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Care transitions coaching saves Medicare & Medicaid dollars

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This article was originally published in January 2010.

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As part of the Stepping Stones Project in Whatcom County, WA, Qualis Health coached a dual-eligible Medicare/Medicaid beneficiary with multiple chronic illnesses how to better manage her own care. For seven months, she remained in her own home and successfully managed to avoid a return trip to the hospital—quite an improvement compared to the previous 13 months, when she was hospitalized nine times.

Qualis Health's coaching not only resulted in avoided rehospitalizations and improved quality of life, but also represents a significant savings in Medicare and Medicaid dollars. (According to the Care Transitions QIO Support Center, each re-admissions costs on average $9,360. Nine typical re-admissions, therefore, cost Medicare approximately $84,000.)

At the first coaching meeting, the beneficiary and her family caregiver were overwhelmed and unable to mobilize self-management skills. Over the course of a month, Qualis Health coached the beneficiary and her caregiver on the Care Transitions four pillars (medication reconciliation, physician follow-up, red flags, and personal health record). Our coach also referred them to existing community services, where the caregiver was able to receive further training.

Over time, the pair became much more activated in her care. The beneficiary understood that she could have a voice in her own healthcare decisions, and was empowered to make her needs known. Consequently, our coach was able to complete the intervention knowing that Qualis Health had made a lasting improvement in this beneficiary’s healthcare.