Managed Healthcare Executive: Health Plans in Ideal Position to Identify Readmission Risks

Managed Healthcare Executive: Health Plans in Ideal Position to Identify Readmission Risks

The March edition of Managed Healthcare Executive includes an article, “Health plans in ideal position to identify readmission risks,” which highlights the essential role of health plans in reducing preventable hospital readmissions – a top priority for policymakers and health care stakeholders.  The article notes the wealth of information health plans can access to help identify patients at high risk of hospitalization or readmission and the unique position of these plans to put in place programs to help reduce unnecessary readmissions.

AHIP’s Center for Policy and Research has released a number of reports highlighting the success of Medicare health plans in reducing preventable hospital admissions and readmissions compared to the fee-for-service (FFS) part of Medicare.  These include the following:

  • A study in the February issue of the American Journal of Manage Care found that risk-adjusted readmission rates for Medicare Advantage beneficiaries were 13% to 20% lower than in traditional FFS Medicare.
  • An article in the January issue of Health Affairs found that seniors with diabetes in a Medicare Advantage special-needs plan had more primary care physician office visits and fewer hospital admissions and readmissions than beneficiaries in FFS Medicare.
  • A series on hospital readmissions is available here:
  • A recent AHIP publication, Innovations in Reducing Preventable Hospital Admissions, Readmissions, and Emergency Room Use, provides company specific examples of the types of programs and services that health plans have implemented to reduce preventable hospital admissions, readmissions, and emergency room visits.

Here are highlights from the Managed Healthcare Executive article:

  • “Unplanned and preventable hospital readmissions are a major cost driver of healthcare costs.”
  • “Health plans are probably in the best position to make headway at reducing readmissions,” says Anna Sommers, senior health researcher with the Center for Studying Health System Change in Washington, D.C. and co-author of a research brief on the role of physician visits in reducing readmission rates. “Physicians on the front line do not have the tools to identify patients who are at risk of readmission. They often don’t even know that their patients have been discharged from the hospital.”
  • “…health plans have information from claims data, risk adjustment analysis and predictive modeling to identify patients at high risk of hospitalization in general and readmission in particular. Using this data…health plans can act as an intermediary between hospitals, primary care physicians and specialists to facilitate communication at the time of discharge.”
  • One health plan has “implemented a case management initiative to contact patients who are in the hospital to make sure the patient understands the discharge instructions before they leave. Once at home, these patients are contacted by a healthcare coach.”
  • “After about 18 months, the hospitals participating and reporting data in the project reduced their 30-day same-hospital readmission rates by 7%, from 12.2% to 11.4%. In dollar terms, this reduction represents more than $3.8 million in savings on unnecessary healthcare spending and allowed 400 patients to avoid being readmitted.”
  • “…some health plans contact patients three days after discharge to see how the patient is doing and whether the patient has scheduled their follow-up appointments.”
  • “As plans allow billing for electronic visits via e-mail or telephone, these visits and follow up could be a boon to patients who are less mobile following hospitalization. New technology that allows closer home monitoring could also play a role in helping to reduce readmissions.”

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