Operations, Financial & Workflow

Success Stories

Clinically Meaningful Quality Metrics Improve the Provider Experience

Nearly half (46 percent) of all physicians report that they suffer from burnout, citing too many bureaucratic tasks as one reason. Providers want to find meaning in their work, and improvement on many current quality metrics do not predict better patient outcomes or experience of care. They are looking for tools to reduce their workload and improve their ability to provide excellent care, including having metrics and registries that are meaningful and informative.
Faced with the challenge of making quality measures meaningful, Partners HealthCare worked to redefine measures to be more relevant, create point-of-care registries to manage an all-payer population, created teams of Population Health Coordinators to support front-line teams in managing the registries, and used its analytics platform to monitor change and explore provider variation in order to improve quality. This resulted in:

85 percent of clinicians surveyed felt that the new metrics helped them take better care of their patients.
Quality improved at an unprecedented rate on an all-payer population 5 times bigger than the standard P4P population.
Near real-time measurement using clinical data eliminated months-long delays, while run charts and provider and clinic-comparison views turbo charged quality improvement.
125 percent increase in user adoption of the analytic tool (99 unique users, 674 unique sessions, and rising).

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Using Analytics and Technology to Improve the ED Patient Experience

Substantial evidence indicates a correlation between a patient’s experience in a healthcare setting and adherence to medical advice, appropriate use of healthcare services, and clinical outcomes. Many organizations evaluate patient experience using Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey scores.
Mission Health’s patient experience survey scores in the emergency department (ED) were significantly lower than desired. Extended wait times negatively impact patient experience and perceptions of quality of care.
To improve the wait-time experience, Mission changed to a quick registration process, implemented patient notifications via text messaging, and began notifying patients of anticipated delays due to volume surges, thus better managing expectations. Text messaging also improved patient privacy, as did remodeling the waiting room to create a private registration area.
In just over a year, Mission’s ED achieved the highest patient experience ratings it had ever received:

Threefold improvement in patient ranking of:

Overall quality of care.
Provider communication.

29 percent relative reduction in time from discharge order to patient discharge.

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Quick Registration Dramatically Reduces Delays in ED Patient Care

Patient registration is an essential step in the emergency department (ED) workflow—it is required to initiate EHR documentation and impacts patient safety. Correctly identifying patients during registration is critical, as caregivers use historical data in the EHR to make treatment decisions.
Mission Health, as part of its ongoing performance improvement work, discovered that its registration process was lengthy—patients were waiting in line for as long as 15 minutes to be checked into the ED to receive treatment.
To improve its registration process, Mission implemented a quick registration process (e.g., asking fewer questions upon patient presentation at the ED) based on frontline staff feedback that, in a little over one year, dramatically reduced delays in ED patient care:

70 percent relative reduction in the time to complete registration, with current performance under one minute.
33 percent relative improvement in time from patient arrival to triage start time.
24 percent relative reduction in median length of stay (LOS) for discharged patients, 15 percent relative reduction for admitted patients, and 42 percent relative reduction in median LOS for behavioral health patients.

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A Data-Driven Systems Approach to Improving Emergency Care

Health systems can directly impact the quality of emergency department (ED) care by reducing the time patients wait between arrival and seeing a qualified medical professional. Long ED wait times can reduce patient satisfaction and put patients at risk.
Mission Health determined that patients in its ED often waited more than 50 minutes to receive qualified medical care. To decrease this wait time, the hospital system sought to improve its ED patient flow. Using data-driven insights provided by use of its analytics platform, Mission could visualize each portion of the ED patient flow, enabling the improvement team to identify and respond to opportunities for process improvement.
Using this strategy, Mission achieved the following:

89 percent relative reduction in the rate of patients who left without being seen (LWBS), resulting in the current performance of 0.4 percent.
29 percent relative reduction in the time from discharge order to ED departure time.
24 percent relative reduction in the median length of stay (LOS) for patients who are discharged.

