6. Horizontally integrate the electronic health record (EHR) and the patient's personal healthcare record (PHR) so that all parties have immediate access to clinical information
Healthcare is the last industry to digitalize. It is often difficult for ambulatory-based providers to access inpatient electronic clinical information and for the hospital-based clinician to access ambulatory clinical information, thus making access to critical information challenging and fragmented.
Some hospitalist services have little if any contact with a patient's primary care practitioner (if she or he has one!) and it is difficult for organizations to realize the 48 percent reduction in readmissions that Dallas-based Baylor Health Care System achieved without a smooth transition of care based upon the seamless flow of electronic information.
7. Create patient registers with an interdisciplinary team approach to care in and out of the hospital
Nurse navigators functioning through centralized patient registers can influence unnecessary readmissions and visits to the emergency department by as much as 65 percent by coordinating and guiding the patient's post-discharge care. Once the patient is discharged, the follow up and compliance rates are low due to the complexity of care, as well as the natural social and financial obstacles that face patients with medical conditions and pharmaceutical regimens of which they have little understanding. Community nurses may have a significant impact upon a patient safely taking medications post-discharge and obtaining timely and efficient follow-up services to reduce the likelihood of readmission.
8. Focus on home health services and telemonitoring
Horizon Blue Cross Blue Shield of New Jersey has significantly reduced readmissions by providing coverage for home health services and telemonitoring, which detect clinically significant changes in vital signs, blood sugar, and other health screens early in order to provide timely nursing intervention by home healthcare providers. This has significantly reduced the insurer's cost and has improved the quality of care and services to its beneficiaries. Similar pilot projects will lead to a greater emphasis on home health, as well as effective preventive strategies that reduce the rate of physician, emergency department and hospital visits and lower the cost for defined covered lives.
9. Create strong financial incentives for patients to do the "right thing" (secondary prevention)
Third-party payers are finally providing significant financial incentives for beneficiaries who make wise healthcare decisions by not smoking or excessively drinking/eating and who exercise regularly through the use of reduced premiums, deductibles and co-payments. In addition, the same payers are providing the same financial incentives for patients who go to practitioners who voluntarily report their quality and service data to the Centers for Medicare & Medicaid Services and who demonstrate a commitment to continually improve their care. These incentives help patients to make good healthcare decisions and will have a profound influence upon the rate and severity of comorbidities that significantly impact preventable readmissions.
10. Implement public health initiatives to educate everyone regarding preventive practices (primary prevention)
Good healthcare decisions depend upon education, which allow patients to make wise choices throughout their lives. Schools and publicly-funded organizations have a ways to go to offer the kind of preventive health education that will enable people to have a basic understanding of nutrition, primary prevention of infections and health maintenance. Most of the improvement in life expectancy in the past century is a result of public health measures (e.g., improved drinking water and uncontaminated food, etc.). Focusing on giving the public empowering healthcare information will reduce the demand for and need for non-value added healthcare services.
These improvements are vast and require change at all levels of the healthcare system. The best thing your organization can do is to invest in those initiatives that provide a good return on investment (ROI) by reducing cost and improving outcomes/service, particularly in light of the reimbursement changes yet to come.
Jonathan H. Burroughs, MD, MBA, FACHE, FACPE is a certified physician executive and a fellow of the American College of Physician Executives. He is president and CEO of The Burroughs Healthcare Consulting Network and works with some of the nation's top healthcare consulting organizations to provide "best practice" solutions and training to healthcare organizations.