The Medicaid Readmission Challenge

The Agency for Healthcare Research and Quality (AHRQ) last week released its Hospital Guide to Reducing Medicaid Readmissions publication that functions as a federal toolkit to assist hospital teams in designing and delivering transitional care to better serve the adult Medicaid population. Adult Medicaid recipients tend to be 65 and older, have multiple chronic diseases, and often also have a behavioral health issue. Hospital discharges for these patients can be fraught with issues, and many of these patients end up returning to the hospital. The care-seeking behavior of those patients can remain constant as they age into Medicare eligibility. With that in mind, an examination of 2015 Virginia data reveals interesting statistics about discharge dispositions for Medicaid patients. For instance, the readmission rate for Medicaid patients is slightly greater than 14 percent (see Figure 1). That rate is 15 percent higher than Medicare patients, and 42 percent greater than other payer groups. One option to reduce readmissions is to refer patients to either home health, or a post-acute care facility to ease their return home and provide interim support. Such referrals don’t appear to occur at a significant , however. The data show Medicaid patients are in the minority of referrals to either a skilled nursing facility or intermediate care facility (see Figure 2) or home health care (see Figure 3). Among the payer groups, a larger percentage of Medicaid patients were discharged to home (see Figure 4) than patients covered by other forms or insurance, or the uninsured. This is likely a reflection of Medicaid coverage rules, and the ability of the patient to pay out-of-pocket for additional support not covered by Medicaid.

To address Medicaid patients’ needs, the AHRQ guide recommends an easy-to-remember “ASPIRE” framework whose process promotes these steps:

  • Analyze your data;
  • Survey your current readmission reduction efforts;
  • Plan a multi-faceted data-informed portfolio of strategies;
  • Implement whole person transitional care;
  • Reach out to collaborate with cross-setting partners; and
  • Enhance services for high-risk patients.

The lead author for the guide is Dr. Amy Boutwell, a VHHA consultant on readmission reduction efforts. AHRQ is offering a webinar on the guide and its tools, and an evaluation of findings from its implementation with safety net hospitals. Click here to register for the free webinar scheduled for Sept. 9 from 3-4:30 p.m. The hospital-wide readmissions data cited in this analysis is available on the new, data-rich VHHA Analytics website. Please contact David Vaamonde ( for access to a trial license to explore all the site has to offer. (8/26)

Figure 1

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Figure 2

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Figure 3

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Figure 4

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