Report: CMS Community Initiatives Could Reduce Health Costs

A pilot program introduced by the U.S. Centers for Medicare and Medicaid Services to boost quality of care for seniors by developing community approaches to health problems could play a key role in bringing down costs, according to a new report in the Journal of the American Medical Association.

Quality Improvement Organizations, or QIOs, are private groups in each state and U.S. territory that contract with the government for three years to improve health services for Medicare patients. They are comprised of health care providers and other medical professionals, social services workers and other community members.

In Tuesday’s report, researchers found a 5.7 percent average reduction in 30-day hospital readmissions across 14 economically and demographically diverse communities over a two-year period. The number of patients admitted to the hospital within 30 days of a prior admission is one possible measure of efficiency, since the cost and burden of readmission can be preventable.

One in five Medicare patients returns to the hospital within 30 days of being discharged. The problem is an expensive one: in 2004, these readmissions cost Medicare $17.4 billion dollars.

The interventions used by the 14 community groups varied, but they included efforts to improve medication management and transitional care for patients leaving the hospital. Author Dr. Jane Brock, a coordinator at the Colorado Foundation for Medical Care’s Medicare quality improvement program, said that providing social services that can monitor and track patient treatment was one key to the project’s success.

Author Dr. Joanne Lynn, a director at the Altarum Institute, said the average community with 50,000 Medicare beneficiaries could have saved $4 million on readmissions alone if they used the various interventions that the QIOs practiced within their communities.

“Even those with low rates of readmissions had plenty [of hospitalizations] to be avoided,”Lynn said.

The report also included the results from patient satisfaction surveys, emergency room visits and mortality rates to screen for negative changes from the interventions. They found that other health factors remained stable or improved with the reduction of readmissions.

Brock said the successful outcomes will help expand the idea of community based interventions.

“My hope is there is great recognition that this is the best purpose of the QIOs: We’re not competitors, we’re not regulatory, they really bring people together,” she said.

This article was produced by Kaiser Health News with support from The SCAN Foundation.