06/29/2011
Readmission prevention program for Regence MedAdvantage launching in July 2011
A 2009 New England Journal of Medicine (NEJM) article states Medicare payments for unplanned readmissions in 2004 accounted for about $17.4 billion of the $102.6 billion in total hospital payments, making them an important target for cost reduction. When we looked at our own data, we found a similar trend. We also realized a high percentage of readmissions had been sent home with no follow-up.
To improve the experience of our members and reduce the cost of avoidable readmissions, we are launching a Regence MedAdvantage Readmission Prevention program in July 2011. The program will focus on members with recent admissions for conditions that have a high likelihood for readmission within 30 days of discharge—cardiology, gastroenterology or pulmonary.
Program nurses will call members within 72 hours of their discharge (the optimal window for intervention) to make sure they have adequate discharge plans, are screened for adherence to the post-hospitalization treatment plan, and receive care coordination and transition-of-care services when they need them. By doing this, we hope to reduce hospital readmissions, reduce complications and promote more effective use of outpatient health care benefits.
This program will promote quicker recoveries for participants and should help reduce the overall cost burden to the health care system. If it performs as well as we hope, we'll consider expanding it to our group and Individual members.
If you have questions, please contact your Regence sales representative.
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