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Ensuring Excellence with a Trusted Intermediary

Best Practices Winner: Vanderbilt University
Project: A Computerized, Clinically-Intelligent System to Deliver Clinical Alerts to Physicians and Their Patients. Improves Care and Lowers Health Care Costs
Category: Knowledge Management
Nominated by: ActiveHealth Management

By Allison Proffitt

July 20, 2009
| The success of Vanderbilt University’s disease management program is not just due to the technology provided by ActiveHealth Management, the company responsible for alerting Vanderbilt physicians to potential discrepancies in a patient’s care, but to Vanderbilt’s Internal Medicine team that vets the alerts before passing them on to other physicians.

In 2007, Vanderbilt implemented ActiveHealth’s CareEngine System, a clinical decision support technology, with the goals of improving the quality of care through fewer adverse events, such as heart attacks, strokes, or exacerbations of certain chronic conditions, and as a result, decreasing the cost of care.

Typically, a clinical alerting system, “sends information to a physician and patient at the same time that says, ‘We have found something... going on with this patient’, maybe a patient is taking medications from two different doctors that shouldn’t be taken together. Sometimes there’s a valid reason, but sometimes it’s a mistake and one or the other doctor will fix it,” explains Ginny McLean, marketing coordinator and benefits communicator for Vanderbilt.

ActiveHealth’s CareEngine System runs “a set of about 1000 highly-specific clinical rules against an integrated and constantly-refreshed set of eligibility, demographic, claims (medical and pharmacy), lab results, and physician- and patient-reported data.” Any red flags are sent as “Care Considerations” to the doctors. “Some doctors will get the information from a disease management company and just toss it, or say I don’t need to be verified by a disease management company,” says McLean.

Vanderbilt solved the problem by pairing ActiveHealth’s existing CareEngine System with “triage” by Vanderbilt’s Health Promotion Disease Management Center. Vanderbilt established a “trusted clinical intermediary,” a team of clinical nurse specialists who first review the alerts to ensure they are accurate at the time of receipt, and consider any additional patient data not available to the CareEngine.

 “The process we developed with ActiveHealth has helped us measurably improve the quality and safety of the care we provide,” says Jim Jirjis, medical director, Vanderbilt Primary Care group. “Having our nurses review the Care Considerations before sending them on to the physicians personalizes health management for the patient.”

Workflow Integration
“Care Considerations are uniquely valuable to Vanderbilt because it’s information they wouldn’t otherwise have,” says Henry Wei, medical director, ActiveHealth Management. “And you have the combination of that factor with another that you don’t often have in that these alerts are integrated into their daily work flow through a trusted intermediary... We at ActiveHealth view this as a best practice.”

The goal of the effort was to increase the likelihood that Care Considerations would be viewed as current and appropriate by physicians, and ActiveHealth measured a 5% increase in physician compliance by the doctors supported by the Health Promotion Disease Management Center’s efforts. The financial ROI was just as encouraging. Vanderbilt Health Plan compared the cost savings between the population that see Vanderbilt doctors and benefit from the alert triage and the population that see non-Vanderbilt doctors that do not have access to the alert triage. The group without triage saw a savings $45.06 per insured patient thanks to ActiveHealth’s product. The group benefiting from CareEngine and Vanderbilt’s nurse review saw savings of $83.73 per patient.

“This approach to disease management has resulted in a significant increase in compliance and adherence through this joint effort between Vanderbilt University and ActiveHealth,” says Luke Beauchamp, benefits administrator for the Vanderbilt Health Plan.

The relationship between ActiveHealth and Vanderbilt was a strong one. “From the beginning we wanted [ActiveHealth] to be involved,” says McLean. “We were on conference calls together; we were setting up the system to do this.”

Wei agrees. “The work with Vanderbilt is a great example and we believe we can continue to build upon that innovation... We continue to work with financial data to make sure this is a sustainable initiative. It’s not just IT for IT’s sake. It’s truly sustainable and leading to improved outcomes [for patients].” 

This article also appeared in the July-August 2009 issue of Bio-IT World Magazine.
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