Sutter Health Launches Innovative Advanced Care Program in Sonoma County

Posted on Nov 16, 2012 in Transformation

AIM Patient Edward Fogarty

“Doctors have too many patients,” said 81-year-old Edward Fogarty. “I understand it’s very hard for a doctor to focus in on one patient. When I couldn’t reach the doctor, I tended to panic. Before AIM, I had a choice of calling 9-1-1 and that’s it, and I’d end up in the hospital. I don’t want to go to the E.R. What AIM gives me is that I can call someone besides 9-1-1, and they give me advice and counsel, which really helps.”

Advanced Illness Management (AIM)® Reduces Hospitalizations, Health Care Costs

Even with COPD and heart problems, 81-year-old Air Force veteran Edward Fogarty of Rocklin says he leads a fulfilling life thanks to Sutter Health’s Advanced Illness Management (AIM)® program. Now, Sonoma County patients with late-stage chronic illness like Edward can access the same resources and support needed through AIM’s first major expansion in Northern California. The expansion extends access to eligible Sutter Pacific Medical Foundation’s North Division and the Sutter Medical Center of Santa Rosa patients.

“AIM uses a nurse-led interdisciplinary team to bridge the gaps between the hospital, the community physician’s office, and home for our sickest patients,” said Brad Stuart, M.D., Senior Medical Director for Sutter Care at Home, an affiliate of Sutter Health. “Quality, affordable care for all of our patients is a priority and the expansion of AIM systemwide complements our mission and values. AIM supports giving the right care, at the right time, at the right level of care for the patient’s goals.”

The AIM program provides nurse-led care management, palliative care, and advance care planning for patients with late-stage chronic illness. With a pilot in Sutter Health’s Sacramento Sierra Region showing positive outcomes, the Center for Medicare & Medicaid Innovation (CMMI) awarded Sutter Health a three-year, $13 million Health Care Innovation Award to support the expansion of AIM throughout Northern California.

The Sacramento Sierra Region pilot showed reduced hospitalizations and improved care transitions, contributing to an improved quality of life for patients enrolled in AIM. The success of this pilot was crucial to Sutter Health receiving the CMMI grant. Since 2010, the Sacramento Sierra Region pilot:

  • Reported a 75 percent reduction in ICU days, an average decrease of one or more days for hospital stays, and more than 50 percent reduction in hospitalizations at 90 days post-enrollment.
  • Showed high patient and family satisfaction (4.7 out of 5).
  • Reduced costs for payers by $5,000 per patient at 90 days post-enrollment.

Learn more about AIM.

Posted by on Nov 16, 2012 in Transformation | Comments Off on Sutter Health Launches Innovative Advanced Care Program in Sonoma County