data driven improvement
TRANSCRIPT
© 2015 Health Catalyst
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© 2015 Health Catalyst
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November 5, 2016
Data Driven ImprovementAbbott Northwestern Innovation Summit
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We believe that with the right
evidence, analytics, and methods,
providers can transform healthcare.
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Components of a Data Driven Organization
3
• Enterprise Data Warehouse
• Actionable Metrics
• Predictive Models
• Checklists
• Protocols
• Interventions
• Adaptive Leadership
• Governance
• Improvement Teams
• Clinical Outcomes
• Cost Outcomes
• Experience Outcomes
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Transitioning to Value-based Payments
• Tracking quality measures and
improving performance
• Need analytics to measure
cost and quality for each
patient population so
providers can take action
• If a provider or facility is not
meeting quality standards we
need ability to pinpoint the
cause
• Reducing care variation
• Eliminating waste
4
Measure Name Hospital A Hospital B Hospital C Benchmark $ at-risk*
Communication with nurses 48.0 84.0 92.0 86.68
Communication with doctors 80.0 91.0 84.0 88.51
Responsiveness of hospital staff 51.0 86.0 94.0 80.35
Pain management 56.0 91.0 93.0 78.46
Communication about meds 52.0 81.0 92.0 73.66
Overall rating of hospital 71.0 89.0 56.0 84.58
3-Item Care Transitions Measure 80.0 85.0 68.0 62.44
PSI-90 Composite 0.76 0.92 1.06 0.40
CLABSI 0.77 N/A N/A 0.00
CAUTI 0.57 N/A N/A 0.00
SSI Colon 2.36 N/A N/A 0.00
SSI Hysterectomy N/A N/A N/A 0.00
C.Diff 0.84 2.91 1.09 0.00
MRSA 0.00 N/A N/A 0.00
PC-01 Elective Delivery 0.00 0.00 30.43 0.00
PSI-90 Composite 1.03 0.92 1.07 0.81
CLABSI 0.67 N/A N/A 0.50
CAUTI 0.67 0.00 1.40 1.07
SSI Colon 1.47 N/A N/A 0.95
SSI Hysterectomy 1.98 N/A N/A 0.95
C.Diff 0.87 1.10 0.79 TBD
MRSA 0.19 N/A N/A TBD
30-Day AMI Readmissions 0.74 0.00 0.52 1.00
30-Day HF Readmissions 0.86 0.61 0.73 1.00
30-Day PN Readmissions 1.21 1.41 0.57 1.00
30-Day COPD Readmissions 0.97 0.94 0.74 1.00
30-Day THA/TKA Readmissions 0.80 0.47 1.33 1.00
30-Day CABG Readmissions 0.53 N/A N/A 1.00
$23,725,072
Medicare Pay-for-Performance Scorecard FY 2018
Val
ue
Bas
ed
Pu
rch
asin
g
$8,908,000
HA
C R
edu
ctio
n P
rogr
am
$4,454,268
Rea
dm
issi
on
s
Red
uct
ion
Pro
gram
$10,362,804
Total
*Not actual dollars, scorecard as example only
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Partnership with Health Catalyst
• Accelerated outcomes
improvement
• Access to catalog of Health
Catalyst technology and clinical
content
• Team of analytical professionals
• What drives us:
Healthcare Analytic Adoption Model
Allina 2008
Allina 2010
Allina 2014
Allina +
Catalyst
Working with teams across Allina
Health to turn data into information
and information into action
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Practical Examples
6
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Reducing Care Variation
Outlier Reduction
Reduce outlier practices in a smaller number of facilities or providers
Provides more immediate results, but diminishing returns over time as outliers are reduced
Shifting The Mean
Requires a change in practice
amongst the majority
Continuous focus on improvement:
takes longer to achieve but drives
long term results
Opportunity Cases
Source: Advisory Board -
https://www.advisory.com/-/media/Advisory-
com/Technology/Crimson-Continuum-of-
Care/Success-
Pages/CCC_CareVariation_CG_011615.pdf
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Improving Patient Care
Improving Spine Care Outcomes by Decreasing Care Variation
Low back pain is a common and expensive problem. Allina recognized their spine care could be improved. Through the establishment of a spine care governance program, the development of standard care guidelines, and use of analytic dashboards to drive behavior change, Allina dramatically improved the care processes and outcomes for patients receiving spine care.
