Preventing Avoidable Readmissions
Every Day Matters, as we work together to prevent avoidable readmissions.
One of AmeriHealth Caritas Pennsylvania's goals this year is to develop targeted strategies to reduce the number of avoidable readmissions. Often, our members may feel isolated after they're discharged and confused about their medications. They may not know how to follow the hospital's instructions.
AmeriHealth Caritas Pennsylvania is committed to a collaborative approach to follow-up care—one that helps members overcome barriers so they can get better faster and avoid readmission. For example, we're working to:
- Proactively identify members with chronic conditions who are likely to be hospitalized
- Partner with hospitals, providers, and clinical staff to get ahead of the issues that affect vulnerable members
We're here to help
AmeriHealth Caritas Pennsylvania has developed a series of tools and programs so providers can identify these patients and work with us to reduce the number of avoidable readmissions.
1. Use Admit and Discharge Reports available through NaviNet.
Visit https://navinet.navimedix.com daily for customized reports that provide snapshots of patients who have been admitted to—or discharged from—the hospital.
- Go to Report Inquiry on the left-hand menu.
- Choose Clinical Reports and select either "Admit" or "Discharge Report" from the drop-down menu.
- Simply enter the "to" and "from" dates to generate your report.
2. See AmeriHealth Caritas Pennsylvania patients between 7 to 14 days after discharge.
- This will help with continuity of care and identify potential problems early for prompt and effective treatment.
3. We also offer a report that identifies members in your practice who have chronic conditions.
Members listed in this report were either hospitalized in 2013, or their medical conditions increase the likelihood of future hospitalizations.
- We can email or deliver this data to you. Contact your Provider Account Executive for details.
Contact an Account Executive
- We can schedule in-person meetings help you create plans that help manage these patients through established care management and member outreach and education programs.
4. Participate in the Let Us Know Program.
We're committed to helping you improve communication and patient outcomes during transitions in care.
Contact the AmeriHealth Caritas Pennsylvania Complex Care Management Team at 1-877-693-8271, option 2, for assistance with outreach for non-compliant members. Examples include failing to keep post-discharge appointments or not filling prescribed medications.
Tell your plan account executive about your needs. We value your feedback on how to work together to prevent avoidable hospital readmissions. Contact an Account Executive
Member Education and Outreach
AmeriHealth Caritas Pennsylvania has developed a multi-faceted member education and outreach program to help prevent avoidable readmissions. Every day matters during recovery.
This program stresses the importance of:
- Making, keeping, and preparing for a follow-up appointment with a member's primary care physician or specialist within 7 to 14 days after discharge
- Bringing medications and discharge papers to the follow-up visit
- Filling and following all prescriptions instructions
- Taking recovery notes and writing down questions to ask the physician
Because every day does matter, AmeriHealth Caritas Pennsylvania's clinical and member outreach staff will:
- Initiate "welcome home" phone calls to members in our targeted group
- Send personalized letters to targeted members being discharged from the hospital
- Provide contact information for Member Services, Rapid Response, Outreach and the 24- Hour Nurse Call Line
- Help to coordinate local transportation to assist members in keeping all of their appointments
- Visit certain high-risk members in their homes if they cannot be reached by phone
5. Provide members with our guide for care outside of the hospital.