By Laura Ramos Hegwer Nov 17, 2016
Trained as a researcher, Vivian S. Lee, MD, PhD, MBA, the CEO of University of Utah Health Care (UUHC) in Salt Lake City, tends to approach problems by asking questions. So when she joined the organization back in 2011, her strategy to bend the cost curve started with a simple question to her department chairs: Where is the costing tool to help providers understand costs at the patient-visit level? When no such resource was available, she led her organization’s efforts to create what is now called the value-driven outcomes (VDO) tool.
Today, UUHC’s VDO tool has been credited with taming the annual growth rate in total facility expense per case mix index-adjusted discharge to -0.5 percent, compared with 2.9 percent for other academic medical centers.
The VDO tool analyzes labor, supplies, imaging, pharmacy, lab, and other services to understand costs at the patient-visit level. The tool even breaks down procedure costs to the amount of each supply and minutes of provider time spent on a procedure to reveal variation that can raise costs and have a negative impact on quality.
A recent study in the Journal of the American Medical Association found that the VDO tool helped cut costs by 10 percent among hip and knee replacement patients. Leaders also saw similar cost reductions with in-hospital lab testing after clinicians reduced unnecessary tests.
Engaging clinicians with actionable data. “One of the biggest lessons that we have learned is just how powerful engagement of our physicians can be in helping us transform our healthcare delivery system,” says Lee, who is also senior vice president of University of Utah Health Sciences and dean of the School of Medicine.
After viewing the costing data from the VDO tool, most physicians want to understand the root causes of variability and are motivated to outperform their peers, Lee says. To help them achieve this goal, business professors at the David Eccles School of Business have trained physician-led provider teams in Lean and other process improvement principles. Armed with training that is not typically offered in medical schools, physicians can develop evidence-based practices and clinical pathways aimed at improving quality while lowering costs, Lee says.
Creating a “perfect care” index. Lee and her team have engaged physicians and other clinicians to develop measures of quality called the “perfect care index,” a weighted average of several different criteria—some that affect payment and some that are simply measures of good care. Sample measures for joint replacement patients include 30-day readmission rate, early mobility rate, and emergency department (ED) visits within 90 days of discharge.
“By creating the perfect care index, we are able to have it both ways,” Lee says. “We are able to value and prioritize process measures, but we also are able to introduce some of our own metrics that the physicians feel are better predictors of good patient outcomes. The measures they choose are all evidence-based, so by enabling the physicians to help define what perfect care is, we get a lot more buy-in.”
To further achieve compliance with these measures, leaders incorporate some of the key metrics into the electronic health record (EHR) via pop-ups, reminders, and check-offs so they become part of routine care. “We have been able to get 100 percent compliance on many of these initiatives because we provide that real-time feedback to clinicians via the EHR,” Lee says.
Targeting outpatient outcomes. To shed more light on cost and quality metrics in outpatient settings, leaders at UUHC are working with primary care providers to develop costing tools for better population health management. “Where we have the greatest potential benefit in the future is in primary care,” Lee says. “We know the vast majority of dollars are spent on patients with chronic diseases, so putting a quality and costing tool into the hands of a primary care provider would be very valuable.”
Another step toward transparency is helping patients understand the price of their healthcare services—specifically, what they need to pay out of pocket. This past August, UUHC launched an online tool that had been in development for two years. Consumers can select from among 100 common procedures, choose their type of insurance coverage (commercial, Medicare, Medicaid, or self-pay), and then enter specifics such as deductibles, copays, coinsurance, and out-of-pocket maximums. The tool provides users with their estimated financial responsibility and links to financial advocates and providers who offer the service requested.
“Putting prices online was a huge challenge because there is so much variability across the health plans,” Lee says. Another concern was creating misinformation for consumers based on their own potentially incomplete knowledge of their benefits. “We want to be as accurate as we can be, but we also recognize that we are providing information that depends on the consumer’s knowledge of what their health plan does and does not do,” she says. By initially focusing on well-defined procedures such as Cesarean sections and imaging tests, leaders hope to sidestep some of these issues, Lee says.
The new pricing tool builds on the organization’s other transparency efforts. In 2012, UUHC became the first academic medical center in the United States to publish physician reviews online. Since then, patient satisfaction has jumped from the 28th to the 85th percentile, and organizations such as Geisinger, Kaiser Permanente, and Cleveland Clinic have begun posting patient satisfaction scores online.
Encouraging resource stewardship. Despite the challenges associated with making price information available to patients, Lee says her team recognizes that putting this information in the hands of consumers is an important step. “What happens when you make costs more transparent to patients and clinicians is that they begin to take more responsibility for costs expended for care,” Lee says. “Having the cost and price data often helps people behave more responsibly.”
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.
Interviewed for this article: Vivian S. Lee, MD, PhD, MBA, CEO, University of Utah Health Care, senior vice president, University Health Sciences, and dean, School of Medicine, Salt Lake City, Utah.
Lee V. et al, “Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association with Reduced Cost and Improved Quality,” Journal of the American Medical Association, Sept. 13, 2016.
reposted from: http://www.hfma.org/Leadership/Archives/