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Four Ways Data is Transforming Your Health

The increasing availability of data about health care in the U.S. is empowering patients to take charge of their care and quietly revolutionizing how patients are treated. Last month, the Centers for Medicare & Medicaid Services released data on which services were provided by over 880,000 health care providers, how many times each service was provided, and what the providers charged. Yesterday, top health and technology experts for the federal government and the Brookings Institution gathered to discuss how the growing catalogue of public health care data is leading to profound improvements in America’s health care. The event was hosted by Brookings’ Engelberg Center for Health Care Reform in collaboration with 1776 DC’s Challenge Festival.

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Here are the top four ways that data transparency is already beginning to transform Americans’ health. The benefits are expected to grow as the data is analyzed, matched with other sources, and organized into user-friendly and accessible formats.

 

1.    Selecting the best doctor

When Farzad Mostashari learned that his mother needed an epidural steroid injection, he wanted to find out which orthopedic surgeon was the best at this specific procedure. So he searched the millions of medical claims recently released by the Centers for Medicare and Medicaid Services (CMS) to discover which providers were the most experienced in this procedure.

An interesting result emerged. “There is one provider who does more than everyone else combined,” said Mostashari, who is a Visiting Fellow at the Brookings Institution, where he is focused on payment reform and delivery system transformation. “He’s probably pretty good.”

As health care data increasingly becomes available, patients will have more information to make the most rational decisions for their health care, said Kavita Patel, a physician and fellow in the Economic Studies program and managing director for clinical transformation and delivery at the Engelberg Center.

Patel asks her patients why they choose to see her. “Nobody’s ever said: ‘I looked up your quality scores and saw that your out-of-pocket costs are less than the average provider in your area,” Patel said of her 12 years in medical practice. “This is one of the first times that everyone in this room can take out a laptop…and look at this data.”

Mostashari added that the data can be used to identify outliers. For instance, he found that while the average orthopedic surgeon performed controversial spinal fusion surgeries on 7 percent of the patients they saw, some did so on 35 percent. This knowledge empowers patients to choose providers that best align with their health care values and preferences.

 

2.    Reducing costs

The newly-released CMS data enables comparisons of the prices different providers charge for the same services. This data reveals that in some cases providers charge vastly different rates to Medicare for the same services, Mostashari said. The Wall Street Journal provides a consumer-friendly database detailing the types of procedures, number of each, and costs per procedure charged by individual health care providers.

Last year’s release of hospital charges led some hospitals that were charging higher rates to uninsured and underinsured patients than their peers to seek advice from CMS. “Some hospital associations called us and said, ‘We want to change. Help us develop new accounting practices to set prices more fairly for those who are uninsured or underinsured,’” said Jonathan Blum, Principal Deputy Administrator at CMS.

The ability to access and analyze a growing amount of data on procedures performed and their outcomes also helps patients and providers avoid low value services and make decisions about the relative risks and benefits of different procedures. Patel pointed out an ABIM Foundation initiative called Choosing Wisely that equips providers and patients with lists of procedures that should be carefully considered and discussed to ensure that care is supported by evidence, not duplicative, free from harm, and truly necessary.

 

3.    Promoting accountability

When health care providers know that their records will be publically available for scrutiny, they are incentivized to ensure that they won’t be embarrassed by what people find. This can profoundly change which procedures providers choose. For instance, one analysis revealed a wide disparity between the percentage of black versus white patients who were tested for cholesterol levels. “Simply asking providers how often they were doing [cholesterol tests], without any payment incentive,” removed this disparity, said Darshak Sanghavi, the Richard Merkin fellow and a managing director of the Engelberg Center. “This is one example of how simple transparency can improve health care and ultimately save lives.”

 

4.    Expediting spread of best practices

Jonathan Blum, Principal Deputy Administrator at CMS, has seen data transparency expedite the uptake of best practices by health care providers and public health authorities. For example, when analyzing the data on dialysis providers, CMS found that there was an uptick in blood transfusions by certain providers in specific geographic regions. “Our medical team got on the phone and called the dialysis providers and said: ‘Did you know you are doing more blood transfusions than your peers?’” The result? Those providers decreased blood transfusions, improving health outcomes for their patients. The same pattern occurred for nursing home facilities that overused antipsychotic drugs.

