New Mexico QIO Focuses on Care Transitions to Reduce Readmissions

HealthInsight New Mexico, the Medicare Quality Improvement Organization (QIO) for the state, is working with health care providers in four communities to reduce avoidable hospital readmissions by improving transitions of care, which occur when patients move from one setting of care to another, such as from the hospital to home.

Across the U.S., Medicare beneficiaries experience more than 13 million transitions of care every year, and one in five beneficiaries is readmitted to the hospital within 30 days of being discharged, according to the Centers for Medicare & Medicaid Services (CMS). Readmissions for Medicare patients cost $26 billion annually, with $17 billion paying for potentially avoidable rehospitalizations.

Since August 2011, HealthInsight New Mexico has focused on addressing patients’ changing needs through system-level process improvements with providers, including:

  • Instituting medication reconciliation programs
  • Adopting information technology solutions
  • Enhancing service options such as palliative care, that can decrease readmissions because patients have alternatives to hospitalization
  • Ensuring comprehensive patient education about their health conditions as well as clear understanding of their discharge instructions and follow-up care
  • Redesigning discharge protocols and creating new protocols for transferring patients

HealthInsight New Mexico also helps providers explore system changes, such as disease management programs, that reduce readmissions for patients with specific diseases or conditions.

From the fourth quarter of 2010 to the second quarter of 2013, the readmissions rate per 1,000 Medicare beneficiaries improved from 7.3 percent to 6.2 percent in the four communities in which HealthInsight New Mexico worked with hospitals on this initiative, representing a relative improvement of 14.9 percent. New Mexico saw a reduction in readmissions from 9.7 percent to 8.2 percent across all hospitals in the state over the same timeframe. One hospital that worked with HealthInsight New Mexico dropped its readmissions rates from 17.5 percent to 11.1 percent over the measurement period, representing a relative improvement of 37 percent.

HealthInsight New Mexico continues to work with hospitals and other health care providers across the state in an ongoing effort to improve care and reduce readmissions.