AAIHDS
American Association of Integrated Healthcare Delivery Systems

 

 

 

2014 AAIHDS Innovation Award

 

The criteria for the 2014 AAIHDS Innovation Award which was sponsored by DGA Partners includes:

m  Highlight innovative solutions that bring increased value to the healthcare delivery system
m  Improve population health
m  Demonstrate the important role of the provider engagement and collaboration in transforming the    healthcare delivery system

 To sponsor or apply for the 2015 Innovation awards, contact Katie Eads at keads@aaihds.org

 Candidates include:

          Blue Cross Blue Shield of Michigan -“Care Transition  to Home Program”

          Lehigh Valley Health Network – “Managing High Risk Patients in Primary Care:  Community Care Team Approach

          McKenzie Health System“The Oxy-Free Emergency Department”

          North Shore-LIJ Health System Center for Learning & Innovation“Innovative Solutions to Improving Outcomes for Patients with Sepsis”

          Pinnacle Health Inc. – “Pinnacle Perks”

          Populytics “Better Health, Better Care, Better Cost”

          St. Elizabeth Physicians“Direct Scheduling”

          St. Joseph Mercy Oakland – “Patient Early Warning Detection System”

          Yale New Haven Health“Clinical Redesign Initiative”
 

 The winner of the 2014 AAIHDS Innovation Award is:

 Yale New Haven Health – “Clinical Redesign Initiative” 

 Description of their program:

Fee for service reimbursement rates are decreasing. Revenue per equivalent discharge at Yale-New Haven Hospital reached a peak in FY2012 and has since decreased rapidly. Medicare is projected to continue cutting its rates, and hospital costs are continually increasing, with YNHH expense per discharge more than 40% higher than the US average in FY2013 (HCUP Cost of Inpatient Discharges Report, 10/2013).

These revenue and expense pressures are felt by providers across the United States. One common institutional response has been to lower expenses by decreasing labor costs. Over 30 hospitals and health systems removed 100 or more employees or positions in 2014, for a total of more 7,700 employees and positions removed between January and August 2014 (Becker’s Hospital Review, Sep 5 2014) 

Our belief has been that in order to successfully meet the demands of the changing healthcare environment, costs must be sustainably eliminated from the patient care enterprise without compromising the quality of care delivered or managing expenses through FTE reduction. YNHHS’s clinical redesign initiative offers a systematic and comprehensive approach to improving the value of care delivery, and aims to achieve over $60M in annual expense reduction. 

Clinical redesign at Yale-New Haven aims to address the problem of unnecessary variation in care and, in partnership with patient safety and quality, eliminate the incidence of adverse events across the system. Clinical redesign is based on evidence that a focus on reducing unnecessary variation, improving quality, and improving efficiency in care will reduce the expenses associated with care delivery. Only by focusing on achieving best practices and standardizing them across the system can the System sustainably reduce its expenses and meet the challenges of the evolving healthcare environment.  

Clinical redesign at Yale-New Haven is accomplished through a combination of leadership line of sight, central governance, engaged clinician and project management resources, and innovative analytics and decision support capabilities. The initiative is structured around clinical services (or service lines), and features close partnerships and mutual accountability between nursing, physician, and administrative leadership. There are currently over 70 clinical redesign projects underway, with key improvements to date in medicine, cardiology, orthopedics, surgery, oncology, laboratory medicine, and children’s services. Clinical redesign implementation is supported by the Epic EHR and is driving the adaptation of best practices across system providers.   

A significant driver of clinical redesign is a close partnership between clinical teams, finance, analytics and decision support to identify redesign opportunities and track and measure project results. One key analytic element is an innovative tool that synergizes clinical data, cost accounting information, benchmarks from like institutions, and rigorous financial processing. This tool, called DATA-VIEW, allows clinical redesign teams to integrate quality and financial analyses for any given selection of patients and/or providers and design clinical redesign projects to target the areas of greatest opportunity. In addition, clinical redesign’s partnership between clinical and analytics leaders has created a robust measure of Quality Variation Indicators (QVIs), or a ranked series of adverse hospital events or conditions that are not present on admission. QVI-related analyses capture the frequency and cost of complications in care delivery and allow clinical redesign teams that reduce the incidence of QVIs, such as procedure complications and infections, to accurately identify how their efforts have improved outcomes while decreasing the costs of care. Our analyses suggest that cases flagged for a QVI cost an average of $15,000 - $25,000 more to treat than non-QVI flagged cases, offer the hospital a smaller operating margin than non-QVI cases, and clearly represent opportunities for improvement in patient care. 

In addition, clinical redesign is closely aligned with transformation in medical delivery and reimbursement. Clinical redesign teams are managing how patients in eleven cardiac and orthopedic bundles are treated and managed across the continuum of care. A key member of the clinical redesign central steering group is Yale-Haven Hospital’s executive director for care management. Clinical redesign is currently integrating outpatient care delivery improvements with inpatient initiatives in order to more seamlessly manage patient care within and outside of an acute care facility.  The benefitting population for the initiative is all patients who receive care at Yale-New Haven Hospital, Bridgeport Hospital, or Greenwich Hospital, as well as an increasing number of patients treated in a Yale New Haven Health System outpatient care setting. 

 

To sponsor or apply for the 2015 Innovation Award, contact Katie Eads at keads@aaihds.org

The 2015 Innovation Award will be presented at the 2015 Fall Managed Care Forum.