MultiCare Health System
In the U.S., 5.7 million adults have heart failure (HF), costing the nation an estimated $30.7 billion each year. Learn how MultiCare leveraged AI and machine learning to more accurately predict the readmission risk for patients with HF.
For healthcare organizations, sustaining improvements that have been adopted in more than one part of an organization remains a serious challenge. Learn how MultiCare has sustained its elective colon surgery improvement efforts while identifying new opportunities.
Healthcare organizations need to be cognizant of their readiness for change, enabling them to create a plan that will enhance the organization’s ability to successfully drive change. While many studies have been completed on the importance of organizational readiness in non-healthcare organizations, there is little research and relatively few, measurement tools focused specifically on healthcare organizations.
To cement the Pulse Heart Institute (Pulse Heart) as a destination for adult heart health, and ensure its long-term success, Pulse Heart required a better understanding of its readiness to drive and sustain outcomes improvements—which it found through an onsite assessment that leveraged the Health Catalyst® Outcomes Improvement Readiness Assessment (OIRA) framework. Using the assessment findings and subsequent recommendations, Pulse Heart successfully developed, and continues to develop, the findings to guide workplans to improve competencies and enable the organization for long-term outcomes improvements success.
Based on the results of the onsite readiness assessment they have identified and implemented interventions to improve readiness for change in each of the five major OIRA Tool categories:
Leadership, culture, and governance
Nationally, readmission within 90 days after colorectal surgery occurs in about one in four patients, at a cost of approximately $9,000 per readmission. Committed to improving its clinical and financial outcomes, MultiCare, an integrated healthcare delivery system in the Pacific Northwest, decided to focus an improvement effort on elective colorectal surgery when it recognized that patient population had a high opportunity for improvement in both clinical outcomes and cost.
Effectively using its existing quality improvement methodology and Collaborative structure, MultiCare leveraged the work of the Enhanced Recovery After Surgery (ERAS) Society and identified and implemented standardized best practice care routines and interventions that would benefit this population. By using the information in the Enterprise Data Warehouse and analytics applications to monitor clinical outcomes and compliance, and leveraging technology in the EHR to provide decision support and order sets at the point of care, MultiCare was able to significantly improve the clinical outcomes for these patients.
19 percent reduction in readmission rates.
22 percent reduction in length of stay.
85 percent reduction in infections related to colorectal surgery.
At MultiCare Health System, the processes for denial management were not as effective as they could be, negatively impacting net patient revenue and financial performance through millions of dollars in adjustments. While only two-thirds of denials are recoverable, nearly 90 percent are preventable. MultiCare looked at improving denial management as an opportunity to improve appropriate revenue capture for services provided. Through targeted improvement efforts that included standardized workflows and increased data visibility, the health system is improving the root cause of denials.
$14.99M reduction in denials and avoidable write-offs.
Mixed reviews of the effectiveness of pay-for-performance programs leave hospitals wondering how to affect meaningful change in patient care and outcomes. However, MultiCare’s experience with focused improvement efforts supported by analytics for pneumonia, sepsis, and women’s care showed that better data consistently leads to better patient outcomes.
Committed to improving population health, and informed by their experience as well as national trends and outcomes, MultiCare formed a new partnership with Health Catalyst, a next-generation data, analytics, and decision support company. The shared risk partnership generated an improvement framework and governance structure formed around a Shared Governance Committee which is responsible for prioritizing, resourcing, and aligning improvement initiatives across MultiCare. The committee and the projects it ultimately approves are informed by data-driven opportunity analysis and ongoing analytics support. This partnership and structure have achieved the following:
Strategic alignment of outcomes goals across the organization.
Established an Analytics Center of Excellence.
Integrated financial data into outcomes improvement initiatives.
Nationally, approximately 700,000 hospitalizations occur each year with the principle diagnosis of Chronic Obstructive Pulmonary Disease (COPD), with one in five patients being readmitted within 30 days. Even with a national cost for each COPD readmission costing between $9,000 and $12,000, evidence-based measures that improve patient outcomes and decrease COPD readmissions are largely lacking.
