Latest Success Stories

Mission Health Receives 100 Percent of At-Risk Dollars in Payer Incentive Program

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement.  The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.

Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract.  The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.

Results:

  • Achieved 100 percent of all at risk dollars.
  • 100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
  • All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.
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How Texas Children’s Turned Child Diabetes Management into a Community Cause

Patients with diabetes are at a high risk for infections and substantial complications, including the risk of death from infections. Further, social determinants in these patients’ communities have a tremendous influence on their health.

Texas Children’s Hospital, ranked as one of the top four Best Children’s Hospitals by U.S. News & World Report, recognized that there were gaps in diabetes care coordination in the community—where the majority of a child’s diabetes management takes place. The hospital initiated a coordinated community response, aided with an analytics platform, which is setting the standard for community management of pediatric diabetes.

Results

  • 4 percent relative improvement in the percentage of patients with diabetes who received the influenza vaccine.
  • 3 percent relative improvement in pediatric provider diabetes knowledge.
  • 90 percent of patients now have individualized school packets developed and available in the EHR.
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Systematic Improvement of Diabetes Care in the Inpatient Setting

Texas Children’s Hospital is improving the care delivery of its patients with diabetes, one of the most common diseases in school-aged children. How? Powered by dedicated improvement teams and analytics, they have focused on order utilization, timeliness of IV and subcutaneous insulin administration, length of stay (LOS), establishing a diabetic care unit (DCU), educating core diabetic nurses (CDNs), frontline staff adoption, and more.

Care delivery improvements include the following:

  • 94 percent of patients with diabetic ketoacidosis (DKA) are assigned to diabetic care unit.
  • 17 percent relative increase in patients with DKA receiving an evidence-based evaluation and order sets.
  • 19 percent relative increase in patients with DKA receiving IV insulin within one hour of order.
  • 50 percentage point improvement in the percentage of patients transitioning to SubQ insulin in less than four hours after medical readiness.
  • 44 percent relative decrease in LOS for patients with DKA.

 

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DKA Risk Prediction Tool Helps Reduce Hospitalizations

Each year, more than 12,700 pediatric patients are diagnosed with diabetic ketoacidosis (DKA), a life threatening complication of diabetes. Texas Children’s Hospital sought a way to accurately predict risk of DKA in time for care team members to intervene before these patients suffered a severe episode.

The health system ultimately formed a multidisciplinary high risk diabetes team to devise pre- and post-discharge strategies, and DKA risk prediction tools aided by the Health Catalyst Analytics Platform built using the Late-BindingTM Data Warehouse.

Results:

  • 30.9 percent relative reduction in recurrent DKA admissions per fiscal year.
  • 90 percent of all patients with new onset type 1 diabetes at the Medical Center Campus have a documented RIPGC in their medical chart.
  • 100 percent of patients with type 1 diabetes have a risk index for DKA documented every 6 months.
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Improving Population Health for Children with Diabetes

Diabetes is the most common chronic illness for children living in developed countries. Leaders at Texas Children’s Hospital wanted to take a more data-driven approach to population health management for children with diabetes. They created a Care Process Team (CPT) to pursue outcomes improvements related to diabetic ketoacidosis (DKA) since data from the EDW revealed that 64% of diabetes patients discharged had this life-threatening condition.

After the CPT achieved their initial goal of improving care for patients admitted to the hospital with DKA, they set out to implement larger improvements that would benefit the entire population of diabetes patients.

By empowering CPT members, leveraging data to drive decisions, and implementing new interventions effectively, the Diabetes CPT members have improved population health for patients with diabetes across all settings of care. Below are a few of the most significant results.

  • 44 percent relative decrease in LOS for patients with DKA.
  • 30.9 percent relative reduction in recurrent DKA admissions per fiscal year.
  • 34.4 percent relative improvement in the percentage of patients with diabetes who receive the influenza vaccine.
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Analytics Support the Delivery of Effective Diabetes Self-Management Education

Effectively educating pediatric and adolescent patients and families to self-manage diabetes is a critical part of diabetes care. Leaders at Texas Children’s Hospital, one of the top four children’s hospitals in the country, recognized that diabetes self-management education that incorporates national standards and empowers patients can improve clinical outcomes and quality of life. While diabetes education has always been important to Texas Children’s, the education provided to patients was varied, no organizational standards existed, and tracking the effectiveness was not possible.

To address these challenges, Texas Children’s created an Education Care Process Team (CPT) that focused on: developing a standard education curriculum based on national guidelines, creating consistent education materials, leveraging powerful analytics to identify potential learning gaps and customize patient goals, and investing in the professionals who deliver education.

