Advanced payment models incentivize Accountable Care Organizations (ACOs) to deliver high-quality care and close gaps in care for members, thereby earning shared savings and increasing profits. However, in order to succeed and identify gaps in care, ACOs must be able to rely on solid data and analytics to avoid losing income that could be invested back into patient care. Utilizing its analytics platform and a quality measures solution has allowed Hospital Sisters Health System to close care gaps, improve ACO quality measures performance, and enhance reporting accuracy and effectiveness.
Quality Metrics Tracking
Dartmouth-Hitchcock Health (D-HH) was committed to improving its provider performance reporting method so that providers could easily access their performance data and deliver better care to patients. With the right analytics, D-HH was able to implement an affordable solution and reduce the manual reporting required by its financial analysts.
Increased Visibility into Value-Based Performance Results in $2.1M in Additional Pay for Performance
Data-driven decisions and analytics are critical for organizations and physician practices attempting to thrive under value-based care. With the help of data analytics, UTMB Health was able to focus on improvement efforts for specific patient populations and boost reimbursement based on DSRIP performance.
Operating room (OR) costs are substantial—time in the OR can cost between $22 and $133 per minute. Even a slight delay in start time can cost organizations hundreds of thousands, if not millions, annually. Learn how John Muir Health utilized analytics in the OR—giving the organization the ability to access the data it needed to educate staff on the reasons behind delays so that start times could be improved.
On an annual basis, ACOs are required to accurately report data that is used to assess quality performance which is also linked to eligibility to share in any savings generated. Read how Mission Health implemented a proactive approach to measure and evaluate performance, including widespread adoption of analytics and shared responsibility for ACO measure performance, enabling the organization to sustain and further improve its performance across multiple ACO measures.
Providing and documenting best practice preventative and primary care measures is critical for MSSP success. Read how USMM integrated data from disparate sources and utilized its analytics platform and applications to achieve 80th and 90th percentile performance for various ACO measures, resulting in significant contributions to Medicare savings.
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.
$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.
Publicly reported measures of healthcare quality includes the Hospital Safety Score Grades which award a letter grade representing performance for 30 evidence-based measures of patient safety. An “A” represents the best Hospital Safety Score, followed in order by “B,” “C,” “D,” and “F.” In the fall of 2014, Piedmont’s Hospital Safety Score Grade for its five hospitals included four “C’s” and a “D.” This demonstrated a need to change its approach to quality improvement and ensure proper resources were allocated and aligned with the value chain, enabling it to efficiently conduct surveillance activities, perform analysis, and facilitate sustained outcomes improvement.
To increase capacity for performing more value-added work, Piedmont leveraged its analytics platform to automate surveillance activities and monitor the effectiveness of quality improvement efforts. These tools helped Piedmont redesign its quality improvement efforts, resulting in a:
35 percent relative reduction in healthcare facility acquired infections per patient day.
50 percent reduction in the time required for peer review.
50 percent reduction in the time to implement improvement projects.
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).
Allina Health needed to ensure the data it reported to regulatory agencies was timely and accurate. The integrated health system sees 100,000 inpatient hospital admissions annually, 340,000 emergency care visits, and 6,000 physicians and 1,600 nurses providing and documenting care. Due to the sheer volume of patients and employees, clinical data abstraction at Allina Health is not a small undertaking.
Looking to stay compliant while reducing resource utilization, Allina Health sought to change its workflow procedures for faster, more accurate clinical data abstraction. A large amount of clinical data required for compliance with CMS performance measures and Joint Commission Core Measure resides in unstructured data, such as narrative notes, which require manual data abstraction. With the help of data analytics, Allina Health was able to develop evidence-based standardized processes for clinical reporting and automate some clinical data abstraction.
76 percent relative improvement in time to data availability at each site. Data is typically available within 14 days of discharge, far exceeding the 30-day target.
95.5 percent accuracy for CMS validation.
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.
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.
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.
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.
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.
Hospital-acquired conditions (HACs)—such as central line-associated blood stream infections (CLASBIs) and pressure ulcers (PUs)—cause harm and adversely affect patients’ lives, while also increasing hospital length of stay (LOS) and total hospital costs. In fact, each case of CLABSI alone costs up to $55,000 to treat and makes health systems vulnerable to reimbursement penalties.1
Children’s Hospital of Wisconsin (CHW), a nationally ranked pediatric center with two hospitals and a surgery center, recognized that reducing the rate of HACs in its facilities would require major systematic changes. CHW’s approach to transforming care to prevent HACs included cultural changes with an emphasis on staff education and engagement and a new governance structure to support the initiative. These changes were powered by high-tech tools and quicker access to new types of data that CHW didn’t have in the past.
The hospital’s implementation of its comprehensive and collaborative HAC reduction plan has resulted in measurable quality of care improvements and cost reductions, including:
$1.6 million savings realized to date as a result of a 30 percent reduction in the overall number of HACs
23 percent reduction in central line-associated blood stream infections (CLABSIs)
74 percent reduction of pressure ulcers (PUs)
68 percent reduction in venous thromboembolisms (VTEs)
How to Avoid PQRS Penalties and Earn Potential Incentives with Accurate Submission of Quality Measures
CMS has recently transitioned its Physician Quality Reporting System (PQRS) program from a pay-for-reporting program to a program that will now apply a negative payment adjustment to providers who do not satisfactorily report data on quality measures. Memorial Hospital faced a significant problem when its PQRS reporting process was hampered by its transition to a new EHR system. They needed a solution. Learn how Memorial successfully used their enterprise data warehouse to submit the necessary data to a certified registry, avoiding a four percent Medicare reimbursement adjustment, and providing them with the potential to earn an incentive payment. They also now have several patient registries that can be used for quality improvement initiatives in clinical care, patient safety, and care coordination.
The need to effectively manage the health of populations is largely driven by the fact that 5 percent of the population accounts for 50 percent of healthcare costs. Being able to identify these patients, provide high-quality care and reduce their utilization is a pressing goal for many of today’s primary care providers (PCPs). Learn how this healthcare organization used a healthcare enterprise data warehouse and analytics to better manage their individual patients and patient population, integrate regulatory and performance reporting, and allow PCPs to spend more time with patients and less time collecting data.
Addressing The Joint Commission (TJC) core measures is a challenge for healthcare organizations. Hospital EMR data issues are well known by quality and patient safety, and clinical quality improvement clinicians. Read how this healthcare organization is using their healthcare enterprise data warehouse and clinical analytics to establish accurate baseline measures and ongoing near real time performance tracking for their TJC perinatal core measures.
Learn how Community Care Physicians used clinical analytics to drive a 75 percent reduction in patient navigator reporting and chart abstraction time. Now RNs can spend more time focused on quality improvements. Patients also receive timely outreach for overdue treatment and upcoming reminders. View sample regulatory and patient level visualizations and learn how these graphical visuals — including clinic and provider comparison metrics — helped drive provider engagement.
What do you get when you combine an enterprise data warehouse with analytics applications? Texas Children’s Hospital used this dynamic duo to help them identify and implement improvement programs that drive measurable — and sustainable — results.
Discover how a healthcare system went from manually pulling together reports with varying data to having near real-time data that one executive says, “enables our care coordinators to drive preventive care and ultimately lower our population health costs” all thanks to a Late-BindingTM data warehouse.
Adopting an enterprise data warehouse had a number of positive affects for one medical center. Not only did they create way to more effectively discover and treat certain hospital-acquired infections, the organization also developed five steams of quality improvement—infectious disease, population health, cardiovascular, neuroscience and oncology.