Bruce Vanderhoff is chief medical officer for OhioHealth, a network of 17 hospitals in central Ohio.

And “it is no exaggeration," he says, "to say that we are working with them to transform the model of health care delivery.”

That transformation was sparked by a provision of the Affordable Care Act, which penalizes hospitals with high readmission rates. With a possible cut to Medicare reimbursement on the line, medical facilities around the country are thinking of new ways to make sure patients don’t need to come back for additional treatment.

Like many other hospitals around the state, OhioHealth is placing an emphasis on patient education, making sure they know everything about their treatment and medication before they walk out the door.

Health coaches
Vanderhoff says it’s also important to identify which patients are at a higher risk of readmission. Hospitals do this by providing health coaches who visit patients’ homes and help further their treatment. Follow-up phone calls, pharmacy consultations, and in-depth meetings with a patient’s family are also used in the process.

“I’m always impressed by how energetically our nurses and doctors and respiratory therapists and ... our pharmacists have engaged in that good work, because they have to help the patients understand their medication — understand their treatment plan.”

Urban and rural communities
OhioHealth serves a wide area that includes many urban communities. But what about the state’s rural areas? Berger Health System has a hospital in Circleville that serves a smaller population. Tim Colburn, president and CEO, says this can sometimes be a good thing.

"Our physicians probably know our patients a bit closer — more intimately. Our health care providers inside the hospital know their patients better so we get that interactive, personal relationship to impact an individual or a patient’s behavior.”

Keith Holten, chief medical officer for Berger, acknowledges there are unique challenges when it comes to reducing readmissions at a smaller establishment, but says that’s no excuse.

“As an organization, we view this as an opportunity to be innovative and to think outside the box because of our size.”

Dealing with a population instead of disease
Both Holten and Colburn echoed Vanderhoff’s belief that the effort to bring down readmission rates has helped redefine the culture of health care, with community engagement as the cornerstone. 

“One of the important transitions that’s occurring in health care is for all of us to understand that we care for a population and a community of patients, instead of taking care of them in the hospital. And many of the things that we have done are helping us to move in a direction of managing the populations instead of their diseases.”

OhioHealth and Berger Health Systems say the foundation for readmission reduction has been established in the first year of the Affordable care Act and believe their rates will continue to decline as the roots of their policies settle in.