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As the Chief Medical Officer of North Memorial Health Care, Dr. Kevin Croston’s ultimate objective is to improve healthcare by driving variation out and improving cost efficiencies at North Memorial Healthcare. Core to his success has been a fundamental culture shift with physicians who are now using data to drive care optimization. During this webinar, you’ll learn: 1) how to shift to a data-driven decision making culture, 2) how to make the data meaningful so providers can make better decisions, and 3) examples of successes and challenges, including how North Memorial has reduced unnecessary pre-39 week inductions, improved cardiovascular care and uncovered a substantial revenue cycle process issue.
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Changing Healthcare Using Data: A Case Study of One Small Health System's Odyssey To Achieve Material Improvements
North Memorial Health Care J Kevin Croston, MD FACS CMO, President -‐ Physician OrganizaEon
Poll QuesEon #1 What is your primary area of focus? q Physician/clinical care provider q Quality q InformaEon system q Finance q AdministraEve execuEve q Other
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ObjecEves You will learn:
– How to shiQ to a data-‐driven decision making culture • KPA
– How to make the data meaningful so providers can make beTer decisions
• Permanent processes and teams – Examples of successes and challenges
• Pregnancy – ReducEon of pre 39-‐week unnecessary inducEons
• Cardiovascular care • Revenue cycle process – professional billing • Catheter associated urinary tract infecEons (CAUTI)
About North Memorial StaEsEcs (2012)
Number of Licensed Beds
648
Annual InpaEent Admissions
33,718 (includes nursery 4,852)
Emergency Room Visits
87,684
InpaEent Surgeries 8,722
OutpaEent Surgeries 19,181
Providers in MulE-‐Specialty Clinics
300
Total FTEs 4,281
• Minneapolis-‐based two-‐hospital health system
• Provides full conEnuum of services
• Level I Trauma Center • CommiTed to developing
clinical effecEveness guidelines to deliver the highest quality care at a lower cost
North Memorial SituaEon
Challenges • Tough regional compeEtors • Declining payment stream • Data created confusion
“data rich -‐ informa/on poor”
• Clinicians and execuEves clamoring for answers
• Hospital-‐centric decisions (not enterprise based)
Opportuni@es • Strong improvement and
quality culture • Insighiul and supporEve
leadership • Recognized substanEal
changes were required for survival
Key Process Analysis (KPA)
KPA Results
North Memorial Resources Consumed
CumulaEve %
% of Total Resources Consumed for each clinical work process
Key Findings:
Number of Care Process Family (e.g., ischemic heart disease, pregnancy, bowel disorders, spine, heart failure)
• 80% of all in-‐pa@ent resources are represented by 18 Care Process Family
80%
50%
• 50% of all in-‐pa@ent resources are represented by 7 Care Process Family
Poll QuesEon #2 What percent of your quality improvement efforts are priori@zed using a similar varia@on/resources analysis? q 76-‐100% q 51-‐75% q 26-‐50% q 0-‐25% q Unsure
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How North Made Data Meaningful People • Formed permanent teams
– Clinical OperaEons Leadership Team (COLT)
– Guidance Teams (ex. Women & Newborn, Primary Care, Cardiovascular, OPPE, InfecEous Disease)
• Repurposed resources without adding FTEs
• Selected medical leadership to champion the vision and process
Processes • Data organizaEon -‐ EDW • Data governance • OrganizaEonal team
structure to support outcomes improvement processes
• Ensured hospitals and clinics were included in consistent change while maintaining autonomy
• ArEculated the vision
Care Process Model (CPM) Core Work Group
Pregnancy (OB) Team Structure
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Knowledge Manager Cathy Anderson, R.N.
Outcomes Analyst Ashley Nguyen
Data Architect Joel Zwinger
Data Provisioning Data Analysis Key: Subject Matter Experts
Clinical Director Lead Linda Engdahl R.N.
Physician Lead Dr. Jon Nielsen
Quality/ Work Flow Expert
Mike Choi
Nurse Expert Barb Pavek , R.N.
Knowledge Manager Bethany Hjelle, R.N.
Nurse Expert Tanya Thomas, R.N.
Nurse Expert Sally Walstrom, R.N.
Nurse Expert Maureen Ehlers, R.N.
