HFMA ANI: Data Key Healthcare System Efficiency, Says Gawande

In order to a have a significant impact on cost, hospitals have to use data to focus on their most complex patients and get at the root cause of their illnesses, said keynote speaker Atul Gawande, MD, at the Healthcare Financial Management Association's ANI conference.

Hospitals and health systems must use data analytics to identify their sickest patients and reinvent the way healthcare is delivered in the United States, Atul Gawande, MD, said in his keynote address on Monday at the Healthcare Financial Management Association's ANI conference in Las Vegas.

"The healthcare delivery system in America is broken, and we are not seeing the value and quality we would expect for the kind of money we are putting in," said Gawande, a surgeon at Brigham and Women's in Boston, a professor at the Harvard School of Public Health, a staff writer for The New Yorker, and the author of three books on how to improve the nation's healthcare system.

Gawande said that while mortality rates have remained steady since 2000, healthcare costs have continued to climb. "That is where the value equation comes from. People are asking questions about what we are getting for all that money."

In order to a have a significant impact on cost, hospitals have to use data to focus on their most complex patients and get at the root cause of their illnesses, Gawande said.

"The sickest 5% of people in the healthcare system account for 50% of all healthcare spending, while half of the population accounts for less than 3% of all healthcare costs. Yet, it's the sickest people in our system who get the worst care. When we start making the data in our system a resource, we understand the connection between sickness and cost," Gawande said.

He cited as an example a 25-year-old woman who had 29 emergency department visits, 51 office visits, and one hospital admission in a 12-month period. In all cases, the diagnosis was headache or migraine, and the assumption was that she was a drug seeker looking for narcotics.

Closer examination of the data, however, told a different story and helped clinicians get to the real health issue.

"She filled her prescriptions faithfully every time she saw a physician. This is not the behavior of a drug seeker. It's the behavior of someone with severe headaches," Gawande said. "The reality is she was on the wrong medication, but no one saw the pattern of her suffering because they were just looking at one moment of care. The ability to connect the dots is the power that comes from using the data."

"Success requires making data the most important resource to clinicians and patients for improving care," he added.

The current design of the healthcare delivery system is inadequate to serve patients with complex health problems and leads to expensive and ineffective care for this difficult demographic, Gawande said, noting that once a hospital identifies its highest cost patients, new models for delivering care should be tried.

"What we are beginning to see is that healthcare has the completely wrong design," he said. "We have three systems for being able to help people. You can see a doctor in a 20-minute office visit. If the doctor can't help you there, you can escalate your treatment to the ED. If they can't do anything for you there, they will put you in the hospital. If they can't do anything for you there, they will discharge you and put you back on the merry-go-round and have you go back to your primary care doctor."

"For high-cost patients, we need entirely new systems and entirely new investments," Gawande added. "The 5% don't come with just one problem. They come with many problems. They come with suffering that hasn't been resolved. We need to see people not just in doctors' offices or the ER or hospital, but we also need to connect with them through email, through web connections, through health coaches, and through in-home services. Let's begin to reinvent the way we connect with those who suffer the most."

Gawande said hospitals should also use data to help change physician behaviors to improve quality and outcomes and lower overall costs.

"For example, an OR checklist is a very simple, almost crude tool, but we know the major issues that affect quality in the operating room," he said. "With a simple checklist, the surgeon and the team pause before the patient is put to sleep, before the incision is made, and before the patient leaves the OR to make sure they are all on the same page… It is asking surgeons to give up some of their autonomy to say we are going to do things as a team, and we are all going to do things the same way."

However, the data shows powerful results and can encourage physician buy-in. For hospitals that adopted the OR checklist system, the average reduction in complications is 35%, and the average reduction in deaths is 47%, Gawande said, adding, "No drug, no device could work as well."