An Informatics-Based, Payer-Led, Low-Intensity Multichannel Educational Campaign Designed to Decrease Postdischarge Utilization for Medicare Advantage Members: Retrospective Evaluation

Abstract

Background: Readmission avoidance initiatives have been a priority for the Centers for Medicare & Medicaid Services for over a decade; however, interventions are often high-intensity, costly, and resource-intensive, and therefore, rarely scalable or sustainable. Large national payers are in a unique position to leverage data to identify members in real-time who are at high risk of readmission to prioritize the scaled delivery of tailored behavior change techniques to provide an educational intervention to modify health behaviors.

Objective: This study aims to examine the impact of an informatics-driven, multichannel educational messaging campaign implemented to decrease 30- and 90-day acute inpatient readmissions and emergency department (ED) visits among Medicare Advantage members of a large national payer.

Methods: A quality improvement initiative was designed and implemented to provide an evidence-based outreach campaign using human-centered design and behavior change principles to deliver multiple intervention functions, including timely, contextual, and relevant delivery of education, enablement, and persuasion, to reinforce health-promoting behaviors related to planned or unplanned inpatient admissions. Outcomes, including 30- and 90-day acute inpatient readmissions and ED visits, were retrospectively evaluated from Medicare Advantage members enrolled in a large national health plan residing across the United States between May 2020 and July 2022. Leveraging utilization management data, rules-based logic identified members (N=368,393) with a planned acute inpatient procedure (ie, preadmission) or discharged from an acute hospital stay (ie, postdischarge) within 15 days. Members were sequentially assigned to a standard (N=141,223) or an enhanced (N=227,470) messaging group, whereby the standard group received usual outreach and the enhanced group received an educational intervention via a messaging campaign deployed through multiple low-intensity communication channels (eg, text message, email, direct mail) in addition to standard outreach.

Results: Members who received enhanced outreach had fewer relative 30-day acute inpatient readmissions (-4.1%, 95% CI -5.5% to -2.7%; P<.001) and ED visits (-3.4%, 95% CI -5.0% to -1.7%; P<.001) compared with members receiving standard outreach. Similarly, these findings persisted for relative 90-day outcomes such that members receiving enhanced outreach experienced fewer acute inpatient readmissions (-5.4%, 95% CI -6.5% to -4.3%; P<.001) and ED visits (-3.8%, 95% CI -5.0% to -2.5%; P<.001) compared with members receiving standard outreach messaging.

Conclusions: Behavior change techniques deployed via educational interventions as low-intensity multi-channel outreach is an effective strategy to reduce avoidable 30- and 90-day inpatient readmissions and ED visits in recently discharged Medicare Advantage members (primarily >65 years).

Keywords: behavior change; clinical informatics; design; digital health; educational; health behavior; hospital readmission; human centered; human-centered design; inpatient; medicare; messaging; messaging campaign; outreach campaign; personalized education; population health; readmission; utilization; utilize.