The Well-Being Journal

New Study Demonstrates Impact of Care Transitions in Preventing Hospital Readmissions

Cameron Bowman

To circumvent the $17 billion in preventable readmissions costs paid by Medicare each year, financial incentives imposed by the Hospital Readmissions Reduction Program (HRRP) now penalize hospital and healthcare providers for unnecessary or excessive readmissions for several common diagnoses. These conditions include heart failure, pneumonia, heart attack, COPD, elective hip or knee replacement procedures and, beginning in October 2016, coronary artery bypass grafting.

In the past year, over 2,500 hospitals nationwide received penalties amounting to $420 million because they did not meet HRRP requirements, and of those, 38 hospitals accrued the maximum possible penalty. In order to avoid punitive measures, healthcare providers are increasingly concerned with improving overall quality of care and reducing the rate of preventable hospital readmissions. A recent study published in the American Journal of Managed Care highlights the effectiveness of one solution aimed at lowering preventable readmissions through a comprehensive, patient-centric approach.

The Healthways Care Transitions Solution® demonstrated impressive results in real world analysis, reducing 30-day readmission risk by 25% overall and the odds of any readmission within six months by over half among program participants with readmission penalty conditions, including heart failure, heart attack, chronic obstructive pulmonary disease and/or pneumonia. By addressing the underlying causes of preventable readmissions, rather than just managing the primary diagnosis, the program improved the overall health of patients and allowed hospitals to efficiently implement an effective approach to reduce the number of preventable hospital readmissions.

Through the use of science-based predictive modeling, the program is able to selectively deliver care to those patients at the highest risk of readmission prior to discharge. Additionally, trained clinicians complete follow-up interventions with patients telephonically to prevent readmissions post-discharge. The Healthways Care Transitions Solution represents the type of innovation that is increasingly in demand by health systems, physicians and patients.

Earning the exclusive endorsement of the American Hospital Association, the acute and post-acute care transitions management solutions provided by Healthways succeed not only in effectively navigating the shift from fee-for-service to value-based care, but also supports the interdisciplinary management of patients across the continuum of care.

For more information on the Healthways Care Transitions Solution, view our webinar or download our fact sheet.

To read the full study, click here.

Topics: Healthcare Trends in Healthcare Science and Research Care Transitions Solution

Can an Employer Sidestep the Negative Impact of a Transition to a High-Deductible Health Plan? New Study Shows It’s Possible

Madison Agee

Over the 5-year period of the study, healthcare costs decreased 21.5% as well-being improved 13.5%.

Perhaps spurred by a desire to avoid the looming 40 percent excise tax on so-called “Cadillac health plans” that’s set to come into effect in 2018, more employers are offering or considering offering consumer-driven health plans (CDHP)—also known as high deductible health plans. According to 2014 research by Aon Hewitt, 60 percent of organizations currently offer a CDHP to their employees—a 4 percent increase from the previous year. Maybe even more telling of this industry-wide shift to CDHPs is that 42 percent of employers are considering offering one as its sole benefit option within the next three to five years, entirely phasing out alternate options such as preferred provider organizations (PPO).

Both employers and employees are unsure about the potential pitfalls of the higher employee cost-share that is the hallmark of a CDHP—which may include employees feeling less engaged at work, being more apt to leave for other organizations where their cost-share would be lower, and delaying or avoiding necessary healthcare such as office visits, testing or medication. A new study authored by the Healthways Center for Health Research, which was published last month in the Journal of Occupational and Environmental Medicine, provides a case study in which an employer was able to sidestep these negative consequences and actually experience significant positive outcomes, even when executing an organization-wide transition to a CDHP.

The study, “The Value of a Well-Being Improvement Strategy: Longitudinal Success across Subjective and Objective Measures Observed in a Firm Adopting a Consumer-Driven Health Plan” makes a significant scientific contribution, as it’s one of the first longitudinal studies of the effect of a well-being improvement strategy on outcomes over an extended period of time—five years, in this case.

The linchpin of the employer’s strategy was twofold: 1) implement a robust well-being improvement program and 2) support the program by creating and sustaining a pervasive culture of well-being throughout the organization. The employer’s program included such rich offerings as company-sanctioned fitness activities, weight loss and tobacco cessation programs, online well-being improvement plans and resources, free membership at a national network of gyms, and health coaching. All of these offerings were underscored by a visible and purposeful organizational culture of well-being.

The study measured five key outcomes: healthcare costs (as measured by allowed amount per member per month and includes both the employee and the employer cost-share), smoking rates, obesity prevalence, job performance and absenteeism. Study outcomes include:

  • Average individual well-being statistically significantly trended upward by 9.8 points (or 13.5%) between 2009 and 2013 and remained stable in the last three years
  • Healthcare costs declined 21.5 percent, at an average annual rate of 5.2 percent, an important result given that inflation alone would have yielded an expected positive trend over the five-year period
  • Compared with 2009 when the CDHP was initiated, smoking and obesity prevalence rates in 2013 were 36 percent and 18 percent lower, respectively
  • Average self-reported job performance increased 2 percent (2010-2013)
  • Absence on average declined by 4 percent, or approximately six-tenths of one day per person per year (2010-2013)

This new study shows that a comprehensive, multi-year well-being improvement program can reduce healthcare costs and create a workforce that is healthier, has higher well-being, and is more productive. It also builds on earlier Healthways research that demonstrated the important role culture plays in supporting the success of a well-being improvement program.

