I imagine there will be a lot of heat about the Affordable Care Act (ACA) over the next few months, but I hope we’ll soon get past the analysis of winners and losers to have a more constructive dialogue. Perhaps this little story can help. In Glendale, we are experiencing a very positive systemic impact from the ACA: collaboration with a group of hospitals who otherwise are competitors.

The ACA will soon implement penalties for hospitals whose discharged patients return for care. The idea is that the discharge from the hospital should be enough to keep the patient from having more problems. They should be on the road to recovery, not so vulnerable that they have to come back for more care. Better discharge planning means better outcomes for the patient and reduced costs for the hospital. Win-win!

But when the patient has no home, discharge planning becomes all the more challenging. There are fewer than 60 recuperative care beds for Los Angeles County’s 78,000 homeless people. Shelters have their own constraints and usually cannot take a newly discharged patient. We struggle with this problem regularly at Ascencia. Some patients are released to us too soon and we are not funded to be open during the day. So when clients are sick, we cobble together staff time so the clients can stay in.

When we learned the Corporation for Supportive Housing would be funding projects to identify, house and serve the most frequent utilizers of hospital services, we jumped at the chance to join an LA-based collaborative, the 10th Decile Project. The proposal was funded and we begin in July, possible because for months we have been meeting with the very sharp staff from Glendale Memorial Hospital, Glendale Adventist Medical Center and Verdugo Hills Hospital to address the problem of discharged patients returning to the hospital. The 10th Decile Project became the perfect opportunity to address in a meaningful way the hardest to serve and costliest patients and, by the way, aligns with our 100,000 Homes campaign goals. The project also will mean substantial adjustments to practices both in the hospitals and at Ascencia so that we can coordinate seamlessly for the patient.

The 10th Decile Project is just the beginning and by tackling the most extreme cases promises to have the greatest pay-off.  Another project that we continue to pursue with the Glendale Healthier Community Coalition is to support the hospitals’ goal of reducing general readmissions.  In this case, we would be targeting people who are homeless, but would not be considered “frequent utilizers.”

In this way we are bridging our cultures and practices to gain ground on a longstanding failure for our homeless and medically at-risk neighbors. Win-win indeed.

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