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Reading Hospital Saved $1 Million in Emergency Department Costs for Medicare and Medicaid Patients

By Reading Hospital Tower Health

Jul 13, 2020

A new case study released from Reading Hospital and Healthify shows the positive real-world impact Reading Hospital has made in the community by identifying and addressing the health-related needs of local Medicare and Medicaid beneficiaries. Reading Hospital formed the Community Connection Project (CCP) consortium to align community and clinical linkages between the hospital and Berks County organizations such as New Journey Community Outreach, Berks Encore, and Centro Hispano. Healthify’s platform provides the means for the CCP consortium to screen and refer patients. In just one year, Reading Hospital and the CCP consortium reduced the cost of unnecessary emergency department visits by $1 million for Medicare and Medicaid patients.

The Centers for Medicare and Medicaid Services (CMS) awarded Reading Hospital a grant to implement an Accountable Health Communities model. The goal of this program is to assess whether identifying and addressing the health-related social needs of local Medicare and Medicaid beneficiaries would impact their total healthcare costs and inpatient and outpatient healthcare utilization.

“Social determinants of health are defined as conditions and health outcomes impacted by the places people live, learn, work, and play,” said William M. Jennings, President and CEO of Reading Hospital. “Reading Hospital has made it a priority to address these factors in our community, and the CMS funding helped us provide the infrastructure necessary to be successful.”

The purpose of the CCP is to connect positively screened patients with local organizations that can help those patients receive the assistance they need to live a healthy life, ultimately reducing medical costs. The case study highlights one patient with a history of substance use who suffered from COPD (chronic obstructive pulmonary disease) and Type 2 Diabetes. This individual had nine hospital encounters between 2018 and 2019 with an estimated cost of $82,000. The patient was screened at an ED visit in 2018 and reported being food-insecure and lacked both adequate housing and transportation. Through the CCP intervention, the patient received assistance from a community navigator which included direct referrals to organizations within the consortium. When the patient was rescreened on October 1, 2019, the patient reported having access to transportation, a reliable source of food, and a reasonable place to live. In addition, there was a decline in ED visits since the initial screening – credited to the navigator’s assistance, the CCP consortium, and timely intervention. 

“We were looking for a way not just to identify social determinants of health, but also to connect our patients to the right resources,” said Desha Dickson, Associate Vice President for Community Wellness at Reading Hospital. “Having a consortium that meets frequently allows us to engage with one another in different ways, discuss hot topics, and generate solutions.”

The initial findings suggest that, if sustained over time, the CCP consortium will continue to make a significant positive impact on improving the quality of life for many Berks residents while also reducing the use and costs of healthcare resources. 

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