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.
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