Intensive post-discharge outpatient care for the most high-need, high-cost Medicaid patients after hospital stays can reduce readmissions, improve outcomes, and lower overall costs, according to findings of the SafeMed study conducted by a multidisciplinary team from UT Health Science Center and Methodist Le Bonheur Healthcare system. The findings are published in the current issue of the Journal of General Internal Medicine.
The SafeMed transitional care study was funded by a $3 million Health Care Innovations Award from the Centers for Medicare & Medicaid Services (CMS). It was led by Jim Bailey, MD, MPH, professor of internal medicine and preventive medicine in the UTHSC College of Medicine and director of the Center for Health System Improvement at UTHSC, with Michael Ugwueke, DHA, MPH, president and chief executive officer of Methodist Le Bonheur Healthcare.
The two-year study assessed the benefits of providing intensive outpatient care, including home visits emphasizing medication adherence and rapid primary care follow-up for patients facing complex medical and social issues. Known as super-utilizers, these patients are high users of hospitals and emergency services and generally are more likely to return to hospitals soon after discharge.
The SafeMed team identified 285 participants to receive care-transition intervention and 1,950 to serve as a control group. The patients were from three hospitals, including one academically affiliated university hospital and two community hospitals in the Methodist Le Bonheur Healthcare system.
The SafeMed team began by getting to know these complex patients in the hospital before discharge, meeting with them to understand their needs, and helping to coordinate their follow-up care at discharge. After discharge, a nurse and a pharmacy technician conducted regular home visits and telephone follow-up for at least 45 days.
The intensive intervention was associated with 7 percent fewer hospitalizations, 31 percent fewer 30-day readmissions, and a reduction of more than $8,600 in medical expenditures per person over six months. Medicaid patients showed decreases of 39 percent in emergency room visits, 25 percent in hospitalizations, and 79 percent in readmissions, and even greater cost savings. Medication adherence was unchanged.
“Our SafeMed study shows that strong outpatient support for high-need, high-cost Medicaid patients results in decreased hospitalizations, fewer hospital readmissions, and substantially lower costs,” Dr. Bailey said. “By targeting only about 200 complex patients a year, we saved around $1 million a year beyond program costs. SafeMed saved money by providing better care where and when patients needed it most — in the home and the clinic right after being in the hospital.”
While the research shows better outpatient care can yield a substantial reduction in hospital costs and improve outcomes, care like that provided by SafeMed does not pay well, Dr. Bailey said. “More people in Memphis will get life-saving help from programs like SafeMed when we (employers, insurance companies, and the government) start paying per person for overall high-quality care, instead of paying piecemeal for procedures, visits, and hospitalizations.”
Dr. Ugwueke, who championed the SafeMed program at Methodist Le Bonheur Healthcare, said strong primary-care-based programs like SafeMed can help keep people out of the hospital. “Our research raises a critical question for policy makers — should they consider creating reimbursement mechanisms that recognize total patient care delivered at the right time and right place? Our study indicates that if you pay providers for total patient care, they can innovate to reduce costs, while providing better care and improving outcomes.”