“I want to convince folks that you can change policy, you can change procedures, you can make things safer,” Blum said. “Data liberation can help us build [accountable care organizations], help us build better payment policies, help us reduce hospital readmissions. There is tremendous opportunity ahead for us.”

Bryan Sivak, Chief Technology Officer at the Department of Health & Human Services, added that data transparency is affording entrepreneurs from outside the health care sector – such as startups Aidin, Purple Binder, and Oscar – the potential to transform the health care system.

“We’re sitting on the edge of an incredible moment in history,” he said. “Everybody is looking at things in a different way because everybody understands that we have to do things differently.”

“Government data is a public good and a national asset,” said Claudia Williams, Senior Advisor for Health IT and Innovation for the U.S. CTO in the White House. “It’s something we have to release if we can to allow innovation and change.”

How do you make your health care decisions? Have you used any of these new tools?

Categories: General

Cleveland Clinic’s Value-Based Care Team Improves Patient Wait Times, Saves Costs

Cleveland Clinic CEO and President Toby Cosgrove, MD, believes that the medical center is ready to “lead the charge” in delivering better patient outcomes and faster care, all at a lower cost.

Dr. Toby Cosgrove

Toby Cosgrove, MD

To that end, the Cleveland Clinic has established a Value-Based Care Team, made up of physicians, nurses and other experts who will work together to translate “better, lower cost and faster” into everyday practice. Services are rationalized across the network, with multi-specialty teams using system-wide resources to deliver the right care at the right place for every patient, at the right time with the right cost.

“Value is the centerpiece of Cleveland Clinic’s strategy,” said Associate Chief of Staff for Clinical Integration Development, Dr. David Longworth, who heads the Clinic’s Value-Based Care Steering Committee. “We are focused on two areas. One is to eliminate unnecessary practice variation by developing evidence-based care paths across diseases. The other is comprehensive care coordination to allow patients to move seamlessly through the system so that we reduce unnecessary hospitalizations and ER visits.”

According to Dr. Longworth, the TeamCare model helps to:

  • Increase throughput.
  • Reduce the cost-per-unit of service.
  • Improve patient and provider satisfaction.

“In the past, each physician had one medical assistant who simply roomed the patient and took vitals,” he explained. “All the chart work was done by the physician, often at home in the evenings, adding several hours of work to their day and extra time to the entire process. Now, physicians go home at the end of the day with all their charts closed.”

The TeamCare model helps the Cleveland Clinic improve its Patient Experience ratings in a number of measured metrics, including:

  • 22.8 percent improvement in wait time at clinic.
  • 10.7 percent improvement in wait time in exam room to see provider.
  • 8.9 percent improvement in the time the provider spent with the patient.

While the Value-Based Care Team may be a concept borne of the new world of health care, the Cleveland Clinic has a rich history of improving patient outcomes. In 2000, the Clinic became the first hospital in the U.S. to publish its outcome measures and now publishes outcome books for every department, comparing itself to the best available benchmarks.

The Cleveland Clinic further changed the way it delivers care by developing Institutes to house medical and surgical specialties, working under one Institute leader and one budget. In some Institutes, inpatient and outpatient care are co-located, and Institute leadership is charged with defining what diseases and conditions each Institute cares for, developing a set of shared outcome measures for which the team is jointly accountable. Leaders also identify the skills that need to be brought together to care for patients with the sets of conditions the team treats.

Institutes are given autonomy to pursue different implementation approaches and are expected to share insights with others. For example, the Neurological Institute created a website so that others at the Clinic could learn how it was developing performance measures and decide whether to use a similar approach.

In the case of a primary care pilot program, Value-Based Care relies on a team approach that leads to a higher-efficiency practice style. Responsibilities are shared among two medical assistants and the physician, with each individual functioning to the highest level of their scope.

