A Continuing Collaboration

Randall Krakauer, MD 

Five years ago there was considerably less attention paid to the issue of readmissions than is the case today. Mary Naylor, Mark Pauly and the University of Pennsylvania team had already demonstrated the potential to reduce 90 day readmissions through better management of the discharge process, including the period immediately after discharge. Our team at Aetna was busy building Medicare care management infrastructure to impact chronic illness and Advanced Illness at the intersection of quality and cost - and had already seen a reduction in avoidable admissions and readmissions through telephonic case management. We needed to know whether there was incremental opportunity with on-site and home care management. So began a very productive collaboration that continues. Our program began with collaboration with Mary, Mark, and their team on Aetna Medicare Advantage members in metropolitan Philadelphia, with a Transitional Care program, measured against a clinically matched group in another region. With the demonstration of a 20% reduction in 90-day readmissions (publication 1), and considerable cost savings (impact at the intersection of quality and cost) we began building Transitional Care programs that are now nationwide. With the increased importance of Star Rating measures for Medicare programs, this experience has served us well. Such programs are still being expanded, but they are part of comprehensive care management programs everywhere - it is no longer necessary to demonstrate their value.

My collaboration with Mary, Mark, and their team has also led me to another venture: my role on the National Advisory Committee (NAC) for the Interdisciplinary Nursing Quality Research Initiative (INQRI) program. Since joining the NAC in 2006, I have been pleased to review research proposals, advise funded grantees on their project plans, and offer advice and support to Mary and Mark as they lead this impressive program. Like Aetna’s work with the Penn team, INQRI teams have continually shown the value of nurse-led interventions.

Our work and collaboration on reducing readmissions has been very productive and valuable. But since we don't actually achieve Nirvana in this world, this work and collaboration will continue, and we expect to continue pushing the limits of our potential. Similarly, I look forward to seeing the continued impact that I know INQRI teams will have on improving healthcare quality.

Dr. Krakauer is the National Medical Director for Aetna Medicare and a member of INQRI’s National Advisory Committee. 

1) Naylor, M; Bowles, K; McCauley, K; Maislin, G; Pauly, M; Krakauer, R: "High Value Transitional Care: Translation of Research into Practice." J. Eval. Clin. Practice. 16 March 2011, 1-7.

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