For healthcare organizations, the ability to analyze problems and implement timely, effective improvements is necessary to maintain a competitive advantage, requiring a consistent, systematic approach to introduce and implement change. By developing a new strategy focused on uniform adoption, education, and ongoing oversight, Community Health Network changed the way it approached all organizational improvement efforts.
Operations, Financial, & Workflow
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.
Operating room (OR) costs are substantial—time in the OR can cost between $22 and $133 per minute. Even a slight delay in start time can cost organizations hundreds of thousands, if not millions, annually. Learn how John Muir Health utilized analytics in the OR—giving the organization the ability to access the data it needed to educate staff on the reasons behind delays so that start times could be improved.
Offering a competitive healthcare plan for employees is a business essential, and a differentiator for organizations to attract top talent, but as healthcare costs continue to rise, employers are increasingly challenged to offer affordable employee healthcare with extensive benefits. Learn how Health Catalyst embraced self-insurance to take the management of its healthcare costs and benefit design into its own hands.
Read how Allina Health is transforming healthcare by embracing a vision of the future where 100 percent of healthcare services add value, and everyone has access to quality, compassionate care. Utilizing data and analytics to drive its improvement efforts, the health system has continued to improve and sustain outcomes.
Read how UnityPoint Health leveraged information from a readiness assessment, an opportunity analysis, and expert resources, enabling the organization to establish a prioritization and implementation strategy to drive outcomes improvement and reduce clinical variation.
An efficient accounting closing process delivers timely and accurate information to guide decisions and operational adjustments. Learn how UPMC implemented an analytics-driven cost management system, supporting a 50 percent reduction in the time needed to complete month-end close.
Healthcare is undergoing a significant transformation, requiring an objective way for organizations to understand its strengths and weaknesses relative to outcomes improvement and readiness for change to improve patient outcomes. Read how UnityPoint Health utilized an outcomes readiness assessment tool to successfully identify its competency levels, providing a clear direction for its improvement efforts.
To succeed as a coordinated care organization and better serve its Medicaid population, Health Share of Oregon leveraged analytics to obtain a holistic evaluation of the drivers of per member per month payment performance.
Providing and documenting best practice preventative and primary care measures is critical for MSSP success. Read how USMM integrated data from disparate sources and utilized its analytics platform and applications to achieve 80th and 90th percentile performance for various ACO measures, resulting in significant contributions to Medicare savings.
It is estimated that $25 to $45 billion is spent annually on avoidable complications and unnecessary hospital readmissions—the result of inadequate care coordination and insufficient management of care transitions. By implementing care coordination programs and leveraging its analytics platform, the University of Texas Medical Branch reduced its readmission rate and achieved significant cost avoidance.
Improving Accuracy of Clinical Documentation Positively Impacts Risk Adjustment Factor and HCC Coding
Improving accuracy of clinical documentation can impact risk adjustment factor and HCC coding, significantly enhancing reimbursements for health systems. Read how Allina Health leveraged its analytics platform and applications to help improve HCC coding efforts and more accurately reflect patient complexity.
To address physicians’ concerns with value-based care requires timely and actionable data for generating insights and initiating improvement programs. Read how Acuitas Health utilized its analytics platform to support the development of practice intelligence profiles—comprehensive views of partner practices used by the practice intelligence team to increase provider engagement and strengthen improvement efforts.
Unwarranted variation in clinical care is costly, representing as much as $30 million of actionable savings opportunity for a typical organization. Allina Health launched its Clinical Value Program—a systemwide effort to measure and improve clinical value. The program quantifies the value of clinical change work to improve outcomes while reducing costs and increasing revenue for reinvestment in care.
Activity-Based Costing and Clinical Service Lines Team up to Improve Financial and Clinical Outcomes
Cost challenges in healthcare are threatening the future of many healthcare organizations and their ability to effectively care for patients. Read how UPMC took on these challenges by partnering activity-based costing and service line operations to gain insight into cost and clinical variation.
Financial challenges rank as the number one issue hospitals face. As a result, these organizations are constantly looking for strategies to improve outcomes, manage costs, and boost revenue. Learn how Thibodaux Regional Medical Center sustained and improved its discharged not final billed (DNFB) efforts.
Hospital readmissions carry significant financial costs and are associated with negative patient outcomes. With the help of data analytics, Mission Health developed its own predictive model for assessing readmission risk, aimed at preventing readmissions and improving outcomes for patients.
Growth in the government payer mix and an increased cost burden to the commercial population, decreases in the private payer population, and programs like the Medicare Shared Services Program, have caused joint ventures, partnerships, and co-branding efforts, better known as at-risk contracts, between payers and providers to increase.
Allina Health has three Integrated Health Partnership (IHP) contracts, an accountable care model that incentivizes healthcare providers to take on more financial accountability for the cost of care for Medicaid patients, which cover approximately 90,000 members. To achieve success in its IHP contracts, and avoid losses, Allina Health needed to reduce healthcare costs while improving patient outcomes and experience.
