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“Making the Numbers Work”: Henry Ford Leaders Explain ACO Critical Success Factors, Step by Step

March 5, 2018
by Mark Hagland
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Leaders from Detroit’s Henry Ford Health System have achieved significant success in their early work in the Next Generation ACO Program—through careful strategic planning and intensive analytics work

What is it like to actually build an accountable care organization (ACO) from the ground up? And what kinds of calculations go into the decision to participate in any of the available federal ACOs sponsored by the Centers for Medicare and Medicaid Services (CMS). Leaders from the Henry Ford Health System in Detroit shared a wealth of insights on Monday morning, during the Population Health Symposium, one of numerous pre-conference symposia held at the Sands Convention Center in Las Vegas, as part of the annual HIMSS Conference.

Bruce K. Muma, M.D., CEO of the Henry Ford Physician Network (HFPN), and Matt Hussman, the HFPN’s director of analytics, shared insights with their audience around how they and their colleagues ultimately made the decision to participate in the Next Generation (Next Gen) ACO program under CMS.

The Henry Ford Physician Network is a 2,000-plus network of physicians, some of them employed by Henry Ford Health System, and others independent. It overlaps with the Henry Ford Medical group, a 1,300-employed physician and scientist group within HFHS.

Despite the large size of the Henry Ford Health System—the integrated system encompasses eight hospitals, 200 care sites, 30,000 employees, a durable medical equipment company, home healthcare, and pharmacy, and a service area with 1 million residents of southeast Michigan—“Despite the fact that we’re a really large health system, we really struggled over the decision to take on two-sided risk,” Dr. Muma told the audience on Monday.

“Henry Ford was an early adopter of value-based concepts,” Dr. Muma said. “We formed our first ACO in 2010, a year after the ACA [Affordable Care Act] was passed. The early intent was to create an ACO that would be attractive to commercial payers from a narrow-network standpoint. We had reached a size of 40,000 covered lives over a period of four years; but to be honest, in the overall scheme of things, considering the size of our service population, that didn’t end up being that huge a deal,” he said.


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“Still,” Muma continued, “when the Pioneer ACO model came along, we looked at that. But we chose not to pursue it, because of the financial model. The formula wasn’t conducive to success; the shared savings threshold looked pretty steep to us.” In fact, he said, “Probably the biggest reason we didn’t do Pioneer was the adverse impact of the IME and DSH payment pass-through,” he said, referring to the federal Indirect Medical Education and Disproportionate-Share Hospital Adjustments to Medicare Inpatient Payment Rates under the Medicare program. “Those pass-through payments were not taken out of the formula, so we would automatically be designated as a ‘highly inefficient performer’” under that system. Further, he reported, “We opted not to pursue the MSSP [Medicare Shared Savings Program] opportunity in 2014 and 2015, because the same pass-through problem persisted.”

But, “Finally, when the Next Gen model came along and the pass-through problem was solved, we chose to go forward,” Muma explained, and on Dec. 21, 2016, HFPN signed a two-sided risk contract covering 21,000 attributed Medicare beneficiaries, in the Next Gen program.

“We really struggled with the decision” to go forward, Muma said. “The biggest risk was a $35 million downside. Even as a $6 billion [in annual health system revenues] system, sending CMS a check for $35 million would have taken a really big bite out of our contribution.” What’s more, Henry Ford Health System is a safety-net health system that serves an aging, underserved, inner-city population, he noted. But, he said, the opportunity to leverage strategic partnerships in the region, and to learn how to be successful with value-based care, was appealing enough to overcome those hesitations, he said.

