While countless factors contribute to growing healthcare costs across the continuum— from preventive appointments to ambulatory care to rehabilitation—hospital readmissions consistently top the list of concerns. Patients who have been discharged from the hospital have an average readmission rate of 14% to the same or another facility within 30 days of their initial stay, resulting in an estimated $50 billion in annual healthcare spending.
Although, not all patient populations are equal. The hospital readmission rate for Medicare members is 20%—higher than any other payer. Regarding costs, Medicare plans experience significant expenses due to readmissions, totaling $26 billion annually. Nearly $17 billion of this cost is associated with potentially avoidable readmissions.
As pressure mounts to curb healthcare spending and improve care quality, public health insurance plans are increasingly implementing strategies to reduce hospital readmissions. While the elements of a hospital stay and post-discharge plan are largely outside a plan’s scope, Medicare Advantage plans should focus on what they can control. Removing barriers to care, such as lack of reliable access to transportation, could prevent a portion of unexpected readmissions and reduce the downstream costs for plans, providers, and patients—by getting them to the drugstore to pick up the appropriate medication or to urgent care to address an issue before it becomes emergent.
Addressing the Social Determinants of Health
First, it’s critical to understand that the risk of hospital readmission isn’t always entirely clinical; it could be environmental, financial, or cultural. Often, the issues leading to readmission may be related to social determinants of health (SDoH) or non-medical factors that impact overall wellness. Transportation access plays a key role in the SDoH landscape, as traveling to and from medical appointments is a critical part of the patient journey.
Medicare Advantage plans can reduce the cost of non-emergency ambulatory services and expand access to care before and after a hospital visit by offering a non-emergency medical transportation (NEMT) benefit. Addressing health disparities can help reduce hospital readmissions, as individuals with low socioeconomic status and those living in disadvantaged areas are more likely to contribute to the rising readmission rate.
Keeping Up with Follow-up Care
Leaving the hospital after an illness or surgery is overwhelming and the post-discharge plan can be complicated. When members aren’t feeling a hundred percent, and they are expected to read pages of “do this, but not that” instructions, there’s a good chance something gets missed—maybe a prescription isn’t picked up or an appointment isn’t scheduled. However, staying on top of follow-up care is critical to driving positive health outcomes. Early follow-up care and regular check-ins help catch complications and diminish developing issues that often lead to readmission. But engaging patients for follow-up care isn’t always easy.
A 2015 study revealed while most patients recognize the importance of follow-up care, they often still fail to attend the appointments. This isn’t necessarily their fault; low follow-up care attendance is often a result of low health literacy and a lack of transportation access. For Medicare Advantage plans, a member-focused NEMT benefit can increase adherence to follow-up appointments and ultimately prevent unnecessary hospital readmissions.
Avoiding Hospital Admission Altogether
Aging adults and those with chronic conditions are expected to have occasional hospital admissions. However, some initial hospital visits are avoidable if patients have easy access to preventative care. As a key component of population health management, Medicare Advantage plans need to consider the reasons for members’ initial hospital admission. For instance, consistently missing health services leads to the mismanagement of chronic conditions and poor health outcomes, which may result in a visit to the emergency room or a lengthy post-operative stay.
Member Spotlight [similar to Lance’s story from white paper]
Lance, a 68-year-old Medicare Advantage member with advanced heart disease, missed a checkup with his cardiologist because the ride he scheduled through a traditional NEMT broker failed to pick him up. Lance called his doctor’s office and rescheduled his appointment—the first opening was three weeks after his original appointment. A few days after the missed appointment, Lance started having chest pain, called an ambulance, and was admitted to the emergency room. Lance experienced a heart attack; now, he needs post-acute rehabilitation and has an expensive medical bill to pay off.
Research revealed that nearly a third of Medicare beneficiaries miss healthcare appointments or run out of medicine because they are unable to access transportation. When a patient misses an appointment, there’s a snowball effect that can change a treatment plan from routine or preventative to a reactive response or unexpected procedure. Getting members to their preventative care appointments helps avoid emergency care and hospital readmissions. As members age into plans, they increasingly rely on critical health benefits, like NEMT, to access life-sustaining care.
Reliable transportation is critical to accessing the right care at the right time, yet it’s one of the main barriers to accessing health services for older adults. While there are multiple reasons for health plans to offer a NEMT benefit—such as improving the member experience, alleviating grievances, and boosting Star ratings—meeting the unique needs of a member after a hospital stay is crucial. Empowering members with mobility will not only reduce hospital readmissions, but it’ll decrease unnecessary healthcare spending, too.
To learn how SafeRide can help Medicare Advantage plans gain a competitive advantage, watch our recent webinar on-demand or visit our site.