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Employer Health Plan Successfully Lowers Costs and Boosts Benefits

Offering competitive employee health benefits is a business essential, and a differentiator for attracting top talent, but as healthcare costs continue to rise, employers are challenged to offer affordable healthcare with extensive benefits. The traditional approach of reducing benefits and raising premiums is unsustainable as a long-term strategy, but without a good way to understand, rationalize, or reduce healthcare costs, these costs are unpredictable and unmanageable.

Health Catalyst decided to embrace self-insurance earlier than what would be typical for a company of its size to take the management of its healthcare costs and benefit design into its own hands, as well as gain access to the data it needed to manage its population health. The organization is leveraging data and analytics to help uncover insights into improvement opportunities and methods to drive behavior change in its team member population. The company designed an intelligent benefit plan based on the needs and preferences of its team member population and engaged team members in an ownership and accountability mindset. These efforts have resulted in:

• Successfully moved from a fully-insured/unmanaged organization to a self-insured/managed organization in less than five years.
• Reduced healthcare spending by more than 20 percent while increasing the benefits offered in significant ways.
• Maintained cost-effective, data-driven quality solutions that sustained the overall level of benefits offered to team members.
• Re-invested cost savings into enhancing employee benefits.

Quality as Strategy Transforms Care

Wasteful spending in healthcare now exceeds $1 trillion annually, which is double the money required to fund Medicare each year. Allina Health, a non-profit healthcare system, embraced a vision of the future where 100 percent of healthcare services add value, and everyone has access to quality, compassionate care.

Allina Health president and chief executive officer Dr. Penny Wheeler recognized the critical importance of data and analytics to measure and track performance. To meet those needs, the organization leveraged its analytics platform, using the integrated clinical, financial, and operational data to enable, measure, and scale data-driven improvement initiatives. With input from users, the analytics platform delivers ready access to the data and information providers and operational leaders need to improve and sustain outcomes.

Since undergoing this healthcare quality improvement initiative, select results include:

• Improved care for spine patients.
  • 31 percent of complications avoided.
  • 22 percent relative reduction in SSIs.
  • $1 million VMP incentives received and over $2 million additional cost savings.

• Enhanced recovery program elective colorectal surgery improvements.
  • 78 percent relative reduction in elective colorectal systemwide surgical site infections.
  • 19 percent relative reduction in systemwide length of stay, saving $90K in just six months.

Improving Identification of Hospitalized Patients with Sepsis

Patients who are diagnosed with sepsis present on admission (POA) account for nearly 85 percent of cases. However, outcomes for patients with sepsis not on arrival (NPOA) are poorer due to higher acuity of the sepsis at the time of diagnosis. Because of the challenge associated with the early identification of sepsis for hospitalized patients, those with sepsis NPOA have a mortality rate as high as 35 percent, making outcome improvements for this patient population a top priority for hospitals.

Mission Health, a comprehensive healthcare system located in Asheville, North Carolina, sees the early identification of sepsis as a key part of achieving its goal of providing exceptional patient care. However, Mission lacked a mechanism to assist the clinicians in differentiating between sepsis and the patient’s acute illness, making the early diagnosis of sepsis challenging, negatively impacting outcomes. With the help of data analytics, Mission was able to gain a comprehensive view of sepsis outcomes, so that improvement efforts that help clinicians identify and provide early intervention for patients who may be septic could be effectively implemented and sustained.

Results:

• 45.3 percent relative reduction in severe sepsis and septic shock NPOA mortality rate.
• 14.4 percent relative reduction in length of stay for patients with severe sepsis and septic shock NPOA.

Integration of Community Health Workers Improves Care Management Effectiveness

While the delivery of healthcare is essential to staying healthy and getting well, it is not the only determinant of health. Other factors such as psychosocial factors and environmental conditions in which people live, work, and age can have a far greater influence. These factors are referred to as social determinants of health. Existing evidence has found that addressing social determinants of health like housing and food, is effective in improving patient health outcomes and decreasing healthcare costs.

Social determinants of health can significantly affect a person’s overall health and quality of life. Patients with social determinants that negatively impact health, such as lack of access to transportation and the place in which they live, can be exceptionally challenging to keep healthy and often rely on the emergency department (ED) for care. Reaching and engaging with patients in primary care settings can be vital to addressing patient needs. The positive influence of community health workers (CHWs) acting as a bridge between vulnerable patients and the healthcare system has shown to decrease emergency department visits and hospital admissions.

Partners HealthCare, a non-profit health system located in Boston, recognized that meeting the needs of vulnerable patient populations was an opportunity to improve patient outcomes as well as reduce cost. Through its integrated care management program (iCMP), the Partners system had some success in improving the care delivered to underserved communities. Partners’ academic medical centers, Brigham and Women’s Hospital and Massachusetts General Hospital, conducted pilots which focused on the CHW role; one model that empowered CHWs to serve as care leads, and one model that incorporated CHWs into the care team.

Results:

Integration of CHWs into the iCMP is yielding positive results for both pilots. Using a pilot conducted at Brigham and Women’s Hospital and Massachusetts General Hospital, when comparing the difference in six months post-program outcomes to six months pre-program outcomes:

• When the CHW functions as a lead, results include a:
  • $664 larger per member per month (PMPM) reduction in total medical expense and an 11 percent larger reduction in ED visits compared to the control group.
• When the CHW functions as a part of the care team, results include a:
  • $635 larger PMPM increase in total medical expense, however, patients with a CHW team member had a 28 percent larger reduction in ED visits, and an 11 percent larger decrease in office no-show rates compared to the control group.

Optimizing Sepsis Care Improves Early Recognition and Outcomes

Early identification of sepsis is challenging, as the patient’s physical response to this overwhelming infection presents as a syndrome of non-specific symptoms, delaying recognition, diagnosis, and treatment, which increases mortality rates.

Mission Health, North Carolina’s sixth largest health system, had implemented evidence-based sepsis care bundles; however, processes for identifying patients with sepsis and initiation of care was fragmented and varied widely across the system, negatively impacting sepsis outcomes.

Using a comprehensive data-driven approach to facilitate early sepsis identification and standardize the treatment of sepsis, including the addition of evidence-based alerts, Mission has gained insight into sepsis performance to drive improvement. This approach has resulted in:

• 14.1 percent relative reduction in mortality for patients with severe sepsis and septic shock.
• 24.9 percent relative difference in mortality for patients that received the evidence-based protocols compared to those who did not—the evidence-based protocols substantially reduce mortality.
• 6.4 percent relative reduction in emergency department (ED) length of stay (LOS) for patients with severe sepsis and septic shock.
• Four percent relative reduction in ICU LOS for patients with severe sepsis and septic shock admitted from the ED.