DENVER -- A northwest Denver pilot program to prevent expensive
hospital returns for relapsed patients has gone nationwide and is
demonstrating hundreds of millions of dollars in potential Medicare
savings, according to preliminary results.
The 14-city demonstration has already saved an estimated $100
million in Medicare spending on hospitals, among about 1.25 million
enrollees.
The 14 cities are a year and a half into the demonstration,
which links elderly hospital patients with transition coaches who
help them coordinate drugs, doctor follow-ups and home health care
aids to prevent pricey and dangerous hospital readmissions.
The Denver program shows a 9.3 percent cut in readmissions among
80,000 Medicare patients in the study group, which covers 44 ZIP
codes.
Medicare defines readmissions as returning to the hospital
within 30 days of the initial admission.
The coaching also helped cut new hospital admissions in that
population, after the 30-day standard, by 8 percent.
Program designers say the self-management skills taught to
patients as part of the transition coaching help them stay
healthier overall, even when faced with another illness or
accident.
Multiplied by the 620,000 Colorado Medicare patients and 46
million nationwide, expanding the program could save much more in
one of the largest and fastest-growing portions of the federal
budget.
"The model now has a strong track record," said Dr. Eric
Coleman, a University of Colorado medicine professor who first
developed the transition-care concept. "We believe it's scalable
in a variety of populations and payment mechanisms."
The original Colorado model used nurses, hospital employees and
others to reach out to elderly patients leaving the hospital.
Departing patients received coaching and follow-up on drugs and
physical-therapy regimens, securing doctor appointments,
encouraging weight and diet control and anything else needed.
Subsequent programs have shown the idea does not require a new
layer of specialists to carry it out, Coleman said. Social workers,
nurses or family members can use the regimen to keep vulnerable
patients from more hospital trips.
"You're giving people the knowledge and the confidence,"
Coleman said. "Building up the patient/family skills to
participate. You're teaching someone to fish instead of handing
them the fish."
U.S. Sen. Michael Bennet, D-Colo., an advocate of using quality
measures and prevention programs to reduce costs, inserted funding
for the pilot expansion in the 2010 Affordable Care Act.
It allows Medicare to spend $500 million over five years,
expanding the sites that offer transition coaching and providing
federal reimbursement for some of the cost.
"It expands and makes potentially available to the nation what
has proven to be very successful in Colorado," said Dr. Jane
Brock, who helped conduct assessments on the pilot for the Colorado
Foundation for Medical Care.
"These findings show that we can achieve higher-quality care at
a lower cost. Investing in coaching and transitional,
patient-centered care now -- as we've done in Colorado -- can head
off huge costs down the road," Bennet said.