BlueChoice HealthPlan Program to Reduce Hospital Readmissions Marks 10th Anniversary, Expands to Serve More Members
May 9, 2012
COLUMBIA, SC – May 9, 2012 – A BlueChoice® HealthPlan of SouthCarolina program that has reduced expensive hospital readmissions andimproved health outcomes for seriously ill members for the past decadehas been expanded to serve those facing joint replacementsurgeries. Nurses with the health plan’s Care CallsSM program will nowcontact all members planning to undergo hip or knee replacementsurgeries. The nurses will identify issues that could complicate amember’s hospital stay, rehabilitation or full recovery – such asobesity, diabetes, or heart or lung disease. Then they will provideeducation or assistance if necessary. Nurses also will explain what toexpect after surgery, and will follow up with members after they leavethe hospital.
Care Calls nurses work collaboratively with health carefacilities and physicians to reinforce the doctor’s plan of care beforeand after the joint replacement procedure, said Rolanda Aiken,BlueChoice HealthPlan’s vice president of health services.
When the member is discharged following the surgery, we try toensure that the member understands the physician’s instructions, has allprescribed medications as well as medical equipment and supplies, andthat the member has made appointments for follow-up care.
BlueChoice HealthPlan launched Care Calls in 2002 as a serviceenhancement for seriously ill members and their employers. Until therecent addition of joint replacement surgeries, the program focused oncontacting members immediately following discharge for certainhospitalizations. These include an extended or complicated hospital stay- ones involving members with chronic diseases or members dischargedwith home health or durable medical equipment – to ensure neededservices are in place.
Over the past 10 years, Care Calls nurses have successfully contactedmore than 6,000 members, and those interactions have helped preventpotential complications or delays in care more than 1,100 times.
During the past year, more than 900 members were contacted. Those havingcontact with Care Calls were 6 percent less likely to be readmitted tothe hospital within 14 days of discharge than those who were notreached. BlueChoice HealthPlan attempts to contact every member whomeets criteria for Care Calls, but contact is not always successful dueto incorrect telephone numbers and other factors.
With an average readmission costing almost $33,000, we estimate 10-yearsavings for the program at approximately $4 million, Aiken said. Moreimportantly, members who avoid readmissions recover more quickly andhave a better quality of life.
BlueChoice HealthPlan created Care Calls after documenting that somepatients do not fully understand their physicians’ dischargeinstructions. Most patient discharge education is provided immediatelybefore a patient leaves the hospital, an often stressful time when manypatients and their families are easily distracted.
About BlueChoice HealthPlan
Headquartered in Columbia, S.C., BlueChoice HealthPlan of SouthCarolina is an independent licensee of the Blue Cross and Blue ShieldAssociation. BlueChoice HealthPlan has an A+ rating from A.M. Best andan Excellent accreditation status, the highest level awarded, from theNational Committee for Quality Assurance. BlueChoice HealthPlan offersfour categories of group health plans, as well as individual plans foradults, family plans, and a South Carolina Medicaid product.
