Camden’s 7-day pledge is cutting hospital re-admissions

The 7-Day Pledge created by the Camden Coalition of Healthcare Providers has gained national attention for reducing the number of hospital re-admissions by making sure patients connect with their doctors within a week of leaving the hospital.

Natasha Dravid, director of clinical redesign initiatives, said the idea is to reduce the risk of being re-admitted to the hospital in that 30-day window after you've been to the hospital because you're vulnerable. She said a lot of time patients have multiple medications and discharge instructions they need to understand. So by connecting back with a primary care physician, you reduce the risk in that vulnerable period.

Dravid said during the seven days when patients go back home, they leave the controlled environment of the hospital. If they are able to reconnect with primary care, the most important thing is for a doctor to lay eyes on what was the hospital admission for, what caused it and what were the changes to the medication. The doctor will do a medication reconciliation to make sure the patient is not taking multiple versions of the same medication.

The 7-Day Pledge started in 2014. Dravid said The Camden Coalition of Health Care Providers was trying to improve the quality of care and reduce the cost of care for Medicaid patients in Camden. They wanted to implement a strategy that would bring together hospitals, primary care providers and patients around a common goal.

So they pushed out patient campaign material which stated that if you're hospitalized, it's important to follow up with your doctor.

"We also got primary care providers themselves to take the pledge and say they would do everything in their power to get patients in within that seven day window," said Dravid.

She also said they leveraged their citywide house information exchange. Everyday, they would look at a data feed of every patient who went to a Camden hospital. They would then reach out to every patient, offering them assistance with scheduling an appointment. They also offered a taxi ride to and from the appointment and a $20 gift card if the patient could attend the appointment. The gift card was meant to offset some expenses associated with the office visit, such as child-care costs or lunch on the road.

Incentives were also offered to primary care physicians. On top of the reimbursement that they were getting from Medicaid, Camden Coalition of Health Care Providers also pushed out an extra $150 to help practices create that bandwidth in that capacity to prioritize patients who had been to the hospital.

Rough calculations from the two year study suggested there could be more than $10,000 savings in healthcare costs in each hospitalization that's avoided. In Camden's case, these costs were covered by Medicaid.

More than 1,500 patients took part in the 7-Day Pledge study from 2014 to 2016. Dravid said the results showed a statistically significant reduction in hospital re-admissions at both the 30 day and 90 day marks. Results showed that less than 13 percent of those who saw a doctor within the seven day window were re-admitted to the hospital within 30 days and 18 percent of those who did not get that follow-up care wound up back in the hospital.

Dravid said the next goal is to figure out how to make this program sustainable. Other communities have been asking Dravid if this pledge is possible to do in their cities. Dravid said she believes this is definitely scalable.

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