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Randi Berkowitz, MD

Project: "Skilled Nursing Facility Network Increase Days at Home (SNIDH Intervention)"
Commonwealth Care Alliance
Boston, Massachusetts

Dr. Randi Berkowitz is a geriatrician at Commonwealth Care Alliance in Boston, MA. Dr. Randi Berkowitz is Medical Director for Care System Improvement and Care Delivery Innovation at Commonwealth Care Alliance, a nonprofit prepaid Medicare and Medicaid financed care system caring for thousands of Medicaid and Dual eligible elders and younger individuals with disabilities through multidisciplinary primary care teams in Massachusetts' low income communities. Randi is a current recipient of an Innovation Advisor award from the Centers for Medicare and Medicaid Services.

She graduated from Barnard College, University of Chicago Medical School, and the Harvard Geriatric Fellowship, and completed the Practice Change Fellows Program, a two-year national fellowship program designed to build leadership capacity among nurses, physicians, and social workers who have operations-level responsibility for geriatric programs and service lines. The rehospitalization project she completed at Hebrew SeniorLife during her participation in the University of Colorado Denver’s Practice Change Fellows Program succeeded in reducing the number of acute patients transferred from a SNF unit to the hospital by 20%. This reduction was accomplished via a multipronged approach, which includes standardizing the physician admission process, identifying high risk patients who might benefit from palliative care consults, improving team communication, learning from cases of avoidable readmissions, standardizing the home discharge process, and sharing knowledge with referring hospitals. A description of this project was published in June 2011 in the Journal of the American Geriatrics Society and has received national attention, including an article in USA Today.

Dr. Berkowitz’s current project with the Practice Change Leadership fellowship is to develop a SNF network at Commonwealth Care Alliance to reduce hospitalization rates by implementing a similar program in SNFs throughout Massachusetts. Commonwealth Care Alliance is also exploring the provision of financial incentives to participating facilities and physicians based on both process and outcome measures to increase patient and family engagement, lower readmissions, and improve care coordination between SNF, primary care, and hospital teams.

For a brief project summary click here.


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