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Resource:
Geisinger Health System: Reducing Readmissions for Medicare Advantage Patients
Geisinger Health System wanted to cut all-cause 30-day hospital readmissions among Medicare Advantage patients.
THE COMPANY:
GEISINGER HEALTH SYSTEM
Founded in 1915, Geisinger Health System is a physician-led organization that serves more than two million residents throughout Pennsylvania. The organization includes two medical center campuses, three hospitals, a 720-member group practice, a not-for-profit health insurance company and the Geisinger Center for Health Research.
THE CHALLENGE:
IDENTIFYING AND FIXING GAPS IN POST-DISCHARGE CARE
Geisinger Health System wanted to cut all-cause 30-day hospital readmissions among Medicare Advantage patients. Studies show that 75% of re-hospitalizations may be preventable, and Medicare 30-day re-hospitalizations cost the U.S. $15 billion annually. Geisinger telephone case managers worked with patients who were identified at hospital discharge as being at high risk for readmission. Multiple telephone calls to patients to identify gaps in care were effective, but they required a significant amount of staff time that made the program difficult to scale.
THE STRATEGY:
USE TELEHEALTH TO IDENTIFY GAPS IN CARE
Geisinger and AMC Health thought that interactive voice response (IVR) could be used to automate the routine calls to identify care gaps, enhancing the case management program and improving quality of patient care and financial performance. The telehealth component alerted case managers when gaps in care were uncovered, enabling them to intervene promptly to close those gaps.
THE SOLUTION:
COMPREHENSIVE CASE MANAGEMENT WITH IVR YIELDS DRAMATIC RESULTS
Geisinger and AMC Health jointly developed and implemented an IVR strategy in 2008, beginning in two clinics and expanding the program to 42 sites. Geisinger case managers added the customized IVR to the existing post-discharge program as part of their comprehensive Medical Home case management model. The program is ongoing, with several hundred patients at any one time, and more than 5,800 participants to date. In a study by the Geisinger Center for Health Research, patients who received the IVR program with traditional case management had a 44% lower risk of 30-day readmission than patients who received case management alone (n = 875, p<0.0004.)*
Building on the success of this partnership, Geisinger and AMC Health are collaborating on a hypertension telehealth pilot program for patients with chronic kidney disease, diabetes and hypertension, and an e-diabetes pilot program that will use telemonitoring for patients with non-insulin dependent diabetes.
*Graham J; Tomcavage J; Salek D; Sciandra, J; Davis DE; Stewart WF. Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day Readmission Rates in a Case-managed Medicare Population. Medical Care 50(1):50-57, January 2012.
