Top Takeaways from COPD Program that Reduced Readmissions, Costs

December 4, 2018

The Integrated COPD Care Initiative in Alabama aims to reduce hospital readmission rates and acute to post-acute care-associated costs in COPD patients. Here are the results so far and insight from one of the program’s leaders.

Reducing readmissions has become increasingly important for all stakeholders in the age of value-based care.

Already in 2018, nearly one in six Medicare patients returned to the hospital within one month of discharge, costing the healthcare industry an estimated $25 billion. This expected cost will increase as the number of people with COPD and related chronic conditions rises.

There are more than 251 million people with COPD worldwide and it is the third leading cause of death globally. An estimated $50 billion annual direct and indirect costs of care are associated with COPD annually in the U.S. The average cost per COPD patient readmission in the U.S. is between $9,000 and $12,000. Last year alone, CMS fined more than 2,500 hospitals for excessive 30-day readmission rates, totaling more than $564 million.

“To address these costly challenges, healthcare stakeholders must seek more effective solutions to monitor, diagnose, treat, and measure patient outcomes,” says Eli Diacopoulos, Respiratory Care, Business Leader at Philips. “Reducing readmissions requires coordination and collaboration with organizations from acute to post-acute to home care. With integrated COPD care pathways and connected care technology, providers have the ability to greatly improve the healthcare experience from hospital to home.”

In Alabama, a group of institutions collaborated with Philips on an initiative-the Integrated COPD Care Initiative-to reduce hospital readmission rates and acute to post-acute care-associated costs in COPD patients, as well as to identify gaps in care, while improving outcomes and healthcare costs for patients with COPD.

Researchers found that a strategically defined integrated care pathway can play an essential role in creating positive results for COPD patients, such as significant reductions in costs and readmission rates.

According to Diacopoulos, throughout the deployment of evidence-based care strategies, pathways and processes, the initiative found the following results after only three fiscal quarters of implementation:

  • 80% reductions in acute 30-day COPD readmissions for cost reductions of $1.3 million. 
  • 70% reduction in all-cause diagnoses readmissions equating to savings of $4.4 million.

Diacopoulos spoke with Managed Healthcare Executive (MHE) specifically about the initiative, what outcomes are being measured, and how healthcare executives can start their own COPD program.

MHE: What is The Integrated COPD Care Initiative?

Diacopoulos: The Integrated COPD Care Initiative was a pilot program in the state of Alabama, which aimed at reducing hospital readmission rates and acute to post-acute care associated costs in patients with COPD. Philips worked with IncreMedical, a developer of healthcare management solutions, to implement integrated care pathways that monitor patients seamlessly across the care continuum from hospital to home. Through the deployment of these evidence-based care strategies, pathways and processes, hospitals achieved impressive 30-day readmission and substantial cost reductions within nine months of implementation. This initiative enabled Philips and IncreMedical to identify ways to track, measure, and improve patient outcomes working with the initiative’s partners to place the patient in the center of care, while also reducing readmissions and highlighting the value of integrated pathway solutions.

MHE: Who was involved in the effort?

Diacopoulos: The initiative was a collaborative effort involving a Philips’ durable medical equipment provider, customer hospitals, and IncreMedical and Philips teams to implement an integrated, cross-continuum COPD care program utilizing customized care pathways to identify gaps in care and improve patient outcomes. This program ensured patients were appropriately screened, prescribed proper therapy, and set-up for success when transitioned from acute to post-acute/home settings. Additionally, the importance of tracking and measuring data points was a critical part of this initiative and produced continuous improvement and better patient outcomes.

MHE: What fueled the initiative?

Diacopoulos: The objective of the Integrated COPD Care Initiative was ambitious and aligned with today’s value-based care approach: provide real-world insight into longitudinal patient care, while reducing avoidable readmissions for patients with COPD. The need to improve outcomes and control healthcare costs in patients with COPD has never been greater. The number of people with COPD continues to grow worldwide, with tens of millions more remaining undiagnosed. As these numbers continue to multiply, so do the challenges of caring for them. For homecare providers and health systems alike, managing patient care within home environments has become a priority that presents a number of economic, operational and clinical challenges. Despite advances in care, too many patients with COPD continue to suffer through repeated hospital readmissions, increasing the burden on the patient as well as the provider. In an effort to reduce the staggering number of readmissions, the Centers for Medicare & Medicaid Services (CMS) began penalizing hospitals in 2015 for 30-day readmissions. This all fueled the request and drove the objectives of the COPD Initiative.

As a result of the request coming from our stakeholder partners, Philips and IncreMedical developed acute to post-acute care pathways that focused first on early identification, and then on placing patients on the right therapies at the right time in the right venue. As part of our innovative program, we focused on the ability to measure and prove outcomes throughout the process.

As the third leading cause of death worldwide, COPD is a critical, global issue-and the problem is only expected to get worse as the aging population grows. More than 251 million people suffer from COPD worldwide, but many are not always screened correctly and 45% are not treated with evidence-based guidelines. This means that the time for integrated, coordinated care is now.

MHE: What outcomes are being measured?

Diacopoulos: The Integrated COPD Care Initiative focused on achieving four key outcomes:

  • Reducing avoidable readmissions (COPD and related all-cause readmissions),
  • Improving the data collection and analytics of care from hospital to home,
  • Improving patient engagement in the post-acute setting, especially the home, and
  • Improving outcomes.

MHE: What is included in ‘total costs of care’?  Is anything excluded?

Diacopoulos: ‘Total cost of care’ includes a number of variables, including: hospitalizations and associated costs, emergency department visits, pharmaceuticals, respiratory therapies, physician visits, home healthcare, and myriad additional post-acute costs. While different provider organizations focus on their respective services, managing total costs require consideration of the full continuum. Today, all provider organizations are seeing a significant shift from fee-for-service to value-based, pay-for-performance models, and thus the idea of finding ways to lower the total cost of care while maintaining quality is more important than ever.

MHE: What are the future plans for the Integrated COPD Initiative?

Diacopoulos: Philips is committed to development and continued improvement of solutions that improve outcomes and facilitate proper care for patients with COPD and related chronic conditions. Philips and IncreMedical plan to continue working with hospitals, payers, and home medical equipment providers across the country.

MHE: What advice do you have for healthcare execs looking to implement a similar program?

Diacopoulos: First, you must have a champion to lead and facilitate change within the hospital. Second, leadership must stay engaged and guide the teams throughout the initiative. After you have that leadership in place, you need to understand your why and what, and identify the hospitalization, readmission rates and associated costs for your patients with COPD. That drives identification of gaps in care, or missing data that informs the infrastructure and partners you need for visibility into the care of those patients across all care venues. Not all healthcare organizations integrate care at every touchpoint, so finding the right technologies and partners are vital to the success of any program.