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CASE STUDY - Using Analytics to Improve Patient Outcomes and Billing Accuracy at Marshfield Clinic

With more than 50 regional locations staffed by 6,500 administrative and healthcare workers and over 800 physicians, Marshfield Clinic is a true innovator in patient care, efficiently managing more than 375,000 patients every year.

Commentary by Kate Konitzer, Manager of Analytics, Marshfield Clinic
and Mike Cummens, M.D. Associate Chief Medical Information Officer, Marshfield Clinic

With more than 50 regional locations staffed by 6,500 administrative and healthcare workers and over 800 physicians, Marshfield Clinic is a true innovator in patient care, efficiently managing more than 375,000 patients every year. For example, the management team made an early investment in electronic patient records. To facilitate the evolution to a completely chartless environment, Marshfield Clinic provided its staff with electronic tablets for history taking that automatically populate a centralized patient data warehouse. All financial and clinical care information about each patient—including histories, lab tests, medications, and diagnostic records—is safely stored, continuously updated, and ready for analysis and reporting.

Innovating to Keep up with Industry Change

The clinic recently participated in a high-profile pilot program through the U.S. Centers for Medicare & Medicaid Services (CMS) that rewards providers for improving patient outcomes and delivering efficient patient care. The CMS demonstration project included 32 quality metrics. The clinic used SAP BusinessObjects solutions to monitor these metrics as it implemented improvement initiatives. “We already had a system for collecting patient care data,” said Mike Cummens, M.D., associate chief medical information officer at Marshfield Clinic. “What we needed was the right analytics tool to push key patient care metrics and user-friendly reporting right out to physicians’ desktops to support real-time decision making.”

Marshfield Clinic is intensely interested in the accuracy and consistency of the billing codes assigned to a patient care visit. Investing in the right analytics software would also augment the clinic’s existing processes for evaluating medical coding appropriateness. It would enable the clinic to compare its coding to national benchmark data to help utilization review nursing staff identify physician training needs as they apply to medical coding.

“The analytical tools helped us identify outliers, increase medical coding accuracy, and decrease the variance by $5 million.” —Kate Konitzer, Manager of Analytics, Marshfield Clinic
An Upgrade Becomes an Opportunity for Change

Before Marshfield Clinic implemented SAP BusinessObjects solutions for analytics and reporting, it relied on complex ad hoc query tools for which users needed to undergo extensive training. As a result, the clinic’s ability to maximize benefits from its vast data repositories was severely hindered because routine report development fell to the business intelligence team.

“We were keenly aware of the limitations of our analytics software, which was overdue for an upgrade,” explained Kate Konitzer, manager of analytics for Marshfield Clinic. Before the clinic invested in an upgrade of its existing software, its information systems (IS) department decided to research other options to see if another product could better meet Marshfield’s current and future needs. “For example, with our previous solution, there was just no good way to share patient care metrics information with physicians,” Konitzer said. In addition, people who requested reports often had to wait a week or more to get the insight they needed.

In choosing a new tool set, the IS department wanted one that would provide self-service reporting and analytics, more meaningful visual displays, and more powerful analytical functionality. “Our existing software wasn’t designed to support the fast decisions that our physicians, management, and clinical care teams need to make every day, right down to each individual patient,” Cummens said. “It was by improving these frontline decisions that we could actually improve patient outcomes—one of the primary metrics the federal government is using to determine payment bonuses.”

SAP BusinessObjects: The Right Fit

After evaluating various options, Marshfield Clinic chose to deploy three SAP BusinessObjects solutions: SAP BusinessObjects enterprise software, SAP BusinessObjects Xcelsius® enterprise software, and SAP BusinessObjects Web Intelligence® software. “When it came down to it,” said Konitzer, “we needed software that non-IT people—especially our doctors—could use by themselves. The SAP BusinessObjects software gives us the best toolkit to accomplish our goals, and it really sets the organization apart from the competition.”

Equally important, by using SAP BusinessObjects Web Intelligence, the IS department could deploy these applications once and make them instantly accessible to all 50 satellite locations and every physician’s PC via a simple Web browser. This substantially reduced deployment effort and costs.

A Smooth Rollout and Adoption Process

Because Marshfield Clinic didn’t have to deploy the new software across its many locations, installing and configuring it was quick. The challenging aspect of the rollout was converting the clinic’s existing 60 Cognos catalogs into new semantic layers that worked with SAP BusinessObjects software. The entire process took nine months to complete. The clinic used a train-the-trainer approach for end-user training. “Physicians embraced the analytics after seeing how it could help them take better care of patients,” Konitzer said. The clinic continues to hold monthly brown-bag sessions as opportunities for power users to share best practices and foster a culture that uses analytics to improve patient care and operations.

Improving Patient Care—and the Bottom Line

SAP BusinessObjects applications have enabled Marshfield Clinic to meet all of its goals from a reporting and analytics perspective. Today, physicians’ key metrics are at their fingertips, right from their desktops. The clinic uses the applications to constantly monitor and track more than 30 metrics across six different categories (such as primary care) and subcategories (such as cardiology). Reports and dashboards are available by clinic, region, specialty, physician, patient, and more.

Perhaps most important, doctors can quickly identify patients at risk and proactively address issues with each patient, which has resulted in impressive patient care improvements. “For example, we currently manage about 19,000 diabetic patients,” Cummens explained. “Because our doctors can see trends and zero in on patients with potentially poor outcomes, they can proactively work with these patients—for example, by identifying smokers and getting them involved in cessation programs. As a result, the clinic has seen a 24 percent increase in blood pressure control, a 10 percent increase in A1C control, and a 24 percent increase in LDL control.”

These kinds of improvements have helped Marshfield Clinic successfully show improved quality of care in the CMS demonstration program for physician group practices. SAP BusinessObjects solutions have also enabled the clinic to address its concerns about billing inconsistencies.

“Using an evaluation and management dashboard, we identified a variance in our medical coding when compared to national benchmark data,” Konitzer said. “The analytical tools helped us identify outliers, increase medical coding accuracy, and decrease the variance by $5 million.”

Looking Ahead

After all of its success, Marshfield Clinic is hooked on analytics and eager to see how it can leverage its investments in SAP BusinessObjects solutions to address other challenges. “We plan on doing more predictive analytics—for example, to forecast demand and align clinical staff scheduling to meet that demand,” Konitzer said.

The clinic is also considering getting involved in other “accountable care” programs in which it would be responsible for providing care to a certain population as part of a larger network of hospitals and other clinics. “But before doing so, we will use analytics to assess risks, monitor the quality of care beyond our four walls (for example, at affiliated hospitals), and make informed decisions.”

This article originally appeared in the issue of .

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