Improving Accuracy of Clinical Documentation Positively Impacts Risk Adjustment Factor and HCC Coding

The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to estimate predicted costs for Medicare beneficiaries, and the results directly impact the reimbursement healthcare organizations receive for patients enrolled in a Medicare Advantage plan. CMS requires that all qualifying conditions be identified each year by provider organizations. Documentation that is linked to a non-specific diagnosis, as well as incomplete documentation, negatively affects reimbursement.
Allina Health, a not-for-profit integrated healthcare delivery system serving Minnesota and western Wisconsin, needed to improve its HCC coding and clinical documentation in order to ensure the correct risk adjustment factor (RAF) was applied to its patients, since failing to do so would jeopardize its reimbursement and result in lower than expected compensation. After identifying opportunities for improvement by comparing its HCC risk adjustment coding data to other organizations and vendor metrics, Allina Health improved clinical documentation precision, medical diagnoses accuracy, and ensured eligible patients are seen each calendar year.
Results:

10 percent increase in RAF for the target population in one year.
72 percent relative improvement in four key problem list diagnoses.

Opportunity Analysis Permits Successful Execution of At-Risk Contracts

Growth in the government payer mix and an increased cost burden to the commercial population, decreases in the private payer population, and programs like the Medicare Shared Services Program, have caused joint ventures, partnerships, and co-branding efforts, better known as at-risk contracts, between payers and providers to increase.
Allina Health has three Integrated Health Partnership (IHP) contracts, an accountable care model that incentivizes healthcare providers to take on more financial accountability for the cost of care for Medicaid patients, which cover approximately 90,000 members. To achieve success in its IHP contracts, and avoid losses, Allina Health needed to reduce healthcare costs while improving patient outcomes and experience.
Allina Health has integrated several data sources, including claims and developed the infrastructure required to perform opportunity analysis. Using data and analytics for opportunity analysis has given Allina Health insight into its IHP patient population, supporting the development of interventions to decrease the total cost of care and improve outcomes.

Clinical and Financial Partnership Reduces Denials and Write-Offs by More than $3 Million

CMS denies nearly 26 percent of all claims, of which up to 40 percent are never resubmitted. The bane of many healthcare systems is the inability to identify and correct the root causes of these denials, which can end up costing a single system tens of millions of dollars. Yet almost two-thirds of denials are recoverable and 90 percent are preventable.1 Despite previous initiatives, The University of Kansas Health System’s denial rate (25 percent) was higher than best practice (five percent), and leadership realized that, to provide its patients with world-class financial and clinical outcomes, it would need to engage differently with its clinical partners.
To effectively reduce revenue cycle and implement effective change, The University of Kansas Health System needed to proactively identify issues that occurred early in the revenue cycle process. To rethink its denials process, it simultaneously increased organizational commitment, refined its improvement task force structure, developed new data capabilities to inform the work, and built collaborative partnerships between clinicians and the finance team.
As a result of its renewed efforts, process re-design, stakeholder engagement, and improved analytics, The University of Kansas Health System achieved impressive savings in just eight months.

$3 million in recurring benefit, the direct result of denials reduction.
$4 million annualized recurring benefit.
Successfully partnered with clinical leadership to transition ongoing denial reduction efforts to operational leaders.

Unleashing the Data to Sustain Spine Service Line Improvements

Research shows that despite an increase in the number of improvements in clinical, cost, and operational outcomes, there is a lack of sustained improvements. Some of the key challenges can be access to the data and analytics, and adherence to data-driven clinical standards, things the Allina Health Spine Clinical Service Line (CSL) clinical leadership team experienced.
By providing widespread access to the data and analytics, the Spine CSL at Allina Health has been able to continue its reduction in LOS and further improve its reduction in complications, all while increasing cost savings and achieving pay-for-performance incentives.
Results:

$1 million in pay-for-performance incentives received.
More than $2 million in supply chain savings, a result of data-driven clinical standardization.
31 percent of expected complications avoided.
22 percent relative reduction in surgical site infections.

