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.

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Danno wrote on June 14, 2013 at 8:06 am

I can hear it now. Sung to the tune of 'Along Comes Mary' by The Association; 'Along Comes Prussing.'

Commonsenseman wrote on June 14, 2013 at 8:06 am

Health Alliance and its "death panels" at work", Heres why people get readmitted to the hopital....their "doctor" made them leave too soon because Carle and Health Alliance didnt want to pay for them to stay any longer.  So now they are looking at ways to prevent readmission by dumping people into nursing homes and not taking them back.  Health Alliance was the worst insurance I ever had and wouldn't pay for my kids medicine because they wanted her doctor to use something cheaper even though the medicinne she had worked well for her.  

Danno wrote on June 14, 2013 at 8:06 am

It's this way everywhere, Commonsenseman, and getting worse as B-Boomers are going to overwhelm the already stressed Medical System. I do have empathy for your child's situation; it exists in determing which Chemo 'cocktail' to change/administer, et.al., also. Twice, I've had Blue Cross Blue Shield, twice, Health Alliance. Personally, overall, Health Alliance has been best for wifey and me. With what other providers might you be referring to?

Danno wrote on June 14, 2013 at 8:06 am

It's this way everywhere, Commonsenseman, and getting worse as B-Boomers are going to overwhelm the already stressed Medical System. I do have empathy for your child's situation; it exists in determing which Chemo 'cocktail' to change/administer, et.al., also. Twice, I've had Blue Cross Blue Shield, twice, Health Alliance. Personally, overall, Health Alliance has been best for wifey and me. With what other providers might you be referring to?

Commonsenseman wrote on June 14, 2013 at 10:06 am

We got out of Health Alliance and found a doctor outside of the Carle Medical Sweatshop (the doctors own words, he also said Carle was in the bottom ranking of physcian satisfaction in the nation) who was able to get her back on proper medicine.  I think  doctors should be allowed to treat patients instead of being forced to meet arbitrary goals in time and production. We buy insurance but the price keeps going up, and we pay more for copays and visits than people on medicaid, but the people on medicaid get the same or better care than us, how does that make sense?  Another problem was that Health Alliance wouldnt pay for a doctor outside of the Carle system.  There were lots of very dirty and angry people at the clinic, it was likea giant dept of public health, overall we are very disappointed in what we had to deal with as paying customers.  If my doctor is unhappy with their administration how can they take care of us properly?  Unhappy people are always bad employees.  We are worried what will happen next year, most people on the medical profession tell me it will get worse.