Challenges

After expanding the scope of its system through the acquisition of several hospitals across the state of Michigan, leaders at McLaren recognized the need for standardization of care and efficient delivery of services throughout the system. The organization sought external guidance from Dr. Tim Hannon, who had established McLaren’s comprehensive blood management program several years prior. The blood management program reduced blood utilization across the system by 30%, saving millions of dollars in healthcare resources while reducing avoidable harm from unnecessary transfusions. "After the success of the blood management program, we realized that the educational and communication methodologies, measurement and analytical tools, and technology infrastructure we had developed could be applied to other clinical projects," says Michael McKenna, MD, McLaren Executive Vice President and Chief Medical Officer.

Solution

A critical first step was to align the initiative with the strategic goals of the McLaren organization by defining High Value Care as an outgrowth of their mission "Doing What's Best." The next step was earning physician buy-in and having them lead the way in how to best evaluate care from a value vs. cost perspective. A physician-led governance structure was developed at the system level through a High Value Care Steering Committee, chaired by Dr. McKenna and populated by physicians of different specialties from across the system. High Value Care Committees were then established at each McLaren subsidiary hospital, again chaired by a senior physician leader and populated with key physicians along with nursing, lab, imaging, and information services representatives. Data and evidence based literature were used to target initial clinical projects, which were then assigned to task forces and working groups to develop implementation plans. Utilizing this newly established infrastructure has allowed McLaren to fundamentally change how care is delivered across the system, effectively driving healthcare value and clinical standardization.

Results

The initial focus area was on unnecessary laboratory testing, which wastes an estimated $200 billion nationally every year and results in both major costs and added risks to patients. Within 25 months of rolling out the project there was a 6.5% reduction of inpatient lab test utilization rate, eliminating 329,000 unnecessary tests and saving $3,223,000 in laboratory-related expenses.*

Some highlighted successes at individual hospitals include:

Blood management also got a renewed focus using the High Value Care program framework. System and hospital blood management best practices were revisited and metrics and accountability were assigned to the local HVC teams. As a result, an adverse utilization trend was reversed, decreasing red blood cell utilization rate by 4.9% (1,743 units) and total blood product utilization rate by 5.7% (2,828 units), saving $2,710,000 in transfusion-related expenses.

Future State

McLaren Health recognizes that the High Value Care Program, while still early in its development, is a strategic platform to drive their transformation from volume to value. In addition to reducing repetitive testing, there are ongoing initiatives to reduce unnecessary or inappropriate reference lab testing, to improve antibiotic stewardship, and to implement Appropriate Use Criteria for imaging. Future projects will standardize high value practices in critical care and explore patient-centered approaches to palliative care. "High Value Care is about fundamentally changing how we deliver care across the continuum," says Dr. McKenna. "This is a never-ending process of trying to do the right thing, all the time."