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Introduction: Taking on a Complex Challenge Despite national attention and the threat of Medicare penalties, many hospitals and health systems continue struggling to reduce hospital readmission rates. A recent Dartmouth Atlas study found that average 30-day readmissions not only did not decline between 2004 and 2009 but in some areas of the United States actually rose.Readmissions are a complex problem caused by factors ranging from psycho-social issues to fragmented care and lack of follow-up. Given an aging population, sicker patients, and a rising use of outpatient procedures, it’s not surprising that readmissions are difficult to reduce. But they’re not impossible. Presbyterian Healthcare Services (PHS) shows that comprehensive efforts to coordinate care as patients move through the healthcare system, supported by healthcare information technologies and a commitment to the whole patient can produce striking improvements. PHS’s readmission rates are well below the national average, and the organization is driving them lower.As an integrated delivery system (IDS) with 20 years’ experience in digital information technologies, PHS is in a good position to streamline the flow of information and deliver coordinated care as patients move across the care continuum. However, not all patients at PHS hospitals are part of the IDS. Many of PHS’s practices are relevant to accountable care organizations (ACOs) and others that want to reduce readmissions and coordinate care more effectively. The PHS experience also shows that a committed health plan can exert leadership to help reduce readmissions for its members. Equally significant, PHS leaders say that efforts to reduce readmissions can help improve healthcare outcomes, increase patientand member satisfaction, enhance resource utilization, and reduce costs.Read the full Intel Healthcare IT and Coordinating Care Reduces Readmissions White Paper.
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