Advanced payment models incentivize Accountable Care Organizations (ACOs) to deliver high-quality care and close gaps in care for members, thereby earning shared savings and increasing profits. However, in order to succeed and identify gaps in care, ACOs must be able to rely on solid data and analytics to avoid losing income that could be invested back into patient care. Utilizing its analytics platform and a quality measures solution has allowed Hospital Sisters Health System to close care gaps, improve ACO quality measures performance, and enhance reporting accuracy and effectiveness.
Smartsourcing Clinical Data Abstraction Improves Quality, Reduces Costs, and Optimizes Team Member Engagement
Health Catalyst smartsourced two of its clients’ clinical chart abstraction efforts to significantly reduce costs, improve value, and optimize team member engagement. Banner Health and Community Health Network (CHNw) were collectively spending more than $10 million annually to manually abstract clinical measures for submission to CMS, NSQIP, tumor registries, and more than a dozen cardiovascular registries. The smartsourced relationship, leveraging the Health Catalyst® Data Operating System™ platform and a robust suite of analytics applications and improvement services has reduced costs, enhanced data quality, and improved the team member experience for these organizations.
On average, claim denials cost each healthcare provider $5 million every year. This loss of revenue resulting from claim denials is a concern for healthcare providers. Billings Clinic sought to determine the cause of claim denials and realized that it needed an analytics solution that could integrate data from multiple sources. The health system leveraged its data platform and analytics applications to pinpoint the sources of the denials, allowing the organization to implement prevention plans and procedures for recovering the denials. Billings Clinic achieved significant results, including:
Acuitas Health was challenged to identify opportunities for shared savings, reducing cost while also improving quality outcomes. Using Acuitas Health’s advanced analytics, providers and payers can now connect, communicate, and share insights that enable the organizations to identify opportunities to decrease costs for all partners, and increase outcomes that yield benefits in several areas, including quality improvement, claims optimization, and risk adjustment.
UC San Diego Health sought to transform its organization, expanding beyond fee-for-service, transitioning to value-based care, and improving the health of its patient population—forming its Medicare Shared Savings Program (MSSP) ACO. It realized it needed a better understanding of its organizational strengths, opportunities for improvement, and needed actionable, timely data that would enable it to improve outcomes, reduce waste, and succeed in value-based care. The organization leveraged an analytics platform to give insight into performance and improvement opportunities, educating and engaging ACO providers.
The amount of time a patient may have to wait for a scheduled appointment at Texas Children’s Hospital varied greatly as a result of a lack of standardized processes. After taking a deeper look at its scheduling process with the help of analytics, it was able to develop an improvement strategy aimed at improving access to care—enhancing patient care and boosting revenue.
Banner Health identified considerable variation in surgical supply use across its facilities. The health system desired a collaborative, data-driven strategy that would allow it to maintain high-quality outcomes while simultaneously decreasing costs across all procedures systemwide. To standardize supply use, Banner Health implemented an analytics application to help identify high-volume, high-cost surgical procedures that varied across the system. It then built standardized surgical preference cards for the high-volume procedures.
Community Health Network (CHNw) rapidly adjusted to COVID-19, changing primary care appointments to virtual care. With this change came the need for new data and analytics to assess the impact on the number of completed appointments, and the implications for provider productivity and reimbursement rates. CHNw is using data and analytics to effectively manage the transition from in-person visits to virtual visits, safely meeting patient needs while also ensuring ongoing financial viability.
Community Health Network (CHNw) desired to understand the financial, provider, and overall impact of COVID-19 related declines in elective surgeries. The data needed to understand the impact and prioritize the organization’s elective surgery restart plan resided in disparate systems, requiring hundreds of hours of manual data review. Using data and analytics, CHNw is able to plan how to optimally meet its patients’ needs and effectively recover from COVID-19 revenue loss.
Memorial Hospital at Gulfport (Memorial) knew that decreasing clinic no-show rates was an opportunity to increase revenue, eliminate delays in care, and improve care coordination for its patients. With a robust data platform, Memorial leveraged its data and analytics to better understand the reasons behind its high no-show rates. With actionable data, the organization implemented measures to effectively improve its no-show rates and increase revenue.
Community Health Network identified that inconsistent oversight of durable medical equipment (DME), and process variation, were a likely source of waste and lost revenue. The health network sought a systemwide, data-driven process for the purchasing, dispensing, and billing of DME. A data platform and analytics applications were utilized to understand organizational performance, identify opportunities for improvement, and evaluate the impact of these changes on patient, financial, and organizational outcomes.
