Hallmark Health System, in collaboration with Cambridge Health Alliance, Mystic Valley Elder Services and Somerville Cambridge Elder Services, is among the top performers in an innovative national pilot program aimed at reducing hospital readmission rates.
The four organizations, known collectively as the Mystic Valley Community-Based Organization, joined 47 other community-based organizations (CBOs) across the US in the Centers for Medicare & Medicaid Services (CMS)-commissioned Community Care Transitions Project (CCTP) in 2012. According to early findings by the CCTP, over a two-year period the Mystic Valley group reduced 30-day readmission rates in certain high-risk patient populations by 3.74 percent – the third best results in the national CCTP project. Their results were shared as a best practice at a national conference in Baltimore, MD in November 2014.
The goals of the CCTP are to improve transitions of patients from the inpatient hospital setting to other care settings, to improve quality of care, to reduce readmissions for high-risk patients and to document measurable savings to the Medicare program.
Thirty-day hospital readmission rates for certain high-risk patients have increased over recent years and CMS has initiated steep fines for hospitals whose patients return to the hospital within 30 days of discharge.
The Mystic Valley CBO has shown very promising results and was awarded an additional one-year extension based on their performance. The group has reduced 30-day readmission rates for a test group of complex medical/surgical patients over the age of 65 with a length of stay of three days or longer, and also of all heart failure patients, by 3.74%.
The CCTP incorporates a new service delivery model, using transition facilitators who meet with patients while they are still in the hospital and then meet with them again within three days of discharge. The transition facilitators’ role is similar to that of a health coach.
Additionally, hospital nurse practitioners visit with the newly-discharged patients in the home or other care settings such as a nursing home or rehabilitation facility. Nurse practitioners can write prescriptions and adjust medications and treatment plans in collaboration with the patients’ primary care providers.
“Between the transition facilitators and the nurse practitioners we are able to identify indicators that could eventually lead to a readmission and take immediate corrective action,” said Cheryl Warren, MS, RN, chief clinical integration officer at Hallmark Health. “The new teams can assess social and physical triggers and make adjustments to medications and treatments in real time in the patients’ home or care facility, keeping patients home, healthy and well cared for.”
Hallmark Health System, in partnership with The Massachusetts Department of Public Health, The Massachusetts Department of Children and Families, Middlesex District Attorney Marian Ryan, Congresswoman Katherine Clark, Melrose Substance Abuse Prevention Coalition and Jewish Family and Children’s Service recently hosted a summit to discuss the region’s rapidly growing number of patients with maternal substance use disorders and their substance exposed newborns.
Sixty-five providers from across the care continuum and the state, along with epidemiologists and researchers, joined federal and state legislators in identifying goals and strategies for caring for mothers with substance use disorders and substance exposed newborns.
Speakers included Middlesex District Attorney Marian Ryan, who spoke about her commitment to community collaboration, education and prevention. "I applaud Hallmark Health and Melrose-Wakefield Hospital for their commitment to addressing the issue of substance exposed newborns by promoting early intervention practices and establishing a coordinated community network of care," she said. "This problem is too complex, too pervasive, and too large in scope to address in any other way. As District Attorney, I have been working across Middlesex County to confront the opiate crisis through a multipronged approach. Early intervention, comprehensive treatment, and the continuum of care model must be essential elements to this effort. I appreciate Hallmark Health and Melrose-Wakefield Hospitals for being proactive in this regard, and for being at the forefront of this critical public safety and public health problem."
Next, US Congresswoman Katherine Clark spoke about her newly authored federal legislation. “Last month, we re-introduced the Protecting Our Infants Act of 2015 with strong bipartisan support in both the House and Senate,” she said. “This bill is the first federal bill to help opiate exposed newborns. The aim is to help hospitals determine the best method of diagnosis and compassionate treatment, reduce hospital stays for newborns with NAS, and the enormous costs of this care. It is the product of work that started in our community with care providers and treatment advocates. My hope is that partnerships between us and the communities we serve will continue to lead to solutions.”
Mentoring Mothers Kimberly Byrnes and Erica Asselin from the Jewish Families and Children’s Service’s NESST program (Newborns Exposed to Substances; Support and Therapy) spoke about the disease model of addiction shared their own stories of becoming a parent while in recovery from addiction, and the transformative power of the peer support offered through their program. Participants also engaged in hands-on breakout sessions.
“This summit served to establish an ongoing formal collaborative of providers from every point of the care continuum of services for women and children, from the first pre-natal visit to the baby’s fifth year of life,” said Summit organizer Laura Sternberger, LICSW, clinical social worker in Maternal Newborn Medicine at Hallmark Health. “It was exciting to see summit participants learn from each other about the great work already being done in our communities. In the summary sessions participants universally emphasized the importance of seamless collaboration between providers and the pressing need for more services to help families touched by maternal substance use and neonatal abstinence syndrome.”
More than 220 supporters sampled delicacies from some of the area’s finest restaurants to help make Hallmark Health’s second annual Taste of Spring a tremendous success. The event raised more than $46,000 to benefit Hallmark Health’s bariatric support programs, cancer care, cardiology and the North Suburban Child and Family Resource Network.
Taste of Spring, hosted by Flagship Motorcars of Lynnfield Mercedes Benz, featured gourmet food and wine tastings from a dozen restaurants and specialty shops, live entertainment and live and silent auctions. Boston Bruins legend and executive director of the Boston Bruins Foundation Bob Sweeney served as master of ceremonies and auctioneer.
The Taste of Spring would not have been possible without the generous support of these top sponsors:
• Jennifer Wu, MD
• Hallmark Health System Medical Staff
• Eastern Bank
• Whole Foods Market
• Action Ambulance Service, Inc.
