Hospital Readmissions

1 in 5 Medicare patients discharged from a hospital returns within 30 days $17B / year cost.1

Hospital Medicare funding is decreased by up to 3% in 2015 and beyond.

In 2016, 2665 hospitals will lose a combined $420 million in Medicare payments. Of the 3400 hospitals subject to HRRP, 514 will face a penalty of more than 1%.

Effective discharge instructions can reduce readmissions by 30% to 60%.2

CASE: San Francisco General Hospital pilot saw a 70% better 30-day readmission rate amongst patients counselled with Meducation, compared to patients counselled with standard discharge documentation.

What CMS says hospitals can do to mitigate readmissions:

  1. Ensure patients clinically ready for discharge
  2. Reduce infection risk
  3. Reconcile medications
  4. Improve communication with community providers for post discharge
  5. Improve care transitions
  6. Ensure patients understand care plans

1 Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, Medicare & Medicaid Statistical Supplement.
2 KHN analysis of CMS data, August 2013

Value-Based Purchasing

Hospital Medicare DRG payments reduced 1.75% in 2016 100% earned back if meet all 12 clinical, 8 HCAHPS patient satisfaction, health outcomes & efficiency measures.

Meducation directly impacts 1 Clinical Measure and 5 Patient Satisfaction measures.

CASE: Implementing only Meducation, a Connecticut hospital’s 3 HCAHPS scores went from 1%ile, 1%ile & 4%ile to 52%ile, 85%ile & 98%ile approximately $167k Medicare funding impact year 1, $1.06M over 5 years.

Value-Based Purchasing Impact of Meducation

6 of 20 VBP measures impacted by Meducation Meducation
% of Heart Failure patients given discharge instructions
Patients who reported that their Nurses “always” communicated well
Patients who reported that their Doctors “always” communicated well
Patients who reported that staff “always” explained medicines before giving to them
Patients who reported “Yes”, they were given information about what to do during their recovery time at home
Patients who gave their hospital a rating of 9 or 10 on a scale of 0 to 10

Directly addresses
Indirectly addresses

CMS Shared Savings Plan

ACOs benefit from flexible combinations of shared savings and FFS + care coordination.

Quality & care measured by HEDIS, CAHPS, PQRS, MU, NCQA and others.

51% of ACOs participating in CMS Shared Savings Program 50% to 60% of savings retained by the ACO.

Accountable Care impact of Meducation

15 of 33 ACO Measures for SSP impacted by Meducation Meducation
2. CAHPS: Patients who reported that their Doctors “always” communicated well
5. CAHPS: Patients who reported that staff “always” explained medicines before giving to them
12. Medication Reconciliation: Reconciliation after hospital discharge
22-27. Diabetes outcomes, including medication therapy
28. Blood Pressure Outcomes, including medication therapy
29-30. Ischemic Vascular Disease outcomes, including medication therapy
31. Heart Failure outcomes, including beta-blocker medication therapy
32-33. Coronary Artery Disease outcomes, including statin or ACE inhibitor medication therapy
Directly addresses
Indirectly addresses

PCMH Qualifications

PCMHs benefit from a combination of shared savings and incremental funding from Health Plans.

CMS pays $2.5 PMPM if score 35 points, $3 PMPM for 60 points, $3.5 PMPM for 85 points.

Meducation delivers 6 points of PCMH qualification.

  • For 50k covered lives, Meducation delivers attributable CMS funding = $257k/yr

North Carolina (Example)

BCBS of NC reimburses 10-30% more for clinics satisfying sufficient PCMH criteria.

Community Care of North Carolina estimated $382M in cost savings from their Patient Centered Primary Care initiatives in 2010.1

PCMH impact of Meducation

11 of 27 PCMH Measures impacted by Meducation Meducation
1F4: CLAS - Provide printed materials in patient language
3D1-2: Reviews & reconciles medications for >80% of transitions, 50% minimum
3D3: Provides information about new prescriptions >80% of patients
3D4: Assess patient understanding of medications >50% of patients
3D5: Assess patient response & barriers to medication adherence >50% of patients
3D6: Document OTCs and herbal/supplements for >50% of patients
4A1: Provides education resources or refers at least 50% of patients to educational resources
4A2: Uses EHR to identify education resources and provide them to 10% of patients
4A3: Collaborates with >50% of patients on self-management plans and goals
6C2: Set goals & act to improve on any 1 measure from 6B, such as patient communication
6C3: Set goals & address at least one (1) identified disparity in care for vulnerable populations

Meducation delivers 100% score
Meducation positively impacts

1 Our Results: Making headway on Cost & Quality.

Star Ratings

Health Plan CMS Star Ratings provide a 5% Medicare Advantage and Part D Quality Bonus Payment for 4-5 rating, 3.5% for 3.5 , 3% for 3 , 0% for < 3 0% if under 4 in FY15.

Improving 3 to 4 is worth ~$50 incremental PMPM. EX: 10M member plan earns $6B.1

Competitive Advantage: 1 higher 9.5% increased likelihood of new beneficiary choosing that plan & 4.4% increased likelihood of switching beneficiary choosing that plan.2

Star Ratings impact of Meducation

10 of 50 Star Rating Measures Impacted by Meducation Meducation
D16: 80% Medication adherence for Oral Diabetes, with 3X weighting
D17: 80% Medication adherence for Hypertension (RAS antagonists), 3X
D18: 80% Medication adherence for Cholesterol (Statins), 3X weighting
D15: Diabetes drug treatment, with 3X weighting
C11: Annual Medication review for patients >65 years old
C17: Diabetes Care, Blood sugar controlled, with 3X weighting
C18: Diabetes Care, Cholesterol controlled, with 3X weighting
C19: Controlling blood pressure, with 3X weighting
C20: Rheumatoid Arthritis management, with 3X weighting
C29 Care Coordination, with 1.5X weighting
6C3: Set goals & address at least one (1) identified disparity in care for vulnerable populations

Directly addresses
Positively impacts

1 Journal of the American Medical Association
2 L.E.K. Consulting Study 2013

Fulfill Regulatory Language Requirements

Joint Commission

PC.02.01.21: The hospital effectively communicates with patients when providing care, treatment, and services.

  • EP 1: The hospital identifies the patient's oral and written communication needs, including the patient's preferred language for discussing health care. Note: Examples of communication needs include the need for personal devices such as hearing aids or glasses, language interpreters, communication boards, and translated or plain language materials.
  • EP 2: The hospital communicates with the patient during the provision of care, treatment, and services in a manner that meets the patient's oral and written communication needs.

Title VI of the 1964 Civil Rights Act

No person in the United States shall, on the ground of race, color, or national origin be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program to which this part applies.

National Standards on Culturally and Linguistically Appropriate Services (CLAS) - 14 Standards

Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area