Peter S. Nakhla, M.D., senior medical director, Blue Cross & Blue Shield of Rhode Island

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our overarching goal is to make healthcare affordable and simple for Rhode Islanders. We work to achieve this through our triple aim of enhancing patient experience, improving quality and outcomes, and controlling costs. One of the biggest culprits when it comes to controlling healthcare costs is hospital readmissions - often a readmission costs MORE than the initial hospitalization.  

But how do we prevent avoidable readmissions? One way is to transform the way healthcare is delivered and paid for, but that’s not something we can do alone. Healthcare is a team sport. So, BCBSRI sent out a call for the expertise of our provider community – those on the front lines of patient care – to ask, how do you think we could reduce hospital readmissions? And, wow, did they rise to the occasion.

Earlier this year, we held our second Provider Medical Expense Trend Summit, or “MET Summit." We asked the Rhode Island provider community to partner with us to bend the trend and reduce unnecessary medical costs through the identification, oversight, execution and monitoring of savings opportunities. Healthcare providers from across the state submitted their ideas, and five finalists presented at the MET Summit with proposals that were innovative, timely and targeted at meeting the needs of the Rhode Islanders they serve.

We heard presentations from teams across multiple specialties, targeting several critical areas. Their proposals were so strong, I want to share a brief overview of each.

• “Reducing Readmissions by Transforming Patient Access" – Coastal Medical

After an in-depth chart review Coastal found that half of their patient readmissions occurred either just before timely post-discharge outreach, or after their period of engagement in case management. This remote patient monitoring program offers providers a means of connecting with patients during a time of need and alerts care management that a patient is in need, so they can respond and offer help before a hospital readmission occurs. Remote patient monitoring offers a virtual connection for every Coastal patient to their care team. Coastal found that the primary cause of their readmissions is NOT the condition or the complexity of illness, but ANY unmet need of the patient. Remote patient monitoring would address this and empower and inform effective care management with timely and effective communication for every patient during transitions of care.

• “Integra at Home Community Paramedicine"

This program aims to reduce unplanned hospitalizations and ED visits by providing at-home care for high-risk patients 24/7. The program is targeted at breaking the cycle of an unplanned health event leading to an ED visit. Within 30 minutes of a patient call to the program, they are triaged and a care provider (nurse practitioner, physician assistant or a community paramedic), is at their home to provide things like an EKG, bloodwork, a home safety evaluation or medication check, before they have an escalation of their unplanned health event. An initial pilot of this program already demonstrated an ED visit reduction of 27%, a 20% reduction in inpatient admissions, and a 15% percent reduction in hospital readmissions.

• “Medically-Tailored Meals" – Integra

A pilot program providing meal delivery to patients with diabetes who have recently had an inpatient hospital stay. This program would provide six months of weekly delivery of pre-prepared frozen and refrigerated meals accompanied by meetings with a nutritionist. This new program would address not just patients receiving enough food, but rather the right food for their health conditions, with personally individualized meal plans. Studies have shown a significant reduction in cost and utilization after six months of medically tailored meals, and this new pilot proposes to assess the potential impact on hospital readmissions.

• “Coping with Crisis" – ME Psychotherapy

A pilot program offering a virtual mental health drop-in center via Zoom meetings, aimed at addressing the mental health crises that account for a significant proportion of readmissions by offering brief stabilizations and resource gatherings. Drop-in center would feature a 60-minute group session offering crisis stabilization (DBT, safety planning, emergency contact ID) and case management (assessment, individual services referral, community support referral). The overarching goal is to reduce crisis situations, so patients can maintain without needing the ED.

• “Exercise is Medicine" – Performance Physical Therapy

A virtual physical therapy pilot of Performance’s iPerformance program, which features a daily, virtual exercise program; a monitoring app; monthly assessment with a physical therapist; and ongoing communication with the patient’s primary care provider to discuss outcomes. BCBSRI is already piloting this program for knee and hip PT, but this new pilot would target people recently discharged from the hospital with certain comorbidities that place them at higher risk of readmission, such as diabetes or COPD. The program would measure repetitions and length of activities, such as a 30-second sit to stand, to assess if a patient’s quality and quantity of movement is improving.

So, what happens now? The good news is that Coastal’s remote patient monitoring program and Integra’s community paramedicine program are both up and running after receiving the most votes from MET Summit participants. And BCBSRI’s medical expense cost of care office continues the conversation with each of these presenters to discuss how to best leverage their initiatives and programs for members. Then we adjust course for our next plan cycle. Bending the medical expense trend at is an ongoing effort, and BCBSRI is thankful for the innovation shown by our provider community when it comes to meeting Rhode Islanders where they are with simple and affordable healthcare.