Clinically Meaningful Quality Metrics Improve the Provider Experience

Nearly half (46 percent) of all physicians report that they suffer from burnout, citing too many bureaucratic tasks as one reason. Providers want to find meaning in their work, and improvement on many current quality metrics do not predict better patient outcomes or experience of care. They are looking for tools to reduce their workload and improve their ability to provide excellent care, including having metrics and registries that are meaningful and informative.
Faced with the challenge of making quality measures meaningful, Partners HealthCare worked to redefine measures to be more relevant, create point-of-care registries to manage an all-payer population, created teams of Population Health Coordinators to support front-line teams in managing the registries, and used its analytics platform to monitor change and explore provider variation in order to improve quality. This resulted in:

85 percent of clinicians surveyed felt that the new metrics helped them take better care of their patients.
Quality improved at an unprecedented rate on an all-payer population five times bigger than the standard pay-for-performance population.
Near real-time measurement using clinical data eliminated months-long delays, while run charts and provider and clinic-comparison views turbo charged quality improvement.
125 percent increase in user adoption of the analytic tool (99 unique users, 674 unique sessions, and rising).

Readiness Assessment Crucial First Step in Building an Outcomes Improvement Focused Organization

Healthcare organizations need to be cognizant of their readiness for change, enabling them to create a plan that will enhance the organization’s ability to successfully drive change. While many studies have been completed on the importance of organizational readiness in non-healthcare organizations, there is little research and relatively few,  measurement tools focused specifically on healthcare organizations.
To cement the Pulse Heart Institute (Pulse Heart) as a destination for adult heart health, and ensure its long-term success, Pulse Heart required a better understanding of its readiness to drive and sustain outcomes improvements—which it found through an onsite assessment that leveraged the Health Catalyst® Outcomes Improvement Readiness Assessment (OIRA) framework. Using the assessment findings and subsequent recommendations, Pulse Heart successfully developed, and continues to develop, the findings to guide workplans to improve competencies and enable the organization for long-term outcomes improvements success.
Based on the results of the onsite readiness assessment they have identified and implemented interventions to improve readiness for change in each of the five major OIRA Tool categories:

Leadership, culture, and governance
Analytics
Best practices
Adoption
Financial Alignment

Driving Strategic Advantage Through Widespread Analytics Adoption

With the current state of uncertainty facing healthcare organizations, survival requires unprecedented agility when it comes to acquiring and responding to meaningful, strategic information. After adopting the Health Catalyst Analytics Platform, including the Late-Binding™ Data Warehouse and broad suite of analytics applications, Partners HealthCare promoted a philosophy of expanded access to the enterprise data warehouse (EDW) to increase adoption and self-service analytics to improve patient care and outcomes.
Partners needed widespread adoption of the EDW so that information could be meaningfully incorporated into strategic, clinical and operational decision making to support patient care. This meant that users who had a legitimate need to access data to support their job function were encouraged to seek access to the EDW. The organization continues to focus on further increasing the effectiveness of this strategy by ensuring that users have the means to acquire the skills, knowledge, and support they need to effectively use data stored in the EDW.
Results:

243 percent increase in user base—achieved over a two-year period (700+ unique users).
More data available to a broader audience than ever before.
Physician time to access data reduced from weeks to clicks.
87 percent of user community satisfied with the effectiveness of communication provided to support their use of the EDW.

MultiCare’s Transformational Journey Toward Sustained Outcomes Improvement

Mixed reviews of the effectiveness of pay-for-performance programs leave hospitals wondering how to affect meaningful change in patient care and outcomes. However, MultiCare’s experience with focused improvement efforts supported by analytics for pneumonia, sepsis, and women’s care showed that better data consistently leads to better patient outcomes.
Committed to improving population health, and informed by their experience as well as national trends and outcomes, MultiCare formed a new partnership with Health Catalyst, a next-generation data, analytics, and decision support company. The shared risk partnership generated an improvement framework and governance structure formed around a Shared Governance Committee which is responsible for prioritizing, resourcing, and aligning improvement initiatives across MultiCare. The committee and the projects it ultimately approves are informed by data-driven opportunity analysis and ongoing analytics support. This partnership and structure have achieved the following:
Results

Strategic alignment of outcomes goals across the organization.
Established an Analytics Center of Excellence.
Integrated financial data into outcomes improvement initiatives.

Collaborative Partnerships and a Three-System Approach to Driving Healthcare Transformation

Healthcare organizations are among the most complex forms of human organization ever attempted to be managed, making transformation a daunting task. Despite the challenges associated with change, Texas Children’s Hospital identified that it needed to evolve into a data-driven outcomes improvement organization.
Texas Children’s embarked on a journey to transform care, building a three-systems approach—analytics, best practice, and adoption—designed to develop a data-driven quality improvement organization that could achieve outcomes improvement expediently and at scale across the entire organization. Texas Children’s leadership knew that the foundation for clinical systems integration would be meaningful, actionable data. That realization prompted the organization to implement the Health Catalyst Analytics Platform including a Late-Binding™ Data Warehouse (EDW) and a broad suite of analytics applications.
After deploying the analytics platform supported by multidisciplinary quality improvement teams, Texas Children’s was able to improve patient outcomes related to the following:

35 percent relative decrease in hospital-acquired conditions (HACs).
44 percent relative decrease in LOS for patients with Diabetic ketoacidosis (DKA).
30.9 percent relative reduction in recurrent DKA admissions per fiscal year.

