Adding value to patient care is on the mind of nearly every health care organization across the country. As we shift from a volume-based to a value-based health care world, improving outcomes and reducing costs has become critically important.
UTMB is on the right track. We have proven we deliver Best Care by moving into the top 12 among academic health centers participating in the 2017 Vizient Quality and Accountability Study. Now, Dr. Gulshan Sharma, UTMB’s chief medical and clinical innovation officer, said it’s time to “hardwire” the gains, to build upon that foundation and become a “high-value practicing organization.”
In the coming months, several projects will aim to improve the quality of medical practice and reduce the cost of health care by eliminating unnecessary tests, procedures and treatments; better managing valuable resources such as blood products; and continuing to manage patient medications and the protocols under which providers prescribe.
“Value is not just about cost, it is also about outcomes that matter to the patient,” said Sharma. “We need to continue on this Best Care journey and maintain our gains while asking ourselves, ‘What are the health outcomes achieved per dollar spent?’ We need to make sure we are using resources appropriately to manage our patients, eliminate variation in care, be efficient and safe in the care we provide, and be courteous to our patients.”
Sharma recently introduced five pillars of stewardship to help UTMB become a high-value practicing organization:
(1) antibiotics stewardship, (2) blood management, (3) laboratory testing, (4) imaging utilization and (5) opioid stewardship.
“These five pillars cut across every specialty and are of national importance,” he said. “It doesn’t matter where you practice, you are probably doing three or four of these activities such as ordering labs or imaging, or giving patient medications, or blood products or antibiotics. In all these areas, we need to demonstrate that we deliver great value.”
For example, one area Sharma wants to take a look at is how often CT scans are used for patients presenting to our Health System with abdominal pain and determine what provides the highest value for patients.
“We see a fair amount of radiation-based imaging used for evaluating patients,” said Sharma. “There is large variation among providers in the use of CT scans for patients with abdominal pain. So we are trying to encourage evidence-based approaches to avoid unnecessary expense and radiation exposure for our patients. It all boils down to being good stewards of our resources.”
To encourage evidence-based practices, the Epic team recently added several questions to the electronic medical record for providers to answer before ordering a certain test. UTMB also will continue the Patient Resource Optimization Program, or PROP, which seeks to reduce variation in care to ensure we are getting the best quality supplies at the best cost.
While cost was not considered in the FY17 Vizient study due to changes in methodology, it will be part of the FY18 study and will account for 5 percent of each institution’s overall score. Sharma said its inclusion underscores the importance of appropriate use of resources in health care.
“Our focus now is to take responsibility of what is under our control and work on that, as well as train our future physicians on understanding the concept of value-based care,” he said.