By Katie Wike, Contributing Writer
For OSF HealthCare, manually identifying costly patients was wasting both time and money.
Patients who frequent the ER multiple times per month and require expensive tests are often referred to as super-utilizers. Often they suffer from chronic diseases such as diabetes or kidney disease, and some are Medicare patients who cannot afford their prescription drugs. While they account for only one percent of patients in the United States, they were responsible for an astounding 21 percent of the $1.3 trillion dollars spent on healthcare in 2010. According to the Washington Post, that amounts to nearly $88,000 per person. These patients may include, for example, a woman who, after breaking her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, visits an emergency room 30 times in 6 months.
Since hospitals are under more pressure than ever to provide better and more affordable care, identifying these patients becomes a critical part of saving money. Pricey readmission fines through the Affordable Care Act penalize providers for Medicare patients who return to the hospital within 30 days of discharge. Identifying these patients and providing preventative care or care reminders can reduce readmissions.
Rather than sifting through patient and ER data to identify those people categorized as superutilizers, analytic technology, such as population health management (PHM) solutions, frees up time for physicians to see patients. Installing this new software was the first step toward better data analytics for OSF HealthCare, a Pioneer ACO and integrated healthcare network.
OSF HealthCare of Peoria, IL includes the OSF Healthcare System, which consists of eight hospitals and medical centers and two colleges of nursing. Additionally, OSF Medical Group is a physician network of nearly 700 primary care and specialist physicians and more than 300 advanced practice providers.
New Tools Needed To Effectively Manage Risk
Before installing a PHM analytics solution, the staff at OSF HealthCare found it difficult to identify and track super-utilizers. The IT department had to turn raw claim data from insurance companies into a table format that was readable. Physicians then needed to screen each claim report to see if it was manageable. For the more than 3,000 claim reports being screened each quarter, IT spent more than 8 hours converting data, followed by an additional 50 to 60 hours per quarter of physician time screening and confirming manageability. Dr. Timothy Vega, M.D., F.A.A.F.P., medical director at OSF HealthCare, estimates the cost was more than $11,800 per review, noting that this doesn’t include the time it took to measure each patient OSF HealthCare was trying to manage.
Staff used Access tables with information from a three-year period to identify at-risk populations, but it was virtually impossible to accelerate the process. Because of this, OSF HealthCare began looking for more efficient ways to obtain and track quality measures.
As Vega said, “Healthcare is changing, and we are right in the middle of that transition. It’s a transition of determining who should accept the risk and cost for health and disease. Should it be the insurance company, the government, the provider, the patient? As providers, we are taking on more risk, and IT tools help us to mitigate it.”
To lessen that risk, OSF HealthCare sought a technology that would uncover the needed patient data and allow the company to measure and quantify the programs implemented in order to help manage super-utilizers and identify other population statistics. That meant finding software that could take what seemed like random data points and produce understandable patterns.
Medical Intelligence Enhances Provider Visibility
The ACO selected solutions from Verisk Health to help uncover the data it needed. At first, OSF HealthCare worked with Verisk Health to manage the health of the network’s own employees. Using Verisk’s Medical Intelligence platform, OSF HealthCare was able to identify and sort employees into three categories:
- Super-utilizers — so the network can develop outreach programs to help manage their care;
- Those on their way to becoming super-utilizers — so proper intervention can take place to reduce risk; and
- Healthy individuals — to whom wellness activities can be offered.
OSF HealthCare also now uses Verisk Health’s Provider Intelligence solution. This tool enables staff to accurately assess practiceand physician-level efficiency across the network. In doing so, they can identify opportunities for optimizing clinical value, managing medical costs in and out of network, reducing waste, and improving the patient experience.
In addition to the Medical Intelligence platform and Provider Intelligence solution, OSF HealthCare also has begun working with Verisk to determine how to streamline the current identification process for super-utilizers. The network is also working to integrate health risk-assessment information and EMR data into the claims data received from Verisk. This would give staff a better overall picture of what occurs at the patient and population levels.
PHM Provides The Proof Needed To Drive Action And Improve Outcomes
Before creating reports, Vega explained, “We are always making sure we can answer the questions, ‘What will I do with this information? Do we have something in place to make the data actually accomplish something?’ The deep information created from these reports can overwhelm people, so we make efforts to assure that each data run has a specific purpose.”
Instead of taking days to identify super-utilizers, it now can be done in just two minutes using the Medical Intelligence platform. Medical Intelligence also allowed the network to identify and stratify opportunities for clinically sound, financially effective interventions. It reduced inefficient use of resources by giving providers a list of patients to contact for reminders and preventative care, rather than dealing with larger and more costly problems later in the ER.
While OSF HealthCare has been able to reap many benefits from the PHM platform, the most impressive has been the time savings for physicians. What previously took 50 to 60 hours per quarter is now completed in a matter of minutes by the Verisk software. The tool also helps staff identify when it is best to hand off patients to less intensive or more intensive treatments/healthcare engagement. By doing so, the ACO reduces wasted staff and patient time by putting the right people with patients at the right time.
Another benefit of the PHM platform is that the program quickly identifies areas where OSF HealthCare can intervene with highrisk patients. “In our old medical system, the highest-risk diabetics were the ones a physician never saw, and our medical people did not know who they were. Now we can reach out to these individuals at risk and engage them,” explains Vega. “We can also do the same with groups, such as those with back pain or emphysema, and help with lower-cost office or wellness care before costlier care is required. We aren’t guessing — we have the proof we need to target individual populations and help manage their care.”
Finally, OSF HealthCare now has the ability to immediately see if newly implemented programs are working or not. For example, if a new wellness program is implemented, the health data of the patients who participate in the program and those who do not can be compared to determine the effectiveness of the program. Vega says, “For prevention and wellness, this is a truly exciting and powerful capability. Now that physicians can have this data in hand, it revolutionizes the work they are doing and the role they can play in helping their patients.”
Overall, Vega and OSF HealthCare are pleased with the results of installing the Verisk solution. “Both as a Pioneer ACO and an organization focusing on PHM and evidence-based medicine, it’s important to learn what medical activity works (clinically and economically). This is the only way we can enhance and sustain our entire medical system.”