‘Communities of Care’ Model Saves $5 Million In Hospital Costs

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Connecticut has saved an estimated $5.4 million in Medicare costs since 2010 by reducing re-hospitalizations of patients through a collaborative “communities of care” model in place in 14 regions around the state, including Hartford, New Haven, Milford, Meriden and Torrington.

The estimate by Qualidigm, the state’s Medicare quality improvement organization, coincides with a study in the Journal of the American Medical Association (JAMA) that showed a marked decrease in both hospitalizations and readmissions of Medicare patients in regions where quality improvement organizations (QIOs) coordinate interventions that engage community partners to improve care after discharge.

Hospital clinicians and their community partners in the 14 regions of Connecticut have stepped up “to find solutions (so that) patients are benefitting from enhanced coordination among providers across the care continuum,” said Dr. Mary Cooper, vice president and chief quality officer of the Connecticut Hospital Association, which is working with Qualidigm on the “communities of care” model.

Readmitting Medicare patients to the hospital within a month of discharge is a frequent—and expensive — occurrence. A new report published this week by the Robert Wood Johnson Foundation shows that hospitals and their community allies made little progress from 2008 to 2010 at reducing readmissions for elderly patients. It found that one in eight Medicare patients was readmitted to the hospital within 30 days of being released after surgery in 2010, while one in six patients returned to the hospital within a month after receiving medical care.

While the report showed little progress from 2008 to 2010, many hospitals have increased efforts to reduce readmissions since then.

In Connecticut, 23 of the state’s 30 acute-care hospitals lost Medicare funding this year because of high rates of readmitting patients. Four faced the maximum loss, a 1 percent reduction in funding: Griffin Hospital in Derby, the Hospital of St. Raphael (now part of Yale-New Haven), the Masonic Home and Hospital in Wallingford, and MidState Medical Center in Meriden. On the other end of the spectrum were hospitals including Middlesex, Hartford, Manchester Memorial and William W. Backus in Norwich, which had no readmission penalties.

The federal government tracks 30-day readmissions of patients who are hospitalized for three conditions: pneumonia, heart attacks and heart failure. A readmission is counted, no matter why a patient lands back in the hospital. Medicare began reducing payments to more than 2,200 hospitals nationwide – including the 23 in Connecticut – in October.

Leaders of the “communities of care” program note that many of the causes of re-hospitalizations lie outside the hospitals’ control and are related to patients’ transitions to community providers. Hospitals are working with nursing homes and other providers to improve the transitions.

“Each step of a patient’s health care journey carries the potential of a faulty transfer of important medical information or a poor hand-off process,” said Dr. Thomas P. Meehan, Qualidigm’s chief medical officer. “Since the program’s inception, ‘communities of care’ participants have learned valuable lessons and improved their systems of transitioning patients to another setting.” He said one of the key strategies has been to ensure that every patient has detailed health information with them as they transition out of the hospital.

Connecticut’s “communities of care” program has grown more than three-fold, now involving more than 150 health and home care partners.

The JAMA study focused on 14 communities around the country, where researchers found that interventions helped to avert about 6,800 hospitalizations and 1,800 re-hospitalizations per year. In a hypothetical average community of 50,000 fee-for-service Medicare beneficiaries, the collaborative effort would have saved Medicare more than $4 million per year in hospitalization costs, while costing less than $1 million to implement, the study authors said. However, the study found no change in the rate of re-hospitalizations as a percentage of all hospital discharges.

At Yale-New Haven Hospital, Kathleen Tynan-McKiernan, director of clinical effectiveness, said participating in the community model has “opened up the frequency and ease of communication between post-acute providers and hospital staff.”

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