Healthcare spending in the United States is higher per-capita than in any other OECD country. Reasons for this unfortunate distinction are many and varied—uncoordinated care, specialty Rx, underutilization of palliative care—but there many hidden factors driving costs for providers.
Re-admissions remain a focus and albatross on the system. They can be incredibly expensive for hospitals, especially if the patient is being treated in a value-based relationship with a payer.
The Affordable Care Act placed a much heavier burden on healthcare providers to prevent readmissions within a 30-day window after discharge, and punishment from government payers can be swift and ruthless. In October 2019, Medicare cut payments to more than 2,500 hospitals, to the tune of $563 million over one year. Hospitals are already feeling a budget crunch from the loss of elective surgeries during the COVID-19 pandemic, so administrators are managing smaller margins.
A well structured value-based arrangement is only as effective as its infrastructure and care model behind it. Given that hospitals discharge patients to dozens, if not hundreds, of nursing homes and home health agencies, it can be difficult to maintain adequate communication across the care continuum. There are a number of ways to improve coordination with post-acute community partners, and hospital administrators and heads of population health should consider the following when developing a plan to address re-admissions:
Guest post by Mohd Haque, vice president and global business head, healthcare, Wipro Technologies.
Mohd Haque
Population health management (PHM) isn’t just the latest buzzword. Or a new initiative mandated by the Affordable Care Act. Implementing a successful PHM program requires a complete shift in mindset from volume healthcare to value-based and outcome-based. PHM can’t be something that your healthcare facility “does,” but it must become the cornerstone of everything related to how your facility practices medicine.
Although the shift in perspective is the first step, it is essential to arm yourself with Population Health Management IT tools as well. According to 26th Annual HIMSS Study, half of the respondents (51 percent) have improved PHM through IT tools with only 38 percent saying that their organization was using specific Population Health Management tools.
By using big data analytics, EHR integration, IT infrastructure and security as part of a PHM program, providers can ensure patients that need high levels of care aren’t overlooked and the lower risk patients don’t get unnecessary care. This will in turn increase quality of care while saving money on interventions needed for low risk patients.
What are the Components of Effective PHM Program?
Since PHM is such a large shift, it is important to know exactly how to go about creating an environment that focuses on outcomes instead of volume. Population Health Alliance recommends the following four components to a PHM program:
Assessment – Evaluate each patient’s health and assign patients to a risk group (high to low)
Stratification – Provide the same interventions for everyone in the same risk group
Person-Centered Intervention – Provide interventions based on each specific patient’s needs, including community health research
Impact Evaluation – Determine the impact of interventions for each risk group as well as each individual patient
However, you can’t simply change the process without changing how each person on the team views healthcare and their patients. It must be a fundamental shift in your facility from the receptionist to the department chief.