Employers interested in better understanding how to create a roadmap for creating a strong culture of well-being (similar to the employer studied in this paper) will want to see our infographic, “Creating a Culture of Well-being: Five Steps to an Action Plan.” In it, we’ve collected five top characteristics of organizations that have achieved a culture of well-being. We’ve also identified key questions your planning team should ask to help benchmark your organization’s current position and help create a roadmap to your ultimate goal.

Topics: Well-Being Science and Research

Advancing the Science of Predictive Modeling

Madison Agee

Central to a successful population health management strategy is identifying, assessing and mitigating risk, since you want to be able to implement appropriate interventions for those individuals who will incur the highest healthcare costs. But how do you determine those individuals in your population who represent future risk? There are challenges around such identification, including:

  • High-risk individuals may not be participating in the formal healthcare system (through a lack of regular exams or other provider visits) which prevents insight from the physician.
  • Some individuals simply don’t present as high-risk today, but because of lifestyle or other factors, they could potentially be so in a year or two.
  • Because of financial reasons or a perceived lack of urgency, individuals could be delaying necessary care. This could lead to compounded risk and higher future costs.

Challenges such as these emphasize the importance of predictive modeling, which helps organizations identify and assess future risk and then use that insight to develop interventions that can proactively mitigate it. Given this valuable role, it’s important that such modeling is as robust as it can be. A study published earlier this year makes an important contribution to the field of predictive modeling, by advancing the science of such models with a more accurate framework.

Published by Population Health Management and authored by the Healthways Center for Health Research, “Predicting Health Care Cost Transitions Using a Multidimensional Adaptive Prediction Process” introduces a new method of predictive modeling called the Multidimensional Adaptive Prediction Process (MAPP). MAPP improves upon traditional predictive modeling, which uses a single model based on a limited and fixed set of variables and then applies that across an entire population.

In contrast, MAPP doesn’t rely on a single model – it instead draws from a collection of predictive modeling methods. Nor does it rely on a single set of covariates within a given model, instead allowing for a multitude of covariate combinations within each model. In this study, rather than be estimated on the entire population at one time, MAPP is estimated on four distinct cohorts of the population – low, medium, high and very high – each defined by total annual healthcare cost. By incorporating such a multi-faceted approach based on multiple models, covariate sets and cost cohorts, MAPP more explicitly accounts for the multi-dimensional, dynamic nature of a real-life population.

MAPP was tested on three years of administrative healthcare claims for approximately 25,000 people. A traditional predictive model was also estimated in order to yield a ”status quo” or reference modeling set of results. The two modeling approaches were then compared to see which one was more effective in predicting how individuals would move between cost categories from one year to another.

The study showed that, when compared to the traditional model, MAPP correctly identified 25 percent more individuals who remained in a high-cost cohort and 10 percent more individuals who transitioned from a lower-cost to a higher-cost cohort. Overall, MAPP more accurately identified $17.6 million of incurred healthcare costs.

The confirmation of MAPP as a more accurate methodology for predictive modeling has important applications. MAPP could improve traditional uses of predictive modeling, such as population risk adjustment, premium settings and targeted interventions designed to reduce costs. MAPP could also help health systems, providers and plans improve allocation and planning of their human, technology and physical resources, which could lead to lower cost of care and superior patient outcomes.

Topics: Health Plan & Health System Predictive Modeling Science and Research

New Research Introduces New Way to Gauge Efficacy of Well-Being Improvement Programs

Madison Agee

Organizations are searching for new ways to determine the efficacy of well-being improvement programs, a search that new studies from the Healthways Center for Health Research help to support. Published in Population Health Management, “Regional Economic Activity and Absenteeism: A New Approach to Estimating the Indirect Costs of Employee Productivity Loss”, introduces a new method for measuring the economic impact of work-related absences. Another recently published study makes an additional important contribution to the science of measuring the effectiveness of well-being improvement programs.

The study, “Extending Coarsened Exact Matching to Multiple Cohorts: An Application to Longitudinal Well-Being Program Evaluation within an Employer Population”, appeared in Health Services and Outcomes Research Methodology (HSORM). As with the regional productivity loss (RPL) study, this study expands upon an existing methodology and introduces a more robust and comprehensive measure useful for gauging the efficacy of well-being improvement programs.

The study focuses on a methodology known as Coarsened Exact Matching (CEM), which is used to remove imbalance (i.e., biases) between two groups and therefore create an “apples to apples” comparison of impact between them over time. To measure the effectiveness of a well-being improvement program, CEM compares two groups – those who participate in the program and those who do not but are of similar prospective risk – and systematically removes imbalance between the groups based on shared characteristics such as age, gender and disease status. This process enables an unbiased estimation of the program’s causal effect.

This “binary group” application of CEM for measuring the impact of well-being improvement programs is useful, but does not reflect the reality of these programs in which there is usually a wide spectrum of participation levels within a population. The recent HSORM study expanded the scope of CEM beyond the traditional binary group application to determine whether CEM could be an effective method for quantifying causality among multiple groups with different levels of program participation.

The study was able to show that the new multi-category specification of CEM accounted for and removed more bias than the traditional binary group application. Thus, multi-category CEM was found to produce a more comprehensive and robust measure of the impact of well-being improvement than the traditional application.

In addition to showing the validity of a multi-category CEM application, the study also demonstrated that higher levels of participation within a well-being improvement program led to a larger improvement in overall well-being. Well-being among non-participants improved 0.57 points, while well-being improved 1.32 and 1.48 points among the low- and high-intensity participants, respectively.

Together with the RPL study, these two studies make important contributions to the scientific literature and provide employers with new methodologies for measuring the impact of their well-being improvement programs.

Topics: Measure Wellness Methodology Science and Research ROI