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Targeting All-Cause Readmissions an Ambitious Strategy

Philip Betbeze, for HealthLeaders Media, October 21, 2013

Reynold Jennings, WellStar's president and CEO, says what makes implementing a readmissions strategy so complicated is that there's no single reason anyone gets readmitted to the hospital, so it's an imperfect metric of quality care to begin with. But the holistic approach works better because all facets of care delivery have an impact on readmissions.

Focusing on just the three diagnoses that may generate penalties is shortsighted and may be counterproductive in the long run. That's why so many CEOs these days boil down their strategy to reduce avoidable readmissions to "doing what's right for the patient," as Jennings says. That's a frustratingly simple answer to a very difficult question, and "doing what's right" can mean spending lots of capital and staff time on things that may not yield a definable return on investment.

Jennings says WellStar, which also owns ambulatory, primary care, imaging, and other therapeutics, was able to get to a viable readmissions strategy that is scalable through its medical home program.

"The 3%–5% of the sickest patients who have three or more chronic illnesses consume at least 30% of all healthcare dollars and maybe as much as 50%," he says.

So it makes sense to focus on that group of chronically ill patients. Studies have shown that many such patients get readmitted due to environmental factors beyond the health system's control, such as compromised financial means, mental health problems, or lack of a strong family support system. Jennings thinks, however, that about half of the system's patients don't have those additional risk factors, and thus are a good place to start.

"There's nothing a hospital can do to take care of thousands of patients who fall into that first category, but the other half of readmissions is due to poor chronic medical management," he says. "Originally, most of the literature focused on the primary care physician's office, but without specialty physicians and their teams aligned with the primary care doc, you can't get to medical home management on an outpatient basis."

What WellStar is doing to intervene with patients for whom it can make a difference on readmissions is an approach that has already paid dividends, Jennings says.

"I personally don't think most hospitals are implementing a proactive strategy," he says.

Based on published readmission rates, he says an 8% readmission rate for all causes is the best case, while 14% is the midpoint. WellStar is at 8%.

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