Health Alliance working to prevent hospital readmissions
URBANA — Health Alliance Medical Plans says it has been working with several area skilled nursing facilities to help reduce preventable readmissions to the hospital.
The Urbana-based managed-care company said it has completed the first nine-month phase of collaboration with the Champaign County Nursing Home, Clark-Lindsey Village and Heartland Health Care Center facilities in Champaign, Paxton and Normal.
The goal is not only to cut avoidable readmissions, but also to improve care and outcomes for Health Alliance Medicare Advantage members and lower costs, the company said.
With nearly one in five Medicare patients returning to the hospital within 30 days of being discharged, reducing readmissions has become a big focus in health care.
Readmissions cost Medicare $26 billion a year, and Medicare began fining hospitals last October for having excessive numbers of patients readmitted in connection with heart attack, congestive heart failure and pneumonia.
April Ogle, revenue management director for Health Alliance Medicare Advantage, said Health Alliance has seen a high percentage of readmissions from skilled nursing facilities, but this is the first time the company has tried working with any of the facilities to make a difference.
So far, Health Alliance doesn't have data to support that readmissions have declined over the past nine months of collaboration, but the company will be looking for that in the next three months, Ogle said.
Meanwhile, she said, there have been improvements that should lead to fewer readmissions.
Some facilities involved in the project have made staffing changes — for example, boosting shifts from eight hours to 10 hours, because more readmissions occur after an 8 a.m.-to-5 p.m. shift, Ogle said.
"Reducing the number of hand-offs between caregivers tends to result in a better coordination of care," said Dr. Robert Parker, Health Alliance's chief medical officer.
Nursing facilities have done more staff education, too, about what health services can be provided there rather than at a hospital, Ogle said.
Some other changes have included increasing medication reviews prior to patients being discharged and increasing end-of-life discussions and planning, according to Health Alliance.
A second, yearlong phase of the project, perhaps bringing in other skilled nursing facilities, is starting this month, Ogle said.