Reducing hospitalizations is a critical component of delivering value-based healthcare and a key performance metric for Accountable Care Organizations (ACOs). It’s especially important in managing complex, long-term conditions like chronic kidney disease (CKD) and its comorbidities such as diabetes and hypertension, which can frequently land patients in the hospital if their care is not well managed.
By taking steps to prevent unnecessary hospital stays for these populations, ACOs can achieve significant financial savings, deliver better patient outcomes, and contribute to a more efficient healthcare system. For ACOs needing assistance with achieving these goals, working with a population health management organization like Healthmap Solutions can offer helpful data-driven insights and clinical expertise that can contribute to a material reduction in preventable hospitalizations.
The Importance of Reducing Preventable Hospitalizations
- Financial Benefits to ACOs
An article1 published by Becker’s Healthcare states, “The average adjusted expenses per inpatient day at hospitals was $2,883 in 2021, hitting as high as $4,181 in California, according to the Kaiser Family Foundation.” Across the U.S., the average length of a hospital stay is 4.5 days, according to Definitive Healthcare.2 Therefore, the cost of an average hospital stay can range from just over $12,973 to more than $18,800. For patients with chronic conditions like CKD, poorly managed care and a lack of attention to comorbidities often lead to costly hospitalizations that could have been avoided. Cutting down on these hospitalizations reduces the total cost of care, which helps ACOs earn incentive payments by meeting financial and quality benchmarks set by the Centers for Medicare & Medicaid Services (CMS). (For more on these incentive payments, read Healthmap’s blog3, “Financial Incentives and Performance Measures for ACOs.”)
- Improvement in Patient Outcomes and Quality of Care
Avoiding preventable hospital admissions and readmissions improves the patient experience and leads to better health outcomes. Proper management of chronic conditions and timely interventions can prevent hospital stays, which often expose patients to further risks, such as nosocomial infections and complications from prolonged bed rest. Reducing these hospitalizations can help ACOs perform well against several quality measures, including those dealing with patient experience, care coordination, and patient safety.
- Benefits to the Broader Healthcare System
Reducing hospitalizations can ease the strain on chronically understaffed hospitals, especially Emergency Departments, allowing resources to be used more effectively while improving overall healthcare delivery and positively impacting the quality measures that are used to evaluate ACOs’ success.
How ACOs Can Succeed in Reducing Hospitalizations
To hit the target of fewer hospitalizations, ACOs need to focus on some key strategies:
- Identifying High-Risk Patients: Using data analytics and predictive modeling, ACOs can pinpoint patients who are at high risk of hospitalizations and intervene earlier with the right interventions to avoid an admission or readmission.
- Care Coordination and Management: Effective care coordination ensures that patients receive the necessary care and follow-up across various providers. This is especially important after a hospital discharge to prevent readmissions. Providing appropriate specialist referrals and emphasizing preventative screenings, wellness visits, and coordinated outpatient care can improve patient’s overall health while reducing emergency visits and inpatient admissions.
- Patient Education and Engagement: Educating patients about their conditions, treatment plans, medication adherence, and lifestyle improvements is crucial. Empowered patients are more likely to manage their health and avoid hospitalizations.
How Healthmap Supports ACOs in Reducing Hospitalizations
Healthmap Solutions is here to help ACOs reduce hospitalizations for their patients with kidney disease through its Kidney Population Health Management program. Here’s how:
- Patient Identification and Risk-Stratification: Healthmap uses advanced data analytics to identify high-risk patients who need special attention. This includes those who haven’t been seeing their doctors regularly or who have had frequent but preventable hospital visits. These insights are then delivered directly to the patient’s doctors by Healthmap’s Care Navigation team along with recommendations for clinical interventions to prevent adverse health events and hospitalizations.
- Personalized Care Plans: Customized care plans are created for each patient based on their specific needs, helping to proactively manage their conditions and prevent hospitalizations. Healthmap’s multidisciplinary Care Navigation team, comprised of registered nurses, social workers, registered dietitians, behavioral health clinicians, and pharmacists, works directly with patients throughout their health journey to make sure their care plans are followed.
- Coordination and Communication Among Providers: As discussed in Healthmap’s article,4 “Tearing Down Treatment Silos,” fragmented or “siloed” treatment is a major obstacle to achieving greater efficiency and improved health outcomes for all patients, especially those with a complex condition like CKD. Healthmap’s clinical teams support collaboration through regular interactions with primary care providers, nephrologists, endocrinologists, cardiologists, and other specialists to review patient risks, identify care gaps, and eliminate unnecessary treatments.
- Medication Management: Proactive medication management is essential to avoid potential complications that could put a patient back in the hospital. Our Care Navigation team supports medication adherence and management through patient education and provider collaboration.
Conclusion
In order for Accountable Care Organizations to deliver efficient, value-based care, reducing hospitalizations must be made a top priority. Doing so can help ACOs save money, achieve better patient outcomes, and contribute to a more efficient healthcare system. Through advanced data analytics, personalized care plans, effective care coordination, and workflow integration, Healthmap Solutions offers valuable support and collaboration to ACOs looking to boost their financial and clinical performance.
Interested in learning more about how Healthmap’s program can support your ACO? Contact us at Sales@healthmapsolutions.com.
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Sources:
- beckershospitalreview.com/finance/hospital-execs-zero-in-on-length-of-stay.html
- definitivehc.com/resources/healthcare-insights/average-length-of-stay-by-state
- https://news.healthmapsolutions.com/blog/financial-incentives-and-performance-measures-for-acos-the-impact-on-kidney-disease-management
- https://news.healthmapsolutions.com/blog/tearing-down-treatment-silos
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