The pessimist sees difficulty in every opportunity. The optimist sees the opportunity in every difficulty.

— Winston Churchill

There is probably no other industry today that is more fraught with difficulty than healthcare. The healthcare leader simultaneously has to drive major reductions in costs while adopting rapidly evolving value-based care models and creating new structures to align physicians, all while achieving superior quality scores.

These challenges have opened windows of opportunity for innovative provider organizations to make key changes in care delivery models to both lower the cost of care and increase quality. While the innovations vary, the characteristics of successful projects are identical:

  • Providing strong leadership to remove barriers to change
  • Using information technology to augment decision-making at the point of need
  • Reengineering care processes to support evidence-based care standards
  • Using advanced analytics to make more informed decisions.

McKesson’s Better Health 2020™ framework defines the core competencies that will be required over the next decade as healthcare continues to transform:

  • Optimizing performance and quality
  • Coordinating care across settings and stakeholders
  • Navigating evolving payment models
  • Maximizing technology’s value as a foundation for growth

This issue of Performance Strategies concludes this series on the theme of “doing more with less” by highlighting a number of organizations that have demonstrated success and strengthened their Better Health 2020 competencies through innovative clinical projects. The other issues in the series focus on optimizing operations and improving financials.

Peninsula Regional Medical Center (PRMC), winner of McKesson’s 2013 award for clinical excellence, maximizes the value of its technology investment by using its systems to facilitate and support new care processes. For example, PRMC tackled the challenge of proactively identifying patients at risk for deterioration in order to intervene before an adverse event such as cardiac arrest occurs.

Using information already captured in its enterprise electronic health record (EHR) PRMC implemented a process that leverages IT to apply a scoring mechanism for constantly evaluating changes in patient vitals. The system alerts care team members to initiate care protocols or perform a detailed patient evaluation. PRMC estimates it has saved $2.3M in direct care costs in nine months while reducing cardiac and respiratory arrests by 67%. Read about PRMC and the strides they’ve made in improving outcomes and reducing costs.

Coordinating care across settings and stakeholders has long been a challenge for most healthcare systems, yet UnityPoint Health-Methodist did just that to improve care for chronic obstructive pulmonary disease (COPD). Using an EHR combined with advanced analytics, patients with a diagnosis or potential diagnosis of COPD were properly stratified according to evidence-based care guidelines across the settings of care. This knowledge drove a risk-based care model that ultimately led to a reduction in readmissions and a 50% increase in pulmonary rehabilitation referrals. Read about UnityPoint Health-Methodist’s achievements in creating a repeatable process for addressing chronic conditions.

New Jersey is a leader among the states embracing the evolving value-based care models. With the foresight to see the need for fluid information exchange across settings, Barnabas Health, which has two accountable care organizations, worked with competitors to create Jersey Health Connect. The exchange enables regional caregivers to access past patient care information, leading to a reduction in duplicate testing and potential medication conflicts while improving the efficiency of caregivers. Read about Barnabas Health and the journey to Jersey Health Connect.

St. Francis Medical Center focused on improving the quality of care by using evidence-based guidelines to change its care model for critical care patients by identifying those at risk for delirium upfront. Using a standard assessment tool, they proactively assess and document the condition, and provide immediate interdisciplinary consultation and treatment. With fewer complications and delirium-related consequences, they’ve been able to reduce extra care and length of stay. Read how St. Francis has improved performance and quality.

While clinical excellence always has been the mission of Englewood Hospital and Medical Center, the advent of health reform and changing payment models drove the need to use advanced health IT in supporting improved workflow and outcomes. Englewood has established a single, extensive improvement initiative supported by medication administration bar-coding, information to help with decision-making at the point of care, and detailed clinical documentation for a longitudinal patient record. Read how Englewood is using people, process and technology to drive change.

Evidence-based care is a well-regarded approach for improving care delivery. Now organizations can use an evidence-based approach to improve the accuracy of staff scheduling. Predictive staffing helps managers schedule the right number of staff at the right time and with the right skill level, helping improve financial performance and quality of care. Read how novel technologies can leverage an organization’s data on historical patient demand and combine it with real-time patient activity data to improve and optimize staff scheduling.

There are no easy answers to the cost and quality challenges of healthcare in America, and there are innumerable factors driving change that are beyond the control of health systems. However, these organizations have demonstrated material cost reductions while advancing their missions of providing high-quality care. While the future is unclear, the path to success is not.

Now is the time to empower clinical leaders to make bold changes in care models: ones that embrace clinical decision support technology, interoperability, and advanced analytics. Doing so can help caregivers improve clinical efficiency, reduce variability of care, and hard-wire evidence-based decision making – ultimately leading towards optimal patient outcomes and financial performance.

12 Strategies to Improve Clinical Performance

Below are just a few of the strategies for improving clinical performance that have been recommended by experts and peers in Performance Strategies.

  • Proactively identify patients susceptible to readmission or non-medication adherence. Establish hand-off processes and preventive strategies like referrals to targeted programs, home follow-up and patient/family education.
  • Connect and coordinate care across settings – hospital, employed and community physicians, pharmacies, extended care settings and the home – even other organizations in your region.
  • Manage your patient population to protect reimbursement. Analytics help provide insights into specific populations and reveal preventive strategies.
  • Use analytics to pinpoint improvement opportunities and measure outcomes. Use benchmarking to understand organizational performance against peers, and industry and quality standards.
  • Ensure clinicians and IT staff work together to design systems that support clinician workflow that employs best practices. Use health IT to help you provide information at the point of need as well as to hard-wire processes that help reduce variations in care and enable proactive care.
  • Promote patient-centered-medical homes (PCMH) to your employed and community physicians. PCMHs promote a team-based approach that avoids unnecessary or duplicate care, and provides a central contact for the patient that can quarterback care needs.
  • Use analytics to identify low acuity emergency department visits. Create alternative, lower cost care settings or improve access in clinics to reduce non-emergent visits.
  • Talk to patients – they can point the way to process and care improvements, which can boost patient satisfaction scores, outcomes and efficiencies.
  • Educate patients and families on their conditions, and how they can help improve them. Use a “teach back” methodology that helps you gauge their understanding. Engaged, educated patients can contribute to better outcomes, shorter lengths of stay and fewer readmissions.
  • Maximize resources by ensuring professional caregivers are working at the top of their certification, treating patients in the least expensive setting for the care required, and investing in wellness programs that can help prevent the need for hospital admissions.
  • Leverage clinical champions to help gain adoption of care delivery changes. Multidisciplinary teams help bring a comprehensive perspective to improvement efforts.
  • Ensure you have the right staff at the right time with the right skill level. Leverage historical data and real-time patient acuity data to help predict and schedule the resources needed to provide optimum care.
Andrew Mellin

About the author

Andrew Mellin is a vice president and medical director for McKesson, where he currently provides strategic direction for the Population Health & Risk Management group for McKesson Connected Care & Analytics. He received his MD from Duke University, completed his residency in internal medicine at Barnes Hospital in St. Louis, received his MBA from the University of Minnesota, and is board certified in Internal Medicine.