Engaging Patients Beyond the Hospital

Upstate University Hospital, an academic medical center in New York, focuses on providing comprehensive and innovative patient and family-centered care. Since 2012, Upstate has redefined patient experiences by improving care transitions and reducing readmissions.

PROGRAM BACKGROUND

Upstate successfully implemented a centralized call center to assist patients transitioning from one care setting to another. To increase resource efficiency, the hospital deployed the CipherHealth hybrid model in which CipherOutreach sends an initial automated call to 100% of patients discharged to home. Patients then respond to a series of customized questions and should he or she indicate an issue or concern, the call is routed to designated staff members on the centralized team.

IMPROVEMENTS

Upstate has leveraged CipherHealth’s reporting and support services to continuously improve the follow-up outreach program. Armed with the data-driven recommendations of their dedicated CipherHealth Customer Success Manager, Upstate developed clinically-focused questions and improved response timeliness to patient concerns.

RESULTS

From 2014 to 2016, Upstate has reported a 9% overall decrease in readmissions and nearly a 10% increase in the Hospital Rating HCAHPS domain. Coupled with other care transition initiatives, CipherHealth Outreach helps further drive experience and outcomes success as patients who participate in the program demonstrated an average 12.7% lower readmission rate and 2.8% higher HCAHPS score across domains compared to the overall scores. Upstate’s streamlined approach to follow-up allows for patient concerns to be resolved quickly and effectively before an adverse event occurs.

HCAHPS Comparison 2014 – 2016 Overall Scores vs. Patients Engaged with CipherHealth

Readmission Rates 2014 – 2016 Total Readmissions vs. Patients Engaged with CipherHealth

CLIENT: Upstate University Hospital, PROFILE: Academic Medical Center in Upstate New York, PRODUCT: Post-Discharge Follow Up, PROGRAM: Readmissions Reduction, DATA PERIOD: 2014 – 2016