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Boosting Readiness and Change Competencies Key to Successfully Reducing Clinical Variation

Reducing unnecessary clinical variation is necessary in today’s healthcare market for both clinical and financial reasons. Two major drivers for this are the shift from fee-for-service to value-based reimbursement and the need for improving clinical outcomes such as reducing complications and readmissions.

Leaders for UnityPoint Health, a healthcare system serving Iowa, western Illinois, and southern Wisconsin, recognized the importance of reducing clinical variation, and the need to have strong physician champions and robust analytics to effectively support improvement efforts. However, it also realized that without understanding organizational strengths and weaknesses related to adopting change and improving outcomes, it would struggle to successfully implement initiatives that delivered the desired benefits and sustained improvements over time. By consistently integrating information from a readiness assessment, an opportunity analysis, and expert resources, UnityPoint Health was able to establish a prioritization and implementation approach to outcomes improvement that has produced the following results:

• Variable costs were reduced by more than $1.75 million based on the deployment of interventions in sepsis alerts, order sets, and other clinical decision support tools.
• Reductions in length of stay have allowed patients to return home earlier and spend more than 1,000 additional nights in their homes.
• Millions of clicks have been reduced for clinicians based on deployment of new sepsis screening tools.
• 36 percent increase in sepsis screenings completed in the emergency department (ED).
• Sepsis order set utilization in the ED has increased by more than 185 percent.

New Generation Activity-Based Costing Accelerates Timeliness of Decision Support

In healthcare, the timely delivery of patient-activity level cost metrics to clinical, financial, and operational leaders is critical; it allows the organization to respond to internal and external shifts and challenges to positively impact financial performance without negatively impacting patient care and the patient experience.

UPMC determined that the amount of manual effort needed to overcome the deficits of a suboptimal technical infrastructure and database supporting its cost management system drove many of the delays built into its closing process. After exploring the options to enhance and commercialize its cost management intellectual property, UPMC partnered with Health Catalyst to use the Health Catalyst^® Data Operating System (DOS™) to co-develop and commercialize the CORUS™ suite activity-based costing module.

The new, analytics-driven cost management system supported a 50 percent reduction in the time needed to complete month-end close:

• Three-day reduction in time to close.
• Monthly preliminary results are typically reviewed within one business day, affording more time for validation and analysis.
• Executives receive financial data up to three days sooner.
• Reduction of 3.5 FTEs needed to complete the monthly close.
• Reduced 60 human touchpoints and opportunity for error.
• Multiple months of data can now be run simultaneously.
• Provided support for new data-driven governance structure.

Reducing Sepsis Mortality and LOS with Improved Recognition and Treatment Protocols

In the U.S., over 1.5 million people are treated for sepsis annually. One in four people with sepsis die, making improving early identification and providing patients with timely treatment a top priority. Hospitals and health systems continue to look to improve outcomes for patients with sepsis.

Allina Health, a not-for-profit healthcare system of 12 hospitals and 90 clinics, all serving patients throughout Minnesota and western Wisconsin, previously implemented a rapid process improvement project using a three-part bundle focused on the early identification of sepsis. However, sepsis mortality rates remained higher than desired. After turning to an analytics platform to replace its burdensome manual review process, Allina Health was able to identify opportunities for improvement and develop evidence-based processes for sepsis identification and treatment.

Results:

• 18.6 percent relative reduction in mortality rate and 10.9 percent relative reduction in hospital length of stay (LOS) for all patients with sepsis.
• 30.3 percent relative reduction in mortality rate and 18.4 percent relative reduction in hospital LOS for patients with severe sepsis and septic shock.
• $1.1 million in annual cost savings, the result of efficiencies and substantial reductions in hospital LOS for patients with severe sepsis or septic shock.

Systematic, Data-Driven Approach Lowers Length of Stay and Improves Care Coordination

Improving and reducing length of stay (LOS) improves financial, operational, and clinical outcomes by decreasing the cost of care for a patient. It can also improve outcomes by minimizing the risk of hospital-acquired conditions.

Faced with declining revenue related to changes in Medicare and Medicaid reimbursements, Memorial Hospital at Gulfport knew additional methods of providing more efficient and cost-effective quality care were needed to maintain long-term success. The organization embraced the challenge of reducing LOS to lower costs and lessen risk for its patients. By adopting a systematic, data-driven, and multi-pronged approach, Memorial has achieved significant results in one year including:

• $2 million in cost savings, the result of decreased LOS and decreased utilization of supplies and medications.
• 47-day percentage point reduction in LOS.
  • Improved care coordination and physician engagement have successfully reduced LOS.
  • The 30-day readmission rate has remained stable.
• Three percent increase in the number of discharges occurring on the weekend.

Readiness Assessment Key to Sustainable Outcomes Improvement

Experiencing pockets of success is not enough to prosper during the transformation to value-based care. Leaders at UnityPoint Health, a healthcare system serving Iowa, western Illinois, and southern Wisconsin, determined that outcomes improvements needed to be sustained and spread easily across the organization to best utilize resources and serve its patients.

UnityPoint Health required an objective way to understand the strengths and weaknesses of the organization relative to outcomes improvement and its readiness for change. To this end, it chose the Health Catalyst^® Outcomes Improvement Readiness Assessment (OIRA) Tool and professional services to administer it and identify the competency levels in the organization in the five areas known to influence an organization’s readiness for change. This resulted in:

• Competency for improving outcomes measured at the organization, department and role level.
• Recommendations made for increasing competency levels across the organization.
• Clear direction and focus obtained from opportunity analysis.