Reducing hospital readmission is important to patients and to their insurers as a quality and outcomes indicator and results in cost reductions for all concerned.
One way SurgeryShopper.com’s concierge team helps to reduce readmission is by working both before and after a patient’s surgery. Our clinically-trained team members engage with patients as the point of contact to help navigate the entire episode of care.
How long is the episode of care?
The episode of care for the care navigator is defined by the care navigator service. You may get a care navigator who is simply involved to set up a referral to a surgeon and nothing more. While that’s not how SurgeryShopper.com operates, it is a legitimate service and there are hundreds of thousands of “medical tourism facilitators” who operate this way. They “assume” that the surgeon or hospital will handle the rest. In the business of patient navigation services, one should never “assume”, but we see it more frequently than note.
An episode of care can last an hour or a day or 3 months or in our case… 36 months. Our service intensity is greatest just prior to and immediately after a procedure, but we stay on to measure outcomes for up to 36 months depending on the procedure. Over that long a duration, our measurements and notes serve as an extraordinary level of service and documentation source that our competitors don’t bother with. So why do we do it? We’re interested in the outcomes of each procedure, each patient and each surgical episode of care.
3 Key Metrics Help Reduce Hospital Readmissions
1. Information about their condition and treatment goals and objectives
To reduce hospital readmission rates, the patient must be informed both before and after their procedure. “Informed” refers to having information that they understand about their condition, the procedures available to address their medical problem(s), the goals and objectives of treatment, the goals and objectives of the followup during recovery, the goals and objectives of the medications prescribed, the goals and objectives of their course of physical therapy, and what risks they assume if they don’t follow through or stay on track with their surgeon’s treatment plan. Many times, the patient is still wobbly and groggy when these things are explained just before discharge from hospital.
Some of our surgeons have created care management videos that the patient watches while still at the facility prior to discharge. These videos cover demonstrations of exercises, the importance of follow up, medication management and compliance, signs and symptoms to watch for, and what to do if a problem or concern arises. They are then given a link to the video to watch as often as they like. But beyond the video, our concierge team conducts outreach to ensure that they understand their diagnosis, expected outcome, and the treatment plan that their surgeon outlined, and to obtain and communicate answers to any questions the patient has. We do this for one flat care management fee that the patient or their employer or insurer pays so there’s never any concern about the cost of our outreach over time. Our concierge team serves as the point of contact for patients who might not grasp what the physician just told them during their office visit, or what the potential impact of a planned surgery might be on the member and their family, and a whole list of other concerns and bits of information.
2. Their medication and physical or other follow-on therapy and the importance of following the plan
At SurgeryShopper.com, our concierge team members conduct follow up communications with the provider to get any clarification that might be needed regarding treatment and rehabilitation plans. We manage and monitor the care that our clients receive to assure that it is provided in an appropriate time frame by an appropriate provider in each situation and that recuperation and recover remain on course for the best possible outcome.
If that means we must work with the hospital’s or surgeon’s case management team or social workers to ensure that everything our client requires is in place, then that’s what we do. By charging one flat fee for this concierge level of service, no one is tempted to cut corners. Our value proposition is in the reduced hospital readmission by ensuring that the agreed upon course of treatment continues. Discharge planning is crucial for reducing the chance that the member will need to be re-hospitalized. Interventions and swift action can prevent things escalating to the point where readmission is required. Experience over time enables us to assume the financial risk associated with performing these services under a bundled flat fee. A novice would need to charge by the hour or simply not offer the service. So when you are shopping for care management and navigator services, keep that differential in mind.
3. Adherence to prescribed outpatient follow up appointments and rehabilitation therapies
What happens after discharge can make or break a surgical outcome. Timely and consistent support makes a world of difference. Our concierge team check in on clients to keep tabs on the status of their pain, mobility, activities of daily living, and medications. We do this to make sure that clients engage with and remain engaged with their follow up regimen and that they understand their treatment options for any complications that may arise. We empower our clients to take charge of their health care and their outcomes.
We cannot claim with any certainty that you or your plan participant will experience improved outcomes. But what we can tell you is that we have observed and measured improvements that accrue over time for clients using our health care management team. Our concierge case management services show up in increased patient satisfaction, clinical outcomes, utilization metrics and cost containment:
- Combined 7:1 ROI for Case Management
- Average readmission rate of 4.5 percent versus MCG Health’s 22nd Edition Benchmark rate of 8.0 percent
We learned over the years that subtle differentiation yields huge results in cost containment, patient experience, safety, quality and benefit satisfaction. Smart investments in innovative health benefits plans and effective care management services can help employers and patients achieve more positive outcomes at a lower per-case cost.
Maria K Todd, MHA PhD
Award winning speaker, consultant and author, Maria Todd writes articles of interest to patients, employers, insurers and healthcare providers on her blogs on AskMariaTodd™ and on Facebook and LinkedIn. She appears frequently at international conferences and events on cost containment, medical travel, managed care and physician integration and alignment and in industry and popular press articles and media interviews. She is the author of 19 internationally-published, peer-reviewed books, including “The Employer’s Guide to Medical Tourism Program Development”, “The Handbook of Medical Tourism Program Development”, “The Managed Care Contracting Handbook” 2nd edition, and “The Medical Tourism Facilitator’s Handbook”.