Fremont Health Increases Value-Based Purchasing Score Using Premier’s Quality Improvement Tools

In 2014, C-suite leaders at Methodist Fremont Health (Fremont, NE) challenged their clinicians to identify new opportunities that would improve outcomes while reducing costs. This challenge led to an enterprise-wide engagement that has allowed Fremont Health to improve quality and outcomes across the board over the last four years.

To identify opportunities, physician-led clinical effectiveness committees examined various diagnoses and patient groups, using Premier’s QualityAdvisor™technology to drill down into specific data points. Through this process, leaders were able to identify inconsistencies in documentation, allowing them to implement more comprehensive guidelines regarding coding and documentation.

One of the key elements of the engagement was the increase of dialogue and education regarding available data, allowing individual providers the ability to see their own data and compare it to their peers.

“By understanding what that data really means, providers want to improve and do better,” said Sara Vech, Senior Decision Support Analyst at Fremont Health. “We also used resource utilization reports to look at costs and outcomes. By using evidence-based data sets showing what providers always do versus whether or not it is necessary, we were able to get some of those costs down.”In addition to QualityAdvisor, leaders tapped into the data in Premier’s Quality Measures Reporter®, QUEST®and TheraDoc®technologies. While the combined data power of these tools helped clinicians improve various outcomes across the board, one of the biggest improvements was in the area of C. diff.

Prior to implementing any changes, Fremont Health’s high C. diff rates were resulting in regular penalties from CMS. Using TheraDoc data and additional support from QUEST collaborative members, leaders were able to identify several paths to lower C. diff rates.

“Our biggest hurdles were that we weren’t reacting quickly enough or communicating effectively,” said Tammy Hill, Infection Preventionist at Fremont Health. “The QUEST monthly calls gave me several ideas to correct the problem. We improved communications across departments by creating signage, talking to staff and sending a weekly newsletter. We were also able to implement a first protocol for nurses.”

After implementing changes, the health system’s C. diff rates dropped from 3.2 to 0.8.

“TheraDoc was key to help us realize how many cases we had and how to pinpoint the problems,” Hill said.

Since starting the initiative in 2014 to improve outcomes, Fremont Health has seen many departments shift toward better numbers. Rates for length of stay and mortality have dropped from 1.8 to 0.9. Pneumonia complication rates have dropped from 1.2 to 0.5. And at the start of the initiative, Fremont Health’s Value-Based Purchasing (VBP) Score was 19 – one of the lowest in the state. Today, they have exceeded both state and national averages with a score of 52.

Factors that increased Methodist Fremont Health’s Value-Based Purchasing (VBP) Score:

• A Patient Experience Leadership Committee and service award for improved scores
• Improving use of post-hospital care, discharge planning
• Clinical Effectiveness Committees*
• Reviewing all mortalities and creating incentives to improve O/E, palliative care*
• Reducing readmissions*
• Reducing C. diff infection rates*
• Increasing the use of evidence-based order sets
• Antimicrobial Stewardship*
• Implementing new protocols for lab testing, removing Foley’s, etc.*
• Achieving zero early elective deliveries (EED)

*Supported by QualityAdvisor™and/or TheraDoc®