Gainwell Enables Breakthrough Southern Methodist University Research on Hospital Readmissions for Medicaid Diabetes Patients
New model holds key to accurately predicting 30-day patient readmission
IRVING, Texas – Hospital readmission for diabetes patients is an enormous health risk and an expensive problem for the U.S. healthcare system. The question is how do we address it?
Gainwell Technologies (Gainwell), a leading innovator in healthcare technology solutions, partnered with its state Medicaid clients and SMU (Southern Methodist University) to develop an answer.
Diabetes affects roughly 13 percent of the U.S. population. These patients have elevated rates of hospital admission and all-cause mortality. They are also twice as likely to be readmitted within 30 days of discharge as similar patients without diabetes. The estimated cost of hospital readmissions is $20 billion to $25 billion annually.
While predictive hospital readmission models for diabetes exist for Medicare, they do not for Medicaid, which is the single largest source of health insurance in the U.S. This fact helped motivate this research.
SMU determined the first step was to develop a model to predict which Medicaid patients admitted to a hospital for any reason are most likely to be readmitted within 30 days. To develop a predictive model, Gainwell enabled SMU’s research by providing an advanced research platform and de-identified Medicaid claims from its clients in seven states.
SMU used 69,640 claims for the research that focused exclusively on patients who were diabetic, admitted to the hospital for any reason and discharged either to their homes or a non-hospice facility.
Using claims data only, SMU concluded Medicaid patients with diabetes were much more likely to be readmitted to hospitals within 30 days of their release than Medicaid patients without diabetes.
This important research was published in The American Journal of Managed Care (AJMC), a respected peer-reviewed medical journal.
Some of the most significant findings from the research were:
- Researchers derived and validated a Medicaid claims-only statistical model to predict 30-day readmission for hospitalized Medicaid patients with diabetes.
- The model’s accuracy is similar to that of other models that are based on more granular clinical and demographic data. It identifies populations by risk and suggests targets for interventions to improve outcomes.
- The model will be of use to insurers, policymakers and health systems as they seek to categorize patients by risk to improve health outcomes and contain readmission costs in Medicaid programs.
The research will enable payers and health systems to use a patient’s age, gender and admissions history to predict the likelihood of a readmission.
“This research provides important guidance to clinicians,” said Daniel Heitjan, Ph.D., professor and chair of Statistics and Data Science at SMU. “Our new predictive model is accurate and much simpler to process. That’s a significant advantage when predicting the likelihood of readmission.”
A cost driver in healthcare
Thirty-day readmissions are widely recognized as a driver of increased healthcare costs. And it is to the benefit of hospitals and health plans to address it.
“These results are important to ensure patients get the care they need for this pervasive and deadly disease. This predictive model will help providers and payers identify Medicaid patients with a higher risk of readmissions. It also enables them to proactively focus on care transitions to improve outcomes and decrease costs,” said Gainwell Chief Medical Officer Dr. Gary Call.
“By identifying high-risk diabetics, clinicians will be better equipped to focus on patients during and after hospitalizations to improve treatment adherence and avoid readmissions. These models can also track high-risk population outcomes, develop care management programs and monitor the effectiveness of existing ones,” Dr. Call said.
He added the research would not have been possible without the foresight of Gainwell’s clients who enabled the company to share the de-identified Medicaid claims for this vital research.
This research is one in a series of studies Gainwell has enabled for top universities on issues ranging from hospital readmissions to opioid addiction to the impact of the social determinants of health.
Gainwell facilitated the research data environment for SMU under the umbrella of Australia’s Digital Health CRC (Cooperative Research Centre) to sponsor this study. The DHCRC connects government, academic and industry partners to harness digital technology to address many of the world’s most challenging healthcare issues.
About Gainwell Technologies
Gainwell Technologies is the leading provider of digital and cloud-enabled solutions vital to the administration and operations of health and human services programs. With more than 50 years of proven experience, Gainwell has a reputation for service excellence and unparalleled industry expertise. We offer clients scalable and flexible solutions for their most complex challenges. These capabilities make us a trusted partner for organizations seeking reliability, innovation, and transformational outcomes. Learn more at gainwelltechnologies.com.
SMU is the nationally ranked global research university in the dynamic city of Dallas. SMU’s alumni, faculty and over 12,000 students in eight degree-granting schools demonstrate an entrepreneurial spirit as they lead change in their professions, communities and the world.