http://chqpr.org/blog/index.php/2009/01/marrying-the-medical-home-and-hospital-readmissions/ Fri, 21 Jan 2011 22:19:06 +0000 hourly 1 http://wordpress.org/?v=3.3.1 http://chqpr.org/blog/index.php/2009/01/marrying-the-medical-home-and-hospital-readmissions/comment-page-1/#comment-222 Harold Miller Thu, 09 Apr 2009 17:49:40 +0000 http://chqpr.org/blog/?p=29#comment-222 Reducing readmissions will, by definition, save money. The challenge is getting the right programs in place to do that. The problem with most of the care coordination interventions is that reducing readmissions is a post-hoc evaluation metric, rather than a primary focus of the program from the beginning. The most recent evaluations have shown that telephone-based care management doesn't work, but care management that includes home visits does (or at least can) work, and programs like Care Transitions do work reliably. There has to be both the ability and the motivation by the organization doing care coordination -- which should ideally be a physician practice, not a disease management company -- to focus its efforts on the populations that are (a) at high risk of readmission and (b) with high probability of success in avoiding readmission. That may be at odds with process-driven P4P systems that force a focus on making sure every single patient gets an Hba1c check, regardless of whether they are at risk of hospitalization, readmission, or other high utilization of services. Harold Miller Reducing readmissions will, by definition, save money. The challenge is getting the right programs in place to do that. The problem with most of the care coordination interventions is that reducing readmissions is a post-hoc evaluation metric, rather than a primary focus of the program from the beginning. The most recent evaluations have shown that telephone-based care management doesn’t work, but care management that includes home visits does (or at least can) work, and programs like Care Transitions do work reliably. There has to be both the ability and the motivation by the organization doing care coordination — which should ideally be a physician practice, not a disease management company — to focus its efforts on the populations that are (a) at high risk of readmission and (b) with high probability of success in avoiding readmission. That may be at odds with process-driven P4P systems that force a focus on making sure every single patient gets an Hba1c check, regardless of whether they are at risk of hospitalization, readmission, or other high utilization of services.
Harold Miller

]]> http://chqpr.org/blog/index.php/2009/01/marrying-the-medical-home-and-hospital-readmissions/comment-page-1/#comment-219 steve Wed, 08 Apr 2009 18:03:27 +0000 http://chqpr.org/blog/?p=29#comment-219 "The savings achieved by payers from reduced hospitalizations would more than offset the costs of the improved services, justifying funding those services at levels sufficient to achieve the desired results." - At this time, no actual study has proven this. The most recent, published in the Journal of the American Medical Association, which is physician, not hosptial run, did not demonstrate that active structured coordinated interventions signifcantly decresed readmissions in 13 of 15 projects a round the country and in all of them, there were no costs savings. There needs to be more studies defining the spcifiec subpopulation of the chronically ill that would benefit from Medical Homes, in order to reach the desired outcomes. “The savings achieved by payers from reduced hospitalizations would more than offset the costs of the improved services, justifying funding those services at levels sufficient to achieve the desired results.” – At this time, no actual study has proven this. The most recent, published in the Journal of the American Medical Association, which is physician, not hosptial run, did not demonstrate that active structured coordinated interventions signifcantly decresed readmissions in 13 of 15 projects a round the country and in all of them, there were no costs savings. There needs to be more studies defining the spcifiec subpopulation of the chronically ill that would benefit from Medical Homes, in order to reach the desired outcomes.

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