How TriHealth Reduced Readmissions by 28% with Post-Acute Care Technology

Hospital readmissions from skilled nursing facilities (SNFs) have long posed a challenge for healthcare organizations, costing both lives and dollars. In Ohio, TriHealth, a renowned four-hospital nonprofit ACO, was facing a daunting 25% readmission rate, well above the national average. Outdated methods based on fax and phone calls left care managers with delayed, incomplete data. However, by adopting an innovative post-acute care collaboration system via PointClickCare’s PAC Management platform, TriHealth transformed its approach to care coordination, reducing readmissions by 28% and saving an estimated $8 million annually.

The Challenge: Gaps in Post-Acute Care Coordination

Before implementing a robust technology solution, TriHealth grappled with several critical issues:

• Delayed Communication: Reliance on faxes and phone calls resulted in slow data transmission, delaying timely interventions.
• Lack of Real-Time Data: Care teams had limited visibility into a patient’s condition post-discharge, contributing to a high 25% SNF readmission rate.
• Manual Data Entry: Administrative tasks consumed valuable time that could be better spent on collaborative care efforts.

Overall, these operational bottlenecks compromised the ability of healthcare providers to act swiftly, leaving patients vulnerable to complications and readmissions. For further context regarding national challenges, consider reviewing the readmission rate study and the AHRQ statistical brief.

The Solution: PAC Management Platform by PointClickCare

Recognizing these issues, TriHealth sought a solution that could modernize and streamline post-acute care coordination. The answer lay in a state-of-the-art, automated post-acute care management platform with the following key features:

EHR Integration

The platform was integrated seamlessly with TriHealth’s Epic electronic health record (EHR) system, enabling comprehensive patient data exchange between the hospital and SNFs. This integration provided:

• Real-Time Data: Immediate updates on patient status and clinical notes.
• Comprehensive Dashboards: A unified view of a patient’s history, current condition, and care plans.

Predictive Analytics with Machine Learning

The technology leveraged a machine learning algorithm to predict readmission risk. For a deeper dive into the benefits of machine learning in healthcare, check out this insightful video from Healthcare IT News. The platform’s predictive capabilities allowed care managers to:

• Quickly identify high-risk patients.
• Prioritize care interventions before deterioration occurred.
• Optimize allocation of clinical resources.

Automated Alerts and Streamlined Communication

By automating many of the manual tasks previously handled via phone and fax, the platform ensured that:

• Care managers received actionable alerts directly within their workflow.
• There was a significant reduction in non-clinical administrative burdens.
• Communication between hospital teams and SNFs was more efficient and reliable.

Key Results & Quantifiable Benefits

With the implementation of the PAC Management platform, TriHealth witnessed remarkable improvements:

• 28% Reduction in Readmissions: The rate dropped from 25% to 18%, demonstrating the platform’s efficacy in mitigating rehospitalizations.
• Shorter SNF Stays: Average lengths of stay were reduced from 25 days to 18 days, enhancing patient throughput and resource allocation.
• $8 Million in Annual Savings: The financial benefits of reduced readmissions and shorter hospital stays were substantial.

Additional real-world benefits included improved workflow efficiency for care managers and enhanced satisfaction among patients and their families. For more on these benefits, see the Healthcare IT News feature on post-acute care management.

Lessons for Healthcare Administrators and ACO Leaders

TriHealth’s experience offers several key takeaways for other healthcare organizations:

• Embrace Technology: The integration of EHR systems and automated platforms is critical to reducing readmissions.
• Invest in Predictive Analytics: Machine learning algorithms can identify at-risk patients much earlier, allowing for proactive care management.
• Streamline Communication: Eliminating manual, repetitive tasks helps care managers focus on patient-centered activities rather than paperwork.
• Prioritize Real-Time Data: Immediate access to patient updates can transform clinical decisions and outcomes.

Bridging the Gap: A Call to Action

The healthcare industry is evolving rapidly, and the case of TriHealth is a stellar example of how technology can drive better clinical outcomes and significant cost savings. For hospitals and ACOs still relying on archaic systems, adopting a modern post-acute care collaboration system like PointClickCare’s PAC Management platform is no longer optional—it’s essential.

Are you ready to reduce readmissions, shorten SNF stays, and achieve substantial annual savings? Learn more about PAC Management and request a demo to see how your organization can transform patient care. You can also explore insights on population healthcare management boosted by AI to further enhance your clinical strategy.

In conclusion, TriHealth’s journey toward improved care coordination stands as a powerful testament to the impact of leveraging real-time EHR data, automated analytics, and seamless communication in the realm of post-acute care. With healthcare challenges today more complex than ever, the integration of technology into care management is vital for sustained success and enhanced patient outcomes.

Contact us today to discover how these innovations can be tailored to your facility and drive the change needed for better healthcare delivery.