THE 2023 INNOVATOR AWARDS PROGRAM


every facility, every department, every employee and every patient to ulti- mately achieve value-based care: a model wherein Memorial Hermann provided the highest quality care with the best service at the lowest possible cost.” For their comprehensive work to re-vision care delivery, the leaders at Memorial Hermann have been named the fourth-place-winning team in our annual Innovator Awards program. The Cl inical


Care Redesign (CCR)


initiative Erin Asprec


began five years ago, s tar t ing with an in-depth analysis of the patient journey across Memorial Hermann’s contin- uum of care, with,


as the health system’s leaders describe it, an examination of “all processes and touchpoints, and identifying opportuni- ties to improve clinical care. The goal was to streamline practices, improve safety and reliability of care, develop standards for medical necessity, reduce costs by eliminating unnecessary variation, and ultimately, create a better experience for the people who entrust Memorial Hermann with their lives and the lives of their loved ones.” The Memorial Hermann folks have focused on four areas that they believed might yield the greatest return on investment of effort, time, and resources. First is reducing clinical care variation, “by targeting spe- cific APR-DRGs (taking into consideration the patient’s diagnosis, the severity of his or her condition and the risk of mortality) and establishing a foundation and work processes that support evidence-based standards of care.” Second is “care progression,” which


means “empowering the patient’s mul- tidisciplinary care team to help move patients toward discharge through a flex- ible model for daily meetings to review every patient, every day, including tools and processes to identify and resolve barriers to care progress.” Third is case management, encompassing “increasing the effectiveness of case management to provide earlier intervention in patient placement and discharge planning with an aim to create seamless and coordi- nated care for the patient throughout their care.” And fourth is “clinical documentation integrity,” which has


“Clinical Care Redesign was a complete transfor- mation of the organization’s longstanding business practices that re-envi- sioned the way Memorial Hermann cared for patients. It touched the entire spec- trum of care and impacted every facility, every depart- ment, every employee and every patient to ultimately achieve value-based care: a model wherein Memorial Hermann provided the high- est quality care with the best service at the lowest possible cost.” — Erin Asprec


involved “increasing the accuracy and diligence of all clinical documentation to ensure all necessary steps are taken and documented appropriately.” The results speak for themselves:


through continuous benchmarking and measurement, Memorial Hermann lead- ers note today that “Through Clinical Care Redesign, the system has already achieved a savings of $236 million on a goal of $200 million since its rollout. In addition, the program has led to improve- ment in experience and mortality, and a decrease in readmissions.” Among the key changes: care delivery is more standardized than ever before, with clinical pathways established in core areas, including COPD/pneumonia, tra- cheotomy and ventilation, and coronary artery bypass graft, or CABG, to name a few, as well the standardization of surgi- cal supply packs. Reducing unnecessary variation, a key focus, has proven to be a huge success. At the same time, the Memorial


Hermann leaders note, their Clinical Care Redesign work has helped them in their accountable care organization (ACO) development, as they have com- mitted to continuing to move forward into value-based contracting. Memorial Hermann participates in the Medicare Shared Savings Program (MSSP), as well


14 hcinnovationgroup.com | MARCH/APRIL 2023


as in ACO contracts with all the major private health plans operating in the Houston metro area—Aetna, Humana, Cigna, and UnitedHealthcare. Altogether, they say, between 500,000 and 600,000 patients/plan members are attributed. Looking back at the start of the work,


COO Asprec says that, “From a broad- brush standpoint, Clinical Care Redesign started in 2017. Here in Houston, we had the oil bust, and the economy was poor, and frankly, our financials were challenged, as were those of other orga- nizations, at the time. So to turn that challenge into an opportunity, CCR was born. And we wanted to improve quality, outcomes, and cost. And now, our system is very intently moving towards value, and our definition for value is the high- est quality and outcomes, a phe- nomenal patient experience, and an improved cost pro- file. It literally is the initiative that will help us get to value. It’s con- tinued past


Matthew Harbison, M.D. the five-year mark,


and will continue until we can show what we’re doing is best for patients. We started out in the inpatient space only; now we’re following up in the outpatient space and across the continuum.” Among the critical success factors


so far, says Matthew Harbison, M.D., vice president of hospital care and


“We also underfstood that if we were going to tackle an issue, we needed to deter- mine what the KPIs were for that issue. For example, we developed about ten KPIs for fragility fracture, which is a measure of our clinical performance around caring for patients who have experienced bone fractures”—such as hip fractures.


— Matthew Harbison, M.D.


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