The hospitals will use electronic medical records to guide a care team that includes hospital staff, primary care physicians, patients and their families, and health coaches to coordinate daily post-discharge follow up to ensure that treatment regimens such as medication compliance are followed.
If successful, the pilot project hopes to reduce patient costs by 7% to 15% for the three-year period, improve outcomes by 10%, and improve patient satisfaction by 30%. Traeder says many cost drivers have already been identified.
"We are looking at avoidable readmissions. We are looking at ambulatory care sensitive areas, hot spotting them, care coordination and prevention and the number and source of those. Are we duplicating many tests from critical access hospitals to regional facilities and if we are what is the cost," she says.
"Another issue is transportation. We are calling out a fixed wing or a rotary much more often than we need to. Ground transportation would be much more appropriate when one flight is about $15,000. That is going to be a huge cost savings for us. It is going to be tricky because we are going to have to tease out what is appropriate and what is not. But if we can train our staff to appropriately use ground transportation or some of the other interventions we will reduce the costs of those areas. Those are a huge cost that we are identifying."
Another key responsibility of these better health improvement specialists will be to collect data—which has been a particularly nettlesome problem for critical access hospitals.