MHA FPX 5014 Assessment 3 Cost-Benefit Analysis for Transitional Management Care MHA-FPX 5014 Health Care Quality, Risk, and Regulatory Compliance

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Abstract

Transitional Care Management (TCM) pertains to the process of transitioning patients from hospital discharge to ongoing care within the community. This study aims to conduct a cost-benefit analysis (CBA) to evaluate the costs and benefits associated with the TCM program, focusing on its benefit-to-risk ratio. The advantages and objectives of TCM in a hospital context include reducing patient readmissions, enhancing the quality of care outside the hospital, ensuring continuity of care, and promoting long-term health for discharged patients (Elsener et al., 2023). The CBA will assist in determining the cost-effectiveness of TCM by identifying anticipated costs over a five-year period and comparing them with projected benefits, thereby facilitating informed decision-making (Elsener et al., 2023).

Keywords: Transitional Care Management, Cost-Benefit Analysis, Continuity of Care, Readmissions, Centers for Medicare and Medicaid Services

Focus of Stakeholders for a Cost-Benefit Analysis

Identifying stakeholders involved in TCM within a hospital setting is essential. Key stakeholders include patients, their caregivers, and the hospital responsible for discharging the patient. External stakeholders consist of pharmacists, transitional care center management, payors, and community service agencies. The hospital and these stakeholders aim to evaluate how the implementation of TCM will benefit patients upon discharge and reduce readmissions in relation to the program’s costs over five years.

Patients discharged under TCM will have designated caregivers or facilities to ensure seamless care and continuity of treatment. Once in the community, external medical professionals will oversee patients to bridge the gap between inpatient and outpatient services. Furthermore, hospitals that adopt TCM can benefit financially from the Centers for Medicare and Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP), which incentivizes hospitals to reduce readmissions within 30 days of discharge (CMS, 2021).

Value Proposition for Change Management

Implementing change in healthcare organizations often presents challenges that require systematic strategies for effective transitions. Change management is critical for the successful implementation of TCM, as it represents a new approach for healthcare organizations, providers, patients, and staff. Effective change management necessitates administrative, financial, and provider support, as well as team collaboration. It ensures a smooth transition for patients, caregivers, team members, and healthcare providers during the TCM implementation process.

Through community partnerships, change management in TCM will emphasize the program’s benefits (Nathan et al., 2021). A well-executed change initiative will enhance the quality of patient care and satisfaction during hospital stays and upon discharge for both short-term and long-term care. Neglecting change management can lead to prolonged transition times, increased long-term patient care costs, and suboptimal care, resulting in higher readmission rates. Mitigated risks include lower mortality and infection rates, fewer emergency room visits, and reduced readmissions. Additionally, TCM will lower costs by decreasing readmissions and improving financial incentives under the CMS HRRP program (Nathan et al., 2021).

Strategies to Influence and Impact Changes for Quality Improvement

Research indicates that poor communication and coordination significantly contribute to preventable hospital admissions and readmissions. Hospitals lacking TCM models often experience higher rates of readmissions, mortality, infections, and long-term illnesses due to inadequate patient coordination upon discharge. The absence of TCM also suggests insufficient patient education, self-care, family involvement, and communication with external caregivers (Racheal & Shen, 2023).

The success of TCM relies on strong leadership and support. Active leaders provide oversight and direction, ensuring strategic momentum and accountability during TCM implementation. Key strategies for quality improvement within the TCM model include robust internal and external communication and coordination, guided by strong leadership. Follow-up care within 14 days of discharge is crucial to ensure proper patient care. Furthermore, fostering a culture of safety and continuous improvement is vital when implementing TCM (Hughes, 2008).

Cost-Benefit Analysis and Assumptions

A cost-benefit analysis (CBA) is necessary to project the costs associated with implementing a TCM program. Given that TCM is a service-based care model, predicting the return on investment (ROI) can be challenging. Research highlights the immediate benefits and potential cost savings of TCM, such as