Moving forward—analytically

In making the momentous decision to join the Next Generation ACO program, Muma, Hussman, and their colleagues knew from the start that they needed to engage in some scenario-based strategic thinking around the risk/reward calculations involved. So, Muma said, “We did an intensive sensitivity analysis, looking at how CMS might view our level of efficiency” as a participant in the Next Gen program. “We looked at best-case, moderate or average, and worst-case efficiency scenarios. In the best-case scenario, we found that we were looking at the possibility $11 million-shared savings check. On the other hand, if we let healthcare spending go up 3 percent—which is simply the national rate of annual medical inflation, we’d have to write a check to CMS for $4 million. The middle-of-the-road scenario gave us a $2.2 million gain. In other words, those calculations were based on a decreased total spend of 3 percent; an increased total spend of 2 percent; or staying at the same rate of spending.”

Meanwhile, Muma said, “We realized that this Next Gen ACO contract really would be a tipping point for Henry Ford Health System. As one of the speakers earlier this morning stated, if a health system has 30 percent or more of their volume based on risk, that’s a tipping point, and this took us from the mid-20s to about 33 percent. So that was a tipping point.”

Not only was it necessary to engage in a great deal of scenario-driven analysis to calculate the potential for success in the Next Gen ACO program, once the decision was made to go forward, it was vital to engage all the stakeholders in the organization, Muma said. As a result, he said, “We did more than 40 presentations in the first six months, talking to governing councils, boards, medical staff committees, corporate groups, business units—in the first six months—and that was important.”

Meanwhile, Muma said, “Another key challenge was engaging the beneficiaries. Unfortunately, despite, intensive effort in that area, we didn’t really make a difference” in terms of engaging beneficiaries to the point of broadly changing their behaviors. “We still struggle with beneficiary engagement,” he conceded, “though we agree it’s one of the most important things you can do” in achieving ACO program success.

Defining and eliminating waste—on a broad scale

Early on, Muma, Hussman, and their colleagues came to the conclusion that eliminating a variety of types of waste would be essential to success in the Next Gen program. They concluded that it would be important to identify and attack “hot spots of waste.”

In practice, Muma said, “It was pretty simple” to focus on the waste issue. “We looked for the places where we had the biggest piles of low-value care, or waste. Looking at our data, and benchmark data that we used, from a variety of sources, including from the Premier ACO Collaborative, which HFPN joined shortly after joining the Next Gen ACO program, “we identified three main hot spots,” he said.

The first was the high- and rising-risk populations”—typically, frail people with multiple chronic conditions, or cancer. The biggest opportunity with those populations, Muma said, “is changing the site of care from admissions, ED visits, or long stays in SNFs”—skilled nursing facilities. The second area of opportunity was around the high variation of medical decision-making within acute care. And the third was around post-acute care and transitional care. “Here,” he said, “it meant looking at variation in medical decision-making” in terms of managing post-acute care. “We didn’t own any SNFs, so we were spending money outside our system that wasn’t coming back in,” he said.

And the actions taken? Several. “First,” Muma said, “we built programs for the top 5 percent of patients in terms of prospectively determined risk. Then, we drilled down on acute episodes. We found that the decision to admit a patient from the ED to the hospital involved a three-to-four-fold variation in doctor decision-making. There were also huge variations in referrals to specialists.” In terms of transfers to SNFs, he said, “We found that our average length of stay in SNFs was 27 days. Looking at national benchmark data,” he said, they learned that other ACOs had reduced that average to 14 days; thus, there was great opportunity there.

As a result of all of those initiatives, Muma reported, the organization saved $5 million, in an overall spend that was $244 million in the first year, down from HFPN’s previous annual spending of $248.9 million; in other words, $3.9 million in net shared savings (about 2 percent), or $16.48 per member per month.

