Physician-led clinical councils seize on opportunities to improve quality and cut costs.
This article appears in the January/February 2019 edition of HealthLeaders magazine.
In the effort to improve quality and save money, IU Health is creating service line-based clinical councils to tap into the problem-solving power of its medical staff.
The Indianapolis-based health system is seeing promising results, in both identifying workable solutions and engaging physicians along the way. The tactic could catch on, especially as systems across the country respond to the industry's business model shifting from volume to value.
Since last year, IU Health has formed 18 clinical councils to identify and pursue value opportunities in areas such as information services, pharmacy, and supplies. Service lines picked for clinical councils include cardiovascular surgery, cardiology, orthopedics, neurosurgery, neurology, medical oncology, emergency medicine, palliative care, and general surgery.
The clinical councils are physician-led, with members selected by IU Health regional presidents and chief medical officers.
"We tell the presidents and CMOs that we are interested in people who are actively practicing in the specialty and who are considered thought leaders in their region. Often, it is somebody who is a medical director or leader by title, but it doesn't have to be that way," says Chris Weaver, MD, MBA, senior vice president of clinical effectiveness at IU Health. "We really want someone who is a thought leader—someone others will follow."
The primary duties of the clinical councils are improving quality through eliminating variation in care and seeking opportunities to lower costs.
"When it comes to variation from region to region and provider to provider, we are able to dig into the data and the processes and see whether there are opportunities to bring everybody up to the best performer," he says.
The clinical councils are well-positioned to root out cost savings at the provider level, Weaver said. "Differences in costs are often something the provider is unaware of. They may be using a supply that costs $500 more than everybody else."
He says the clinical councils, which meet quarterly or every other month, have generated several "wins" over the past year:
- Pharmacy: Clinical council initiatives have saved more than $7 million in inpatient pharmacy costs year-over-year. The percentage of patients discharged from emergency departments across the system with a narcotic decreased from 14.5% to 8.3%.
- Supply chain: Preferred-vendor contracting saved $3.5 million annually. Contracting changes lowered the cost for total hip and knee replacement procedures.
- Information services: Order sets guidelines have been reduced by 651 from a total of about 3,500 to decrease care variation. The percentage of EMR transactions that take more than 5 seconds has been reduced by more than 50%, easing user burden on clinicians.
IU Health has taken five primary steps to form its clinical councils and put them to work.
1. Borrow from other health systems
Before launching its clinical councils, IU Health found two other health systems that were pursuing similar concepts: Phoenix-based Banner Health and Vanderbilt University Medical Center in Tennessee.
"Banner Health has care collaboratives, where they bring providers in their regions together. They really focus on information services like care pathways and order sets. We took their idea and broadened the scope to areas like pharmacy and quality work," Weaver says. "Vanderbilt has a similar idea that we have tweaked and made it a much broader approach."
2. Roll out strategically
IU Health started its clinical council initiative with the health system's top service lines.
"We wanted to start with those councils to make sure that they had support and direction at the system level. So we started with cardiovascular surgery, cardiology, orthopedics, neurosurgery, neurology, and oncology. Then, when we had big initiatives that we knew we wanted to drive across the system, we would organize a council," Weaver says.
There are three strategies to form a clinical council and guide a new council, he says.
First, when clinical councils are organized, members are asked to identify opportunities where they see practice varying or where they see variation in quality or cost from place to place or provider to provider.
Second, the health system uses Vizient data to benchmark externally and identify opportunities in either quality or cost for supplies and drugs. If significant opportunities are found, it prompts formation of a new council.
Third, physician leaders have sometimes prompted IU Health to form a clinical council. When providers push initiatives to improve quality or reduce costs, a clinical council can start with "buy-in that we need," Weaver says.
3. Select council members purposefully
The clinical councils exemplify how IU Health has embraced and elevated physician leadership, Weaver says.
"Our leadership at the highest level is saying, 'Instead of us sitting in offices making decisions for physician practices or the whole system, we believe in the experts providing care to patients making these decisions,' " Weaver says. "The one caveat is they have to make decisions; otherwise, someone will come along and make decisions for them."
4. Prepare to tackle tough issues
Clinical councils must be ready to confront resistance to change, Weaver says.
Making changes in supply chain such as reducing 10 vendors to two for implants can be controversial. "Some providers can be adamant about practicing under those guidelines, but the clinical council can get involved along with the regional leadership to have a conversation about why there are quality benefits," he says.
5. Capitalize on physician engagement
IU Health's clinical councils have successfully heightened physician engagement despite challenging circumstances, Weaver says.
"It's not an easy environment for providers these days, with all of the changes in healthcare. So, engagement and satisfaction are more and more of a struggle," he says.
The clinical councils are a genuine attempt to enlist physicians in significant decision-making, and they appreciate the effort, Weaver says.
"As decisions are being made, we are putting them in providers' hands, so they don't feel like changes are happening to them," he says.
A recent survey of healthcare providers on the clinical councils found a 90% attendance rate and 85% of members indicating the highest level of satisfaction, Weaver adds.
"They felt the health system was listening to them."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
IU Health has established 18 clinical councils organized by service line to seek cost-cutting and quality improvement opportunities.
The clinical councils are led by practicing physicians with reputations for thought leadership.
Areas where the clinical councils have achieved success include information services, pharmacy, and supply chain.