Readmissions: The Big Picture
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"That's where it's difficult for hospitals—where the savings are not accruing to them. That's the dilemma. The question was how do we move to the place where the way we are reimbursed works with this?"
Montefiore leadership makes a compelling case to local payers that using the same case manager who intervenes during hospitalization and follows up for 60 days postdischarge builds trust as well as, critically, compliance with postdischarge physician appointments and drug regimens. The case managers integrate such follow-up into what Meara calls "usual care" to enhance transitional planning processes.
"We have very strong working relationships with the two health plans involved," says Janet Kasoff, EdD, RN, the senior director of the Center for Learning and Innovation for CMO, Montefiore Care Management. "I'm really happy that those people did see this as an opportunity. In order to reduce readmissions, we need to work together."
As part of the discussions about readmission prevention with payers, the Bronx Collaborative was formed to improve healthcare in the Bronx, with the Care Transition program to combat high readmission rates at all three hospitals.
"Working together, we did craft a care transition fee such that we were paid for this work," Meara says. "That's a differentiator. Hospitals need to be looking to go down this path of contracting in different ways with payers, but who has? It's a huge challenge to make this kind of investment if there's not some share in the savings to be had."
That said, now is the time for hospitals to face up to going down that path with payers. Given the readmission penalties that are there now and those that are likely in the near future, sticking to business as usual is clearly not the right way to go.
"You need to be asking yourself, if I'm not part of an ACO, how can I partner? One of our partner hospitals is not going to be an ACO, but it will be a good partner in our ACO and I think that's the pathway," says Meara.
"The ability to demonstrate that hospitals and payer organizations can work collaboratively toward a goal and establish standards and processes across organizations that sort of collaboration has much broader implications," Meara says. "We can't only rely on ourselves to be successful."
This article appears in the October issue of HealthLeaders magazine.
Philip Betbeze is senior leadership editor with HealthLeaders Media.
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