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Postdischarge engagement decreased hospital readmissions in Medicaid populations
Wanzhen Gao1, David Keleti, Thomas P Donia
1AmeriHealth Caritas Family of Companies, 200 Stevens Dr, Philadelphia, PA 19113.
Objectives:
To investigate the effect of managed care organization (MCO)-implemented postdischarge engagement, supported by other broadly focused interventions, on 30-day hospital readmissions in 6 at-risk Medicaid populations.
Study Design:
Prospective cohort study.
Methods:
One-year follow-up analysis of member claims data was performed following an intervention period from January 1, 2014, to December 31, 2014. Postdischarge engagement, supported by additional MCO-initiated interventions, was implemented to reduce 30-day hospital readmissions in Medicaid members having 1 or more dominant chronic conditions. Hospital readmission rates were calculated at baseline and at 1 year post intervention. Bivariable and multivariable generalized estimating equation analysis was used to quantify the likelihood of hospital readmissions.
Results:
Following implementation, postdischarge engagement rates increased significantly, whereas provider follow-up rates remained unchanged. Increased member engagement resulted in statistically significant reductions in weighted readmission rates enterprise-wide (-10.1%; P <.01) and in 3 of 6 MCOs (-3.9% to -15.8%; P ≤.05) in 2014. Compared with nonparticipants, members who were successfully reached for postdischarge engagement displayed a 33% decrease in 30-day readmissions enterprise-wide (adjusted odds ratio, 0.67; 95% CI, 0.62-0.73) and a comparable decrease (-23% to -39%) in 5 of the 6 MCOs. In this context, greater frequency of postdischarge engagement was associated with proportionally decreased likelihood of readmissions.
Conclusions:
Postdischarge engagement, against the backdrop of multifaceted MCO-implemented interventions, was associated with significantly reduced hospital readmissions in at-risk Medicaid subjects. Reduced likelihood of readmissions was observed at both the enterprise-wide and plan levels in a manner proportional to the frequency of engagement, a novel reported outcome for this population.
Insights
Managed care organizations reduced hospital readmissions in at-risk Medicaid populations through postdischarge engagement. Higher engagement frequency correlated with lower readmission rates, showing a significant impact on patient outcomes.
Area of Science:
- Health Services Research
- Public Health
- Health Policy
Background:
- High hospital readmission rates pose a significant burden on healthcare systems, particularly for at-risk populations like Medicaid beneficiaries with chronic conditions.
- Managed care organizations (MCOs) are increasingly implementing interventions to mitigate readmissions, but the specific impact of postdischarge engagement requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of MCO-implemented postdischarge engagement strategies in reducing 30-day hospital readmissions among at-risk Medicaid populations.
- To determine the association between the frequency of postdischarge engagement and the likelihood of hospital readmissions.
Main Methods:
- A prospective cohort study analyzed one year of member claims data following a 2014 intervention period.
- Postdischarge engagement interventions were implemented for Medicaid members with chronic conditions.
- Bivariable and multivariable generalized estimating equation analyses quantified readmission rates at baseline and post-intervention.
Main Results:
- Postdischarge engagement rates significantly increased post-intervention, while provider follow-up rates remained stable.
- Enterprise-wide weighted readmission rates decreased by 10.1% (P < .01), with significant reductions in 3 of 6 MCOs.
- Members successfully engaged post-discharge showed a 33% decrease in 30-day readmissions enterprise-wide (aOR, 0.67; 95% CI, 0.62-0.73).
Conclusions:
- Postdischarge engagement, as part of multifaceted MCO interventions, significantly reduced hospital readmissions in at-risk Medicaid populations.
- The frequency of postdischarge engagement was proportionally associated with decreased readmission likelihood at both enterprise-wide and plan levels.
- This study reports a novel outcome demonstrating the positive impact of engagement frequency on readmission reduction in this vulnerable group.
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