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Digging into Episode of Care Data to Improve Patient Care

09/07/17

By:

Jay Prystowsky, MD, MBA, Principal, Sg2, a Vizient company

It’s no secret that doctors love data. We love it because it informs which devices we use, our treatment methodologies and how we can improve patient outcomes. And, while the move to value-based care has been a challenge for physicians, I believe the data that is being generated as a result offers an incredible opportunity to advance the quality of care as well as lower costs.

A great example of this is the information captured in episodes of care.

In an episode of care, let’s consider a patient who undergoes knee replacement surgery followed by a 90-day post-acute period. We must consider the entire episode, starting from the moment the decision is made to have surgery to the end of post-acute care. The data can help predict the different providers the patient will see over the course of the episode. It can also provide meaningful insight to the points of care which tend to fragment as the patient goes from one provider to the next for reasons such as communication breakdowns or conflicting treatment plans.

Looking at the evidence within an episode of care underscores the need for efficiency between all providers. Obviously, they try to put forth the best possible care across the entire episode but all too often, there is fragmentation and the overall mission of value-based care can be lost.

Episodic data is critical and compelling. Organizations that are operating in this type of environment should dig through their data for these important performance takeaways:

  1. As a physician who has been on the other side of the table, the need for supply chain to come to the value analysis table with valid, precise, transparent information is paramount. Autonomy is important to us when making patient care decisions, but it needs to be tempered by an insightful assessment of the data. Find and present hard evidence that patient outcomes can be improved and we’ll adjust our processes and care delivery methods.
  2. Identify the rationale if significant variability among providers in episodic spending is found. Is it due to one provider delivering a higher quality of care with measurably better outcomes that justifies the higher expenditures? Most often, the answer is no. It is expected there will be a slight variance, e.g. 4-5 percent as opposed to a more significant 200-300 percent. If a provider is spending more than others, what is the reason?

By mining episode-of-care data in this way, an organization can identify areas of cost drivers that must be addressed to gain efficiencies and improve care. In addition, episode of care offers the opportunity to look at the patient experience in a very granular way – by specific patient. A granular view is very compelling to physicians and can’t be underestimated; it results in instant validity and credibility.

The value of episodic data is also important at the facility level where the concern is that post-acute cost is a key driver of episodic spending. It motivates hospitals to find ways to improve their delivery of care to reduce post-acute episodic costs, like readmissions.

In a recent webinar, my co-presenter and I shared an example from the Sg2 database where hospitals engaged in bundled payments experienced 30,000 knee and 16,000 hip replacement episodes, spread out over an 18-month period. After evaluating the data, we discovered a reduction of episodic cost as the hospitals got more operationally efficient in their processes, and there was also a simultaneous decrease in length of stay. This demonstrates the facilities evaluated their episodic data and cost variations, made adjustments in their care delivery model and improved both efficiency and cost levels.

The right data can effectively highlight both processes and outcomes that need to be improved, as well as suggest what the best tools for improvement should be. Providers share in the risk and reward of managing the episode of care, so it’s in their best interest evaluate the data and collaborate to increase efficiency.

As value-based care increasingly rewards better outcomes, providers will seek to align with health systems that support mutual success.

To listen to the final Evolve Strategies webinar recording, click here. For more information about applying episode analytics across the value-based care continuum, click here to read a recent white paper.

About the author. As a principal with Sg2, Dr. Prystowsky provides thought leadership to help shape Sg2’s editorial perspective and vision for future care delivery models and patient-centric approaches in medicine and surgery services. A general surgeon, Prystowsky practiced for 25 years at Northwestern Memorial Hospital in Chicago and was a full-time member of the faculty in the department of surgery at Northwestern Medical School.

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