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99 Executive Briefing Sponsored by: Controlling Avoidable Utilization: How to Use Clinical Evidence and Data to Improve Care U nder outcomes-based medicine, healthcare providers are under growing pressure to demonstrate to the purchasers of care — patients, payers and employers — that they can deliver high-quality clinical services at an affordable and compet- itive price. To accomplish this, some organizations are targeting "wasteful spending" in their clinical service lines, or spending not associated with improved quality or patient outcomes. Unnecessary testing, duplicative services and other low-value care represent a substantial opportunity for healthcare pro- viders to reduce costs and improve patient health across their enterprise. Combining and analyzing clinical, financial and op- erational data can help organizations pinpoint opportunities to reduce or eliminate low-value care. However, implementing a robust analytics program can be cost-prohibitive and impracti- cal for organizations facing capital constraints or interoperabili- ty issues, limiting the amount of data they can access. To overcome these barriers, hospitals are finding it worthwhile to partner with a group purchasing organization to leverage their extensive data and reduce avoidable utilization of health- care products and services—especially technologies that are un- proven as well as costly. The cost of avoidable utilization Unnecessary medical services fuel a large portion of waste- ful healthcare spending. In 2012, the Institute of Medicine re- leased a report stating 30 percent of total healthcare spending in the U.S. — or $750 billion — provided no value to the patient. Avoidable utilization carries repercussions for patients' well-be- ing. When physicians order excessive testing or treatments that offer little proven benefit, the cost of care increases while the health of patients remains unchanged or, in worst case scenar- ios, is actually harmed. Studies have found low-value care is prevalent in the U.S. healthcare system. A 2014 study of Medi- care claims data revealed between 25 percent and 42 percent of patients receive at least one of 26 tests or treatments that scientific and professional organizations have consistently de- termined have no clinical benefit. Given the potentially drastic effects of unneeded medical ser- vices on patients and finances, reversing the trend is now a top priority for many healthcare leaders. The Advisory Board's most recent Annual Health Care CEO Survey revealed that 49 per- cent of respondents are worried about controlling avoidable utilization — a 5 percent increase from the year prior. CEOs rank the issue as their fifth-highest concern out of 26 topics. Hospital CEOs are not the only ones concerned about the overuse of medical services. The American College of Physi- cians (ACP) cites high rates of unneeded care, as well as the use of unnecessary technology, as major drivers of healthcare spending. In fact, the organization's top recommendation for achieving cost savings is to "reduce avoidable, ineffective and duplicate use of services — including technology that does not improve patient care — and encourage clinically effective care based on comparative effectiveness research and implemen- tation of information technology," according to an ACP white paper on controlling healthcare costs. Hospitals can combine cost, outcomes and reimbursement data with outside clinical evidence to better inform their de- cision-making, reduce extraneous patient care and enhance overall clinical value. Once the benefits of procedures and ser- vices are better understood for specific patient populations, clinicians can tailor treatment plans to ensure the best care pos- sible, delivered in the most efficient manner. Defining the data challenge To create a clear picture of value, hospital systems must be able to quickly and efficiently combine the data they collect and manage on a daily basis — clinical, financial and operational — and use it to understand processes and drive insight. This al- lows clinicians to tie the products they're using to procedures and patients, along with associated outcomes, so they can com- pare the total cost of care to its effectiveness. By identifying inefficient and ineffective approaches to patient care, health systems can implement appropriate use criteria or initiate a usage monitoring process to ensure patients who will benefit most from a product or treatment are the ones receiving it. To determine the cost effectiveness of their clinical care, hos- pitals must have analytics technology, data scientists and gov- ernance processes in place to extract meaning from the data, according to Michael Schlosser, MD, CMO of HealthTrust, a Nashville, Tenn.-based group purchasing organization serv- ing more than 1,600 hospitals and 26,000-plus ancillary sites. Specifically, they need access to information on product and technology costs, use rates, and clinical outcomes of specific products and services. Since GPOs have access to a much larger amount of data than an individual hospital, they're a helpful resource for information to drive change. GPOs also have the tools and expertise neces- sary to extract meaning from the clinical evidence and data by evaluating its potential value, biases or flaws. While this type of data analysis is still a largely manual process, HealthTrust has begun automating the process by vetting evidence and evalu- ating new technologies on behalf of its member hospitals. Healthcare organizations that try to gain information about cost- effectiveness from other sources, such as product suppliers and government agencies, face three key challenges, according to Dr. Schlosser: