Healthcare providers are always on the lookout for strategies to reduce preventable readmissions, and leaders at one of the nation's foremost integrated health systems say the answer lies in integrating provider and payer operations, MobiHealthNews reports.
University of Pittsburgh Medical Center (UPMC), the nation's second-largest integrated payer-provider network, cut readmissions from 16.5 percent in 2008 to 13 percent in 2015 with its access to both payer and hospital big data, UPMC Chief Data Analytics Officer Pamela Peele said at the HIMSS Big Data and Healthcare Analytics Forum last week, according to the article.
UPMC conducted an initial round of modeling using only claims data in an attempt to build a profile of the patients most associated with readmissions, and significantly cut the likelihood of readmission by requiring all its doctor to follow up with patients within five days. Soon after, the hospital side conducted similar modeling based on electronic health record data on indicators such as hemoglobin.
"We're predicting readmission before they're ever admitted and this is predicting the readmission risk based on drastically different inputs while they're in the hospital, yet the two models perform almost identically," Peele said.
Once system leaders had data from both ends side by side, they were able to look at patients for whom the claims and hospital data disagreed on risk level and reconcile the disparities by making a decision about whether it was more cost-effective to prioritize avoiding false negatives or false positives, eventually deciding on the latter.
Providers that decide to combine payer and care delivery operations have the choice between partnering with existing payers or creating their own plans, according to the New Yorker. Kaiser Permanente, the nation's largest integrated-care system, has found great success with the latter, consistently achieving high-quality scores thanks to its alignment of incentives. However, the historical distrust between providers and insurers remains a consistent obstacle to successful integration. But collaboration is key to the model's success, according to the CEO of Blue Cross Blue Shield of Rhode Island.