Resource:

Healthways Care Transitions Solution

Article

Challenge: Care Continuum  

Content provided by AHA Endorsement partner: Healthways

Learn how Healthways Care Transitions Solution™ offers the perfect combination of people, processes and technology to achieve success.


The healthcare market is rapidly moving from fee-for-service to value-based care. Hospitals and health systems must be able to quickly adapt to evolving market conditions to not only unlock the value in new models but to stay competitive. Strategic initiatives aimed at operating at the lowest cost possible while maintaining the highest levels of quality and patient/provider satisfaction are paramount.

Reducing hospital readmissions has risen to the top of many organizations’ priority lists:

  • In 2011, readmissions contributed $41 billion in total costs across all payers in the United States. Medicare had the largest share of total readmissions at $26 billion per year with $17 billion associated with avoidable readmissions.1
  • The Centers for Medicare & Medicaid Services (CMS) will penalize 2,610 hospitals with high readmission rates for an estimated $428 million in fiscal year 2015, up 89 percent from $227 million across 2,225 hospitals.2

 

Hospital readmissions are costly, potentially harmful and often avoidable. Hospitals, their aligned post-acute partners, and primary care providers along the care continuum must quickly innovate both to avoid penalties and to take advantage of the financial opportunities presented by higher quality care.

The ability to support seamless transitions between care settings is at the core of any readmission avoidance program. Healthways Care Transitions Solution™ offers the perfect combination of people, processes and technology to achieve success.

Addressing Systematic Problems with an Integrated, Essential Solution
Evidence demonstrates that hospitals can reduce the rate of avoidable readmissions through a combination of the following:

  • Improving core discharge planning and transition processes in the hospital
  • Improving transitions and care coordination at the interfaces between care settings
  • Enhancing coaching, education and support for sustained patient self-management

 

Healthways Care Transitions Solution™ is a comprehensive solution designed to reduce avoidable hospital readmissions by:

  • Early identification and engagement of at-risk patients
  • Ongoing assessment of post-acute support needs and alignment of community resources
  • Assimilation and communication of the care plan during each point of transition
  • Tailored interventions and communications throughout the post-acute period

 

The solution supports organizations in unlocking the value in existing or emerging readmission avoidance efforts regardless of whether those efforts are restricted to management of Medicare penalty conditions or represent broader initiatives such as episode management.

“Healthways has been improving the care and outcomes of patients before, during and after hospitalization for more than three decades. We found that Healthways’ people have a genuine passion for advancing the well-being of all community members. For them, it is simply the right thing to do. In addition, the Healthways solution delivers proven effectiveness. Its pilot study, for example, showed a year-to-year 44 percent reduction in self-pay readmissions.” –Anthony J. Burke, Senior Vice President, American Hospital Association, and President and CEO, AHA Solutions, Inc

Delivering Value within the Hospital and Beyond to Support Healthcare Initiatives
By partnering with Healthways for readmission avoidance, hospitals see increased patient and provider satisfaction and better quality of care. Our proven methods of patient engagement and intervention increase adherence to discharge medication and appointment regimens, improve self-efficacy in self-management, and reduce avoidable readmissions.

While achieving better outcomes for patients, addressing avoidable readmission builds a healthier bottom line. Healthways Care Transitions Solution addresses critical healthcare reform initiatives, including but not limited to:

  • Hospital Readmission Reduction Program (HRRP / CMS)
  • Hospital Value-Based Purchasing / Medicare Spend per Beneficiary (VBP / MSPB / CMS)
  • Bundled Payments for Care Improvement Initiative (BPCI / CMS)
  • Post-Acute Care (PAC) Alignment Services and Strategies
  • Accountable Care Organizations (ACO) and other shared savings or at-risk arrangements
  • Physician Quality Reporting System / Physician Value-Based Payment Modifier (VBPM / CMS)