From the 2019 HVPAA National Conference
Dr. Michael McKenna (McLaren Health Care), Ms. Chandan Gupte (McLaren Health Care), Ms. Danette Hayman (McLaren Health Care), Dr. Tim Hannon (Healthcare Forward)
Background
It has been estimated that up to 30% of US healthcare spending is wasted on tests and treatments that do not benefit patients, otherwise known as low value care. McLaren Health Care is a Michigan-based health system with 12 hospitals and a commitment to quality and value. Based upon the success of a comprehensive blood management program that reduced system-wide blood utilization by over 30%, a decision was made to use the infrastructure and tactics on an expanded range of clinical projects through the creation of a High Value Care (HVC) program.
Objective
The goal of the McLaren HVC program was to create a system-wide, scalable platform to sustainably reduce low value services and promote high value care.
Methods
Program infrastructure included a System HVC Steering Committee as well as multidisciplinary hospital HVC teams. A process map was established to guide clinical practice changes, and infrastructure was then developed to support the process map. This included task forces to assess needs, develop clinical projects, and support implementation plans. A data team was established to develop and track metrics, and an informatics group was created to hard wire changes in the information systems. Another key component was an Education Committee that created a program newsletter and a mobile friendly website for disseminating communication and education across the system, including online CME and shareable infographics for clinical practice changes.
Results
The initial clinical focus area that was added to blood management was lab utilization. The first clinical practice change focused on reducing unnecessary and repetitive inpatient lab testing. Substantial reductions in the utilization rates of individual analytes at the hospital level were achieved within 10 months, including:
· 63% reduction in unnecessary potassium tests
· 44% reduction in unnecessary TSH tests
· 40% reduction in unnecessary magnesium tests
· 40% reduction in unnecessary lipid panels
· 39% reduction in unnecessary phosphorus tests
· 29% reduction in unnecessary CBC w/ diff tests.
The system-wide impact of these efforts has been a 3.1% reduction in lab tests per patient day which peaked at the time of the program start, and a 1.8 % reduction compared to the prior fiscal year system average. The 1.8% reduction amounts to 65,000 fewer unnecessary tests per year and a conservative cost savings of $170,00 based upon a variable cost of $2.60/ test.
Conclusions
An innovative approach to high value care using a system-wide governance infrastructure, education and communication strategies, multidisciplinary teams along with robust implementation and monitoring strategies can reduce unnecessary use of resources, including blood and lab tests. The HVC program is now expanding to include antimicrobial stewardship, imaging utilization and outpatient resource stewardship.
Clinical Implications
High Value Care programs can be used as an efficient platform to reduce low value care, improve costs and to standardize clinical practices across large community health systems.
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