St. Luke’s University Health Network (SLUHN) shared $38 million in savings with the Centers for Medicare and Medicaid Services (CMS) as a reward for controlling costs while providing the highest possible quality medical care to Medicare patients in 2022.
SLUHN's success is attributed to their accountable care organization (ACO), which includes approximately 2,000 healthcare providers and serves 45,000 Medicare patients.
SLUHN leveraged PINC AI™ technology to improve healthcare quality and reduce costs in several ways, including enhancing HCC coding processes, reducing clinical variation, improving quality and streamlining breast cancer diagnosis.
In today's healthcare landscape, the shift from traditional fee-for-service payment models to value-based care (VBC) is gaining momentum. This transition has ushered in a unique healthcare environment where many healthcare organizations are actively implementing systematic changes aimed at improving the quality of care while better controlling costs.
St. Luke’s University Health Network (SLUHN), a nationally recognized nonprofit healthcare network, is a leader in VBC. In fact, SLUHN recently achieved a major milestone by becoming the only health network in their region to significantly reduce costs, resulting in a savings of $38 million for CMS in 2022. “Our top priority at St. Luke’s is to improve the well-being of all patients inclusive of our Medicare beneficiaries while reducing the costs associated with their care,” said Donna Sabol, Senior Vice President and Chief Quality Officer at SLUHN. “We are pleased that our organization has successfully showcased how accountable care models can expedite this journey and turn our objective into a concrete reality.”
An accountable care organization (ACO) is a coalition of healthcare professionals and facilities, including physicians, nurse practitioners, physician assistants and hospitals, voluntarily working together to offer cost-efficient, high-quality care to Medicare and Medicaid patients.
St. Luke’s formed their ACO in 2018, which today includes roughly 2,000 physicians and advanced practitioners, both employed by SLUHN and independent community offices, serving 45,000 Medicare patients who selected primary care physicians participating in the ACO.
SLUHN credits their long-standing partnership with Premier as a factor that helped the health system in their Medicare Shared Savings Program (MSSP) success. “St. Luke’s is dedicated to providing care for those in need, improving the overall health of our communities and educating our healthcare professionals,” said Sabol. “Our collaboration with Premier has empowered us to develop innovative ideas that promote patient-centered care and better educate our providers and communities.”
By harnessing the capabilities of PINC AI™, Premier's technology and services platform, SLUHN achieved remarkable success in several areas. Here are three ways SLUHN utilized PINC AI™ technology to improve care while reducing costs:
Advancing HCC Coding Processes: SLUHN successfully improved their healthcare quality and cost through an initiative focused on Hierarchical Condition Category (HCC) coding and clinical documentation, utilizing the PINC AI™ advanced HCC analytics tool, CQDoc Insights. HCC coding is crucial for estimating future healthcare costs and ensuring appropriate reimbursement for Medicare Advantage (MA) plan patients. SLUHN leveraged artificial intelligence (AI) to enhance coding accuracy by analyzing patient data with CQDoc Insights, identifying potential risk factors and suggesting appropriate codes, thus streamlining the coding workflow. They engaged specialists in the HCC capture process and followed three key strategies: defining specialists' roles in HCC capture, providing HCC education and offering coding support. As a result, SLUHN increased their Risk Adjustment Factor (RAF) scores, becoming a top performer in their region, with significant improvement seen in nephrology specialists due to focused analytics. Their commitment to accuracy and quality, along with AI-enabled tools like CQDoc Insights, ensures their continued success in an ever-evolving healthcare landscape.
Reducing Clinical Variation and Improving Quality: SLUHN recognizes the importance of reducing clinical variation in healthcare delivery to improve quality and outcomes. They implemented PINC AI™ INsights, an analytics solution, to access and analyze their data efficiently. This technology provided benchmarks for comparison and empowered healthcare leaders to make informed decisions across various functions. Collaboration among three distinct data analytics teams, transparent data sharing and physician engagement were crucial for success. By making accurate, actionable data accessible throughout the organization, SLUHN reduced clinical variation and received A ratings from the Leapfrog Group across all hospitals, as well as recognition as a 15 top healthcare system from Merative (formerly known as IBM Watson Health). Premier has since acquired the 100 Top Hospitals® program from Merative to help health systems identify opportunities for performance improvement. SLUHN has been recognized 11 times as a top 100 hospital. The health networks success proves that, with the right strategy and tools, analytics can enhance patient care and lower costs, highlighting the significance of data-driven healthcare improvement.
Streamlining Breast Cancer Diagnosis: SLUHN partnered with GE Healthcare and Premier's PINC AI™ Applied Sciences (PAS) team to implement the groundbreaking One-Stop Clinic™ (OSC) for Breast to expedite breast cancer diagnosis. OSC is a comprehensive approach that streamlines the patient journey from the initial appointment through diagnosis and treatment planning, all in one location with a dedicated team. The OSC approach reduced the diagnosis time from a national average of 26 days to just approximately 48 hours or less. St. Luke's achieved this remarkable success, with 100 percent of patients diagnosed within 48 hours by September 2022. Customizations, including contrast-enhanced mammography and patient-controlled breast compression, further improved the process. The initiative demonstrated the value of early detection and personalized care and continues to evolve with a focus on patient outcomes and research.
St. Luke’s remains at the forefront of healthcare innovation, actively participating in forward-thinking VBC initiatives. Their impressive outcomes underscore the value of the ACO model, illustrating that healthcare providers, when provided with the right incentives, can revolutionize care, improve quality and reduce costs.
Transitioning to VBC and population health models, such as ACOs, can be challenging for any healthcare organization. Nevertheless, SLUHN’s VBC journey demonstrates the multitude of diverse approaches to population health management. Ultimately, healthcare organizations have the power to shape their own future in the VBC landscape, and Premier is here to provide support at every stage of their VBC journey, regardless of where they are in the process.
Learn more about how PINC AI™ solutions can help your healthcare organization achieve MSSP success.
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