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March 1, 2017

How one pediatric hospital targeted unnecessary care—and saved $1 million

Daily Briefing

California-based Children's Hospital of Orange County (CHOC), in a partnership with Rady Children's Hospital-San Diego, is working on a population health initiative that creates evidence-based guidelines to reduce inefficiency and improve quality of care.

Initiative details

The initiative, which launched last year, targets unnecessary care and procedures, such as emergency department visits, hospitalizations, referrals, and tests, for six conditions that are common among children and adolescents:

  • Acne;
  • Acute gastroenteritis;
  • Asthma;
  • Bronchiolitis;
  • Headaches; and
  • Pneumonia.

For the initiative, which is funded in part by a $17.7 million CMS grant, evidence-based medicine committees developed practice guidelines for the six conditions that were embedded into EHRs.

The guidelines, for instance, call for a pediatrician to attempt to treat a teenager's acne before handing the patient off to a dermatologist. About 1,450 pediatric primary-care providers and specialists are taking part in the initiative.

Michael Weiss, head of CHOC's division of population health, who is leading the initiative, said, "The thought process was, if we could use our experts in various fields to help create applicable, readily usable guidelines to help reduce variation in care, we'd be able to improve quality."

Providers receive data on how well they perform and follow the initiative practice guidelines, Modern Healthcare reports. While most of the performance data pertains to Medicaid beneficiaries, CHOC is working on collecting data on commercially insured children as well.

The hospital also established patient registries to facilitate clinical data sharing among providers and overhauled its medical record systems to improve communication and reduce duplication. To help implement the initiative, CHOC hired a manager, two data analysts, and seven or eight quality improvement advisers.

Early data show savings

According to Modern Healthcare, the model established financial incentives for the hospital to prevent children from becoming sick, instead of profiting from when they are ill.

Implementing the guidelines for neuroimaging helped providers reduce unnecessary tests, such as brain MRIs. Weiss said the guidelines generated $350,000 in savings for neuroimaging over six months.

In addition, a pilot of the initiative had shown an 18 percent year-over-year reduction in asthma-related ED visits. Weiss said that decline translated to about $1 million in annual savings in just one of CHOC's clinics.

Claire Brindis, a professor of pediatrics and health policy at the University of California-San Francisco who is not involved in CHOC's initiative, said, "They're being very proactive in trying to understand the environment of the children and families that they care for" (Whitman, Modern Healthcare, 2/25).

Want to learn best practices for reducing care variation?

It’s difficult to decide how to best reduce unwarranted care variation. To help you along the way, we’ve studied the top-performing hospitals to understand the best practices for success. Join us on March 7 at 1 p.m. ET for a complimentary webconference to learn more about the research and possible solutions for engaging your physicians in care variation reduction.

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