Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2018

Decreasing Preventable ED Visits and Hospital Readmissions


At the most recent Massachusetts Medical Directors’ Meeting, Harvard Pilgrim medical directors, the medical leaders of participating hospitals and provider organizations, and other local industry leaders discussed the importance of decreasing avoidable emergency department visits and hospital readmissions.
 
Research indicates that the number of U.S. emergency department visits increased by 21% from 2004 to 2014, and that 5-8% of emergency department users account for 21-28% of emergency department visits. Data from the Massachusetts Center for Health Information and Analysis found that 41% of inpatient discharges return to the emergency room within 90 days.
 
At the meeting, Lowell General and Mary Hitchcock Memorial Hospitals shared the work they’ve done to address this issue, including:

  • Identifying the critical characteristics of over-utilizers in this space
  • Developing action plans with emergency department staff
  • Supporting primary care provider practices, and adding community health workers to support the health care and non-medical needs of the patients

The group examined the role of collaboration and provider incentives and multiple ways of measuring outcomes, quantifying cost containment success, and ultimately improving the health and coordination of care for patients.

Upcoming follow-up WebEx
Meeting participants agreed to continue this discussion through an upcoming WebEx that will focus on steps that can be taken to decrease avoidable hospital readmissions.
 
Look for an article in next month’s issue of Network Matters providing additional details and registration information.

Upcoming Medical Directors’ meetings
Harvard Pilgrim’s medical directors regularly meet with the clinical leadership of our provider partners to discuss important clinical topics and share ideas for improving care. You can find informational resources from these meetings, including key topics, links to full presentations, and event summaries, on the Medical Director Meetings page on Harvard Pilgrim’s website.

    Email this article to a colleague   


    Network Matters Archives

    Download printer-friendly version

    HPHCURRENT EVENTS

    Sign Up for a Webinar on Our Genetic Testing Program

    CLINICIAN CORNER

    Decreasing Preventable ED Visits and Hospital Readmissions

    Coverage of Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

    Prior Authorization Required for Brineura

    Prior Authorization Criteria Updated for Xgeva

    Mental Health Month and Alternative Health Benefits

    OFFICE ASSISTANT

    Reminder: Report Condition and Value Codes on Institutional Claims

    Update to Reimbursement of Codes With PC/TC Indicator of 3

    Reimbursement of 3D Rendering of Imaging Studies

    Correct Usage of Modifiers LT, RT, and 50

    PUBLICATION INFORMATION

    Eric H. Schultz,
    President and Chief Executive Officer

    Robert Farias,
    Senior Vice President, Corporate Network Strategy

    Annmarie Dadoly,
    Editor

    Joseph O'Riordan,
    Writer

    Kristin Edmonston,
    Production Coordinator