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Why Clinical Quality Should Drive Healthcare Business Strategy

Health systems feel mounting pressure to demonstrate ROI from analytics investments but are faced with inefficacies and delays. Fortunately, the Rapid Response Analytics Solution delivers a 10x increase in analytics productivity and a 90 percent decrease in the time required to develop new analytic insights. The Rapid Response Analytics Solution solves these tough analytics problems through two primary elements: curated, modular data kits called DOS Marts; and Population Builder, a powerful self-service tools that lets any time of user, from physician executive to frontline nurse, explore data and quality build cohorts of patients without relying on IT staff and with no need for sophisticated and customized SQL and data science coding.

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Why Clinical Quality Should Drive Healthcare Business Strategy

  1. 1. Why Clinical Quality Should Drive Healthcare Business Strategy
  2. 2. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Transforming Healthcare Business Strategy This report is based on a 2018 Healthcare Analytics Summit presentation given by Brent C. James, MD, MStat, former Vice President and Chief Quality Officer at Intermountain Healthcare. Brent James, MD, MStat Former Vice President and Chief Quality Officer Intermountain Healthcare
  3. 3. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A hundred years ago, the healing professions went through a massive transformation in healthcare delivery. William Osler, a Canadian physician practicing at Johns Hopkins University and the founding father of internal medicine, was one of the architects of that transformation. In 1916, when the transformation of healthcare was underway, Osler spoke to a group of new physicians at Phipps Clinic in England. Transforming Healthcare Business Strategy “I’m sorry for you, young men and women of this generation. You’ll do great things, you’ll have great victories, and, standing on our shoulders, you’ll see far, but you can never have our sensations. To have lived through a revolution to have seen a new birth of science a new dispensation of health, reorganized medical schools, remodeled hospitals. A new outlook for humanity that is not given to every generation.”
  4. 4. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. When William Osler gave that speech, he and his colleagues were establishing the current model of care delivery still used today. Now, the healthcare industry is currently experiencing a change of a similar magnitude. With that challenge comes massive opportunity, one in which today’s pioneers will be able to echo Osler’s words to the next generation. While healthcare organizations need to reduce costs to maintain viability, the change must come from clinical quality as the core business strategy. Transforming Healthcare Business Strategy Photo: Wellcome Library, London
  5. 5. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. One such massive opportunity is reducing unwanted variation in clinical practice. Variation in clinical practices undermines the goal of providing high-quality care for all patients. High rates of inappropriate care, where the risk of harm is inherent in the treatment, can outweigh any potential benefit. This leads to preventable care-associated patient injury and death due to an inability to do what healthcare providers know works. Reducing Clinical Variation
  6. 6. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Investigators began to apply rigorous clinical research measurement methods to routine care delivery performance. In doing so, they discovered that these systems identify evidence-based best practice protocols that could be incorporated into the clinical workflow. Reducing Clinical Variation
  7. 7. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Data from these best practices are then fed back through a continuous-learning loop that enables healthcare teams across organizations to constantly update and improve the protocols, ultimately reducing waste, lowering costs, and improving access to care and patient outcomes. Reducing Clinical Variation
  8. 8. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. In the 1980s, healthcare organizations began using activity-based costing (ABC) systems that had been successful in other industries. At the same time, The Dartmouth Atlas, developed by Jack Wennberg, worked to measure and identify significant geographic variations in care. Activity-Based Costing in Healthcare
  9. 9. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. In 1986, Intermountain Healthcare localized the otherwise broad approach of the Dartmouth Atlas within its own healthcare system, incorporating ABC principles and standardizing the tool across the system. Intermountain’s Quality, Utilization and Efficiency (QUE) studies applied rigorous clinical research methods to routine care delivery performance in six clinical areas at the health system’s inpatient facilities on a local level. Activity-Based Costing in Healthcare
  10. 10. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The QUE studies identified massive variations among physicians and care teams, even within a single hospital with all physicians following Intermountain’s best practice protocols. That variation was true for all six areas measured: transurethral prostatectomy, cholecystectomy, artificial hip joints, bypass graft surgery of the heart, permanent pacemakers, and community-acquired pneumonia. Activity-Based Costing in Healthcare
  11. 11. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Each study showed a roughly two-fold variation. In the case of the QUE studies, the amount of variation within a single hospital is larger than the amount of variation that Wennberg and others were showing across hospital referral regions. That large amount of variation inside each individual facility represents a huge opportunity for improvement. Activity-Based Costing in Healthcare