Women & Children AnalyEcs
Pre-‐39 Week ElecEve InducEons
Women and Newborn Pre-‐39 Week ElecEve InducEons
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ObjecEve Health Catalyst SoluEon Results to date • Define exisEng workflows
and idenEfy improvement opportuniEes
• Establish baseline metrics and measures
• Define evidence based
standards for elecEve inducEons
• Reduce rates of pre-‐39
week deliveries from 1.2% to 0.6% to qualify for a payer partner bonus
• Late-‐BindingTM Data Warehouse Plaiorm
• Cohort Finder
• Key Process Analysis applicaEon (KPA)
• Early inducEon advanced applicaEon
• CollaboraEve IT and clinical
care workgroups
• Adopted evidence based guidelines and standardized workflows
• Established elecEve
delivery baseline measurements to track quality improvement gains
• Established a permanent collaboraEve team
• Reduced early-‐term
deliveries from 1.2% to 0.3%
• $200K payer partner bonus
payment
“We wouldn’t have had a chance to do some of the things we’ve done in last 18 months to enhance care, reduce waste and lower costs without Catalyst. It’s amazing how differently and effec/vely we can gather and use data now.” -‐Jon Nielsen, MD, Medical Director Women and Children’s Services at North Memorial Health Care
MAJOR LEARNING:
FOLLOW THE PLAN!
Cardiovascular Care Challenges • Difficulty replicaEng first
clinical program success • Department vs condiEon-‐
based issue • Difficulty understanding
importance of guidance teams
• OrganizaEonal readiness • Physician leaders changed
weekly
Lessons Learned • Inspire knowledge
leadership and organizaEonal readiness – Include the right people in
the development of the care model
– Know when you should and shouldn’t be involved
– Require buy-‐in for the methodology
– Focus of project did not line up with opportuniEes based on KPA analysis
.
Professional Billing ApplicaEon
Professional Billing ApplicaEon
Professional Billing Efforts
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ObjecEve Health Catalyst SoluEon Results to date • Ensure accurate and
complete charge capture of professional services performed in the hospital
• Address physician concerns that charges were not reflecEng actual services rendered
• Reduce manual data pulls by professional coders to determine which provider notes to review
• Deliver provider educaEon to improve clinical data capture
• Late-‐BindingTM Data Warehouse Plaiorm
• Professional Billing applicaEon to idenEfy revenue cycle and educaEonal opportuniEes
• Automated data capture for efficient and complete revenue cycle analysis
• Starter set value stream
mapping to idenEfy workflow process gaps
• IntuiEve applicaEon for professional coders to opEmize workflow
• 6% increase in billing for notes that had sufficient clinical data
• PotenEal $5.7M charges over 3 years from unbilled services
• 25% improvement in professional coder efficiency, allowing Eme for provider educaEon
• Health Catalyst delivered results in 6 weeks vs. consulEng firm who was unable to deliver data capture and applicaEon
“The Health Catalyst Professional Billing Applica/on has given me what I need to be successful. Now I can finally accomplish what I was hired to do!” Nancy Young, Manager Professional Coding, North Memorial Professional Services
Catheter-‐Associated Urinary Tract Infec@ons (CAUTI)
• According to the CDC urinary tract infecEons (UTIs) are the most common type of healthcare-‐associated infecEon • Cause of 450,000 annual infecEons leading to
13,000 deaths • Increasing lengths of stay by as many as four days,
and increasing healthcare costs by as much as $500 million per year naEonally.
• CMS has proposed expansion of CAUTI measures beyond current ICU areas to include medical units, surgical unites and medical/surgical units
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CAUTI ApplicaEon
CAUTI Surveillance
ObjecEve Health Catalyst SoluEon Results to date
• Scalable CAUTI soluEon to meet proposed CMS regulatory measures
• Leverage NaEonal Healthcare Safety Network (NHSN) definiEons and calculaEon algorithms
• ShiQ clinical resources from surveillance to intervenEon
• Late-‐Binding™ Data Warehouse
• CAUTI ApplicaEon
• Clinical Improvement Services
• Starter set to idenEfy
workflow process gaps
• Automated data capture for efficient hospital surveillance
• 50 percent esEmated reducEon in CAUTI surveillance acEviEes
• PotenEal to convert from
manual to electronic tracking for NHSN required catheter days reporEng
• Rapid Eme to value with 10-‐week implementaEon
• InfecEon prevenEonists can now focus on intervenEon instead of data provisioning
“We’re extremely strapped for /me in the infec/on preven/on world and CMS is coming out with new regula/ons every year. The more we’re out there preven/ng – rather than measuring – infec/ons, the bigger a difference we can make, educa/ng clinicians and, as a result, increasing pa/ent safety and quality.” ~ Terra Menier, R.N., Infec/on Preven/on Prac//oner
Conclusions • Spend a lot of Eme up front with teams before they start down this quality improvement journey. Working on the fly comes with major problems.
• Don’t ignore the warning signs (Cardiovascular). • Commit one physician to the team. An outside champion may try to prop up a team.
• SEck to the plan and moEvate people to work together.
• Communicate successes and explain reasons for success. Hold on to those principles rather than jumping to the next “shiny object.”
• Financial improvements do follow improvements in quality of care.
Thank You!
Please submit your QuesEons
and Answers
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