Jody Reduced Emergency Department Costs and Hospital Readmissions*

February 07, 2017
Heather Lavoie, Chief Strategy Officer, Geneia


It’s been nearly a year since I wrote about Jody and her success using Geneia’s advanced analytics solutions. As you may recall, she works for the chief medical officer of a health system, and she was charged with creating initiatives to help her organization quickly recoup its investment in analytics.

She did just that.

She used Geneia’s Theon® analytics platform to identify low-hanging fruit - a severe leakage problem – and the solution - a comprehensive physician and patient education program, a new incentive for in-network referrals, and the addition of in-network gastroenterologists.

The results: Jody reduced out-of-network referrals by five percent in the first year.

A year later, value-based care is advancing at Jody’s health system, and the Theon® solution is helping to improve the system’s performance with its risk-based contracts.

In year two, Jody used the Theon® platform to focus on lowering the per-member-per-month (PMPM) costs. Like many health systems, significant pain points – also known as opportunities – for addressing costs and quality were:

  • Emergency department utilization and cost
  • Hospital admissions and readmissions

The Theon® platform dashboard readily and easily provides health system administrators like Jody with a wealth of important information, including the number of patients currently admitted in the hospital, the number discharged in the last 10 days, and the readmit percentage (see Population Measures in the Theon® platform screenshot below). Opt 4 Jody Update Blog Chart

Reducing Emergency Department Utilization & Costs

Upon closer review of acute care utilization, Jody realized:

  • Emergency department visits were significantly higher than the health system’s peer group; approximately 380 emergency department visits per 1,000 patients compared to 260 per 1,000 for the peer group.
  • Utilization of urgent care was significantly less than the peer group; approximately 90 urgent care visits per 1,000 patients compared to 155 per 1,000.

Armed with the knowledge that shifting appropriate utilization from the emergency department to urgent or primary care would result in financial savings, Jody leveraged the Theon® platform to pinpoint the opportunities and saved nearly $143,000 on emergency department costs alone.  

Here’s how:

  • Jody used the platform’s drill-down capabilities to identify the providers attributed to the patients receiving services through the emergency department, and any trends.
  • She learned one provider group had a very high PMPM cost associated with emergency department visits and 40 percent of emergency department costs were attributed to two provider groups not affiliated with the health system. This level of network leakage was driving up costs for Jody’s health system.
  • Jody then outreached to the providers and patients and provided targeted educational information to redirect services to the most appropriate in-network sites of care.  

Reducing Admissions & Readmissions

The population measures in the Theon® dashboard gave Jody immediate access to populations in the patient panel that:

  • Had increasing admission and readmission risk,
  • Were currently admitted to the hospital,
  • Had been discharged in the last 10 days, and
  • Were producing the highest costs. 

The population measures showed Jody’s health system had a readmission rate of 7.67 percent. To mitigate the risk for admissions:

  • Jody investigated patients who had not been seen by a PCP in the past 12 months, yet had a chronic condition, and
  • She drilled into exactly which high-cost chronic conditions led to readmission among her population of patients. Having this information allowed her to impact admissions and readmissions by ensuring engagement with high-risk populations.

The Theon® solution easily showed Jody the Top 10 Conditions Leading to Readmission. For her patient population, the leading cause of readmissions was heart failure. This knowledge enabled Jody and her colleagues to launch a number of new initiatives, including provider and patient outreach and a remote patient monitoring program to support earlier response to clinical deterioration, which led to a reduction in hospital admissions.

In the words of Jody,

“I’m not sure my health system could have achieved our cost and quality goals and succeeded in our value-based contracts without the Theon® analytics and insights platform. Given our success in years 1 and 2, I am confident the Theon® platform will support our achievement of even more aggressive metrics in the third year of our risk-based contracts.”

*Jody’s experience is an illustrative example based upon the actual experience of a Geneia client. This information is provided for illustrative purposes only. Jody is fictional and not intended to represent any specific person. Any direct similarities to any real person are purely coincidental and unintentional.