For providers transitioning to value-based care models, one of the keys to successfully controlling costs and improving outcomes is eliminating unnecessary clinical variations in care. These inconsistencies not only have the potential to prolong common health problems and delay a patient's return to health, but they can also have a negative impact on the bottom line.
When patients take longer to heal and require excessive tests and treatments, it drives up costs and reduces potential revenue for accountable care organizations (ACOs) and other providers that bear financial risk. To support these organizations and help patients return to health faster, evidence-based, clinical guidelines presented at the point-of-care can help ensure the consistent application of effective treatments and expected recovery times across entire populations.
When these clinical guidelines are integrated into electronic health record (EHR) systems and made part of the clinical workflow, providers can access valuable decision support in a way that is both efficient and does not disrupt the patient encounter. Once implemented across an entire organization, the result is a more effective utilization of healthcare services, better outcomes and improved financial performance under value-based payment models.
Adhering to evidence-based protocols
Unnecessary variations in care is one of the major contributors to the estimated $992 billion of healthcare spending that is wasted every year.1 Overtreatment, a common result when organizations lack standard evidence-based protocols, adds between $158 billion and $226 billion in wasteful spending.2 All of this excess care directly impacts provider reimbursement under value-based payment models. While unnecessary variations in care are almost never intentionally wasteful, many clinicians lack reliable, evidence-based tools at the point-of-care to help support and document their treatment decisions.
To help providers better adhere to established, clinical guidelines, numerous resources can be integrated directly into the EHR to offer additional decision support. Among these tools are physiological duration tables that help physicians offer reliable estimates to patients about how their activity will be impacted during an illness or injury. These tables are informed by millions of observed cases collected from a variety of credible sources and give patients clear expectations on recovery times.
Physicians can also, with greater certainty, offer a range of activity recommendations for patients during their injury or illness to ensure recovery is safe and rapid. Predictive modeling capabilities can further help physicians to offer individualized estimations of how long it will take patients to fully resume active living based on factors like age and comorbid conditions. This approach also offers an opportunity for additional chronic condition management education for the patient, which is essential to reducing costs in a value-based environment. Then, as patients near the window for estimated recovery times, providers can determine if patients are progressing as planned or if proactive interventions are needed in order to keep recovery times on track.
Enabling continuous improvement
When organizations take a more consistent approach to care recommendations, they can also better track and measure clinical and financial performance – a key requirement for continuous quality improvement across the enterprise. At the medical code or diagnosis group level, organizations can evaluate how long it takes their patients to return to health. Those figures can be benchmarked against an average or "normative" dataset of millions of cases. Comparisons can also be made against the physiological ideal or "optimum" duration of inactivity.
This analysis is often eye opening for many healthcare providers. Some organizations are pleasantly surprised to learn they are saving millions of dollars in medical costs because their patients' illness durations are much shorter than the normative benchmark, or even the optimum duration timeline. For employers, a decrease in illness duration equates to additional savings in wages, benefits and lost productivity.
Equally important, these analytics offer insight into the specific conditions where care may have strayed from standardized treatment protocols, giving healthcare administrators clear targets for improvement initiatives going forward.
Getting back to active living
By supporting physicians with evidence-based tools at the point-of-care, healthcare organizations can help eliminate potentially costly variations in care and more promptly return individuals back to active living. Consistently following evidence-based treatment guidelines results in decreased utilization and better outcomes. These results can then be shared with employers or payers to demonstrate both the organization's clinical quality and its commitment to cost-effective care.
The bottom line? When individuals are able to return to healthy living, everyone benefits — not only the patient, their family and the community, but also hospitals, providers, payers and employers.
About the author:
Joe Guerriero is senior vice president of MDGuidelines at Reed Group.
1 http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_82.pdf
2 http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_82.pdf
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