And what were the specific programs that came out of this? There were several, in fact:

  • Post-Acute Care (PAC) Surveillance. “We stole the idea from other organizations that had done this,” Muma said. “We hired two case managers, had them call the SNFs, ask for a care plan, and assist patients in getting back to their primary care physicians. And that alone resulted in about a 10-percent reduction in SNF length of stay.
  • Emergency Department Disposition Support (EDS): “This program was designed to help ED doctors make the right decisions—ED doctors are most fearful of sending a patient home with risks,” Muma explained. “Our ED chair [at the flagship Henry Ford Hospital] said, give us tools that will help reassure us that a particular patient will be safe if they’re sent home” rather than admitted. “So we developed a toolbox for them, and implemented that at our main hospital. That has resulted in a 7-percent reduction in admissions to the main hospital; and we’re hoping to replicate that at our other hospitals,” as that program is rolled out at the system’s other facilities.
  • Comprehensive Care Clinics (ambulatory intensive care units. “We’ve opened two of these—they were functioning like ambulatory ICUs; they involve two physicians armed with a team of support, including nurses, pharmacists, etc., who run IV fluids, oxygen, etc., on patients. We enrolled about 500 patients, from that top 5-percent category [of high utilizers]—and in the first year, we saw about a 25-percent reduction in their PMPM [per member per month] costs.”
  • Case Management Integration: equipping those case managers with the highest-risk patients in the ACO
  • Clinical Decision Support: We adopted the Choosing Wisely/Referring Wisely program early on, and we essentially implemented a program purchased from a spinoff of Cedars-Sinai—they’ve spent a lot of time translating Choosing Wisely recommendations into clinical decision support alerts.” The result? $500,000 in reductions in claims expenses. In that, he said, “We worked with the chairman in their departments to identify the top four or five inappropriate decisions, and we asked them to develop recommendations for avoiding referrals; we want to develop e-consult capabilities to support this, so that that will create a kind of economy consult for PCPs; specialists are overburdened with volume, and this will help both types of physicians.” That program is set to roll out this year.

Data analytics—an essential component to ACO success

Data analytics has been essential to facilitating all of this work, Muma noted. “We realized early on that we needed to leverage our EMR/Data/analytics platform, HELIOS. We needed to understand clinical and claims data, and build risk prediction/benchmarking, and performance dashboards.”

One major operational challenge? “We also started to conduct ROI analysis. And that proved to be the most difficult part—we had to convince senior leaders to invest in us, hire staff, and develop models, and we found that we could reduce claims expense, but the finance people said, claims expense is just revenue reduction, and unless you can reduce variable or fixed costs, we can’t count this” as financial gain. “We still struggle with that. We’ve come to a common understanding, and our finance people understand that somebody else is going to have to do the ‘backfill.’”

With regard to some of the nitty-gritty of the analytics work, Hussman said, “You have to start with your eligibility or membership files first. A key enabler,” he noted, “is being able to look at external claims, and to see true performance of at-risk contracts. We started being able to take external claims and plug into analytics and see claims,” he said. And, he added, “We spend a lot of time bringing in that external claims data. We’re a bit different, where we’re looking to create the final claim.”

Importantly, Hussman noted, “CMS data does not look like commercial data; they look completely different. And data from two different commercial payers can look totally different, too. And you need to normalize all the different types of data,” in order to make the analyses work.

Key lessons learned

What have been the key lessons learned in all this work so far? There are several, Muma told the audience. First, he said, “Perfect data is not required; there’s lots of waste out there! You just need to start the discussion.” Meanwhile, “Internal EDW analytic capability is a required element in managing financial risk.” What’s more, “Building an executive dashboard is very important, to get executive buy-in.”

In addition, Muma said, “Aggregation and analysis of claims/EMR data is hard—building trust with physicians is even harder; they’re still struggling with the idea that variation in medical practice is form of waste.” And, with regard to waste, he urged his audience to “Focus on the large buckets of waste, and on supporting providers to do the right thing, as opposed to imposing controls.” Empowering clinicians, he said, “is the most effective strategy; an example of that was working with our ED director—he said, do something to help us send the patients home.” Meanwhile, in all this, he said, “The biggest challenge remains how you translate value-based initiatives into traditional ROI models” in calculating financial and operational success in the new healthcare.

