Joe GuerrieroArmed with evidence-based clinical decision support tools and analytics at the point of care, health care providers can play a pivotal role in improving the health of patient populations and achieving positive financial outcomes in the delivery of health care.

Using evidence-based treatment guidelines in conjunction with population-data-based predictive modeling and physiological duration data, healthcare providers can work with patients to set realistic recovery expectations and develop treatment plans that safely return patients back to activity, resulting in lower costs and potentially larger value-based payments.

This type of provider engagement is needed to root out waste in the nation’s healthcare system. Each year, $750 billion in care is wasted due to costly variations in treatment, according to an article in the Oct. 13, 2015, issue of Harvard Business Review. Regardless of what the new presidential administration has in store, any successful government initiative to make health care more widely accessible and affordable will depend on the ability of providers to deliver high-quality care while also managing costs. The recently finalized Medicare Access and CHIP Reauthorization Act of 2015 and the Hospital Readmissions Reduction programs, for example, demonstrate that clinical quality, such as ensuring more rapid sustained patient recoveries that help prevent hospitalizations, will have a significant impact on the bottom line.

Intuitive Clinical Decision Support at the Point of Care

Evidence-based treatment guidelines provide information on prevention, diagnosis, prognosis, treatment and follow-up care. Using treatment guidelines and insight from other analytical tools, healthcare providers can tailor appropriate treatment plans for each patient, set expectations regarding recovery times and empower the patients to play an active role in their return to health, all essential for value-based success.

Treatment guidelines can eliminate costly variations in care and help to avoid unnecessary treatments, tests, and rehabilitation that can prolong an illness or injury and increase costs. Physiological duration guidelines, which are informed by data and clinical expertise, provide expected recovery timeframes for specific illnesses and injuries. Duration guidelines are intended to represent uncomplicated cases and are tiered according to the activity level of the injured or ill patient. Used at the point of care, these timeframes can help providers set expectations for timely and medically appropriate return to activity. For example, if a patient with light job duties or activity level is diagnosed with carpal tunnel syndrome and is treated medically, the recovery durations will be different than they would with a patient with the same condition that is treated surgically (with return to activity expected at 7 days vs. 14). Setting expectations with the patient for return to activity can help eliminate unnecessary disability. These guidelines can help further improve outcomes and facilitate patient engagement and are important components of a comprehensive demand-side strategy in health care that aims to provide patients as consumers with incentives and information to be better purchasers of health care—a goal advocated by the authors of the Harvard Business Review article.

Using evidence-based guidelines, predictive modeling, and physiological duration data to improve health outcomes and reduce costs also is important for health systems that partner with health plans and employers. Health systems equipped with these clinically validated tools can effectively differentiate themselves from their competitors in the market and will be seen as partners truly delivering on the promise to reduce costs and improve care quality.

Case Study: Kaiser Permanente       

Kaiser Permanente recently demonstrated the clinical and financial efficacy of using evidence-based guidelines and physiological duration data at the point of care in the treatment of its patient population in Northern California. In 2012, Kaiser Permanente integrated these tools into its electronic health record, and in February 2016, the health system presented initial results of its program at the Integrated Benefits Institute’s annual forum in San Francisco.

The findings: Kaiser Permanente’s Northern California region was able to safely return its patients to activity more quickly than the population benchmark average, saving up to $30 million per year over the period of 2012-13. A follow-up report developed in late 2016 found that illness and injury cases in Kaiser Permanente’s Northern California region were, on average, 14 days shorter than the population benchmark, with the result that the health system was able to achieve $267 million in savings from 2012 through 2015, including cost savings associated with wages, benefits, and lost productivity. By returning patients to health and productivity safely and quickly, Kaiser Permanente has demonstrated the inherent value of evidence-based guidelines and physiological duration data at the point of care as a means for improving clinical and financial outcomes.

Too Powerful to Ignore

As hospitals and health systems are able to see the documented benefits of evidence-based guidelines and physiological duration data and begin to adopt these tools, the experience of Kaiser Permanente will become much more the norm among these organizations. Moreover, such results will provide a compelling case for providers’ adoption of these tools, thereby helping the nation’s healthcare system take a significant step forward in the advancement of value-based goals. With these points in mind, it is incumbent on finance leaders of hospitals and health systems to become well informed about these tools and to work in partnership with clinical leaders to ensure that they are used effectively to help reduce unnecessary cost in healthcare delivery while achieving the highest-quality outcomes.


Joe Guerriero is senior vice president of MDGuidelines, Westminster, Co. 

Publication Date: Tuesday, January 10, 2017