In the U.S., 5.7 million adults have heart failure (HF), costing the nation an estimated $30.7 billion each year. Learn how MultiCare leveraged AI and machine learning to more accurately predict the readmission risk for patients with HF.
Machine Learning, Predictive Analytics, and Process Redesign Reduces Readmission Rates by 50 Percent
The estimated annual cost of readmissions for Medicare is $26 billion, with $17 billion considered avoidable. Readmissions are driven largely by poor discharge procedures and inadequate follow-up care. Nearly one in every five Medicare patients discharged from the hospital is readmitted within 30 days.
The University of Kansas Health System had previously made improvements to reduce its readmission rate. The most recent readmission trend, however, did not reflect any additional improvement, and failed to meet hospital targets and expectations.
To further reduce the rate of avoidable readmission, The University of Kansas Health System launched a plan based on machine learning, predictive analytics, and lean care redesign. The organization used its analytics platform, to carry out its objectives.
The University of Kansas Health System substantially reduced its 30-day readmission rate by accurately identifying patients at highest risk of readmission and guiding clinical interventions:
39 percent relative reduction in all-cause 30-day.
52 percent relative reduction in 30-day readmission of patients with a principle diagnosis of heart failure.
Every three seconds, someone in the United States will need a blood transfusion, which adds up to nearly 17 million blood components transfused annually. Yet, evidence shows that up to 60 percent of red cell transfusions may not be necessary. In 2011, Allina Health, a healthcare delivery system that serves Minnesota and western Wisconsin, had a wide variation in transfusion practices throughout the system and a transfusion rate that was 25 percent above national benchmarks. In an effort to improve outcomes of high-risk transfusions, Allina Health turned to its data to develop an evidence-based blood conservation program aimed at reducing costs and saving valuable blood resources.
$3.2M decrease in annual blood product acquisition costs since 2011
30,283 units saved annually
111 units of red cells saved per 1000 inpatient admissions
Data-Driven Clinical Documentation Improvement Program Increases Revenue and Improves Accuracy of Risk Adjusted Quality Metrics
Allina Health, an integrated delivery system throughout Minnesota and western Wisconsin, has long understood the value of clinical documentation improvement (CDI), and its growing importance in recent years. With the implementation of ICD-10, the specificity needed for accurate coding has increased, and reimbursement shifts have occurred as well, creating sizeable payment disparity for some clinical conditions. Leaders at Allina wanted to understand where their CDI program would have the greatest return on investment. However, data from the EHR was not sufficient to inform their strategy. CDI specialists still lacked the ability to perform a comprehensive assessment of the accuracy of clinical documentation, and were unable to confidently target improvement efforts in areas that would generate the greatest return on investment. To take a more data-driven approach, team members leveraged the Health Catalyst Analytics Platform, including their Late-Binding™ Data Warehouse and broad suite of analytics applications to develop a CDI analytics application. With the application, the team identified opportunities and thoroughly vetted them, before collaborating with physicians and service line leaders to educate providers on documentation improvements.
They achieved the following results:
12.1 percent improvement in CV surgical cardiology CC/MCC capture rate.
6.3 percent increase in medical cardiology CC/MCC capture rate.
Increased accuracy in publically reported risk adjusted quality metrics
Revenue capture improvement across the system – resulting in millions of dollars of additional reimbursements.
A stay in the intensive care unit (ICU) is both costly and risky. In a sobering example of the latter, nearly one third of patients admitted to the ICU experience delirium, a state of cognitive impairment that can increase risk of death in the hospital. Still, many cardiovascular patients need intensive care that can only be provided safely in an intensive care unit, requiring hospitals to assure enough beds and skilled ICU staff for these patients—while quickly identifying which patients can receive care as good or better in another unit.
Allina Health has achieved this dual objective with a concerted ICU avoidance strategy for specific complex sub-populations of cardiovascular (CV) patients. The foundation of this strategy is risk-informed decisions about which patients can avoid the ICU; clinical staff education; and an analytics platform and enterprise data warehouse (EDW) from Health Catalyst that enables CV care leaders to monitor safety metrics for those patients who avoid a stay in the ICU. So far, Allina Health’s efforts have resulted in the following achievements:
636 additional ICU days made available for more critically ill patients by employing ICU avoidance strategies
One-day reduction length of stay (LOS) for Transcatheter Aortic Valve Replacement (TAVR) patients
$589,000 cumulative cost savings
Post Operative Atrial Fibrillation occurs in up to 30 percent of all patients after cardiac surgery. This serious complication increases the length of the patient’s hospital stay, and is associated with a twofold increase in the incidence of cerebral infarction and an increased risk of 30-day mortality. Timely and consistent management of Post Op Afib can prevent significant complications and help prevent death. To standardize such an approach to managing Post Op Afib, Allina Health’s Minneapolis Heart Institute created a physician committee to raise consensus on and develop a protocol for Post Op Afib management.
The committee ultimately created a nurse-driven protocol and decision support algorithm linked to the health system’s electronic health record (EHR). Additionally, it uses analytics, supported by Health Catalyst’s Late-Binding™ Enterprise Data Warehouse (EDW), to track physician ordering rate, patient outcomes, and cost. This combination of people, processes, and analytics tools has made a significant difference for Allina and its patients.
Two-day reduction in ICU LOS.
5.9 percentage point reduction in ICU readmission rate.
$1.5 million savings.
Percutaneous Cardiac Intervention (PCI) is a minimally-invasive alternative to open heart surgery—a procedure that approximately 600,000 U.S. patients will undergo this year.
