The Care Variation Short List

Transcription

1 Crimson Continuum of Care The Care Variation Short List Targeting High ROI Opportunities for Reducing Care Variation For more information about Crimson Continuum of Care, please contact Corey Lewson at 2015 The Advisory Board Company

2 Care Variation Critical to Health System Sustainability A High Priority for Leadership But Is It High Enough? Care Variation Costs the U.S. Billions in Wasted Spending Estimates of Annual U.S. Health Care Waste by Category (in Billions) 42% of of wasted spending due due to care to care variation $177 $128 $192 $248 CFOs overwhelmingly see clinical protocol standardization as the biggest opportunity for not only reducing waste, but also slowing long-term [cost] growth and they also see it as the best means of reducing utilization of supply and labor. $35 $131 Managing Director, Health Care Advisory Board Failures of care coordination Pricing failures Failures of care delivery Fraud and abuse Overtreatment Administrative complexity Many But Not All Health Systems Looking at Care Redesign As Key to Financial Sustainability Systems Citing Care Redesign as a Top Source of Cost Containment 26% 55% of small 36% of medium of large 2015 The Advisory Board Company 2

3 Reining in Care Variation is an Ongoing Task and in Need of a Fresh Approach Years of Awareness (and Effort) Can Make Variation Seem Like Old News CMO Evaluations of Evidence- Based Practice Performance Key Imperatives for Jumpstarting Efforts Thinking All is Well Evidence-based practice is yesterday s issue. We ve created a lot of order sets in computerized physician order entry and are doing really well on core measures. System CMO, Four-hospital System 1 Target Standardization of Highest- Return Areas Focus leadership and team bandwidth on highest-impact, greatest cost-avoidance ROI areas Recognizing the Larger Opportunity 2 Set Fresh Eyes on Old Issues Understand and address drivers of persistent variability in well-known challenge areas The process is never perfect. It s always worth assessing how to improve over and over again. To say we re happy where we are would be contrary to our culture. CMO, Integrated System 3 Elevate the Importance of Care Standardization Increase all stakeholders awareness of the importance of reducing care variation and their role in it 2015 The Advisory Board Company 3

4 Creating a Short List for Reducing Care Variation Joint Physician Executive Council and Crimson Continuum of Care Analysis Analysis in Brief Vertical approach to analyzing biggest areas of opportunity: by disease state or DRG Based on Crimson Continuum of Care s cohort database: nationwide all-payer sample of more than 600 hospitals, representing > 25% of all inpatient admissions Compared variation across like cases (adjusted for severity) within the same facility (to adjust for geographic variation), summed the variation across facilities, then aggregated across the cohort to identify key DRGs Crimson drill-down analysis of the top charge drivers of variation key DRGs, coupled with Advisory Board and academic research to determine specific, feasible opportunities and targeted solutions Assess the Areas of Greatest Potential ROI Pinpoint the Most Leveraged Opportunities Identify Effective Solutions Where are the biggest areas of charge variation based on: degree of variation within a DRG 1 volume and the total impact on the organization Which DRGs are likely to yield ROI in the short-term vs. impact in the long-term? What are the discrete drivers of variation within each DRG? Can inpatient physician leaders impact these drivers? Would reducing variation within a DRG improve care quality for patients? What tactics and strategies can physician leaders use to tackle the variation drivers within each clinical area? 2015 The Advisory Board Company 4

5 Understanding Distinct and Equally Important Ways to Achieve ROI Analysis of Opportunities Suggests a Two Step Approach to Reducing Care Variation First Step: Outlier Reduction Strategy Drives Early ROI Second Step: Shifting the Mean Drives Long-Term Results Outlier cases Immediate Behavior Change from Few Reduce outlier cases by targeting smaller number of physicians with practice patterns that fall outside facility norm Provides faster impact, but diminishing returns over time as outliers are eliminated Gradual Behavior Change from Many Need the majority of providers to make continuous, minor tweaks to their practice that improve care and reduce costs Takes longer to do, but offers consistent returns over time (constant evolution) The Care Variation Short List 1 2 Heart Failure Sepsis 3 4 Hip and Knee Replacement Labor and Delivery For more information on the Care Variation Shortlist research and how Crimson Continuum of Care can help you rein in care variation, please contact Corey Lewson at Lewsonc@ 2015 The Advisory Board Company 5