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Q: Why is THA partnering with IllumiCare on this project?

THA has been tasked by its board and members to develop data analytics that support value-based and high-quality health care across all Texas hospitals.

Q: Why a three-year project timeline?

A one-year commitment to a project is seen as temporary and hinders the ability to recognize the project’s full benefit. With a three-year commitment, hospitals will have a small economic stake and enough time to recognize early successes and properly evaluate continuation.

In the three years, hospitals will receive:

  • Year 1: Early/anecdotal savings and benchmarking across participating hospitals;
  • Year 2: Benchmarking and detailed cost-saving analyses; and
  • Year 3: Internal and external publication/study results (aggregate/de-identified).

The project is three years in duration, but hospitals must only commit to the initial implementation period plus 12 months of services. They may opt out at the end of that 15-month period. Continuation would commit them for the remainder of the three-year project.

Q: What is the THA Smart Ribbon implementation process?

There are two elements of its technical implementation.

Clinical Data Acquisition
IllumiCare uses existing HL7 messages for admit/discharge/transfer, laboratory orders, pharmacy orders and radiology orders. A secure link is established (e.g., VPN), and a copy of these existing HL7 messages is sent to a HIPAA-compliant data center. This data is then combined with external data sources and proprietary algorithms to comprise the IllumiCare data warehouse.

Smart Ribbon Application (.exe)
The Smart Ribbon Application is a light-weight executable file that is placed as a published application to select providers who already have access to the electronic medical record. It piggybacks on existing permissions; no separate sign-on is required. Each hospital can control which individual providers have access to IllumiCare by creating a sub-group of virtualized users in their Citrix or similar environment. The application examines the Windows UI Automation layer, which contains meta-data on every element seen on the user interface. It never touches or examines the EMR. It is EMR-agnostic.

Q: Why should hospitals participate?

Surveys show that physicians have little knowledge about the hospital costs of provider-controlled expenditures (meds, labs, etc.). Many studies show that we get better and cheaper care if providers are empowered with patient-specific, real-time human and economic cost data at the time and place of writing their next order.

In addition, accountable care organizations align the financial incentives of physicians and hospitals. Empowering physicians with cost data at the point of care supports value-based care decisions.

Finally, employers and patients are concerned about health care pricing. Excessive utilization of health care resources costs us all money and causes patient discomfort, complications, harm and lost productivity.

Q: What are the key project dates?

The key dates are as follows:

  • Application due date: March 31, 2016;
  • Hospital selection announcement: April 7, 2016;
  • Contracting complete: April 29, 2016; and
  • Implementations: April-June 2016.

The first year will end in June 2017; the second in June 2018; and the third in June 2019.

Q: How did you determine the first-year hospital investment?

THA and IllumiCare agreed that starting a cost- and risk-awareness project linking hospitals across the state of Texas requires multinetwork participation for an effective demonstration. Making the first-year economic cost and IT effort minimal was key.

Q: How do hospitals participate in the project?

Hospitals interested in participating in this project will need to fill out a simple application form. If you have additional questions, contact Alex Huff at THA at 512/465-1558 or ahuff@tha.org.

Q: How are hospitals selected for participation?

Ten hospitals will be selected based on ability to implement in the near term, commitment to provider adoption, demographics, size and system affiliation to represent a broad cross section of Texas hospitals.

Q: How will you measure the effects?

The goal of the project is to reduce the cost of medications, labs and radiological tests per admission, with the length of stay, mortality and readmissions held constant or improving. The data collected about provider usage and risk-adjusted costs per admission will allow us to measure aggregate changes pre- and post-intervention, using a direct adjustment method to adjust risk by APR-DRG.

Q: What are the ROI estimates to participating hospitals?

Using publically available hospital cost data, THA can compute reasonable expectations for return on investment to participating hospitals. We calculate savings based on reduced medication, lab and radiology spend, looking only at hospitals’ actual, inpatient, non-salary cost reductions. Most of the models we have produced for hospitals and hospital networks demonstrate ROI opportunities of around 2X-8X per year. These estimated reductions are based on the average experienced in published studies of costs awareness campaigns for meds, labs and radiology.