Elderly womanAs year-end approaches, employers and every individual approaching retirement age is carefully considering the impact of rising healthcare costs and insurance premiums. Decisions related to lifestyle, employment and even medication or recommended health treatment are influenced by finances.

A survey conducted by the Kaiser Family Foundation and the New York Times explored the burden of medical debt related to lifestyle sacrifices and ability to cover basic needs, such as housing, food and heat. Emergency room visits and hospital stays generated the biggest bills and were typically the result of a healthcare crisis. Surgeries or care for specific diseases were reported by 36 percent of individuals as the reason for the medical cost burden.

 “Individuals diagnosed with one or more chronic health conditions, mental illness or substance abuse are among those seeking frequent care at hospitals and emergency rooms,” stated Katy Burket, RN, program manager for Great Plains Quality Innovation Network (QIN). “Identifying the factors contributing to a patient’s increased demand for care and finding ways to address them is the ultimate goal.”

A 2016 study published in Journal of the American Medical Association (JAMA) Internal Medicine estimated that roughly 27 percent of hospital readmissions could have been prevented.   According to the Centers for Medicare & Medicaid Services (CMS), nearly one in five Medicare consumers discharged from the hospital are readmitted within 30 days.  Medicare spent $672.1 billion in 2016, a 3.6 percent increase, and accounted for 20 percent of the total national health expenditure.

Reducing hospital readmissions by addressing the complex needs of super utilizers is an ongoing concern, and Great Plains Quality Innovation Network (QIN) in South Dakota has invited thought leaders and healthcare professionals to participate in Let’s Not Re-invent the Wheel: A Patient-Centered Approach to Preventing Readmissions to consider high-impact opportunities and best practices. The round table events launched in Sioux Falls on October 16 and will be hosted in Rapid City on October 22 and Aberdeen on November 6.

Promoting system approaches rooted in data, clinical redesign and stakeholder engagement allows coordinated care to stretch beyond the door of individual healthcare facilities to reach every healthcare setting including hospitals, nursing facilities, home health agencies and beyond.

The CMS Quality Payment Program has created additional incentive for focusing on healthcare transformation and data provides valuable insights by highlighting the difference between healthcare costs and positive health outcomes.

Burket summarized her perspective of a patient-centered approach to preventing readmissions, “Addressing super utilizers will transform overall healthcare delivery. Using a healthcare transformation strategy provides a framework for changing the system instead of patching a hole in care.”