Exciting things are happening these days at MultiCare Health System, an integrated delivery network based in Tacoma, Washington, and serving the Puget Sound metropolitan area. MultiCare Health operates five hospitals and is building a sixth; it encompasses 11,000 employees, and is the largest private employer in the second-most-populated county in Washington. MultiCare also encompasses n employed provider group of 600 physicians and practitioners.
Leaders at MultiCare have been moving forward to leverage data warehousing, data analytics, and knowledge management, to reduce mortality from septicemia, demonstrate promising results in reducing readmissions for congestive heart failure (CHF), and prepare for value-based payment-based contracting. MultiCare’s leaders have been collaborating with Health Catalyst, a Salt Lake City-based analytics company that was launched through Intermountain Healthcare seven years ago.
As a result of their work, the leaders at MultiCare can boast the following results to date:
- A 24-percent reduction in readmission rates for CHF—19.3 percent, versus 25.4 percent baseline—within 12 months
- An 18-percent decline in mortality (from 4.5 percent to 3.7 percent) within 12 months
- A 22-percent reduction in septicemia rates within 12 months, at a resulting cost savings of $1.3 million
- A slight increase of 0.4 days in length of stay, with additional time being used for each back and medication education, resulting in reduced readmissions
Christopher Kodama, M.D., who served for several years as MultiCare’s chief medical officer and medical vice president of clinical operations, last year became president of the organization’s new commercial accountable care organization (ACO), MultiCare Connected Care Network, LLC, when it came into existence in July 2014. Dr. Kodama and his colleagues have been building a clinically integrated network encompassing the health system’s 600 employed physicians and providers, and another 600 community-based physicians.
HCI Editor-in-Chief Mark Hagland met with Dr. Kodama at the McCormick Place Convention Center in Chicago in April during the annual HIMSS Conference. Below are excerpts from that interview.
You’ve clearly been building a strong integrated clinical network to support accountable care. Do you have any contracts live yet?
Yes, several are moving forward. One contracting partner that’s gotten a lot of press is the Boeing Accountable Care Network. Group Health has had one with the Boeing Accountable Care Network, too. That contract opened January 1 of this year, and encompasses multiple health systems. This is focused on their non-union employee base, which includes tens of thousands of employees. That’s our main contract under MultiCare Connected Care today. We have several other contracts for accountable care. And then there’s a lot of activity around what’s going on with accountable care organizations in the Northwest. One major public healthcare purchaser here is the Washington State Health Care Authority—one of their programs is the Washington State Public Employee Public Benefit Board, which covers state employees. They’re creating an accountable care program similar to Boeing’s for $65 million federal grant to transform care in Washington.
What are the core things you’re using Health Catalyst for?
We’re using their solutions for advanced applications. The goal is population-based care. One of the things about ACOs compared to the HMO experience in the 1990s is access to real-time, credible data that helps you improve performance. So the ability for people at the point of care to have access to care information—if we agree on standards of clinical performance, how do we know we’re meeting those standards? The goal of population health is to have full accountability and transparency. Our challenge is creating visibility around clinical performance. That’s where what we and Health Catalyst do dovetails.
And early on in our relationship with Health Catalyst, we focused a lot of attention on creating that “data source of truth” through our warehouse. The hard work, in that regard, also includes galvanizing a group of non-technical people—physicians, nurses, care managers— to embrace these tools for clinical improvement. We’ve been a bit of an innovator in the IT space. We just achieved Stage 7 status this past year. And a lot of what we did was a means to an end. Being able to bind EHR-provided data with other forms of data in a new visual form, less reliant on an army of analysts to create reports for individuals, has been a goal.
As an end-user clinician, I want to be able to click on data to find out what my performance has been. That’s really an accelerator. And we’ve spent a lot of time and energy with Health Catalyst, and have created use cases around sepsis mortality and heart failure readmissions. We started those in 2011. And the general approach is that we’ve assembled multidisciplinary teams of people involved in care, physician-led, but encompassing nursing, respiratory therapy and care management; but this time around, we also added some new resources to the game, including the data analyst and architect functions to concurrently track what the physicians say are important to measure—so we can build those systems concurrently with their collaboration.
We also resourced these teams with tools from our clinical applications team. For example, ejection fractions in heart failure, a measure of how well your heart is performing—it’s a single number, but it can be measured by a lot of tools, so we created a consolidated tool to measure that. And even standardizing our electronic order sets.
What has led to your gains in the area of sepsis?
For both congestive heart failure and sepsis treatment, standardizing the physician computerized order set was important, particularly when you had multiple teams managing patients. And we have created an early warning system for sepsis, as others have. So providers defining what the best practices are for a disease treatment process; then you have your applications specialists helping to configure and design the tools that make it easier to do the right thing; and then the folks creating the data architecture so that the people at the point of care have access to data in an actionable way.
What have been a few of the metrics that have been most impressive to you?
Probably the most compelling is our sepsis mortality rates. We saw a 22-percent drop in sepsis mortality. As of December 2014, we went from about 15-16 percent mortality rate to today of about 7-8 percent, over three-and-a-half years. But the first year, we saw a 22-percent drop, for a $1.3 million reduction in costs.
What choices have you made around inpatient versus outpatient areas to work on?
In our journey, we picked sepsis, because it’s an acute-care hospital disease, and it is episodic. But outpatient, we picked heart failure. And that has pushed our thinking around continuum of care. And even though there are certain CMS [Centers for Medicare and Medicaid Services] measures, the meat of the management of that chronic disease is in the ambulatory space. And we’ve given individual outpatient-based providers their own individual CHF dashboard, and can see the core sets of data like weight, blood pressure, ejection fraction, etc., and there’s a customized view of the patient’s care plan; and that’s been live since early 2014.
How have you helped to improve clinical performance in these areas?
Our first phase was to get the providers familiar with the dashboard and using it, trying to navigate it. We’ve defined the standards, this outpatient dashboard will help us bridge the gap. We’re hovering around the national average of about 20 percent readmissions for CHF; we were at 25-26 percent when we first started. That’s been over three and a half years—a longer journey. One key lesson is, with chronic disease processes, we have to get out of the bricks and mortar mentality and focus on the continuum of care, and make sure the information is handed off and that we’re able to maintain the integrity of that, wherever you are. So that’s a big one.
What has been the value of analytics in facilitating this?
I’ll throw a couple of things out there. I don’t think that folks can overestimate the value of having a data governance infrastructure. It’s not the sexy stuff, but it’s really important. Are people across the organization using the same definitions for data? If you’re measuring different things using the same terminology, you’ll lose credibility with the clinicians. Second, knowledge management or knowledge governance, that group is responsible for that and also for creating a streamlined process for how we allocate our resources and knowledge. And Health Catalyst helped us with something as simple as the Pareto principle. How do you figure out which 20 percent of diagnoses are creating 80 percent of your costs? And sometimes you end up with a proliferation of decision-making bodies, or sometimes each as a piece of the puzzle. So staying focused in all this is extremely important.
Based on your experiences so far, what would your advice be for colleagues around intelligently leveraging data for population health management?
As a physician, I do believe that the physician sensibility is really critical—engaging your physicians. They’ll understand in general terms what the key priorities are. So it will be important to create and maintain a balance between paying attention to what the consumers are telling you and the providers are telling you, and really embedding them into the journey of embarking on creating change through data use. It’s teaching a fisher to fish. And there are many layers to that. How do you begin to teach them to fish, in a space that’s historically been relegated to a technical space? That’s the challenge we continue to face and to succeed at.
