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Serious Illness Conversation Helps Patients Choose What Matters

The U.S. faces an aging population, and more people are living longer with chronic illness. It can be challenging for patients with serious, life-threatening illnesses to make choices about the treatment they would prefer. Often, these important discussions happen too late, and occur when patients are already in crisis or when they are unable to speak for themselves. Technology-heavy end-of-life care is associated with poorer quality of life and decreased patient satisfaction, as well as anxiety and depression for family members.

Partners HealthCare, a not-for-profit health care system, recognized that less than one-third of patients with an advanced, serious illness discussed their goals and preferences with their clinicians, and that when the conversations did occur, they often took place late in the course of illness when there was little time to translate them into meaningful actions. In general, clinicians did not feel well prepared to have conversations with seriously ill patients about their goals and wishes. The organization committed to supporting patients with serious illnesses, and their families, by providing the opportunity to discuss their treatment preferences early in the course of illness, increasing the likelihood that the patient would receive the care they wanted to receive. By implementing a Serious Illness Conversation Guide, and better preparing clinicians to have serious conversations with patients, Partners achieved:

• 53 percent of patients with clinicians who used the Serious Illness Conversation Guide used hospice in the last six months of life.
• $15,588 savings in total medical expense in the last six months of life.

A Better End of Life Experience: Enhancing Patient Care and Reducing Costs

Despite well-documented benefits, palliative care remains underutilized, with many Americans passing away in hospitals or nursing homes without care that is aligned with their treatment preference. Many health systems also group patients with an advanced chronic illness into one of two groups—traditional clinic-based care or hospice. Hospice remains underutilized for patients with long-term, complex illnesses who may not yet be eligible to enroll in hospice, or for patients who are not ready for hospice, despite qualifying.

Partners HealthCare recognized that patients in this hospice “grey area” often suffer from gaps in care. To address the unique needs faced by this patient population, the Partners system sought to better support its patients and their families with end of life care planning, through support from its population health department. By utilizing data from its analytics platform, along with a risk predictive modeling solution, Partners was able to identify patients with advanced, complex illnesses who may not yet be eligible to enroll in hospice but who would benefit from the home-based palliative care program. Program results include:

• $8,106 savings in total medical expenses in the last six months of life.
• 67 percent of home-based palliative care program patients received hospice care at the end of life, compared to 40 percent of patients that did not receive this option.
• Overall, patients who received home-based palliative care had savings associated with decreases in expense rather than utilization.

Integrated Care for High-Risk Patients: Keeping Patients Healthy and Costs Down for Over Ten Years

People with chronic and mental health conditions account for 86 percent of the $2.7 trillion in healthcare expenditures made in the U.S. each year. Patients with multiple chronic conditions cost up to seven times more than those with one. In total, five percent of patients account for half of all healthcare spending.

Managing costs for these high-risk patients are not easy. Patient needs are largely influenced by a variety of medical, social, and economic circumstances. Combined with chronic illnesses, these circumstances add up to substantial challenges for patients and their families, as well as care teams. In an effort to expand its care management program to include patients with multiple chronic conditions and complex social and economic factors, Partners HealthCare, a non-profit healthcare network in Boston, utilized data and analytics to identify patients at high-risk in order to improve outcomes and reduce costs. Overall, integrated care management program (iCMP) Medicare results include:

• $125 per member per month savings upon enrollment into the iCMP compared to patients not enrolled.
• Similar to cost findings, the relative risk of any emergency department (ED) visits, non-emergent ED visits, and hospitalizations decreased as length of program enrollment increased, specifically for Medicare patients. In months 24+ in the program, the relative risks of all three types of utilization were lower than 0.60.

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.