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Extra Attention to High Risk Patients Saves Money, Improves Outcomes

By Gregory A. Freeman  
   September 27, 2017

A California physician network is reducing utilization by providing special attention to patients most at risk for readmission after hospitalization.

A physician network in California is addressing one of the biggest challenges in the healthcare community, high utilization that blows up budgets and cost projections, with a program that uses home visits to improve outcomes following hospitalization.

In its second year the program has reduced 30-day hospital readmissions for participating members by 67%, via home visits conducted by non-clinicians.

That is twice the reduction of the first year, with results improving as more data is collected and the program is fine-tuned.

Regal Medical Group, one of the largest physician networks in Southern California and part of the Heritage Provider Network (HPN) managed care organization, is using its Member Advocate program to improve outcome and reduce costs.

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It employs non-clinicians who use a patient-centered approach to address the complex healthcare needs of high-risk Medi-Cal and dual-eligible members who experience an acute hospitalization, says Jennifer Dunphy, vice president of population health with Regal Medical Group and Lakeside Community Healthcare.

"We found that a large proportion of our Medi-cal and dual-eligible patients have very complex needs. They have low functionality, a high proportion of behavioral health disorders, and a lack of coordination in terms of all their providers and different aspects of their health," she says.

Gregory A. Freeman is a contributing writer for HealthLeaders.

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