Alliance Community Hospital towards Clinical Transformation

1. Clinical Transformation Initiative by Alliance Community Hospital

2. About Alliance Community Hospital Alliance Community Hospital, an independent 104-bed hospital with an attached 78-bed skilled nursing facility. One of the largest employers in the community. Does not have any risk-based contracts.

3. For Alliance Community Hospital, a stand-alone hospital in Alliance, Ohio, with no risk-based contracts (other than the self-insurance arrangement for its own employees), clinical transformation means creating a care coordinator network for patients experiencing significant social and economic barriers that affect their care, helping local employers increase primary care access to reduce emergency department (ED) use, and analyzing claims data for its own workforce to identify opportunities for improved care.

4. Key Features Alliance Community Hospital started innovative initiatives to improve care delivery. They are: • Health coaches • Expanded access • Data into information

5. Health coaches Alliance Community Hospital started a health-coaching program last year using local university students. Target was to • Keep people out of Emergency Department. • Reduce Hospital readmission.

6. Each university student was assigned to patient who is suffering from a chronic condition and having other challenges like low income, lack of food and other problem. The goal is to understand the barriers of keeping them good in health and help them to overcome the challenges.

7. Expanded Access • A large number of employer in Alliance community found that their employees had high rates of ED visits. • 80% of the employees don’t have primary care physicians. • Alliance community Hospital opened a onsite primary clinic for employees to increase access the primary care.

8. Data into information Alliance community Hospital recently tied knot with VitreosHealth, a predictive & prescriptive risk analytics company, to analyze insurance claims of its employees and their dependents. The analysis found that about 20% of its employees & their dependents are high risk/ high cost, causing $1,179 a month in healthcare costs. 35% of its workers are high-risk/low-cost, accounting for $58 per month in expenses.

9. VitreosHealth also found that nearly 40% employees are falling into “Hidden Opportunity” category. Although their cost for healthcare was low last year but there are gaps in care. For example, a patient diagnosed with diabetes but no claims for corresponding medication.

10. VitreosHealth’s analysis on 3 year’s claims data showed that how many employees and their dependents moved from ‘high-risk/low-utilizers’ to ‘high-risk/high-utilizers’ during that time period and why they are called “Hidden opportunity”. The hospital administrators planned to share patient centric data with the physicians, so that they can work with the patients proactively to manage their chronic illness effectively.

11. VitreosHealth’s analysis on claims data also showed that Alliance Community Hospital could save more than $850,000 or 12% of their total healthcare spending, if • The patient with chronic conditions received more timely care management. • Physicians had cost data about the drugs they prescribe. • Employees had cost information so that they could shop wisely for prescription medicines.

12. Course of action The Alliance Community Hospital includes four physicians in their executive team who worked with hospital administrators for years. According to Alliance Community Hospital • New analytics system or access to big data and all the comparative information isn’t as important as trusting relationship. • Being able to decide how you are going to use the information and figuring out new processes is just as important as having the data.

14. Source: • Alliance Community Hospital • HFMA Article http://www.hfma.org/Content.aspx?id=25738