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A Clear Case

February 25, 2009
by Mark Hagland
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Selective investment in case management applications can yield significant returns

Historically, case management applications have been listed under the “nice to have” category. All of that is changing these days, as purchaser and payer demands for greater accountability and improved outcomes change the ROI calculus.

Mike smith

Mike Smith

And CIOs are finding that there are indeed strong returns for implementing such systems. David House, vice president and CIO at Baptist Health, a seven-hospital system based in Little Rock, Ark., certainly thinks so. Working with ThomsonReuters, the folks at Baptist Health were a beta site for its CareFocus solution, which has increased the number of clinical interventions by about 30 percent, with an average monthly cost savings of $39,000 per month. And on top of that more than $1 million was saved at its 220-bed North Little Rock campus.

It started a few years back, when Baptist Health became the second customer of MercuryMD (later acquired by ThomsonReuters). MercuryMD approached Baptist with the idea of building patient lists based on data attributes. For example, the hospital could look at all male patients who were over 50 years old and had a particular lab result or diagnosis, and were on a particular medication.

The opportunity was for clinicians to build profiles that identify high-risk patients within the active hospital census - based on their medications, lab and radiology results, vital signs, diagnoses, active orders, and other reports - who would be good candidates for intervention, based on real-time delivery to physicians' handheld devices.

As part of the collaboration with the vendor, Kevin Robertson, Pharm.D., the system's pharmacy clinical coordinator, developed the queries for the program. “Examples of clinical ROI opportunities,” Robertson says, “include prevention of adverse drug events (such as prevention of excessive dosing with renal impairment), the refining of patient care (such as appropriate antibiotic therapy), and transition to outpatient therapy.” All of these, in combination with enhanced clinician workflow, ultimately have a positive impact on the hospital's financials,” he adds.

There's strong ROI in case management system implementations, agrees Mike Smith, CIO of the five-hospital, 1,600-bed Lee Memorial Health System, which is based in Fort Myers and whose service area covers a large part of southwestern Florida. Given that Lee Memorial is a public hospital system, and because the system's goals include “optimizing our care setting,” he says, “we're willing to move patients to a more efficient care setting and take a loss at times. So the notion of having tools that help us manage patient care and patient flow is a big deal.”

Smith and his colleagues have invested in multiple clinical solutions related to case management, including those from the Chicago-based Allscripts and the Reston, Va.-based QuadraMed Corporation, which together help Lee Memorial case managers handle discharge planning and patient flow across the entire system.

Chris Nesheim, R.N., systems director, care management, for the Lee Memorial system, reports that, “We make all our discharge planning and referrals to long-term care, hospice, palliative care, IV infusion, and to home now, all in an automated way. The amount of faxing and follow-up phone-calling done previously was huge,” she notes. And not only do all appropriate clinicians and managers have the clinical information they need electronically, but turnaround time for moving patients from one environment to another has been decreased “tremendously,” she says.

In addition, though the Lee Memorial organization invested in this with a primary focus on care and service quality and efficiency, “We're saving half a million dollars, conservatively speaking, on an annual basis,” from these implementations.

Prioritization, organization-wide goals cited

Many hospital executives agree that there is tremendous potential ROI from case management- and care management-related IT investments, as long as such investments are keyed strongly to organizational strategic goals. Says Lee Memorial's Smith, “We could invest in more projects every year than we could fund or support.” But the focus at the organization is on “prioritization and readiness.”

Most of all, he says, “You have to look at the total cost of the care process, not just at any one component. We do that as a system, and are willing to value all the different pieces. It's not just reducing length of stay; it's not just reducing manpower. It's taking the system view of it.”

Timothy Zoph, vice president and CIO of 775-bed Northwestern Memorial Hospital in Chicago, agrees. “With information now automated, we ought to be able to anticipate care management models, beginning with the emergency room visit.” With as much as 50 percent of Northwestern admissions coming through the emergency room, and with high daily census rates, reducing diversions makes sense for patient care and business, Zoph says.

Most importantly, says Baptist's House, the key is to look at the difference between a cost-focused mindset and an investment-focused one. “Cost is something to be minimized, while investment is something to be grown and developed. And figuring out the difference is not always intuitive. You have to be strategic, and to help connect the dots. And value is really the keyword.”

Healthcare Informatics 2009 March;26(3):39-40

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