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Home / News & IndustryManaged Care Insight and Analysis
Updated: March 29, 2011
Illinois Blues, Hospital Association Collaborate To Reduce Readmissions

Blue Cross and Blue Shield of Illinois (BCBSIL) and the Illinois Hospital Association (IHA) are joining forces to reduce Illinois hospital readmissions through a new quality initiative – Preventing Readmissions through Effective Partnerships (PREP).

The parties are collaborating with experts from the Division of Hospital Medicine at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine and the Society of Hospital Medicine.

PREP will help Illinois hospitals significantly reduce the rate of patient readmissions by 2014 through the following five key initiatives:

  • Redesigning hospital discharge processes;
  • Improving transitions of care;
  • Developing and improving palliative care programs;
  • Reducing readmissions from infections; and
  • Measuring reductions in readmissions using standardized metrics

BCBSIL expects to invest up to $1 million a year over the next four years to reduce preventable hospital readmissions.

"This partnership is an outstanding example of how the provider and payer communities can work together to transform health care in Illinois. PREP has great potential for both improving the quality of health care and reducing costs," said Maryjane A. Wurth, IHA president.

"We believe investing resources to improve transitions of care will have major payoffs in costs andquality," said Dr. Scott Sarran, the Blues CMO.

The Commonwealth Fund State Scorecard 2009 ranked Illinois 44th in the rate of Medicare 30-day readmissions as a percentage of admissions, with a rate of 20.3 percent, an increase from 19.6 percent in 2007. Nationally, the median is 17.5 percent.

So far, 201 Illinois hospitals have pledged to reduce readmissions by the end of 2013 with the goal of raising the state’s performance from the bottom quartile to an upper quartile.

Dr. Mark Williams, chief of the Division of Hospital Medicine at Northwestern, will be leading efforts to optimize the transition of care for hospitalized patients through mentored implementation.

"A critical component of PREP is patient education – assessing what a patient’s unique needs are before going home, then making sure they have the information they need to ensure a smooth transition," he said.

Research published in the April 2009 New England Journal of Medicine indicates that 1 in 5 hospitalized Medicare patients are readmitted to the hospital within one month of discharge, with the second hospitalization being more expensive than a comparable first admission.

In 2009, there were more than 50,000 readmissions to Illinois hospitals, with each patient spending, on average, five additional days in the hospital. Sarran points out that improvement of the Illinois readmission rate to the current national average has the potential to save or avoid costs of approximately $150 million dollars in the first year.

Addresses: Blue Cross and Blue Shield of Illinois, 300 East Randolph Street, Chicago, IL 60601-5099; (800) 654-7385, www.bcbsil.com. Illinois Hospital Association, 1151 East Warrenville Rd., P.O. Box 3015, Naperville, IL 60566; (630) 276-5400, www.ihatoday.org.


  This article was taken from:
The Executive Report on Managed Care

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