Critical success factors? “It’s impossible to over-communicate the vision and expected challenges,” Muma said. In addition, “You need to engage your clinical leaders as care process owners, and inspire them to create better models of care.” What’s more, “Multidisciplinary teams are vital for creating value across the horizontal continuum of care.” And, when it comes to the data and analytics, “you need to build reliable metrics and dashboards to demonstrate value in population health programs in real time, as much as possible,” and importantly, “You need to engage your organization’s finance team to fully understand and be able to measure the impact of value-based care programs.”


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How a Data-Driven Approach Can Bolster the Fight Against Opioid Abuse

October 12, 2018
by Steve Bennett, Ph.D., Industry Voice
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I want to tell you about Andy. Andy’s mom, Pam, is a colleague of mine. Growing up an only child, Andy was a happy kid. He was a straight-A student, loved to play the violin, and spent a year as an exchange student in Europe. Andy had two loving parents. But Andy suffered an injury in college, and needed to have some minor surgery performed to repair his sinuses. Following that surgery, his doctor prescribed opioid pain medication for him, to which he became addicted. Despite several years of effort, Andy was unable to shake the addiction, and tragically lost his life to a heroin overdose two years after his surgery. This was a normal kid with a normal family, like mine, and like yours.

Andy’s story is an important story. The opioid epidemic has led to the deadliest drug overdose crisis in the history of the United States, killing more than 64,000 people in 2016 alone – the last year numbers were available. This is a true national epidemic, and one that continues to get worse. For the first time in nearly 60 years, life expectancy for Americans has dropped for two years in a row due to the opioid epidemic.

The opioid crisis has been so difficult to curtail, in part, because of the inability to integrate data from various stakeholders and systems. With so many players and data sources, today’s information is partial, fragmented, and often not actionable.

While this disconnect applies directly to the opioid epidemic it is a systematic problem that affects the healthcare community at large. Better data and analytics can help develop better treatment protocols for a wide array of medical and public health challenges that affect the general public. For opioids, that could be to develop better pain management programs or for better, more-targeted remediation and rehabilitation for those that become dependent on drugs.

A Data-Driven Healthcare Approach: Making Information Real


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Ample data has been collected on the opioid epidemic, but disparate sources are not communicating with one another. Addressing this disconnect and lack of communication is something that can provide researchers, lawmakers and the public with improved insights.

Data-driven healthcare can help provide this guidance by using available data and analytics to help create programs that can make a tangible difference on population areas that need the most help. By looking at the data, lawmakers, hospital administrators and doctors can begin to make impactful changes throughout the system.

While much can be learned from this data, most of it is not being analyzed in a way that brings true benefits. It has been put in a silo and/or it is not organized in a way that is interoperable with other data systems.

The 21st Century Cures Act, which established the Health Information Technology Advisory Committee, shows the commitment of national leaders to improving healthcare information sharing. Analytics can take this data and turn it into something real. Subsequent visualization of this analyzed data presents the information in a way that can truly tell a story, making sense of data that analysts sometimes miss. Analytics can arrange and organize data in different ways and pick up previously undetected trends or anomalies. This information can be turned into real programs that produce real outcomes for those affected.

The data management and integration process can also help us understand where our knowledge gaps are, revealing flaws in data quality and availability. Organizations may learn that they lack sufficient data in a certain area where they want to learn more, but are currently limited. They can then make changes to data collection efforts or seek out different sources to fill these larger gaps. They can resolve data quality issues across systems and arrive at a consistent, reliable version of the truth.

As organizations get better at assembling and managing the data, automating processes to generate standard reports and file exchanges can ease the burden on analysts. Streamlining the user interfaces for prescription drug monitoring programs and other systems allows analysts and medical informatics staff to spend less time working on the data itself and more time enabling and encouraging the use of predictive modeling and “what-if” scenario capabilities.

Helping to Solve a Problem

The national opioid epidemic is a terrible and complex issue. It is not something that can be solved with just one action, approach or program. It is a layered issue that will require systematic changes to how patients are treated and how the healthcare system operates. Some of the nation’s best continue to work on providing operational solutions to these problems, but as the statistics show, they need more help.