Allina Health, a non-profit health system with 90+ clinics and 13 hospitals with locations throughout Minnesota and western Wisconsin, is a leading provider of the procedure in Minnesota. Allina Health discovered that major bleeding events following PCI procedures (the most common non cardiac complication of PCI), though not affecting mortality, were increasing length of stay (LOS) and cost.
To improve the quality of its PCI procedures and decrease costs, Allina Health recognized the need to accurately assess bleeding risk and then implemented best-practice interventions to prevent major bleeding events.
Already, physicians and patients have seen that these new interventions, which includes a bleeding risk assessment tool, allows clinicians to focus interventions based on risk and reduce complications. The top results from Allina Health’s interventions include:
5.3 percentage point reduction (a 21.7 percent relative reduction) in complication rate.
$1.8M cost savings.
1.4 percentage point reduction (a 36.5 percent relative reduction) in LOS for patients at high risk for bleeding who receive a closure device.
Health spending in the United States is greater than the gross domestic product of most nations, and the costs for cardiovascular disease (CVD) and stroke care alone total $193.1 billion. CVD accounts for approximately one out of every three deaths in the U.S. and contributes to the shorter life expectancy of Americans. Thirty-five percent of CVD related deaths occur before the age of 75 years, and 19 percent before the age of 65.
Allina Health is a large integrated healthcare delivery network operating in Minnesota and western Wisconsin that includes three large cardiac centers. Due to the prevalence and mortality rate of CVD, leaders at Allina Health recognized that they needed to focus on cardiovascular health in order to truly impact the population health and patient outcomes of the communities they serve.
By leveraging real-time data from its enterprise data warehouse (EDW), Allina Health effectively identified and addressed clinical practice variation and operational issues affecting cardiovascular care and costs. In doing so, the health system realized more than $75 million in performance enhancement savings and revenue increase over a four-year period by focusing on supply chain, lab test and blood utilization, clinical practice changes and clinical documentation improvement.
Heart attacks are the leading cause of death for both men and women in the United States, yet heart attacks are largely preventable through healthier lifestyles. Spurred on by this knowledge, New Ulm Medical Center, the Minneapolis Heart Institute Foundation, and the rural community of New Ulm, Minnesota, teamed up to create Hearts Beat Back: The Heart of New Ulm (HONU) Project. This population-based prevention demonstration project aims to reduce the number of heart attacks and heart disease risk factors among the New Ulm population.
Recognizing the complex web of personal, institutional, and societal factors that influence an individual’s heart-health behaviors, HONU leaders implemented a multilevel strategy spanning 10 years to improve the health of the entire population.
The HONU Project’s multilevel, data-driven approach has resulted in substantial changes in improving population health in New Ulm:
Significant improvements in blood pressure and cholesterol at the population level.
86 percent of residents now have blood pressure within the recommended range.
72 percent have LDL cholesterol within the recommended range.
Improvements are greater than changes seen in the national comparison population.
Achieve Reduced Heart Failure Readmission Rates: One Healthcare Organization’s Care Coordination Strategy
Heart failure (HF) sends more US adults over 65 to the hospital than any other cause—costing Medicare alone more than $17 billion annually—with readmissions significantly contributing to the issue. For large integrated networks like Allina Health, efforts to reduce readmissions for HF patients are challenged by the need for coordinated care and consolidated data across the care continuum. Allina implemented a multidisciplinary HF management program with a nurse care coordinator and nurse practitioners who assure patient engagement and provide a “bridge” between different points in the care continuum. These important people and processes are aided by access to data from an enterprise data warehouse that merges data across the health system and gives providers insight into HF care and performance metrics. The program has helped Allina achieve a 30-day HF readmission rate well below the national average —17 percent in 10 of 11 hospitals doing cardiac care.
With nearly one in four Medicare patients hospitalized with heart failure (HF) being readmitted to hospitals within 30 days of discharge, healthcare organizations like MultiCare are primed to develop care improvement initiatives focused on reducing readmissions. MultiCare has had a HF collaborative for several years, focused on standardizing and increasing the quality of care for its cardiac patients—resulting in a 24 percent improvement in HF readmission rates and an 18 percent improvement in mortality rates. With this proven commitment to its patients, MultiCare was selected for participation in the American College of Cardiology’s Patient Navigator program, opening up the opportunity to provide cardiac patients with an advocate dedicated to helping patients navigate their pathway to improvement. Through participation in this patient navigator program, MultiCare has ability to further bring the patient’s voice to the forefront and improve its quality of cardiac care even more dramatically in the future.
An estimated 24 percent of patients who are discharged with heart failure (HF) are readmitted to the hospital within 30 days. Learn how this healthcare organization engaged physicians and multidisciplinary teams to improve their outcomes. Deploying evidence best practices—medication reconciliation, follow-up appointments, follow-up phone calls and teach back—they reduced and sustained their 30-day HF readmission rates by 29 percent, and their 90-day HF readmissions by 14 percent. They have seen their process measures increase significantly: 120 percent increase in follow-up appointments; 78 percent increase in pharmacist medication reconciliation; 87 percent increase in follow-up phone calls; 84 percent increase in teach-back interventions.
The Centers for Medicare & Medicaid Services (CMS) is tying reimbursement to hospital readmissions. Healthcare systems are investigating hospital readmissions reduction programs to improve patient outcomes and avoid CMS penalties. Learn how this healthcare system, determined to improve heart failure care for its patients, increased their documented follow-up appointments by 270 percent.