2019 Acclaim Award Recipient

The Road to Care Transformation: Accomplishing Reliably Excellent Care That Is Patient-Centered and Mission-Driven

 

UW Medicine is an academic health system affiliated with the University of Washington in Seattle. With a workforce of more than 27,000, including 4,670 clinicians at 4 hospitals, UW Medicine is one of the Pacific Northwest’s largest health systems. UW Medicine’s application highlighted their strategies to measurably improve outcomes, lower costs, reduce inequity, and better manage populations of patients.

UW Medicine has incorporated AMGA’s High-Performing Health System Attributes into their multispecialty practice in the following ways:

Accountability

• UW Medicine implemented a system-wide, high-risk care management program to provide support for the most complex and high-utilizing patients in their population. They quickly expanded the program to include proactive approaches to address gaps in care and to improve transitions of care management for empaneled patients. In 2017, they deployed internal access to a statewide health informatics exchange to provide notifications and clinical encounter data about their population’s emergency department visits and hospital admissions occurring outside of their organization.
• In 2016, they launched an organizational initiative to empanel nearly 400,000 primary care patients to more than 450 primary care physicians (PCPs) across 38 clinics. In that year, UW Medicine was able to empanel 92% of patients. In 2017, they also set organizational targets for panel management, including annual wellness visits, updating active hierarchical condition categories (HCC) codes, and closing clinical care gaps related to prevention, screening, and chronic condition management. These efforts resulted in significant increases in the annual completion rate for all three metrics.

Care Coordination

• In order to address disparities in healthcare processes and outcomes across minority and often marginalized populations, UW Medicine brought together stakeholders from across their community and developed an organizational “Healthcare Equity Blueprint.” The blueprint has three objectives: (1) increase equity, diversity and inclusion in their healthcare workforce; (2) engage the communities of patients they serve as partners in assessing and addressing healthcare equity; and (3) deploy targeted quality improvement and patient experience initiatives to meet the needs of marginalized populations.
• Patients have an active partnership with a PCP, who leads a medical home-based care team dedicated to providing proactive preventive care and chronic disease management. These teams are responsible for the patient's coordination of care across healthcare settings as facilitated by electronic health record (EHR) registries, clinical-decision support tools, and health information exchanges. 
• UW Medicine was able to implement 79 standardization projects over 20 service areas. They were able to accomplish this by engaging the clinical care team across the organization to lead projects within their areas of expertise. For example, they paired care teams with process improvement staff for project management and change management support. This resulted in the development of patient care maps, treatment algorithms, clinical decision support tools and patient educational aids. Clinicians and care teams are able to access real-time performance dashboards to monitor adherence to and outcomes of standardized care plans. With these projects, UW Medicine has dramatically reduced length of stay as well as provided more efficient care and better health outcomes.

Compensation Practices and Incentives

• UW Medicine aligned compensation and incentives for clinicians with their care transformation strategies. Clinicians receive financial incentives to provide better access to care, improve the patient experience, and complete documentation of care in a timely manner. UW Medicine also incentivized participation in organization-wide transformation work through short-term stipends and encouraged clinicians to take leadership roles in standardization projects. To reinforce these efforts, the academic promotions process was modified to credit participation in care transformation, process improvement, and healthcare equity activities in consideration for a promotion through the academic ranks.

Efficient Provision of Services

• In order to improve patient experience and  reduce the use of low-value care at the end of life, UW Medicine improved patient-provider advance care planning in outpatient settings and increased the use of standardized protocols to access palliative care services in the inpatient setting. Their current approach focuses on transforming palliative care of hospitalized patients from an “individual-referred model” to a “population-screened model.”

Organized Systems of Care

• UW Medicine implemented their Population Approach to Health (PATH) programs for common chronic conditions and preventive screenings to better population management. PATH programs use a central personnel team of specialist providers, patient care coordinators, and data analysts to work with patients and their local clinical care teams to monitor and manage health status and outcomes.
• They started a campaign to recognize “exercise as a vital sign” (EVS) to promote provider-patient communication on the health impact of increased physical activity and to prompt “exercise prescriptions” to meet evidence-based activity guidelines. They developed a screening process, a standardized protocol, and EHR documentation templates to support providers. In 2017, the EVS was recorded in more than 8,000 patient visits. They are now scaling to more service areas as well as developing exercise prescription referrals to community-based wellness programs and resources. They have formalized a partnership with YMCAs across their region for direct referrals of patients to a year-long community-based diabetes prevention program to make lifestyle changes, improve health, and reduce the risk of developing Type 2 diabetes.

Quality Measurement and Improvement Activities

• UW Medicine transitioned from individual entity-based reporting of population health performance to organization-wide analyses. They deployed new visualization tools in and out of the EHR and moved toward real-time performance reporting for key initiatives. They created specific forums for clinician and operations leaders to collaboratively assess and address population health performance using these visualization tools.  
• Collecting and integrating patient-reported outcomes data into the clinical workflow caused a dramatic shift in the way they treat conditions like depression and assess the success of treatments like spine surgery. The increased provider awareness of patients’ concerns, symptom distress, and outcomes has also enhanced patient-provider communication, improved the quality of shared decision-making, and improved the patient experience.

Using Technology and Evidence-Based Medicine

• UW Medicine developed a health technology assessment to address the challenge of introducing innovative products and services. This process applies to health technologies used for screening, diagnosis, or treatment that are expected to cost more than $50,000 or more than $1,000 cost increase per procedure from baseline, or that represent a new clinical treatment paradigm. Technologies undergo a review of the supporting scientific evidence base (for example, clinical trials, systematic reviews, or other third-party evaluation of the technology) and a financial impact assessment.

Broadening the Lens to Focus on the Continuum of Care

• UW Medicine developed a collaborative of 14 skilled nursing facilities into a post-acute care network.
• Using telehealth-based “warm” handoffs, they standardized reviews of medication and treatment plans for high-risk patients, protocols for management of adverse events, and root cause analysis. The network is improving quality and efficiency of transition, and it has decreased readmission and emergency room visits.

Improving Access and Experience

• UW Medicine adopted the broad use of eConsults, including more than a dozen specialties. The use of eConsults has reduced patient wait time to get to a treatment decision, avoided thousands of unnecessary clinic visits, empowered primary care physicians, and improved access for patients who need to see a specialist.