Minnesota Readmissions Initiative Breaks Down Silos


In less than four months CMS' Hospital Readmissions Reduction Program will start penalizing hospitals with higher-than-projected readmissions rates. But as the Oct. 1 program launch looms for many hospitals, one readmission initiative is making significant progress to reduce unnecessary hospitalizations.

The Minnesota Reducing Avoidable Readmissions Effectively (RARE) campaign set a goal of preventing 4,000 avoidable readmissions among commercial health plan patients by the end of 2012, a 20% reduction from 2009 baseline data. The campaign was launched last September by three operating partners: the Minnesota Hospital Association (MHA); the Institute for Clinical Systems Improvement (ICSI), a nonprofit collaborative of 55 medical groups and hospitals; and Stratis Health, the state's QI organization. RARE's partners include more than 80 hospitals, which according to the MHA already have prevented 1,011 avoidable readmissions in 2011 and expect to surpass the target goal by the end of 2012.

"We had a specific process for each partner to follow, including a commitment by leadership to support and provide needed resources and development of a guidance team and a working team at each site," says Kathy Cummings, RN, MA, project manager at ICSI.

Each participating hospital was invited to join one of three quality collaboratives: one based on Project RED; one based on Dr. Eric Coleman's Care Transitions model; and one focused on safe transitions-of-care communication developed by the MHA.

"Everyone is rallying around the goals. They are all talking at the table, and starting to break down the silos between hospital, nursing home, clinic, and the chasms in between," says hospitalist Howard Epstein, MD, FHM, ICSI's chief health systems officer. "One of the key attributes of hospitalists is collaboration and systems improvement within their hospitals. Working with RARE is broadening their perspectives on the workings of the healthcare system as a whole."

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