Hospital readmissions are a significant challenge for healthcare providers, payers, and patients alike. Not only do they increase healthcare costs, but they also often indicate gaps in care coordination and patient management. For healthcare organizations striving to improve quality and reduce unnecessary readmissions, partnering with the right organization can make all the difference. But how do you choose the right partner to effectively reduce member readmissions? Let’s explore the key considerations and benefits of forming the right partnership.
Understanding the Impact of Readmissions
Readmissions occur when a patient who has been discharged from a hospital returns within a short period, often 30 days, due to complications or unresolved health issues. These readmissions are costly — both financially and in terms of patient well-being. According to the Agency for Healthcare Research and Quality (AHRQ), nearly 20% of Medicare patients are readmitted within 30 days, costing billions annually.
Reducing readmissions is not just about cutting costs. It’s about improving patient outcomes, enhancing member satisfaction, and meeting regulatory standards. Healthcare organizations need partners who understand these complexities and can deliver innovative, patient-centered solutions.
Why Partnering Matters
Successfully reducing member readmissions requires a multi-faceted approach involving care coordination, patient education, timely follow-up, and data analytics. Many healthcare organizations lack the internal resources or expertise to implement these strategies effectively on their own. That’s where a strategic partner comes in.
The right partner brings specialized knowledge, technology, and a proven track record in managing transitions of care and reducing readmissions. They can help identify high-risk members, provide personalized care plans, and coordinate post-discharge support—all crucial elements in preventing unnecessary hospital returns.
Key Qualities to Look for in a Partner
- Data-Driven Approach: A partner should leverage advanced analytics to identify members at risk of readmission and tailor interventions accordingly.
- Comprehensive Care Coordination: Look for partners who facilitate seamless communication between hospitals, primary care providers, specialists, and community resources.
- Patient Engagement Expertise: Empowering members through education, reminders, and support can significantly reduce readmission risk.
- Technology Integration: The partner’s platform should integrate smoothly with your existing electronic health records (EHR) and claims systems for real-time insights.
- Proven Results: Request case studies or performance metrics that demonstrate their success in reducing readmissions.
Benefits of the Right Partnership
By choosing the right partner, healthcare organizations can expect:
- Improved Patient Outcomes: Better management of chronic conditions and timely interventions reduce complications.
- Cost Savings: Lower readmission rates translate into reduced penalties and overall healthcare spending.
- Enhanced Member Satisfaction: Patients feel supported and valued, leading to increased loyalty and positive reviews.
- Regulatory Compliance: Partners help meet requirements such as those from CMS, avoiding financial penalties.
Conclusion
Reducing member readmissions is a complex but critical goal that requires more than just internal effort. Selecting the right partner can amplify your organization’s ability to deliver coordinated, effective care that keeps members healthy and out of the hospital. By focusing on data-driven strategies, patient engagement, and seamless care coordination, the right partner becomes an invaluable asset in your healthcare journey. Invest the time to evaluate potential partners carefully — your members’ health and your organization’s success depend on it.