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Welcome to the Group Practice Improvement Network

GPIN is a nonprofit organization created in 1993 by the founders of the Institute for Healthcare Improvement to provide a vehicle through which medical groups achieve and sustain performance excellence by sharing knowledge of best practices.

Our Mission

GPIN serves as a catalyst for large multi-specialty group practices to achieve performance excellence through shared learning.

Our Vision

GPIN member groups will be leaders in quality of care, patient experience and cost effectiveness.

GPIN Membership Information

Interested in an overview of GPIN? Click here to review the slides along with the GPIN orientation slides, Frequently Asked Questions, plus the website orientation video and instructions.

GPIN Members in the News


Long-acting injection clinics expand across St. Louis area for those with chronic mental illness

Michele Munz | 

FERGUSON — Maurice Bostic was in a vicious cycle of using alcohol to deal with pain, which only led to more pain — struggles with relationships, money and drugs. When his 6-year-old granddaughter was accidentally shot seven years ago in her home, Bostic drank even more.

“If I had kept her with me, it wouldn’t have happened,” said Bostic, 55. “I drank so much that I was going to kill myself.”

Bostic finished a 90-day inpatient treatment program, but addiction continued to haunt him. What finally worked was a monthly injection of Vivitrol, a medication that blocks the euphoric effects of alcohol and opioids.

Bostic received the expensive shot at no cost at the Long-Acting Injection Clinic at SSM Health DePaul Hospital in Bridgeton, which opened just over five years ago to treat those with behavioral health disorders such as schizophrenia, bipolar disease and substance abuse disorder.

The symptoms of mental illness can make it difficult to stick to a daily medication regimen. The clinic allows patients to substitute daily oral medications with injections given every month, sometimes even longer.

Because of the clinic’s success, SSM Health opened another at St. Joseph Hospital in Wentzville and is poised to open a third LAI clinic this spring in the former St. Louis University Hospital building off Grand Boulevard.

The DePaul clinic went from serving 1,100 patients in its first year to 4,331 last year, while the Wentzville clinic grew from serving 340 patients in 2020 to 1,641 last year, hospital officials say.

The clinics have greatly reduced the number of patients landing in the emergency room because of uncontrolled symptoms, and patient success stories abound.

“My life has changed,” Bostic said. “I don’t feel depression. I don’t feel suicidal. I don’t feel like I want to go drink. I feel like I got my life back together.”

Pointing to SSM Health’s success, Mercy officials in July 2022 opened a small LAI clinic on its Mercy Hospital South campus to reach those in the southern parts of the metropolitan area.

In November, the Missouri Hospital Association awarded DePaul Hospital’s LAI clinic its annual Aim for Excellence Award, which recognizes hospital innovation.

“The clinic represents the exact kind of innovation we want to celebrate and replicate,” said Jon Doolittle, MHA president.

Revolving door

SSM Health opened its DePaul clinic after seeing the need for mental health care far outpace the resources, said Michelle Schafer, SSM’s regional vice president of behavioral health. People were ending up in emergency rooms because they had nowhere else to go for help.

Providers were caring for a revolving door of patients. “We would admit them and get them stabilized, but it wouldn’t be long before we would see them again,” Schafer said.

Patients were struggling to take their medications, she said, often not able to keep up because of other overwhelming issues such as lack of transportation, housing or food.

“We really wanted to find a better way to care for the patients and to really assure their long-term stability and path to wellness,” Schafer said.

What emerged as a solution were long-term injections, which have seen improvements in side effects and options over the past 20 years, said Dr. William Wang, psychiatrist and medical director of DePaul’s outpatient behavioral health program.

The shots have grown in use over the past decade and, other than temporary pain at the injection site, have similar side effects as oral versions of the drugs, Wang said.

With injections, there’s no daily regimen that can be difficult for some to keep up with. And, he said, there’s a more steady level of the medication and its effects in the blood, rather than the peaks and valleys that occur with daily pills.

“This is a great advancement to me,” Wang said. “When I used to give a patient medicine, and the patient goes home, in the night I would get anxious, ‘is he taking the medicine?’ And now I know, OK, once you get the injection, for one month, you are safe.”

