Tony Berberabe

High quality post-hospital orders can cut readmissions by 30 percent. Medical administrators may soon insist on it.

Tony Berberabe

Patients who have a clear understanding of their after-hospital care instructions, including how to take their medications and when to make follow-up appointments, are 30 percent less likely to be readmitted or to revisit the emergency department than patients who lack this information.

Fewer readmissions and emergency department visits mean lower total costs. According to a new study funded by the Agency for Healthcare Research and Quality (AHRQ) and published in the Feb. 3 Annals of Internal Medicine, total costs (a combination of actual hospitalization costs and estimated outpatient costs) were $412 (33 percent) lower for patients who received complete information than for those who did not.

That’s a significant saving to insurers, but not necessarily an incentive to hospitals, says Brian W. Jack, MD, of Boston University Medical Center’s Department of Family Medicine, the lead author of the study. “This definitely decreases hospital utilization,” says Jack.

The research team developed a multifaceted program to educate patients about their post-hospital care. Called the Re-Engineered Hospital Discharge Program (RED), the program used specially-trained nurses to help one group of patients arrange follow-up appointments, confirm medication routines, and understand their diagnoses using a personalized instruction booklet. A pharmacist contacted patients between two and four days after discharge to reinforce the medication plan and answer questions.

Thirty days after discharge, the 370 patients who participated in the RED program had incurred 30 percent fewer emergency visits and re-admissions than the 368 patients who did not. Participants in the RED program were also more likely to have a follow-up appointment with their primary care physician and say they were prepared for leaving the hospital than non-participants, according to the study findings.

Nearly all (94 percent) of the patients in the RED program left the hospital with a follow-up appointment with their primary care physician, compared to 35 percent for patients who did not participate. More than half (53 percent) of participants had their updated medications included in their post-hospital care plan, and nearly all (91 percent ) had their discharge information sent to their primary care physician within 24 hours of leaving the hospital.

Making post-hospital care available to patients did not prevent medication problems from occurring, the study noted. Sixty-five percent of the RED program participants who completed the medication review with the pharmacist had at least one problem with their drugs. In half of those cases, the pharmacist needed to take action, such as contacting the patient’s doctor.

“Patients are sometimes placed in a difficult and complex situation upon discharge,” says Jack. “Having a pharmacist call a few days later to check on how the medication is working or whether there are any problems with medications can have good results.”

Rollout

“This program meets all the national accrediting organizations’ best practices guidelines for high quality discharges,” says Jack. “Our research shows that it can decrease the risk of a patient coming back to the emergency room. That’s a major clinical outcome.”

The Centers for Medicare and Medicaid Services (CMS) has a request for proposals for the quality improvement program of each state to develop a new payment structure. Grants have been made to 14 states and “Project RED is being used in 8 of the 14,” says Jack. “The first rollout is occurring in Rhode Island.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.