Community health plans are improving how patients transition from hospital to home by breaking down silos of care, coordinating among providers, and directly engaging with patients, according to a new report entitled Transitions of Care from Hospital to Home. In the report, prepared by Avalere Health for the Alliance of Community Health Plans (ACHP), Avalere researchers examined ACHP community health plans and found five practices that the plans identified as facilitating the success of their care transitions programs:
“With the increased use of quality based payments, health plans and providers have shared incentives to improve the quality of care delivered to patients,” said Dan Mendelson, CEO and founder of Avalere Health. “Our study illustrated that community health plans have taken on this charge to improve care transitions to better manage post-acute care and reduce disruptive re-hospitalizations.”
A 2009 study published in the New England Journal of Medicine found that nearly one in five Medicare patients discharged from a hospital is readmitted within 30 days, leading to high costs of care, poor quality, and low patient satisfaction.1 In addition, according to the Department of Health and Human Services, one in five patients discharged from the hospital to home experiences an adverse event—or harm resulting from medical care—within three weeks of discharge.2 By managing transitions, health plans can ensure timely follow-up care, instruct patients on proper use of medications, and reduce preventable hospital readmissions.
“We must move beyond thinking about care as individual episodes of service where one piece of the delivery system hands off a patient to another,” said ACHP President and CEO Patricia Smith. “Successful care transitions require a patient-centered approach in which providers and health plan staff are working in partnership and utilizing their unique roles and skills to provide the best care for patients.”
The new Avalere report notes patient satisfaction surveys conducted by the plans that showed care transition programs are viewed positively by patients. For example, Geisinger Health Plan, an ACHP member, uses case managers to assist patients with referrals and facilitate communication between physicians and patients. Ninety-nine percent of patients surveyed rated these services as “very good” or “good.” Ninety-six percent of surveyed patients enrolled in UPMC Health Plan’s care transitions program were either “satisfied” or “very satisfied” with the plan’s program, which uses a patient-centric care management documentation system that provides one system for all care managers to use when coordinating the care of the patient.
Additionally, Avalere found that plans featured within its report credit their care transitions programs with reducing readmission rates and decreasing costs. ACHP member HealthPartners reduced its readmission rate from 10.1 to 8.6 percent in a year for patients in its Inpatient Case Management Program. Presbyterian Health Plan estimated that its care transitions program saved approximately $1.8 million in 2010 as a result of reduced readmissions.
ACHP commissioned the report as the second in a new series, Health Plan Innovations in Patient-Centered Care. This series fills a gap in the literature on the role of health plans in delivering high-value care. Transitions of Care from Hospital to Home was developed to help other health plans build on ACHP plans’ years of experience, and lessons learned, when designing or transforming their own care transitions programs.