By using a beefed-up type of teamwork in caring for patients, an Omaha outpatient clinic has tallied more than $4 million in cost savings in a year, mostly by reducing hospital and emergency room visits.

In a new study, Creighton University and CHI Health researchers who followed a group of high-risk patients at the north downtown clinic found improvements in diabetes control and reductions in hospitalizations, emergency room visits and the total cost of patients’ care.

Patient costs, specifically, decreased by 48.2%, said Joy Doll, an occupational therapist and one of the authors of a report on the study.

“If we don’t collaborate, we can’t stop that kind of utilization,” she said.

The study, results of which were published recently in the Annals of Family Medicine, was conducted at Creighton University Medical Center-University Campus. CHI Health opened the outpatient clinic near 24th and Cuming Streets in January 2017.

The clinic was built to promote collaboration among health care professionals in different fields, following what’s known as an interprofessional collaborative practice model, said Thomas Guck, a psychologist and professor of family medicine at Creighton and the report’s senior author.

While more primary care clinics are adding collaborative elements, such as pharmacy and behavioral health, the University Campus brings together a number of them, including occupational and physical therapy, Guck said.

As part of Creighton’s family medicine residency program, those health professionals are also training future health care providers in the collaborative model, he said.

In addition, they’re preparing students for an ongoing shift in how health care providers are paid. Medicare and Medicaid and some commercial insurers increasingly are paying providers according to how well they keep patients healthy, such as keeping their blood pressure or diabetes under control. That’s compared to the current “fee for service” model.

Such efforts are seen not only as good for patients but also for health care’s bottom line, because those patients are less likely to require costly hospitalizations or ER visits. Indeed, some local clinics focusing on providing a more collaborative type of care also have reported improvements in patient’s health measures and cost.

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Plenty of studies have shown that an interprofessional collaborative practice model can lead to better, less costly outcomes in patients with specific conditions, such as diabetes and heart disease.

But previously, according to the researchers, no one has studied whether the interprofessional model can do the same with high-risk patients, such as those with frequent ER or hospital visits, in a primary care clinic.

Among those included in the study were some who had visited the ER 50 times in the previous six months, with many of those visits attributed to behavioral health problems or chronic pain, followed by diabetes, said Doll, executive director of Creighton’s Center for Interprofessional Practice, Education and Research.

Under the model, staff huddle for 10 to 15 minutes each morning and afternoon to discuss patient needs. Small groups may see patients together or consult with one another throughout the day. Guck, for instance, often spends time in physical therapy helping work through chronic pain problems, which often have a psychological component.

The researchers compared patients’ results from the year before the clinic opened to those during its first year of operation. After the first year, the researchers reported reductions of 16.7% in ER visits, 17.7% in hospitalizations and 48.2% in total patient charges.

Todd DeFreece, CHI’s vice president of operations for the health center, said team concept was successful not only in ensuring that patients received high-quality care but also in reducing costs for patients and the health system. The clinic sees some 6,500 primary care patients.

It also provided a bonus — a significant drop in burnout among health care providers, a growing concern in health care.

Previously, Doll said, the clinic had ranked among the lower two-thirds among CHI Health’s 151 clinics in terms of employee engagement. Now it’s among the system’s top clinics. Employee retention is high, which produces its own cost savings.

The researchers have begun analyzing results from a second group of patients they began following in 2017. While those results still are preliminary, the researchers are finding that they’re similar to those for the 2016 group. And they’ve been able to sustain the results among the 2016 patients. The researchers also have hosted visits by people from other institutions interested in the model.

“This will hopefully be the first of multiple studies that will demonstrate that,” Doll said.

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Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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