By Katie Sullivan
To adapt to the evolving healthcare market, Jim Hinton, president and CEO of Presbyterian Healthcare Services in Albuquerque, New Mexico, said his organization ventured in the health plan business and started a medical group that now covers 435,000 members with more than 600 providers across the state.
The organization did this through various programs, such as "Hospital at Home," which brings the hospital to its patients, complete with equipment, monitors and treatment. The clinical results of the program are equal to or better than the inpatient setting, with no recorded falls so far, a 0.3 percent lower readmission rate and a mortality rate that is 2.57 percent lower than in the inpatient setting, Hinton said during a presentation this week at the American Hospital Association's annual membership meeting in the District of Columbia. It boasts a 97.9 percent patient satisfaction rating, which is 6.8 percent higher than hospital scores, and nearly 20 percent cost savings for Medicare and Medicaid patients.
Presbyterian also implemented the "Emergency Department Navigation," a program that gives able ED patients the option to go to an in-network primary care physician for treatment or stay in the emergency room and pay full fees on the spot, Hinton said. The program redirected 14,000 patients (10 percent of all ED patients) in two years, which led to a 40 percent reduction in ED use post-navigation, and a 25 percent reduction in ED use by the health plan's Medicaid population. Only 7 percent of patients come back for repeat navigation, Hinton said.
These care coordination programs require collaboration, aligned financial incentives, clinical leadership and rapid cycle improvement in order to succeed, Hinton said.