As health systems continue to navigate several interrelated challenges — from rising costs to shifting reimbursement models — many are leveraging innovative strategies that positively impact clinical practice variation and their bottom line.
Practitioners and health system administrators have long endured the complex issue of unwarranted clinical variation, defined as over or under-utilization of care due to deviations from evidenced-based care standards. It remains a crucial area of healthcare system improvement, with the latest research suggesting that most provider organizations have actionable savings opportunities amounting to $20M-$30M per $1B in revenue1.
Factors contributing to clinical care variation may include individual physician beliefs, patient preferences, and the absence of clear, measurable criteria to guide treatment options. The complexity and diversity of care variation can lead to disparities in patient outcomes and a health system’s financial burdens.
Many health systems leaders grappling with this issue have realized the need for implementing a well-rounded, systematic strategy that utilizes valuable data and analytics to identify areas of improvement.
A data-driven approach allows for targeted improvement efforts that have the potential to yield significant cost savings without compromising the quality of care. Indeed, with high-value data and analytics capabilities and a standard approach to quality improvement, organizations can transcend mere pockets of excellence and achieve widespread transformation.
Issues Driving Unwarranted Clinical Variation
One cause for care variation is the lack of standardized clinical guidelines or protocols across healthcare providers.
Another factor contributing to care variation is the influence of financial incentives on treatment decisions. In fee-for-service payment models there is a potential for over-utilization of tests and procedures. On the other hand, in capitated payment models there may be underutilization of necessary treatments due to cost-saving measures.
Compounding these issues is the scarcity of meaningful data and a robust data platform that serves as a single source of truth.
Stakeholders need access to a breadth of data and detailed insights, including:
- Electronic health records (EHR),
- Patient satisfaction surveys,
- Payer claims information,
- Costs associated with materials and supplies,
- Prescription medications,
- Factors influencing social determinants of health,
- Reports on patient engagement and more.
The availability of these data and analytics to the entire care team is crucial for maximum impact. As such, leaders can identify variations by analyzing patient location and risk cohort or by provider. What’s more, reliable data access enables practitioners to proactively adjust the clinical course of treatment for individual patients.
Five Components of Care Standardization
- Screening and assessment to address population health risk factors,
- Patient involvement in their plan of care,
- Outpatient care management focused on medication and chronic condition management,
- Acute decompensation management treatment protocols and
- Smooth and effective transitions of care across settings and providers.
Organizations should dedicate time and resources to addressing each aspect of standardization to achieve lasting change. It is recommended that organizations approach these tasks methodically, giving priority to issues impacting high-value outcomes, such as improvements in clinical, financial, or operational functions.
A Systematic Approach
Standardized processes for implementing evidence-based practices and prioritizing opportunities for change may include creating a governance structure and change management system. Researchers posit that collaboration and joint decision-making among physicians, along with implementing feedback loops in clinical care, can enhance mutual learning and minimize unwarranted variations in care.
This calls for strong clinical and executive leadership, direct physician involvement, and continuous program oversight and monitoring. To that end, oversight committees, comprised of frontline providers, administrators, and data analysts at the helm of strategic and operational changes, can ensure that improvement efforts are coordinated across departments and are consistently applied throughout the organization. This systematic approach also promotes team alignment and engages providers as champions in improving care delivery.
Removing the Guesswork
To standardize healthcare and address the five pillars adequately, organizations must move away from relying on disparate data systems and limited interoperability, which stores data in separate and often incompatible formats, making it difficult for healthcare professionals to retrieve data and obtain a comprehensive view of a patient’s medical status or history. Disjointed data systems hamper continuous monitoring and improvement efforts, preventing leaders from identifying bottlenecks or inefficiencies in their current processes.
Health systems must adopt an analytical framework that uses high-quality data to drive decision-making for outcome improvements. Since most health systems have limited resources and can’t address all areas needing enhancement at once, organizations can use a Key Process Analysis (KPA) application. This allows them to focus scarce resources where they will have the greatest impact.
A KPA tool identifies clinical processes with significant variation and resource consumption by analyzing comprehensive datasets that include clinical practices, billing procedures, and cost evaluations. Using KPA for clinical quality improvement, health systems can shift towards value-based care, emphasizing advanced clinical outcomes and cost-effectiveness.
Quality Improvement Efforts Must Target Clinical Variation
Implementing strategies to reduce care variation is crucial for improving patient care, overall population health, and controlling healthcare costs while achieving a positive and sustainable work environment for providers. By standardizing processes and protocols, practitioners can consistently deliver care across settings and patient populations, enhancing patient safety, improving resource allocation, and alleviating financial burdens.