Data Analysis Provides Intelligence for Success in New Payment Models By Connie Moser
Vice President and Solution Line Manager,
Enterprise Intelligence Solutions
McKesson Provider Technologies
About 10 years ago, the world of professional baseball was rocked by the introduction of a new approach to statistical analysis. Instead of looking at batting averages or stolen bases, “sabermetrics” examined what actually determined success on the field. The conclusion: it was largely due to on-base percentage. The GM of the cash-strapped Oakland Athletics used that statistical approach to stock his team with less expensive but more effective players and managed to compete with the Yankees who paid their stars three times as much.
In healthcare, we’re seeing our sabermetrics moment arrive. Most health systems are being squeezed financially even as they are driven to improve care outcomes. New payment pressures include bundled services, pay-for-performance initiatives, accountable care, patient consumerism and the looming influx of millions of new users. But financial incentives seem to be at odds with clinical practice.
According to a 2009 NY Times article, Park Nicolett, a hospital and clinic system in St. Louis Park, Minn., reportedly spent $750,000 on readmission prevention follow-up that reduced readmissions by 25% but earned only a $247,000 bonus from Medicare. Organizations will always opt for quality improvement at whatever cost, but when does quality become financially impossible to deliver? The answer may be that, like professional baseball, healthcare needs to manage under a new set of metrics.
Many Questions, One Answer
A better understanding of what care processes cost and how breakdowns impact quality across the healthcare continuum will help organizations prepare for the future. That future is likely to be characterized by value-based reimbursement — reimbursement that looks at quality, cost and population health.
Fortunately, a better approach to data analytics will help organizations meet these challenges immediately. Effective use of analytics points the way to improvements from an integrated clinical and financial view across the enterprise. However, developing a level of analytics maturity requires long-term discipline and attention to detail across the organization. Doing it wrong means devoting significant resources to systems that will fail to improve efficiency or quality.
Implementing information technologies to support business operations, decision making
and innovation
Management of the tsunami of data that healthcare technology creates so that it is
“consumable” by caregivers and administrators
Inform decision-making and influence behavior using intelligence generated from the data
The convergence of these capabilities sets a new standard for how progress is measured. And since reimbursement is tied to that progress, it will affect strategic decisions about service lines, staffing, technology investments and care delivery.
For example, as an organization launches readmission prevention programs, it must evaluate the cost and quality of care across the continuum, not in silos. This means it must aggregate data from all of those care settings in order to look at where costs are incurred, identify appropriate care settings to achieve the highest level of quality and monitor patient experience.
If organizations use the information to identify high-risk patients while they are still in the hospital, they can target their limited resources to patients where they can make a difference. The measure of success becomes not just readmission rates or patient days but variable cost by phase of care linked to patient outcome and experience. When viewed holistically, one may find that investment in prevention does produce a financial return, especially under a bundled payment model.
This approach applies to any performance improvement initiative in healthcare, such as preventing hospital-acquired conditions. PeaceHealth Southwest Medical Center used McKesson’s enterprise visibility solution to display real-time messages to alert nurses of patients with a fall risk, leading to workflow changes, a 17% fall reduction and $630,000 in cost avoidance over two years.
Ensuring Success
Data credibility is improving as technology becomes more widely adopted. However, tight governance and data stewardship are essential, as are business advisors that ensure data use is optimized. It is equally important that care providers are presented data in a manner that truly affects the way they do their work. Whatever alert system is used to push the business intelligence to providers, it must be simple, timely and insistent of notice.
Ultimately, however, the success of a better approach to data analytics starts with leadership. To adopt a sabermetrics model in healthcare means organizations have to rethink the traditional measures of success and engage their stakeholders in a new dialog about performance. A new analytics solution can’t be relegated to the financial administrators or the clinicians — it must be seen as an enterprise-wide, integrated view of performance. Real executive sponsorship and awareness are essential for the organization to improve its .numbers and provide better care.
Connie Moser leads the Enterprise Intelligence division within McKesson Provider Technologies and has more than 21 years experience in the healthcare industry. She served a three-year term as the public board member for the Competency and Credentialing Institute, a nonprofit organization focused on enhancing patient safety through surgical nurse certification, where she also held the roles of Secretary/Treasurer for two years. Additionally, Moser has presented on various topics sponsored by HIMSS, HFMA and NAHAM, and most recently at the HFMA Thought Leadership Leadership Conference in Washington, DC.
Starting in Federal fiscal year 2013 (October 2012), hospitals face a reduction in payments for all Medicare patients for preventable readmissions incurred by the hospital in 2012. Each year through 2015, an additional 1% reduction in reimbursement is added, capping at a 3% reduction.
The preventable readmissions defined under the healthcare reform legislation, include: heart failure, acute myocardial infarction and pneumonia. In addition, the Hospital Compare website reports how hospitals’ 30-day readmission rates for certain conditions compare to the US national rate.
To prevent readmissions, hospitals need to ensure that there are education and discharge instructions before the patient leaves the hospital, and that outreach continues after the patient returns home. To build a bridge to the home, hospitals are enlisting family members to help ensure the prescribed treatments are followed and medications taken.
Some hospitals are using call centers to provide: post-discharge care coordination, education on the condition, follow-up on medication adherence, customized care plans, scheduling and reminders for recommended appointments, and monitoring of the patient’s condition via telehealth devices.
“In 2008, we launched our heart failure disease management program,” says Rita Satvos, RN, BSN, PN, director of Affinity NurseDirect/Population Health NurseDirect. “Our nurses work with patients to educate them on their condition and the importance of adhering to the treatment plan. We integrate telemedicine technology and monitor patients on a regular basis, based on their need.
“As a result of our efforts, Affinity Health Systems places in the top percentage for heart failure treatment in the Hospital Compare rankings. Two area healthcare organizations also use our services, and in the first quarter of 2010, they significantly reduced their readmissions. Only three patients were readmitted to either facility.”
Previously, St. Luke's practice
data was located in silos.
Cross-continuum data
integration now offers a clearer
view to address the future of
healthcare reform.
Cowherd Family Medical
Center used its EHR to
improve the population health
of its patients. The practice
received a top score from
CMS and $75K in P4P funds.
Sky Lakes Medical Center
implemented a variety
of strategies to increase
revenue and reduce costs —
and ultimately improve the
bottom line.
HFMA’s CEO Richard Clarke
advises providers to view value
in healthcare from the eyes of
the purchaser. When care
costs outpace gains in care
quality, there is a value gap.
Print This Issue | 
Share this Page
Implementing information technologies to support business operations, decision making
