Can Targeting High-Risk Patients Reduce Readmission Rates? Evidence from Israel

We study a large intervention to reduce hospital readmission rates by the largest Israeli integrated healthcare system. Since 2012, the intervention flagged patients aged 65 and older with high readmission risk to providers, both upon admission and after discharge. Risk scores were based on patient-specific prior healthcare utilization. Analyzing 171,541 covered admissions during 2009–2016, we find that the intervention reduced 30-day readmission rates by 5.9% among patients aged 65–70 relative to patients aged 60–64, who were not targeted for inclusion in the intervention, and for whom no scores were calculated. The largest reduction, 12.3%, was among high-risk patients. Primary care post-discharge follow-up encounters were significantly expedited. The magnitude of the estimated effect peaked during the first two years, and it declined subsequently, after incentive payments by the Israeli Ministry of Health to organizations that reduce readmission rates were discontinued. Taken together, the evidence demonstrates that informing providers about patient risk in real time can improve care continuity and reduce hospital readmissions, and that maintaining such efforts on an ongoing basis is important to sustain their impact.