Prior to this technology implementation, two SCL Health care sites and a commercial payer already had been particularly interested in hip and knee surgery improvement within the Comprehensive Care for Joint Replacement bundled payment model. Both care sites had desirable performance with length of stay (LOS) as measured against Medicare and all-payer benchmarks in the TBS database, its officials attest.
But they realized that customized benchmarks would provide a stretch goal appropriate to best-practice hip and knee surgery outcomes at the care sites. To develop the benchmarks, SCL Health and TBS collected and analyzed data from Healthgrades on organizations that had five-star ratings for hip and knee surgery. Importantly, organizations that could offer stretch goals for the care sites also required appearance on the U.S. News and World Report “Best Hospitals” list, and a similar patient volume to the care sites. Indeed, 80 hospitals providing knee surgery and 56 providing hip surgery met the criteria for “best practice” organizations with both low LOS and low complication rates. Data from those organizations were used to establish the tailor-made benchmarks, SCL Health officials say.
Advice for the C-Suite
All of the healthcare leaders interviewed for this story agree with the notion that with all of the initiatives that federal healthcare officials are creating now—around readmissions reduction, value-based purchasing for both hospitals and physicians, bundled payments, and accountable care—the leveraging of data and healthcare IT will be critically important.
So what is the best plan of action for CIOs and CMIOs right now around leveraging robust data analytics to bend the healthcare cost curve? Well, there isn’t one single answer for organizations nationwide, says Impact Advisors’ Golder, who notes several options for health systems such as: aggregating data by building data warehouses; integrating data sources themselves; looking at their existing vendor partners to help them since their doctors don’t want to leave the EHR; and finding third-party vendors for data aggregation. “So, for the provider organization, what’s your appetite for risk?” Golder asks.
Independence Blue Cross Blue Shield’s Vennera says that payers should be talking to the providers they work with in their market, if they aren’t already, about how they can share data, particularly if there is no regional data exchange program or HIE in place. And on the analytics specific side, he adds, “The big thing for CIOs is to strike the right balance between insourcing and outsourcing. With the analytics arms race and the cost of analytics resources, you can’t build everything in-house. But also you can’t bend your way to the answers. You need a combination of vendor solutions and building the in-house talent to interpret results, challenge findings, and think through and develop proprietary analytics.”
Moore agrees with this advice. He says: “Put stakeholders in a room together and have them each bring the data they believe is most important and share it with each other, so they could understand the data that exists rather than create something new.” Moore believes that there is a tendency in healthcare to try to create something new and constantly look at something differently. “Right now, we have many different data points that are not necessarily used as well as they could be and integrated as well as they could be. Start with the data you have and figure out how to best leverage it,” he says.
The Advisory Board’s Cinque further brings up the point that when an organization begins collecting information and data, and synthesizes it across different sites of care, it forces interactions with other EHR systems, or in some cases, places that don’t even have EHRs. “You need to understand the IT landscape of your partners and other providers in your community. That will influence your success on these programs,” he says. “For CIOs and CMIOs, there is a belief in if they are not on our EHR platform, we shouldn’t work with them or it shouldn’t matter. That’s not a tenable strategy with these interconnected programs.”
On the risk-based side, Moore also notes the fact that there is still such a mix of fee-for-service and value-based reimbursement, which ultimately slows things down. He calls it “a schizophrenic way for a provider to try to practice.” He says that provider organizations need to figure out how to segregate, meaning having a fee-for-service group and value-based group that is at least 75 percent reimbursed from one side or the other. “Until the majority of a doctor’s compensation is tied to one side, they won’t behave in that certain way. That’s one of the biggest challenges for us in the next five years,” he says.
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