EmblemHealth Pilot Program Documents the Value of Providing Additional Care and Services to Members after Hospitalization Peer-reviewed study shows lowered hospital readmissions and reduced costs.

NEW YORK, Aug. 22, 2012 /PRNewswire/ -- Patients receiving additional services and medical care after hospitalization had fewer hospital readmissions, and the savings outweighed the cost of the program, according to findings published this week in the American Journal of Managed Care.

The study, "Impact of Point-of-Care Case Management on Readmissions and Costs," was authored by Andrew Kolbasovsky, PsyD, MBA, Director, Provider Group Clinical Management, EmblemHealth; Joseph Zeitlin, MD, Vice President, Clinical Utilization, EmblemHealth; and William Gillespie, MD, Chief Medical Officer, EmblemHealth.

In 2010, EmblemHealth, a New York-based health insurance company, integrated a dedicated health care treatment team consisting of a nurse, social worker, pharmacist and two health navigators into a large urban medical group to deliver transitional care and services to EmblemHealth members following hospitalization. Timely identification prior to discharge and intervention in the first 30 days following discharge was critical.

Lead investigator Dr. Andrew Kolbasovsky stated, "By locating this diverse clinical team at the point of care — in the offices of a medical group — we were able to significantly reduce hospital 30-day hospital readmissions and their associated costs. The savings we realized were more than sufficient to cover the costs of the program."

The purpose of the study was to measure the impact of this team on the 30-day hospital readmission rate, as well as the costs associated with deploying this treatment team. Following discharge, EmblemHealth members received extensive services including ensuring that they were able to keep follow-up appointments and that they were taking their medications as prescribed. The team identified barriers to treatment or medication adherence and worked with members to overcome those barriers.

There were no statistically significant differences — age, sex, type of insurance coverage — between the 244 baseline group members and the 298 intervention group members. In the baseline group, 17.60% of members were readmitted within thirty days as compared with 12.08% in the intervention group, resulting in the 31% reduction in the readmission rate. The total number of readmissions per member was reduced by almost 37% and the total number of hospitalized days was reduced by 43%.

"The costs of hospitalization are commonly cited as the largest driver of health care expenses," noted EmblemHealth Chief Medical Officer Dr. William Gillespie. "Yet despite the high costs of hospitalization, readmissions in the 30 days following discharge are common. Further development of programs focused on easing patient transition from the hospital has the potential for significant savings in future health care costs."

To read the complete article: "Impact of Point-of-Care Case Management on Readmissions and Costs" go to http://www.ajmc.com/articles/Impact-of-Point-of-Care-Case-Management-on-Readmissions-and-Costs

About EmblemHealth
EmblemHealth, Inc., through its companies Group Health Incorporated (GHI) and HIP Health Plan of New York (HIP), provides quality health care coverage and administrative services to approximately 2.8 million people. Groups and individuals can choose from a variety of PPO, EPO and HMO plans, as well as coverage for prescription drugs and dental and vision care. EmblemHealth offers a choice of networks, including quality doctors and other health care professionals throughout the region, leading acute care hospitals across the tristate area, and physicians and hospitals across all 50 states. For more information, visit www.emblemhealth.com.

SOURCE EmblemHealth



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