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Talking analytics and readmissions with PinnacleHealth System

May 28, 2014

Healthcare organizations are now feeling a great deal of pressure due to rising costs and health reform-driven reimbursement cuts. On May 21, IBM hosted a webcast,“Analytics to Improve Outcomes at the Point of Care – A PinnacleHealth Case Study,” during which PinnacleHealth described how they used analytics to address these pressures and improve their quality outcomes.

The webcast started with a high-level overview on the drivers of the movement to value-based care and population health management and the application of big data and analytics. Following this introduction PinnacleHealth System (3 hospital system based in Harrisburg, PA) Chief Clinical Officer, Dr. George Beauregard and Matt Sabo, the practice leader for Waypoint Consulting, discussed their vision and process for implementing predictive analytics (SPSS/Cognos) to reduce the readmission rates for their Chronic Obstructive Pulmonary Disease (COPD) population.

healthcare_17.jpgBeauregard and Sabo estimated a $200k annual savings by reducing readmissions by 30 percent. Dr. Beauregard emphasized their goal of integrating analytics into the clinical workflow to ensure that they provided the proper intervention at the point of care.

Readmissions are a key metric in healthcare. The readmission rate is defined as a patient's being hospitalized within 30 days of an initial hospital stay. Frequent readmissions are a strong indicator of a fragmented healthcare system that discharges patients without the proper follow-up care. Medicare alone reports spending $17.8 billion a year on patients whose return trips to the hospital could have been avoided.

As a result, Medicare began instituting penalties for readmissions for three chronic conditions (heart attack, heart failure and pneumonia) in 2013 and 2,213 hospitals were hit with about $280 million in fines. In 2015, CMS will expand the list of conditions to include elective total hip arthroplasty, total knee arthroplasty and acute exacerbation of COPD. Providers can lose significant revenue if they do not limit their exposure in readmissions as the penalties are scheduled to increase.

IBM is working with healthcare organizations around the world, delivering comprehensive big data and analytics solutions that enable providers to mine and interpret structured and unstructured data, opening up possibilities and creating a greater impact on the well being of their patients.

I encourage you to watch the webcast replay for strategic process best practices and more useful information.