MultiCare Health System’s Pulse Heart Institute (Pulse Heart) recognized that better care coordination was required for patients receiving cardiac, thoracic, and vascular care. The organization wanted to further improve quality outcomes, provider engagement and recruitment, and its own economic health. To meet these objectives, Pulse Heart focuses on clinician engagement and organizational alignment, ensuring widespread access to meaningful, actionable data and analytics to inform decisions and drive improvement.
OneCare Vermont, an accountable care organization (ACO), is focused on reducing costs by reforming payment models. As the organization methodically and rapidly moves toward value-based payments, it is challenging current delivery methods and seeking to engage providers and patients in new care models. To be successful, OneCare needed to implement strategies to effectively drive change. With robust data analytics, it was able to prioritize opportunities for improvement and ultimately change the way care is coordinated and delivered throughout its network. Results include nearly $20M in positive, value-based financial results in just one year.
Albany Med’s clinical documentation improvement specialists provide high-quality care to complex, acute-care patients; however, Albany Med was experiencing lower reimbursement rates due to gaps in clinical documentation. The organization created a seamless process for clinical documentation with the use of an analytics application as driven by clinical leadership.
To gain more efficient access to data that could reduce unwarranted variation and reduce costs, Dartmouth-Hitchcock Health (D-HH) leveraged a data platform to automate analysis of its financial data. D-HH has substantially improved its ability to use clinical, operational, and financial data to perform opportunity analysis, decrease unwarranted variation, and decrease costs.
Managing and retaining a talented workforce represents approximately 60 percent of hospital costs. In an effort to improve staffing efficiency, Hawai‘i Pacific Health (HPH) sought to realign its staffing practices to better manage and predict its labor needs. Utilizing its data platform and analytics, HPH was able to forecast its workforce needs and effectively manage staff schedules—two changes that led to significant cost savings.
Dartmouth-Hitchcock Health (D-HH) was committed to improving its provider performance reporting method so that providers could easily access their performance data and deliver better care to patients. With the right analytics, D-HH was able to implement an affordable solution and reduce the manual reporting required by its financial analysts.
Actionable Analytics Enables Improved Care, Reduced LOS, and Costs in Patients with Traumatic Brain Injury
To provide high-quality, cost-effective care to patients with traumatic brain injury (TBI), Mission Health needed insight into individual patient and provider performance data. Without access to accurate data, Mission couldn’t accurately pinpoint patient outliers, understand causes of TBI, and identify opportunities to improve TBI patient care. By utilizing its data platform and analytics accelerators, Mission was able to utilize patient data to identify patients suffering from TBI.
Annually, U.S. hospital supply chain overspend costs an estimated $25.4 billion, which represents 30 percent of all hospital spending. Utilizing data and analytics, Hawai’i Pacific Health gained a deep understanding of its supply chain processes and data, allowing it to improve and maintain the reliability of this information, leading to meaningful and sustained improvements across the system.
Community Health Network (CHNw) was keenly aware of the needs of the elderly population in its communities of impact. However, despite the development and implementation of a successful geriatric program, the organization lacked access to, and visibility of, meaningful data to quantify program outcomes. The CHNw Geriatric Evaluation and Management (GEM) team used an analytics application to demonstrate the sizeable, positive impact of the GEM team care and interventions on both patient and financial outcomes:
With patients responsible for an increasing amount of their healthcare costs, self-pay accounts are now the top contributor to bad debt for hospitals and health systems—accounting for more than $55 billion annually. Allina Health partnered with Health Catalyst, using catalyst.ai™, to create a predictive model that could successfully support a propensity to pay strategy.
Increased Visibility into Value-Based Performance Results in $2.1M in Additional Pay for Performance
Data-driven decisions and analytics are critical for organizations and physician practices attempting to thrive under value-based care. With the help of data analytics, UTMB Health was able to focus on improvement efforts for specific patient populations and boost reimbursement based on DSRIP performance.
Learn how Allina Health leveraged its analytics platform and Health Catalyst professional services to perform an analysis demonstrating the impact of pharmacist-led medication therapy management (MTM).
By leveraging data from its analytics platform along with a risk predictive model to identify patients who would benefit from its home-based palliative care, Partners HealthCare has improved the end of life care for patients and reduced costs.
Five percent of patients account for half of healthcare spending in the U.S., and patients with multiple chronic conditions cost up to seven times more than those with only one. Read how Partners HealthCare has maintained its integrated care management program (iCMP) and is continuing to decrease costs while improving outcomes.