Reducing Avoidable Readmissions Effectively (RARE) Kathy Cummings, RN, BSN, MA Institute for Clinical Systems Improvement

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1 Reducing Avoidable Readmissions Effectively (RARE) Kathy Cummings, RN, BSN, MA Institute for Clinical Systems Improvement

2 Martha and James

3 Acute Episodes Family Doctor Life Expectancy from chronic diseases was shorter Care giver in the home Limited number of specialists available Patient knew who to call with an issue

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6 Hospital Compare Data Heart Attack Heart Failure Pneumonia MN US MN US MN US Better than national average Same as national average Worse than national average Too Small

7 MN Hospital 30-Day Readmission Rates from Heart Failure Nat'l Avg.: 24.8%

8 Federal What are business issues? 1% penalty on Medicare for greater readmissions than expected in 2013 Looks at heart attacks, congestive heart failure, pneumonia, COPD, and potentially other conditions Penalty increases.25% per year until reaches 2% Only big hospitals (so far) MN Medicaid payments reduced by 10%, can earn back 5% if reduce avoidable admissions over 2 years

9 Why Is Campaign Needed? Almost 20% of Medicare patients in Minnesota are readmitted within 30 days of discharge Huge opportunity to fix gaps in fragmented system Reduce unnecessary burden on patients, families Preventable readmissions are contributing to unsustainable climb in health care costs CMS penalties for low-performing hospitals clock begins ticking Oct. 1, 2011

10 RARE Campaign A campaign across the continuum of care to reduce avoidable hospital readmissions across Minnesota and surrounding areas Regional approach, supported by hospitals, providers, health plans, other key stakeholders Goal: Prevent 4,000 avoidable readmissions by Dec. 31, With average hospital stay at 4 days, help patient spend 16,000 more nights in their own beds.

11 RARE Campaign Campaign seeks commitment from all hospitals in Minnesota Particularly those hospitals that account for roughly 80% of readmissions Campaign is engaging other care providers, acknowledging that readmissions are the result of a fragmented health care system

12 Triple Aim Goals Population health Prevent 4,000 avoidable readmissions within 30 days of discharge OR in other words, Reduce overall readmissions rate by 20% from 2009 base by 12/31/12 Care experience Recapture 16,000 nights of patients sleep in their own beds instead of in the hospital Improve by 5% on HCAHPS survey questions on discharge Affordability of care Save an estimated $30 million for commercially insured patients; additional savings for Medicare patients

13 Broad Community Support Operating Partners: Manage operations, secure involvement, support rapid progress, provide the majority of staffing and resources Institute for Clinical Systems Improvement (ICSI) Minnesota Hospital Association (MHA) Stratis Health

14 Broad Community Support Supporting Partners: Provide significant resources and support to develop and implement specific aspects of the campaign Minnesota Medical Association Working to link providers with hospitals to address fragmentation together MN Community Measurement Developing measures for public reporting in 2012

15 Broad Community Support Community Partners: Endorse and actively support the campaign A growing list of providers, health plans, state health agencies, home health agencies, nursing homes, patient advocacy groups and other community organizations

16 Two approaches: Campaign Design Collaborative, evidence-based approach: RARE Operating Partners provide resource consultant and best practice toolkits Flexibility in choice of starting times Innovator approach: Intensive/highly compressed approach (i.e., Lean) to identify new ways to achieve results faster Link with other efforts of Supporting ad Community Partners, e.g., health care homes

17 Five Focus Areas Comprehensive discharge plan Effective communication for transitions of care Engagement of patient and family in discharge process Medication management Transition care

18 Participating Hospital Requirements Commit to specific readmission reduction goals based on MHA analysis Conduct an organizational assessment of its readmissions; tools provided by the RARE Operating Partners

19 Participating Hospital Requirements Share organizational assessment results and readmissions data with the RARE Operating Partners Commit to improving performance in key areas identified through the organizational assessment Agree to publicly disclose participation in the campaign

20 Operating Partners Support Each hospital is assigned a resource consultant from one of the Operating Partner organizations Operating Partners staff works with hospital on analysis to identify gaps contributing to avoidable readmissions

21 Operating Partners Support Hospitals are supported in selecting and implementing interventions most likely to accelerate their work and achieve success Hospitals will focus on 1 to 5 areas Each focus area incorporates details of recognized best practices; has designated list of activities

22 Support for Hospitals Best practice toolkits Face-to-face sessions Webinars Conference calls Peer coaching Data reporting Innovator approach: intensive, rapid process improvement work

23 Analysis and Measurement MHA Potentially Preventable Readmissions (PPR) data used to establish each hospital s goal Progress monitored with quarterly PPR results Hospitals collect data on variety of process measures; report their progress 30-day all cause readmission rates for select clinical conditions will be publicly reported on MN HealthScores for hospitals and provider groups in 2012

24 Campaign Rollout, Timing Hospital engaged July/August 2011 Participation secured through September 2011 Hospitals can choose among several modalities of improvement activities Improvement work, measurement continues through Dec. 31, 2012

25 Results to Date Key medical systems have committed their hospitals to the campaign Allina CentraCare Essentia Health Fairview HealthEast HealthPartners

26 Results to Date 64 hospitals have signed up Includes 18 of 25 hospitals with most readmissions Includes 32 of top 50 hospitals with most readmissions Participating hospitals cover broad geographic area in Minnesota

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28 Community Partners to Date AARP Aging Services of Minnesota Area Agency on Aging AXIS Healthcare Blue Cross Blue Shield of Minnesota Care Choice Care Providers of Minnesota Central Minnesota Council on Aging Courage Center Healthcare Discharge Planning Resources LLC. HealthPartners Health Plan Land of the Dancing Sky Area Agency on Aging Medica Metropolitan Area Agency on Aging Metropolitan Health Plan Mission Healthcare, LLC MN Alliance for Patient Safety MN Chapter of the Society of Hospital Medicine MN Council of Health Plans MN Department of Health MN Home Care Assn. MN Organization of Leaders in Nursing MN Network of Hospice & Palliative Care MN River Area Agency on Aging MN Visiting Nurse Agency PreferredOne Southeastern Minnesota Area Agency on Aging Tubman UCare Walker Methodist Health Center

29 16,000 Nights At Home Will Make Our Day.

30 Thank You For Helping Everyone Sleep More Peacefully.

31 Questions? Thank you.