In today’s quality-driven, outcomes-focused landscape, it is important for healthcare organizations to strike the proper balance between driving better patient outcomes and enhancing efficiencies while still controlling overhead costs. A growing number of forward-thinking organizations are accomplishing this by implementing utilization programs that put operational processes under a microscope and turn lagging, outdated workflows into lean, money-saving activities.
It is a wise target, because unnecessary testing and blood waste put a huge financial strain on health systems. More than $340 billion is spent every year on excessive and inefficient care services, while nearly 50% of all blood transfusions and lab tests run across the continuum of care are unnecessary.
A utilization program is a long-term, cost-effective way to initiate large scale change in a healthcare organization because it goes beyond just surface-level strategy and to focus on foundational processes that can make the biggest impact—unnecessary testing and excessive blood waste. By strengthening testing and blood utilization programs, heath systems can:
- Gain 100% visibility into all lab orders to ensure appropriateness.
- Track metrics to reduce inappropriate, unnecessarily expensive, or duplicate testing and blood waste inventory.
- Increase patient satisfaction by ensuring the right test is being ordered at the right time for the right patient.
The following three-step guide walks healthcare teams through establishing test and blood utilization programs in their health systems to reap the clinical and financial benefits and advance value-based care.
Step 1: Understand the Current State
Before any utilization processes can be built or implemented, the overarching problems must be identified. Gathering, organizing, and analyzing such data can be an eye-opening experience for health system executives—one that can get leadership on board with a large-scale utilization initiative.
The two main areas of utilization most organizations focus on first are test utilization and blood utilization. This is because more than 94% of a patient’s medical record is influenced by lab data—and utilization decisions are no different. Thus, analyzing laboratory data is the first step in determining whether any existing utilization programs are working. Project leaders should focus on how and how often tests are being ordered and overall test volume, paying specific attention to high cost, outdated, and unnecessary tests that don’t provide value medically.
As for blood utilization metrics, these deal almost exclusively with overall volume and usage rates. Nearly half of all blood transfusions are inappropriate or medically unnecessary, a reality that is often overlooked because leadership has no idea how their organization handles blood volume. Blood products and blood transfusions aren’t typically reimbursed for inpatients and are minimally covered for outpatients, turning a seemingly life-saving product into a costly procedure.
When delivering findings on the current state of test and blood utilization, it is important to do so in a way that is easily understood by all stakeholders. Therefore, it is best to avoid data that is too granular or that zeroes in on individual physician ordering behaviors in a specific department. Instead, show the overall percentage of unnecessary tests ordered in a particular department or another broader statistic.
Also important is to present data in a way that promotes clear action and change. For example, if half of the organization’s ordering providers are requesting an outdated test, follow up that finding with an action plan on how to educate them to change behaviors. This information can help spark a system-wide change in how providers think and engage with test ordering and blood volume.
Finally, share findings throughout the entire organization rather than just with high-level executives. When building an internal utilization program committee, project leaders should involve peers, medical directors, and physicians to generate a mix of outlooks that contribute to fuller, more informed outcomes down the road.
Step 2: Set Realistic Goals and Measures
Developing long-term goals to help set the direction of new utilization programs is a multi-pronged step that requires leveraging both public governance programs to provide guidance and structure and a technology platform that delivers actionable insights.
There are five recognized categories for utilization management: high cost and unreimbursed testing; unnecessary blood transfusions; duplicative or repetitive tests; clinical pathway diversions; and obsolete or unproven tests. Most systems initially focus on or two utilization areas based on need as identified in the evaluation step. Separating utilization programs out into these smaller buckets results in faster wins and stronger, more focused solutions.
When it comes to tracking, measuring, and acting on new utilization outcomes, it is important to leverage a platform that is full-service, built for healthcare and supported by a vendor with in-house experts who can work closely with the internal team throughout this process. Your platform should be able to gather and analyze all lab, clinical, and blood transfusion data for a complete picture of utilization management, which legitimizes a utilization program and lets stakeholders take immediate action for continuous progress and change.
With the dashboard providing real-time updates on orders, reimbursements, and exceptions, physicians are provided the insights needed to support long-term utilization programs that can create cost efficiencies and improve patient care quality.
Step 3: Education and Marketing to Drive Change
Utilization programs are all about delivering safe, high-quality care to patients. But how effective they are at creating an enterprise-wide infrastructure for delivering high-value care depends on how well patients, physicians, and other staff members are educated on their importance.
When developing long-term internal education programs, an important first step is to seek feedback from those with the most experience, such as lab professionals or pathologists. Release new data and results quarterly to let physicians and executives know exactly how utilization impacts the healthcare system’s bottom line. Stand firm on new processes and change management procedures established as part of the utilization program.
Internal and external marketing campaigns are crucial for long-term buy-in and change management. Create webinars, videos, and seminars to explain the goals of the utilization program and to convey the benefits of compliance. Promote high-quality, patient-focused outcomes in your community to spread the word to patients and other stakeholders and share the program’s long-term results with all stakeholders.
Scheduling casual peer-to-peer learning opportunities can create long-term, interdepartmental collaboration, while expanding the utilization committee by recruiting team leads and other interested stakeholders will help build a more efficient, leaner organization.
Time — and Money — Well Spent
Replacing inefficient and expensive practices with a leaner, more effective utilization strategy isn’t easy. Success requires dedicating time, resources, and the right solutions.
However, getting focused test and blood utilization programs in place allows leaders to put in motion plans to drive high-value care for patients that lower costs and increase internal efficiencies. Most importantly, patients will have access to safer, evidenced-based care without having to suffer through unnecessary re-draws or costly transfusions.
Eliminating these expensive, careless procedures goes a long way toward providing patients with better care and lets health systems recover billions of wasted dollars that can be better spent on value-based initiatives.