Systematic overutilization of hospital services is not only a drain on provider and patient finances and a misappropriation of resources, it can also lead to poorer health outcomes. In an effort to reduce overutilization, Jamaica Hospital Medical Center (JHMC) used the New York State Department of Health Medicaid Accelerated eXchange (MAX) program to develop a strategic plan.
Once high utilizers are identified, senior clinical leadership and post-discharge staff connect patients with community-based care and support. JHMC created visible, real-time alerts in the electronic medical record and senior clinical leaders perform aggressive case review. When a patient comes to the emergency department for a potential fourth admission within a 12-month period, a best practice advisory occurs for all care providers, prompting the attending physician to consult with the inpatient service attending physician before admitting the patient. Dedicated patient care facilitators enforce and ensure continuation and adherence to the individualized care plan designed by the medical team.
From these efforts, JHMC reduced 90-day pre/post hospital utilization by 72 percent. A root cause analysis conference is now conducted within one business day of a patient’s admission, allowing the hospital to be “self-critical” on behalf of the patient.
For more information, contact Angelo Canedo, PhD, Vice President, Jamaica Hospital Medical Center at (718) 206-6595 or at firstname.lastname@example.org.