How Highmark BCBS Helps Reduce Hospital Readmissions

Hospital readmission rates remain stubborn. Hoping to move the needle, Highmark Blue Cross Blue Shield has made its care transition program, which tracks readmissions indicators, mandatory for hospitals that have failed to meet a certain threshold.

Halting hospital readmissions is everyone's business now. Payers are no exception.

To that end, Highmark Blue Cross Blue Shield has operated a pay-for-performance program called Quality Blue for many of its network hospitals since 2001. The program tracks 15 indicators of care quality and patient safety. Typically it allows the participating hospitals to select their focus indicators. Depending on their size, hospitals select between one and four indicators to help them track improvements each year.

Readmission rates remain stubborn, and there is some disagreement over to what extent hospitals can influence them. So in 2012, with CMS's 30-day readmissions penalty about to become a reality, Highmark decided to make its readmissions indicator mandatory for hospitals that failed to meet a threshold score.

Through the Pittsburgh-based insurer's "defect-free transitions of care bundle," 68 hospitals embarked on a program to reduce inpatient readmissions.

Highmark modeled the effort after a care transition program from the Physician Consortium for Performance Improvement. Page Babbitt, director of provider engagement at Highmark, identified these three steps as central to the success of the program:

• Medication reconciliation process reviewed with the patient prior to discharge.
• Detailed transition of care plan developed by the inpatient care team.
• Transmittal of care plan provided to the patient at discharge and to their PCP or specialist physician within 24 hours of discharge.

Babbitt reports that the outcomes from this effort "have been fairly significant." Looking at the 68 participating hospitals over a three-year period, the overall compliance with all three steps increased from 12% in 2011 to 78% this year.

See Also: Toxic Hospital Practices May Fuel Readmissions

There was a 119% increase in the percentage of patients who received the medication list, a 425% increase in the percent of patients who received a transition of care plans, and an 87% increase in the percent of care transition plans that actually made it into the hands of physicians or specialists.

Meanwhile, there was a 2.8% decrease in seven-day readmission rates and a 5% decrease in 30-day readmissions. Overall, Babbitt says the participating hospitals saved almost 1,300 hospital readmissions.

Babbitt says the hospitals have implemented several additional interventions that contribute to reduced readmissions, including:

Patient Education
Teach Back is an education intervention that has patients explain, in their own words, their care plans. "It's a way to find out if the patient really gets it," says Babbitt. She explains that when she speaks to a congestive heart failure patient, she talks about the importance of a low salt diet. Then she'll ask the patient to describe to her what they need to do, in their own words. "If they tell me that they're going to go home, stock their cupboards full of canned soup, and stick to their diet, well that's a learning opportunity. We course-correct them.

Health Team Huddle
This is a multidisciplinary team that includes case managers, social workers, nurses, and pharmacy staff who meet every day to discuss patient discharges. Babbitt says the conversation often includes identifying patients with a high probability for readmission. "They talk about steps to take to prevent the readmission, transportation issues that might affect the patient's ability to get to a doctor's office, [and] issues at home that could affect recovery."

Outreach Beyond the Hospital Walls
"[Providers] understand that readmissions is larger than the hospital itself and they have to involve their community," says Babbitt. Her staff works with hospitals to develop the outreach. Hospitals are particularly interested in partnering with skilled nursing facilities. They are sharing data, including the readmissions report care, and helping educate SNF staff about high-risk patients who might be readmitted over and over again.

Post-Discharge Dialogue
Almost all of the hospitals are reaching out to patients with a post-discharge telephone call. The purpose is to have a chat with the patients about how they are doing and to pick up any signs that the patient may be in distress. The call may be followed by a visit from home health.

One unexpected side effect of this program has been the buy-in of hospital administrators.

Certainly there is revenue associated with readmissions, but Babbitt says the hospital leaders she speaks to understand that a readmission is not the right thing for the patient. "We're not getting push-back anymore on reducing readmissions. They realize this is something that they absolutely have to do."