PHILADELPHIA, Nov. 16, 2018 /PRNewswire/ -- After the first
year of an innovative, five-year contract between the University of Pennsylvania Health System (UPHS) and
Independence Blue Cross (Independence), the health system is
reporting a more than 25 percent cut in hospital readmissions – the
largest readmission reduction in both organizations' history. As
part of the first collaboration of its kind in the United States between a health system and
a health insurer, the two organizations have launched a new slate
of innovations to reduce the number of patients who return to the
hospital within a month of going home. The contract provided that
Independence wouldn't pay for the resulting hospitalization in
those cases.
The new contract, which took effect July
1, 2017, marked UPHS's entry into a new way of working with
Independence that is designed to encourage collaborative efforts by
the insurer and health systems to improve quality of care and
reduce health care costs for Independence members.
Many factors contribute to a patient's likelihood of being
readmitted, including disease progression, complications or
infections that happen after an initial hospital stay, emergency
room visits for management of chronic conditions, and
miscommunications between patients or caregivers and medical teams
regarding medications and other discharge instructions. These
factors are often co-mingled, especially among patients with
complex diseases like heart failure and cancer, or those who are
managing multiple serious conditions. Making a dent in the number
of patients who are readmitted is notoriously difficult: On
average, hospitals' typical interventions only cut readmissions by
approximately one percent annually.
"To see such a drastic improvement just one year into our
partnership with Independence serves as a great motivator to
continue finding ways to bend the curve of rising health care
costs," said Ralph W. Muller,
CEO of the University of Pennsylvania
Health System. "That can only happen if we work together to keep
patients healthier, and in the first year of our new model, we're
proud to have shown that we can achieve both goals."
At the outset of the new initiative, Penn Medicine leveraged its
electronic health record platform to identify patients at high risk
of readmission, which includes many with cancer, heart disease,
gastrointestinal conditions, and sepsis. Risk of readmission varied
greatly across these patients -- patients classified with a high
risk of being readmitted returned to the hospital 16 percent of the
time, while patients classified as low-risk were readmitted less
than one percent of the time. Stratifying patients based on
readmission risk helped Penn Medicine to focus their efforts on
patients at the greatest risk of readmission. During FY18,
approximately 15,000 inpatient admissions were for patients insured
by Independence.
New electronic medical record functions provided clinicians
across Penn Medicine's many care settings, including emergency
departments, outpatient clinics, and home care, with access to
real-time insights on each high-risk patient. The platform helped
clinicians take proactive steps to reduce common post-discharge
hurdles and make more informed decisions to keep patients well at
home. For certain patients with complex medication regimens, this
included use of pre-packaged medication boxes that were developed
through a joint Independence and Penn Medicine initiative to
remotely monitor and ensure patients took their medications as
prescribed.
"These results are phenomenal and prove just how much we can
achieve if we innovate together on purposeful programs to improve
patient and member care," said Daniel J.
Hilferty, president and CEO at Independence Blue Cross.
"We hope our experience reinforces to others in the health care
field how important it is to work together to find solutions that
can positively impact the quality and coordination of care and
fight rising health care costs for patients and members."
An analysis of data sourced by both Independence and Penn
Medicine from before the new effort began showed that 40 percent of
readmissions occurred within seven days of discharge, underscoring
the need to improve patient education and expand access to
outpatient follow-up care and home health visits. Now, patients who
are found to be at high risk of readmission receive a call from a
scheduler who assists in setting up all their follow-up outpatient
appointments – typically combining them on the same day – even
before they're discharged from the hospital. Dashboards were
developed to track follow-up visits at seven and 14 days after
discharge to ensure patients receive timely follow-up care. Most
patients now also leave the hospital with all their prescriptions
in hand to avoid any delays in beginning new drug regimens.
Additional efforts included:
- Focusing on improved coordination between the inpatient
clinical team and outpatient follow-up and home health care
providers to close any treatment gaps that put a patient at a
higher risk for readmission.
- Implementing more robust home care services to provide new
opportunities for disease management and medication teaching after
patients are discharged from the hospital.
- Monitoring high-risk patients remotely after leaving the
hospital – a strategy Penn Medicine has also used to identify
complications among heart failure patients and new mothers – to
quickly identify and treat any problems.
- Reviewing patient data daily and having a care coordinator
reach out to the patient if indicators are trending toward
trouble.
As a result of the initiative, new services were also added to
better care for patients without readmission. For example, data
showed that many cancer patients were readmitted through the
emergency room. In response, Penn Medicine developed an outpatient
Oncology Evaluation Unit where patients can be seen as outpatients
and effectively treated for common issues like dehydration. This
program has been so successful that Penn Medicine is now reviewing
other patient populations that would benefit from a symptoms
management clinic.
"Research suggests that 25 percent of all readmissions are
preventable, so what we've been able to demonstrate in this first
year working with our partners at Independence is that we can
implement strategies that substantially reduce our readmission
rates and improve overall patient care," said Patrick J. Brennan, MD, chief medical
officer and senior vice president of the University of Pennsylvania Health System. "When we
treat patients at or close to home, we are giving them the best
chance at staying healthy and staying out of the hospital. By
lowering our readmission rates we are improving the patient
experience from the moment they walk through our doors until well
beyond the time they leave the hospital."
"Additional enhancements to care delivery, such as remote
monitoring, virtual interaction, and intensive management in
post-acute care and home settings, will further improve access to
well-coordinated and satisfying care for our members and Penn
Medicine patients," said Richard L.
Snyder, MD, senior vice president and chief medical
officer at Independence Blue Cross. "The creative energy of our two
organizations to improve the experience and outcomes of care is
truly energizing and rewarding."
UPHS's contract with Independence includes the Hospital of the
University of Pennsylvania, Penn
Presbyterian Medical Center,
Pennsylvania Hospital, and Chester County Hospital,
as well as care delivered in
outpatient facilities, hospice, and home care services.
Media
Contacts:
|
Diana
Quattrone
|
Katie
Delach
|
|
215-241-3113
(o)
|
215-349-5964
(o)
|
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215-815-7828
(c)
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215-776-6063
(c)
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Diana.Quattrone@ibx.com
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Katie.Delach@uphs.upenn.edu
|
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SOURCE Independence Blue Cross