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.

Using Value to Prioritize and Guide Analytics Investments

With the advent of analytics, hospitals have new access to high quality, reliable data. In turn, this can fuel any number of outcomes improvement projects, but hospitals have finite resources to expend on these initiatives. A process is needed to identify which ones will deliver the highest value and best align with the hospital’s overarching priorities.
To balance the demand for analytics support of improvement projects Mission Health designed a prioritization tool that has helped them identify the right projects to approve–while keeping stakeholders more engaged than ever in improving outcomes for patients.
To date, 80 percent of 55 approved projects have met or exceeded their initial targets. Actual realized targets include:

32 percent reduction in sepsis mortality
20 percent improved compliance with the sepsis care process
7 percent reduction in LOS for bowel surgery patients

Service Lines and Activity-Based Costing Reveal True Cost of Care for UPMC

Between 2007 and 2014, U.S. healthcare costs per capita increased by almost 25 percent. The way in which health systems are typically organized, managed, and budgeted (as departments and units within separate hospitals) works against them when they attempt to improve population health and decrease costs. The University of Pittsburgh Medical Center (UPMC), a large health system with more than 20 hospitals and 500 clinics, was keenly aware of this challenge as it embarked on population health and value-based care initiatives that spanned the entire organization.
The health system determined that it needed to break down the virtual walls between care centers and standardize service lines across the enterprise. By extension, this organizational change mandated the need for activity-based costing in healthcare that would deliver the insight necessary to run a service line effectively. UPMC organized six service lines within the health system, each spearheaded by clinical, operational, and financial leadership. Each service line uses the health system’s innovative, data-driven activity-based costing methodology to understand the true cost of care.
Notable, measurable results of UPMC’s service lines and activity-based costing methodology to date include:

$42 million of cost reduction opportunities (approximately 2 percent of targeted service line cost)
$5 million in supplies savings
Transparency toward identification of contribution margin variation for specific procedures
Up to 97 percent improvement in time to access information

40,000 Covered Lives: Improving Performance on ACO MSSP Metrics

The U.S. healthcare system is the most expensive in the world, but data consistently shows the U.S. underperforming relative to other countries on most dimensions of performance. The Centers for Medicare & Medicaid Services’ (CMS’s) accountable care organization (ACO) model is aimed at addressing that issue by offering financial incentives for providers to improve the health of populations and reduce costs through greater efficiencies and a focus on preventive care.
Mission Health formed a Medicare Shared Savings Program (MSSP) ACO called Mission Health Partners (MHP), which is responsible for 40,000 patient lives. MHP knew that its manual approach to data collection and reporting would not be sufficient for the required ACO quality metrics. By leveraging a previously implemented enterprise data warehouse platform and implementing an ACO MSSP analytics application, MHP was able to automate the processes of data-gathering and analysis and align the data with ACO quality reporting measures. The visibility and transparency of near real-time, online performance data coupled with focused process improvement has resulted in subsequent improvement in all 33 of the ACO performance metrics. Specifically, improvements have included:

9.6 percent increase in compliance over all reported ACO metrics, with 23,000 more patients receiving recommended treatment or screenings.
98.9 percent of eligible patients received screenings for clinical depression and follow up.
40 percent increase in number of patients receiving any cancer screening; 46 percent improvement in the number of patients receiving colorectal cancer screening.
456 percent increase in the number of patients getting fall risk screening.