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Readiness Assessment Crucial First Step in Building an Outcomes Improvement Focused Organization

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
Analytics
Best practices
Adoption
Financial Alignment

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Clinical Data Abstraction as a Service Improves Accuracy and Efficiency

Allina Health needed to ensure the data it reported to regulatory agencies was timely and accurate. The integrated health system sees 100,000 inpatient hospital admissions annually, 340,000 emergency care visits, and 6,000 physicians and 1,600 nurses providing and documenting care. Due to the sheer volume of patients and employees, clinical data abstraction at Allina Health is not a small undertaking.
Looking to stay compliant while reducing resource utilization, Allina Health sought to change its workflow procedures for faster, more accurate clinical data abstraction. A large amount of clinical data required for compliance with CMS performance measures and Joint Commission Core Measure resides in unstructured data, such as narrative notes, which require manual data abstraction. With the help of data analytics, Allina Health was able to develop evidence-based standardized processes for clinical reporting and automate some clinical data abstraction.
Results:

76 percent relative improvement in time to data availability at each site. Data is typically available within 14 days of discharge, far exceeding the 30-day target.
95.5 percent accuracy for CMS validation.

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Denial Managements Improvement Effort Produces $14.99M Reduction in Denials

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.
Results:

$14.99M reduction in denials and avoidable write-offs.

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Improving the Transparency of Physician Compensation in Value-Based Care

Healthcare reimbursement continues to shift away from fee-for-service reimbursement models to value-based, risk-sharing agreements. This shift has resulted in organizations revising compensation strategies to engage physicians in value-based compensation arrangements. An effective value-based physician compensation plan is critically important, particularly in competitive environments where organizations must optimize the ability to recruit and retain highly skilled providers. One commonly used physician compensation approach includes a base salary and productivity incentives, coupled with additional compensation opportunities for achieving quality and service goals. The physician compensation package at John Muir Health is not only competitive, it is also complex, but the support process was burdensome, inefficient, and lacked transparency.
John Muir Health developed a plan to leverage the Health Catalyst® Analytics Platform, including the Late-Binding™ Data Warehouse and broad suite of analytics applications, to develop an automated process for physician compensation. The plan created efficiencies in time and effort across multiple domains and produced software to automate future work. The benefits included:

Saving 1,560 hours of time required to produce the data necessary to calculate physician compensation.
Successfully integrating more than ten different compensation models and 20 different data elements for more than 300 different providers into the physician compensation analytic application, automating the process.

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MultiCare’s Transformational Journey Toward Sustained Outcomes Improvement

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:
Results

Strategic alignment of outcomes goals across the organization.
Established an Analytics Center of Excellence.
Integrated financial data into outcomes improvement initiatives.

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How Allina and Minnesota Perinatal Physicians Lowered Stress and Raised Satisfaction for High Risk Maternal Patients

Assuring patient satisfaction can be challenging, particularly when providing care to pregnant women with high-risk pregnancy conditions. As one of the foremost perinatal practices in the country, Minnesota Perinatal Physicians (MPP) acted swiftly to end a significant delay in scheduling ultrasound appointments, and reduced wait times for other visits.
With an aim to improve patient care and experience, the maternal fetal medicine (MFM) specialists at MPP, employees of Allina Health, leveraged Allina’s “Improving Clinical Value” Program—an initiative that has elevated the patient care experience for numerous other patient populations while simultaneously lowering the per capita cost of care for each one.
Results:

$210,000 in increased revenue because of improved access, projected to be $280,000 within 12 months.
20.8 percent relative improvement in no-show rate.
20 percent increase in available ultrasound appointments and an 18.2 percent increase in utilization.

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Data-Driven Clinical Documentation Improvement Program Increases Revenue and Improves Accuracy of Risk Adjusted Quality Metrics

Allina Health, an integrated delivery system throughout Minnesota and western Wisconsin, has long understood the value of clinical documentation improvement (CDI), and its growing importance in recent years. With the implementation of ICD-10, the specificity needed for accurate coding has increased, and reimbursement shifts have occurred as well, creating sizeable payment disparity for some clinical conditions. Leaders at Allina wanted to understand where their CDI program would have the greatest return on investment. However, data from the EHR was not sufficient to inform their strategy. CDI specialists still lacked the ability to perform a comprehensive assessment of the accuracy of clinical documentation, and were unable to confidently target improvement efforts in areas that would generate the greatest return on investment. To take a more data-driven approach, team members leveraged the Health Catalyst Analytics Platform, including their Late-Binding™ Data Warehouse and broad suite of analytics applications to develop a CDI analytics application. With the application, the team identified opportunities and thoroughly vetted them, before collaborating with physicians and service line leaders to educate providers on documentation improvements.
They achieved the following results:

12.1 percent improvement in CV surgical cardiology CC/MCC capture rate.
6.3 percent increase in medical cardiology CC/MCC capture rate.
Increased accuracy in publically reported risk adjusted quality metrics
Revenue capture improvement across the system – resulting in millions of dollars of additional reimbursements.

