When Brigham and Women's Hospital ventured into risk contracts a couple of years ago, analysts dove into big data hoping it would guide them to the best ways to reduce excessive spending while improving healthcare outcomes.
The data revealed a lot, but it did not provide a clear path to better population health. So clinical leaders at the hospital decided to step out of the data pool and into the tank.
Inspired by the venture capital approach and pitch competitions as depicted on the TV show “Shark Tank,” the hospital and Brigham and Women's Physicians Organization launched BCRISP, the Brigham and Women's Care Redesign Incubator and Startup Program, in 2013.
The approach has yielded encouraging results. Its leaders say the 24 pilot projects funded have saved about $4.5 million in annual medical expenses and have provided measurable quality improvements. Last year, the program was selected as one of six winners—out of more than 60 submissions—in the Massachusetts Hospital Association's inaugural Accountable Care Compass Awards.
One initiative, devised by a team from thoracic surgery and medical oncology, developed a process to speed up and improve the diagnostic timeline for patients with potentially cancerous lung lesions. The focus was on “vulnerable” patients—racial and ethnic minorities, disabled individuals and others—who were more likely than other patients to lose contact with the hospital either before they received a diagnosis or follow-up care.
The initiative relied on the use of a “clinical strategist” to improve logistical coordination, ensure only necessary diagnostic interventions were administered and function as a resource and advocate for patients. During the nine-month pilot, the approach reduced the average diagnostic wait period from 175 days to 15. Treatment wait times dipped from an average of 194 days to 31 while the number of average physician appointments was cut to two from six. Organizers also estimate that using this model saved about $19,000 per patient.
Other pilots have yielded similarly promising results. An initiative aimed at curbing elective cesarean section births saw the rate of vaginal birth after C-section increase from 14% to 27%. In another project, clinicians worked with costly emergency department “super users” to address the medical and nonmedical issues that kept them coming back. Yet another successfully cut hospital readmissions by one-third for complex patients who had been discharged to a long-term acute-care rehabilitation facility.