Aligning value-based efforts across an organization is never easy, especially for a 28-hospital health system with a 400-mile footprint.
In April 2018, the two largest health systems in Illinois and Wisconsin merged to form Advocate Aurora Health. Today, Advocate Aurora manages 25 value-based contracts spanning 1.3 million lives across the two states.
According to the Advocate Aurora Health 2019 value report, the system has limited medical cost increases for patients in its value-based plans to 1 to 2 percent per year, compared to the industry average of 6 percent, per a 2019 report from PwC’s Health Research Institute.
The Advocate Physician Partners Accountable Care Medicare Shared Savings Plan (MSSP) was also among the top 10 MSSPs for earned shared savings in 2018, according to CMS data.
A contributing factor to the system’s efficiency in containing cost and managing care is data, stated Carrie Nelson, MD, system vice president of population health and health outcomes of Advocate Aurora Health, and chief clinical officer of Advocate Physician Partners, a clinically-integrated network that includes more than 5,000 clinicians in Illinois.
During a recent interview with Becker’s, Dr. Nelson discussed how Advocate Aurora standardized its performance metrics after the merger, why data is so important for value-based initiatives and how the system is tackling unnecessary readmissions, among other topics. Her insights are below.
Standardization of performance metrics post-merger
"When we came together, we had a lot of the same perspectives on what was important to measure in health care, but different ways of measuring," said Dr. Nelson.
The two main areas Advocate Aurora had to standardize were its health outcomes scorecard and population health metrics. To create a single population health index, leaders and clinicians in both states united to identify common quality, efficiency and cost metrics.
Role of data in successful quality initiatives
"We've all seen instances in which we think certain tactics would be valuable, but then the results are not what we expected," Dr. Nelson said. "That's because our intuition isn’t always as accurate in determining what works for our communities and patients to achieve better health outcomes."
Data and analytics are needed to identify the root causes of these quality lapses and cost containment challenges to implement more strategic value-based efforts within clinician groups that get results.
Application of insights to reduce avoidable readmissions
Through a collaboration with Cerner, Advocate Aurora implemented a data analytics strategy to help reduce unnecessary readmissions and manage episodic care among heart failure patients. The program creates an acute utilization prediction score for each patient that accounts for EHR data, labs and medication use, among other clinical information. This scoring system enables care managers to identify and contact a patient with a higher risk of being readmitted and/or those patients going to the emergency department who may not have otherwise been on their radar.
"This program really supports better use of our care management teams," Dr. Nelson said. "They can be extremely focused and manage by exception, instead of sorting through all the people on their list who might be worthy of a phone call."
Advocate Aurora saw a 25 percent reduction in heart failure admissions when comparing acute encounters pre- and postimplementation in Illinois. It plans to expand the program to Wisconsin and is assessing how to use the same methodology for other chronic condition states.
On the inpatient side, Advocate Aurora is also leveraging a readmission risk prediction model to stratify patients based on the level of intervention needed post-discharge to determine an appropriate transition plan and venue.
Cost-conscious quality strategies in the COVID-19 era
Along with reducing unnecessary admissions and utilization, Advocate Aurora's population health competencies also proved valuable in the organization’s response to COVID-19.
The system rolled out a mobile app for confirmed or suspected COVID-19 patients who did not require hospitalization. The app connected patients to Advocate Aurora’s care management team, who monitored patient’s symptoms and evaluated whether they needed additional outreach.
To extend an additional hand, Advocate Aurora also provided care packages of over-the-counter symptom-management medications that were hard to come by and cost-prohibitive for some communities.
While the COVID-19 pandemic revealed opportunities to address health equities, a focus is also needed for more routine types of care. As such, the system is planning to implement an initiative to decrease disparities among hypertension patients. Advocate Aurora is also working to segment quality data by patient populations to ensure quality targets are met across all racial and ethnic groups.
The quest for more strategic quality, cost-containment initiatives
Ultimately, when it comes to implementing quality and population health initiatives in care delivery networks, Dr. Nelson’s biggest takeaway for leaders is to learn how to talk with clinicians about reducing unnecessary spend.
"Reducing unnecessary spend is being patient-centered," she said. “Excess health care utilization contributes to potential harm and syphons money away from areas where health care dollars could be better spent. … It’s our responsibility to make changes that will help both improve quality and decrease unnecessary costs."