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Mission Health Receives 100 Percent of At-Risk Dollars in Payer Incentive Program

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement.  The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.
Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract.  The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.
Results:

Achieved 100 percent of all at risk dollars.
100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.

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How to Significantly Reduce Inpatient Admission Times and Improve Patient Satisfaction

Admitting a patient to inpatient care is a complex process that, unless carefully managed, can lead to long delays in service and a poor patient experience.
Thibodaux Regional Medical Center’s consistent focus on patient satisfaction has earned the 185-bed community hospital, located one hour southwest of New Orleans, the Healthgrades® Outstanding Patient Experience Award™ every year since 1998. Not surprisingly, when Thibodaux leadership recently analyzed the hospital’s inpatient admit process, they did so from their patients’ point of view and determined to cut admission wait times. Using focused process improvement methodologies, areas of waste were uncovered, exposing problems such as redundant data collection, and inconsistent processes, which would require innovative solutions.
Integrating concepts from the Health Catalyst improvement methodology into its own Lean Six Sigma processes, and with the support of professional services from Health Catalyst, Thibodaux deployed a systematic set of solutions to significantly improve the admission process.
Thibodaux’s efforts are driving measurable improvements in the hospital’s inpatient admission process, including:

55 percent reduction in average inpatient admission time
Ranked 99th percentile for patient experience

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From the Boardroom to the Bedside—Using Analytics to Drive a Culture of Continuous Improvement

Tracing its roots back nearly 120 years, Mission Health has a vision to provide world-class care to western North Carolina and beyond—even as the entire healthcare profession experiences a disruptive upheaval. Mission determined to meet these external changes by making a big change of its own: embracing a culture of continuous improvement.
Mission subsequently engaged physicians and other clinicians to increase process improvement skills, while expanding access to meaningful data via an analytics platform from Health Catalyst.
Results:

20 percent improvement in compliance with severe sepsis; 32 percent reduction in mortality rates; 58 percent increase in sepsis detection.
7 percent reduction in LOS for bowel surgery patients.
34 percent improvement in heart failure LVEF assessment rates.
20 percent increase in “on time” starts as result of OR dashboard.

 

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Using Value to Prioritize and Guide Analytics Investments

With the advent of analytics, hospitals have new access to high quality, reliable data. In turn, this can fuel any number of outcomes improvement projects, but hospitals have finite resources to expend on these initiatives. A process is needed to identify which ones will deliver the highest value and best align with the hospital’s overarching priorities.
To balance the demand for analytics support of improvement projects Mission Health designed a prioritization tool that has helped them identify the right projects to approve–while keeping stakeholders more engaged than ever in improving outcomes for patients.
To date, 80 percent of 55 approved projects have met or exceeded their initial targets. Actual realized targets include:

32 percent reduction in sepsis mortality
20 percent improved compliance with the sepsis care process
7 percent reduction in LOS for bowel surgery patients

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Data-Driven Approach to Improving Cardiovascular Care and Operations Leads to $75M in Improvements

Health spending in the United States is greater than the gross domestic product of most nations, and the costs for cardiovascular disease (CVD) and stroke care alone total $193.1 billion. CVD accounts for approximately one out of every three deaths in the U.S. and contributes to the shorter life expectancy of Americans. Thirty-five percent of CVD related deaths occur before the age of 75 years, and 19 percent before the age of 65.
Allina Health is a large integrated healthcare delivery network operating in Minnesota and western Wisconsin that includes three large cardiac centers. Due to the prevalence and mortality rate of CVD, leaders at Allina Health recognized that they needed to focus on cardiovascular health in order to truly impact the population health and patient outcomes of the communities they serve.
By leveraging real-time data from its enterprise data warehouse (EDW), Allina Health effectively identified and addressed clinical practice variation and operational issues affecting cardiovascular care and costs. In doing so, the health system realized more than $75 million in performance enhancement savings and revenue increase over a four-year period by focusing on supply chain, lab test and blood utilization, clinical practice changes and clinical documentation improvement.
 

