Health Index Priority: Decrease Preventable Hospitalizations
MaineHealth remains focused on high-quality, community-based primary care to manage chronic illnesses and improve care coordination as patients transition from one care setting to another.
For the Health Index initiative, the primary metric used to monitor preventable hospitalizations is the rate of admissions for 12 ambulatory care sensitive conditions.
This metric reflects the efficiency of a population’s access to and use of primary care and the quality of the primary healthcare received. For these 12 health conditions, high-quality community-based primary healthcare- that includes routine care for non-emergent acute or chronic conditions- often can avoid hospitalizations or more severe disease that require treatment within a hospital.
The three conditions with the highest admissions rates are heart failure, bacterial pneumonia, and chronic obstructive pulmonary disease. The remaining nine conditions are angina (when no intervention is completed during the hospitalization), asthma, cellulitis, convulsions, dehydration, diabetes, gastroenteritis, hypertension, and kidney/urinary infections.
Why does MaineHealth focus on decreasing preventable hospitalizations?
- Avoiding preventable hospitalizations improves the quality of life for both patients and families.
- Reducing unnecessary admissions reduces healthcare costs.
We support a variety of clinical, community and policy actions to help decrease preventable hospitalizations throughout the MaineHealth service area. Here are some of the ways that MaineHealth and our partners are responding:
The Health Index initiative tracks and monitors a variety of data sources to measure progress being made to decrease preventable hospitalizations. In 2016, MaineHealth leaders set bold, aggressive targets for two of these measures as a way to challenge MaineHealth organizations to continue achieving positive steps toward the MaineHealth vision.
Short-term measure and target:
- As of September 30, 2018, the annual rate of hospitalization for COPD and Heart Failure for MaineHealth Accountable Care Organization’s Medicare Shared Savings Program will be equal to or less than 8.31 and 10.0 per 1,000 beneficiaries, respectively.
Long-term measure and target:
- In 2019, the most recent annual rate of hospitalizations for ambulatory care-sensitive conditions will be ≤30/1,000 Medicare enrollees.
Within the MaineHealth Accountable Care Organization (MaineHealth ACO), the hospitalization rate for beneficiaries with Chronic Obstructive Pulmonary Disease (COPD) was at the lowest level in over a year. The hospitalization rate of 8 per 1,000 is below the MaineHealth short term target of 8.3/1,000. The hospitalization rates for admissions related to Heart Failure has been rising steadily rising and is at the highest level of 14.5 hospitalizations per 1,000 beneficiaries. This is above the MaineHealth target of 10 admissions per 1,000 beneficiaries in the Medicare Shared Savings Program (MSSP).
One metric often used to monitor potentially preventable hospitalizations is the rate of admissions for ambulatory care-sensitive conditions (ACSC). For these health issues, high-quality outpatient care often can avoid hospitalizations, or early intervention can prevent complications or more severe disease.
The ACSC hospitalization rate in the MaineHealth service area and for Maine overall increased from 2014 to 2015. The service area's ACSC rate remains lower than the U.S. rate, although the U.S. rate decreased more from 2012 to 2015 than the service area rate did.