AHRQ Data and New Guide Highlight Need To Reduce Medicaid Readmissions
Over the past several years, hospitals, physicians, and the Federal Government have made it a priority to reduce hospital readmission rates for Medicare patients. While still at an early stage, strategies put into place as part of the Affordable Care Act, such as evidence-based safe care transition practices, are showing good results.
But adults covered by Medicaid have readmission rates that are just as high, or even higher, than Medicare patients, according to findings from the Agency for Healthcare Research and Quality (AHRQ). For example, nearly one in three adults covered by Medicaid with congestive heart failure, a condition for which there is a high risk of readmission, returned to the hospital within 30 days. This compares with one in four among Medicare patients who had the same condition.
Medicaid readmission patterns differ in important ways from those of the geriatric population. Young adult Medicaid patients are more likely than Medicare patients to be rehospitalized for illnesses such as behavioral health conditions and sickle cell disease. Additionally, Medicaid patients face distinct socio-economic challenges such as low income, discontinuities in coverage, language barriers, and unstable housing. According to an AHRQ-funded literature review, medication noncompliance, unstable post-hospital environments, and substance abuse co-morbidities are among the risk factors for Medicaid readmissions. Because of these differences, transitional care strategies that have been effective for geriatric patients may need to be modified to better meet the post-hospital needs of adult Medicaid patients.
To help hospitals reduce preventable readmissions among Medicaid patients, AHRQ has developed a new guide that identifies evidence-based strategies that can be adapted to meet the needs of this population. The Hospital Guide to Reducing Medicaid Readmissions provides in depth information about the unique factors that are often associated with readmissions among Medicaid patients. It also offers a step-by-step process for designing an array of strategies that fit a hospital’s unique patient needs.
The guide distills and tailors best practices for the Medicaid population from evidence-based toolkits, as well as guidance from the Centers for Medicare and Medicaid Services (CMS). The recommendations in the guide are drawn from an extensive literature review of the characteristics of the Medicaid population and the drivers of Medicaid readmissions and have been refined through field testing with seven hospital readmissions teams across the country. Nationally recognized experts in the fields of implementation science, quality improvement, behavioral health, and Medicaid policy and payment contributed to the development and review of the guide and its tools.
Reducing Medicaid readmissions has been a priority for CMS, as well as other public and private sector groups. CMS continues to partner with State Medicaid and Child Health Insurance Program agencies to reduce hospital readmissions through the collection and use of two Medicaid core set measures related to plan-all cause readmissions and transitions of care. States are also building on work related to readmissions as part of their health care delivery and payment reform efforts. These efforts are complemented by the activities of other groups such as the National Academy of State Health Policy on care coordination.
Reducing the rate of preventable hospital readmissions requires a keen understanding of the reasons for readmissions and the clinical needs of Medicaid beneficiaries. AHRQ’s resources can help health providers assess their current needs, understand where interventions would help, and take steps to improve their future performance.
If we are going to have an impact on Medicaid readmissions, we cannot simply apply the interventions that have been successful in the Medicare population—we must understand the specific needs of this critical population and apply measures and resources accordingly.
Richard Kronick, Ph.D., is Director of the Agency for Healthcare Research and Quality.
Page originally created December 2014