REDUCE PREVENTABLE READMISSIONS, LENGTH OF STAY AND MEDICARE SPEND PER BENEFICIARY
Q: Why is there such a huge focus on care transitions in healthcare today?
DT: The data is so compelling. Within 30 days of discharge, 2.6 million Medicare beneficiaries are re-hospitalized at a cost of $26 billion every year. In one study, only 14 percent of patients knew common side effects of their medications! That's got to change particularly since 20 percent of patients experience an adverse event within three weeks of hospital discharge. These represent huge risks for patient safety as well as reimbursement.
Q: What differentiates Studer Group's care transition offering?
DT: Hardwiring the tools and tactics in the Evidence-Based LeadershipSM framework builds a strong foundation for results in all areas, including care transitions. Because we know that patient ratings on the HCAHPS care transitions domain strongly correlates with the overall rating, coaches frequently focus on ways to drive higher ratings there.
Care transitions coaching goes further and deeper to assess and improve the safety and experience along the longitudinal continuum for the patient, including any handovers between shifts, changes in level of care and transition from the hospital to another care facility or home. The goal is to identify any existing gaps that may lead to failure along the transition of care continuum.
Q: What does a care transitions coaching plan look like?
DT: We typically do two assessments. One on the front-end and one by walking the gemba to identify gaps in systems or processes where failure may occur, risking harm to our patients. We develop a specific and focused coaching plan that responds directly to the organization's goals. Just as organizations often retain us for specific coaching on flow and throughput in emergency departments, many are looking for a holistic approach to care transitions.
Sometimes organizations are successfully using Studer Group tools, but they haven't been optimized yet for care transitions. There are dozens of ways this can make a dramatic difference.
Q: What’s the best way to learn more about coaching for care transitions?
DT: I'd recommend reading Studer Group's thought leadership on care transitions. There are a number of complimentary resources available, including those that focus on comprehensive care plans and managing bundled payments with care transition calls. Leaders who are interested in discussing their organization's specific opportunities and challenges in care transitions can reach me at Diana.Topjian@studergroup.com.