JMIR Publications

ABSTRACT

Background:

Readmission avoidance initiatives have been a priority for the Centers for Medicare & Medicaid Services for over a decade; however, interventions are often high-intensity, costly, and resource-intensive, and therefore, rarely scalable or sustainable. Large national payors are in a unique position to leverage data to identify members in real-time who are at high-risk of readmission to prioritize the scaled delivery of tailored behavior change techniques to provide an educational intervention to modify health behaviors.

Objective:

Readmission avoidance initiatives have been a priority for the Centers for Medicare & Medicaid Services for over a decade; however, interventions are often high-intensity, costly, and resource-intensive, and therefore, rarely scalable or sustainable. Large national payors are in a unique position to leverage data to identify members in real-time who are at high-risk of readmission to prioritize the scaled delivery of tailored behavior change techniques to provide an educational intervention to modify health behaviors.

Methods:

A quality improvement initiative was designed and implemented to provide an evidence-based outreach campaign using behavior change techniques to deliver multiple intervention functions, including education, enablement, and persuasion, to modify health behaviors related to planned or unplanned inpatient admissions. Outcomes including 30- and 90-day acute inpatient readmissions and ED visits were retrospectively evaluated from Medicare Advantage members enrolled in a large national health plan residing across the United States between May 2020 and July 2022. Leveraging utilization management data, rules-based logic identified members (N=368,393) with a planned acute inpatient procedure (i.e., pre-admission) or discharged from an acute hospital stay (i.e., post-discharge) within 15 days. Members were randomly assigned to a standard (N=141,223) or an enhanced (N=227,470) messaging group, whereby the standard group received usual outreach and the enhanced group received an educational intervention via a messaging campaign deployed through multiple low-intensity communication channels (e.g., text message, email, direct mail) in addition to standard outreach.

Results:

Members who received enhanced outreach had fewer relative 30-day acute inpatient readmissions (-4.1%, 95% CI: -5.5 to -2.7 %; P<.001) and ED visits (-3.4%, 95% CI: -5.0 to -1.7%; P<.001) compared to members receiving standard outreach. Similarly, these findings persisted for relative 90-day outcomes such that members receiving enhanced outreach experienced fewer acute inpatient readmissions (-5.4%, 95% CI: -6.5 to -4.3%; P<.001) and ED visits (-3.8%, 95% CI: -5.0 to -2.5%; P<.001) compared to members receiving standard outreach messaging.

Conclusions:

Behavior change techniques deployed via educational interventions as low-intensity multi-channel outreach is an effective strategy to reduce avoidable 30- and 90-day inpatient readmissions and ED visits in recently discharged Medicare Advantage members (primarily >65 years).