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Maintaining patient health after a hospital stay…. …So We All Sleep More Peacefully. RARE Action Day October 18, 2011. Statewide Triple Aim Goals. Population health Prevent 4,000 avoidable readmissions within 30 days of discharge OR, in other words,
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RARE Action Day October 18, 2011
Statewide Triple Aim Goals • Population health • Prevent 4,000 avoidable readmissions within 30 days of discharge OR, in other words, • Reduce overall readmissions rate by 20% from 2009 base by 12/31/12 • Care experience • Help patients and their families spend 16,000 more nights in their own beds instead of in the hospital • Improve by 5% on HCAHPS survey questions on discharge • Affordability of care • Save an estimated $30 million for commercially insured patients; additional savings for Medicare patients
Broad Community Support • Campaign Operating Partners Role • Design and lead the effort, manage operations, coordinate partner and stakeholder involvement, and support, and provide the majority of staffing and resources to support participating hospitals • Institute for Clinical Systems Improvement (ICSI) • Minnesota Hospital Association (MHA) • Stratis Health
Broad Community Support • Supporting Partners Role • Provide resources and support to develop and implement specific aspects of the campaign • Minnesota Medical Association • MN Community Measurement • Community Partners Role • Endorse and actively support the campaign • A growing list of providers, health plans, state health agencies, home health agencies, nursing homes, patient advocacy groups and other community organizations
Why Is Campaign Needed? • Almost 20% of Medicare patients in Minnesota are readmitted within 30 days of discharge • Great opportunity to improve care delivery by correcting gaps in fragmented system • Reduce unnecessary burden on patients, families • Preventable readmissions are contributing to unsustainable climb in health care costs • CMS penalties for low-performing hospitals – “clock” began ticking Oct. 1, 2011
Five Key Areas • Comprehensive discharge planning • Medication management • Patient and family engagement • Transition care support • Transition communications
Participating Hospital Requirements • Commit to specific readmission reduction goals set based on MHA analysis • Conduct an organizational assessment of its readmissions • Commit to improving performance in key areas • Agree to publicly disclose participation in the campaign
Support for Participating Hospitals • RARE Resource Consultant assigned to each hospital • Work with hospital on analysis to identify key improvement areas • Assist in selecting and implementing interventions most likely to accelerate their work and achieve success
Support for Hospitals • Learning collaborative options • Best practice toolkits • Face-to-face sessions • Webinars • Conference calls • Networking opportunities • Data reporting • “Innovator” approach: intensive, rapid process improvement work
Analysis and Measurement • MHA data for establishing individual hospital goals • Hospitals receivequarterly Potentially Preventable Readmissions (PPR) data from MHA • Hospitals collect data on variety of process measures; report their progress • CMS Hospital Compare readmission measures monitored over time • 30-day all cause readmission rates for select clinical conditions will be publicly reported on Minnesota HealthScores for hospitals and provider groups in 2012
16,000 nights at home… Together we can make a difference for patients in Minnesota
Questions? For more information: • Kathy Cummings kathy.cummings@icsi.org • Tania Daniels tdaniels@mnhospitals.org • Karla Weng kweng@stratishealth.org www.RAREreadmissions.org