Hospital Readmissions

Common Utilization Measures That Impact Value-Based Care Efforts

July 20, 2023 - Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality care. As a result, utilization measures that track the use of high- and low-value care are critical to a value-based structure. The triple aims of...


More Articles

CMS Home Healthcare Policy Reduced Hospital Readmissions

by Victoria Bailey

The CMS post-acute care transfer (PACT) policy and the use of home healthcare helped reduce hospital readmissions for recently discharged patients and lower hospital expenditures, according to a study...

Medicare Advantage COVID-19 Hospitalizations Were Lower Than FFS

by Kelsey Waddill

Updated 11/10/21: This article has been updated to elucidate the differences between Medicare Advantage beneficiaries' and fee-for-service Medicare beneficiaries' use of telehealth and...

Payer Launches Discharge Program To Lower MA Hospital Readmissions

by Hannah Nelson

UnitedHealthcare has announced the launch of a new program that aims to lower hospital readmissions by helping Group Retiree Medicare Advantage beneficiaries safely transition back home after discharge...

Humana’s Value-Based Care MA Model Cuts ED Admissions, Costs

by Kelsey Waddill

Humana’s value-based care models in Medicare Advantage helped lower emergency room admissions and, in turn, boosted savings for Medicare Advantage members, according to the payer’s recent...

Integrated Care Reduces Hospital Stays for Medicaid Children

by Samantha McGrail

Children enrolled in Medicaid and exposed to an integrated care management program experienced a decrease of 0.39 monthly hospital admissions and 2.20 monthly bed-days per 1,000 children, compared to...

Wellness Program Success Hinges on Long-Term Participation

by Kelsey Waddill

Members highly engaged in Humana’s long-term wellness program, Go365, spent on average $116 less per member per month in healthcare costs than low-engaged participants, a five-year study...

Challenges of Investing in Social Determinants of Health

by Kelsey Waddill

Despite widespread industry calls to prioritize community health benefits, investing in social determinants of health can be risky for health payers. Between questionable return on investment and...