When Texas announced its participation in the federal Delivery System Reform Incentive Payment program, University Medical Center of El Paso saw an opportunity to improve outcomes for its Medicaid and low-income patients – the majority of its patient population – while protecting its long-term financial viability.

With the goal of achieving DSRIP financial incentives, UMC launched an ambitious improvement effort targeted at 32 quality metrics, with priority focus on preventing avoidable readmissions. Error-prone and time-consuming manual data analysis was replaced with an advanced analytics platform.

The platform:

• provides near-real-time data on performance issues at the department, service-line and individual-physician levels.
• assesses how the program team accesses a comprehensive view of the organization's performance.
• identifies care gaps or process issues.
• collaborates on workflow changes.
• applies data-based evidence for system-wide interventions that improve outcomes.

Reducing readmissions with analytics

Oscar A. Perez Jr. is program manager at UMC. Here he previews his upcoming HIMSS21 educational session entitled "Real-Time Analytics to Reduce Readmissions."

He discusses:

• strategies employed by UMC to reduce potentially preventable readmissions, successfully meet quality-outcomes benchmarks and attain financial incentives under DSRIP.
• how the data analytics platform prioritized focus areas, designed interventions and impacted performance metrics.
• how he and his team fostered an interdepartmental culture of learning and improvement.

"UMC used many strategies over the past 10 years to reduce preventable readmissions," he recalled. "These strategies have allowed us to successfully meet several quality outcomes under DSRIP and realize financial gains. UMC averages about $30 million in new monies per year through the Texas DSRIP. Most of the incentive dollars are tied directly to outcome attainment.

"The basic strategy used by UMC was to optimize, strengthen and expand the healthcare delivery network throughout the UMC enterprise, including the hospital inpatient setting, primary care setting, outpatient setting and emergency care setting, by identifying those delivery gaps that existed and minimizing their causes," he added.

A Lean Six Sigma technique

The UMC DSRIP team began by using a Lean Six Sigma technique in mapping a patient experience from their arrival through their discharge. This allowed the team to understand the "current state" and envision improvements to the process that would benefit the patient.

Once the improvements were identified, the team works on the implementation of the improvements using a PDSA (Plan-Do-Study-Act) methodology to assess feasibility. This is an ongoing process and continues to affect the culture of change at UMC.

"The second strategy used was to more carefully and purposefully manage the care transitions," Perez explained. "This required the UMC team coordinate not only with in-house case management and social workers but with home health agencies as well. Part of the DSRIP project was to have a home health nurse assigned inside the hospital to act as the liaison between the home health agency and the hospital's case management team. This allowed for rapid intervention thus preventing potential readmissions."

The third strategy UMC incorporated was to invest in in-home interventions, especially for those high-acuity chronic disease patients (those experiencing diabetes, heart disease, kidney disease, etc.).

"These patients are at high-risk for admission and readmission," Perez said. "Having a dedicated contract with a home health agency that is committed to achieving targeted outcomes for the hospital, UMC was able to identify those individuals who are driving a disproportionate share of the cost of care, especially the indigent population, and avoid costly ED visits and preventable admissions and readmissions due to lapses in care."

Prioritize, design, impact

UMC carefully and strategically used a data analytics platform to prioritize focus areas, design interventions and impact performance metrics.

"The data used for these meetings is extracted from our 3M Health Information Systems coupled with custom reports that extract data from our Cerner EHR," Perez said. "This combination of data allows for the leaders of the organization to probe the data, ask questions and make decisions in real time.

"The 3M tools use UMC claims data that is uploaded on a daily basis; and the EHR data extractions are real-time," he continued. "The web-based dashboards allow UMC decision-makers the ability to access details on service area, provider, diagnosis-related group (DRG) and even costs. Prior to this analytics platform, change agents had to endure extreme wait times for customized reports by those IT professionals in the organization."

A culture of learning and improvement

So how did Perez foster an interdepartmental culture of learning and improvement that encourages providers and administrative staff to address problem areas with practical, evidence-based solutions? He explains.

"The concept of 'It Takes a Village,' Hillary Clinton's book, always comes to mind when examining any problem areas, especially in healthcare," Perez said. "The key is to constantly and consistently communicate the specific goals and the reasons to achieve these goals. Success cannot happen unless the 'village' is on board with the goals.

"At UMC, I constantly meet with the team members, every two weeks, and I update the executive leadership team on a monthly basis," he added. "I also meet with the external stakeholders every month. All of the meetings include data showing where we are and where we need to be. This has helped UMC make practical, evidence-based decisions quickly, and has allowed the UMC culture to be less hesitant when pursuing improvements to patient care."

Perez will offer more detail during his HIMSS21 session, "Real-Time Analytics to Reduce Readmissions." It's scheduled for August 12, from 1:15 to 2:15 p.m., in Caesars Forum 131.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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