The Collaborative Forum

I am sure you have seen the reports, including the 2009 article in the New England Journal of Medicine (Jenks, et al), that highlight the cost and prevalence of 30, 60 and 90 day hospital readmissions. I think it’s safe to say that we all agree that this is a major issue that our healthcare system needs to address.

Where we don’t all agree is how to get there. Organizations across the country are looking for effective initiatives and innovations to reduce these costs. In their quest, some organizations are looking for easy solutions, such as the simple scheduling of follow-up visits post discharge.  However, as detailed in a new study from the Mayo Clinic, published in the Archives of Internal Medicine, siloed, quick-fix initiatives, while very important, alone will not provide the true behavior change needed for measurable reductions in avoidable hospital admissions and readmissions. Read the rest of this entry →

Another article caught my attention last week. It was an article in HealthLeaders  on a report issued as part of the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project, which covered 12 states including Arizona, California, Florida, Hawaii, Massachusetts, Missouri, Nebraska, New Hampshire, New York, South Carolina, Tennessee, and Utah.

The key finding of the report was that the problem of readmissions and use of emergency room resources is more problematic than originally presumed.

According to the AHRQ report, “most readmission studies only report information on patients who have multiple hospital inpatient stays,” and in so doing exclude patients who seek care in the emergency department (ED). Once the researchers included ED visits, the rate of multiple visits jumped by more than one-third—from an average of 1.5 to 2.1 acute care hospital visits per patient. Read the rest of this entry →

I’ve been in the healthcare field for over 20 years now, and I still believe that the vast majority of those involved—whether on the payer or provider side—truly want what’s best for their patients or members.  After all, healthcare quality and cost affects everyone.

In an editorial published earlier this week in the New York Times entitled “The Gaming Begins,” the editors point out the difficult struggle over how to calculate medical loss ratio under the new healthcare law and discussed concerns that insurers could “game” medical loss ratio by spending money on administrative costs, rather than on meaningful measures to improve quality.

Beginning in 2011, the new law requires health insurers to spend 80-85 percent of the premiums they collect on medical services or activities that improve the quality of care (the medical loss ratio).  Insurers can then use the remainder of the premiums for things such as marketing, overhead, salaries, and profit. Read the rest of this entry →