U.S. states are not exactly known for healthcare or technology innovation, let alone a combination of the two. But a few are trailblazing, even tapping into cutting-edge trends like big data analytics for better managing patient populations, and seeing impressive early results of the work.
Government Health IT Editor Tom Sullivan spoke with 3M Health Information Systems President JaeLynn Williams about how Colorado, Maryland and Minnesota are reducing avoidable care and readmissions and saving real money in the process.
Q: You’ve mentioned in the past state health departments embracing analytics to reduce avoidable care and readmissions. What are some of the success stories you’ve seen lately?
A: There are quite a few. The real innovation around quality and cost is happening in the states. That’s where we’ve seen results. The general approach that they’re taking is looking at how to identify preventable events, outcomes that lead to these unnecessary services or care and they’re focusing on those avoidable things. And it’s important to focus on those because not everything is avoidable. Some readmissions cannot be avoided, but they’re focusing on those that can. They’re linking them to meaningful financial incentives so the incentives have to be substantial enough to actually reward action so people can see the benefit from a certain activity.
An example is Maryland, which has some readmission reduction programs they initiated to look across the state and use risk-adjustment methodologies and it was a fair program, it had consistent incentives. The result: complication rates in Maryland declined over 15 percent in two years. To give a sense of what that means: Maryland estimated cost-savings of $121 million during those two years. So that’s one state’s effort. Imagine if you could extrapolate that same benefit across all 50 states and the impact that would have on reducing unnecessary or avoidable costs across the country.
Q: What other states are on the cutting-edge here?
A: Another state is Minnesota. They have the RARE [Reducing Avoidable Readmission Events] program and they estimated that their in-patient medical costs were reduced by $70 million. That’s some really great innovation from a collaborative in Minnesota looking at how to reduce readmissions. And again if we could take the success of that program and replicate it across the country that would yield significant dollars and better patient care if only because we’d all rather be at home than in a hospital.
Q: It’s always kind of tempting to think that state governments are behind the private sector, way behind. Is that really true when it comes to these initiatives?
A: We are very encouraged by the results states are achieving with innovative tools and methodologies. It’s the incentives, if you think about a state Medicaid program, it doesn’t have the option of going over budget. So there’s that incentive driving innovation in a meaningful way at the state level in terms of healthcare. We’re also seeing some private payers adopt similar use of these methodologies in their work. It’s not as easy to calculate as a state but we do see Blue Cross Blue Shield and others who have started to use similar technologies around complications, readmissions, and admissions to determine the appropriate settings of care.
Q: And what about other types of innovation?
A: One of the things that’s a little different is what’s happening in Colorado — the Colorado Center for Improving Value in Health Care — they've created an all-payer claims database for the state. The state of Utah has created a similar one and Healthy Rhode Island set up one as well. All-payer claims databases provide all the stakeholders in that state that are researchers, consumers, clinicians, providers, payers with cost and outcome data to understand how to improve the quality of care. It’s all visible so the transparency is driving improvements in quality. Some very good conversations are starting as a result of it. In addition Colorado has an accountable care collaborative with about 350,000 people enrolled, and reaches 40 percent of their entire Medicaid population. It’s focused on population health, improving the patient experience, and controlling costs. So far they’ve seen a 9 percent reduction in readmissions, high-cost imaging is down by just over 3 percent, and the state has saved over $44 million in two years.
Q: So why aren’t other states following suit?
A: It’s not well known that there are these great successes that can be modeled. We hope the great work states like Colorado, Maryland and Minnesota are doing will be recognized to elevate awareness so we can basically copy that and extend it out across the country. That’s a big part of it.
We need to basically look at how to make the methodologies for measuring and risk-adjusting quality comprehensive, understandable, fair, clinically credible, and that requires transparency. What’s great about what these states have done is that they are transparent, you can understand the methodologies, see what’s happening and people can really feel comfortable that there’s no mystery black box there.
Q: So, we’ve talked about 3 states. Are there others?
A: Even outside of those areas, states are going to carry the momentum because Texas and New York are two very politically diverse states — and I think this kind of puts to bed the idea that this is a political — both have started looking at potentially preventable readmissions, and events around complications, ER visits. Both have adopted similar methodologies and implementing them with their Medicaid programs. So they are two very different-minded states in terms of how to govern but aligned in the success of these programs that they both see in other states.
The states are going to be the ones that create the momentum. They are the innovators and the proof that it’s working is in the results the states are presenting and showing.
Q: As a final question, in addition to preventable events and readmissions are there other areas that states are innovating?
A: We’re seeing it expand. It started with preventable events and the transparency of all-payer claims databases is a new innovation states are moving forward. I see that taking off quite a bit as we look at how to aggregate the data and that will drive innovation across healthcare as well — making more data available that will be far-reaching.
