The Alabama Quality Assurance Foundation is one of seven organizations nationwide to be selected by the Centers for Medicare and Medicaid Services to implement the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. UAB geriatrician Clare Hays, M.D., along with others in the UAB Division of Gerontology, Geriatrics and Palliative Care, will provide medical leadership for the initiative.
The AQAF team will work in 23 nursing homes in 14 counties in central and north central Alabama. The core intervention of the Alabama model is the creation of care pathways coaches who will be assigned to each of the participating nursing homes. The coaches, who will be registered nurses, will work hand in hand with the nursing home team to accomplish the aim of reducing avoidable hospitalizations.
Nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled in Medicare. These Medicare-Medicaid enrollees are among the most fragile and chronically ill individuals served by the programs. Research has found that approximately 45 percent of hospitalizations among Medicare-Medicaid enrollees receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided. Total costs for these potentially avoidable hospitalizations for Medicare-Medicaid enrollees for 2011 were estimated to be between $7 billion and $8 billion.