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NACHC CHI poster 8-23-14 (4)

Published on: Mar 3, 2016
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Transcripts - NACHC CHI poster 8-23-14 (4)

  • 1. RESEARCH POSTER PRESENTATION DESIGN © 2012 www.PosterPresentations.com Hospital readmissions account for $17.5 billion of Medicare payments annually. In 2010, hospital admission for Medicare beneficiaries were just under 10 million and of those beneficiaries, approximately 1.9 million or 19% were readmitted within a 30 day interval. Readmission have been attributed to several reasons including failure in discharge planning, insufficient outpatient and community care, and uncontrolled chronic illnesses. Furthermore according to the 2013 CMS Hospital Quality Chartbook, Camden, NJ hospitals are one of the worse performing Hospital Referral Regions in the US for 30 day readmissions(CMS, 2013). CAMcare Health Corporation (CAMcare) has just concluded it’s first year and a half pilot of the Medical Home Shared Savings Program created to address these staggering metrics as well as the current shift in healthcare from fee-for-service to quality metric payment-structures. The program developed out of a partnership with UnitedHealthcare (UHC) and focuses on mutual, measurable goals; a collaborative, data-driven partnership; and provider-payer team approach to the coordination of care. The goal is to manage costs, promote health care quality, access, and accountability in South Jersey. This study is a culmination of the portion of the pilot program that embedded a care coordination team into CAMcare’s primary care practice with a focus on reducing avoidable hospital admissions and decreasing overall cost associated with these admissions. INTRODUCTION STUDY DESIGN & METHODS RESULTS CONCLUSIONS & IMPACT ON HEALTH CENTERS REFERENCES • Medicare Hospital Quality Chartbook: Performance Report on Outcome Measures. (2013): CMS. •Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics. (2013). Data shows Reduction in Medicare Hospital Readmission Rates During 2012. Medicare & Medicaid Research Review , 3 (2), E1-E12. •Huntley, A. L., Thomas, R., Mann, M., Huws, D., Elwyn, G., Paranjothy, S., & Purdy, S. (2013). Is case management effective in reducing the risk of unplanned hospital admissions for older people? A systematic review and meta-analysis. Fam Pract, 30(3), 266-275. doi: 10.1093/fampra/cms081 ACKNOLWEDGEMENTS Maechiel Lluz & Corinne Bostic CAMcare Health Corporation & UnitedHealthcare Community Plan Effectiveness of an Embedded Care Coordination Team in a Primary Care Setting on the Reduction of Hospital Readmission and Avoidable Admission Rates This study examines the efficacy of an embedded care coordination team in a Federally Qualified Health Center with reducing hospital readmissions and decreasing overall avoidable hospital admissions, ultimately resulting in reduction of hospital costs and shared savings for Medicaid beneficiaries. According to the UHC claims data, readmission rates for the Shared Savings Program Intervention patients averaging 8.5% have been consistently below the baseline of 18% (March 2014-6.5%) and goal of 15%. In addition, statistical significance (p=0.01; p≤0.01) is seen between 30 day readmission rates at baseline (February 2012- December 2012) and during the current intervention (February 2013-December 2013). In addition, the risk adjusted data for avoidable hospital admissions is currently at 51.3 per 1000 admissions, significantly below the target threshold of 74.3 per 1000 admissions. In order to address hospital readmissions and avoidable admissions and also meet the metrics for the Medical Home Shared Savings Program with UHC, CAMcare implemented the Care Coordination Program Intervention. A team composing of an RN, LPNs, and health coaches, identifies high risk patients admitted in local hospitals and bridges the gap from discharge to the first primary care appointment. Monthly and yearly baseline readmission and avoidable admission rates will be compared to pre-intervention implementation and current utilization rates with the intervention. To determine statistical significance, the t-test and other statistical analysis methods will be performed. After reconciliation, the shared savings pool between UHC and CAMcare totaled $538,295 in one year. The success of CAMcare’s Care Coordination intervention in reducing readmission and avoidable admission rates, demonstrates that a community-based, multi-disciplinary care coordination team embedded in a primary care health center is not only effective in improving health outcomes, but also in decreasing health care costs. The efficacy of case management in the reduction of unplanned hospital admissions has mixed results within research literature. In one meta-analysis conducted by Huntley et al, found that among the geriatric population, none showed statistical significance in the decrease of unplanned hospital admissions especially among community-based case management programs. However, CAMcare’s embedded care coordination program within an FQHC is statistically significant in reducing hospital readmissions for a period of 11 months. In addition, the shared savings pool between UHC and CAMcare totaled $538,295 in one year after reconciliation. The success of CAMcare’s Care Coordination intervention in reducing readmission and avoidable admission rates, demonstrates that a community-based, multi-disciplinary care coordination team embedded in a primary care health center is not only effective in improving health outcomes, but also in increasing shared savings return through a decrease in health care costs. Goal: Readmission target rate of 15% Goal: Post-Discharge PCP follow-up visits with target rate of 80% of pts. Within 7 business days Goal: Avoidable hospital admissions target rate of 74.3 per 1000 OBJECTIVES 17% 12% 27% 23% 32% 20% 17% 24% 14% 10% 4% 7% 4% 0% 20% 8% 14% 12% 5% 7% 11% 5% 0% 5% 10% 15% 20% 25% 30% 35% Feb March Apr May June July Aug Sept Oct Nov Dec 30 Day Readmission Rates Baseline: 2/2012-12/2012 Current: 2/2013-12/2013 135 5265 148 0 50 100 150 200 Shared Savings Program Care Coordination Intervention No Care Coordination Readmissions for Patients Receiving Care Coordination vs. No Care Coordination No Readmission Readmission Linear (Readmission) Table 2: Odds ratio of likeliness of readmissions (for 200 pts) with the Shared Savings Program care coordination vs. patients receiving no care coordination services for the program period of 2/1/2013-12/31/2013. 18.6% 19.98% 8.5% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% US New Jersey CAMCare Shared Savings Program Shared Savings Program Readmission Rates vs. US & NJ Table 1: 2012 US and New Jersey readmission rates compared to Shared Savings Program patients receiving care coordination intervention for the program period of 2/1/2013-12/31/2013 (Centers for Medicare & Medicaid Services , 2013). Home Visits Medication Reconciliation Health Coaching & Patient Education Resolving patients’ economic and/or social barriers to care Appropriate PCP follow-up post- discharge Shared Savings Program Intervention Key Elements CONTACT INFORMATION •Scot McCray, MPH –Asst. VP of Operations- smccray@camcare.net •Shelly Lluz- Senior Health Coach- mlluz@camcare.net •Debra Zubris, RN •Mayriam Zayas-LPN •Nijita Rivera-LPN •Nekia Rosado-Health Coach •Rasheed Pollard-Health Coach •Scot McCray, MPH •CAMcare Health Corporation Physicians and staff •UnitedHealthcare Community Plan Staff Table 3: Through t-test Shared Savings Program –Care Coordination Intervention was found to be statistically significant (p=.01; p≤0.01)

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