are utilizing claims-based drug history infor- mation to intelligently match patients with the medications they have received over time and at diff erent locations. When combined with health information-exchange technolo- gies and e-prescribing modules, clinicians have a powerful tool for preventing potential drug- to-drug or drug-to-allergy interactions. Additionally, utilization management is being used eff ectively to lower readmission rates. On a daily basis, caregivers must assess the most appropriate course of treatment for a patient’s set of circumstances. Eff ective utilization management adds to the ongo- ing evolution of team-based healthcare by delivering intelligence to groups of providers and health plans in a way that allows them to collaborate on medical decisions. Enhanced by technologies that provide utilization alerts, either at the point of care or shortly thereafter, hospitals can start discharge planning and begin utilization reviews much sooner. Population health and disease manage-
ment eff orts are also coming to the forefront as a preventive measure against readmission. Dis- ease management attempts to engage patients with information about their chronic condi- tion and encourage them to make lifestyle and behavior changes, often through a variety of health coaching programs. With relevant data aggregated from multiple points along the care continuum and delivered to patient, provider or health plan, all constituents are empowered to make important healthcare decisions that will prevent return trips to the hospital. Of course, with the prospect of payment
reductions for preventable readmissions, caregivers must also eff ectively use IT to help monitor potential impacts on the revenue cy- cle. Analyzing claims data, for example, allows an organization to track readmission rates hospital-wide to identify troubling variations. T is information could be used to pinpoint root causes and inspire physician performance improvements. And with claims data analysis tools, hospitals have the ability to model the fi nancial impacts of re-hospitalizations and continually make the necessary adjustments.
Preparation benefi ts patients, revenue In addition to the CMS plan to reduce pay- ments to organizations for disproportionately
high readmission rates, providers are being fur- ther incentivized to step up re-hospitalization prevention eff orts, given the prospects of an emerging delivery system driven by pay-for- performance reimbursement models. Granted, high readmission rates are not always – or at least easily – solved. But hospitals that don’t make the proper adjustments today
will face signifi cant revenue cycle challenges in the future. Hospitals can take a proactive ap- proach to reducing re-hospitalizations through an eff ective combination of medication recon- ciliation, utilization and disease management programs, and revenue cycle analytics. Many are already experiencing the cost and quality benefi ts of such measures.
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