Key results of the effort to date include:
• 16% reduction in LOS, decreasing from an average of 4.26 days to 3.6 days
• 3.6% reduction in post-op complications
• $2.7M projected savings achieved through supplies standardization
8
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Improving Patient Care
Bleeding Risk Assessment Decreases Complications and Costs
Bleeding is common in PCI and increases length of stay (LOS), costs and mortality. The literature has shown that the use of closure devices decreases bleeding complications in patients at high risk for bleeding.
Key results of the effort to date include:
• Closure device usage for high risk patients increased from 39% to 78%
• Length of stay for high risk patients with closure devices decreased from 3.81 to 2.42 days
• Complication rate decreased from 23.3% to 18.0%
• $1.8M cost savings since implementation
9
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Drug Cost Opportunity in Total Knee Replacements (345k)
10
Selections: July 2015 – June 2016, Inpatients only, Outliers removed, Case
min 10, Knee Replacemnt HARs
Reducing average (avg) drug costs for those using Ropivacaine to $500 through the elimination of pain pump
use creates opportunity equal to ($2,800 - $500) * 150 = $345,000.
Provider VolumeSeverity 1&2 %
Severity 3&4 %
Performance to Geometric Mean
Length of Stay (LOS)Avg Drug
Costs
PPR A/E Ratio (Excess)
PPC A/E Ratio (Excess)
A 17 100% 0% 97% $3,038 0.00 (-0.3) 0.00 (-1.1)
B 97 96% 4% 90% $2,832 1.03 ( 0.1) 0.29 (-5.0)
C 36 97% 3% 87% $2,711 0.00 (-0.7) 0.00 (-2.5)
D 172 92% 8% 93% $500 0.84 (-0.6) 0.54 (-5.8)
E 104 91% 9% 94% $493 0.86 (-0.3) 0.36 (-5.4)
F 125 95% 5% 88% $490 0.85 (-0.4) 0.12 (-7.5)
Using
Ropivacaine
Not using
Ropivacaine
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Analyzing average cost by drug for the top providers shows that Ropivacaine is driving up costs.
Med Breakout for Total Knee Replacements
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Lumbar Posterior Fusion DecompressionSeverity of Illness (SOI) level 2, smoker, diabetic, or >75yo(Supply Opportunity $245K)
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Responsible Provider N- size Avg Supply Cost %PGMLOS
PPC A/E (excess)
PPR A/E (excess)
A 14 $ 15,431 105% 0.00 (-2.0) 0.00 (-0.6)
B 13 $ 12,943 128% 0.56 (-0.8) 1.90 (0.5)
C 36 $ 11,830 90% 0.00 (-5.0) 0.00 (-1.5)
D 11 $ 11,216 102% 0.00 (-1.6) 0.00 (-0.5)
E 51 $ 10,204 102% 0.14 (-6.1) 0.00 (-2.1)
F 41 $ 10,251 102% 0.00 (-5.8) 0.58 (-0.7)
G 15 $ 9,292 98% 0.00 (-2.2) 0.00 (-0.6)
H 22 $ 9,026 115% 0.33 (-2.1) 1.10 (0.1)
I 19 $ 9,571 105% 0.40 (-1.5) 1.36 (0.3)
J 24 $ 8,325 119% 0.64 (-1.1) 2.25 (1.1)
K 19 $ 7,800 115% 1.13 (0.3) 0.00 (-0.8)
L 27 $ 7,933 100% 0.00 (-3.8) 0.00 (-1.1)
M 58 $ 7,371 112% 0.49 (-4.2) 0.42 (-1.4)
N 21 $ 6,680 107% 0.00 (-2.9) 0.00 (-0.8)
• A & B have higher utilization of expensive products compared to colleagues driving overall supply opportunity
(see products to right).
• K has higher utilization of Brand X BONE MATRIX OSTEOAMP PUTTY, MIX, OR SPONGE products compared
to colleagues.
Population: Fusion decompression; lumbar; posterior approach; 1-2 levels; SOI 2, smoker,
diabetic, or >75yo; excl outliers
Selections: July 2015 – June 2016, Providers with >= 10 cases. 91% of supply opportunity is
associated with the above providers.
• Brand Y BONE MATRIX INFUSE BMP
• Brand Y BONE MATRIX MAGNIFUSE DBM
• Brand Y Brand Y SEALER TISSUE AQUAMANTYS
BIPOLAR
• Brand Y BONE MATRIX GRAFTON PUTTY DBM
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