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Service Lines and Activity-Based Costing Reveal True Cost of Care for UPMC

Between 2007 and 2014, U.S. healthcare costs per capita increased by almost 25 percent. The way in which health systems are typically organized, managed, and budgeted (as departments and units within separate hospitals) works against them when they attempt to improve population health and decrease costs. The University of Pittsburgh Medical Center (UPMC), a large health system with more than 20 hospitals and 500 clinics, was keenly aware of this challenge as it embarked on population health and value-based care initiatives that spanned the entire organization.
The health system determined that it needed to break down the virtual walls between care centers and standardize service lines across the enterprise. By extension, this organizational change mandated the need for activity-based costing in healthcare that would deliver the insight necessary to run a service line effectively. UPMC organized six service lines within the health system, each spearheaded by clinical, operational, and financial leadership. Each service line uses the health system’s innovative, data-driven activity-based costing methodology to understand the true cost of care.
Notable, measurable results of UPMC’s service lines and activity-based costing methodology to date include:

$42 million of cost reduction opportunities (approximately 2 percent of targeted service line cost)
$5 million in supplies savings
Transparency toward identification of contribution margin variation for specific procedures
Up to 97 percent improvement in time to access information

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How to Reduce Clinical Variation and Improve Outcomes While Demonstrating a Positive ROI

Clinical variation can be frustrating for patients and their families, often leaving the impression that healthcare team members are not on the same page and don’t agree on the plan for the patient’s diagnosis or treatment. It is also costly—the Institute of Medicine estimates that $265 billion (30 percent) of healthcare spending is waste that directly results from clinical variation.
To reduce unwanted variation, Texas Children’s Hospital invested considerable resources to develop clinical standards tools, including evidence-based order sets; however, demonstrating the effectiveness and utilization of those guidelines, pathways, and order sets had been daunting. To that end, Texas Children’s deployed an analytics platform from Health Catalyst to aggregate and analyze the data needed to perform both of these critical functions.
Results:

$2,401 reduction in cost per patient with order set utilization, and an 8.4-day difference in average length of stay (LOS).
$15 million reduction in total direct variable costs in Fiscal Year 2015, $32 million anticipated reduction in Fiscal Year 2016 at the current order set usage rate, and a potential $64 million annual reduction with a hypothetical 80 percent order set usage rate.
1,629 percent return on investment (ROI).

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How One Hospital Embraced Patient Satisfaction Transparency

As consumers pay more for their healthcare they are demanding more transparency. In a telling example, it’s estimated that over 84 percent of patients use online provider reviews to help make care decisions. With increased transparency, hospitals need to develop strategies to address patient satisfaction while finding a way to participate for more fully in the patient satisfaction dialogue and social media communications, including the rating process.
One large hospital has done just that by increasing transparency in the patient review process. A key component is providing physician star ratings by patients on the hospital’s own website, with patient survey data sourced from Health Catalyst’s analytics platform. While this strategy took time and effort to win over physician acceptance, it has paid off considerably by taking patient satisfaction to new heights.
The overall patient satisfaction improvement initiative, of which the physician transparency effort was a key component, has proven to be resoundingly successful in supporting physicians and staff in the difficult work of providing outstanding and compassionate care – and has reaped impressive results including,

Improved patient satisfaction scores from 60 percent to over 90 percent
Successfully implemented a physician mitigation strategy with a 98 percent comment acceptance rate
Intensified focus on the patient experience through data and education

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Patient-Centered LOS Reduction Initiative Improves Outcomes, Saves Costs

U.S. hospital stays cost the health system at least $377.5 billion per year. In today’s value-based care environment, hospitals are under increasing pressure to avoid patient harm and maintain quality while also lowering costs. Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals.
El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. However, when it came to its goal of reducing LOS, leaders recognized that they faced some major challenges, including:

The complexity of implementing a multi-layered, multi-disciplinary approach to improving the patient discharge process.
Identifying what issues were contributing the most to increased LOS so that they could be addressed.

By implementing analytics and protocols that provide access to actionable data, the LOS reduction team was able to identify patients at high risk for increased LOS so that they could develop and track critical interventions. El Camino’s patient-centered approach to tackling LOS reduction also included multi-disciplinary cooperation, leadership buy-in, and additional resources to enhance discharge care coordination.
This innovative, systematic approach resulted in not only a better than anticipated reduction in ALOS of 7.8 percent, but also:

14.8 percent reduction in readmissions
55 percent reduction in healthcare acquired conditions (HACs)
32 percent reduction in incidence of AHRQ patient safety indicators (PSIs).
$2.2 million projected annual cost savings

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How One Hospital Took the Pain Out of Getting Paid

