Reducing Hospital Readmissions Through a High-Touch Customer Service Model

Through a high-touch customer service model, WEA Trust—a nonprofit insurance company in Wisconsin—is reducing hospital admissions and cutting costs by closely working with and educating their members.

WEA Trust was originally formed in the 1970s by the Wisconsin Education Association, the teacher’s union in the state, to provide insurance benefits to school district employees. Since then, they have transformed their charter to serve all public employees statewide, with approximately 110,000 members.

Now, 2 years after initiating a high-touch customer model to better serve their members, the insurance company has achieved a 31% reduction in readmission rates, resulting in savings of $1.9 million, as well as a 7.1% reduction in emergency room use, translating to $2.4 million in savings.

“Customer service has always been something we’ve prided ourselves on and have really focused on for our members,” explained Mary Hughes, vice president of medical affairs, WEA Trust, in an interview with The American Journal of Managed Care^®. “We’ve been trying to leverage our call center to engage our members in activities, but also to screen when a member could benefit from talking to either a nurse, social worker, or a pharmacist for more detailed clinical conversations.”

Citing high readmission costs of approximately $30,000, Hughes explained that readmissions burden patients with high out-of-pocket costs and raise premiums for the employer group.

The staff takes on a 2-pronged approach. Utilizing claims data, the staff identifies members who went to the emergency room without an apparent emergency. Once these members are identified, the staff members conduct outbound calls to inquire about the member’s health, have a dialogue about alternatives to the emergency room, and see if the patient has a relationship with a primary care provider.

For upcoming planned hospital admissions, the staff reaches out to members to help them understand what they can expect during their visit, how long they should expect to stay in the hospital, and how to best prepare for their return home, explained Hughes. Follow-up calls are made after the hospital stay to help members understand the signs of potential problems they can experience, such as infections or medication side effects, as well as make sure that the member makes follow-up appointments with their provider.

“Our approach is really to empower our members to be an engaged patient and be involved in all the decisions they make,” said Hughes. “Our responsibility is not to direct care, but it’s really to empower our members to get the care that’s most appropriate and safe."

“It’s really hard to make some of these decisions and really know how to navigate the system, and I think this approach in services really helps our members with some of those pain points,” she added.

Looking forward, WEA Trust will work more closely with cancer care, Hughes said. Noticing that cancer care largely attributed to readmissions and hospital visits, the insurance company has teamed up with Interlink’s CancerCARE to implement an oncology care program for members. According to Hughes, the program will verify that the initial diagnosis is appropriate, determine if genetic testing is necessary to identify a treatment plan, and make sure the prescribed treatment is evidence-based. Throughout the member’s journey, he or she will be paired with a nurse with expertise in cancer care in order to identify early problems, prevent them from escalating, and subsequently prevent unnecessary care in the emergency room.