Healthcare Week in Review: Readmissions, Reimbursement Strategies, mHealth

Monday, April 15th, 2013
This post was written by Cheryl Miller

Emergency physicians are increasingly picking up the slack left by difficult or unsuccessful transitions of care, says a new study from the Perelman School of Medicine at the University of Pennsylvania, but these visits, often within 30 days of hospital discharge, are not being counted as hospital readmissions unless they are admitted as inpatients.

In fact, as many as one in four patients discharged from the hospital end up right back there as emergency patients. Failure to measure these visits is leading to faulty hospital utilization and care transition assessments, and needs to be addressed, say researchers. Details inside.

Transforming healthcare payments from a fee-for-service (FFS) system to one that rewards quality and value also needs to be addressed, and is one of five recommendations aimed at improving healthcare quality while lowering costs nationwide.

The recommendations, from five national healthcare organizations and nationally prominent advocates for employers, insurers, consumers, healthcare providers and others, is the result of a yearlong discussion funded by the Robert Wood Johnson Foundation. Among the recommendations: providing a tiered reimbursement strategy that links payment directly to effectiveness, and encouraging consumers to select high-performing providers.

Another strategy for reducing healthcare costs: taking an innovative approach to classifying patient populations, so that health systems can more effectively prevent “triple fail” events — or outcomes that fail to advance population health, reduce healthcare costs and improve patient experiences and satisfaction, according to a recent Walgreen’s study published in Health Affairs.

Researchers examine how classifying (or ‘stratifying’) patients according to individual risk and expected response to an intervention can further the “Triple Aim.” The Triple Aim framework, created by the Institute for Healthcare Improvement (IHI), asks that health systems evaluate performance by simultaneously pursuing three dimensions: improved patient experience of care (including quality and satisfaction), improving population health and reducing per capita cost of healthcare.

Identifying the main drivers of cost in a Physician Hospital Organization (PHO) population, and then the biggest cost consumers, are key toward managing that population, says Greg Mertz, MBA, FACMPE, director of consulting operations, Healthcare Strategy Group, in our upcoming book, Essential Guide to Physician-Hospital Organizations: 7 Key Elements for PHO Success, which describes describes the seven critical areas of PHO development.

And lastly, despite the rising popularity of mobile health, and smartphone apps for monitoring everything from blood sugar to heart rhythms, the practice of health coaching remains a critical tool in population health management, helping to boost self-management of disease and reduce risk and associated cost across the health continuum, according to the latest e-survey from the Healthcare Intelligence Network (HIN). The telephone remains the chief modality for health coaching delivery, according to our infographic: “Health Coaching’s Call to Manage Weight and Chronic Disease.” Weight and chronic disease management remain the top two areas addressed by coaching, but in terms of populations, those considered ‘well’ are just as likely to receive coaching today as those with chronic diseases.

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