How One Hospital Took the Pain Out of Getting Paid

A hospital’s core mission is to provide the best care possible. To continue to do so, however, hospitals must be paid promptly. Discharged not final billed (DNFB) cases—where bills remain incomplete due to coding or documentation gaps—represent an ongoing challenge for hospitals around the country.
Thibodaux Regional Medical Center, like other hospitals, faces a myriad of new government regulations that have made hospital bill collection efforts more onerous. Its leaders recognized their inadequate manual DNFB process left hospital staff overburdened and put at risk the necessary cash flow to best serve patients.
The hospital automated and streamlined this process to relieve the burden on physicians, provide an integrated view of data, optimize visibility and workflow, and reduce the need to “downcode” reimbursements due to missing documentation. The hospital leveraged analytics to provide actionable feedback to continuously improve the process.
Thibodaux has already achieved significant improvements to cash flow and operational efficiency:

44.4 percent improvement in delinquency rate
8.2 days reduction in A/R days
70.5 percent decrease in the number of billhold accounts outstanding
50 percent decrease in physician portion of DNFB dollars
97 percent improvement in operational efficiency

Turning Data from Five Different EHR Vendors into Actionable Insights

When healthcare information systems don’t talk to each other, countless inefficiencies and patient safety issues may arise.
Community Health Network (CHNw) believes in delivering outstanding care to every patient. In order to minimize patient safety risks and inefficiencies resulting from using different EHRs, CHNw embarked on a journey to integrate its healthcare information technologies. After implementing a Late-Binding™ Data Warehouse from Health Catalyst that integrates all key data sources, CHNw now has a consistent and comprehensive perspective for multiple patient encounters across the enterprise. It has achieved the following results:

Data from multiple EHR vendors, including four inpatient EHRs and two ambulatory EHRs, plus five transactional systems—HR, patient experience, patient safety, finance, and supply chain— were integrated within 12 months.

More than 55,000 data elements and over 18 billion rows of data were incorporated.

Patient-to-patient matching was implemented for over one million patients across the four inpatient EHRs. This is vital for managing patient populations.

Operational efficiency was improved by 70 percent, with data architects spending an estimated 15 percent of time supporting interfaces compared to an estimated 40-50 percent before the integration. In one example, CHNw linked its ERP/costing system to the EDW’s EHR source marts with just a single interface; previously, this would have required building separate interfaces for all six EHRs.

Sepsis: The Impact of Timely, Trustworthy Data and a Systemwide Approach to Care Improvement

For patients with the severest form of sepsis, the chance of survival decreases by 7.6 percent for every hour that antimicrobial treatment is delayed. Coordinated team work and the speed with which recognition, diagnosis, and treatment of sepsis occur are critical. Health systems across the country have discovered that by successfully engaging clinicians in driving and maintaining best practice interventions they are able to save lives and improve patient outcomes. At Piedmont Healthcare, the work of educating clinicians on the importance of following sepsis care best practices had been done. The missing pieces were a well-resourced, systemwide improvement team to improve sepsis care, and a concise way to view and give timely feedback on performance based on accurate, trusted data. To fill in these missing pieces, Piedmont created a cross-representative sepsis improvement team and enabled tracking for compliance to best practices with an analytics application from Health Catalyst. Within just three months of deploying the Sepsis Improvement Application, Piedmont has accomplished significant improvements in efficiency—and completely won trust in the data. Piedmont has already identified early indications of patient outcome improvements. Initial achievements of its sepsis improvement team include deploying systemwide visibility into sepsis care performance and best practices compliance, improved acknowledgement of first alert by 19 percent across the system, and a reduction in manual data collection by 97 percent.

The Improvement Methodology From Thibodaux That TJC Calls “Best Practice”

Thibodaux Regional Medical Center has always excelled in delivering quality care to its patients, but a fundamental tenet of its culture is continuous improvement.
Driving that continuous improvement is a methodology The Joint Commission called “best practice in how to use data and get physicians engaged.” This quality improvement methodology centers around a three-systems care transformation model that includes best-practice care protocols, analytics, and rapid time-to-value analytics application development and frontline clinician adoption.

Keys to Successful Quality Improvement: A CEO’s Perspective

We believe healthcare is undergoing a transformation and that CEOs need to promote a culture of dialogue and adaptive learning to drive continuous quality improvement. Thirty years ago Greg Stock, CEO of Thibodaux Regional Medical Center, was seated in a healthcare conference when he heard a presenter say, “Thirty percent of clinical care is waste.” These words triggered something in Stock that sent him down a relentless path to transforming healthcare in his community.
Learn how Stock is leading and sustaining outcomes by establishing a culture of quality with an adaptive leadership style, engaging physicians, and using analytics, best practices and adoption processes that work.

