integrated Mental Health Solutions). Over a three-year period, ICSI and its partners will train the approximately 80+ care managers needed for this new model.

Insights Results

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