Posts Tagged ‘telephonic outreach’

Tactics That Curb Hospital Readmissions Can Also Reduce Avoidable ED Use

October 14th, 2014 by Patricia Donovan

To reduce avoidable emergency room use, particularly by perennial high utilizers, many healthcare organizations are replicating post-discharge data mining and care coordination tactics that successfully reduce hospital readmissions—namely, heavy applications of predictive modeling supported with a blend of embedded case management, telephonic outreach and patient education.

The use of predictive modeling in particular for this purpose has jumped from one-quarter of respondents in 2011 to one-third of this year’s respondents, while ED registry and census use has jumped from 16 to 25 percent in the last three years according to results from a third comprehensive survey on reducing avoidable emergency room use by the Healthcare Intelligence Network.

Telephonic outreach to patients recently visiting the ER has almost doubled in the three-year period, with 31 percent making contact within 24 hours and 29 percent within two days.

The percentage of respondents placing either a case manager or social worker in the ED for the purpose of managing ED utilization has risen from 33 percent in 2011 to 50 percent this year.

Melanie Fox is director of the Caldwell Physician Network Embedded Case Management program at Caldwell UNC Health Care, where embedded case managers in both primary care practices and work sites use telephonic outreach to reduce avoidable hospital utilization.

“One of the goals of embedded case management is to reduce ED visits,” she says. “This is one of the harder things to be able to manage but it is a goal. We don’t know our outcomes yet, although I am starting to measure that.

“We do a lot of education with patients when we follow up,” Ms. Fox continues. “We look and see how many times they’ve been to the ER, and if they’re abusing the ER. Maybe they don’t really have a way to get to the hospital or to the doctor’s office; they end up in a hospital because they don’t have a ride to the doctor. We try to get them to be more proactive with their care. If they let us know ahead of time about a health issue, we can help them stay out of the ER.”

Ochsner Health System is also applying its automated and risk-based post-hospital-discharge follow-up approach to its ED population, connecting them to community resources, a nurse advice line, or the opportunity to schedule a follow-up appointment, depending on need. The process has reduced avoidable ER utilization by between 13 and 15 percent, depending upon payor and location, according to Mark Green, system AVP for transition management at Ochsner Health System. Rather than driving business away from Ochsner ERs, “We’re just letting [ER staff] manage a higher risk population within their emergency room and giving them time to spend more of it with the patients,” explains Green.

Excerpted from: 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits

2014 Healthcare Benchmarks: Reducing Avoidable ER Visits delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital emergency departments.

6 Strategies Help Stem Hospital Readmissions, Streamline Processes and Care Transitions

February 27th, 2014 by Cheryl Miller

Development of post-acute partnerships with home health, skilled nursing facilities (SNFs) and hospice is emerging as a key strategy to stem hospital readmissions, according to new market data from the fourth annual Healthcare Intelligence Network (HIN) Reducing Hospital Readmissions Survey.

More than half of survey respondents participate in post-acute partnerships, with home health collaborations the most common (79 percent). These partnerships serve to streamline processes and care transitions, educate and align staff, and implement changes of value to patients, respondents say.

Looking at more conventional approaches, medication reconciliation and telephonic monitoring of patients post-discharge emerged as frontrunner strategies to curb readmissions. Moreover, the 2013 survey revealed significant upticks in the use of each tactic over 2012 levels: medication reconciliation is now conducted by 73 percent of respondents, versus 54 percent in 2012, while the use of telephonic monitoring jumped from 48 to 71 percent over the same 12-month period.

In other new data, almost half of respondents — 47 percent — aim programs at individuals already assessed at high risk for readmission as well as traditional Medicare (53 percent), Medicaid (28 percent) and high utilizer (23 percent).

Other key findings include the following:

  • Two-thirds of respondents to HIN’s December 2013 Readmissions e-survey have a program to reduce readmissions.
  • In a new metric from the 2013 survey, more than half — 52 percent — aim readmission reduction efforts at individuals with diabetes.
  • Case management is the most successful approach to curbing rehospitalizations, say 27 percent. The case manager retains chief responsibility for reducing readmissions, say 34 percent of respondents.
  • Heart failure remains the top condition targeted by programs, although a fifth already track readmissions for hip and knee replacements, a metric the Centers for Medicare and Medicaid Services (CMS) will examine more closely in 2015.

Excerpted from 2014 Healthcare Benchmarks: Reducing Hospital Readmissions.

Healthcare Business Year in Review: A Look Back at 2013’s Top Stories

January 9th, 2014 by Cheryl Miller

From an early surge in Medicare accountable care collaborations to the rocky introduction of ACA-mandated health insurance exchanges during a government shutdown, healthcare in 2013 was nothing short of unpredictable.

But in this issue, as in “Best of” issues past, we bring you the stories that resonated most with you. Your top story was one that ran nearly a year ago: Post-Hospital Telephonic Outreach Reduces Readmissions by 22 Percent for High Risk Patients. This initiative from Cigna monitored telephonic outreach by health plan case managers within 24 hours of hospital discharge, finding that they reduced future readmissions by 22 percent. Resulting in more physician visits and prescription drug fills, the timing and prioritizing of the calls was critical to its success.

Case managers’ roles in long term care also spiked your interest in our featured white paper: Case Management in 2013: Achieving Results with Cardiovascular Disease; Long-Term Care Next Frontier for Embedded Case Managers. As care coordination by healthcare case managers continues to drive clinical and financial outcomes in population health management, expect to see lots more case managers — not just coordinating care telephonically like Cigna, but co-located in nursing home, long-term care (LTC) and assisted living settings.

Other top stories included CMS’ announcement that Medicare beneficiaries saw significant out-of-pocket savings due to the ACA, including provisions to close the prescription-drug “donut hole” that saved more than 7.1 million seniors and people with disabilities $8.3 billion on their prescription drugs since it took effect.

How the ACO model figures in most hospitals’ futures also topped your reading list, as did a story on how 24 states and the District of Columbia chose a benchmark health insurance plan that met the ACA’s essential health benefit requirement, which is scheduled to begin next month, January 2014. Researchers found that 19 of the states that selected plans chose existing small-group plans, employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans.

An infographic on 2013’s Most Significant Healthcare Issues, and our podcast on Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements also attracted the most views.

We will continue to provide you with the kind of up-to-the-minute coverage you need to stay informed.

And as with issues past, we send our best wishes to all of you for a happy, healthy, prosperous and peaceful new year.