A data-driven approach can be that help. Using data analytics to find better and deeper insights into the root problems of this epidemic can help decision-makers make real change. While opioids are the focus now, there will come a day when a new problem emerges. Having data and analytic solutions in place can prepare these organizations to tackle these future challenges as well.

64,000 people died in 2016 as a result of opioid abuse. But 64,000 is more than a large number – it’s also Andy and his family. With analytics and a data-driven approach, government and healthcare leaders can make better decisions that can help people in need.

Steve Bennett, Ph.D., is the director of SAS' global government practice. He is the former director of the National Biosurveillance Integration Center within the Department of Homeland Security

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DOJ Approves CVS-Aetna $69B Merger, On Condition Aetna Divest Part D Business

October 10, 2018
by Heather Landi, Associate Editor
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The Department of Justice (DOJ) has approved a $69 billion merger between mega-pharmacy retailer CVS Health and health insurer Aetna, after Aetna entered into an agreement with the DOJ to divest is Medicare Part D prescription drug plan business.

According to a statement released by the DOJ on Wednesday, the settlement, in which Aetna will sell off its Part D business, was a condition of the merger’s approval and resolves the DOJ’s “competition concerns.”

The deal is the latest in a wave of combinations among healthcare companies, including many pharmacy benefit manager (PBM) and insurer integrations. Last month, the Justice Department approved Cigna’s $67 billion takeover of Express Scripts.

CVS Health announced in early December 2017 its intention to acquire Aetna in a $69 billion-dollar merger, marking the largest ever in the health insurance industry. Woonsocket, R.I.-based CVS operates the nation’s largest retail pharmacy chain, owns a large pharmacy benefit manager called Caremark, and is the nation’s second-largest provider of individual prescription drug plans, with approximately 4.8 million members. CVS earned revenues of approximately $185 billion in 2017. Aetna, headquartered in Hartford, Connecticut, is the nation’s third-largest health-insurance company and fourth-largest individual prescription drug plan insurer, with over two million prescription drug plan members. Aetna earned revenues of approximately $60 billion in 2017.

Following news of the deal back in December, there was speculation that antitrust regulators might not approve the deal. Back in January 2017, a federal judge blocked a merger that would have resulted in Aetna acquiring Louisville, Ky.-based insurer Humana, which at the time was the largest acquisition of its type in the history of health insurance in the U.S., reported at $37 billion. At the time, U.S. District Judge John D. Bates in Washington said that proposed deal would “violate antitrust laws by reducing competition among insurers.” Similarly, a proposed combination of two other health insurers, Anthem and Cigna, was also shot down last year.


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According to the DOJ’s statement issued today on the CVS-Aetna deal, the Justice Department’s Antitrust Division had significant concerns about the anticompetitive effects of the merger with regards to the Medicare Part D businesses. CVS and Aetna are significant competitors in the sale of Medicare Part D prescription drug plans to individuals, together serving 6.8 million members nationwide, according to the DOJ.

In a press release issued today, CVS Health said, “DOJ clearance is a key milestone toward finalizing the transaction, which is also subject to state regulatory approvals, many of which have been granted.” CVS Health's acquisition of Aetna remains on track to close in the early part of Q4 2018, the company said.

“DOJ clearance is an important step toward bringing together the strengths and capabilities of our two companies to improve the consumer health care experience,” CVS Health president and CEO Larry J. Merlo, said in a statement. “We are pleased to have reached an agreement with the DOJ that maintains the strategic benefits and value creation potential of our combination with Aetna. We are now working to complete the remaining state reviews.”

Merlo also said, “CVS Health and Aetna have the opportunity to combine capabilities in technology, data and analytics to develop new ways to engage patients in their total health and wellness. Our focus will be at the local and community level, taking advantage of our thousands of locations and touchpoints throughout the country to intervene with consumers to help predict and prevent potential health problems before they occur. Together, we will help address the challenges our health care system is facing, and we'll be able to offer better care and convenience at a lower cost for patients and payors.”

