utilizing data for a better tomorrow - memberclicks

Utilizing Data for a Better Tomorrow:Practice Sustainability and Workflow Optimization

Kim Woofter, RN,

EVP Strategic Alliances and

Practice Innovation

Where We Started

Challenges Facing the Practice

Practice Sustainability

Increasing competition

Increasing costIncreasing complexity

Decreasing reimbursement

Biggest Pain Points

Drug costsRevenue

CycleStaffing

ReferralsEmployer

Engagement

What We’re Doing Today

Drug Financials: Dashboard

Drug Financials: Purchasing & Administration

Drug Financials: Physician

Revenue Cycle Management

Driving Growth through Referral Analytics

Acuity-Based Staffing

Acuity “Complexity” Based Infusion Suite Staffing

• Each Regimen is assigned a numeric value of 1 (low) to 6 (high) complexity

• Numeric value aligns with resources utilization (staff time)

• RN Standardization in workload – Daily acuity average 25-30*

• Scheduling templates to ensure appropriate RN to patient ratios

• Metric for performance - Staff incentives or need for Development

• Scheduling in pods of 10 chairs with 2 RN’s / pod – Target 4-5 chairs / RN

*Varies by practice

Level 1Biologic injections; LMW Heparins; Hormone agonist injections; Supportive drug injections; Vaccinations; Scheduled port flush; Discontinuing a continuous infusion CADD pump; Central line dressing change; PT/INR’sCriteria: Any injection (subcutaneous or IM), Port flush, D/C 5FU pump, Central line maintenance

Level 2Avastin; Herceptin; Dacogen; Vidaza; Velcade; Alimta(without B12)Infed; Feraheme; Venofer; Aredia; Zometa; Reclast; Sandostatin IV for diarrhea; IV hydration w/o assessment (day 2 hydration); IV antibiotic; Hook up 5FU pump; Patient educationCriteria: Level 2 infusions require less than 1 hour of nursing care; Monoclonal therapy with low incidence of adverse event; Chemotherapy that is infused in less than 15 minutes or that is IVP; Uncomplicated hydration; Bisphosphonate therapy; Iron replacement therapy

Level 3Erbitux; Vectibix; Taxotere; Taxol; Gemzar; Doxil; Hycamtin; Irinotecan; Oxaliplatin; Camptosar; Abraxane; Cytoxan; Carboplatin; DTIC; BCNU; Navelbine; Mitoxantrone; Torisel; Campath; Treanda; Fludara; Rituxan; Cladribine; Campath; Ontak; Adriamycin; Epirubicin; Platinol-single agent; Any of the above combined with Zometa or ArediaCriteria: Level 3 infusions require 2-3 hours of nursing care; Single agent chemotherapy, Single agent chemotherapy + bisphosphonate; Single agent chemotherapy + monoclonal (excluding Rituxan), Side effect management requiring supportive drugs, Subsequent day chemotherapy less than 3 hours; Single agent Rituxan, Weekly combination therapy requiring 2-3 hours of nursing care

Level 4 (schedule between 10:00-13:00)A/C; E/C; TAC; FAC; FEC; CHOP; ICE; FOLFOX; FOLFIRI; DCF; ECF TCF; Taxol/Carbo; Taxotere/Carbo; Platinol +1 additional agent; IV Interferon (first week)Criteria: Level 4 infusions require 4-5 hours of nursing care; Combination therapy; Any combination therapy requiring 4-5 hours of nursing time; Any level 3 regimen on a research protocol that requires VS monitoring should be increased to a level 4; Weekly combination regimens with a monoclonal

Level 5 (schedule between 0800-1100)BEP; RCHOP; ABVD; Hyper CVAD; ESHAP; Dartmouth protocol for melanoma; Ifex/Bicarb regimen; Platinol +2 additional agents; Chemo desensitization regimens; Intraperitoneal chemotherapy; Patients requiring one on one care.Criteria: Level 5 infusions require 6-8 hours of nursing care; Combination therapy lasting more than 6 hours; Chemo regimens requiring an advanced procedure; Patients with a lesser acuity level but patient requires full care

*Patient Education will be scheduled as a Level 2. Regimens with Neulasta OBI +1. Nursing discretion may add +1 to any regimen based on patient care needs. Total regimen maximum is a Level 5

How has “Acuity” based staffing impacted the practice?

• Increased patient satisfaction

• Increased nursing satisfaction

• Cost effective scheduling

• Infusion suite staff savings (4FTE)

• Objective performance metric

• Predictive analytics for add-ons

Employer Collaboration

Transparency in the cost of care

Collaboration in controlling costs

Payer Contracting: Employers

What comes next for employer –provider engagement?

• Continued dialogue and understanding between providers and employers

• Collaborative development of value based contracts

• Engagement of specialty provider groups (Orthopedics, Surgical, Imaging)

• Comprehensive Care Centers to meet employer group needs

• Community leaders participating in the “value” discussions

What We’ve Found

Area Impact

Drug financials Informed dialogue with

Pharmacoeconomics discussion & decisions

Visibility of underwater scenarios

Revenue cycle Significant recovered revenue (over $1M)

Significant improvement in team efficiency

Acuity-based staffing Smoothing of clinical workload

Savings of 4 RN FTEs

Referrals Awareness and prompts for intervention:

Trends of top referrers

Awareness of first time referrals

Employers Transparency and dialogue

Thoughtful plan language

Future of Data-Driven Decision Making

Questions?

Kim Woofter, RN, EVP Strategic Alliances and

Practice Innovation

kimwoofter@ac3health.com