A hospital’s core mission is to provide the best care possible. To continue to do so, however, hospitals must be paid promptly. Discharged not final billed (DNFB) cases—where bills remain incomplete due to coding or documentation gaps—represent an ongoing challenge for hospitals around the country.
Thibodaux Regional Medical Center, like other hospitals, faces a myriad of new government regulations that have made hospital bill collection efforts more onerous. Its leaders recognized their inadequate manual DNFB process left hospital staff overburdened and put at risk the necessary cash flow to best serve patients.
The hospital automated and streamlined this process to relieve the burden on physicians, provide an integrated view of data, optimize visibility and workflow, and reduce the need to “downcode” reimbursements due to missing documentation. The hospital leveraged analytics to provide actionable feedback to continuously improve the process.
Thibodaux has already achieved significant improvements to cash flow and operational efficiency:

44.4 percent improvement in delinquency rate
8.2 days reduction in A/R days
70.5 percent decrease in the number of billhold accounts outstanding
50 percent decrease in physician portion of DNFB dollars
97 percent improvement in operational efficiency

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A Care Model to Support the Needs of Medically Complex Patients

People with disabilities face daunting challenges in accessing basic healthcare. As a result, they frequently use hospitals and emergency rooms, and are four times as likely to be hospitalized compared to the general population.
Allina Health has deployed an effective “primary care medical home” model that gives patients with disabilities the care and support they need outside of the hospital setting. Key strategies of the model include assigning dedicated care coordinators to each patient; strengthening care coordination across the continuum of services; and an analytics platform from Health Catalyst to target opportunities for improvements and savings.
Allina’s data-driven efforts to strengthen care of patients with disabilities have made a clear and meaningful impact; most importantly, on patient outcomes. They have achieved: 30% reduction in hospitalizations and 66% reduction in hospitalization days; 79% reduction in 30-day readmissions days; significantly improved access to care; and saved $4.5 million over a one-year period.

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Reduce Readmissions with Predictive Analytics and Process Redesign

With nearly 20 percent of elderly patients released from a hospital being readmitted within 30 days, Allina Health is focused on providing patients optimum care and support post discharge to minimize readmissions. Focusing on 30-day potentially preventable readmissions (PPRs) as its global outcome measurement, Allina Health used key clinical variables to derive the clinical relationships between hospitalizations that determine PPRs. It further built analytic capabilities to identify opportunities for improvement in care management and to test quality improvement ideas.
Allina Health’s multipronged solution included redesigning care management processes, implementing predictive analytics to identify at-risk patients, using analytics to measure the impact of its interventions, and educating patients, families, and clinicians.
These efforts are driving measurable improvements including: 10.3 percent overall reduction in PPRs, 27 percent reduction in PPRs for patients with clinic follow-up within 5 days, and $3.7 million reduction in variable costs due to avoided readmissions.

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Calculating the ROI of Diabetes Care Improvement

Texas Children’s Hospital has dedicated itself not only to successfully improving diabetes mellitus (DM) outcomes, but also to developing a framework for measuring the ROI of its performance improvement efforts. Texas Children’s tackled its DM initiative with a combination of technology investments and new organizational models, including an enterprise data warehouse (EDW) and analytics platform, a clinical care process team model for improving the quality and cost of care, and a diabetic care unit (DCU) staffed by a highly specialized, highly trained group of providers. Health system leaders also worked with the business school at Rice University to develop a model for measuring ROI that focused on easily quantifiable drivers. The results of this effort include substantially improved quality of care for DM patients, an increase in net revenue by a projected $232,000 annually, and an estimated ROI of 53 percent.

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Allina Health’s Dedication to Quality Improvement Delivers On the Triple Aim

Improving clinical outcomes is good for patients and good for health systems. In fact, Allina Health’s focus on data-driven outcomes improvement realized a total financial improvement of $125 million in a single year.
Allina embraced the mandate of achieving the Triple Aim: improving the quality and cost of care, as well as the patient experience. To achieve this goal, Allina’s leaders recognized that they would need to realign their strategies, organizational structures, and management practices. Confident that data would help the health system improve the quality of patient care and reduce costs, they implemented a data-driven performance improvement strategy.
The results are astounding. This strategy has achieved financial improvements for the health system of $100+ million per year, four years running, while also advancing Allina Health’s Triple Aim goals of improved clinical outcomes and a better patient experience through dozens of improvement initiatives.

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