ACO roundup: Mount Sinai teams up with community health workers to cut readmissions

  • How many ED visits are avoidable? About 3.3%, study finds. About 3 percent of ED visits are "avoidable"—and a significant number of those avoidable visits involve health issues that the ED "is not fully equipped to treat," according to study published in the International Journal for Quality in Health Care. For the study, researchers assessed 424 million ED visits and found 115,081 qualified as avoidable, which the researchers defined "as discharged ED visits not requiring any diagnostic tests, procedures, or medications." According to the researchers, the most common reasons for avoidable visits were toothache, back pain, headaches, mental health concerns, and throat soreness. The researchers said the findings suggest a need for "increased access to mental health and dental care," which "have traditionally been treated as separate categories of health care." They concluded, "Our findings serve as a start to addressing gaps in the U.S. health care system, rather than penalizing patients for lack of access, and may be a better step to decreasing 'avoidable' ED visits."

  • Majority of physicians say overtreatment is common, study finds. Nearly 65 percent of physicians believe that at least 15 to 30 percent of medical care is unnecessary, according to a study published in PLOS One. For the study, researchers in 2014 surveyed 2,106 physicians who at the time were members of the American Medical Association. According to respondents, the top three reasons for overutilization were fear of malpractice, cited by 84.7 percent of respondents; patient pressure or requests, cited by 59 percent of respondents; and difficulty accessing patients' medical records, cited by 38.2 percent of providers. To curb overutilization, the researchers recommended boosting doctors' access to outside health records, increasing practice guidelines, and training physicians on appropriate criteria. 

  • Mount Sinai teams up with community health workers to curb readmissions. Mount Sinai Health System's St. Luke's Hospital has partnered with not-for-profit City Health Works to launched a one-year pilot program aimed at reducing the readmission rate among Medicaid beneficiaries with congestive heart failure by teaching them how to manage their illness at home. The program, which launched in July, provides 100 Medicaid beneficiaries in Harlem, the Upper West Side, and Washington Heights with individualized health coaching from community health care workers trained by nurse specialists on St. Luke's cardiac-care team. The community health care workers will educate patients on their condition, including health issues and possible warning signs of heart failure. Mount Sinai officials said based on the pilot programs results, they plan to extend the program system-wide.

From Advisory Board:

  • How to close the housing gap through strategic partnerships. Hospitalized patients with unstable housing often have longer lengths of stay, poorer health outcomes, and preventable costs. Join us on Tuesday, Sept. 19, to find out how innovative providers are forming partnerships to provide supportive housing options for high-risk patients.

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  • Is your Medicare risk strategy MACRA-ready? While the GOP's health reform effort continues to evolve, Medicare payment reform has quietly marched on with bipartisan support. And with MACRA well underway, the new administration has shown no signs of reversing course. As a result, hospital and health system leaders need to develop an intentional Medicare risk strategy. Check out our new research report to learn how to navigate the Medicare ACO programs, expand into the Medicare Advantage market, and ensure the longevity of your Medicare risk strategy by actively cultivating contracts over time.

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