Following the close of the transaction, Aetna will operate as a standalone business within the CVS Health enterprise and will be led by members of its current management team.

The American Medical Association (AMA), an industry group that has been opposed to the merger, issued a statement saying the agreement that Aetna divest its Part D business doesn't go far enough to protect patients.

"While the AMA welcomes the U.S. Department of Justice (DOJ) requiring Aetna to divest its Medicare Part D drug plan business, we are disappointed that the DOJ did not go further by blocking the CVS-Aetna merger," Barbara L. McAneny, M.D., president, American Medical Association, said in a statement. "The AMA worked tirelessly to oppose this merger and presented a wealth of expert empirical evidence to convince regulators that the merger would harm patients. We now urge the DOJ and state antitrust enforcers to monitor the post-merger effects of the Aetna acquisition by CVS Health on highly concentrated markets in pharmaceutical benefit management services, health insurance, retail pharmacy, and specialty pharmacy."

Agreement with DOJ Resolves “Competition Concerns”

Late last month, Aetna agreed to sell its Part D business to WellCare. According to a Securities and Exchange Commission (SEC) filing from WellCare Health Plans last month, WellCare entered into an asset purchase agreement with Aetna to acquire the company’s entire standalone Medicare Part D prescription drug plan business, which has 2.2 million members. According to the agreement, Aetna will provide administrative services to and retain the financial risk of the Part D business through 2019. In that filing, it states that Aetna is divesting its Part D business as part of CVS Health’s proposed acquisition of Aetna.

“Today’s settlement resolves competition concerns posed by this transaction and preserves competition in the sale of Medicare Part D prescription drug plans for individuals,” Assistant Attorney General Makan Delrahim of the Justice Department’s Antitrust Division, said in a statement. “The divestitures required here allow for the creation of an integrated pharmacy and health benefits company that has the potential to generate benefits by improving the quality and lowering the costs of the healthcare services that American consumers can obtain.”

In its statement, the DOJ referred to WellCare as “an experienced health insurer focused on government-sponsored health plans, including Medicare Part D individual prescription drug plans.”

The Department’s Antitrust Division, along with the offices of five state attorneys general, today filed a civil antitrust lawsuit in the U.S. District Court for the District of Columbia to enjoin the proposed transaction, along with a proposed settlement that, if approved by the court, would fully resolve the Department’s competitive concerns. The participating state attorneys general offices represent California, Florida, Hawaii, Mississippi, and Washington.

In a complaint filed to the U.S. District Court, DOJ attorneys argued that without the divestiture, the combination of CVS, which markets its Medicare Part D individual prescription drug plans under the “SilverScript” brand, and Aetna would cause “anticompetitive effects, including increased prices, inferior customer service, and decreased innovation in sixteen Medicare Part D regions covering twenty-two states.” DOJ attorneys also argued that the loss of competition between CVS and Aetna would result in “lower-quality services and increased costs for consumers, the federal government, and ultimately, taxpayers.”

Under the terms of the proposed settlement, Aetna must divest its individual prescription drug plan business to WellCare and allow WellCare the opportunity to hire key employees who currently operate the business.  Aetna must also assist WellCare in operating the business during the transition and in transferring the affected customers through a process regulated by the Centers for Medicare and Medicaid Services (CMS).


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A Data-Driven Effort to Tackle Indiana’s COPD Problem

October 9, 2018
by Rajiv Leventhal, Managing Editor
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One patient care organization in Indiana has leveraged a robust data analytics platform to reduce avoidable COPD readmissions and improve the overall health of the community

Although reduction in avoidable readmissions after chronic obstructive pulmonary disease (COPD)-related hospitalizations is a national objective, in one Indiana community it’s moved its way up to the very top of the healthcare priority list.

