Quantification of admission diagnoses in an employer-based transitions of care program.

ABSTRACT

BACKGROUND: Transitions of care (TOC) are critical times for patients, and if not conducted effectively, can lead to adverse events, preventable treatment, and costly readmissions. TOC programs are implemented to improve patient care, prevent hospital readmissions, and lower financial penalties associated with readmissions. Medicare's hospital readmission reduction program (HRRP), a value-based care model, targets specific conditions and procedures. Although many TOC programs focus on HRRP conditions, there are few studies looking at prevalence of disease states seen in TOC programs embedded within an employer-based insurance program in which financial ramifications exist for all hospitalizations. There is a need to better understand the potential missed opportunities for employer-based programs solely addressing HRRP conditions. OBJECTIVE: To quantify admission diagnoses in a nontargeted employer-based TOC program. METHODS: We conducted a descriptive study of patients enrolled in a TOC program conducted by a self-insured grocery store chain. We included all patients enrolled in this TOC program who experienced a hospital admission between January 1, 2017 and August 31, 2019. Each admission diagnosis was categorized into the appropriate anatomic and physiological groups using the 2020 ICD-10-CM categories. Data were reported using descriptive statistics. RESULTS: We identified 180 eligible patients with 328 hospital admissions. The mean (± SD) age of the study population was 53.6 ± 14.4 years. The most common admission diagnoses were those in the digestive category (n = 61, 18.6% of admissions); elective total hip or knee replacement was the most prevalent HRRP condition (n = 30, 9.1% of admissions). Overall, HRRP conditions accounted for 58 (17.7%) of eligible admissions. CONCLUSION: Most of the patients seen by an employer-based TOC program were for conditions not targeted by the HRRP. By including patients beyond those covered by the HRRP, such TOC programs may realize greater improvements in financial and clinical outcomes. These benefits, however, need to be confirmed in future studies.