Aligned Intervention: How MultiCare Saved Millions By Targeting Clinical Waste

MultiCare's CMO breaks down how the system achieved cost savings through clinical and financial alignment.

From overtreatment like repetitive lab tests and duplicate imaging studies, to unnecessary medicine usage and care coordination failures, clinical waste can quickly devour a health system's budget.

Research shows that clinical waste is a big driver of excess health spending, accounting for anywhere between 5.4–15.7% of national health spending.

MultiCare Health System, a 2,413-bed network in Tacoma, WA, has taken an incremental approach to tackling clinical waste, and has seen significant results.

By using a report by IllumiCare to analyze opportunities for areas of clinical stewardship within the organization, MultiCare took the first step towards understanding where the system needed help. Now it's made measurable progress with lllumiCare's Epic integration via CDS Hooks. This integration allows for real-time recommendations within the provider's workflow when ordering medications, lab tests, or imaging studies.

How It Works

The program works by nudging clinicians when they are about to place a potentially redundant or less cost-efficient order and then offers appropriate alternatives. These recommendations aren't created by just a new, flashy AI model, but by evidence-based research focused on clinical best evidence through a database called the Choosing Wisely database, which is built out of a relationship with the American Board of Internal Medicine, designed specifically to reduce unnecessary tests.

The interventions have helped MultiCare achieve a 26% acceptance rate for recommendations, with 23% for medications and 36% for lab orders. These numbers may sound low, but they far exceed national averages.

Working with Physicians

The potential of this integration was clear. The next step, according to MultiCare CMO Arun Mathews, was getting physicians to love it.

Once there was an understanding by physicians that the recommendations they were being given were sound, then it became time to perfect the process.

"One thing that has become apparent in the [informatics] literature is best practice. These alerts, being too prodigious, actually occur too many times and it's causing something called alert fatigue."

MultiCare then worked with IllumiCare, as well as its own internal governance, to develop an understanding as to what are the most significant and clinically relevant alerts needed so physicians didn't become overwhelmed. Physician engagement caught on a bit, but not entirely.

"The work of this involved allowing our physicians a little bit of time to become comfortable just turning it on and seeing the level of engagement," said Mathews.

The next step, Mathews said, was partnering with MultiCare's contracted hospitalist physician group, and developing a quality performance metric that helped physicians find an understanding that the work that they were doing in responding to these alerts was actually helping to reduce clinical waste.

"[Then], we could share some of that savings of some of that clinical waste reduction with our physicians by having them follow through with some of these best practice recommendations," said Mathews. "That was a bit of a breakthrough for us."

Lastly, what Mathews calls phase three of this integration, came in the form of Epic's CDS (clinical decision support) Hooks, which operates within Epic. This function took the extra work off of physicians when a new recommendation was made and functions so the program completes the task for the physician. 

"The doctors have been really grateful for the fact that they don't have to do these extra sort of thought cycles to jump into the orders pane and order and do the extra work when they've already cognitively agreed with the decision to follow the alert."

The Results

Mathews says MultiCare was conservative with its predictions for the new integration, but the end results were staggering. Where the system was expecting around a 5% waste reduction, the results translated into more than a 13% reduction.

"[That] reduction in waste translated in our pilot program of five hospitals to about $2.5 million worth of savings within one calendar year," Mathews said. "And again, all tied to best practice, best evidence and aligned with our physicians so that they can get credit for making those decisions by the bedside."

The financial results were great, but what about the patients? MultiCare wanted to ensure patients were safe, satisfied and still encountering a great care experience. Every initiative at MultiCare, Mathews says, gets reframed as a patient safety and or quality initiative.

"If we uncovered a concern around patient experience or uncovered a concern around increased risk of readmission as a result of these changes that were recommended, we would certainly consider placing the program on pause," he said. "I'm pleased to report that we saw no statistically significant changes in either of those two countermeasures as a result of rolling this out."

Overall, the integration of the new program revived an understanding amongst clinicians and executives about the importance of meshing clinical and financial stewardship based on better clinical practices.

"I think the unintended consequences have been better awareness about where the hidden costs within healthcare actually exist," he said.

MultiCare plans to integrate this into its radiology department next.

The Bedrock of Efficiency: Collaboration and Alignment

Yes, this is a lot of clinical talk for a finance article, but CFOs need to recognize the importance of their involvement here. It's critical for finance leaders to collaborate with not only CMOs, but lead physicians and physician groups to develop a thorough understanding of where medical inefficiencies and clinical waste lie, and how much that can cost a health system each year.

The underlying opportunities for a health system's financial prosperity can be uncovered with the right collaborations. CFOs should note that informed decisions take time, organization, and alignment with care practitioners to truly understand the nuanced pitfalls in modern healthcare.

"The key here is a single word, and to me it's alignment," Mathews said.

"While I strongly believe that financial stewardship is how we keep the lights on and the doors open so that we can render care for our communities, it has to be done on the bedrock of making sure that that care is the same care that I would want."