Avoidable readmissions are a major financial major problem for the healthcare industry, especially for government payers. To tackle this problem, CMS launched the Hospital Readmissions Reduction Program (HRRP). While some hospitals may be able to absorb the financial penalties under HRRP, they still need to track increasingly complex reporting metrics. Most tracking solutions are inadequate for today’s complicated reporting needs. A healthcare enterprise data warehouse and analytics applications, however, are designed to solve the numerous reporting burdens. When used together, they also deliver a robust solution that enables hospitals to track and drive real cost and quality improvement initiatives, all without the need for users to be technical experts.
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What most often restricts IT innovation at a healthcare organization? It's not limitations of the tools for innovation (the data infrastructure) or the workforce, but the organizational culture of the health system. A culture that's too focused on past failed initiatives and their consequences won't identify opportunities that lead to new ideas. They likely have the right parts for a great idea, but aren't enabling those parts for innovation. Organizations can build and environment that fosters innovation in healthcare IT by operating with three principles:
- Give teams the freedom to fail.
- Remember the adjacent possible.
- Leverage organizational networks.
Successful outcomes improvement in healthcare requires strong leadership to make decisions, allocate resources, and prioritize initiatives. For improvement to succeed and endure, health systems can’t leave any part of leadership to chance. Instead, effective governance requires thoughtful, deliberate development. Otherwise, improvement initiatives stall or fail to launch, as stakeholders debate goals and strategies. To succeed, governance structure must be solid enough to withstand any challenges to improvement initiatives—from resource constraints to skeptics. Effective governance in healthcare operates with four guiding principles:
- Engage the right stakeholders.
- Establish a shared understanding of objectives.
- Align incentives and rules of engagement.
- Practice disciplined prioritization.
For better or worse, hospitals are obligated to collect and report data for regulatory purposes. Or they feel compelled to meet some reputational metric. The problem is, an inordinate amount of time can be spent on what is considered data for accountability or punishment, when the real focus should be on data for learning and improvement. When time, effort, and resources are dedicated to the latter, it leads to real outcomes improvement. Deming has three views of focusing on a process and this article applies them to healthcare:
- Sub-optimization, over-emphasizing a single part at the expense of the whole.
- Extreme over-emphasis, also called gaming the system.
- The right amount of focus, the only path to improvement.
The patient outcome benefits of effective care management programs are indisputable, as are the numerous economic factors driving the long overdue industrywide shift toward care management and value-based payment (VBP) models. The National Health Expenditure Accounts (NHEA) estimates that U.S. healthcare spending reached $3.2 trillion in 2015 ($9,900 per person). And as of 2012, half of American adults (117 million people) had one or more chronic conditions—the most common, costly, and preventable of all health problems. The key to addressing these alarming, unacceptable, rapidly increasing expenditures and saving the nation hundreds of billions of dollars in healthcare costs is better care management and the continued transition from fee-for-service to VBP models.
The Medicare Access and CHIP Reauthorization Act (MACRA) overhauls the payment system for Medicare providers. It’s a complex program that requires careful study so physicians can make the best choice for how they want to report. This choice ultimately impacts reimbursement and the potential bonuses or penalties associated with each reporting option. This FAQ covers both tracks of the new rule, the Merit-based Incentive Payment System (MIPS), and the Advanced Alternative Payment Model (APM), with a background review and a comprehensive list of questions and answers. It’s a practical guide complete with next steps for strategic and tactical planning.
Ineffective communication between care providers is a major problem. According to the Joint Commission, 80 percent of serious medical errors involve miscommunication between caregivers during the transfer of patients. Care management teams need to place emphasis on good communication to effectively coordinate care and improve health outcomes. This point is illustrated by Keisha’s story, a patient who had a severe heart attack just two days after her catheterization was postponed due to incomplete information and miscommunication between her PCP, cardiologist, and nurse care manager.
When it comes to maximizing analytics ROI in a healthcare organization, the more domains, the merrier. Texas Children’s Hospital started their outcomes improvement journey by using an EDW and analytics to improve a single process of care. It quickly realized the potential for more savings and improvement by applying analytics to additional domains, including:
- Analytics efficiencies
- Organization-wide clinical improvement
A mission-driven culture is a must-have in today’s rapidly changing healthcare environment. Culture is a vital component of a successful organization, as it builds an engaged and committed workforce that’s capable of adapting to shifting demands. Four principles form the basis of a mission-driven culture:
- Engage life-long learners and great listeners.
- Assume positive intent.
- Avoid entitlement.
- Aim for long-term commitment.
The healthcare industry is increasingly focusing on care management, and it shows—patients with serious illnesses and injuries are experiencing better outcomes and living longer. But more needs to be done, as demonstrated by Carlos, the patient in this article who was headed toward invasive, expensive care because he had trouble being compliant with his diabetes plan. Care must be coordinated across the continuum, and tailored to the patient. The role of care management is expanding and can become more effective than ever.