When reviewing organizational performance for 30-day all cause readmission, MultiCare Health System identified COPD as one of the top two readmission diagnoses, along with a rate higher than expected. This prompted the organization to take action. MultiCare implemented a NOREADMITS bundle, using the Health Catalyst Analytics Platform and integrating performance measures for each element of the bundle, resulting in:
16.5 percent reduction in readmission rate.
Approximately 34 fewer patients with COPD readmitted each year, saving an estimated $360,000 annually based on national benchmarks.
95 percent of COPD patients were assessed for readmission risk.
Two-fold increase in COPD order set utilization.
One in three pregnant women give birth via cesarean section in the United States, which is more than double the rate the World Health Organization (WHO) recommends. And instead of decreasing, the overall C-section rate in Washington State increased 73 percent from 1996 to 2009. C-section rates are just one area of maternal care where our practice in the U.S. lags behind the science and knowledge of best practice. MultiCare Health System believes that all of its female patients should experience the same high-quality care across its integrated delivery system. The health of the next generation depends on it.
MultiCare recognized that it had to standardize care across its system to meet quality standards, improve its patients’ experiences and outcomes, and maintain its market share. The health system launched a Women’s Collaborative, the sole purpose of which was to improve clinical care and patient outcomes for women’s services systemwide.
By working with clinicians to implement standards of care, and using analytics to measure performance, the Women’s Collaborative achieved the following:
NTSV (low-risk, rst-time mother) C-section rate 9 percent less than the national average and already below the 2022 national goal of 23.9 percent
Six-point increase in market share for inpatient OB/GYN services
Improvements in care delivery:
63 percent reduction in episiotomy rate
11 percent reduction in SSI rate for C-sections
14 percent reduction in 3rd or 4th degree perineal laceration rate
Non medically indicated induction rate consistently less than a quarter of one percent
6.7 percent reduction in the percentage of abdominal hysterectomies
MultiCare Health System, an IDS serving communities throughout Washington State, recently undertook an initiative to improve the care of, cost of, and experience for pneumonia patients. This initiative included the building of evidenced-based order sets (and driving their adoption), assigning a team of social workers called “personal health partners” to research and improve patient follow-up and communication, and deploying an analytics application to provide near real-time feedback on compliance and performance while offering a single view of patient-specific data across multiple visits and care settings, such as medication and readmission histories. Through these efforts, MultiCare has realized significant outcome improvements including reducing pneumonia readmissions by 23 percent, a 28 percent reduction in mortality rate, a 2 percent decrease in LOS, and a 6.4 percent reduction in average variable cost per patient.
MultiCare, an integrated delivery system (IDS) in the Pacific Northwest, has established a Clinically Integrated Network (CIN) to serve as a model for value creation that benefits patients, providers, and payers. However, to create a truly integrated network, MultiCare needed to build a system of collaboratives—multidisciplinary, clinically focused teams charged with developing clinical care standards and pathways and then collaborating with operations to get them implemented across the enterprise—to improve outcomes in a growing range of clinical domains including Critical Care, Women’s, Surgery, Medicine, Cardiac, and Pediatric. The outcomes of this collaborative care include a 65 percent reduction in sepsis mortality rate, a 75 percent reduction in time required to approve system-wide care guidelines, and a significant contribution to a system-wide cost savings trajectory of more than $100 million over the last three years.
With nearly one in four Medicare patients hospitalized with heart failure (HF) being readmitted to hospitals within 30 days of discharge, healthcare organizations like MultiCare are primed to develop care improvement initiatives focused on reducing readmissions. MultiCare has had a HF collaborative for several years, focused on standardizing and increasing the quality of care for its cardiac patients—resulting in a 24 percent improvement in HF readmission rates and an 18 percent improvement in mortality rates. With this proven commitment to its patients, MultiCare was selected for participation in the American College of Cardiology’s Patient Navigator program, opening up the opportunity to provide cardiac patients with an advocate dedicated to helping patients navigate their pathway to improvement. Through participation in this patient navigator program, MultiCare has ability to further bring the patient’s voice to the forefront and improve its quality of cardiac care even more dramatically in the future.
Northwest healthcare organization Multicare reduced septecemia by 22 percent, leading to a $1.3 million cost savings in the same period. Now the organization is tackling other areas of improvement. Discover what triggered the improvements — and how these resulted in savings.