At Southeast Texas Medical Associates (SETMA), a 32 doctor primary care practice and NCQA Level 3 Patient-Centered Medical Home which sees some 7,600 diabetic patients each year, words like metrics, ratios,
reductions and calculations are used almost as frequently as medical terminology. That’s because this practice relies heavily on analytics and patient quality measures. In turn, the practice has reduced hospital readmissions by 22 percent over a six month period.
In 1998, SETMA was an early adopter of electronic health records, but soon realized that they were too expensive and difficult to manage if they only served as a repository of data. Instead, Dr. James Holly, CEO of SETMA, set out to use technology to develop disease and data management tools. Using IBM analytics software, clinicians at SETMA are determining similarities among re-admitted patients and are instituting new post-hospital treatment plans. The patient experience has changed too. Each patient’s care is evaluated on the basis of more than 200 quality metrics. Patients leave the office with a “plan of care” and are connected to a healthcare team to help them meet their goals. After just one year of implementing the program, SETMA saw a significant improvement in their diabetic patient population, with a decrease in annual patient visits by nearly 15%.
In the past, SETMA’s doctors would typically spend upwards of an hour evaluating data on individual patients, whereas today they are evaluating data points of patients with similar conditions across the entire practice, allowing them to evaluate trends and gain valuable insight around more effective ways to manage illness. SETMA doctors are also calculating cardiovascular risk measures at each and every office visit. What used to take clinicians over an hour – sitting and calculating just one patient’s score by hand; can now be done in less than a second.
SETMA continues to apply analytics to various health issues their patients face to quickly identify new trends and alter treatment accordingly to ultimately reduce reoccurrence and readmissions.
The work that Dr. Holly and his team of physicians are doing to successfully reduce readmission rates through the use of analytics is being used as a best practices case study for other healthcare organizations as they look to tackle issues around healthcare transformation. Next week, Dr. Holly will be an invited speaker in Washington, DC at the Patient Centered Primary Care Collaborative Stakeholder’s meeting where he will speak about Practice Transformation.
Additionally, Dr. James Holly, CEO of SETMA and IBM’s Sue Noack, WW Health Care Executive, Business Analytics are available for interviews. Dr. Holly can also discuss their decision to become a Medical Home practice, the 400 page assessment conducted on the practice prior to making the transition, the personnel, reimbursement and business impacts on the practice as well.
Analytics helps practice reduce hospital readmissions by 22 percent in first six months
ARMONK, NY – March 23, 2011: IBM (NYSE: IBM) today announced that Southeast Texas Medical Associates (SETMA), a primary healthcare group based in Beaumont, Texas., is utilizing IBM business analytics software to gain greater insight into hospital re-admissions and review trend data that will help identify causes and design interventions to prevent patients from having to return to the hospital soon after their discharge.
As a result, in just the first six months of the practice level research, SETMA has been able to cut the number of their patient hospital readmissions by 22 percent by helping doctors identify trends, and assess treatment protocols to support the creation of a more comprehensive post-hospital treatment care programs. Additionally, SETMA physicians have been able to reduce time make to evaluate patients data prior to treatment from a hours to a second.
According to an October 2010 study titled “Hospital Readmission: Influencing Factors Identified” at the University of California San Francisco (UCSF), unplanned hospital readmission within 30 days — occurs in nearly one in five Medicare patients in the US. These readmissions are not only extremely costly, but it can put the patient at higher risk of increased illness, and in some cases death.
SETMA is utilizing IBM analytics software to identify the treatment interruptions and causes that lead a patient back into the hospital after discharge. Physicians are collecting data on specific patient characteristics that did not require re-admission, beyond traditional information to include ethnicity, socioeconomic groups, the follow-up care received, and how much and how quickly they were able to receive that care, against those who were re-admitted for hospital treatment. Utilizing IBM analytics software the clinicians are determining similarities within re-admitted patients, and are instituting new post-hospital treatment plans which will replace the typical transition of care documents to include recommendations, for example such as immediate at-home care, or interventional support if the patient lives alone. SETMA describes these types of treatments as the most vital component in a patient’s recovery plan.