Allina Health has integrated several data sources, including claims and developed the infrastructure required to perform opportunity analysis. Using data and analytics for opportunity analysis has given Allina Health insight into its IHP patient population, supporting the development of interventions to decrease the total cost of care and improve outcomes.
CMS denies nearly 26 percent of all claims, of which up to 40 percent are never resubmitted. The bane of many healthcare systems is the inability to identify and correct the root causes of these denials, which can end up costing a single system tens of millions of dollars. Yet almost two-thirds of denials are recoverable and 90 percent are preventable.1 Despite previous initiatives, The University of Kansas Health System’s denial rate (25 percent) was higher than best practice (five percent), and leadership realized that, to provide its patients with world-class financial and clinical outcomes, it would need to engage differently with its clinical partners.
To effectively reduce revenue cycle and implement effective change, The University of Kansas Health System needed to proactively identify issues that occurred early in the revenue cycle process. To rethink its denials process, it simultaneously increased organizational commitment, refined its improvement task force structure, developed new data capabilities to inform the work, and built collaborative partnerships between clinicians and the finance team.
As a result of its renewed efforts, process re-design, stakeholder engagement, and improved analytics, The University of Kansas Health System achieved impressive savings in just eight months.
$3 million in recurring benefit, the direct result of denials reduction.
$4 million annualized recurring benefit.
Successfully partnered with clinical leadership to transition ongoing denial reduction efforts to operational leaders.
Data-driven decisions and analytics are critical for organizations and physician practices transitioning to value-based care, although many organizations struggle with measuring the effectiveness of these population health initiatives.
To obtain sophisticated, actionable analytics and automate processes, Acuitas Health deployed the Health Catalyst® Patient Intake and Care Coordination applications concurrent with beginning the implementation of the Health Catalyst Data Operating System (DOS™) platform. Acuitas meets the needs of its customers through a sprint to value—going faster than the typical time to value. The concurrent implementation approach used in this roll out set the pace for that sprint to value. In less than 60 days, the organization successfully implemented these tools and began receiving value. Acuitas is now able to:
Collect discrete data, and begin enhancing the work of the integrated care management team in a user-friendly way.
Identify individual caseloads.
Instantly obtain a complete, comparative, real-time picture of caseloads across the team—this reporting took weeks to compile in the past.
Make data-driven decisions on how to improve outcomes.
Every three seconds, someone in the United States will need a blood transfusion, which adds up to nearly 17 million blood components transfused annually. Yet, evidence shows that up to 60 percent of red cell transfusions may not be necessary. In 2011, Allina Health, a healthcare delivery system that serves Minnesota and western Wisconsin, had a wide variation in transfusion practices throughout the system and a transfusion rate that was 25 percent above national benchmarks. In an effort to improve outcomes of high-risk transfusions, Allina Health turned to its data to develop an evidence-based blood conservation program aimed at reducing costs and saving valuable blood resources.
$3.2M decrease in annual blood product acquisition costs since 2011
30,283 units saved annually
111 units of red cells saved per 1000 inpatient admissions
Publicly reported measures of healthcare quality includes the Hospital Safety Score Grades which award a letter grade representing performance for 30 evidence-based measures of patient safety. An “A” represents the best Hospital Safety Score, followed in order by “B,” “C,” “D,” and “F.” In the fall of 2014, Piedmont’s Hospital Safety Score Grade for its five hospitals included four “C’s” and a “D.” This demonstrated a need to change its approach to quality improvement and ensure proper resources were allocated and aligned with the value chain, enabling it to efficiently conduct surveillance activities, perform analysis, and facilitate sustained outcomes improvement.
To increase capacity for performing more value-added work, Piedmont leveraged its analytics platform to automate surveillance activities and monitor the effectiveness of quality improvement efforts. These tools helped Piedmont redesign its quality improvement efforts, resulting in a:
35 percent relative reduction in healthcare facility acquired infections per patient day.
50 percent reduction in the time required for peer review.
50 percent reduction in the time to implement improvement projects.
Today’s healthcare industry, in which a lack of insight into clinical variation has contributed to increased expenses, has significant opportunities to use data and analytics to improve outcomes and reduce costs. As part of its ongoing commitment to improve clinical value, Allina Health has employed a systemwide process to identify, measure, and improve clinical value. The health system has been able to quantify the value of clinical change work to improve outcomes, while reducing costs and increasing revenue for reinvestment in care.
Allina Health achieved the following meaningful results with this collaborative, data-driven opportunity analysis process:
Identified nearly $33 million in potential cost savings for the first three quarters of 2017.
Achieved over $10 million of confirmed savings during the first three quarters of the year.
Elevated discussions of cost concerns, leading to the development of standard processes, and significantly reducing unwarranted clinical variation.