For value-based care, a Texas health system puts cost and risk data at the point of care
As a health system, Houston Methodist Sugar Land has multiple charges. It’s called to enhance the patient experience, increase delivery of personalized care, improve clinician efficiency and productivity, all while being cost-conscious stewards of resources.
The shift from volume- to value-based care and payment models requires physicians to focus on exceptional care delivery while also managing resources appropriately. Physicians always focus on quality of care. But now, they also are being called upon to partner to reduce overall costs of care.
“Ultimately, however, we can’t partner to manage costs if we don’t have the data we need to aid in cost-conscious, clinical decision making,” said Dr. Nicholas Desai, system chief medical information officer and podiatric surgeon at Houston Methodist Sugar Land. “A 2018 Deloitte survey of 624 U.S. primary care and specialty physicians revealed that 72% of those surveyed consider cost data valuable, especially at the point of care, while only 28% receive this information.”
A smaller survey conducted with physicians at one of Houston Methodist’s hospitals reflected similar results. The adage “You can’t manage what you can’t measure” rings true in this situation, Desai said.
“Our physicians need data to be true partners in clinical and financial stewardship efforts,” he added. “As system chief medical information officer, I wanted us to leverage technology to bring this information to our physicians at the point of care, where it matters most.”
To address the health system’s need to provide cost data at the point of care, Houston Methodist selected vendor IllumiCare, a healthcare IT start-up located in Birmingham, Alabama, to pilot the vendor’s Smart Ribbon product with select providers and pharmacists at Houston Methodist Sugar Land Hospital.
“The IllumiCare Smart Ribbon provides real-time, patient-specific cost and risk data regarding medications, labs, radiology and observational status within the clinical workflow,” Desai explained. “It aggregates this key information, empowering providers with both clinical costs and human costs – or risks – to the patient at the point of care.”
It automatically appears and hovers over clinicians’ screens as they work within patients’ charts in the EHR. It’s designed to help providers balance clinical efficacy with the safest, cost-effective treatments.
“To investigate whether presenting cost/risk data at the point of care impacts ordering behavior and reduces costs, we conducted a 90-day pilot at Houston Methodist Sugar Land with 145 providers and 38 pharmacists,” he recalled. “During the pilot period, providers and pharmacists interacted with the Smart Ribbon as part of their clinical workflows.”
While the pilot demonstrated early financial success, the health system also noticed another powerful finding – the Smart Ribbon offers various clinical efficiencies for providers.
“It aggregates a variety of data points collected across the EHR and presents them in a single location at the point of care, reducing clicks and cognitive burden associated with searching for data,” Desai said. “It puts the right data front and center at the right time. As a result, the Smart Ribbon became part of both our cost transparency and clinical efficiency journeys.”
Houston Methodist Sugar Land uses a variety of healthcare information technologies to make all of this work. At the core is the Epic EHR. There is a wide variety of electronic health records systems vendors on the market, including Allscripts, athenahealth, Cerner, eClinicalWorks, Greenway Health, Meditech and NextGen Healthcare.
MEETING THE CHALLENGE
The Houston Methodist Sugar Land pilot was so successful that executive leadership systemwide supported an enterprise rollout of the tool, which launched April 3, 2019. The Smart Ribbon presents to providers across all eight of the health system’s hospitals in the following areas: hospitalists and internal medicine providers and related subspecialties, pulmonary/critical providers and intensivists, advanced practice providers in these specialties, all residents/fellows, and all pharmacists.
“When a provider accesses a patient’s chart, the Smart Ribbon displays patient-specific cost/risk data directly within their current workflow,” Desai said. “As a result, the provider doesn’t have to ‘swivel chair’ or minimize and maximize windows to find various pieces of information. It’s all in one place, displaying within our Epic EHR.”
In addition to being integrated with Epic, the Smart Ribbon features a Controlled Substances app that’s very valuable to providers. It integrates with Appriss Health’s PMP Gateway. When a provider clicks on the Controlled Substances app from the Smart Ribbon, patient specific PDMP data and NarxCare analytics are presented within the clinical workflow.
“This has been a win for our providers and aligns with our commitment to opioid management,” Desai stated. “Houston Methodist was the first healthcare organization in the U.S. to incorporate all 12 of the CDC’s recommendations for prescribing opioids for chronic pain into the Epic clinician workflow.”
The Smart Ribbon also integrates with VigiLanz’s pharmacy surveillance and antimicrobial stewardship products, providing critical insights for pharmacists within the clinical workflow, he added.
“Our pharmacists have access to the VigiLanz app within the Smart Ribbon systemwide, and we’re currently working on an upgrade that will provide access to a new VigiLanz Worklist app,” he explained. “The Worklist app brings relevant rules and activations front and center with a bidirectional interface to our Epic EHR. As a result, items addressed within the Epic workflow will be recognized in VigiLanz and vice versa.”
Since the pilot, Houston Methodist Sugar Land has reported approximately $717,000 in attributable cost savings with an average incremental cost reduction of $105 per admission.
Since the April 3 systemwide launch, it has seen similar trends in reduction of overall average cost per admission and average lab, medication and radiology cost per admission. Preliminary results are in line with and slightly exceed the results realized during the Houston Methodist Sugar Land pilot.
“We’re carefully monitoring these data points to better understand the true financial impact the Smart Ribbon is having on cost-conscious decision making,” he said. “As our analysis progresses, we’ll also be able to leverage provider utilization data to frame specific conversations with our providers regarding clinical decision making habits that differ from their peers, clinical practice variance and what data elements most impact their clinical decision making process at the point of care.”
ADVICE FOR OTHERS
“As with any technology implementation, you must first know your audiences, anticipate questions and be prepared to address resistance, which is the natural reaction to change,” Desai advised. “You must have a solid understanding of the clinical and business challenges you’re seeking to address with the technology, the ability to clearly demonstrate how you plan to address them, and an understanding of how the technology impacts each audience within their daily workflow.”
The provider organization must bring all necessary stakeholders to the table, whether it be for awareness, for design or for review, he added. It’s not just about technological change – the overall shift from volume to value-based care is about cultural change, he concluded.