Dr. Holly and the 29 physicians of the SETMA practice have also implemented preventative care programs by analyzing key data of their more than 7,500 patients, including comprehensive background information, demographics, types of treatments, history of prescription care, risk factors and outcomes. IBM business analytics software enables the doctors to better assess trends in their patients, so they may quickly adjust medications or treatments.
Physicians Evaluating Cardiovascular Risk in One Second vs. an Hour
Prior to implementing its analytics solution, SETMA’s doctors would typically spend upwards of an hour evaluating data on individual patients, whereas today they are evaluating data points of patients with similar conditions across the entire practice, allowing them to evaluate trends and gain valuable insight around more effective ways to manage illness.
SETMA doctors are also calculating cardiovascular risk measures at each and every office visit, something that was typically unheard of before. What used to take a physician over an hour to sit and calculate just one patient’s score by hand; can now be done in less than a second. With a simple click of the mouse, key data points are instantaneously captured into one report. For example, a doctor can now point out key risk factors around relative heart age scores, so if the patient is 65 years of age, but is showing a relative heart age of 75 years, it allows the physician to discuss ways in which they can work together to adjust lifestyle choices to regulate those numbers.
In addition, patients are able to view, track and compare their own progress against other patients with similar conditions by providing patients access to data related to their own personal health goals, helping the physician offer a more personalized care environment.
“Each day we challenge ourselves to respond faster, more efficiently and more effectively to the needs of our patients. You’d be surprised at the demand we get from our patients; they expect us to not just treat their ailments today, but to help them put plans in place to tackle ailments and challenges they will eventually face when dealing with a chronic disease like diabetes”, said Dr. James Holly, CEO, Southeast Texas Medical Associates. “Smarter healthcare is about always staying one step ahead for your patients, it’s about analyzing information to meet the changing needs of your patient, and the IBM analytics solution allows us to do that.”
Clinical support staff are also working more productively with the help of analytics. For example, if a patient is scheduled for an office visit on a Friday, staff can instantly run reports of all the patients due in on that day for check-ups and review their status to see if anything is out of date or if extra screening work is required. Now, blood work can be done in advance of their appointment with a physician, giving the doctor instant access to the updated information. The test results are discussed face to face with the patient in the exam room, allowing the patient and doctor time to discuss outcomes and put a plan in place around next steps.
SETMA continues to make additional improvements within their system to deliver advanced and personalized care to their patients, and to further their preventative care mission. With the use of analytics, SETMA physicians identified a trend in their diabetic patients that started in October and that lasted through the end of December. They began to see their patients were losing control and becoming less disciplined with their dietary habits when trying to get through the holidays. SETMA responded with a diabetes intervention program that included increasing their frequency of testing, compliance with medications, suggestions on handling diet choices during this difficult time of year, including increasing patient’s exercise to help balance their sugar levels. After just one year of implementing the program, SETMA saw a significant improvement in their diabetic patient population, with a decrease in annual patient visits by nearly 15% during this time frame.
“IBM analytics software allows us to deliver care intentionally, rather than coincidentally. When we see a patient with a master plan already designed based on analysis of their data, we can intentionally intervene in their lives in ways that will make a difference, and that is a beautiful thing, noted Holly.”
IBM is creating a smarter, more connected healthcare system that delivers better care with fewer mistakes, predicts and prevents diseases, and empowers people to make better choices.
The latest example comes from the introduction of Watson. Delivering the only effective and efficient storage, retrieval and analysis system of information, Watson will assist doctors in delivering better care with fewer mistakes, predict and prevent disease, and ultimately improve health. IBM also helps clients apply advanced analytics to improve medical research, diagnosis and treatment in order to improve patient care and help reduce healthcare costs.
For more information on IBM Business Analytics, please visit the online press kit: http://www.ibm.com/press/us/en/presskit/27163.wss.