Altarum Institute, an industry leader in health information technology innovation, received an award from the Centers for Medicare & Medicaid Innovation (CMMI) to reduce use of advanced, high-tech imaging, such as CT and MRI. The award is part of CMMI’s strategy to fund programs that drive transformation and ensure better health care, better health, and reduced costs for beneficiaries, and ultimately enhance the health care system for all Americans. Altarum is one of only 3% of applicants who received an award.
Our team is driving transformative change, and empowering health care providers and consumers by:
- Promoting better health care through evidence-based imaging guidelines provided by clinical decision support (CDS) tools and awareness of prior imaging studies through health information exchange;
- Achieving better health through patient education and coordinated care; and
- Reducing total costs of care by reducing inappropriate utilization of health care services.
Advancing Decision Support
Integrating clinical decision support (CDS) into the ordering physician practice is an effective way to improve quality of care and ensure that imaging tests ordered are medically necessary and appropriate. Through design of a responsive and robust CDS tool, we are able to provide real-time education to ordering physicians by embedding evidenced-based guidelines from the American College of Radiology, as well as local recommendations. By complementing the evidence with valuable information about radiation exposure, prior test results and local cost, physicians have all the pertinent information accessible to make appropriate care decisions when considering a patient's need for advanced diagnostic imaging.
Promoting adoption of technology is a critical and challenging factor in fostering change in health care delivery. Understanding the barriers to use in a busy physician practice is a core competency for the Altarum Team. Through a series of structured workflow studies and focus groups, we are able to isolate the key delivery points in office practices to leverage the use of the tools, as well as design intuitive applications that can streamline existing process flows and facilitate behavior change.
Promoting Alternate Care
Alternate care pathways refer to treatment options that may be used when advanced imaging studies are deemed questionable in value and are unlikely to change treatment decisions or clinical outcomes. Promoting alternate care not only helps to reduce inappropriate advanced imaging use, but can serve to diminish the downstream effect of additional testing, unnecessary surgeries and care delays that are costly and bring little additional value to patients. Such pathways may involve lower cost diagnostic tests in place of an advanced imaging study, deferring a study to a more suitable timeframe, or coordinating referral practices in lieu of imaging.
Providing real-time education of physicians and providing consensus-based care delivery models is one of the key components of the program. By partnering with local physician organizations, we are engaging physicians in the development of care pathways and local practices to consider as alternatives in the decision making process. A robust physician outreach and educational campaign is also being deployed to obtain frequent feedback. Assessing levels of satisfaction with all components of the process provides a mechanism to create additional recommendations and influence behavior change.
Reducing Patient Demand
Care delivery models should be designed to support a patient-centered approach and shared decision-making between physicians and their patients. Educational materials, integrated directly into CDS tools, can be provided to patients to facilitate discussion when imaging is unlikely to change treatment decisions or clinical outcomes. As such, they can also help manage expectations created from direct-to-consumer advertising and improve positive self-care practices. Targeted educational materials have been developed to explain in easily comprehensible language the benefits, costs and associated risks of imaging studies.
For several neuromuscular conditions and headache, materials are presented in the CDS process when any of the clinically specific situations are presented. Generally, these tools are available for use in clinical settings by clinicians and care managers to address patient questions or concerns about care. They are also delivered on a dedicated, public-facing website referenced in the distributed patient materials. Ongoing assessment of patient satisfaction has been integrated into the program to ascertain the effectiveness of the educational campaign, and is a key performance metric to inform into the rapid-cycle improvement process.
Leveraging Provider Accountability
Monitoring provider-level performance and adherence to guidelines is critical to meeting our objectives of reducing unnecessary imaging. Both Altarum and our clinical partners have extensive analytic experience to identify issues of system-wide performance as well as monitoring individual providers whose behavior falls outside an acceptable range of variation. Physician Organization medical directors work directly with underperforming physicians to identify performance problems and remediation strategies to reduce unwarranted variation in practice and bring all practices into an acceptable utilization range.
Aligning provider incentives for program adoption and appropriateness is a necessary driver of program success. Frequent communication of dashboards and profiles designed to measure program adoption, and appropriateness, including peer comparisons, can be essential in creating a culture for change. High-performing physicians achieve higher incentive awards while physicians who are consistently underperforming lose the opportunity for incentive payments after being given an opportunity for improvement.