Hospital readmissions represent a huge portion of unnecessary--and preventable--healthcare costs, accounting for 30 percent of total inpatient costs among commercial health insurance members.
With those avoidable costs in mind, Cigna implemented a program to help reduce readmissions by reaching out to certain members after they're discharged from a hospital to ensure they have all information needed to continue meeting their health needs.
Through a post-discharge telephonic follow-up program involving almost 4,000 Cigna members with high-risk gastrointestinal, heart or lower respiratory health problems, Cigna lowered readmission rates by 22 percent, according to a recent study published in the American Journal of Managed Care.
To learn more about this approach, FierceHealthPayer spoke with Eileen Scott (pictured), Cigna business project manager of consumer health engagement.
FHP: Can you explain the outreach program Cigna implemented, including goals that you hoped to achieve?
Eileen Scott: In order to help improve our customers' health and costs, we have targeted lower readmission rates, which can account for nearly one-third of inpatient costs. In our view, outreach and engagement with recently discharged patients is critical for improving readmission rates. Our study focused on outreach and engagement with patients within 24 hours of discharge, and prioritizing outreach, meaning the patient with the highest likelihood of readmission was engaged first.
FHP: Why did Cigna believe such follow-up was necessary? And why did you choose to target high-risk gastrointestinal, heart or lower respiratory patients?
Scott: Cigna's mission is to improve the health and well being of our customers. One solution used to help us achieve this mission is implementing what we call personal health solutions, led by our clinical operations team. Based on existing published literature and Cigna's desire to provide meaningful support to all customers, we believe post-discharge telephonic follow-up is necessary to assist customers with complying with discharge orders.
We considered all major diagnoses for the program, but since a previous internal study revealed that high-risk gastrointestinal, heart and lower respiratory diagnoses were most associated with 30-day and 60-day readmissions, we chose them as the criteria for this program.
FHP: Do the case managers offer any type of counseling or support services and do they make more than one follow-up call to ensure that patients, for example, took needed medicine, underwent tests and/or visited doctors as ordered?
Scott: Yes, the case managers did offer telephonic counseling where appropriate for discharged customers. Most of our outreaches were two calls--one call to engage the customer and verify that they are receiving their care, such as medications, home health if ordered and have a follow up appointment with their physician. The second call is scheduled after the follow-up appointment with their physician to verify that the customer did see their physician and assist with any changes in their treatment or new identified needs. The initial outreach call averaged 28 minutes and the follow-up outreach call averaged 16 minutes.
The case managers identified access to care or gaps in treatment, the most common of which were educating the patient about filling their medications and seeing a doctor within seven days of being discharged from the hospital. The interventions varied depending upon the information obtained during the initial outreach call. Sometimes case managers helped patients reconcile their medications, facilitate a follow-up appointment with their physicians within seven days of discharge or facilitate specialty pharmacy approvals.
If customers were identified with significant needs after any outreach call, they were referred to one of our case management programs for further engagement and follow up to address their complex or specialty needs. And customers with a chronic stable condition were referred to a disease management program.
FHP: What kind of training or background do the case managers have? Do they work directly for Cigna?
Scott: The Cigna case managers are directly employed by Cigna and are registered nurses. Our RNs have an average of 25 years experience as a registered nurse and have an average of 13 years in case management. Cigna used the existing case management staff for the outreach calls.
FHP: Is Cigna planning to implement the program on a more widespread basis? If yes, how can it be improved to further decrease the risk of hospital readmission?
Scott: We've already implemented the program across all lines of business and taken action to improve the outreach calls by dedicating outreach to a group of case managers as their primary responsibility. That way, the case managers are skilled in quickly identifying access and care gaps and taking action to resolve any identified opportunities.
FHP: How did patients respond to receiving a post-discharge follow-up phone call? Did they appreciate the outreach?
Scott: The patients' overall response was favorable to the post-discharge call because they appreciated talking with a nurse who could answer their questions, give direction on how to access care and resolve transition issues from the hospital to the outpatient setting.
Editor's note: This interview has been condensed and edited for clarity.