Archived Insight | February 1, 2020
Hospitals provide patients with some of the best care modern medicine can offer, but it can come with a hefty price. Inpatient hospital admissions usually rank among the highest expenses on your health plan’s balance sheet.
This means avoiding preventable hospital readmissions (defined as patients going back to the hospital within 30 days of discharge) needs to be a top priority. Here are some strategies to help reduce the number of participants who are readmitted to the hospital.
People go to the hospital for all sorts of reasons, but the research shows patients suffering from psychiatric disease, substance abuse, or chronic illness tend to be readmitted more often than other populations of patients.
As a plan sponsor, how do you manage the risk of hospital readmissions with your most vulnerable participants? By holding your carrier responsible for the actions of its healthcare facilities in their network. Here’s what many hospitals do to exacerbate the problem of readmissions.
Readmission rates are key metrics for measuring performance of hospital, health plans, facilities, physicians and accountable care organizations (ACOs) because many have financial rewards and penalties tied to them, especially under Medicare.
Here’s what you as a plan sponsor can do to help reduce hospital readmissions for your participants.
These services, which your carrier or a third party vendor can often provide, monitors patients during discharge and provides help when needed. You should also make sure your carrier uses predictive data to determine which patients have a greater chance of needing these services.
Hospital readmission rates create a huge burden on your plan’s financials, so create metrics with your carrier that penalizes them for including in their network hospitals with high readmission rates. You should also consider dropping network hospitals with excessively high readmission rates from your network altogether.
You should also try to head off hospital readmissions where they start—the health of the patient. A well-planned communications campaign using your website or a mobile app informing participants on how to lower their risk for hospital admissions can pay dividends in saved costs.
There are certain known risk factors that result in readmissions. The list includes clinical factors such as
Other risk factors are demographic or logistical in nature, such as:
For a plan with inpatient hospital costs that are 30% of total costs and high readmissions rates, significant overall plan savings can be achieved by reducing these rates to industry best practice levels.
While not every hospital readmission is avoidable, the strategies we discussed here can help you reduce the number of expensive, preventable readmissions from occurring to keep your participants—and your plan’s finances—healthy.
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.
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