As a result of these efforts, Texas Children’s achieved the following:

  • Implementation of a standard diabetes education curriculum.
  • 100 percent of diabetes educators are now CDEs.
  • 70.7 percent of patients with diabetes have had an education visit with a CDE, and the hospital is on track to achieve its goal of 80 percent within the year.
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Improving Diabetic Care in the Ambulatory Environment

Diabetes is the most common life-threatening, chronic illness in children who live in developed countries. With effective management of diabetes, children with diabetes can live long, healthy, and active lives.

Texas Children’s Hospital believes that diabetes patients and their families are most successful in managing their disease if they receive standardized, family-centered, multidisciplinary care in both inpatient and outpatient settings.

Texas Children’s created a new Clinic Care Process Team (CPT) which developed a comprehensive approach to standardizing diabetes care by automating best practice alerts that help clinicians recognize the need for testing, so they order labs more quickly.

Within one month of implementation Texas Children’s saw measurable improvements:

  • Screening percentages for each test improved to >80 percent.
  • 28.2 percent relative improvement in the percentage of patients receiving recommended annual thyroid-stimulating hormone (TSH) testing, with current performance greater than 90 percent.
  • 23 percent relative improvement in the percentage of patients receiving recommended annual lipid testing, with current performance greater than 90 percent.
  • 54.1 percent relative improvement in the percentage of patients receiving annual retinal examinations, with current performance at 94 percent.
  • Patient satisfaction is on an upward trend.
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Integrated Care Management – Improves Care and Population Health While Reducing Costs

One hundred thirty-three million Americans, 45 percent of the population, have at least one chronic disease. Chronic diseases are responsible for 7 of 10 deaths each year, killing more than 1.7 million Americans annually. Moreover, chronic disease accounts for 86 percent of our nation’s healthcare costs.

An integrated delivery system and an accountable care organization with two large academic medical centers and six community hospitals, Partners HealthCare is increasingly compensated for outcomes of care. Recognizing the need to more effectively manage its chronically ill patients, Partners implemented an integrated care management program (iCMP) to improve the outcomes of rising-risk patients and better manage treatment costs. The iCMP is a primary-care embedded, longitudinal care management program led by a nurse care manager working collaboratively with the primary care provider and care team.

The iCMP is contributing to Partners effective management of patients and financial success in at-risk contracts. In its Pilot Phase as a Medicare Demonstration Project, the program achieved the following results:

  • 20 percent lower hospitalization rate per 1,000 patients.
  • 13 percent lower rates of emergency department (ED) utilization.
  • 25 percent relative difference in mortality.
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Care Management: A Critical Component of Effective Population Health Management

Unprecedented changes in the healthcare payment system have resulted in health organizations across the country investing in the pursuit of the Institute for Healthcare Improvement’s (IHI’s) Triple Aim to improve population health, improve patient experience and outcomes, and reduce costs per capita. Health organizations must develop effective population health management strategies, and they need the right data and analytics to inform their initiatives.

Once armed with the information to make data-driven decisions, leading healthcare providers are implementing care management programs, which have proven to be helpful mechanisms for achieving the Triple Aim. Many healthcare organizations have identified specific patient cohorts to monitor the impact of care management interventions on individual and population health outcomes.

Data-driven care management programs that target high-risk and rising-risk patients can achieve impressive results, including:

  • Up to 20 percent lower rates of hospitalization in mature care management programs.
  • Lower rates of emergency department utilization.
  • Decreased costs.
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How to Significantly Reduce Inpatient Admission Times and Improve Patient Satisfaction

Admitting a patient to inpatient care is a complex process that, unless carefully managed, can lead to long delays in service and a poor patient experience.

Thibodaux Regional Medical Center’s consistent focus on patient satisfaction has earned the 185-bed community hospital, located one hour southwest of New Orleans, the Healthgrades® Outstanding Patient Experience Award™ every year since 1998. Not surprisingly, when Thibodaux leadership recently analyzed the hospital’s inpatient admit process, they did so from their patients’ point of view and determined to cut admission wait times. Using focused process improvement methodologies, areas of waste were uncovered, exposing problems such as redundant data collection, and inconsistent processes, which would require innovative solutions.

Integrating concepts from the Health Catalyst improvement methodology into its own Lean Six Sigma processes, and with the support of professional services from Health Catalyst, Thibodaux deployed a systematic set of solutions to significantly improve the admission process.

Thibodaux’s efforts are driving measurable improvements in the hospital’s inpatient admission process, including:

  • 55 percent reduction in average inpatient admission time
  • Ranked 99th percentile for patient experience
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