McKesson : The Business of Health Care June 2017

For health care providers, knowing what to do next to improve clinical outcomes and reduce costs is the key to their success in the burgeoning value-based reimbursement world. Eight new developments show them the way in four areas: big data, patient safety, readmissions and telemedicine.

Big Data

32% of surveyed health care executives say useful big data applications are available now

That's according to a survey of 682 health care executives by NEJM Catalyst. 44 percent of survey respondents said useful big data applications are several years away. When asked what the biggest opportunities are to use data in health care, care coordination was No. 1, cited by 81 percent of the respondents. That was followed by improved clinical decision support (79 percent), predictive analytics (68 percent), precision medicine (45 percent) and reduced fraud and abuse (14 percent).

60% of health care organizations to adopt artificial intelligence technologies within five years

That's according to a survey of 85 health care executives by HIMSS Analytics and Healthcare IT News. Just 4.7 percent of the respondents said their organizations are using AI technologies now. But 10.6 percent said they intend to within 12 months, 23.5 percent within two years and another 24.7 percent within three to five years. The five areas the surveyed executives said AI technologies would have the biggest impact on are population health, clinical decision support, patient diagnoses, precision medicine and hospital/physician workflows.

Patient Safety

823 hospitals receive A grade for patient safety from The Leapfrog Group

That represents nearly one-third of the 2,639 hospitals that received patient safety grades in a report by The Leapfrog Group. Some 706 hospitals, or 27 percent, got Bs; 933, or 35 percent, got Cs; 167, or 6 percent, got Ds; and 10, or less than 1 percent, got Fs. The employer-based patient safety organization also said it will be asking hospitals to report additional quality and safety data this year that will be factored into the safety grades in 2018. The new data to be collected include surgical volume for 10 high-risk procedures and percentage of patients who receive medication reconciliation services.

Use of surgical checklist reduces 30-day patient mortality rate by more than 20%

That's according to a study in the journal Annals of Surgery. In the study, researchers studied the impact of a surgical checklist on hospitals' 30-day surgical patient mortality rate. They compared the rate of 14 hospitals in South Carolina that used a surgical checklist to the rate of a peer group of 44 hospitals in the state that didn't use the checklist. The rate at the 14 hospitals dropped to 2.84 percent in 2013 from 3.38 percent in 2010. The rate at the 44 hospitals increased to 3.71 percent in 2013 from 3.5 percent in 2010. The difference equated to a 21.9 percent reduction in postoperative mortality, the study found. 'Our research suggests that the checklist serves as a catalyst for these changes, but that leaders and frontline clinicians, including surgeons, must engage in implementation to produce a meaningful clinical change,' the researchers concluded.

Hospital Readmissions

Higher medication adherence correlated with lower hospital readmission rate

A study in the journal Patient Preference and Adherence found a strong correlation between patients' medication adherence and their odds of being readmitted to the hospital. In the study, researchers studied the readmission rates of 385 patients discharged from a California hospital after being treated for one or more of 10 chronic illnesses. Some 61, or 15.8 percent, of the patients had unplanned 30-day admissions. The researchers used pharmacist consultations with patients to determine how adherent they were to their medications prior to readmission. They found that patients who had low and intermediate medication adherence rates had a readmission rate of 20 percent. Patients who had high adherence had a readmission rate of just 9.3 percent. The researchers concluded that medication adherence 'could identify patients at higher risk of readmission.'

Adding informal caregivers into discharge planning reduces readmission rates for elderly patients

That's according to a report in the Journal of the American Geriatrics Society. In the report, researchers reviewed 11 studies of the impact on health care utilization of using informal caregivers like spouses, partners or adult children in the discharge planning process for older adults released from the hospital. The researchers found that using informal caregivers in discharge planning was associated with a 25 percent decline in the number of 90-day readmissions and a 24 percent decline in the number of 180-day readmissions. 'For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission,' the researchers concluded.

Telemedicine

Availability of telemedicine services increases spending on respiratory infections by $45 per visit

A study in the journal Health Affairs found that giving health plan enrollees access to telemedicine services may increase rather than decrease health care spending. In the study, researchers studied the health insurance claims of about 3,000 employees enrolled in an HMO in California. The employees sought care between April 2012, when the plan began covering telemedicine visits, and November 2013. About one-third of the employees saw their doctor via telemedicine. The average charge for a telemedicine visit ($79) was less than the charge for seeing a doctor ($146) or going to the emergency room ($1,734). Only 12 percent of the telemedicine visits were substitutes for a physician or ER visit. Some 88 percent of the telemedicine visits were new visits, meaning enrollees would not have sought care otherwise and would not have spent anything. The researchers determined that telemedicine increased spending by $45 per visit for respiratory infections because what was saved in price was offset by an increase in new volume.

About one-third of health care providers are using 'virtual care' to connect with patients

That's according to a survey of 147 health care executives conducted by HIMSS Analytics and sponsored by KPMG. Some 31 percent of the executives said their provider organizations use video-based services to communicate with patients, and 34 percent said they use remote patient monitoring to improve clinical capabilities. Some 75 percent said they have a telemedicine or telehealth service, but few described that service as 'advanced,' the survey found. Providers' interest in virtual care is growing as a means to 'improve patient experience, increase access to care and provide continuity of care,' KPMG said.