As healthcare costs continue to rise, employers and benefits managers are increasingly prioritizing strategies to reduce employee inpatient readmissions. Beyond the financial burden, readmissions disrupt productivity, impact workforce morale, and highlight potential gaps in care coordination. The key to mitigating these challenges lies in selecting the right care management partner—one that offers comprehensive solutions to enhance care quality and lower readmission rates.

The Readmissions Challenge

Every hospital readmission represents a failure in the healthcare continuum—whether due to inadequate pre-procedure preparation, lack of post-discharge support, or poor coordination between healthcare teams. Employers who invest in proactive care management strategies can significantly improve member outcomes while reducing healthcare expenditures.

A recent survey by Conifer Health Solutions revealed that 34% of HR leaders consider reducing employee inpatient readmissions a high priority in their benefits strategy. However, 42% of HR leaders are unsure whether their utilization management (UM) and care management (CM) vendors effectively communicate. This gap underscores the need for a well-integrated care management approach.

Three Pillars of Readmission Reduction

A successful care management strategy hinges on three critical components:

1. Pre-Procedure Preparation

Proper planning before a medical procedure is essential in preventing complications that lead to readmissions. A high-quality care management partner should provide:

• Detailed health assessments to identify underlying conditions that could impact recovery.
• Member education to ensure members understand their procedures, recovery timelines, and post-discharge care.
• Support addressing social determinants of health like transportation and access to care resources.
• Medication counseling to prevent drug interactions and ensure adherence to prescribed regimens.

By offering robust pre-procedure preparation, a care management partner helps employees navigate the healthcare system with confidence, reducing the risk of complications and repeat hospital visits.

2. Post-Discharge Follow-Up and Transitions of Care

The immediate post-discharge period is when people are most vulnerable to readmission. A dedicated care management team can ensure:

• Timely follow-ups with primary care providers and specialists.
• Medication reconciliation and adherence support to prevent errors and enhance completion of a medication schedule.
• Coordination with outpatient providers to maintain continuity of care.
• Referrals to support services, including home healthcare and rehabilitation.
• Member education on self-management, empowering members to recognize warning signs and seek timely medical attention.

A well-structured transition-of-care program prevents complications, enhances patient recovery, and reduces the likelihood of readmission.

3. Seamless Coordination Between UM and CM Teams

Employers rely on a vendor partner to perform utilization management and case management for their members.  This may be through a third-party administrators (TPAs) or separate entities.  If performed by the same entity or different, it is critical that the UM and CM vendor are working together to ensure members in need have coordinated care.  This includes:

• Data Transparency:  Timely access and sharing of data between vendors
• Identification of members in need:  Highlighting of members in need of support when inpatient
• Collaboration tracked through metrics:  Expect vendor(s) to report on members referred from UM to CM program
• A focus beyond episodic care to promote long-term health improvements.

Choosing the Right Care Management Partner

Employers seeking to reduce readmissions should look for care management partners who prioritize proactive member support, seamless care coordination, and measurable results. Conifer Health exemplifies this approach by offering tailored care management programs that integrate pre-procedure preparation, post-discharge follow-up, and effective UM-CM collaboration.

By choosing the right partner, employers can foster a healthier workforce, enhance productivity, and achieve significant cost savings. Investing in a strategic care management solution is not just about reducing readmissions—it’s about building a sustainable, employee-centered healthcare strategy.

Learn more about how Conifer Health can help reduce readmissions and optimize your healthcare strategy. Let’s talk.