This week’s blog is written by our US colleague, Douglas Beaudoin, who is a Principal and leads Deloitte Consulting LLP’s Life Sciences and Health Care practice. This article first appeared in the US Center for Health Solutions blog, A View from the Center.1 The article highlights some of the work being done to lower readmissions and reduce unnecessary costs, which may also be pertinent to our system here in the UK.
Predicting and preventing
With the continued shift to value-based care, hospitals are increasingly focused on reducing readmission rates. And preventable readmissions are not just a problem in the US. Globally, 20 percent of patients are readmitted within 30 days of discharge. Researchers in Singapore have developed a web-based tool that predicts a patient’s 15-day readmission rate. By more accurately predicting higher risk patients, hospitals can more effectively target preventable readmissions, and potentially reduce unnecessary costs.
The tool identifies high-risk patients and prompts the care team to consider targeted interventions during admission, discharge, and post-discharge. The research team tested the tool on 621 patients discharged from two Singapore hospitals over two-months. Prior research has shown that early readmission (within seven days or less) is more likely to be causally related to the preceding admission episode, while later readmissions (between eight and 30 days) have demonstrated associations with morbidities and social determinants of health. Both sets of risk factors can be addressed by hospitals and health systems.
The web-based tool calculates the likelihood of readmission based on the presence of certain risk factors, including age, pre-existing conditions, number of discharge medications, discharge destination, and evidence of premature discharge against medical advice. The study showed that the number of medications prescribed at discharge was significantly associated with 15-day readmission risk. For each additional medication prescribed, the risk of 15-day readmission increases by six percent.
Patients who the hospital identifies are at high risk for 15-day readmission may benefit from specialized discharge planning, medication counselling, caregiver training, or be eligible for home visits. Researchers concluded that prescribing additional medications that may be more discretionary, such as for mild pain, mild constipation, or nausea, could harm some patients if it adds to their medication regimen. Timely and targeted medication counselling as well as educational initiatives to help patients understand the importance of medication adherence are likely important to improving overall patient outcomes, including readmission risk reduction.
The study also found that patients discharged to nursing homes had higher readmission risks. The researchers concluded that ensuring that patients enter appropriate care facilities may help reduce readmissions.
The team is now refining the tool and integrating it into electronic medical records in Singapore.
Deloitte’s recent paper, ‘Navigating bundled payments: Strategies to reduce costs and improve health care’, discusses strategies many hospitals, health systems, health plans, and technology companies are trying to reduce readmissions and improve care coordination. Providers that participate in bundled payments, a method of paying for health care in which one price is set for a package, or bundle, of services that previously would have been paid for separately, are often highly motivated to achieve improved health outcomes and reduce unnecessary costs. The strategies identified in the paper that leading stakeholders are finding successful include:
- Investing in care coordinators to track and periodically contact patients after hospital discharge to assist with medication reconciliation, educate them on symptoms to monitor, and encourage follow-up with their physicians;
- Hiring less-expensive staff, and not only relying on nurses to help patients and meet care coordination goals;
- Striving for prompt scheduling with community physicians and outpatient rehabilitation services to improve outcomes, and relying on pharmacists to support medication reconciliation and underscore the necessity for adherence;
- Using analytics to identify patients with the constellation of comorbidities and other health and support issues that put them at the greatest risk for readmissions.
Alternative payment models (APMs) such as bundled payments in health care are becoming more prevalent, as health care stakeholders are interested in strategies that use incentives to achieve better value. Legislation including the Medicare Access and CHIP Reauthorization Act (MACRA) is encouraging more health care organizations to participate in APMs and take on more risk. Aligned incentives, paired with innovative tools like the one coming out of Singapore, is likely to help hospitals and health systems reduce readmissions, improve the patient experience, and reduce unnecessary costs.