The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Tag: health value (page 1 of 2)

Using Clinical Pillars to enhance value in a Joint Replacement Bundled Payment Program

Deby Evans

Deb Evans is the MVC Site Engagement Manager

An article published in the Journal of Arthroplasty in June 2017 discussed 5 clinical pillars that one hospital in New York identified for enhancing value in their joint replacement practices through the bundled payment program.

  1. Optimizing patient selection and comorbidities: The hospital identified common comorbidities within their Total Joint Arthroplasty (TJA) patient population. The most frequent were found to be musculoskeletal comorbidities, hypertension, hyperlipidemia, tobacco use and diabetes. Each of these comorbidities is associated with an increased risk for readmission. By incorporating the use of a readmission risk assessment tool (RRAT) into the Perioperative Orthopedic Surgical Home (POSH) initiative, the hospital identifies patients that are at high risk for readmission and delays surgery in favor of working to optimize the patient’s modifiable risk factors. By getting the patient in optimal condition for surgery, the risk of an unplanned readmission can be reduced, saving the hospital the associated costs.
  2. Optimizing care coordination, patient education, shared decision-making and patient expectations: Multiple studies have shown that splintered care pathways, unnecessary services and a lack of patient-centered care negatively impact clinical outcomes. Characteristics of programs that displayed improved patient outcomes were synchronized management among the patient’s care team and managing the expectations of the patient and family. The goal for this hospital was to institute a streamlined pathway for the duration of the episode of care that focused on collaborative decision making and standardized pathway criteria.
  3. Multimodal analgesia: An increased length of stay not only affects cost but also increases the risk of readmission. One of the factors known to influence length of stay is pain management. This facility reviewed their pain management protocol and made changes with the intention of decreasing opioid use while maintaining pain relief as well as facilitating early ambulation and rehabilitation and decreasing falls. These principles help to reduce length of stay by expediting discharge and decreasing the use of post-acute care facilities.
  4. Risk-stratified Venous Thromboembolic disease (VTED) prophylaxis: Use of an aggressive mode of VTED prophylaxis may be effective in preventing venous thrombosis, but has also shown to increase the risk of major complications. The institution performed a study to analyze their adapted risk-stratification algorithm with positive results. The use of this algorithm to identify which VTED prophylaxis trajectory was most appropriate helped the hospital optimize care and reduce costs.
  5. Minimize Post-acute care facility and resource utilization: Increased costs have been shown to be related to the use of post-acute care facilities and the associated resource utilization. In an effort to help control post-acute care costs, this institution worked on identifying selected post-acute care partners. Once identified the hospital and the partnering skilled nursing facility increased communication and collaboration through meetings and performance and resource utilization monitoring. By establishing these partnerships post-acute care length of stay was reduced with associated cost savings.

Through focusing on these five clinical pillars, this New York hospital was able to identify areas of improvement and subsequently implement initiatives targeted towards care and cost improvement. If your hospital is interested in identifying five clinical pillars of focus, the MVC Coordinating Center can help  identify common readmission diagnoses, along with post- acute care SNF utilization and length of stay information.

Moreover, the MVC Coordinating Center, in conjunction with MARCQI and MOPEN, is also holding workgroups on November 30th and December 7th to discuss pre- and post- surgical pain management. If you are interested in joining either of the workgroups, please register here.

Please contact Abeer Yassine at abeery@med.umich.edu or Deb Evans at debevans@med.umich.edu  for more information and if you have any questions.

Managing High-Needs Patients can Help Improve Outcomes at Michigan Hospitals

Abeer Yassine

Abeer is the MVC Hospital Engagement Associate

Only about 5% of patients are considered high-need, yet these patients constitute nearly 50% of total healthcare costs. High-need patients typically have more complex diagnoses and significant barriers to accessing healthcare that impacts the self-management of their condition(s) outside of the hospital. In a recent, pre-publication report, Effective Care for High-Need Patients, the National Academy of Medicine (NAM) outlines various characteristics of high-need patients, patient taxonomy models, along with care models. This report is a compilation of feedback from relevant workshops, presentations, discussions, and literature and stresses the importance of identifying and managing care delivery to high-need patient populations.

High-Need Patients Characteristics

To better create targeted initiatives in a hospital setting for high-need patients, there needs to be better identification of characteristics using data. Although there is not one, specific definition of “high-need patients”; functional limitations, complexity of care/disease, and health care costs are all characteristics that can be used to identify and analyze these patient populations. These characteristics not only impact the care that is delivered within the clinical setting, but also the ability for that patient to self-manage their health outside of the hospital.

High-Need Patient Taxonomies

NAM reviewed two patient taxonomy models in use by the Harvard T.H. Chan School of Public Health and The Commonwealth Fund to better segment patients for improved identification of high-need populations. Using a taxonomy model can guide health systems to more suitable integration of behavioral, social, and functional characteristics in the patient care plan outside of the clinical setting. What is unique about the taxonomy developed by NAM is that it builds upon clinical and medical characteristics to identify behavioral health and social factors that affect care delivery decisions. More detail about this starter taxonomy and a conceptual model can be found here.

Successful Care Models for High-Need Patients

This NAM report also uncovered common characteristics among care models that are successful in managing high-need patient populations. The report mentions that successful care models typically expand upon domains related to health and well-being, care utilization, and costs. Furthermore, these care models include details on dimensions related to service setting focus, care attributes, delivery features, and organizational culture. By targeting a specific high-need patient population (ex: age group), health systems are better able to create care models and initiatives geared towards improved, more integrated care delivery. The report also outlines an analytic framework that helped NAM identify successful care models for high-need patients.

The MVC Coordinating Center can help member hospitals identify domains and care utilization of high-need patients.  If you are interested in identifying these populations within your hospital, please reach out to Deby (debevans@med.umich.edu) or Abeer (abeery@med.umich.edu).

Interested in learning more about optimizing care delivery for high-need patient populations? More information and a copy of Effective Care for High-Need Patients can be found below:

https://nam.edu/effective-care-for-high-need-patients/

https://nam.edu/wp-content/uploads/2017/06/Effective-Care-for-High-Need-Patients.pdf

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