Case study: post-discharge calls boost patient-centered care, lower readmissions
Today’s healthcare environment is challenging. Regulations and reimbursement structures require a lot of hospital leadership and healthcare providers, including putting processes and practices in place to ensure that patients are not only healthier before discharge, but also well-equipped to continue their health plan—hence avoiding adverse events and hospital readmissions.
However, despite excellent bedside care and intensive discharge preparation, a significant number of patients will require post-discharge support, due to factors such as the patient’s current health condition; and other circumstances—such as unemployment, lack of insurance or the inability to access a primary-care provider—can trigger the need for additional support.
The case study will address how a large health system’s journey to provide more personalized post-discharge care and better overall health care to their community uncovered three specific opportunities that resulted in lower readmissions and significant cost savings in less than a year;
- How to address the needs of high-risk patients with chronic health conditions
- How to target a broader population of patients
- How to implement a mechanism to catch patients who fall through the cracks