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Innovations in Reducing Preventable Hospital Admissions, Readmissions, and Emergency Room Use

June 2010 

An overview of health insurance plans’ creative programs to revitalize primary care, improve care transitions, and help patients across the country achieve better health outcomes and thus avoid preventable hospitalizations and emergency room (ER) visits.

Download the full report. 

Report by Topic

1. Medical Home Programs
   (see also: pp. 12; 15; 17)
2. New Payment and Delivery Models to Promote Evidence-Based Care
   (see also: p.10)
3. Hospital-to-Home Transition Initiatives  
4. Case Management for Patients at High Risk  
5. Home-Based Care Programs  
6. Post-Emergency Room Outreach Programs  

Report by Company

Aetna  

• The Transitional Care Model  

AMERIGROUP Corporation  

• Addressing Readmissions to Psychiatric Hospitals  

Blue Cross and Blue Shield of Florida  

• The Physician Home Visiting Program  
• The Emergency Room Readmission Program  

Cigna Medical Group  

• The Transition of Care Nurse Program  
• The Chronic Health Improvement Program  
• The Home-Based Care Program  
• The Emergency Room Outreach Program  

EmblemHealth  

• The Emergency Room Outreach Initiative  

Fallon Community Health Plan  

• The Healthy Transitions Program  
• The Home Run Program  

Geisinger Health Plan  

• ProvenHealth Navigator^SM Medical Home Initiative  
• ProvenCare Acute  

Group Health Cooperative  

• The Emergency Department and Hospital Inpatient Improvement Program  
• The Medical Home Initiative  

Health Alliance Plan  

• The Heart Failure Readmission Program  

Horizon Blue Cross Blue Shield of New Jersey  

• The Medicare Advantage Emergency Room Initiative  

Humana  

• The Post-Hospital Transition Program  

Independence Blue Cross  

• The Transitional Case Management Program  

Independent Health  

• The Patient-Centered Medical Home Pilot  
• Care Partners for Frail Elders  

Kaiser Permanente  

• The Transitions-in-Care Program  

Keystone Mercy Health Plan  

• The Acute Care Transitions Program  

Neighborhood Health Plan  

• A Multi-Dimensional Approach to Reducing Preventable Emergency Room Use  

Presbyterian Health Plan  

• The Nurse Care Coordinator Program  
• The Hospital at Home Program  

SCAN Health Plan  

• The Care Transitions Program  

Tufts Health Plan and Healthways  

• The High-Risk Care Management Program  

UnitedHealthcare  

• The Medicare Advantage High-Risk Case Management Program  

Universal American  

• The Medical Home Initiative  

WellPoint  

• The Welcome Home Program