Clinical data must figure into value-based care, Yale New Haven executive says

Stephen Allegretto of the $4.4 billion Yale New Haven Health System brought the clinical into the financial side of value-based care Tuesday in addressing how providers should evaluate the cost of quality.

Allegretto gave the example of a case at Yale New Haven, in which a 70-year old man came in for cardiac surgery and suffered a surgical site infection.

This isn't unusual, as infections in cardiac surgeries happen in about 35 percent of cases, Allegretto said. Surgical site infections happen in about 3 percent of all cases, Allegretto said.

The cost for the cardiac surgery for this man was $36,000. Because this was a 90-day bundled payment agreement and the target bundled price was $61,000, the hospital ended up making $25,000 from the original surgery. 

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But because of the surgical site infection, the case ended up generating claims of $95,000. Yale New Haven paid Medicare $30,000.

This is the financial side, but the clinical side also had its consequences, he said.

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Because of the surgical site infection, it took over a year for the patient to get his life back to normal. He's also on oral antibiotics for the rest of his life.

Using a STS adult cardiac surgery risk calculator score in another case, providers knew an elderly woman had a 40 percent chance of dying within 30 days of surgery.  Given her age and the complexity of surgery, the patient and family needed to know the data to make an informed decision of whether to go forward, Allegretto said.

The question for providers is, what is the appropriate use of this data, Allegretto asked?

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The woman received the operation and was in the hospital for 24 days, part of that time spent in the ICU. After release from the hospital, she was readmitted. The total cost was $90,000, and the margin was negative.

"Now what do we do?" Allegretto said. "We started a multidisciplinary heart care team that talks about what's the most appropriate level of care for that patient."

Profit and loss on patients needs clinical data that can get to clinical registries, and needs to be in real time, he said.

Yale New Haven also uses a Rothman index of information including data from labs and nursing assessments.

What is the value of the care patients receive, when the third leading cause of death in this country, after cancer and heart attacks, is from healthcare errors, he asked?

Value equals the quality and safety of the patient experience divided by cost and price, he said.

The road ahead, he said, is measuring value for every patient.

Allegretto, vice president of analytic strategic and financial planning for Yale New Haven, spoke Monday at HIMSS's Revenue Cycle Solutions Summit in Boston.

"The question is," he said, "now that you have data, how do you use it?"

Twitter: @SusanJMorse