Medium-size systems: Care management at the core

At Alegent Creighton Health in Omaha, Neb., high-quality outcomes and the patient experience are among the highest priorities.

“But we don't do it to get awards,” says Richard Hachten, Alegent's president and CEO.

That emphasis helped elevate Alegent Creighton into the ranks of stand-out performers among mid-sized hospital systems in Truven Health Analytics' 15 Top Health Systems for 2013. The 11-hospital system is part of Catholic Health Initiatives, Englewood, Colo.

For the fifth year, Truven, formerly the healthcare unit of Thomson Reuters, released its list of the 15 top systems exclusively to Modern Healthcare. Using quantitative data from the CMS' Hospital Compare and the Medicare Provider Analysis and Review, Truven reviewed eight measures to determine which systems delivered the best clinical performance, highest efficiencies and greatest patient-satisfaction levels in the past year.

Alegent is a first-time winner among the top five in the mid-size category, which included 95 systems with operating expenses between $750 million and $1.5 billion. Other first-timers in the category are Exempla Healthcare, Denver, and TriHealth, Cincinnati. Mission Health, Asheville, N.C., made the list for the second consecutive year, and Prime Healthcare Services, Ontario, Calif., has made the list three times.

Each of the five benchmark health systems performed better on all of the metrics compared with their peer group. Compared with their peers, the leaders posted an 11.6% advantage on the patient-safety index; a 6.4% shorter average length of stay; 3.4% lower overall mortality rates and a 1.9% advantage on patient satisfaction.

One of Alegent's initiatives that improved performance on a number of measures, particularly readmissions and patient satisfaction, is its care management program. Caregivers use a formula to determine which patients are at the greatest risk of being readmitted if they aren't properly managed after discharge from the hospital. At-risk patients are assigned care managers, who contact them in the hospital and after they return home to ensure they understand discharge instructions, attend follow-up appointments and take their prescriptions correctly.

At Mission Health, Dr. Ronald Paulus, president and CEO, credits the system's core infrastructure for these achievements. “My view is that a lot of these results don't happen randomly,” Paulus says. “When I first arrived here, one of the first things we did was try to encapsulate into a simple statement what it is that we're trying to achieve.”

He calls that the bigger aim—to reach a desired outcome for each patient, without harm, without waste and with an exceptional experience for both the patient and family.

One of the ways Mission Health is approaching that is through its patient-safety event program. Safety events, or less-than-ideal occurrences that could potentially inflict harm, are identified, categorized and given a root cause analysis. “Because it's centralized, we can now see if there's a pattern,” Paulus says.

But it doesn't stop there. During the past two years, the system has emphasized linking all of its hospitals and other facilities so they can share information on patient-safety events, no matter where they occur.

“Everybody used to have their own individual goals. Now we have systemwide goals that are common and shared, and everyone's financial incentives are tied to overall system performance,” Paulus says.

That kind of collaboration and transparency also is visible at Alegent, where everyone has the same safe practices, goals and measures, says Angela Ward, Alegent's quality and ancillary services executive.

“We can't have a different standard of care,” Hachten says, referring to Alegent's flagship facilities versus regional locations. “Our name is on those hospitals, and everyone has a very good reason to expect that same kind of care.”

That care includes its eICU, in which a team of critical-care nurses and a board-certified critical-care specialist constantly monitor intensive-care patients from a remote location using special cameras and computer systems that show real-time health information. Launched in 2007, the program was initially just for the Omaha metro area, but has since expanded to critical-access hospitals in rural communities with fewer resources.

While increased monitoring has resulted in the types of outcomes that helped put Alegent on Truven's list, it's not what Hachten acknowledges as the source of Alegent's success. “Programs are very essential, but the one single thing is culture,” he says. “When you have an organization that values quality and safety, when you constantly reinforce the importance of that and put it into practice, it becomes the fabric of the organization.”

Follow Rachel Landen on Twitter: @MHrlanden