By Keith J. Figlioli
According to the federal government, one out of every five Medicare beneficiaries – about two million people annually – are readmitted to hospitals within 30 days of discharge. The cost: $26 billion a year, with more than $17 billion considered unplanned and preventable.
Why is this happening? Well, research shows patients are often readmitted due to their lack of understanding about what’s wrong with them and how to care for themselves at home, which medications they’re supposed to take and when, and how and when they should schedule a follow up appointment.
In August, I wrote about the Data Alliance Collaborative (DAC), a group of leading clinical and IT experts who are co-developing and sharing data analytics to meet unmet healthcare needs. Instead of investing in and developing multiple, fragmented solutions that address the same problem, DAC members are pooling resources to develop single solutions all providers can use.
Among the first is an all-cause predictive readmissions model that analyzes both EMR and administrative data to identify patients who are most likely to be readmitted before they are discharged. Current readmissions models can’t analyze all conditions while accessing both EMR and the administrative data used by payers.
The DAC model will also identify risk factors leading to readmissions, tying patients to appropriate evidence-based checklists based on their condition. Providers can use filters to generate information about certain patients and where they are in their care delivery. For example, providers can search for all COPD patients with any incomplete items scheduled to be discharged within 24 hours. They can then intervene and apply needed resources such as care management programs focused on evidence-based care planning and discharge protocols – all prior to discharge.
This is a perfect example of the power of active collaboration. “Better together” is what Allen Naidoo, Vice President of data analytics for DAC member Carolinas HealthCare System calls it. We have six geographically distinct and innovative health systems – Baystate Health, Carilion Clinic, Carolinas HealthCare System, Catholic Health Partners, Fairview Health Services and Texas Health Resources – sharing their real-world experiences and knowledge. IBM brings unparalleled technology expertise. And the Premier alliance offers scale through its 2,900 hospital members and proven collaborative methodology.
Through active collaboration, best-practice sharing among diverse experts, and pooling resources – coupled with data analytics – we’re building ecosystems that can be built once and then used by thousands of providers, without reinventing the wheel or making duplicative investments.
I think IBM’s Director of Healthcare Transformation Paul Grundy, MD, summed it up well when he said “The analytics we’re developing will advance a smarter healthcare system that can tackle some of the biggest challenges for patients and the providers that serve them.”