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How One Point-of-Care Strategy Cuts Readmissions

 |  By Margaret@example.com  
   September 12, 2012

It is widely accepted that a well run hospital discharge program can reduce hospital readmissions and save money. Health insurers are usually more than happy to tout how their programs trim hospital readmissions. But when it comes to the nitty gritty of actual cost savings, they tend to be a bit vague.

That is why I found a study from New York-based EmblemHealth so intriguing. The insurer lays out the results of a pilot program not only in terms of reduced readmissions, but also in terms of dollars and cents. The study is published in the American Journal of Managed Care.

With human and capital resources often stretched to their limit in busy physician offices, EmblemHealth looked at how a redeployment of its resources could affect patient care and produce a measurable savings in healthcare expenses, William Gillespie, MD, EmblemHealth’s chief medical officer, told me.

Although there is peer review evidence that care coordination and accountable care can make a difference not only in the quality of care, but also in the downstream costs, those systems are often based on predictive modeling that can be impacted by a claims lag.

Gillespie says by working directly with a physician group, EmblemHealth was able to immediately contact discharged patients. As a result of the study, readmissions for the pilot group fell below industry standards and the resulting savings "were more than sufficient to cover the costs of the program," he said.

In 2010 the New York-based health insurance company placed a dedicated healthcare treatment team consisting of a nurse, social worker, pharmacist, and two health navigators in one office of Manhattan’s Physician Group. MPG is a 70-physician multispecialty group with seven offices in Manhattan.

The study compares the 30-day hospital readmissions of a baseline group of 244 patients, who did not receive intervention services, with 298 patients who were part of the pilot program. The pilot participants included commercial, Medicaid and Medicare members.

The pilot participants were supported with point-of-care transition and case management services. The intervention team didn’t focus on patients with a particular disease or condition; rather all discharged patients were provided the opportunity to work with the team.

The services provided included:

  • Appointment scheduling and reminders
  • Follow up for missed appointments
  • Needs assessment for community services
  • Skills for communicating with healthcare providers
  • Indentify red flags for readmission
  • Indentify barriers to meeting treatment or medication plans
  • Medication reconciliation

The baseline group had a 30-day readmission rate of 17%, which Gillespie says is consistent with the industry average. The readmission rate for the pilot group was 12%. The total number of readmissions per member was reduced by almost 37% and the total number of hospitalized days was reduced by 43%.

The total cost of those readmissions for the base group was $673,103. For the intervention group the cost was $640,505. The $32,598 cost differential was more than enough to cover the monthly salaries and benefits of the five-member intervention team.

Although EmblemHealth set out to measure the effect on hospital readmissions, the intervention team’s physical presence in the physician office produced other, unanticipated advantages.

With access to the electronic health records of the discharged patients the team was able to identify other gaps in care for HEDIS quality measures such as a lack of annual screenings or immunizations. EmblemHealth and MPG were able to update those treatments as they worked through post hospitalization issues.

Gillespie says that getting patients on treatment plans and up to date with existing treatment plans produced savings that were not quantified within the study.

And he says the effort also helped improve patients' quality of life by looking at patient needs outside of medical care, such as transportation issues and living conditions. EmblemHealth worked with community service groups to meet those needs.

Along the way, the program has increased patient satisfaction for the participating physicians as well as the health plan.

With a few tweaks the program is being expanded to other large multispecialty physician groups with close ties to EmblemHealth. For instance, case management staff that used to contact patients by telephone is now deployed to have more face to face contact with the patients.

Dr. Navarra Rodriguez, chief medical officer at Manhattan's Physician Group, says the value of the intervention team extend well beyond reduced admissions and cost savings. "Our patients are dealing with a very complex healthcare system. They rave about intervention team and how it makes them feel connected to our doctors and the health plan."

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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