by John Morrissey
The federally legislated shift to value-based payment models requires an alternative care delivery approach to match. Clinical performance is now the supreme consideration for reimbursement. The weekly or monthly retrospective assessment of that performance is now too little, too late. To manage in this era, discovering and reacting to problems has to be done daily or even hourly.
Until recently, hospital executives have followed a standard business model of broadly based revenue and cost management: reducing labor and supply expense, investing in billable medical technology services, shaving tenths off borrowing rates in capital markets. But success in the value-based world will entail addressing highly variable costs of delivering care in a setting so complex that potentially hundreds of clinical demands and inefficiencies crop up every day, with clinical and financial consequences that are often irreversible.
“The delivery of clinical practice really drives the variable costs of health care—not the fixed cost, not buildings and equipment. Most organizations have refinanced their bonds, and optimized their fixed costs. Now it’s the variable costs that we have to get our hands on, and that’s driven by clinical decision making,” says David Goldsteen, M.D., chairman and CEO,VigiLanz Corp., Minneapolis.
The new management reality consists of hundreds of micro-problems, each capable of adverse impact on patient care and operational results. A pediatric patient’s subtle temperature change may quickly progress to severe sepsis. A cluster of health care-acquired infections might be brewing, with potential to spread rapidly. A patient out of surgery is on the wrong antibiotic for their clinical condition and, if not switched to an effective choice, will suffer a costly and painful incision infection. A lab test shows an abnormal result that, if not addressed within a certain time frame, will place a recovering patient at risk for relapse.
Important results posted just after a clinician signs out of the electronic health record (EHR) can languish for minutes or even hours. “Multiply that by hundreds of thousands of times and you can see the risk for human error, the inefficiencies of care, the mismatch of data flow and people flow—and that’s basically the description of medicine and how we practice it,”says Goldsteen.
In this day and age, hospitals and supporting facilities are replete with data documenting all those incipient risks as they occur. But there are disparate systems spread here and there, created in formats that do not mesh with one another and passively posted with no easy, accessible way to get the information to someone able to act on it. In response to this dearth of now essential data acumen, enter enterprise intelligence management: software and associated staff activities designed to manage care in real time.
Download the white paper Integrating Real-Time Health, Discovery Analytics and Predictive Models for Value-Based Care to learn how to use predictive modeling to deal with the many-faceted patient management challenges such as hospital-acquired infections and readmission prevention.