Mass. has hospital readmissions problem

Preventive care, technology can be key to reducing emergency room visits

Steve Strongwater, MD.

THERE IS A great deal to celebrate in Massachusetts following the Health Policy Commission’s recent Cost Trends Hearing. The Commonwealth’s healthcare spending growth was well below the national average in 2017 – the lowest since the agency’s inception to help curb the total cost of care in the state. While it’s important to recognize these achievements, there’s more we can do to make sure Massachusetts is a more affordable place for patients to receive the quality care they deserve.

According to the commission, Massachusetts is the third-worst state when it comes to hospital readmissions, and our inpatient hospital admission rates have lagged over the past three years, remaining higher than the U.S. average. In fact, more than one-third of Massachusetts residents in 2017 reported that their last visit to the emergency department wasn’t for an emergency. While there’s no panacea for solving our readmissions issues, there are several ways we can keep patients healthy and out of the hospital, all while building on our progress to reduce spending growth.

The first step to staying out of the hospital starts with the right preventive care. It’s incumbent upon consumers and primary care teams to actively engage and develop strategies for making healthy lifestyle choices in order to avoid chronic conditions later in life. Clinicians need to partner with the people they serve and educate them about their risks, medications, what screenings are needed to detect and/or prevent chronic illness and how best to manage existing conditions or illnesses.

There is now a wealth of data in our electronic medical records which can be very helpful. At Atrius Health, we’ve developed a predictor based on about 165 variables for adult patients who are at a high risk of hospitalization – these patients are flagged in our electronic records. Our nurses can then reach out proactively to adjust medications or work with them to come into the practice without waiting for an appointment and avoiding an emergency department visit.

Sometimes, however, we know that patients can’t make it to the doctor’s office for a visit when they need urgent care. This is a frustrating reality for many elderly or frail individuals who don’t have reliable transportation or cannot travel to our practice on their own. Traditionally, they’ve either had to call an ambulance for an expensive and stressful emergency department visit that might ultimately be unnecessary, or – even worse – ignore the issue and delay their care. Patients and their families should never have to face such a decision.

A couple years ago, our innovation team took this feedback to heart and developed Care in Place, an initiative which sends home health nurses from VNA Care to provide urgent care to elderly individuals in their homes. The program is intended to help patients who cannot safely travel or when their hospital risk indicator flags in our emergency medical records. Since its inception, this initiative has helped hundreds of patients and has resulted in more than $1.8 million in savings. More than a third of program participants have avoided the wait and anxiety of an emergency department visit. In addition, assuring care is carefully coordinated after a hospitalization is essential to avoiding readmissions. VNA Care’s telehealth monitoring program also has been very effective in preventing readmissions.  By thinking of new ways to deliver the right care when and where patients need it, healthcare organizations across Massachusetts can drastically reduce hospitalizations.

While the responsibility for solving these issues lies largely with health systems and providers, we as a Commonwealth can all contribute to making care in Massachusetts more affordable and accessible. Employers, in particular, can consider how providers are paid to make sure the health systems they partner with are focusing on high-quality patient experience, better access to care and lowering total medical expense. Traditional payment methods where insurers compensate clinicians for each unit of service they provide tend to encourage higher utilization of potentially unnecessary services, like avoidable emergency department visits. However, arrangements known as alternative payment methods focus on value by paying providers for health outcomes. Medicare, one of the largest purchasers of healthcare, has recognized and embraced the need to move to value-based models that reduce the total cost of care while preserving or improving patient outcomes.

While programs such as urgent care in the home, telehealth, video visits and after-hours consultations improve access and help keep patients out of the hospital, many of these services are not routinely billable by providers under fee-for-service models. They do, however, make sense under alternative payment methods. By embracing these value-focused tactics, Atrius Health has been able to serve hundreds of thousands of patients while assuming full risk for the total cost and experience of their care. In 2015 data released this year by the Health Policy Commission, we had the best rate of avoidable ED visits in the state, low hospitalization rates, and were among the least expensive health systems in the eastern Massachusetts market in the commercial space as a result of these efforts.

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There isn’t a one-size-fits-all solution to fixing the readmissions and hospitalization issues facing our state. But together as a Commonwealth, providers, insurers and employers can do a better job of keeping patients out of the hospital and happy in their homes. As a result, we’ll have a more affordable and healthier state, and can continue to celebrate Massachusetts as one of the nation’s healthcare leaders.

Steve Strongwater, MD, is president & CEO of Atrius Health.