Can Savings, Quality Improvement Go Hand in Hand?

June 24, 2013
Once MemorialCare's hospitalists started drilling down into their own data, they realized their group was an outlier in terms of keeping patients in the hospital longer and ordering more tests than peers in other hospitals.

Can providing granular cost and comparative utilization information to physicians have an immediate impact? The answer is yes, according to the quality improvement team at six-hospital MemorialCare Health System in Southern California.

Helen Macfie, Pharm.D., senior vice president for performance improvement and strategy at MemorialCare, told me that when the organization started using the Advisory Board’s Crimson analytics platform in 2011, it decided to add direct variable cost as a utilization indicator that physicians could drill down on.

“We worked to give physicians a view of the fiscal impact of what they order, such as an MRI or a simple blood test,” she said. The idea is to reduce unnecessary expense, she added, not to change how people order simply to reduce costs. The goal is to identify best practices and look at what peers are doing and at outcomes. It is not used for judgment purposes; only to provide physicians with data for learning, she said.

As one of its first steps, system leaders solicited feedback from a pilot group of 50 physicians to help guide the larger system rollout. James Leo, M.D., associate chief medical officer at Long Beach Memorial Medical Center and medical director of best practice and clinical outcomes for the MemorialCare Health System, said that physicians are not traditionally used to looking at their data in this way and the project team knew it would have to overcome some defensiveness.

“We thought if we rolled it out too quickly, the resistance would be even stronger. We didn’t want to have to pull back and start over. So we started with just 50 physicians out of 2,300,” Leo said. Since then the Crimson user base has increased to 430 physicians and 60 other “super-users” in the health system. The system is seeing 400 log-ins per month, so the physicians and the department chairs are using it to pull their own data, Leo added. But there are also reports “pushed” to committees and department chairs. They can also do ad-hoc queries on the data. MemorialCare says it has measured $15.3 million in savings for direct costs through physician alignment initiatives. (For its work in this area, MemorialCare won a 2013 Physician Partnership Award from the Advisory Board for discovering best practices that could be transferred to other institutions seeking to make similar transitions. The other winner was Texas-based Covenant Health Partners.)

Macfie gave one example of how the tool is being used: a physician champion, David Law, M.D., a pulmonary specialist at Saddleback Memorial Medical Center, has worked with a hospitalist group there. Once they started looking at the data closely, they realized their group was an outlier in terms of keeping patients in the hospital longer and ordering more tests than peers in other hospitals, she said. “They started really doing data mining themselves and have since saved $1.4 million in costs while at the same time reducing 30-day readmissions,” she said.

“We are seeking to improve value, but we always have our eye on improving quality,” Leo added.

Paul Roscoe, CEO of the Advisory Board’s Crimson division, told me that industry-wide, more organizations are striving to get granular cost data into physicians’ hands, but that MemorialCare is probably one of the leading examples.

“The data itself is without value,” he added. “It is the insights you drive and the changes you make from analyzing the data that will make a difference,” Roscoe said.

I asked him about the role of CIOs and CMIOs in these physician partnership efforts on data analytics. “Increasingly, we are seeing CMIOs as the bridge between the medical and IT worlds and are seeing health systems interested in one analytics platform rather than a series of point analytic solutions that they have to pull together,” he said. “When you are looking at one enterprise solution, that is when the CIO becomes important in the conversation because it will touch so many different sources of data that have to be normalized and technology standards have to be taken into account.”

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