Ask most any health care expert what single factor drives up the nation’s healthcare bill unnecessarily, and they’ll tell you this: patients who are re-admitted to the hospital within less than 30 days of being discharged.
Now, a report by the Northeast Business Group on Health confirms what those in the field know all too well: It takes a collaborative effort among many stakeholders to reduce those costly trips.
“Hospitals, providers and health plans need to share timely data and take a coordinated approach to care management encompassing pre-admissions and post-discharge care in order to reduce unnecessary hospital readmissions,” NEBGH says in its report, “Reducing Hospital Readmissions through Stakeholder Collaboration.” More than 1 million Americans wind up back in the hospital only weeks after they left for reasons that could have been prevented — a revolving door that for years has seemed impossible to slow.
Medicare has begun punishing hospitals by docking payment to them if they have too many readmissions. The cuts, coming under the Patient Protection and Affordable Care Act, are among the many factors motivating hospitals to spend more time educating patients about their illnesses and partnering with outside caregivers to ensure that treatment doesn’t stop after discharge.
NEBGH hosted a series of “intensive multi-stakeholder work sessions that involved 67 executives from employer organizations, health plans, hospital systems, suppliers and other stakeholders” to drill down on the causes of high readmission rates.
One key, the report says, is to identify “patients at high risk for readmissions.” Focusing on this group will allow healthcare professionals to “engage patients through education and communications, and establish a mutually accountable environment that does not simply penalize hospitals for unnecessary readmissions.”
In other words, rather than blaming hospitals for readmitting a patient, the strategy involves giving hospitals new tools to spot high-risk patients, communicate closely and clearly with them and their caregivers, and monitor the discharge process carefully to make sure the patient is ready to go home, has the medications prescribed in the hospital, and has a caregiver with a plan ready to help them.
“I am happy to report that as a result of this work, we have preliminary interest in moving ahead with a readmissions reduction initiative in New York City involving several major health plans and hospital systems,” said Laurel Pickering, president and CEO of NEBGH, an independent coalition of large national employers and other organizations working to improve healthcare value and reduce cost.
“Employers also have an important role to play by facilitating dialogue around new business arrangements that foster collaboration between health plans and hospital systems, and by assisting in patient education and communications.”
The report identified three critical elements that need to be present for a multi-stakeholder cooperative care model to truly impact readmission rates.
- Collaboration in clinical outreach and care to identify high-risk patients and support them through the transition of care process;
- Financial models that allow all economically involved stakeholders to sustain and continuously improve their efforts; and
- Employee engagement and communication models that fully engage employees and their caregivers.
“Health plans and hospital systems each have a unique vantage point from which to view a patient and his clinical needs, and they typically pursue independent and unaligned readmission reduction activities, including independent data analysis and unilateral patient outreach and support,” said Dr. Jeremy Nobel, executive director of the Solutions Center, NEBGH’s platform for identifying solutions to healthcare issues of critical importance to employers.
“To really move the needle on readmissions reduction, stakeholders need to pool their resources and engage in pre-planned management activities that would better identify patients at high risk for readmissions and lead to more efficient use of clinical support resources from both health plans and health systems.”
The report emerges as year two of a major national Medicaid initiative, Independence at Home, is about to reveal the results of its program aimed at reducing 30-day readmission rates. IAH’s 18 healthcare provider participants have been experimenting with new ways to improve communications designed to reduce these trips; the results are expected to offer new way to those involved in Medicaid patient care to fight spiraling re-admission rates and ER visits.
Photo: Laurel Pickering, president and CEO of NEBGH.