Blue Cross and Blue Shield of Illinois (BCBSIL) and the Illinois Hospital Association (IHA) are joining forces to reduce Illinois hospital readmissions through a new quality initiative—Preventing Readmissions through Effective Partnerships (PREP). Partnering with nationally-recognized experts from the Division of Hospital Medicine at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine and the Society of Hospital Medicine, PREP will help Illinois hospitals significantly reduce the rate of patient readmissions by 2014 through the following five key initiatives:
•Redesigning hospital discharge processes;
•Improving transitions of care;
•Developing and improving palliative care programs;
•Reducing readmissions from infections; and
•Measuring reductions in readmissions using standardized metrics
“The Illinois Hospital Association is proud to be partnering with Blue Cross and Blue Shield of Illinois,” says IHA President Maryjane A. Wurth. “The Illinois hospital community has long been committed to quality improvement and patient safety, and Blue Cross and Blue Shield of Illinois has been a strong advocate for improving the lives of its members. This partnership is an outstanding example of how the provider and payer communities can work together to transform health care in Illinois. PREP has great potential for both improving the quality of health care provided to Illinoisans, and reducing costs.”
According to Scott Sarran, M.D., BCBSIL Vice President and Chief Medical Officer, “This collaboration leverages IHA’s experience and relationships with hospitals, the expertise of the academic community and resources from BCBSIL. We expect this collaboration to have a positive impact on improving the way hospitals, physicians and other health care providers transition patients to outpatient care in the community. PREP is a four-year commitment to improving patient care throughout the State of Illinois. With this project, we hope to achieve higher-quality care at a lower cost. We believe investing resources to improve transitions of care will have major payoffs in costs and quality.”
The Commonwealth Fund State Scorecard 2009 ranked Illinois 44th in the rate of Medicare 30-day readmissions as a percentage of admissions, with a rate of 20.3%, an increase from 19.6% in 2007. Nationally, the median is 17.5% and the average for the top five states is 13.8%.
So far, 201 Illinois hospitals have pledged to reduce readmissions by the end of 2013 with the goal of raising the state’s performance from the bottom quartile to an upper quartile.
Mark Williams, M.D., F.H.M., Professor & Chief of the Division of Hospital Medicine at Northwestern and Principal Investigator for Project BOOST, will be leading efforts to optimize the transition of care for hospitalized patients through mentored implementation. “The PREP initiative represents a remarkable opportunity to disseminate evidence-based approaches to hospital care that enhance quality, increase patient satisfaction, and reduce costs.”
A critical component of PREP is patient education—assessing what a patient’s unique needs are before going home, then making sure they have the information they need to ensure a smooth transition. This patient/provider partnership includes standardized discharge pathways that highlight medications, follow up, pending tests, self-management instructions, and goal setting.
This new initiative builds on IHA’s strong and ongoing commitment to improving quality and patient safety, which is embodied in its “Raising the Bar: A Call to Action” campaign to significantly reduce readmissions and hospital-acquired infections and conditions. More than 200 Illinois hospitals and health systems are participating in the “Raising the Bar” campaign, which was announced last September.
Under PREP, each participating hospital will take specific actions to reduce readmissions. With the financial support of BCBSIL, IHA, through its Quality Care Institute, will provide hospitals with extensive technical assistance, strategic approaches, tools, and other resources. An integral part of this initiative will include a standardized approach to discharge planning, which is critical to addressing the readmissions issue, as well as a focus on reducing infections.
In addition, hospitals will receive resources and training to reduce readmissions through programs, such as:
•The Society of Hospital Medicine’s Project BOOST (Better Outcomes for Older adults through Safe Transitions);
•Illinois Transitional Care Consortium’s Bridge program, which utilizes social workers for the co-management of patients as they transition from the hospital to their homes;
•Northwestern’s Training on Palliative Care and Goals of Care; and
•The Agency for Healthcare Research and Quality’s Project RED—Re-Engineered Discharge.
PREP also will work with critical access hospitals (which serve populations in rural and underserved areas) to adapt the BOOST program to meet their unique needs. For example, patients need appropriate and comprehensive care within their community following a transplant or open heart surgery.
Research published in the April 2009 New England Journal of Medicine indicates that one in five hospitalized Medicare patients are readmitted to the hospital within one month of discharge, with the second hospitalization being more expensive than a comparable first admission.
Research also shows that well-implemented programs—attending to that vulnerable period—can make a positive difference. One program, Project RED, resulted in a 27% decrease in readmissions within 30 days.
BCBSIL expects to invest up to $1 million a year over the next four years to reduce preventable hospital readmissions. “Our commitment to this program is part of our ongoing efforts to work with health care providers to improve the quality of care and slow increasing health care costs,” said Dr. Sarran.
In 2009, there were over 50,000 readmissions to Illinois hospitals, with each patient spending, on average, five additional days in the hospital. Dr Sarran points out that improvement of the Illinois readmission rate to the current national average has the potential to save or avoid costs of approximately $150 million dollars in the first year.
“Over time, these savings will go back to the taxpayers and businesses in Illinois, as the state (Medicaid), the federal government (Medicare), employers, and individual policy holders in the form of lower health care costs,” said Wurth. “More importantly will be the improved health and safety of patients, and the satisfaction hospital and physician partners receive from being able to deliver improved care.”
Dr. Sarran and Wurth agree that reducing readmissions directly benefits everyone. “Quality of life is improved if a complication requiring readmission is prevented,” says Sarran. “Patients who avoid being readmitted also are more likely to return to work more promptly, which is important to employers.”
Source : Blue Cross Blue Shield of Illinois