The shift to value-based care may be occurring more slowly than advocates would like. In a climate of escalating costs and lingering disruption from the pandemic, however, organizations that embrace alternative payment models stand to make significant financial gains in the short term—and set themselves up to be providers of choice as value-based payment models proliferate.
Consider this: as of 2020, 48.5% of commercial healthcare payments were directly tied to clinical quality metrics aimed at reducing costs, improving the health of populations, and enhancing the patient experience. Healthcare organizations are being increasingly incentivized through value-based payment arrangement, and there’s little doubt this will continue.
Partnering for Quality Improvement
Organizations that underestimate the scope of the transition to value do so at their peril. Improving and sustaining quality performance is a substantial organizational effort that hospitals frequently struggle to achieve independently.
In one such instance, ECG partnered with an academic health system (AHS) to implement technology-supported, evidence-based practices and processes to improve outcomes in the most challenging quality measures. ECG’s subject matter experts (SMEs) facilitated clinician/IT collaboration to design new, streamlined EHR documentation workflows that:
- Incorporated evidence-based clinical care practices.
- Accelerated outcome improvements.
- Enabled real-time performance monitoring.
Overview of the Situation
The AHS wanted to reexamine its approach to achieving specific performance targets in one of its commercial insurer’s pay-for-performance (P4P) programs. Despite having numerous initiatives in place, the organization was still leaving millions of dollars on the table each year in P4P payments.
In 2020, ECG partnered with the AHS to rapidly assess its approach to achieving those targets, with a focus on improving measures related to:
- MRSA infections.
- Surgical site infections (SSIs).
- Appropriate use of emergency department (ED) and outpatient cardiac imaging.
- Unplanned hospital readmissions.
We identified several barriers that impeded the AHS’s ability to implement significant and sustainable improvements:
Critical Success Factors
Taking a collaborative approach with our client led to the successful implementation of quality improvement (QI) initiatives.
Outcomes
Through this collaboration, our client achieved meaningful clinical, operational, and financial outcomes across the MRSA screening and intervention, SSIs, and imaging quality measures and will implement workflows to reduce unplanned readmissions later this year.
To sustain improvements, we worked with the AHS to improve its reporting infrastructure to manage real-time measure performance.
MRSA Screening and Intervention
Designed and implemented an inpatient MRSA screening and treatment interventions bundle, identifying patients with community-acquired MRSA (thereby reducing hospital-acquired attribution) and treating infected patients to reduce the in-hospital spread of MRSA.
SSI Reduction
Designed and implemented a pre-operative patient triage tool to identify patients at high risk for SSIs and provide evidence-based interventions to reduce patients’ risk of infection prior to surgery, while simultaneously ensuring appropriate antibiotic stewardship. The health system realized a 40% reduction in SSIs from July 2021 to June 2022.
ED Imaging Stewardship
Developed and implemented best practice guidelines for adult imaging in the ED through detailed process maps, educational materials, and socialization with providers to decrease unnecessary patient imaging.
Unplanned Readmissions Reduction
Designed, led, and implemented interventions to reduce unplanned readmissions, including integrating discharge planning and care coordination, enhancing discharge planning processes for patients with medium and high risk of readmission, addressing social determinants of health that impact readmissions, and increasing outpatient clinic availability to ensure timely postdischarge appointments for patients at risk of readmission.
Real-Time Reporting
Developed MRSA, SSI, and imaging quality measure reports to provide operational and clinical leadership with real-time performance data to ensure the health system had the tools and processes to sustain, and continue to improve, measure performance over time.
A Model for Change
As a result of this work, the AHS is projected to earn approximately $11.6 million in financial incentives over three years while simultaneously improving clinical outcomes and patient safety. ECG’s partnership model was essential in overcoming barriers to acheive these results.
Hospitals and health systems that similarly engage in QI efforts should implement the critical success factors above and, if needed, collaborate with an external partner to overcome barriers to improvement. These organizations will be well positioned to develop strong QI capabilities and realize sustained improvements across value-based care arrangements.
Edited by: Matt Maslin
Published August 17, 2022