Creating the tool is not enough: Implementing and evaluating the Hospital Guide to Reducing Medicaid Readmissions

High rates of avoidable Medicaid readmissions are a particular problem in safety net hospitals, which serve our nation’s most vulnerable, low-income populations. Hospital readmissions are frequent, costly, and can indicate poor quality of care.

To date, most policies and best practice research have focused on reducing readmissions among the Medicare population, but recent studies indicate that non-maternal adult Medicaid readmission rates can be just as high. To reduce readmissions among the Medicaid patients, it is necessary to address this population’s distinct risk factors, including their particular clinical and socioeconomic challenges. As Dr. Richard Kronick, Director of the Agency for Healthcare Research and Quality (AHRQ) points out in his recent blog:

“If we are going to have an impact on Medicaid readmissions, … we must understand the specific needs of this critical population and apply measures and resources accordingly.”

In response to this clear need for guidance, AHRQ contracted with JSI to develop a Guide that identifies evidence-based strategies to reduce readmissions among the Medicaid population. Hospitals can adapt or expand these strategies and tools to address the transitional care needs of the adult Medicaid population. Among the tools, there is an at-a-glance listing of readmission risk factors, as well as data analysis tools to understand local readmission epidemiology, and a checklist for the CMS Discharge Planning Conditions of Participation.

As the first and only federal tool of its kind, we believe this Guide is a major milestone to helping hospital readmissions teams understand what is especially needed to reduce Medicaid readmissions. As a follow-up project, AHRQ has contracted with JSI to disseminate, implement, and evaluate the Guide in a set of hospitals across the U.S., in order to improve the Guide and look for early impact on hospital processes and clinical outcomes. In advancing this work, we continue to pursue better patient care and health for our nation’s vulnerable, low-income populations.

Learn more: Hospital Guide to Reducing Medicaid Readmissions

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