Health reform is creating a new impetus for regional payers and providers to collaborate on long-standing problems. Medicare is proving to be a good place to start.
A one-year pilot project between Capital District Physicians Health Plan and the Albany Medical Center has yielded a 40 percent reduction in readmissions for Medicare Advantage beneficiaries.
The pilot used a healthcare team to focus on education, bedside support and post-discharge coordination of services to help CDPHP's Medicare Advantage members avoid having to go back to the hospital for a subsequent inpatient admission.
Under the pilot, prior to leaving the hospital, patients meet with a CDPHP registered nurse case manager, who follows up with patients with weekly phone calls when they're at home to remind them of their discharge plans, any medications and upcoming appointments. More than 90 percent of CDPHP's Medicare Advantage members who were hospitalized participated in the program.
"The goal of our teams is to ensure that patients receive the very best care while they're in the hospital and do not need to return after discharge," said Bruce Nash, MD, chief medical officer for CDPHP. "This pilot is a major step in the right direction."
Hospitalizations account for about one-third of U.S. health spending and a not insignificant number of them are readmissions, stemming from problems like complications and medication non-adherence -- and costing $18 billion for Medicare alone.
Steven Frisch, MD, Albany Medical Center's executive vice president of integrated delivery systems and hospital systems, said the hospital used the pilot as an opportunity to focus specifically on transitions of care.
"Effective planning and communication with patients, caregivers and post-acute providers is key to reducing potentially avoidable readmissions," Frisch said.
Before the pilot program started, readmission rates for its Medicare members at Albany Medical Center were around 17 percent. A year later, that stands at 10 percent, a significant improvement, the insurer said.