Emblem Health study shows inpatient case management reduces readmissions

A new study from New York-based insurer Emblem Health provides evidence suggesting that inpatient point-of-care case management can both reduce patient hospital readmissions and provide a solid return on investment.

The study followed patients in a pilot program run by the New York-based insurer Emblem Health. After hospitalization, 298 patients in an intervention group were given transitional care and services by a team that included a nurse, a social worker, a pharmacist and two health navigators.

In the 244 patient baseline group, who received no case management following hospitalization, 17.6 percent were readmitted within 30 days, compared with 12 percent of patients in the intervention groups.
That may not be a huge difference, but the savings it yielded were "more than sufficient to cover the costs of the program," said Andrew Kolbasovsky, Emblem Health's director of Provider Group Clinical Management, in a study published in the American Journal of Managed Care.

The findings come as providers work to reduce readmissions, in the face of fines for Medicare readmissions from the Centers for Medicare & Medicaid Services starting in October.

"By locating the team at the point of care rather than in the office of the [managed care organization] and by utilizing protocols designed to reach hospitalized members as soon as possible, the [point of care] team was able to overcome many of the challenges commonly faced by managed care programs," Kolbasovsky wrote in the study's conclusion.

Kolbasovsky said the study has some limitations, most notably that it was not a random sample of patients. But, he wrote, since MCOs have the most experience with case management, point-of-care healthcare teams could be an addition to their toolbox.