Aligning Reimbursement To Reduce Avoidable Hospital Readmissions

Maryland’s Hospital Preventable Readmissions program rewards efforts that reduce hospital readmissions while improving care quality and decreasing cost. Dianne Feeney, associate director of quality initiatives for the Maryland Health Services Cost Review Commission (HSCRC), describes HSCRC’s response to hospitals that claim they can’t afford the empty beds that result from programs like these, as well as processes to help ensure that higher-risk patients are not refused admittance to hospitals. She also explains how partnerships with “siloed settings” — nursing homes and home health providers — can reduce common errors that occur during patient handoffs.

Case managers and advanced practice nurses in Aetna’s Transitional Care pilot have also successfully partnered to reduce readmissions. Dr. Randall Krakauer, national medical director, Medicare at Aetna, describes the key focus and the complementary roles that reduced 90-day readmissions by 25 percent. Dr. Krakauer also weighs in on the pros and cons of bundled payments, and why incentives alone will not significantly impact avoidable readmissions.

Feeney and Dr. Krakauer examined how to structure programs to reduce avoidable hospital readmissions, including the alignment of financial incentives, during the December 2, 2009 webinar, Aligning Reimbursement To Reduce Avoidable Hospital Readmissions.

Length: 5:03 minutes (this sound byte features Dianne Feeney)

Length: 5:06 minutes (this sound byte features Dr. Randall Krakauer)

Reducing Avoidable Hospital Readmissions: A Case Study from Priority Health

Priority Health members play an active role in keeping themselves out of the hospital, explains Mary Cooley, manager of case and disease management at Priority Health. She describes the four-point strategy that is reducing readmissions at Priority Health, the challenges that still exist and the essential tool that Priority supplies to help providers identify and close care gaps.

Cooley provided more details on the strategies that Priority Health is using to reduce avoidable hospital readmissions during Reducing Avoidable Hospital Readmissions: A Case Study from Priority Health, a 45-minute webinar on November 18, 2009.

Length: 7:23 minutes

Effective Case Management in the Medical Home

Case managers are the backbone of the Geisinger Health Plan (GHP) Health NavigatorSM program, a medical home partnership between primary care providers and GHP that has reduced 30-day hospital readmissions by 15 to 20 percent. Providing benchmarks for case manager caseloads and contact frequency, tools to support the case management effort, the key to smooth placement of case managers in the medical home and tips for better management of patients discharged to nursing facilities are Diane Littlewood, R.N., and Joann Sciandra, R.N., who are both regional managers of case management for health services at Geisinger Health Plan.

Littlewood and Sciandra provided more detail on the key components of a winning case management program during Effective Case Management in the Medical Home, a 45-minute webinar on November 11, 2009. The webinar is part of HIN’s continuing Medical Home Open House webinar series.

Length: 8:52 minutes

Predicting Healthcare Reform’s Biggest Losers and Winners

A forecast of 2010 healthcare trends would not be complete without some prognostication on the fate of healthcare reform. The Healthcare Intelligence Network asked William DeMarco, president and CEO of DeMarco and Associates, and Jim Knutson, risk manager and human resources director, Aircraft Gear Corporation, to predict the winners and losers from the controversial legislation — as well as the delivery date of the much-debated package.

DeMarco and Knutson go beyond crystal-gazing to describe the implications for key healthcare stakeholders in the coming year with a special focus on payment reform in Healthcare Trends & Forecasts in 2010: Performance Expectations for the Healthcare Industry, a new special report from the Healthcare Intelligence Network.

Length: 3:57 minutes