Care prevention includes:

• Addressing quality measures for all patients including completion of preventive care services such as yearly physical exams and screenings (Mammogram, Cervical Cancer Screening, Colorectal Screening, Fall Prevention, Depression Screening, Cognitive Screening, etc.).
• Identifying potential quality of care problems and implementing appropriate interventions.
• Referral to appropriate specialists to treat specific health conditions.

Healthcare providers can reduce hospital readmissions through patient care actions that promote improved patient outcomes and therefore reduce overall costs. Actions include:

• Hospital discharge follow up appointments to address post-acute care needs
• Access to home care services upon initial discharge from the hospital
• Improved Medication Management
• Patient Education
• Regular follow up

Although it may be necessary to readmit some patients, the fact is that risk-adjusted readmission rates vary considerably across hospitals. Suggesting that certain readmissions may be prevented through hospital practices, such as: improving patient discharge instructions, coordinating post-acute care, and reducing medical complications during the initial hospital stay.

United Medical ACO utilizes the Delaware Health Information Network (DHIN) event notification system to obtain admission and discharge information for network patients regarding Emergency Room (ER) and inpatient admissions to hospitals throughout the state. Currently United Medical ACO and DHIN exchange data files daily. Utilizing one notification system ensures notifications are not missed and enables our Care Coordination department to timely schedule hospital discharge follow up appointments for our patients with their PCP and specialists.

United Medical utilizes Population Management to track and monitor patient’s conditions, admissions, discharges and overall utilization in an effort to improve the quality of care for patient’s and reduce hospital admissions and readmissions.