For each patient visit, a medical assistant brings the patient to a treatment room and obtains vitals and additional medical history information, which they immediately enter into the patient’s electronic medical record. The medical assistant remains in the room during the examination, acting as a real-time transcriber for the doctor’s notes and orders, which are also sent immediately to the physician’s inbox for verification and signature so the assistant can schedule any follow-up tests or procedures before the appointment is complete. At the same time, the physician’s second medical assistant is getting the doctor’s next patient set up in another treatment room.

Value-Based Care also helps the Clinic reduce costs. In fact, in just under a year, the direct cost per patient encounter dropped by 7.5 percent while the number of patient encounters per day increased by 16.4 percent.

The hospital lowers costs in other ways as well, such as avoiding 12,082 lab tests in 2011 and 2012 for a savings of $1.2 million and lowering the cost of lung transplant surgery by 11 percent. Cleveland Clinic also is getting patients into treatment faster, with the total number of same-day visits increasing by 14 percent and the average emergency room door-to-doctor time reduced to 17 minutes.

These strides are helping Cleveland Clinic reach the Top 20 of the University HealthSystem Consortium’s (UHC) quality index, earning UHC’s Rising Star award by improving inpatient centeredness, mortality, equity, efficiency, effectiveness and safety.

The Cleveland Clinic model is a good example of how health systems can develop evidence-based models to generate higher quality care at a lower cost. What are other hospitals and health systems doing to redesign care delivery paths? Let us know what’s working.

Categories: Cost-Savings

Are Shorter Doctor’s Office Wait Times Just a Phone Call Away?

Nobody likes to wait, especially at the doctor’s office. No one knows for sure what will happen to wait times, which average from about 16 minutes to just over 24 minutes nationwide according to Vitals – as 30 million more Americans obtain health care coverage under the Affordable Care Act. But it stands to reason that wait times could increase. Couple that with the looming shortage of primary care physicians, and time spent in doctors’ waiting rooms may become an even more precious commodity.

Linda Barlow

Linda Barlow

Patients who lack, well, the patience to wait may have a solution – one that is showing great promise to eliminate doctor visit copays and is available even to those without medical insurance. The free Urgent Care app from GreatCall Inc. is designed to give people 24/7 access to health care information anytime, anywhere. Launched in January, the GreatCall app rose to the top of the Google Play and App Store medical categories by mid-May.

Urgent Care is the only app that provides users with round-the-clock access – for a price of $3.99 per call – to a live, registered nurse with LiveCare Clinic who can escalate inquiries to a board-certified doctor for health-related advice, diagnosis and even prescriptions without an appointment. It also provides a medical dictionary and medical symptom checker tool.

Urgent Care empowers patients to make choices about how and where they receive medical consultation. For example, many access the app’s Interactive Symptom Checker feature to pinpoint various symptoms of common ailments they might initially find uncomfortable to discuss in person. The app also helps identify:

  • Possible causes of symptoms
  • When to self-treat
  • When to contact a medical professional

“With the costs of medical care rising, people are looking for other options to get access to quality health care,” said Aaron Amerling, Manager of Mobile Apps at GreatCall. “Urgent Care fills a very real need by giving anyone access to medical resources, as well as the ability to quickly connect to a nurse or doctor for less than the cost of a typical Starbucks beverage.”

Amerling notes that Urgent Care is being used by a wide range of people – from those seeking a Spanish-speaking nurse or doctor to those who have health insurance and are frustrated by sitting on-hold or waiting long periods for returned calls from their health care providers.

When asked whether apps like this undermine the authority of health care providers by placing too much control in the hands of patients, Amerling said, “When people have the ability to look up ailments online, they may find a myriad of potential causes and are unable to self-diagnose safely. That’s why we made the ability to access registered nurses and board-certified physicians for expert opinions an important component of Urgent Care.”

According to Amerling, the app has been so successful that the company is looking to add even more resources for patients, including:

  • Access to health news and videos
  • Drug information forums
  • Expanded medical libraries
  • A Spanish-language version of the app

Have you ever used Urgent Care or another app to obtain medical advice? If yes, how did you feel about the quality of care you received? If not, do you think you would ever use an app like this?

Categories: Access to Care