All healthcare delivery organizations will need to transform themselves in order to meet the quality, safety and cost challenges confronting healthcare. In this free ebook, Healthcare: a Better Way, you'll discover a strategic framework and a practical roadmap for developing a healthcare analytics approach for sustaining quality improvement. Download to learn more about navigating the challenges confronting healthcare today.
Published By: McKesson
Published Date: Jul 09, 2015
When it comes to making decisions that positively impact care delivery and business outcomes, great leaders will tell you it’s better to rely on data than on myth. Through healthcare analytics, the clinical and financial leadership at Regions Hospital in Saint Paul, Minnesota used data to do just that—and set a strong course for reliable, trusted decision-making that helps address their most pressing issues. Using strong IT systems, accompanied by a cooperative and inquisitive organizational culture that brings together clinical and financial decision makers together to address pressing issues, put Regions on the path to create powerful healthcare analytics that fuel organizational change.
Creating a successful patient experience strategy is a long-term investment in planning, surveying, training, and technology. Healthcare organizations hope these efforts will pay off at the very least with a growing base of loyal patients, better care quality, and stable reimbursement. And then there are those organizations that are turning patient experience into a movement. What’s their endgame? They intend to build state-of-the-art service-oriented cultures that rival other industries, and they are doing it through data analytics, unique communication programs, radical cultural shifts, and consumer-centric technologies.
The need for analytic tools to make sense of disparate data sources will certainly be expanding in the upcoming years. This report highlights what analytical data healthcare leaders are currently focusing on, as well as the challenges they expect to face when using analytics to support their organizations in the future.
Healthcare reform regulations, increasing costs, and more competition are driving employers and their health plans to focus more than ever on opportunities to reduce cost trends. For example, the country experienced a 3.0% growth in per capita gross (allowed) medical and pharmacy costs from 2012 to 2013. Truven Health Analytics anticipates those costs in 2014 and 2015 will increase by 4% to 5% or more. By taking a data-driven approach, payers can manage costs and, ultimately, make their benefit programs sustainable in the context of healthcare reform. They can also maximize opportunities to improve population health and productivity and optimize the delivery of care.
In response to concerns raised by healthcare leaders that the absence of adjustment for socioeconomic status (SES) and race characteristics in patient populations impedes the fair comparison of hospitals on risk-standardized 30-day unplanned readmission rates, Truven Health AnalyticsTM evaluated the extent to which risk-adjusted readmission rates for acute myocardial infarction, heart failure, and pneumonia are affected by adjustments for community-level SES factors through its Community Need Index (CNI) and patient race. The study shows there is, indeed, a statistically significant effect. For more, visit truvenhealth.com/wp/readmissionpenalties.
Some factors commonly used to explain poor operating performance do not prevent many hospitals from being highly profitable. For example, Truven Health AnalyticsTM has found that rates of uncompensated care, drug expense, and other factors do not seem to differ between unprofitable and very profitable hospitals. But factors such as Medicaid utilization rates and poor reimbursement rates do appear to impact the least profitable hospitals. One controllable factor that appears to be significant is labor productivity, with the most profitable hospitals posting the lowest labor expense per patient.
The annual Truven Health 100 Top Hospitals® identifies U.S. hospitals with the best overall performance across multiple organizational metrics, including clinical, operational, and financial. The ability of some hospitals to adapt as the industry is changing demonstrates leadership as the winners set the standards their peers seek to achieve. Study projections indicate that if the new national benchmarks of high performance were achieved by all hospitals in the United States, nearly 126,500 additional lives could be saved, almost 109,000 additional patients could be complication-free, and $1.8 billion in inpatient costs could be saved.
The Truven Health 15 Top Health Systems® in the United States outperform their peers by demonstrating balanced excellence—operating effectively across all functional areas of their organizations. Investigating the winner and nonwinner data from this study is a useful way to see how the nation’s health and the industry’s bottom lines could be improved. For apples-to-apples comparisons, the 15 Top Health Systems were placed into size categories by total operating expense: large (>$1.5 billion), medium ($750 million–$1.5 billion), and small (<$750 million).
Healthcare organizations with strong bond ratings are regarded favorably from a financial perspective, of course. In addition, research by the Truven Health AnalyticsTM ActionOI® program shows that such organizations tend to excel in other categories, such as average length of stay and results of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.
The median fiscal and operational performance of U.S. hospitals over the past year remained relatively flat, despite expectations to the contrary. The data spans a four-year period from 2009Q4 to 2013Q4. Overall, hospitals saw flat or no growth in utilization, but major teaching hospitals saw steady utilization growth.
