Finding ways to improve value in care delivery was nothing new to OSF Saint Francis Medical Center in Peoria, Ill., in 2013. The organization became a Pioneer ACO the year before and had done extensive work preparing for the shift from a fee-for-service to a population-based Medicare payment model.
Still, the fifth largest hospital in the state, with more than 42,000 admissions annually and $600 million in operating expenses, looked to the horizon and decided something had to change. The medical center had just come off two straight quarters of not hitting its budgetary targets and, with a shift to caring for an at-risk population differently, it faced potentially significant headwinds. Further complicating its business outlook, the largest employer in the area was closing some of its facilities around the country. No one knew what that would mean locally, but it motivated the organization to explore ways to operate more efficiently while still upholding quality goals.
Jennifer Hopwood, chief nursing officer and vice president of patient care, says it was against this backdrop that OSF Saint Francis’ leadership developed a three-year plan to improve outcomes and operational performance at the system’s flagship hospital while delivering $76 million in savings.
The framework that drove the multidisciplinary initiative became known as the Clinical Financial Integration team, or C-FIT, and leaders from the team recently shared their success story at the American Organization of Nurse Executives conference. Tapping into external databases to benchmark against other similar facilities in a more consistent and comprehensive way, the C-FIT team made quick progress. It used clinical analytics benchmarking data to systematically engage executive leaders, physicians, finance, supply chain, pharmacy and other areas to drive evidence-based quality improvements that would lead to greater efficiencies and cost reduction.
“We really used the information inside the database to structure where we had our opportunities,” Hopwood says.
Areas such as labor and pharmacy optimization, clinical service lines at the DRG level, supply chain standardization and others were scrutinized to find opportunities for improvement.
“When we started digging into the [clinical] data, we found some big buckets like sepsis within the general medicine line and tracheotomies within the cardiac DRG line. From there, we identified our top 10 opportunities for DRGs and assembled teams comprising a nursing leader, a physician leader and a program manager to facilitate meetings to drill down into the data to look at how we were doing things,” Hopwood says.
The C-FIT team and clinicians used performance improvement methodology to explore clinical pathways to review medication selection, how care is provided, order sets, imaging and radiology, blood products used, etc. Hopwood says the team then looked at length of stay data vs. benchmarking data and asked such questions as: Are we preparing patients early enough for discharge? Do we need to engage care management for some patients who may be transitioning to a skilled nursing facility?
Every Friday, the medical center’s executive leadership team, which included the CEO, chief financial officer, chief operations officer, CNO, vice president of quality and the performance improvement division, among others, met to review progress. Operational and financial savings were carefully vetted by the finance department while clinical performance improvements were measured as well, says Robert Garcia, clinical analytics manager.
“One of the main reasons for our success was just having agreement from our C-suite about what we were going to roll with from a data standpoint. We’ve kept to it for going on four years now. Everyone knows our data are true and valid,” Garcia says.
Even though the three-year plan goal has been met, the C-FIT team continues its work, Hopwood says.