SSM Health also realized it needed to take a holistic approach with its clinic — pairing the treatments with free lunches, transportation to appointments, regular phone calls, individual and group therapy, and connections to help with social needs such as housing.

“We wanted to make sure that we could provide a therapeutic environment so that we could check on them and we could understand where there were things coming down the path that might lead them to go into crisis so that we can intervene,” Schafer said.

Results were dramatic. Patients treated at the clinic are far less likely to end up rehospitalized within 30 days of a hospital stay — going from 70% to less than 5%, she said.

The anecdotal evidence, however, has been the most apparent — patients reconnecting with loved ones, going back to work or school and feeling proud.

“The more significant things really are the patient’s ability to return to the lives they’ve always wanted,” Schafer said.

Danger to price program

Long-acting injectables are expensive, costing at least $1,000 a dose, with some as expensive as $8,000, Wang said. With cheaper pills as an option, the injections are not often covered by insurance.

SSM Health funds the array of services at its clinic using the federal 340B Drug Pricing Program, which allows hospitals and clinics that care for low-income and uninsured patients to buy outpatient prescription drugs at a discount of 25% to 50%.

Providers who qualify get to keep the difference between the discounted price and reimbursement rate from private insurance or Medicare. They must use those funds to reach and provide more comprehensive care to financially vulnerable patients.

The 340B program, however, has grown significantly since its inception in 1992, prompting drug manufacturers to call for more transparency and oversight into how providers are utilizing the dollars.

More than 2,600 hospitals across the U.S. — over 40% — participate in the 340B program, federal data shows.

Over the past few years, some manufacturers have tried to institute their own restrictions on the program, which prompted lawsuits between the drugmakers, providers and federal policymakers. The pending cases could change who benefits from the program and how.

Schafer says the 340B program has allowed SSM Health to improve and expand access to mental health care through its LAI clinics.

“It’s the quintessential purpose of why the government put 340B in place,” she said.

The importance of treating chronic mental illness and substance use disorders has become more apparent to lawmakers and providers over the past few years.

“You’ll see more folks leveraging a model like this to help provide services, because it’s really important for us to be able to stabilize folks … otherwise, the need is going to grow and outpace our ability to provide care,” Schafer said.

Mercy’s LAI clinic on the Mercy Hospital South campus served three or four patients a month when it opened a year and a half ago, and now serves about 80, said Mercy South’s director of behavioral health Kristin Eveland.

Among patients who frequently ended up in the hospital, Mercy has seen their readmission rates drop from 74% to 15%, Eveland said.

But like at SSM, seeing patients flourish has been the biggest testament to the clinic’s effectiveness.

“The success stories out of that clinic are just wonderful,” Eveland said. “Just seeing them come back every month and watching them really bloom and become productive members in society, it’s an amazing space to sit in on.”

The clinic is currently only open on Wednesdays, but administrators are looking to expand its service hours because of the growth, she said.

Bostic said with the injections, he has zero cravings for alcohol or drugs. Even when he’s around others who drink, he said, his only focus is on staying sober.

When he tried to stay sober using daily pills, Bostic said it was easy to forget to take the pill or be tempted to skip it.

“When you have that medication, you think I can skip taking that medication and I can drink some today. I can go back tomorrow and take that pill,” he said. “But with the shot, you can’t do that.”

Bostic said he’s become a husband, father and grandfather again. He’s saving money. He’s no longer hungover at work. He’s much healthier. He no longer has to worry about ending up in dangerous situations during his drinking binges.

“My grandkids get to see a sober granddad, and that is the most important thing in the world to me, that my grandkids get to see someone they can look up to,” he said. “They don’t have to be ashamed of me.”
https://www.stltoday.com/news/local/metro/long-acting-injection-clinics-expand-across-st-louis-area-for-those-with-chronic-mental-illness/article_cb2217aa-b58c-11ee-b807-2328b9cd1008.html

Montefiore braids trust with community influencers 
Paige Twenter - December 21, 2023

A community engagement program at Montefiore isn't like the others: Rather than lecturing information to its neighbors, the New York City-based system nurtures relationships with local influencers to quell distrust in healthcare. 

