Trained health care managers should serve as the point of contactfor members who don't understand what the physician just told themduring their office visit, or what the potential impact of aplanned surgery might be. (Photo: Shutterstock)

Hospitalizations are a big deal, both financially andemotionally. Reducing hospital readmission rates is good for everyoneinvolved. For patients, it means less time spent away from familyand work, less stress and better health outcomes. For employers, itmeans reduced health care expenses and improved productivity.

It's a win-win, but keeping readmission rates down can betricky. Often it involves helping recently discharged patients getto “YES” on the three key questions.

1. Is the member informed about their condition and treatmentplan?

When determining that a member requires medical care or a doctorhas diagnosed them with a serious condition, it is important toconduct outreach. Trained health care management professionals,like those on a health care management team, should ensure that thepatient understands the diagnosis and the treatment plan that theirhealth care provider outlined, and find answers to any questionsthe patient has. They should serve as the point of contact formembers who maybe don't quite understand what the physician justtold them during their office visit, or what the potential impactof a planned surgery might be on the member and their family.

2. Is the member receiving and taking their medications asprescribed?

In an equally important part of the process, that health caremanagement professional should also conduct follow upcommunications with the provider to get any clarification thatmight be needed regarding treatment and rehabilitation plans. Thecare that members receive should be medically appropriate andprovided in an appropriate timeframe by the most appropriateprovider, and health care management professionals can make surethis happens.

Additionally, if a member is hospitalized, your health caremanagement professional should plan on working with the hospital'sown case management team or social workers to ensure thateverything the member needs is in place. This way, when thehospital ultimately discharges the member, the agreed upon courseof treatment continues. Discharge planning is crucial for reducingthe chance that the member will need to be re-hospitalized.

3. Is the member making it to their outpatient follow upappointments?

The time after discharge can be pivotal for members, and timelysupport makes a world of difference. Health care managementprofessionals will make plans to check in on members to find outthe status of their symptoms and medications, to make sure themembers stay engaged with their providers and that they understandtheir treatment options for any complications that may arise. Anyoutreach should serve to empower members to take charge of theirhealth care.

Using health care management to improve members' healthcare journeys

As you can see, there are many variables in play, from baselinepatient health to the resources of the hospital, and some of themcome down to timing and good fortune. However, it's been myprofessional experience that there are a few ways we can stack thedeck in favor of members and their recovery. Through education,empowerment, and assistance from health care managementprofessionals, health care management programs can improve members'personal health journeys and help employers control rising healthcare costs.

I can't tell you with certainty that your members willexperience improved outcomes, I can tell you that at my employee,we have seen benefits accrue for clients using our in-house healthcare management team. In 2018, our case management and utilizationmanagement programs helped our clients in many ways:

• Combined 4.5:1 ROI for Case Management and UtilizationManagement (6:1 Case Management ROI)
• Average savings of $7,500 per member engaged in Case Managementduring hospitalization
• Average readmission rate of 7.7 percent versus MCGHealth's 22nd Edition Benchmark rate of 8.0 percent

In medicine, as in most aspects of life, small changes can yieldhuge results. And in our experience, careful investments in stronghealth benefits plans and effective health care management programscan help employers and members achieve more positive outcomes.

Angela Muthis a registered nurse and the executive director of health caremanagement for CoreSource, Inc.

Read more: 

• Employee education can reduce unnecessary ERvisits
• Employer group urges collaboration to cut hospitalreadmissions
• Mistaking freestanding ERs for urgent care carriesexpensive consequences