Sun Health, CMS, Population Health and Jennifer Drago

by Fred Goldstein

PopHealth Week will be featuring Jennifer Drago EVP of Population Health at Sun Health. This week’s show will focus on some of the innovative programs that Sun Health offers in the seniors market including their Care Transitions Program  which has a CMS Community-based Care Transitions Program (CCTP) contract. CMS just  Community-based Care Transitions Programrenewed the Sun Health CCTP contract and increased the number of patients to be managed.

The CCTP  “tests models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries.”  There are currently 72 sites participating in the CCTP pilot.

Per CMS:

  • Approximately 2.6 million seniors, or 1 in 5 are readmitted within 30 days
  • The cost of these readmissions is over $26 billion per year
  • The goal is to reduce readmission 20% per year
  • The program is to run for 5 years
  • The budget was estimated at $300 million over 5 years

To date 29 of the total 101 CCTP-funded sites have withdrawn or been ended.

The CMS First Annual Report stated that of the 48 programs started in 2012 only four programs made statistically significant gains in reducing the ratio of readmissions to discharges from the participating hospitals.

PopHealthWeek-logo-TWTTR-sqBut there is more to this story.

As with other CMS programs there are some concerns regarding the study methodology. The argument against the current methodology, which measures re-admissions within 30 days as a percent of discharges may penalize hospitals, or communities that have worked to reduce hospital discharges in total. Because of the reduction in discharges, these initiatives may not show a reduction in 30 day readmits as a percent of discharges but would better reflect this changes by looking at a population based measure of re-admissions.

Some reference posts on the program are noted below:

  • http://www.medicaringcommunities.org/medicaring-blog-cms-cctp-metrics-have-seious-flaws/
  • http://medicaring.org/2014/12/16/protecting-hospitals/
  • http://www.n4a.org/blog_home.asp?display=16

Join us as we discuss Sun Health and their innovative approach to Senior Health, Care Transitions and the CCTP program.

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