MaineHealth Accountable Care Organization is a network of 10 hospitals, 378 practice locations and 1,600 healthcare providers dedicated to measurably increasing the quality and decreasing the cost of care for 380,000 patients in Maine and northern New Hampshire.

MaineHealth’s coverage area has one of the highest emergency department utilization rates in the country. So the ACO launched the REDUCE initiative: Reducing ED Utilization: A Collaborative Endeavor). MaineHealth’s educational tools assist patients with real-time decision-making, guiding them to the right care at the right place. Predictive analytics and an enterprise clinical data warehouse proactively identify at-risk patients, and help understand the root causes of their utilization.

Kicking things off

Jennifer Moore, president of MHACO, and her colleague Ashley Soule, senior program manager for ACO performance, discussed these efforts in a HIMSS20 Digital educational session, Tackling ED Utilization with Predictive Analytics.

“Most of the state is very rural, which leads to higher emergency department utilization,” Moore explained. “As we looked at our data, that’s what really became apparent. For our Medicare Shared Savings Program, our ED rate per thousand relative to other ACOs was significantly higher. And we do quite well on utilization generally. So this was a real standout for us. We were around 775 visits per thousand, compared to other ACOs well below 700. So we knew we had a lot to address in ED.”

"We were around 775 visits per thousand, compared to other ACOs well below 700. So we knew we had a lot to address in ED."

Jennifer Moore, MaineHealth Accountable Care Organization

MaineHealth also saw in its data that primary care visits were almost 10% below other ACOs.

“So we might have just stopped there and said, ‘Well, that’s an issue, and we might be able to do something about it,’ but we knew there was probably more to the story,” Moore noted. “But those two data points were really what helped us identify ED as an area to focus on for the ACO.”

Going to the committee

When it came to wrapping their arms around the problem of ED utilization, particularly avoidable ED, MaineHealth staff knew they needed very focused strategies and tactics.

“We had to have very specific and well-defined tactics, and knowing that, we leveraged our value oversight committee,” Soule explained.

“The committee is a group of physician and administrative leaders who come together on a monthly basis to: prioritize our goals and initiatives; evaluate and monitor our performance; leverage collective input to identify and spread strategies and tactics; and, lastly and certainly not least, influence local accountability, and that really means working with local leadership to adapt and cascade strategies locally.”

Staff knew when they had all the right data in hand, and brought that data to the value oversight committee. They made sure they had buy-in and engagement from physician and administrative leaders across the network upfront.

Right care, right time, right place

“It was clear this really needed to be a focus area, and we needed to put together a strategy and tactics,” Soule said. “And ultimately, the value oversight committee certainly agreed, and found it helpful to look at the data. And at the end of the day, they knew it was the right thing to do. Getting the right care at the right time at the right place for our patients, and this was just the right thing to focus on.”

Moore and Soule dig deep into predictive analytics and their avoidable ED utilization project in the HIMSS20 Digital educational session. To attend the session, click here.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.