Reducing readmissions is a growing priority in the pursuit of the Triple Aim. While much attention has been paid to Medicare readmissions, evidence demonstrates that Medicaid agencies are increasingly implementing payment penalties for readmissions, and the recent expansion of Medicaid eligibility under the Affordable Care Act (ACA) has provided millions of adults with new health coverage. Hospitals serving large numbers of Medical patients have a mounting interest in adopting strategies to reduce readmissions that address the distinct needs of this population.

1. Implementing and Evaluating the Hospital Guide to
Reducing Medicaid Readmissions
Angel Bourgoin, PhD, James Maxwell, PhD,Amy
Boutwell, MD, MPP, Katie DeAngelis, MPH,
Sarah Genetti, BA,Alyssa Thomas, BA
Background
Methods
Initial Results
Significance
Reducing readmissions is a growing priority in the pursuit of the
Triple Aim.While much attention has been paid to Medicare
readmissions, evidence demonstrates that Medicaid adults have the
highest readmission rates of any payer. Some Medicaid agencies are
increasingly implementing payment penalties for readmissions, and the
recent expansion of Medicaid eligibility under the Affordable Care Act
has provided millions of adults with new health coverage. Hospitals
serving large numbers of Medicaid patients have a mounting interest in
adopting strategies to reduce readmissions that address the distinct
needs of this population.
The Guide
In 2014, the Agency for
Healthcare Research and Quality
(AHRQ) published the Hospital
Guide to Reducing Medicaid
Readmissions. This Guide, along
with 13 tools, walks hospitals
through the process of analyzing
their readmissions data, taking an
inventory of their readmissions
efforts, and developing a portfolio
of strategies that includes
hospital-based transitional care
strategies, cross-continuum team
partnerships, and enhanced
services for high-risk patients.
The Project
AHRQ has contracted with JSI to disseminate, implement, and evaluate the
Hospital Guide to Reducing Medicaid Readmissions. JSI is currently working with
six hospitals in Illinois and Maryland to identify how the Guide can be improved
and supported in future implementation, and evaluate its effectiveness in
reducing readmissions.
Evaluation Design
The evaluation uses a mixed methods approach, with quantitative data
on outcome measures, as well as qualitative data to offer additional context
and detail. JSI will document the hospital implementation progress,
experiences in implementing the Guide, and outcomes of implementation
through three surveys (pre-implementation, post-implementation, and post-
sustainment) and through ongoing calls with hospitals throughout the
project. Participating hospitals will provide monthly Medicaid readmissions
data for the project period, as well as 12 months prior for comparison.
The Intervention
The timeline below shows the duration and sequence of activities that
hospitals will participate in during this project.The intervention is
composed of a 7 month implementation period and 6 month sustainment
period.The implementation phase includes 1) participation in a learning
collaborative hosted by participants’ respective hospital associations that
introduces them to the Guide, and 2) biweekly one-on-one calls between
the project team and hospitals for mentored implementation, culminating
in an in-person learning session. Hospitals are not expected to implement
every strategy mentioned in the Guide, but to select those strategies that
will be germane to the findings from their data analyses and current efforts
and resources. Hospitals will continue implementing their readmission
reduction strategies independently during the sustainment period.
Research Questions
In order to understand the utility of the Guide and improve upon it,
the evaluation is guided by three research questions:
• RQ1. Feedback. – How feasible and useful are the Guide’s tools and
strategies to hospitals? What areas of improvement for the Guide
do hospitals and other stakeholder audiences identify?
• RQ2.Adoption – To what extent did the implementation hospitals
adopt tools and strategies from the Guide over the implementation
period? What factors affect their adoption of tools and strategies?
• RQ3. Impact – What is the impact of the adoption of the Guide’s
strategies and tools on Medicaid readmissions and related
outcomes? What factors influence their effectiveness?
At this point in the project, there are some promising findings with
regard to feedback and adoption of readmission reduction strategies:
• Feedback. Hospitals have responded very positively to the Guide
and tools, describing them as useful for spurring and guiding
improvements to their readmission reduction efforts. Some
recommendations for improvement were to offer increased
guidance for specific staff roles in using the Guide, more cohesion
between the Guide and tools, and content/format changes that
would allow greater ease of use.
• Adoption. Hospitals have varied widely in terms of the strategies
they have pursued, ranging from a focus on hospital-based care
transitions for all patients to developing emergency department-
based care plans for high-utilizers. The portfolio development tool
was especially useful in planning which strategies were of highest
priority, which could then be communicated to senior leadership.
Each hospital has made progress on their selected strategies during
the mentored implementation period, and are anticipated to make
continued progress during the sustainment period.
A final report, presentation, and revised Guide are expected
Summer-Fall 2016.‘
This project is funded by AHRQ (Contract No. HHSA290201000034I).
The driver diagram below, taken from the Guide, illustrates how the six
sections of the Guide work towards the objective of reducing
readmissions among Medicaid patients.