Overcoming Preventable Readmissions: 6 Stories

Here are six stories on the healthcare industry's most recent efforts to tackle and reduce rates of preventable readmissions.

1. A new program at HealthPartners and Regions Hospital in St. Paul, Minn., reduced preventable hospital visits by 65 percent among patients who frequently sought care in the emergency department. A team of providers, including nurses, social workers, physicians, case managers, and other staff, worked with patients to create plans that increased access to primary care providers, specialists and programs. A total 27 care plans were crafted for high-risk patients. In addition, the plan was embedded in a patient's electronic medical record and flagged as a high priority to ensure that the information is visible to other HealthPartners providers. Within two months, the number of ER visits and hospital admissions decreased 65 percent and resulted in an estimated cost savings of $511,000.

2. A new Avalere Health study shows that SCAN's integrated care model, which provides coordinated care for dual eligibles through the Medicare Advantage program, results in fewer hospital stays or readmissions than a group of similar beneficiaries receiving care under traditional fee-for-service. Specifically, the study found that SCAN's dual eligible members had a hospital readmission rate 25 percent lower than those in fee-for-service. It also found that SCAN performed 14 percent better than Medicare fee-for-service on the "prevention quality indicator overall composite," which measures how hospitals keep patients out of hospitals from the get-go.

3. UnitedHealthcare and Dovetail Health launched an innovative pilot in New Jersey designed to help Medicare Advantage members avoid unnecessary hospitalizations and reduce readmissions after a stay at a hospital or skilled nursing facility. A specially trained pharmacist care manager from Dovetail Health will visit the patients in their homes, review their prescription and over-the-counter medications, discuss how these medications should be taken, answer questions and identify ways to better coordinate their care. The patients will also be coached on medication safety for 30 days after discharge.

4. Novato (Calif.) Community Hospital and Marin General Hospital in Greenbae, Calif., partnered with the county of Marin to reduce hospital readmission rates under a new Advanced Care Transitions model. The model was tested and created under the healthcare reform law and is the basis of 30 programs across the country. Under the model, the county will hire two nurses — one for each hospital — who will serve as a transition coach for patients with a higher risk of readmission.

5. The Centers for Medicare & Medicaid Services announced the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, a new effort designed to improve care for people living in nursing facilities who are enrolled in Medicare and Medicaid. Through this initiative, CMS will partner with independent organizations and commit up to $128 million to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and states to provide coordinated, patient-centered care with the goal of reducing avoidable hospital stays. Eligible organizations can include physician practices, care management organizations and other public and not-for-profit entities.

6. Leaders from 34 children's hospitals from across the country gathered at Cardinal Health in Columbus to launch a national effort to improve quality of care and patient safety in pediatric hospitals. Hospitals participating in the Ohio Children's Hospitals' Solutions for Patient Safety will be working together to achieve specific goals by Dec. 31, 2013. They include reducing serious harm by 40 percent; reducing readmissions by 20 percent; and reducing serious safety events by 25 percent. In total, the network will be working to reduce harm in 11 healthcare-acquired conditions.

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