Using Integrated Clinical and Financial Analytics to Drive Change
In a July 2018 survey conducted by Quest Diagnostics, the percentage of physician respondents who said they believe they have the tools needed to succeed with value-based care (VBC) dropped to 42% this year from 46% last year. The percentage of respondents who said they think doctors lack enough information about their patients to make VBC work jumped to 72% this year from 60% last year.1 This recognition of the need for tools and analytics to effect change will likely resonate with cardiovascular service line leaders nationally.
The amount of data required to manage an invasive cardiology department continues to grow in both scale and complexity. Corazon believes it is no longer sufficient to track volumes while relying on months-old registry reports to measure quality. Effective management requires data that ideally addresses operational metrics AND quality initiatives that can be viewed from multiple perspectives in near real time. Using data in context is a key driver for performance improvement. For example, the ability to view the same data in multiple ways, providing an operational or quality-based view by provider, facility, division, and clinical cohort to drive cost efficiencies and outcomes is critical. Further, this data may also be used to gain insight into how specific procedures drive other events through a halo effect, especially by analyzing the encounters around an index event.
Charge Data & Cost Efficiencies
The ability to aggregate and view consumable supplies in the invasive labs is a critical factor in any institution’s effort to reduce costs and improve operational efficiency. A critical step in this process is comparing procedures with common attributes. For example, it would not be helpful to compare a straightforward diagnostic heart catheterization with a similar case that had a potential angiographic finding evaluated with fractional flow reserve (FFR). While the additional cost of the FFR catheter should exclude this case from any diagnostic heart catheterization comparison set, it can still be used in other ways to look at how often this technology is being used and by whom. Comparing costs at a granular level while also generating both site and provider usage of specific technologies is valuable for ensuring provider buy-in and confidence in the data they are using.
Engaging providers with comparative groups’ metrics provides the feedback loop required in order to begin assessing which care pathways provide the best care at the lowest cost. Figure 1, a blinded example, shows how easily this data can be interpreted when comparing a site to its own average and/or a targeted peer-comparative group.
Tools such as these allow a team to transparently share cost data, and Corazon believes that having access to this data changes clinical behavior. These powerful insights can be used across multiple areas to drive adoption and improve patient care, while also being flexible enough to rapidly answer ad hoc questions.
The ability to consume and process granular data also supports multiple other analytical efforts, such as analyzing radiation dose by procedure type, or viewing how femoral, radial, and brachial access impact length of stay and complications, or the utilization of prep and hold resources. Communicating directly with providers about how the adoption of different care pathways impacts patient outcomes can emerge as a key driver to changing behavior. In Figure 2, drilling into the data is vital to understand how care decisions drive complications such as bleeding. This same bleed data looks very different when it is assessed in the context of a facility (Figure 3), however, and can allow the management team to focus on the greatest opportunities for positive change.
Multiple studies have discussed that when physicians are provided with operational and quality data ranking their performance (Figure 4), providers change their behavior.2 The keys to driving these changes are to use metrics that providers have direct control over and then show them their ranking compared to national averages, all hospital, and defined targets. Once again, the ability to view changes in near real time becomes a success factor. Providers who change their behavior can see how this impacts their ranking today, not next quarter.
Halo Effect
New technologies can often have disruptive effects on workflows. One recent disruptor is the transcatheter aortic valve replacement (TAVR) procedure, which replaces an open-heart surgery procedure with a visit to an invasive lab. When viewed as a singular event, these new procedures may not appear to be cost effective, but analyzing patient encounters around the index event is important to understand the full operational impacts. An integrated cardiovascular information system can identify and flag index events like a TAVR procedure, and then aggregate and view the impact of those procedures on pre- and post-procedure office visits, imaging, and lab work. Quickly and easily assessing how many transesophageal echocardiograms or chest CTs the TAVR program generated can assist in the evaluation of a new technology’s impact on an institution. This data can then be summarized to quickly determine the program’s overall impact.
Conclusion
Providers have a wealth of data from disparate systems, but without a tool that transforms reports into cohesive and robust information, efforts to accurately and efficiently detect, analyze, and diagnose performance gaps will fail. An integrated system successfully blends clinical, operational, and financial performance data to engage providers and administrators, as a means to elevate care delivery and optimize program outcomes. By leveraging data, the healthcare team will proactively address opportunities and deliver care that will propel the organization forward.
References
- Burda D. March towards value-based care slipping: survey. Healthcare Business News. July 18, 2018. Available online at https://www.hfma.org/Content.aspx?id=61224. Accessed August 20, 2018.
- Jeong I, Weiner J. When compared to each other, doctors pay attention. Penn Leonard Davis Health Institute of Economics (LDI). November 11, 2016. Available online at https://ldi.upenn.edu/healthpolicysense/when-compared-each-other-doctors-pay-attention. Accessed August 20, 2018.
Matthew Paul Esham is a Director, Business Intelligence at LUMEDX. To reach the co-author, email matthew.esham@lumedx.com.
Susan Heilman is a Senior Vice President at Corazon, Inc., offering strategic program development for the heart, vascular, neuroscience, and orthopedic specialties. Corazon has a full continuum of consulting, accreditation, software solution, recruitment, and interim management services for hospitals, health systems and practices of all sizes across the country and in Canada. To learn more, visit www.corazoninc.com or call (412) 364-8200. To reach the co-author, email sheilman@corazoninc.com.
