Friday, July 31, 2015

Novel MDH study yields first statewide estimate of potentially preventable health care events

For the first time, the Minnesota Department of Health (MDH) has analyzed the state’s emergency department visits, hospital admissions and hospital readmissions and found that over the course of a year nearly 1.3 million of those patient visits costing nearly $2 billion were potentially preventable.
MDH used 2012 claims data from the Minnesota All Payer Claims Database (MN APCD) and data analytics developed by Minnesota’s 3M Company to estimate the volume of potentially preventable patient visits to hospitals and emergency departments.  Minnesota is the first state in the nation to successfully conduct such an analysis using APCD data and set a baseline estimate for potentially preventable hospital visits.

“Minnesota has one of the most efficient and cost-effective health care systems in the nation but this study shows we still have room for improvement,” said Minnesota Commissioner of Health Dr. Ed Ehlinger. “Equipped with these findings, we will work with providers and community leaders to ensure patients more consistently receive the right care, in the right place at the right time.”

In this context, potentially preventable health care events are defined as hospital and emergency department visits that patients possibly could have avoided under the right circumstances such as timely access to primary care, improved medication management, greater health and health system literacy, and better coordination of care among clinicians, social service providers, patients and families.  Examples include a visit to an emergency department for a urinary tract infection that could have been treated in primary care or a readmission to a hospital because of poor follow up care after a discharge.
Volume and cost associated with potentially preventable health care events in Minnesota, 2012These 2012 patient visits consumed about $1.9 billion in health care spending by employers, health plans and individuals. This accounted for about 4.8 percent of total health care spending in the state that year. This volume of spending does not, however, represent real potential savings because not all identified events were actually clinically preventable and preventing them may require new investments elsewhere in the system.

“Even for those events that may be actually preventable, the best opportunity for prevention may exist farther upstream than the points of care included in this study,” said MDH’s State Health Economist Stefan Gildemeister. “Though we do see a substantial opportunity for cost savings in the health care system, the best prevention for many of these events may lie outside of the health care delivery system altogether.”

A large share of 2012 emergency department visits – 1.2 million, or about two out of three visits – was potentially preventable. These visits cost $1.3 billion. Many patients were seen more than once for a condition that was potentially preventable.  For example, as many as 50,000 Minnesotans had four or more potentially preventable ED visits in a calendar year. Of those potentially preventable ED visits, infections of the upper respiratory tract (9 percent), abdominal pain (7 percent), and musculoskeletal system and connective tissue diagnoses such as back pain (7 percent) were the most prevalent diagnoses. Medicaid members made up a disproportionately high percentage of overall emergency department visits.  In 2012, Medicaid patients made up 14 percent of the population, but accounted for 40 percent of ED visits in the state.

Nearly 50,000 events were potentially preventable hospital admissions totaling $373 million. The top three conditions for potentially preventable admissions included: pneumonia, excluding pneumonia related to bronchiolitis and respiratory syncytial virus (13 percent), heart failure (12.1 percent), and COPD (8.1 percent).

About 22,000 hospital readmissions costing $237 million were found to be potentially preventable. For readmissions, the three most frequent conditions account for approximately 15.2 percent of all readmissions and include heart failure (6.6 percent), blood infection (septicemia) and disseminated infection (5.1 percent), and major depressive disorder and other unspecified psychoses (3.5 percent).

“Minnesota’s providers, including Hennepin Health, are very focused on improving outcomes and reducing high-cost care that is not good for patients,” said Ross Owen, director of Hennepin Health. “This work requires approaches that look not just at coordinating medical care but at addressing social factors and preventing these events from happening in the first place. This MDH report is an important statewide step toward understanding that opportunity.”

The report includes a number of strategies for reducing potentially preventable events that Minnesota providers, State agencies, and other stakeholders are already pursing to reduce potentially preventable events.
  • Ensuring all patients have access to timely, high-quality preventive care in outpatient settings, and a usual source of care or medical home
  • Ensuring consistent and strong engagement by patients and families, with a focus on the availability of information or guidance about preventive care and treatment that is accessible to patients with varying levels of health literacy and in multiple languages
  • Improving coordination of care across settings of care, in particular between long-term care settings and hospitals
  • Making use of emerging providers, such as community paramedics or community health workers, to provide care coordination and connect vulnerable patients to social supports that can help them avoid hospitalizations or ED visits
  • Ensuring that secure electronic exchange of clinical information occurs effectively and in real time across settings and provider systems
  • As recommended by the RARE campaign, improving comprehensive discharge planning, medication management and transition care support/transition communications
The study was conducted using data from the Minnesota All Payer Claims Database (MN APCD), which includes data from both public and private insurance payers. Minnesota is one of a small number of states to collect health insurance data on such a comprehensive scale, and the first to use its APCD to conduct a comprehensive analysis of these events. The study also employed patient classification methodologies and analytic services from 3M Health Information Systems, a business of 3M Company.

For more information, see Health Economics Program.