- One way that health IT tools have innovated care is by essentially improving patient health outcomes and reducing hospital readmission rates within a 30-day timeframe. For example, Amerigroup Maryland, Inc., a healthcare coverage provider that serves Medicaid, the Children’s Health Insurance Program (CHIP), Temporary Assistance for Needy Families (TANF), and Supplemental Security Income (SSI) programs, was able to utilize Curaspan technology to reduce readmission rates of high-risk patients across five Baltimore hospitals by 15.7 percent.
Susan Garcia, Director of Health Care Management Services at Amerigroup, and Rob Fisher, Vice President of Hospital Sales at Curaspan, spoke with EHRIntelligence.com to provide more detail on exactly how these health IT tools helped reduce hospital readmission rates.
“About 18 to 24 months ago, we were in discussions with Susan and Dr. Bergman at Amerigroup around a new program that they were putting in place,” Fisher said. “In essence, from our perspective, it was similar to a patient-centered medical home concept of ensuring patients were being managed appropriately for certain diagnoses.”
“Between the hospitals that we had on the Curaspan network leveraging our technology and the admissions that Amerigroup was seeing at those particular facilities, we had an opportunity to provide Amerigroup notifications when certain patients were coming to those facilities,” Fisher said.
“We have for a long time here at Amerigroup stratified members based on the likelihood of readmission, recent history, comorbidity, and a variety of factors,” Susan Garcia mentioned. “We have continuously looked for more and better ways to engage them in care to reduce readmissions.”
Garcia explained that the patient demographic at Amerigroup is unlike others, as it is mostly a Medicaid market with patients who could have difficulty finding transportation and may not own a computer or other device for easy access to a patient portal.
“Some of our processes are based on faxes, notifications, and telephone calls, which didn’t allow us to get to the bedside and engage these members as quickly as we’d like to,” Garcia explained. “What Curaspan was able to bring to us is a more real-time encounter notification that allowed us to deploy our resources more quickly and begin the process of engaging [patients] in care more quickly.”
Fisher also explained that care transitions are Curaspan’s “bread and butter,” as the company has been specializing in this area for many years. The health IT tools developed at Curaspan can be leveraged among providers and communities to create better care transition opportunities for patients with high-risk, chronic conditions.
“Here in Maryland, our membership is around 260,000 residents right now. On any given day, we could have as many as 600 of our members in-patient and that’s a large number to follow,” Garcia stated. “Not all of them need an intervention, but we know that point-of-transition – whether identifying a need to be hospitalized, intervention, discharge planning, or post-acute services – are a point of vulnerability for individuals and hand-off can become very complicated.”
“The alerts that Curaspan is able to provide to us can parse out and share with us those encounters near real-time for stratified members in particular. We’re receiving actionable information on individuals that we have the opportunity to provide interventions for.”
Garcia also spoke about the transitional model of care in which the care team receives alerts and uses medical records to determine which members could benefit from an intervention. Then healthcare professionals are sent to speak to the patients by the bedside.
“We have a transition model of care team consisting of social workers who receive alerts that Curaspan provides to us. They research those members through our medical records system here and determine which members they can provide interventions for,” Garcia mentioned.
“There are four basic pillars of information that has been proven to have an impact on preventing readmissions. Part of that is follow-up care and seeing that the member has a PCP or specialist visit within seven days of discharge,” Garcia explained. “It’s not always done by the hospital. Hospitals give a piece of paper that says ‘Be sure to see a doctor in seven days,’ but it’s left to the member to make those appointments and that’s not always easy for our population. Our social workers can help facilitate that or even make those appointments.”
“Medication management is another big issue,” Garcia went on. “Members will often be given a prescription but they either don’t have the funds or don’t understand they need to continue taking that medication. The social worker is able to support that and involve clinicians if needed.”
The Amerigroup and Curaspan representatives mentioned how by leveraging health IT tools, the results start to show patient readmission rates decline. Garcia mentioned how identifying cohorts or specific groups of people allows physicians to more quickly provide interventions and engage patients in their care.
In order to reduce patient readmission rates and improve transition of care, the primary care provider and the entire medical team need to work together and leverage health IT tools in effective ways that helps target high-risk patients.
“The facilities and hospitals know who the ‘frequent fliers’ are – those who seek their care through the emergency room first. They know who they frequently see,” Garcia said. “Getting the right information to them at the right time is not always consistently successful. By using the alerts and having the feedback mechanism, it allows us to really collaborate and interface in a more productive fashion because we’re all looking at the same information about the same members. That becomes invaluable.”