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New Readmission-Reduction Guidelines Emphasize Medication Management and Improved Adherence

‘Community of Care’ model links patients, families, and stakeholders

A report from the Network for Excellence in Health Innovation (NEHI) has provided a list of recommendations for reducing hospital readmissions through better systemic medication management and adherence, especially for patients at highest risk. The report provides guidance for stakeholders working to reduce hospital readmissions through medication management.

The report was funded by the Anthem Foundation and was completed in partnership with the Foundation, Anthem Blue Cross in California, and Anthem Blue Cross Blue Shield in Connecticut. It was also supported in part by a grant from the California Health Care Foundation in Oakland, California.

Readmissions lead to an estimated $41.3 billion in additional hospital costs each year in the U.S., and hospitals and health systems are being held accountable for this financial burden through new payments models, such as accountable care organizations, and through penalty programs, such as the Centers for Medicare & Medicaid’s hospital readmission reduction program.

To address the need to reduce readmissions, the NEHI conducted interviews and held forums with key stakeholders to develop recommendations that support stronger medication management and adherence, which could lead to reductions in hospital readmissions.

“This report provides a complete set of recommendations for policymakers, hospital administrators, and other stakeholders in the health care ecosystem,” said Jill Rubin Hummel, President of Anthem Blue Cross Blue Shield of Connecticut. “We hope the insights in this report not only spur greater reductions in readmissions in California and Connecticut, but also serve as a roadmap for stakeholders in other states determined to improve medication management and patient medication adherence.”

Among other findings, the NEHI confirmed that while hospitals are subject to readmission penalties, a large portion of a center’s activity must occur in collaboration with patients, families, and other organizations. Thus, person-to-person contact throughout the health care ecosystem is needed to maintain a manageable medication routine.

“We knew that advancing technology and ensuring different electronic systems could communicate would be important. But, what we realized from speaking to providers in Connecticut and California is that person-to-person contact and communication between all stakeholders is just as important to achieve the coordination of care and medication adherence that results in reduced readmissions,” said Thomas E. Hubbard, NEHI vice-president of policy research.

From this finding, the NEHI developed a “Community of Care” model in which the patient and his or her family are at the center of care, with all stakeholders connected and involved, including community resources, primary care providers, and pharmacists.

Other recommendations include:

  • Screening for patients at highest risk for medication-management and adherence challenges upon their arrival at the emergency department.
  • Making available real-time patient medication-prescribing, adherence, and formulary data at all points of care.
  • Creating a clear and focused discussion on how to utilize pharmacists throughout the care process.
  • Exploring evidence-based, practical changes to prescription drug-coverage payment policy among all payers.

Sources: NEHI; June 25, 2015; and Reducing Hospital Readmissions; 2015.

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