• Armstrong Ambulance Service
• Cataldo Ambulance Service, Inc.
• New England Coffee
• Promotional Solutions, Inc.
• Melrose Cooperative Bank
• Right At Home Boston and North
• Flagship Motorcars of Lynnfield, Mercedes-Benz
• Republic Building Contractors, Inc
• Hallmark Health Imaging
Participating restaurants included:
• Turner’s Seafood
• Stearns & Hill’s Bistro
• New England Coffee
• Whole Foods Market
• Burtons Grill
• Teresa’s Prime
• Bobby C’s Ristorante
• La Q Chara
• La Ronga Bakery
Hallmark Health System announced that Alan Macdonald has been named president and chief executive officer. The appointment is effective immediately. A past board chair, Mr. Macdonald, 70, has most recently served as executive vice president for strategy and public affairs.
The message below, from James Herrington, chairman of the board of trustees, was shared with staff and physicians.
After extensive consideration, the Hallmark Health Board of Trustees has decided that the establishment of a CEO search committee is not necessary and has approved the permanent appointment of Alan Macdonald to the position of president and chief executive officer for Hallmark Health System. He assumes his new post immediately.
This year promises to be one of further growth and investment in Hallmark Health, and Alan’s contributions to these efforts will be invaluable. Most prominently, Alan is an influential and highly respected leader in our ongoing affiliation efforts with Partners and with both health care and governmental peers. He is a strategic planner focused on strengthening our organization, and knows decisively what our organization needs to achieve on our own and as part of a larger organization for our future success. He brings positive energy and has been an uplifting force in the short time he has served in his interim role. We believe he is the right leader for our organization at this time.
Alan brings a unique depth of business, political and health care experience to this position. As many of you know, he is a founding trustee and a former chairman of the board for Hallmark Health. Most recently he served as executive vice president for strategy and public affairs for the organization. However, for 23 years prior, he was the executive director of the Massachusetts Business Roundtable (MBR) working with the state's most prominent business leaders on Massachusetts' economic, health care and social issues, and was elected president emeritus of MBR by its board of directors. Before his work with MBR, he was an assistant attorney general for Massachusetts, director of public affairs for Gulf Oil Corporation and manager of government relations in New England for General Electric Company.
For the past 30 years, he has been a member of several state committees on health care reform, addressing the most formidable challenges and changes in health care history, and served more than 10 years as a member of the board of trustees for the Massachusetts Hospital Association. He is founding director, past chairman and current executive committee member of the Massachusetts eHealth Collaborative – established to promote more comprehensive use of electronic health records in managing care.
Alan is a graduate of Dartmouth College with a law degree from Boston College Law School. He is an avid skier, golfer – serving currently as a member of the Massachusetts Golf Association Executive Committee ¬– and competes from time to time in the sport of curling.
On behalf of the board of trustees, I thank you for your ongoing support, leadership and dedication to our organization.
Please join us in congratulating Alan on his new leadership role.
As a gastroenterologist at Hallmark Health System I see firsthand the effects that colon cancer can have on patients and their loved ones. Colon cancer is the second leading cause of cancer deaths in the US for both men and women, behind only lung cancer. The good news is that this is a very preventable and treatable cancer if screening guidelines are followed. According to the American Cancer Society, last year more than 50,000 Americans died from the disease and that death rate could be cut in half if all of those who were due for a screening had one.
Safe, highly effective screening is available. March is Colon Cancer Awareness Month and recognition months such as these give us the opportunity for dialogue to spread the word and, hopefully will serve as an incentive to book that overdue screening.
Hallmark Health and the Boston Bruins have teamed up to fight colon cancer and have produced this public service announcement.
Colon cancer typically develops with precancerous growths called polyps inside the colon. Over time the polyps can develop into cancer. In early stages, colon cancer shows no symptoms, so we rely on finding the polyps as early as possible. A colonoscopy is the most effective way of spotting these polyps. Although other screening tools are available, none are considered more effective or offer the real-time removal and/or biopsies of polyps and other suspicious growths.
During the procedure, the vast majority of polyps that are detected are removed. Polyps that are very large or with cancerous features can be too high risk to be removed during the procedure, but biopsies can still be safely taken for analysis. All removed polyps and tissue samples are then sent to a pathologist for review. The total number of polyps removed and the final polyp pathology results will then help determine the timing of your next surveillance colonoscopy (ranging from several years up to 10 years).
When you do have a colonoscopy, be sure to follow the preparation process closely in order to get the best results. This includes avoiding solid foods the night before and taking a laxative preparation prior to the exam.
There are some misconceptions about the procedure, but it is very safe. It is a same-day procedure performed under sedation, so patients experience very little to no discomfort during or after the procedure.
We typically recommend starting colon cancer screening at age 50 for most individuals. Those considered at higher risk (family history of colon cancer or inherited forms of colorectal polyps/cancer, personal history of chronic inflammatory bowel disease) should be screened earlier. Studies suggest that African-Americans are also at higher risk for colon cancer compared to other ethnic groups and therefore should begin regular screenings at age 45.
Everyone should be encouraged to consult with his/her doctor to set up the appropriate screening schedule.
There are changes that you can make to your lifestyle as well to reduce your risk from developing colon cancer.
• Get screened
• Maintain a healthy weight
• Maintain an active lifestyle
• Smoking/nicotine abstinence
• Drink alcohol in moderation
• Adopt a healthy diet with lots of fiber, whole grains and 2 ½ cups of fruits and vegetables each day. You should also limit the amount of red meat in your diet.
Christopher Leung, MD, is a gastroenterologist at Hallmark Health System
News & Events
Tuesday, 03 January 2017 17:35