  12. 12. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Healthcare falls short of its theoretic potential for the following five reasons: 1. Massive variation in clinical practices 2. High rates of inappropriate care 3. Unacceptable rates of preventable care- associated patient injury and death 4. Inability to follow best care practices 5. Vast amounts of waste The Massive Opportunity: Clinical Quality
  13. 13. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 1. Massive variation in clinical practices With variation so high, this essentially guarantees that not all patients receive high-quality care. The Massive Opportunity: Clinical Quality
  14. 14. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 2. High rates of inappropriate care Care is deemed inappropriate when the risk of harm inherent in the treatment outweighs any potential benefit. The Massive Opportunity: Clinical Quality
  15. 15. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 3. Unacceptable rates of preventable care-associated patient injury and death In a profession aiming to “First, do no harm,” these are situations where patients are placed in harm’s way in violation of health professionals’ core ethical commitments. In fact, research shows there are 210,000 preventable deaths each year in the U.S. alone. The Massive Opportunity: Clinical Quality
  16. 16. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 4. Inability to follow best care practices A study of recommended care processes found that adults surveyed received recommended processes only about half of the time (54.9 percent). If healthcare practitioners can achieve miracles in care delivery, and that happens only half the time, imagine what could happen if best care practices were achieved in close to 100 percent of patients? The Massive Opportunity: Clinical Quality
  17. 17. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5. Vast amounts of waste The U.S. spends $3.6 trillion annually on the delivery of healthcare and as much as $2 trillion of that amount may be quality-associated waste. The Massive Opportunity: Clinical Quality
  18. 18. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. All five of these factors add up to vast amounts of waste in healthcare, leading to spiraling prices that continue to limit access to care. According to the National Academy of Medicine, between 35 and 50 percent of all money spent on care delivery today in the U.S. is technically waste or non-value adding from a patient’s perspective. The Massive Opportunity: Clinical Quality
  19. 19. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Some examples of quality-associated waste include: Recovering from preventable mistakes. Building unusable products. Providing unnecessary treatments. Simple inefficiency. The Massive Opportunity: Clinical Quality > > > >
  20. 20. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing waste is critical to the survival of healthcare systems. The interesting thing about tacking waste reduction is that health systems need to make an investment in order to make system-wide changes that extract waste. Typically, health systems use revenue growth as their primary financial strategy. In the average system, a net operating income drop below three percent can cause failure. The Massive Opportunity: Clinical Quality
  21. 21. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The response of many healthcare systems is to build more hospitals, ambulatory surgical centers, or other specialty care buildings. However, the financial leverage that this mindset can deliver via increased revenue is merely a five to nine percent contribution for each case added. The Massive Opportunity: Clinical Quality
  22. 22. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. In contrast, the financial leverage from waste elimination is a 50 to 100 percent contribution to the operating margin for each case avoided. Reducing waste dwarfs all other financial opportunities in healthcare and in today’s society. The Massive Opportunity: Clinical Quality
  23. 23. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. If health systems, want to survive, they need to focus on waste reduction. Some examples of ways to reduce waste include the following: Examples of Reducing Waste Efficiency This type of waste results from supply chain or administrative inefficiencies. One way to eliminate waste is to get a lower purchase price for a drug or a lower cost to produce a lab test. Improving this type of efficiency represents roughly 15 percent of waste. Within-case utilization This type of waste refers to the number and type of units per case. Some examples are discussed above including clinical variation and avoidable patient injuries, representing roughly 40 percent of all healthcare waste. Case-rate utilization This is the number of cases per population and includes inappropriate cases, avoidable cases, and preference-sensitive cases, such as when patients opt out of elective care. This type of waste represents 45 percent of waste opportunities.
  24. 24. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Waste Class % of all Waste Waste Subclasses 3 Case-Rate Utilization (# of cases per population) 45% • Inappropriate cases (risk outweighs benefit) (e.g., many cath lab procedures; CTPA) • Preference-sensitive cases (when given a fair choice, many opt out) (e.g., elective hips, knees; end-of-life care) • Avoidable cases (hot spotting, move upstream) (e.g., team-based care) 2 Within-case utilization (# and type of units per case) 40% • Clinical variation (e.g., QUE studies; surgical equipment) • Avoidable patient injury (e.g., serious safety event systems; CLABSI) 1 Efficiency (cost per unit of care) 15% • Supply Chain • Administrative inefficiencies - Regulatory burden - Billing thrash - TPS Lean observation - Current EMR function Examples of Reducing Waste Each of these categories has breakouts that healthcare systems can drill down to the level of action and put a plan in place to reduce waste.