The program is called BRAID — short for Bridging Research, Accurate Information and Dialogue. Damara Gutnick, MD, senior director of Montefiore's office of community and population health, told Becker's the initiative first started to dispute misconceptions about the COVID-19 vaccine and improve trust in the healthcare system at large.

BRAID recruits trusted messengers in the Bronx and Westchester neighborhoods, which include prominent community members in faith-based organizations, schools, libraries, shelters, food pantries, housing agencies and community-based groups. 

In 2021 and 2022, between 50 and 60 influencers shared community concerns so clinicians and scientists could better understand where distrust was stemming from. Together, they codesigned messages that wove accurate health information in ways that mattered and made sense to the community.

"What makes it unique from other models is that it really aims to earn that trust with community leaders who are already trusted messengers or influencers," said Dr. Gutnick, who's also a professor at the Albert Einstein College of Medicine in New York City. "We're writing with them, we're publishing with them."

As these cohorts of eight to 12 people worked together, language moved from apathy to action, she said, as community leaders felt more empowered. 

The program published its results in August. 

"The one thing we learned that was really humbling to me is that there is significant distrust in healthcare," Dr. Gutnick said. "It's not just one or two people; it's throughout the community. It's because their personal experiences with the healthcare system often felt transactional, they said 'they only spent a few minutes with me.' They loved it when healthcare providers were able to talk to them as equals and get rid of their hierarchy. They said, 'If I had more experiences like this, I would have trusted the vaccine. I would have gotten the vaccine early. I would have trusted science.'"

For example, one mother part of BRAID was wary of the COVID-19 vaccine even though her husband almost died from COVID-19, Dr. Gutnick said. After participating in these conversations, she gained trust in the vaccine, deciding to use motherly guilt to influence her son to become vaccinated. It worked, and a week later she shared her success with her cohort. 

BRAID is now evolving past fluid conversations between community influencers and clinicians, Dr. Gutnick said. It has now made a robust network that can create new program ideas and partnerships, and it constructed a space where clinicians can ask questions and community members can bring up other issues. 

Those relationships are then strengthened like strands in a braid, which empower community influencers to spread trusted health information within their own spheres of influence. 

The program is now recruiting between 24 and 36 people to help codesign messaging about results from a Montefiore-sponsored study, which is investigating the increased risk of dementia among Latino people.
https://www.beckershospitalreview.com/quality/montefiore-braids-trust-with-community-influencers.html

UChicago Medicine earns Joint Commission, Kaiser award for 'exemplary' equity research
Ashleigh Hollowell | October 25, 2023

UChicago Medicine's push to improve postpartum care has landed it an award for health equity advancement from The Joint Commission and Kaiser Permanente. The university's awarded initiative, known as the Systematic Treatment and Management of Postpartum Hypertension program, focused on studying how a series of interventions could play a role in improving outcomes for patients with the condition, according to an Oct. 24 news release.

Noticing a gap between the percentage of Black and white mothers' attendance at their postpartum six-week visits — 30% for Black patients and 53.5% for white patients — is what prompted UChicago researchers to test the interventions. 

Adding patient and provider education, updating clinic protocols, distributing a treatment and management kit for hypertension patients increased postpartum visitation, closing the disparity gap to 33.5% for Black patients and 59.4% for white patients.

From there, researchers added the option for patients to have a telehealth visit, which boosted attendance to 76.3% for Black patients and 76.7% for white patients — reducing the disparity gap to 0.4%. A final intervention, which involved a remote patient monitoring program, further improved the rate of postpartum follow-up visit attendance to 83.1% with no disparity between races. 

Fewer patients also had high blood pressure after these implementations were added. The clinical outcome was the same for both Black and white patients, according to the release.

The award is given annually to systems "that achieved a measurable, sustained reduction in one or more healthcare disparities," the release states.  

Jonathan Perlin, MD, PhD, president and CEO of The Joint Commission Enterprise, called UChicago Medicine's research "exemplary" and noted that it "has shown that healthcare disparities can be improved – and even eliminated – with intention in determining mechanisms of disparity and perseverance in sequentially addressing them."
https://www.beckershospitalreview.com/health-equity/uchicago-medicine-earns-joint-commission-kaiser-award-for-exemplary-equity-research.html

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