How an IDS Improves Outcomes Using a Clinical Collaborative Structure
To transform the U.S. healthcare system, providers are in determined pursuit of the Triple Aim: improving the experience of care, improving the health of populations, and reducing the per capita costs of care.1 MultiCare, an integrated delivery system (IDS) in the Pacific Northwest, is fully committed to excelling in all three areas of the Triple Aim and is establishing a structure and culture to accomplish that goal. This is no small challenge for an organization with more than 10,000 employees, 500,000 annual outpatient visits, and 1,188 beds.
Creating A Robust Framework For Collaborative Care
MultiCare’s Successful Partnership Between Collaboratives And Analytics
- The Collaboratives were led by physicians.
- Their decisions and improvement recommendations were based on evidence.
- Collaborative teams were multidisciplinary, including clinicians, operations, finance, data analysts, and more.
- The Collaboratives were supported with dedicated resources— including clinical resources as well as technology and analytics experts who could work with frontline teams to interpret the data.
- Technology enabled analytics were used to support the hardwiring of best practices, providing validated data to support decision making and prioritization, and near real-time feedback on performance.
- Technology: implementing an enterprise data warehouse (EDW) that aggregates data across systems and facilities and makes it available for actionable analytics
- Standards: building a mechanism to establish data standards (definitions, presentation of data, and architecture)
- Clinical improvement: determining opportunities for improving care and cost-per-discharge methodology using the Medicare Diagnostic Related Group (DRG)
Setting the Direction and Clinical Content for the Collaboratives
- Reduce clinical variation across the system and standardize care
- Improve and monitor clinical outcomes
- Improve patient satisfaction
- Reduce costs
- Improve documentation and collections
- Written evidence-based guideline for each patient population studied
- Order sets
- Patient pathway
- Patient education materials
- Staff education support materials
- Process and clinical metrics to gauge success
- Implementation plan
- Communication plan
Transforming Culture and Achieving Quality and Cost Improvement
The ability to standardize practice and eliminate unnecessary clinical variation differentiates MultiCare from its competitors and has delivered significant results for the organization. The following are key achievements of MultiCare’s Collaboratives to date.
MultiCare’s Collaboratives successfully made the transition from being improvement projects—as they would be considered in most organizations—to an integral part of the way MultiCare does business. In fact, MultiCare’s Collaboratives now serve as the foundation of a culture of continuous improvement across the health system.
Measurable Financial Results
The immense effort behind MultiCare’s collaborative structure has contributed to a system-wide cost reduction trajectory of greater than $100 million over the last three years.
Creation and Adoption of System-wide Best Practices
The health system achieved a 75 percent reduction in the time required to approve system-wide care guidelines and pathways. Instituting a central body to review guidelines and pathways reduced the approval time from six months to six weeks. This streamlined process is important not only because of administrative time saved but also because it speeds the time between the development of a guideline to improved practice at the point of care.
The work of the Collaboratives also led to high adoption of clinical best practices. For example, MultiCare achieved 92 percent utilization of the pre-op order set and 100 percent utilization of the post-op order set for elective colon surgery patients. The health system has also reached near 100 percent utilization of the standardized delivery note for obstetrics.
Clinical Outcome Improvements
Empowering Collaboratives with clinical decision support and the ability to identify and monitor compliance with in-process measures led to the following clinical outcome improvements:
- Reduction in mortality:
- 65 percent reduction in sepsis mortality rate
- Reduction in readmissions:
- 37 percent reduction in pneumonia readmissions
- 25 percent better than national average for HF readmissions at two hospitals
- 8 percent reduction below target in readmission rates for elective colon surgery patients
- 50 percent reduction below target in readmission rates for total joint surgery patients
- Reduction in length of stay (LOS)
- 8 percent reduction in median LOS for elective colon surgery
- Elimination of vaginal deliveries with LOS > 4days
- 71 percent reduction in C-section deliveries with LOS > 6 days
Up to this time, MultiCare has focused principally on achieving clinical results, addressing such outcome measures as complication rates, readmissions, and mortality. Although the Collaboratives intend to continue to deliver improved clinical outcomes, they will also purposefully renew their focus on patient experience and cost reduction. This three-pronged approach puts MultiCare in a better position to deliver on the Triple Aim.
Furthermore, MultiCare will focus on becoming more agile and flexible in order to respond quickly to patient needs and market pressures. The need for agility is fueled by increasing pressure nationwide to adopt value-based care delivery strategies and to adapt quickly to new information, findings, and regulatory changes. For example, recent studies revealed that spine and back care are associated with a large amount of variation and waste, and the media and payers are placing this area under greater scrutiny. Although back and spine care had not risen to the top in MultiCare’s original prioritization process, the health system needed to address them in response to the media and market attention. Health system leaders will be modifying their processes to ensure that they can respond quickly to such demands.
- Berwick, D.M., Nolan, T.W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs, 27(3), 759-769.
ABOUT HEALTH CATALYST
Health Catalyst is a mission-driven data warehousing and analytics company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 50 million patients for organizations ranging from the largest US health system to forward-thinking physician practices.