Posted on June 24, 2015

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Sarah Carroll, NEHI

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Scarroll@nehi.net

NEHI Proposes National Recommendations for Hospital Readmissions

NEHI Report Documents Actions for Improved Patient Care through Medication Management and Adherence 

CAMBRIDGE, MA (June 25, 2015) – A report released by The Network for Excellence in Health Innovation (NEHI) today provides a comprehensive list of recommendations for reducing hospital readmissions through better systemic medication management that supports improved patient medication adherence, especially for patients at highest risk. The report serves as a comprehensive guide for those working to reduce hospital readmissions through medication management.

The report was funded by the Anthem Foundation and completed in partnership with the Foundation, Anthem Blue Cross in California and Anthem Blue Cross Blue Shield (BCBS) in Connecticut.  It was also supported in part by a grant from the California Health Care Foundation in Oakland, California.

It is estimated that hospital readmissions lead to $41.3B in additional hospital costs.  And, more and more hospitals and health systems are being held accountable for this cost with new payments models, such as Accountable Care Organizations, and through penalty programs such as the Centers for Medicare and Medicaid’s Hospital Readmission Reduction Program. To address this need to reduce readmissions, NEHI conducted in-depth-interviews and held forums with key stakeholders to clarify processes and develop recommendations that support stronger medication management and adherence, which could lead to a reduction in hospital readmissions.

“This report provides a complete set of recommendations for policymakers, hospital administrators and other stakeholders in the healthcare ecosystem,” says Jill Rubin Hummel, President of Anthem Blue Cross Blue Shield of Connecticut. “We hope the insights in this report not only spur greater reductions in readmissions in California and Connecticut, but also serve as a roadmap for stakeholders in other states determined to improve medication management and patient medication adherence.”

Among other findings, NEHI confirmed that while hospitals themselves are subject to readmission penalties, a good deal of activity must occur in collaboration with patients, families and other organizations. Thus, person-to-person contact throughout the healthcare ecosystem is needed to maintain a manageable medication routine.

“We knew that advancing technology and ensuring different electronic systems could communicate would be important. But, what we realized from speaking to providers in Connecticut and California is that person-to-person contact and communication between all stakeholders is just as important to achieve the coordination of care and medication adherence that results in reduced readmissions,” says Thomas E. Hubbard, NEHI Vice President of Policy Research.

From this finding, NEHI developed a “Community of Care” model – inspired by the “Community of Care” stakeholder groups organized to foster local collaboration under an initiative of the Connecticut Hospital Association and Connecticut’s Qualidigm Quality Improvement Organization – where the patient and family are at the center of care with all stakeholders connected and involved, including community resources, primary care providers and pharmacists.

Other recommendations include:

  • Screening for patients at highest risk for medication management and adherence challenges upon arrival at the emergency department.
  • Making available real-time patient medication prescribing, adherence and formulary data at all points of care.
  • Creating a clear and focused discussion on how to utilize pharmacists throughout the care process.
  • Exploring evidence-based, practical changes to prescription drug coverage payment policy among all payers.

The report, “Reducing Hospital Readmissions through Medication Management and Improved Patient Adherence,” which includes profiles of both California and Connecticut, is available here.

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