How Partners HealthCare is Managing Costs in the Emerging At-Risk Environment

In order to thrive in an ever-increasing risk-based contracting environment, accountable care organizations like Partners HealthCare need to deliver high-quality, safe care with minimal risk. Integrated data that reveals cost reduction and care improvement opportunities are necessary to be successful in a risk-based environment, and has historically been fragmented and limited in interoperability in healthcare organizations. To merge, house, and analyze the necessary financial, operational, and clinical data required for risk-based contracting, Partners deployed a late-binding enterprise data warehouse (EDW) and population health management analytics. The EDW and analytics applications are making information accessible to managers as soon as it is released, along with enhanced visualizations that enable data-driven insights. In addition, the analytics application is helping to drive physician awareness and engagement in understanding and managing cost trends.

How Partners HealthCare is Leveraging Episode-Based Data to Improve Care Delivery

U.S. healthcare is shifting from procedure and visit approaches to a longitudinal view of patient care. The Centers for Medicare & Medicaid Services (CMS) is supporting this change with their “Bundled Payments for Care Improvement Initiative.” Under the initiative, healthcare organizations enter into payments arrangements with financial and performance accountability for 48 episodes of care. This requires health organizations to integrate data from a combination of sources in order to identify the bundles with the highest costs and the sources of variation. Learn how Partners HealthCare, an Integrated Healthcare Delivery System and ACO, successfully integrated hospital, provider, and claims information for the first time—and how they can now easily evaluate and compare clinical and financial performance for the 48 CMS episodes of care.

Managing Half a Million Risk-Contracted Lives: Partners HealthCare Population Health Strategy

Population health management in a value-based model requires reengineering care delivery to provide higher quality of care at a lower cost. To address this challenge, organizations need to take a system-wide, strategic approach to defining their structures and processes. Learn how Partners Healthcare, an Integrated Healthcare Delivery System and ACO, developed and successfully implemented a strategic framework —guided by strong leadership and meticulous change management—for managing its half a million risk-contracted lives. The framework enables collaboration and aligns providers across the care continuum, using a unified set of performance targets for all contracts. The framework includes a robust analytics system that provides metrics to deliver the best patient care, while meeting the disparate requirements of multiple external contracts. Partners Healthcare has developed an internal performance framework that can serve as a population health management model for health systems throughout the United States.

How Hospital Financial Transparency Drives Operational and Bottom Line Improvements

In an era of steadily declining operating margins, hospitals are seeking ways to increase their profitability. Learn how one hospital system integrated financial and operational data in near real-time, giving their leaders visibility into how their decisions are impacting the bottom line. Leadership is now making more informed decisions and they are addressing problems as they arise. Budgets are consistently being managed close to target and variances for each cost center are readily explained with drill-down capabilities into the general ledger. A significant manual effort associated with over 1,000 cost center spreadsheets has been eliminated and the organization has saved $12 million in labor savings.

Patient Identification and Matching—An Essential Element of Using an Enterprise Data Warehouse to Manage Population Health

In a healthcare industry transitioning to value-based reimbursement and population health management (PHM), matching patients accurately to their care events across multiple sites of care and sources of information is becoming ever more important. Being able to accurately track utilization of services for a particular patient, patient population, or provider is fundamental to the strategies underlying effective population health management. Partners HealthCare developed an effective patient matching solution for more than 10.5 million patients achieving a 20 percent improvement in patient matching accuracy and a 96-99 percent high-risk patient matching rate. This has allowed the organization to accurately “flag” high risk patient populations and better manage risk under risk-based contracts.

Partners’ Enterprise Data Warehouse: Focus on Service and Value

As the healthcare industry rapidly evolves, implementing an enterprise data warehouse has become essential both for population health management and economic survival. While this requires building analytics competency across the enterprise, once adopted, the benefits are abundant—from improved patient outcomes to reduced waste and costs. To rapidly gain value from this platform, healthcare organizations should follow an implementation strategy that, before anything else, identifies the problems analytics is intended to solve. It should also place as much emphasis on people and processes as it does technology. Partners HealthCare is an example of how implementing a data warehouse can quickly leverage analytics across the enterprise to achieve value with high end-user engagement and satisfaction.

The Enterprise Data Warehouse (EDW): Creating the Foundation for Effective Healthcare Improvement Analytics

Population health management and value-based care has arrived. However, many healthcare organizations don’t have a single source of truth for their data, nor can they easily access their information. In the absence of integrated data visibility, many hospitals are relying on manual workarounds that can take months, and sometimes even years to implement—and in the end, may still fall short of delivering the level of insight needed. Learn how Partners HealthCare consolidated its disparate data warehouses, incorporating more than 27,000 data elements from multiple sources systems—and implemented on time and on budget. Partners’ enterprise data warehouse now serves as the analytics foundation for its overall value strategy.