  25. 25. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Indicates the drop-in revenue is higher than reduction in costs–a paved road to financial dissolution. The alignment of financial incentives. Financial Alignment Around Waste Reduction Opportunities “The Case for Capitation” in the Harvard Business Review, shows how to reduce waste by level shown in Figure 2, (next slide) correspond directly to payment mechanisms (Figure 3). (Figure 2 legend)
  26. 26. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Waste Removal Level % of all Waste FFS Per Case Provider at Risk 3 Case-Rate Utilization (# of cases per population) 45% 2 Within-case utilization (# and type of units per case) 50% 1 Efficiency (cost per unit of care) 5% Financial Alignment Around Waste Reduction Opportunities Payment Method Figure 2: Financial incentive alignment under various payment mechanisms. Note: Green arrows, savings from waste elimination accrue to the care delivery organization; for pink arrows, savings go to payer organizations.
  27. 27. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The financial impacts of clinical quality alignment are real. Intermountain Healthcare reduced its total cost of operations by 13 percent through waste reduction over a four-year period. The opportunity is there and achievable for health systems that make the investment. Financial Alignment Around Waste Reduction Opportunities
  28. 28. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Financial Alignment Around Waste Reduction Opportunities Figure 3: Financial impact of clinical quality improvement.
  29. 29. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Financial Alignment Around Waste Reduction Opportunities In Figure 2, the far-right column shows that the per case payments are lower risk opportunities than fee-for service, but if a healthcare system wants to tackle case-rate utilization opportunities, that comes with some financial or shared risks. The bottom line being, the group that makes the investment must harvest sufficient waste savings to ensure financial survival and contribute to operating margins. Figure 2 also shows that population health-based payments are the only method that allows the health system to benefit from reducing all three categories of waste.
  30. 30. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Lessons Lessons learned about possibilities for healthcare delivery are: Clinicians count successes in lives. While the healthcare industry as a whole is still falling far short of the miracles within reach, patient outcomes can be dramatically better. Knowing that presents an ethical obligation to do so. >
  31. 31. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Lessons Lessons learned about possibilities for healthcare delivery are: The path to financial success leads through clinical management. Almost always with proper clinical management, better care is cheaper care through waste elimination. >
  32. 32. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Lessons Lessons learned about possibilities for healthcare delivery are: Success does not come from comparing oneself to others, but through solid analytics based on good internal data. >
  33. 33. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Lessons Lessons learned about possibilities for healthcare delivery are: The long-term organizational viability of clinical quality improvement strategies requires aligned financial incentives. >
  34. 34. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Future of Healthcare Knowing these lessons, it’s interesting to speculate on what the future of healthcare holds. The two predictions with the greatest implications are: Pay-for-value will continue to grow Healthcare IT will mature. > >
  35. 35. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Future of Healthcare The implications for increasing pay-for value are: Increasing focus on waste elimination through move upstream strategies. Care delivery organizations will increasingly seek capitated risk through ownership or partnership. Stand-alone specialty care practices and hospitals will increasingly become price takers. > > >
  36. 36. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Future of Healthcare What maturing healthcare IT will mean: EMRs’ primary purpose will shift to clinical decision support. The resulting systems will be much more clinically natural and adaptable. Analytics, including AI and machine learning, will explode. > > > Quality will become the core business and that will drive bottom-line cost control and waste in a provider at risk financial environment.
  37. 37. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Conclusion An old Yiddish proverb sums it best: “Better has no limit.” Harkening back to the William Osler quote, healthcare providers and administrators have only begun to discover how good the future of healthcare might be. Each person in the industry should be tasked with the mission of creating a new system and paradigm shift of such great magnitude that future generations can only begin to imagine the possibilities.
  38. 38. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  39. 39. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. Why Clinical Quality Should Drive Healthcare Business Strategy Linking Clinical and Financial Data: The Key to Real Quality and Cost Outcomes Bobbi Brown, MBA, Senior VP Transforming Healthcare Analytics: Five Critical Steps Ann Tinker, MSN, RN, Professional Services, SVP; Dan Hopkins, Professional Services, VP Prioritizing Healthcare Projects to Optimize ROI Dorian DiNardo, Senior VP of Analytics; Aaron Neiderhiser, Product Management, Sr. Director Emergency Department Quality Improvement: Transforming the Delivery of Care Health Catalyst Editors Healthcare Project Management Techniques: A Pragmatic Approach to Outcomes Improvement Curt Sellke, Client Engagement, Sr. Director
  40. 40. © 2018 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes needed to improve population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 65 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. Health Catalyst was recently named as the leader in the enterprise healthcare BI market in improvement by KLAS, and has received numerous best-place-to work awards including Modern Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for Millenials, and a “Best Perks for Women.”

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