CVS Launches Enhanced Initiative to Slash Hospital Readmissions Among Medicare Patients

CVS hospital readmission reduction: In an attempt to lower hospital readmissions, which are expensive and may be harmful to patient health, CVS Health’s Aetna insurance division will grow a new program that pairs nurses with members in its privately managed Medicare plans.

Aetna-employed nurses may be assigned to patients on Medicare Advantage plans for those 65 and older who are discharged from hospitals, moving into nursing homes, or who have impairments in order to assist them with extra requirements. Coordination of in-home care and transportation to follow-up visits are among the services offered.

Dr. Ben Kornitzer, chief medical officer of Aetna, said, “We want to literally have a nurse at the bedside with that member, with that family, starting to think through what their care journey should look like.”

CVS Acts Amid CMS Regulation on Hospital Readmission Fines for Medicare Advantage

Following the Centers for Medicare & Medicaid Services’ July finalization of a regulation that applies Medicare Advantage members to readmission fines assessed to hospitals, starting in fiscal year 2027, CVS took this action. The American Hospital Association has objected, arguing that its inclusion unfairly penalizes hospitals for adverse consequences related to rejections and delays in coverage.

In order to reduce payments by up to 3% of discharge fees paid, the government insurance agency recognizes hospitals with higher-than-expected readmissions over 30 days for certain diseases and recalculates performance annually. The Advisory Board, a research group, analyzed government data and found that 75% of hospitals covered by the law were penalized for the fiscal year 2023.

According to a CVS Health representative, the program’s goal is to enhance patient health, which will benefit Aetna and clinicians. The firm plans to support more initiatives of this kind in the future.

CVS Rolls Out Program in 10 Hospitals to Improve Patient Discharge and Reduce Readmissions

By the end of the year, CVS plans to roll out the program in ten hospitals, including WakeMed Health & Hospitals in Raleigh, North Carolina; Houston Methodist in Texas; and AdventHealth Shawnee Mission in Kansas City, Kansas.
According to Sadhna Paralkar, senior vice president at health consulting firm Segal, “because they have a vested interest in keeping the patient better, sometimes the health plan is more helpful in giving discharge instructions.”