The Truven Health 15 Top Health Systems study annually identifies those health system leadership teams that have most effectively aligned outstanding performance across their organizations, and achieved more reliable outcomes in every member hospital. Truven Health Analytics measures U.S. health systems based on a balanced scorecard across a range of performance factors: care quality, patient safety, use of evidence-based medicine, operational efficiency, and customer perception of care.
Healthcare providers can deliver much more effective care if they have an understanding of the characteristics, attitudes, and self-reported health status of a patient’s age group. By communicating effectively and delivering care in a manner that resonates with that particular group of patients, healthcare providers can strive to achieve better outcomes and higher patient satisfaction.
Spending on supplies and pharmaceutical services varies among U.S. hospitals. It is not uncommon for hospitals with similar types of patients, including case mix and severity, to have significant differences in purchasing intensity for certain clinical services. Even small changes in efficiency can make a difference for hospitals and health systems, because supply-chain spending typically accounts for hospitals’ biggest spend after labor costs. Costs totaled about $74 billion in 2012, according to the Healthcare Supply Chain Association.
The tax on high-cost health plans, which are often referred to as Cadillac plans, is expected to impact a considerable share of the plans provided by healthcare organizations for their own employees, as much as 39% by 2020. The implications are significant because the excess-benefits tax requires the employer to pay 40% on the value of the portion of the plan that exceeds thresholds set by the Patient Protection and Affordable Care Act. Employers also need to consider that the tax is measured as a direct function of plan cost, and not actuarial plan value, and that a number of factors can drive excise-tax exposure.
Medicare spend per beneficiary (MSPB) information is a Centers for Medicare & Medicaid Services metric that reflects the average cost of an episode of care for Medicare patients. This measure is important to consider as part of a hospital’s national balanced scorecard, as it reflects executives’ efforts to transform the healthcare delivery system and manage the full continuum of care, including the prominent shift from inpatient to outpatient utilization.
The Agency for Healthcare Research and Quality’s Patient Safety Indicators (PSI) are a set of metrics that provide information on the potential for inpatient hospital complications and adverse events following surgeries, procedures, and childbirth. PSIs can be used to help hospitals identify potential adverse events that might need further evaluation, provide the opportunity to assess the incidence of adverse events and complications, and understand patient safety events on a broader level.
The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies hospitals that achieve the best performance on a scorecard of performance measures. This year, based on comparisons between the winners and a peer group of similar high-volume hospitals that were not winners, the study found that if all cardiovascular providers performed at the level of this year’s winners, approximately 9,500 additional patients could survive, more than $1 billion could be saved, and almost 3,000 additional bypass and angioplasty patients could be complication-free. This is based on an analysis of Medicare patients; if the same standards were applied to all inpatients, the impact would be even greater.
The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies U.S. hospitals that have achieved the best performance on a balanced scorecard of performance measures. Based on comparisons between study winners and a peer group of similar hospitals that were not winners, winners are achieving better outcomes while operating more efficiently and at a lower cost. If all cardiovascular providers performed at the same level of this year’s winners, almost 8,000 additional lives could be saved; nearly 3,500 heart patients could be complication free; and more than $1.3 billion could be saved.
This Fact File examines trends in the detection and treatment of acute myocardial infarctions, or heart attacks, in two distinct groups:
STEMI—ST segment elevation myocardial infarction, with the ST segment referring to a specific part of an electrocardiogram tracing. In STEMI, the coronary artery is completely blocked and cardiac muscle dies.
NSTEMI—Non-ST segment elevation myocardial infarction. In NSTEMI, a coronary artery is partially blocked.
Truven Health Analytics™ evaluated the extent to which community need— a measure of the underlying economic and social factors that affect the overall health of a community, including income, cultural/language barriers, education, insurance and housing—is associated with elevated rates of preventable hospitalizations or an increased risk of hospitalization believed to be preventable with quality ambulatory care. The results of this investigation reveal a modest but statistically significant association between community need and an increased risk of hospitalizations that are believed to be preventable with good-quality ambulatory care.
The annual Truven Health AnalyticsTM 100 Top Hospitals® identifies U.S. hospitals with the best overall performance across multiple organizational metrics, including clinical, operational, and financial. The ability of some hospitals to adapt as the industry is changing demonstrates leadership as the winners set the standards their peers seek to achieve. The study revealed that the nation’s best hospitals had a lower mortality index, considering patient severity; had fewer patient complications; followed accepted care protocols; had lower 30-day mortality and 30-day readmission rates; sent patients home sooner; provided more timely emergency care; kept expenses low, both in-hospital and through the aftercare process; and scored better on patient surveys of hospital experience