Posts Tagged ‘post hospital discharge’

Infographic: Why Care Coordination Matters

January 23rd, 2015 by Melanie Matthews

As a result of poor coordination of care, one in five Medicare patients is readmitted within 30 days of discharge from the hospital, according to a new infographic by Primaris.

The infographic also examines the level of post-discharge care for Medicare beneficiaries who are re-admitted and the cost of these readmissions.

Scalable Models in Health Risk Stratification: Results from Cross-Continuum Care Coordination Health risk stratification is scalable—whether grouping diabetics in a single practice without an EMR or drilling down to an ACO’s subset of medication non-adherent diabetics with elevated HbA1cs who lack social supports. That’s the experience of Ochsner Health System, whose scaling and centralization of risk stratification and care coordination protocols across its nine-hospital system drive ROI and improve clinical outcomes and efficiency.

Scalable Models in Health Risk Stratification: Results from Cross-Continuum Care Coordination explores Ochsner’s approach, in which standardized scripts, tools and workflows are applied along the care continuum, from post-hospital and ER discharge telephonic follow-up to capture of complex cases for outpatient management.

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Top New Year’s Resolution: Talking More to Increase Medication Adherence

January 8th, 2013 by Cheryl Miller

Can we talk?

That might be all that’s needed to improve medication adherence, according to a new study from the University of California, San Francisco, and the Kaiser Permanente Division of Research. It’s a novel idea, and a worthy new year’s resolution, given that email and social media have all but rendered the art of conversation obsolete.

Researchers found that patients who were taking medications to lower their blood sugar, blood pressure or cholesterol and rated their doctors as good communicators were more likely to be medication adherent. Communication didn’t have to be limited to medication; instead, patients’ adherence was improved if they felt their physician established a trusting relationship with them and prioritized the quality of their communication.

A simple conversation could also help reduce hospital readmissions by 22 percent, according to a new study from Cigna. Researchers found that telephonic outreach by health plan case managers within 24 hours of hospital discharge helped to reduce future readmissions. Critical to the intervention was the timing and prioritizing of the calls, and the risk severity of the patients. The patients in this particular study were suffering from gastrointestinal, heart, and lower respiratory problems, and hospitalized for three days or more. Researchers would like to conduct this intervention on other high-risk patients to see just how widespread this program could be.

Knee sufferers’ laments have also been heard, and a bundled payment program specific to the treatment of knee replacement surgery is now available through a collaboration between Florida Blue and Mayo Clinic.

The program is designed to offset the costs of this surgery, which is considered to be the most common joint replacement procedure in the United States, and is performed on more than 600,000 patients annually, according to the AHRQ. Similar to many surgical procedures, knee replacement involves many individual medical procedures and processes. When done separately, the costs add up quickly. This bundled program compresses the costs into one amount, including the costs of anesthesia services; injections or drugs administered during the surgical procedure, including antibiotics; radiology/imaging services, and discharge planning and nursing care; among other services.

We also provide an insightful conversation with HealthFitness’ Dr. Dennis Richling and Kelly Merriman on providing the right health coach at the right time to the right individual. The integrative heath coaching organization implements this by utilizing three different types of heath coaches trained to interact with a range of patients along the health continuum. We expand on this in an upcoming book.

And if you’d like to talk, please voice your opinion on the subject of medication adherence in our new survey, (link) Improving Medication Adherence in 2013. We’ll be examining this trend and others in this third annual survey, which starts today.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.