• Percent of members attending an aftercare appointment within 7 days post discharge from a hospital.
• Percent of members attending an aftercare appointment within 30 days post discharge from a hospital.

Our baseline measurement for 7- and 30-day aftercare was measured and compared to Beacon’s performance goals in 2001.  Results indicated that 79 percent of members who were hospitalized in 2001 received an ambulatory care visit within 30 days of discharge, 6 percentage points below the performance goal of 85 percent. The 7-day aftercare rate for 2001 equaled 51 percent, which was 29 percentage points below the performance goal of 80 percent.

• Developed an Access database to record, in real time, whether a member kept an aftercare appointment.
• Educated practitioners on the importance of timely aftercare post-hospitalization, including emphasis on making appointments available for inpatient members within 7 days after discharge.  This process included 37 site visits completed in 2002, encompassing the practitioners treating 31 percent of all members accessing services in 2002 and two article publications in plan newsletters.
• Developed a uniform process for obtaining discharge information from the Inpatient facility and training the Beacon Utilization Review staff on the revised aftercare protocol.
• Identified and educated those employees who did not consistently adhere to Beacon’s policy and procedures on aftercare by failing to follow-up with the IP facility regarding the discharge planning review process.
• Hired a full-time Aftercare Coordinator who began follow-up calls to providers to determine if the member kept his or her scheduled appointment and sent letters to members who did not keep their appointment, explaining the importance of aftercare and offering assistance in accessing another appointment.
• Purchased pre-paid outpatient practitioner slots and allocated staff to make aftercare appointments for facilities reporting an inability to access outpatient appointments within 7 days. 
• Developed an appointment reminder system for all members discharged from an IP setting that included calling all members by the aftercare coordinator one day prior to scheduled appointment.  If the member stated that they were not planning on keeping the appointment, the aftercare coordinator offered assistance in rescheduling, discussed the importance of aftercare, and if necessary, referred to a clinician for triage and referral activities.
• Beacon’s Clinical Director contacted non-compliant facilities to reeducate them on Beacon’s aftercare program components and educate them on Beacon’s requirements that discharge information be provided to the UR clinician prior to discharge.
• The Clinical and Quality Directors contacted all facility UR clinicians and supervisors notifying them of the new Beacon aftercare program components.
• Provided all inpatient facilities an Aftercare Card to give to discharged members stating the importance of follow-up after hospitalization.
• Addressed access issues where evident by having Coordinator contact aftercare facility and assist in scheduling an appointment within 7 days.
• Enhanced the discharge review process completed by the UR clinicians regarding every review. 
• Performed a drill down analysis on the 2002 7-day follow up data by facility to determine outliers and sent letters emphasizing Beacon’s 7-day aftercare performance standard and offered assistance as necessary.  

We re-measured the two performance measures in 2002 and 2003 to determine if these interventions were effective in improving aftercare. 

• In 2002, the 7-day follow-up rate improved from 51 percent (in 2001) to 58 percent in 2002 (a 7 percentage point increase). 
• In 2003, the 7-day follow-up rate improved from 58 percent (in 2002) to 63 percent in 2003 (a 5 percentage point increase). 
• The 30-day follow-up rate also improved 7 percentage points, from 78 percent (in 2001) to 85 percent in 2002.  
• The 30-day follow-up rate improved 1 percentage point, from 85 percent (in 2002) to 86 percent in 2003. 
• The 30-day rate now meets Beacon’s performance goal of 85 percent. 
• Although improved in 2003, the 7-day rate continues to fall short of our 80 percent performance goal by 17 percentage points.

We attribute the improved performance in the aftercare appointment rate to the following:

• Development and staffing of a comprehensive reminder and recall program addressing the roles of providers, practitioners and members in making and keeping aftercare appointments.
• Holding providers and staff members accountable for their aftercare rates and implementation of Beacon’s aftercare policies and procedures.
• Educating practitioners and providers in the aftercare program.
• Follow-up with facilities that do not consistently cooperate with the program.

Deborah Nelson, Vice President
Beacon Health Strategies

[Storyboard presentation at IHI's National Forum, December 2004]