OM: NY Hospital/Health Plan Care Management Collaboration Reduces Readmissions

New York Payer & Hospital Behavioral Health Collaboration Reduces Hospital Readmissions To Less Than 10%

Open Minds  July 9, 2012 

 

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In New York, a care coordination and case management collaboration between Samaritan Hospital’s clinical care team and the behavioral health operations of Capital District Physicians Health Plan, Inc. (CDPHP) has reduced behavioral health-related hospital readmissions to less than 10% between 2010 and 2012. The health plan estimates savings of at least $8,000 per avoided readmission.

 

During the second quarter of 2010, the behavioral health re-hospitalization rate was about 11%; by the third quarter of 2010 the readmission rate had dropped to 10%, and for each subsequent quarter has stayed below 10%. The behavioral health readmission rate was about 8% during the first quarter of 2012.

 

The partnership began in 2009 when CDPHP brought behavioral health management in-house; previously, CDPHP had contracted with United Behavioral Health to manage behavioral health benefits.

 

After a year of planning, in 2010, Samaritan Hospital and CDPHP launched the Readmission Avoidance Initiative in which a clinical care coordinator served as a liaison between the hospital and health plan medical director. In 2011, the health plan introduced case management services and a home visit program to the initiative to improve community linkages and care transitions.

 

Both CDPHP and Samaritan Hospital sought to decrease clinical and administrative burden related to pre-authorization and documentation, reach a high level of agreement on medical necessity and appropriate treatment, decrease denials, and improve outcomes for patients/members.

 

The initiative includes a care coordinator, weekly on-site length-of-stay rounds, weekly administrative meetings, and notification and clinical review prior to denial. The care coordinator functions as a primary clinical partner and liaison between Samaritan Hospital and CDPHP’s behavioral health medical director. The care coordinator reviews and determines medical necessity via remote access to patient medical records, telephonic consultation with professionals caring for the patient, information from the length of stay rounds, and participating in case review/conferences.

 

Together CDPHP’s director of behavioral health operations and a Samaritan Hospital clinical team outlined an acceptable utilization management process, launched an on-site care management presence, initiated open access to patient medical records, and identified clinical improvement opportunities to reduce avoidable hospital readmissions.

 

The collaboration extended through contract negotiations on sub-acute care reimbursement rates for a quality initiative-the Readmission Avoidance Initiative-a multidisciplinary approach to improve patient outcomes, enhance patient satisfaction, and reduce costs by avoiding preventable readmissions. Through the Readmission Avoidance Initiative, the partners implemented a readmission “audit tool” interview and experimented with clinical bundles that featured family involvement in care, timely discharge follow-up, post-discharge telephone contact, and primary care collaboration.

 

To further reduce readmissions, in 2011, CDPHP introduced a case manager and in-home visits. The case manager collaborated with Samaritan Hospital, directly contacted patients, and provided post-discharge follow-up via telephone outreach to identify members needing home visits. Hospital readmissions are now below five percent among patients who receive a home visit.

 

The collaboration was the topic of a presentation by Samaritan Hospital and CDPHP at the Healthcare Association of New York State’s (HANYS) first Behavioral Health Strategies, Weapons, and Tactics (SWAT) program, which took place on June 7, 2012. The event focused on tools and information to educate HANYS members serving behavioral health patients in a managed care environment. Other presentations at the event focused on providers’ general legal rights in managed care, managed care contracting for behavioral health provider organizations, and behavioral health revenue cycle management.

 

Robert Holtz, vice president of CDPHP Behavioral Health Services, and Scarlett Clement-Buffoline, assistant vice president of Behavioral Health Services at Samaritan Hospital in Troy, discussed the collaborative relationship between CDPHP and Samaritan Hospital. Their presentation emphasized that as a result of the collaboration, readmissions have been reduced, savings have been achieved, and patient response has been very positive.

 

As of mid-2012, the presenters said the home visit model is maturing, and they are identifying opportunities for collaboration related to chronic medical conditions. Mr. Holtz noted that CDPHP has learned that collaborating and building relationships with hospitals is the most effective way to conduct utilization management. Ms. Clement-Buffoline said Samaritan Hospital has learned that payers can be partners and that transparency drives accountability, but also that change takes time and requires reframing the relationship.

 

Samaritan Hospital, founded in 1989, is a 238-bed community hospital in Troy, New York. In October 2011, it became part of St. Peter's Health Partners as a result of merger of Northeast Health, St. Peter's Health Care Services and Seton Health. The hospital provides critical care, ambulatory surgery, maternity, cancer care, women's health, and behavioral health services. Founded in 1984, CDPHP and its affiliates serve nearly 390,000 people in 24 New York counties: Albany, Broome, Chenango, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Hamilton, Herkimer, Madison, Montgomery, Oneida, Orange, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Ulster, Warren, and Washington.

 

A copy of the presentation about the collaboration can be requested from HANYS. HANYS plans to continue the dialogue with members related to behavioral health payer issues to further its behavioral health managed care advocacy agenda.

 

OPEN MINDS also reported on the merger that created St. Peter's Health Partners in “New York Awards Medicaid Adolescent Addiction Preadmission Contract To St. Peter's Addiction Recovery.” The article is available at www.openminds.com/market-intelligence/premium/omol/2012/032612cs3.htm

For more information, contact:

  • Ali Skinner: Public Relations Manager, Capital District Physicians Health Plan, Inc., Patroon Creek Corporate Center, 500 Patroon Creek Boulevard, Albany, New York 12206; 518-605-4497; E-mail: askinner@cdphp.com; Web site: www.cdphp.com/Commitment-To-Quality
  •  Scarlet Clement-Buffoline, M.S., Assistant Vice President, Behavioral Health, Samaritan Hospital, 2215 Burdett Avenue, Troy, New York 12180; 518-271-3539; E-mail: clements@nehealth.com; Web site: www.nehealth.com/Quality; or Angela L. Yu, Media Relations Manager, Samaritan Hospital, 2215 Burdett Avenue, Troy, New York 12180; 518-271-5045; Web site: www.nehealth.com
  • William Van Slyke, Vice President, Communications and Public Relations, Healthcare Association of New York State, One Empire Drive, Rensselaer, New York 12144; 518-431-7770; E-mail: wvanslyk@hanys.org; Web site: www.hanys.org 

New York Payer & Hospital Behavioral Health Collaboration Reduces Hospital Readmissions To Less Than 10%. (2012, July 9). OPEN MINDS Weekly News Wire.