Optimizing both the quality and cost of care is top of mind for healthcare providers these days. Toward that mission, Physicians of Southwest Washington, an independent physician association based in Olympia, focused on social determinants of health to reduce emergency department utilization.
To keep delivering quality care with seamless patient experiences, the organization looked at ED utilization as an opportunity to enhance financial outcomes -- and of course, to serve patients better.
By leveraging insights from the aggregated ADT feeds, PSW could identify gaps and access issues across their network, and track the ED utilization times across the network along with simplifying the creation of care management referrals.
"We started an ACO in 2017, and we actually started working on ED utilization at that point in time," said Tamra Ruymann, chief of digital health at PSW. "We focused on doing 100% outreach to anyone who had visited the ER. We got to 70% or 80% in the first year, and saw a significant drop in ER utilization that year."
This was possible due in part to population health technology created by Innovacer, which allowed for automation to be introduced into the process, particularly in the area of transitions of care for post-acute care.
Patients discharged from the ED were reached out to within 48 business hours of discharge to assist with transitions of care, while there was an opportunity -- in the right circumstances -- to provide details on an appropriate level of care, as well as alternate facilities such as urgent care and walk-in clinics.
With data-driven care management, along with prompt patient outreach, PSW was able to decrease their ED utilization by 8% from 2017 to 2018.
"We eliminated errors because it's an automated process, picking up the data elements and putting them in the system," Ruymann said.
Ruymann equated the new automated system to TurboTax in terms of its ease of use. What's more implementation was a cinch: It took roughly a day for staff to get accustomed to the new system, and was especially lauded by care management nurses, who have reported it has made their jobs easier.
Having analytics at the ready has been a boon to the organization, especially since actionable data can be hard to come by in the typical electronic health records system.
"EHRs are not population health tools," said Ruymann. "When someone sets up an ACO, they're treating the patient as a whole, so you need to understand what's happening outside the current system. It allows you more insight into the care patients are receiving at other places."
All of these efforts have been made more important by the emergence of value-based care, a framework that is slowly replacing the decades-old fee-for-service reimbursement framework. Rather than being reimbursed based on patient volume, providers are rewarded financially for the quality of care they deliver, increasing the importance of population health initiatives and ED utilization reduction efforts.
"It's been very helpful being able to look at those analytics, and being able to use those for making decisions in the future," said Ruymann. "It's all right there in front of you."
Ruymann will offer more detail at HIMSS20 in her presentation, "Optimization of ED Utilization to Advance Value-Based Care." It's scheduled for Wednesday, March 11, from 4-5 p.m. in room W204A, in Orlando, Florida.