Hospitalizations are a big deal, both financially and emotionally. Reducing hospital readmission rates is good for everyone involved. For patients, it means less time spent away from family and work, less stress and better health outcomes. For employers, it means reduced health care expenses and improved productivity.

It's a win-win, but keeping readmission rates down can be tricky. Often it involves helping recently discharged patients get to “YES” on the three key questions.

1. Is the member informed about their condition and treatment plan?

When determining that a member requires medical care or a doctor has diagnosed them with a serious condition, it is important to conduct outreach. Trained health care management professionals, like those on a health care management team, should ensure that the patient understands the diagnosis and the treatment plan that their health care provider outlined, and find answers to any questions the patient has. They should serve as the point of contact for members who maybe don't quite understand what the physician just told them during their office visit, or what the potential impact of a planned surgery might be on the member and their family.

2. Is the member receiving and taking their medications as prescribed?

In an equally important part of the process, that health care management professional should also conduct follow up communications with the provider to get any clarification that might be needed regarding treatment and rehabilitation plans. The care that members receive should be medically appropriate and provided in an appropriate timeframe by the most appropriate provider, and health care management professionals can make sure this happens.

Additionally, if a member is hospitalized, your health care management professional should plan on working with the hospital's own case management team or social workers to ensure that everything the member needs is in place. This way, when the hospital ultimately discharges the member, the agreed upon course of treatment continues. Discharge planning is crucial for reducing the chance that the member will need to be re-hospitalized.

3. Is the member making it to their outpatient follow up appointments?

The time after discharge can be pivotal for members, and timely support makes a world of difference. Health care management professionals will make plans to check in on members to find out the status of their symptoms and medications, to make sure the members stay engaged with their providers and that they understand their treatment options for any complications that may arise. Any outreach should serve to empower members to take charge of their health care.

Using health care management to improve members' health care journeys

As you can see, there are many variables in play, from baseline patient health to the resources of the hospital, and some of them come down to timing and good fortune. However, it's been my professional experience that there are a few ways we can stack the deck in favor of members and their recovery. Through education, empowerment, and assistance from health care management professionals, health care management programs can improve members' personal health journeys and help employers control rising health care costs.

I can't tell you with certainty that your members will experience improved outcomes, I can tell you that at my employee, we have seen benefits accrue for clients using our in-house health care management team. In 2018, our case management and utilization management programs helped our clients in many ways:

Combined 4.5:1 ROI for Case Management and Utilization Management (6:1 Case Management ROI)
Average savings of $7,500 per member engaged in Case Management during hospitalization
Average readmission rate of 7.7 percent versus MCG Health's 22nd Edition Benchmark rate of 8.0 percent

In medicine, as in most aspects of life, small changes can yield huge results. And in our experience, careful investments in strong health benefits plans and effective health care management programs can help employers and members achieve more positive outcomes.

Angela Muth is a registered nurse and the executive director of health care management for CoreSource, Inc.

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3 questions that can reduce hospital readmissions

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