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Medicaid Nursing Home Collaborative Reduces Rehospitalizations in Pierce County, WA

May 13, 2015

Qualis Health and DSHS Engage 14 Facilities, Prevent 242 Unnecessary Hospital Readmissions

Seattle, WA – Qualis Health has released the results of a project that prevented 242 rehospitalizations among Medicaid nursing home residents in Pierce County, a 34% relative improvement. The project report documents how Qualis Health and the Washington State Department of Social & Health Services (DSHS) engaged 14 nursing homes serving diverse populations in Pierce County, using data-driven quality improvement methods to improve care transitions and reduce unnecessary rehospitalizations.

"Reliable care coordination is critical to assure the health and well-being of nursing home residents after a hospital stay," said Jonathan Sugarman, MD, MPH, President and CEO of Qualis Health. "This project demonstrates that it's possible to achieve better care for a frail and vulnerable population, while also preventing unnecessary Medicaid costs."

Avoidable rehospitalizations result in complications and billions of dollars in healthcare expenditures for Medicaid enrollees across the US. Strengthening states' ability to use data in measuring and improving the quality of care for the approximately 30 million adults currently enrolled in Medicaid is a priority for The U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS). Funding for the Adult Medicaid Quality Grant Program: Measuring and Improving the Quality of Care in Medicaid was granted to 26 state Medicaid agencies in 2012.

In Washington State, the Department of Social and Health Services (DSHS) was the Adult Medicaid Quality Grant awardee. Qualis Health was contracted by DSHS to lead the Pierce County Medicaid Nursing Home Collaborative: Reducing Resident Readmissions. As part of the collaborative, nursing homes worked together for 18 months (April 2013–September 2014) to test system changes aimed at reducing avoidable hospital readmissions and share learning.

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