Care Management Redesign Achieves $10+ Million in Savings

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Situation

A safety net hospital system in New York State sought clinical performance improvements to take care delivery from “good” to “great.” The system has more than 500 inpatients beds, home health, long-term care and a multispecialty medical group.

The two flagship facilities had approximately 17,250 annual discharges. The larger flagship hospital’s Emergency Department (ED) annual visit volume was approximately 37,000. Longer than expected lengths of stay reduced capacity in inpatient units and impeded ED throughput. Low weekend discharges hindered weekday throughput and capacity. Observation patients often stayed longer than 48 hours. The case mix index was 1.64, while actual care needs indicated a higher level of acuity.

Solution

The system partnered with Prism to deploy a two-phase project to revamp care management. First, they restructured core care management operations to align resources and support effective discharge planning. They integrated the Care Management and Social Work Departments and increased weekend and evening staff coverage.

Next, the system and Prism implemented changes to improve patient throughput and reduce length of stay system-wide. Significant initiatives included:

  • Establishing an observation unit to address length of stay.
  • Redesigning work processes, such as inpatient admissions as well as bed assignment and patient placement in the ED and PACU.
  • Engaging the hospitalists group through training, dashboard review and team meetings.
  • Collaborating with Clinical Documentation to educate and train physicians and improve the accuracy of patient status assignment.
  • Implementing a monitoring system to measure and sustain results.

Within 12 months, the system realized over $10 million in total annualized savings.

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Bonnie Barndt-Maglio, RN, PhD

Managing Director

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