Four Questions for CoxHealth: Post-Webinar Interview

Recently, DNV GL Healthcare and CoxHealth participated in a Healthcare Web Summit webinar discussion on Unconventional Paths to Reducing Patient Readmissions. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed the CoxHealth team on four key takeaways from the webinar: 

1. Your study looked at readmission rates for congestive heart failure patients, how did you identify physicians with higher than average readmission rates? 

CoxHealth: We are currently identifying CHF patients who have readmitted for a second time and enrolling them in the Advanced Practice Paramedic Program.  Our data showed that if a person readmits once, they are more likely to readmit a second, third, etc time.  We felt our best use of resources was to stop the multiple readmitters. 

2. From a case management perspective, what were lessons learned from skilled nursing facilities? 

CoxHealth: We brought a few different skilled nursing facilities together and diet was determined to be the single largest item that helped keep readmission rates low.  Our APPs have a great focus on diet with the patient and the patient’s family when they enroll. 

3. Describe your Advanced Practice Paramedics program and key successes with this program in managing emergency department high utilizers. 

CoxHealth: We identify a high utilizer as anyone who visits the ED 5 or more times in a 12 month period.  One of our keys of success, that we learned because we didn’t start this way, is to have an APP in the ED to visit with the patients real-time and enroll them.  We started with a social worker doing this and we weren’t having the acceptance we were hoping for.  When we had the paramedic, who would then be coming into their home, visit about the program, our acceptance rate increased drastically.  

Another key to our success is our goal is to graduate patients from the program in approximately 90 days.  We continue to track the ED utilization after the enrollment period to ensure we don’t need to touch base again with the patient, but our goal is to work with them on what interventions can be implemented so they don’t have to visit the ED as often.  If our APPs didn’t graduate patients, we wouldn’t be able to enroll new patients and continue to grow our success. 

Our final keys to success is to not overly prescribe to the APP what they should be doing for the patient.  We have individualized care plans and encourage the APPs to think outside the box when providing care. 

4. Who pays for the APP program? 

CoxHealth: CoxHealth pays for the program.  We are proving the program’s worth through cost avoidance of low reimbursement patients in the ED as well as decreasing readmissions cost.  We are currently in discussions with two large payers to begin reimbursement for APP visits.