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Widespread Analytics Adoption Improves ACO Measure Performance

On an annual basis, Accountable Care Organizations (ACOs) are required to accurately report data that is used to assess quality performance. This is necessary in order for the ACO to be eligible to share in any savings generated. Improvements in measure performance are often linked with ACOs that have offered providers the skills, tools, and data required to understand and track their own performance, as well as that of their peers.

Mission Health, based in Asheville, North Carolina, is the state’s sixth-largest health system, spanning the 18 counties of western North Carolina. Mission formed one of the largest ACOs in the country, Mission Health Partners (MHP), providing services for nearly 90,000 patients. While MHP had previously achieved success in improving its ACO measure performance, it sought to increase its quality scores even higher. Without access to transparent, actionable data, leadership was unsure if improvements would be sustained, let alone if existing workflows could lead to new improvements. After developing a comprehensive plan that included a massive expansion to data access, Mission practices were able to sustain initial improvements, identify new opportunities, and improve population health quality even further.

Substantial improvement across multiple ACO measures:

• 29 percent relative improvement in the number of patients receiving colorectal cancer screening.
• 10 percent relative improvement in the number of patients receiving breast cancer screening.
• 7 percent relative improvement in the number of patients with blood pressure under control.

Integrated Data Enables Single Source of Truth and Rapid Adoption

Many healthcare organizations struggle to deliver seamless reporting, advanced visualizations, and end-user self-service models, but these types of analytics are critical to business intelligence and have become a practical and strategic necessity.  There is a lack of trust in data because it can be difficult to access and combine information that is fragmented, coming from multiple, disparate sources such as EMRs, billing, claims, and financial systems. Without an integrated source of clinical and business data in a trusted single source of truth, it is difficult, if not impossible to create a data-driven approach to decision making.

Orlando Health, one of Florida’s most comprehensive private, not-for-profit healthcare networks consisting of eight hospitals and 50 clinics, began its journey to integrate clinical and business data into a single source of truth across the organization when it made the transition from a legacy data warehouse solution that employed an enterprise data model to the Health Catalyst analytics platform, and subsequently to the Health Catalyst^® Data Operating System (DOS™) platform.

Integrated data and ability to deliver superior solutions has resulted in a single source of truth, leading to increased adoption. Once customers realized the timeliness, ease of access, and quality of the improved analytics and visualizations available to them, demand and adoption increased and continues to grow.

• 6,120 queries of the analytics platform each month.
• Users access analytic applications and visualizations more than 700 times each month.

Integrated Healthcare Data Quickly Enables Adaptive, Purpose Driven Analytics

Changes in payment models are putting pressure on clinicians to close gaps in care. To do this, they need instant access to actionable information about their patients and their own performance. However, many electronic health records and business intelligence systems are still grappling with how to deliver the insights necessary to revolutionize the way providers work.

Orlando Health, a Florida-based, not-for-profit health system made up of eight hospitals and 50 clinics, found its enterprise data model difficult to scale, making it challenging to gain insights from its healthcare data. Building upon its analytics platform, Orlando Health recognized the value of immediate access to adaptive, integrated healthcare data that could be rapidly deployed in consumable, actionable visualizations to address a wide spectrum of business needs and use cases, and embraced a next-generation data model.

Results:

• Ten data sources loaded into the platform in under six months.
• As little as one week to deploy dashboards, visualizations, and analytic insights.
• 95 percent reduction in work hours required to incorporate system enhancements.
• 88 days saved in the amount of time required to implement system enhancements.

Improving Transitions of Care for Patients with Pneumonia

Nationally, the readmission rate for patients over age 65 with pneumonia is 15.8 percent. Though not all hospital readmissions are preventable, high readmission rates may reflect performance on care quality, effectiveness of discharge instructions, and smooth transitioning of patients to their home or other setting.

Piedmont Healthcare wanted to standardize pneumonia care across its entire system but lacked the data it needed to identify patients who could benefit from additional transition support. Piedmont convened a care management steering committee and deployed analytics tools to generate actionable data for appropriate and effective transitions of care for its Medicare patients with pneumonia. In less than one year, it reduced its readmission rate for patients with pneumonia by 26 percent.

Evidence-Based Care Standardization Reduces Pneumonia Mortality Rates and LOS

Patients with pneumonia account for over 400 thousand emergency room visits, nearly 1.1 million inpatient hospitalizations, and more than 5.7 million inpatient days each year in the U.S. Every year, almost 51,000 patients die from pneumonia. Among the elderly, community-acquired pneumonia is an increasing problem, now ranking as the fourth leading cause of death.

Piedmont Healthcare, a not-for-profit integrated health system serving Georgia, had multiple order sets for disease management, but the health system lacked a uniform care pathway for the treatment of pneumonia. Care provided for the treatment of pneumonia was often not in alignment with evidence-based guidelines, such as antibiotic selections. This lack of consistency increased both LOS and cost, and a lack of case-specific data made the development of a uniform best practice for pneumonia treatment challenging. By accessing detailed case data with the help of analytics, Piedmont was able to identify and develop best practices for the treatment of pneumonia, driving out the variation that increased costs and reduced the overall quality of care.

Results:

• 56.5 percent relative reduction in pneumonia mortality rate.
• $220,000 in savings over one year, the result of a 9.3 percent relative reduction in LOS.

