El Paso, Texas
Like many providers in Texas—one of 19 states that didn’t expand Medicaid under the Affordable Care Act—UMC was faced with this difficult question: How could the organization continue to treat self-pay patients, including those with high-deductible health plans, without jeopardizing its own long-term financial viability?
When Texas announced it would participate in the DSRIP program, UMC knew it had to apply, says David Smead, director of care management. Acceptance into the program would be an invaluable opportunity to reach UMC’s most vulnerable populations, reduce readmissions, and improve clinical outcomes—all while potentially qualifying for federal incentive funds that the organization could reinvest into clinical care, he adds.
Once accepted into the DSRIP program, UMC turned its attention toward data submission requirements, including the mandate to submit semi-annual reports to the state detailing progress in meeting specified metrics or milestones. For the first five years of the program, UMC analyzed and compiled readmissions data using a basic analytics tool. However, this process was time-consuming, prone to errors, and it required additional staff, says Oscar Perez, BS, MA, DSRIP program manager. When it came time to renew UMC’s existing coding software contract with 3M, the organization decided to add 3M performance analytics as well.
3M analytic solutions and risk stratification methodologies help UMC dive more deeply into its data to drive process improvement and qualify for DSRIP incentive payments. For example, the 3M readmissions analytics allows UMC to analyze recent readmission trends and easily identify the top five attending physicians with the highest percentage of all-cause 30-day readmissions.
3M performance analytics allow UMC to slice and dice the data more so than it ever could previously. Smead noticed an uptick in UMC’s 30-day readmissions, he was able to drill down into the cause. Within minutes, he identified the problem—patients with end-stage-renal disease who weren’t eligible for extended Medicare coverage. Many of these patients were waiting until they were in renal failure to present for dialysis at which point they were admitted to UMC for treatment. Through data analysis, Smead could determine that without ongoing dialysis treatments, many of these patients would likely be readmitted within a few weeks.
With its previous software, this type of analysis would have taken days or even longer. “With the 3M software, I literally push a few buttons, and the readmissions data is available to me within minutes,” says Smead.
In the final year of Phase 1 of UMC’s DSRIP project, the organization evaluated high risk discharge management and observed a nine percent reduction in its readmission rate. With the start of DSRIP Phase 2, they will be establishing new baselines using 3M PPRs, and this will be the methodology used for performance management and reporting going forward.
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