[NYAPRS Enews] Study: NYC Care Mgt Pilot Drops Readmissions by 37%

[Harvey Rosenthal]

NYAPRS Note: Here are some impressive results in reducing avoidable
readmissions by a NYC pilot that matched a nurse, care manager, health
navigators and a pharmacist with Medicaid beneficiaries at the point of
hospital discharge. Peers are increasingly demonstrating their great
effectiveness in serving as such navigators, leading ACHMA President Ron
Manderscheid to write in Behavioral Healthcare that "we (now) have a
very large cadre of peers who want to become peer supporters and who are
fully capable to do so. They can provide navigation for insurance,
access, and care, and they can coordinate complex care as well,
especially in the newly emerging health homes. Further, we can and
should encourage the development of more consumer-operated service
programs (COSPs) that can be attached to new accountable care
organizations." 

 

Readmissions Pilot

Crain's Health Pulse  August 22, 2012

 

Health experts have been aggressively tackling the problem of reducing
hospital readmissions before Oct. 1, a date that triggers cuts in
federal reimbursement. 

A pilot program by EmblemHealth has had promising results, according to
an article in this week's American Journal of Managed Care. 

Patients who got additional services and medical care after leaving the
hospital had fewer readmissions, and the savings outweighed the pilot's
costs. 

In 2010, EmblemHealth dispatched a nurse, a social worker, a pharmacist
and two health navigators to a large group practice to deliver
transitional care and services to the insurer's members following
hospitalization. 

They made sure people kept follow-up appointments and took their
medications as prescribed. The pilot consisted of 244 members in a
baseline group and 298 in an intervention group. 

Some 17.6% of people in the first group were readmitted, compared with
12.1% in the second, a 31% drop in the readmission rate. The number of
readmissions per member fell by almost 37%, while total hospital days
plummeted by 43%. Click here
<http://www.ajmc.com/articles/Impact-of-Point-of-Care-Case-Management-on
-Readmissions-and-Costs>  for the article 
http://www.crainsnewyork.com/article/20120822/PULSE/120829970#ixzz24GscV
RHz

 

Impact of Point-of-Care Case Management on Readmissions and Costs
(Excerpt)

Andrew Kolbasovsky, PsyD, MBA; Joseph Zeitlin, MD; and William
Gillespie, MD

(Am J Manag Care. 2012;18(8):e300-e306)

 

A POC (point of care) team consisting of a nurse case manager, social
worker case manager, pharmacist, and 2 health navigators was integrated
into a large urban medical group to work with hospitalized health plan
members at 4 medical offices. These offices provide services to
approximately 23,000 members under a capitated financial arrangement.
These health plan members account for approximately 75% of the medical
group's patients; the remaining 25% are members of other health plans.
Each of the offices provides both primary care and specialty services.


On a daily basis, hospitalized members were referred to a member of the
POC team who, prior to discharge, attempted to contact the member via
telephone for enrollment in the program. During the initial contact, the
POC team member introduced the program and confirmed all contact
information. 

 

In the weeks following initial contact, the team member:

*       discussed the importance of aftercare; 

*       ensured that a timely aftercare appointment was made; 

*       provided appointment reminders and rescheduled any missed
aftercare appointments; 

*       performed a needs assessment and linked the member to health
plan, medical group, and community resources; 

*       coached the member on communicating with the PCP; 

*       reviewed how to access care resources such as after-hours and
express care; 

*       identified red flags for readmission; 

*       developed a plan of action; 

*       identified any barriers to treatment or medication adherence;
and 

*       worked with the member to overcome these barriers. 

In addition, the POC team arranged for the pharmacist to conduct
medication reconciliation. 

 

The pharmacist reviewed medication lists and had telephone or in-person
meetings with members. In addition to their own caseload, each team
member was also available to consult on cases whenever their specific
specialty was needed. Health plan members were able to speak with the
POC team via telephone or have face-to-face meetings in the medical
office. The team had access to members' clinical information in the
electronic medical records used by the medical group....

 

http://www.ajmc.com/articles/Impact-of-Point-of-Care-Case-Management-on-
Readmissions-and-Costs

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