Integrating Data and Analytics into Provider Workflow Improves ACO Performance

Reimbursement rates for an Accountable Care Organization (ACO) are based on the quality composite score from the Physician Quality Reporting System Group Practice Reporting Option, examining best practice preventative care and primary care measures. As a result, ACO participants may receive payment adjustments based on their quality composite performance.

U.S. Medical Management (USMM), a leading provider of home-based primary care services for complex patient populations and managed care clients, also operates a multi-state Medicare Shared Savings Program ACO serving over 23,000 complex or fragile Medicare patients. USMM needed to support its providers in meeting their patients’ necessities, while also ensuring they were providing and documenting appropriate best practice preventative and primary care ACO measures.

USMM turned to its analytics platform and analytics applications, implementing the Community Care Advanced Application to aid its efforts. The analytics platform integrates data from the organization’s EMR, billing system, and external claims data, bringing cross-organizational data into focus and delivering specific, actionable interventions needed to improve performance.

After implementing Community Care, USMM achieved a 90^th percentile performance for:

• Tobacco screening and cessation plan.
• Clinical depression screening and follow-up plan.

The organization also earned an 80^th percentile performance for:

• Influenza immunization.
• High blood pressure screening and follow-up plan.
• Screening for future fall risk.

Standard Approach to Early Induction of Labor Successfully Reduces Unnecessary Cesarean Deliveries

In the U.S., nearly one in three women give birth via cesarean delivery. Rates vary widely by state, ranging from a low of 23 percent to a high of nearly 40 percent. Despite the potential life-saving benefits of a cesarean, this large variation suggests that unnecessary cesarean deliveries are frequently performed and that potentially modifiable factors, such as patient preferences and practice variation among hospitals, systems, and healthcare providers, likely contribute to the high rate.

Gunnison Valley Hospital has a long history of safe obstetric care, delivering more than 150 babies annually, yet the rates of elective early induction (prior to 39 weeks gestation), primary cesarean, and Nulliparous, Term, Singleton, Vertex (NTSV) were somewhat higher than desired. With the help of analytics, Gunnison shined a light on its labor and delivery practices and developed standard procedures aimed at producing better outcomes for patients.

Results:

• 87 percent relative reduction in the number of elective inductions of labor prior to 39 weeks gestation.
• 61.1 percent relative reduction in the number of NTSV cesarean deliveries.

Successfully Sustaining Elective Colon Surgery Outcome Improvements

For healthcare organizations, sustaining improvements that have been adopted in more than one part of an organization remains a serious challenge. After improvement initiatives have been successfully implemented, it is estimated that less than 40 percent of gains are sustained in the long term. Because improvement initiatives are necessary to maintain a high standard of care, sustaining them so that further improvements can be made remains a top priority for health systems.

MultiCare Health System, a not-for-profit healthcare system serving Washington state, successfully implemented improvement efforts for patients undergoing elective colon surgery, which resulted in significant reductions in 30-day readmission, LOS, and surgical site infections (SSIs). However, without ensuring ongoing engagement, accountability, and visibility into performance, MultiCare was concerned improvements could slip away. By supporting continued monitoring powered by insights gained from relevant data, and by closely listening to provider feedback, MultiCare was able to sustain previous improvements while identifying new opportunities.

Results:

• 32.7 percent relative reduction in 30-day readmission rate for patients having elective colon surgery.
• 3.4-day median LOS for patients having elective colon surgery, sustaining previous improvement.
• Among patients who had the complete enhanced recovery after surgery protocol implemented for elective colon surgery, there were no surgical site infections—for an entire year.

Enabling Informed Surgical Choices for Breast Cancer Through Shared Decision Making

One out of every eight women in the U.S. will develop breast cancer in her lifetime, and men have a lifetime risk of one in 1,000. This year, over 3.1 million women are currently being treated or have finished treatment for breast cancer.

The Virginia Piper Cancer Institute had clear evidence-based practice guidelines that directed recommendations for early breast cancer treatment options. Even with these evidence-based recommendations, however, the organization’s mastectomy rates were higher than expected.

Recognizing the organization could do better, the breast cancer program committee endorsed the spread of shared decision making for patients with early-stage breast cancer to all Virginia Piper Cancer Institute locations. The spread of shared decision making allowed patients to receive evidence-based information early in their course of care and make informed decisions that aligned with their values and preferences.

Within nine months of implementing a standard process for shared decision-making visits, the Virginia Piper Cancer Institute clinics that have completely adopted the process have made significant progress in engaging patients with early breast cancer in the shared decision-making process:

• 81 percent of eligible patients (207 people) participated in shared decision-making visits.
• 62 percent of the shared decision-making visits were in person.
• 27 percent relative increase in surgical decision of lumpectomy over mastectomy.

Care Transitions Improvements Reduces 30-Day All-Cause Readmissions Saving Nearly $2 Million

Researchers estimate that in just one year, $25 to $45 billion is spent on avoidable complications and unnecessary hospital readmissions, the result of inadequate care coordination and insufficient management of care transitions.

While increasing its efforts to reduce its hospital readmission rate, the University of Texas Medical Branch (UTMB) discovered that it lacked standard discharge processes to address transitions of care, leading to a higher than desired 30-day readmission rate. To address this problem, UTMB implemented several care coordination programs, and leveraged its analytics platform and analytics applications to improve the accuracy and timeliness of data for informing decision making and monitoring performance.

This combination of approaches proved successful, resulting in:

• 14.5 percent relative reduction in 30-day all-cause readmission rate.
• $1.9 million in cost avoidance, the result of a reduction in 30-day all-cause readmission rate.