In Jackson County, Indiana, the COPD population is roughly two times the national average. And considering that COPD is the third-leading cause of death in the U.S., working to fix the problem has taken precedence at local hospitals—including Schneck Medical Center, a community hospital in Seymour. Says Susan Zabor, vice president of clinical services at the medical center, “We have a high obesity population and a high smoking population, so in Jackson County, COPD is very prevalent. When we looked at our 2014 data, we knew it was an issue and we knew that it was a high-volume diagnosis for us, ranking second in our [hospital] readmissions.”

Indeed, at the time, Schneck Medical Center had a raw readmissions rate of nearly 14 percent for the specific COPD patient population, and these re-hospitalizations were leading to substantial added readmissions costs—upwards of $300,000 per year, according to Zabor. “We needed to put a focused intervention in place,” she attests.


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Susan Zabor

The fines for failure to meet the Centers for Medicare & Medicaid Services’ (CMS’) avoidable readmissions reduction criteria, as part of the government’s Hospital Readmission Reduction Program (HRRP), focus on six conditions: heart attack, congestive heart failure, pneumonia, COPD, elective hip and knee replacements, and for the first time starting in 2016—coronary artery bypass graft surgery. The current focus in the HRRP is on readmissions occurring after initial hospitalizations for these selected conditions, and hospitals with 30-day readmission rates that exceed the national average are penalized by a reduction in payments across all of their Medicare admissions.

As such, it’s clear that in healthcare’s future of value-based care, treating patients outside of an organization’s four walls will be critical to an organization’s success. What’s more, drilling down into the data and being able to specifically predict and target patients who are at high risk for readmissions has become a key point of emphasis for many hospitals.

At Schneck Medical Center, clinical IT leaders launched a data analytics initiative with IBM Watson Health, whereby they were able to analyze treatment patterns, costs, and outcomes data for their own hospital and compare those with peer group hospitals around the country. It was this analysis which showed that Schneck was experiencing much higher than average numbers of complications, readmissions, and patient deaths related to COPD.

Zabor notes that the hospital was “doing well on process measures and publicly-reported measures, but we weren’t doing so well on some bigger issues like complications, mortality and length-of-stay, and we leaned on CareDiscovery [a Watson Health solution] to give us actionable data that was as close to real time as possible to help us improve.”

Using this data, hospital leadership was able to pull together teams focused on closing those gaps. Schneck’s organizational efforts for COPD patients included developing a long-term care practice, which currently includes a physician medical director, a full-time physician, three nurse practitioners and two medical assistants, as well as the hospital’s respiratory care department. This team makes weekly respiratory care visits, incorporates sleep studies into its observations and conducts patient discharge planning. In addition, the hospital put in place new protocols that included the installation of a transition team to help with patient discharge, follow-ups with recently discharged patients, and annual facility education regarding COPD.

Indeed, the data available in the Watson Health’s CareDiscovery solution helped the hospital focus efforts to improve care for COPD patients, eventually resulting in an 80-percent reduction in its unplanned COPD readmission rate and hundreds of thousands of dollars in savings—representing a 99-percent decrease in costs related to readmissions.

“We started doing a better job of managing patients’ chronic illness in whatever setting they were in— be it long-term care, home care, or primary care. Before long, they didn’t need to come into the hospital,” Zabor says. To this end, the hospital also witnessed a 55-percent decrease in patients admitted with a COPD diagnosis from 2014 to 2017. Zabor notes that reducing primary admissions actually was an unplanned result of the organization’s efforts, but one they were happy with nonetheless.

As many hospitals and health systems remain in a position today in which they are straddling two payment worlds—fee-for-service and pay-for-performance—one might ponder if it’s truly in the organization’s best interest to keep patients away. But Zabor says that for Schneck Medical Center’s executive leadership, it was never a question. “For our patients and our community, keeping them out of the hospital is the best thing to do, whether you are making money or not,” she says.

“Zabor adds, “We [do have] one foot in value and one in volume, which is difficult, but we have a patient-first culture here. Yes, have a finance pillar, but it does not overpower our quality of care or customer experience pillars, which all support that patient-first culture.”



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