A regional Medicaid Managed Care Organization (MCO) with a large patient volume in urban areas was facing high readmission rates, with many readmissions qualifying as potentially preventable. The client has historically faced obstacles to reducing readmissions including: locating, contacting, and engaging patients; network strain as a result of limited coverage and oversaturation in certain regions; and outdated tools that were not easy to use for matching patients to providers. The MCO engaged AArete to conduct analytics and implement a strategy that would achieve lower readmission rates long-term.
AArete analyzed available data sources to determine the main drivers of higher than average readmission rates across the health plan and at specific hospitals. Our analysis also included a process review to identify gaps in discharge planning and care management. With the data-driven insights, we developed a process improvement strategy and piloted the solution at the five hospitals with the highest Potentially Preventable Readmissions (PPRs) spend and rates.
Within the first 8 months of the initial phase, we reduced PPRs by 3.9%, overall admission spend by 7.5%, and PPR spend by 47%. Our strategy also resulted in efficiencies within the health plan and improved communication across the care continuum.