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When healthcare organizations cut even a minority of avoidable readmissions, the cost savings can be considerable and the quality impact even greater.

Reducing Readmissions: Interventions, Incentives and Infrastructure presents case studies from three healthcare organizations whose efforts have significantly reduced avoidable hospital readmissions in high-risk populations and include the alignment of financial incentives to readmission rates.

This 50-page special report provides details on:

• The robust initiative behind Priority Health's significantly lower rates of unnecessary hospitalizations among its PriorityMedicare(SM) members as compared to those for traditional fee-for-service Medicare — 6.94 percent compared to the 18.6 percent readmission rate for traditional Medicare. Mary Cooley, manager of case and disease management at Priority Health, details the Care Transition Program Priority Health uses to help patients at high risk for complications or rehospitalization bridge the transition from hospital to home — initially in its Medicare Advantage product line and recently rolled out across its entire book of business with success across all populations.

  Priority Health's multi-faceted care transitions effort for patients with cardiovascular conditions starts in-hospital and follows the patient through discharge and follow-up physician visits, empowering the patient to be an active participant and consumer in their healthcare.
  
  

• An intensive intervention developed by Aetna based on the Transitional Care Model in which advanced practice nurses work extensively with patients after discharge. Dr. Randall Krakauer, national medical director, Medicare at Aetna, provides details on a pilot initiative with a focus on home care that reduced hospital readmissions in the three months post-discharge by 25 percent.

  The Aetna program links transitional care with case management, using targeted interventions aimed at promoting effective hand-offs as well as comprehensive interventions designed to address the root causes of avoidable acute care service use. Aetna is planning a large-scale implementation of this program throughout its Medicare population.
  
  

• A statewide program from the Maryland Health Services Cost Review Commission (HSCRC) that compares actual versus expected rates of performance for hospital readmission rates that is risk-adjusted. Dianne Feeney, BSN, MS, associate director of quality initiatives for the HSCRC, explains the strategic planning, analytics and infrastructure behind Maryland's initiative to incent hospitals to improve readmission rates on a risk-adjusted basis.