Top-performing health systems focus on improving across care continuum

When Kaye Lynn Hall, a data analyst from Candler, N.C., was sent home last month following gastric sleeve surgery at nearby Mission Hospital in Asheville, she was relieved to learn she did not need to memorize a list of detailed discharge instructions.

Hall, 40, was among a few patients participating in a new Good to Go initiative that the six-hospital Mission Health system began testing in February 2014. Video and audio recordings of discharge instructions for certain high-risk patients are e-mailed to patients, so they can refer back to the instructions at a less anxious time.

Hall, who was on pain relievers at time of discharge and was not feeling her best, said knowing that she could rehear the instructions gave her peace of mind. That's very different from previous stays and discharges from other hospitals, she said. “They're like, 'Here it is,' and you nod and say 'OK' because you just want to go home. But you miss all the details.”

The Good to Go program is one of many ways that Mission Health CEO Dr. Ronald Paulus says his system is trying to reduce unnecessary readmissions and improve quality of care. On the basis of its quality-improvement work across all its care settings, Mission Health is one of Truven Health's 15 Top Health Systems for 2015.

Efforts to effectively manage patients after they've been discharged is a key feature distinguishing high-performing health systems from their peers, said Jean Chenoweth, senior vice president of performance improvement for Truven Health Analytics. Truven released its seventh annual list of top performers exclusively to Modern Healthcare.

Truven's top-performing systems include the top five from three categories based on operating expenses: large systems generating expenses of more than $1.5 billion; medium systems generating between $750 million and $1.5 billion; and small systems posting expenses of less than $750 million.

The 15 were narrowed from a total of 340 health systems across the U.S., each evaluated based on publicly available government data looking at nine performance measures, including death rates, complications, 30-day readmissions and lengths of stay. The data were adjusted for the illness severity of patient populations. A new measure on Medicare spending per beneficiary was added to the evaluation this year.

Spending per Medicare beneficiary was on average 5.2% lower per episode at hospitals that were among the top-performing health systems compared with their peers, according to Truven. “That new metric is a way of looking at which hospitals are moving to the continuum of care faster,” Chenoweth said. “If you are making strides across the continuum, and managing what happens to patients post discharge, you tend to have lower costs.”

Among Truven's other findings were that the average inpatient length of stay for top-performing systems was 11% shorter compared with their peers, and complication rates were nearly 3.8% lower.

In addition, ratings on the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which measures patients' hospital experiences, were nearly 3% higher for top performers. Last week, the CMS unveiled a new hospital star-rating system based on an average of the star ratings for 11 publicly reported measures. (See related story, p. 8)

Minneapolis-based Allina Health was on the Truven list for the first time this year in the large-system category. Allina CEO Dr. Penny Wheeler said her system's focus on integrated data, which allows it to collect data points from more than 30 sources using its electronic health record, prepares her system for the new CMS star rating. It allows her organization to reach beyond just clinical aspects of care and evaluate patient outcomes, patient experience and cost.

“We're in the relationship business,” Wheeler said. “A lot of that is putting in the right supports to improve quality, and giving patients the information they need to improve healthcare.”

Other winners in the large-system category include OhioHealth, which has been on the list six times, the most of all the 15 Top systems; the Mayo Foundation of Rochester, Minn., and Spectrum Health of Grand Rapids, Mich., for the fourth time each; and St. Vincent Health of Indianapolis for the second time. Mission Health's Paulus noted an increased emphasis in his system on programs reaching beyond just inpatient care. Besides the Good to Go pilot that helps high-risk patients with discharge information, his system created an Office of Patient Experience, which provides follow-up calls to patients no matter what their experience. “Whether they experienced mistakes or had good experiences, we want to make sure we can identify those and translate them across the entire system,” he said.

Mission Health is ranked in the medium-sized system category and made the Truven list for the fourth consecutive year. Other top performers in the midsized category include Alegent Creighton Health of Omaha, Neb., and Mercy Health Southwest Ohio in Cincinnati, for the third consecutive year each; and St. Luke's Health System of Boise, Idaho, and Exempla Healthcare of Denver, both for the second time on the list.

It's more challenging for smaller systems to dedicate resources to programs that reduce spending across all their facilities, Chenoweth said.

For example, among large health systems, spending per Medicare beneficiary was 7.5% less for the top performers compared with their peers. That percentage difference dropped to 5.1% among medium-sized top-performing systems, and to 4% among top-performing small systems, when compared with peers in the same expense category.

Each of the small systems made the list for the third time this year. They include Asante of Medford, Ore.; Maury Regional Healthcare System in Columbia, Tenn.; Roper St. Francis Healthcare in Charleston, S.C.; St. Joseph Regional Health System in Mishawaka, Ind., and Tanner Health System in Carrollton, Ga.

“We've had to do it through creative partnerships,” Asante CEO Scott Kelly said. For example, the system is launching a population-health-management company called the Health Alliance of Southern Oregon. The physician-led initiative partners with insurers to put case managers in the emergency department to manage frequent users. And it works with employers to improve chronic-disease management in the community.

“We are out in front working with the patients and the community on what they need to stay healthy,” Kelly said.