Common opportunities for improving care abound such as improving financial performance, care coordination, eliminating unnecessary waste, managing clinical resources wisely, and reducing the cost of care. In light of the increased difficulty healthcare faces to achieve the degree of transformation that is necessary the time is ripe for a new call to action. The need to create a fully integrated multidisciplinary approach which identifies, implements, and monitors overall performance and creates a new paradigm for demonstrating value is evident. Implementing the high performance business model of “Clinical Effectiveness” has the potential to align goals and priorities. Clinical Effectiveness is an innovative model that combines the use of evidence to improve clinical performance with the concept of value as measured by quality, cost, and service.
Application of Value
Whether driven by the value-based purchasing movement or the earnest desire to see quality of care and service improve, there is a focus on the use of evidence-based medicine, technology, and transparency of information related to cost and quality. The application of value (value defined as a function of quality and cost) is now a key element in pay for performance which rewards good clinical performance and penalizes medical errors or suboptimal performance.
Linking quality outcomes and appropriate resource utilization is an effective mechanism for bringing clinical and operational areas together with finance to drive the requisite change to meet the upcoming challenges in demonstrating value. Clinical Effectiveness fits hand-in-glove with a value-based approach to clinical quality and moves an approach from process measures such as core measures to outcomes such as patient satisfaction, prevention of harm, survival rates, and profitability.
The principles of a value-based healthcare delivery system begin with a value equation that Value = health outcomes/costs of patient care. The focus is to improve the value of care across distinct patient populations within service lines or episodes of care, to measure outcomes and costs of care, to integrate care across the continuum, to eliminate harm and create a safe and effective delivery system, and to ensure that innovation will be designed into care processes whenever possible.
Clinical Effectiveness Model
The below design of the model will bring key stakeholders together under one roof and is supported by these four guiding principles:
- Patient Safety
The implementation of a clinical effectiveness model and the numerous improvement projects at Stanford Health Care has achieved significant results within each of the four areas of the guiding principles. To ensure that success is measured accurately and results are agreed upon a partnership was formed between clinical effectiveness and the finance department’s decision support to validate cost savings.
A target was set for the first year of the program to achieve $9 Million in cost savings and in that first year the program hit 110% of target for a total of $10 Million. Over the next 4 years a grand total of $100 Million in cost reductions and cost avoidance was achieved. Over that same period of time Stanford clinical outcomes went from the lower third to the top third as compared with similar academic medical centers, adding proof that improving outcomes lowers cost. Our patient satisfaction scores went from average performance to the top tier. And last but not least, our incidents with harm decreased by 50%.
As healthcare leaders, we must find ways to respond to the growing external pressures to focus on the cost-quality intersection. Certainly the CMS stop payment for hospital acquired conditions, the numerous “pay-for-value” programs, and the transparency initiatives will cause us to rethink strategies to improve care and drive down costs simultaneously. Using a new care design and a business management strategy of Clinical Effectiveness will allow us to achieve better results. The goal of this new approach will optimize the use of evidence to identify effective health services. Taking a more longitudinal approach will prepare us for the future and help us to thrive in the long run.
Kim Pardini-Kiely currently serves as Vice President for Safety & Risk Strategic Ventures for The Risk Authority, Stanford Health Care and Stanford Children’s Health. She is a healthcare executive experienced in leading hospital operations and in driving clinical improvements in outcomes. Kim has presented nationally and internationally on a wide variety of healthcare topics and her passion for excellent and down to earth style has earned her high marks. She is a nationally recognized expert in improving clinical outcomes, implementing clinical analytic departments, transforming hospital culture and creating models that focus on value.