Prompt Primary Care Linked to Fewer Rehospitalizations in Medicaid Patients
The Camden Coalition of Healthcare Providers (of hotspotting fame) has published some intriguing findings from a city-wide program to reduce rehospitalizations by linking hospitalized Medicaid patients to primary care follow-up within seven days of discharge.
The study is not an analysis of the “7-Day Pledge” program itself, but instead looks at the 30- and 90-day rehospitalization rate of program participants who did, and did not, have a primary care appointment within seven days. The authors matched two groups of 450 adults with similar demographic and clinical characteristics.
Patients who had a primary care appointment within seven days of discharge had reduced readmissions at both 30 and 90 days, as shown below:
You may wonder, as I did, what it took to achieve these results, in terms of both program activities and resources. The 7-Day Pledge is an intensive intervention. It involves engaging both the patient and the practices, and includes a $20 incentive for patients and a $100 incentive for practices that prioritize these appointments.
Further details of the program can be found in this Camden Coalition brief. During the study period (2014-2016), it had about a 30% success rate in linking participants to a primary care appointment within 7 days, and a 40% success rate for primary care appointments within 14 days.
The authors estimate that each rehospitalization avoided saved $10,300 in costs. A simple cost analysis of the program suggests that it would break even if 27 inpatient admissions were avoided annually by connecting 208 patients to primary care within 7 days of hospital discharge. And with a 30% success rate, that would mean engaging 694 patients per year. Thus, a return on investment is achievable, and could be improved through targeting patients at highest risk.
But the Camden Coalition pulls no punches about the systemic barriers that exist in Camden. In an accompanying brief, the Coalition notes:
Camden, NJ, is a city with deeply-rooted poverty. Camden’s Medicaid patients face language barriers, lack of social support, competing priorities, unstable housing, mistrust of the healthcare system, and other social factors that influence health and decisions to seek care. All of these factors influence program performance. Without sustained efforts to relieve residents of these burdens, the program’s influence on readmissions will be limited.
The article, Outcomes of a Citywide Campaign to Reduce Medicaid Hospital Readmissions With Connection to Primary Care Within 7 Days of Hospital Discharge, was written by Dawn Wiest, PhD, Qiang Yang, PhD, Carter Wilson, MCom, and Natasha Dravid, MBA and was published in JAMA Network Open on January 25, 2019.
Camden Coalition CEO Kathleen Noonan, JD is an LDI Adjunct Senior Fellow.