Personalized Postacute Hospitalization Recovery: A Novel Intervention to Improve Patient Experience and Reduce Cost.

GOAL: Readmissions are a significant financial burden for payers. Cardiovascular-related discharges are particularly prone to readmission. Posthospital discharge support can impact patient recovery and probably reduce patient readmissions. This study aimed to address the underlying behavioral and psychosocial factors that can negatively affect patients after discharge. METHODS: The study population was adult patients admitted to the hospital with a cardiovascular diagnosis who had a plan to discharge home. Those who consented to participate were randomized to intervention or control groups on a 1:1 basis. The intervention group received behavioral and emotional support, whereas the control group received usual care. Interventions included motivational interviewing, patient activation, empathetic communication, addressing mental health and substance use, and mindfulness. PRINCIPAL FINDINGS: Observed total readmission costs were significantly lower in the intervention group than in the control group ($1.1 million vs. $2.0 million) as was the observed mean cost per readmitted patient ($44,052 vs. $91,278). The mean expected cost of readmission after adjustment for confounding variables was lower in the intervention group than in the control group ($8,094 vs. $9,882, p = .011). PRACTICAL APPLICATIONS: Readmissions are a costly spend category. In this study, posthospital discharge support addressing the psychosocial factors contributing to patients' readmissions resulted in a lower total cost of care for those with a cardiovascular diagnosis. We describe an intervention that is reproducible and can be scaled broadly through technology to reduce readmission costs.

Patient Post-discharge Transitions and Inpatient Readmissions Impose Costly Burdens for Employers and Carriers.

Although the Centers for Medicare & Medicaid Services has focused on Medicare hospital readmissions for select diagnoses through the Hospital Readmissions Reduction program, there is no similar initiative for employers, who account for the majority of the 48% of private health care spending in the United States. Readmissions are costly and it is estimated that as many as half of these may be preventable. This study analyzes a national claims database to understand post-discharge transitions and their cost in the working population. Within an employer-sponsored, commercially-insured population, this study found that 4% of members are hospitalized annually and drive 37% of population health care cost. Of these members, 17% undergo additional admissions in the year following discharge and drive approximately 67% of the cost of the admitted population. This study found that the post-discharge site of care transitions has significant implications for the cumulative cost of care. More than a third of patients discharged home will transition to higher cost settings over the course of a year. Mental health and substance abuse diagnoses add significantly to admission/readmission rates and costs. Prior research indicates that post-discharge interventions that activate and engage patients in self-management are beneficial in mitigating overall cost and readmissions.