MedSolutions, the leading provider of medical cost management
services, launched today an innovative new product designed to lower
overall post-acute care (PAC) costs and reduce hospital readmissions.
Spending on PAC has grown by about 9 percent annually, more
than twice the rate at which overall Medicare spending has grown.1
The total spend for PAC combined with readmissions is $150-$190 PMPM,
making up roughly 20 percent of an average plan’s total costs. However,
this increase has not led to improved outcomes. Readmission rates remain
steady at about 20 percent, and they have been at this level as far
back as data is available. It is estimated that 70 percent of
readmissions are avoidable, and 67 percent of these avoidable
readmissions relate to prescription medication issues, such as
duplication of therapy, contraindications or adverse drug-drug
Additionally, decisions about care are often made with
little regard for the resources and liabilities that patients might have
that would impact their ability to get the clinical care they need. For
example, social and environmental factors often play a significant role
in an individual’s ability to recover. Resources such as willing and
able caregivers at home or community-based resources, such as
non-emergency transportation and meal services, can enable an individual
to recover more quickly at home. Conversely, barriers such as health
literacy or the need for home modifications can keep patients from
recovering and can even cause readmissions.
MedSolutions’ PAC management program addresses all of these issues with a comprehensive, patient-centered care coordination solution. All health plan members who enter the hospital are covered by this program, regardless of their risk level. MedSolutions manages each transition along the way, staying with patients from discharge until they have been home for 30 days without home health service. Through the program, MedSolutions:
- Coordinates the Appropriate Site of Care: Using evidence-based guidelines and coordinating additional support services, MedSolutions ensures that patients get the best care at the right place at the right time.
- Manages Length of Stay: Concurrent review with more frequent clinical updates to evaluate patients’ progress toward goals ensures that they stay in intermediate sites of care for the most appropriate length of time.
- Provides Transition Coaching for Readmission Reduction: Patients are assisted through medication reconciliation, connection to their primary care physician, and education on relevant warning signs and appropriate escalation paths.
“Through this program, we’re working to clearly understand
the patient’s individual needs, determine the best care to meet those
needs, and coordinate the required support services,” said Norman A.
Scarborough, M.D., DABR, vice president and senior medical director for
MedSolutions. “This makes for better outcomes and lower costs, and
enables patients to get home faster with the tools, knowledge and
support they need for a successful recovery.”
MedSolutions’ PAC management program is unique in its
comprehensive approach. To manage utilization for just one site of care,
such as skilled nursing facilities, or to only focus on readmissions,
which account for just a fraction of total PAC spending, misses the
broader opportunity to improve patient care and lower costs.
MedSolutions’ PAC program is also unique in that it touches every
patient who is discharged from the hospital, rather than focusing on a
small, select percentage of high-risk heath plan members.
“With this program, we’re building on our years of
experience identifying medically appropriate care in the right setting
at the right time,” said Dr. Scarborough. “Post-acute care is also a
natural fit for our direct-outreach capabilities that enable us to
communicate with patients and educate them about what to expect in the
coming weeks, including risks and warning signs, medication
reconciliation needs and transitions. We’re excited about the
opportunities this presents for health plans and their members alike.”
- MedPac Data Book: Health Care Spending and the Medicare Program, June 2012