In 20 de junio18, we held our first Medical Expense Trend (MET) Summit, where we invited our provider community to join us to brainstorm ideas designed to reduce medical expenses across the healthcare system in Rhode Island. That Summit produced some excellent ideas which became successful initiatives, including a community paramedicine program used by Integra for their Integra at Home program, a safe prescribing program in collaboration with Brown University, a spine care program, as well as our recently launched Dementia Care Coordination Program, in partnership with the Alzheimer’s Association’s Rhode Island Chapter.

The goal of our MET program is to reduce unnecessary medical costs by identifying, overseeing, executing, and monitoring savings opportunities. In that spirit, we’re looking forward to our next MET Summit, happening virtually on Wednesday, 9 de junio from 5:30-8 p.m. This event will focus on ways we can collectively partner to identify initiatives aimed at reducing readmissions. This is a particularly pervasive issue facing the local healthcare system, and we encourage you to submit your ideas about how to tackle this problem in advance of the Summit. Also, you recently received an invitation by email with information about signing up to attend the Summit – we encourage you to participate in this important meeting. Please submit your ideas and sign up to attend by Thursday, 6 may.

The information you received includes guidance about the types of submissions we’re looking for. As a reminder, in-scope submissions will include things like post-acute care coordination, alternatives to IP stays, ER avoidance, chronic condition management, and hospital discharge planning. Out-of-scope for the purposes of the Summit are benefit changes (network design, exclusions, formulary, cost-share), regulatory changes or barriers, and experimental/ investigational efforts.

Why readmissions?

Readmissions are an issue for everyone involved in healthcare – the patient, the payer, and the provider. The fact that they happen and are unplanned events suggests that there was some kind of avoidable failure or breakdown along the way, which is the problem we’re trying to get at.

The key, though, is that these are fixable issues. A study by the Boston University Medical Center’s Project RED—a research group that develops and tests strategies to improve the hospital discharge process in a way that promotes patient safety and reduces readmission rates—suggests that a 30% reduction in all readmissions is possible simply by being more deliberate when explaining discharge instructions, reconciling discharge medications within 48 hours, and PCP follow-ups within seven days.

Closer to home, programs are in flight to address monitoring and readmissions. We recently launched a program with Butler Hospital to create the Transitional Outpatient Program, which provides focused, short-term care to patients immediately following discharge from an inpatient stay. Additionally, we are working with primary care providers on a remote patient monitoring initiative for people with CHF for early detection of deterioration in health status.

On the Medicare side, CMS is moving toward using readmissions as one of their Stars measures, with a 5-Star benchmark likely to be in the single digits. For perspective and full transparency, today our score is in the double digits. Clearly, there’s lots of work for all of us to improve in this area, and that’s the intention of our Summit on 9 de junio – we look forward to your collaboration and participation, and as always, thank you for all you are doing to keep our members and all Rhode Islanders safe and healthy.