McLaren Health Care is a Michigan-based fully integrated health system committed to quality, evidence-based patient care and cost efficiency. With more than 80 primary and specialty centers located throughout the areas served by McLaren Health Care’s 12 hospitals, the McLaren system includes an entire network of professionals and locations that make the highest level of care a priority.https://www.mclaren.org/main/home.aspx
After successfully launching and managing an effective blood utilization program, McLaren pinpointed lab testing as an area for improvement as part of its mission to deliver High Value Care. An often-overlooked service, lab testing is typically the single highest volume medical activity in a health system. But despite its major role in driving clinical decision-making, the use of lab testing is highly variable and riddled with waste.
Nationally, an estimated $200 billion is wasted each year on excessive lab testing and associated treatments, resulting in major costs and added risks to patients.
While McLaren understood the inherent value of improving its utilization efforts, disparate data spread across its various locations —the organization has 4 different LIS’s and 2 blood banks—created complex challenges with respect to even gathering the data for analysis. And the analysis was only the starting point. McLaren needed to ensure that all stakeholders were fully invested in the reasons for, the process for, and measurement of the program in order for it to succeed.
With expertise from Dr. Tim Hannon, a clinical transformation expert and CEO of Healthcare Forward, McLaren began by creating a step-by-step action plan with the objectives of:
Building on this plan, their utilization program emphasized 3 key areas:
For McLaren to understand its biggest opportunities for improvement, it first needed to break down technology barriers. Leveraging the hc1 Platform, the organization was able to gather and house all disparate data in a single repository, clean and organize the data, and automatically deliver dashboards that made actionable metrics available to stakeholders for review.
Focus & Approach
McLaren also followed utilization best practices as set out by the Choosing Wisely list, which provides structure for 5 categories of utilization management:
Tackling all 5 areas at once would make it difficult to zero in on real improvements. Using the visualization offered via hc1, McLaren identified repetitive testing as its first major area of improvement. McLaren also decided to focus its test utilization initiatives on in-patient visits (versus ER or outpatient visits), putting the weight of its resources towards driving change among its own providers.
Actions to Drive Positive Change
With real-time visibility and a clear focus for initial improvement, McLaren was able to then quickly compare utilization trends by site location, physician, and several other attributes to bring issues and opportunities to light.
These findings were then presented to all stakeholders with real-time, data-backed reports and benchmarks. With an education-oriented mindset, the utilization committee met with ordering physicians to guide behavior toward safer, more patient-focused care.
McLaren was able to drive further change by including hard stops and semi-hard stops via an integration between hc1 and its EHR. For example, lipid profiles, consistently topping the list for over-utilization at several sites, were previously an unnecessary part of an order set and have since been removed. In other instances, the physician is now presented with all associated information (including previous test information) to determine whether a test that is flagged as an unnecessary reorder should be ordered.
Effective utilization programs begin with internal buy-in and are reliant on pinpointing key metrics and providing an infrastructure for change. We are now able to continually identify areas of opportunity and benchmark our performance across locations. At the same time, by delivering the right test to the right patient, the end result is better patient care and higher patient sentiment.
Recognizing that test utilization is an ongoing process, McLaren has quickly achieved measurable success at several of its sites. Examples include:
Flint: Over a four-month period, lipid panels declined by 43% and the overall decline in exceptions was 44%.
Northern Michigan: Over the same time, this location’s CKMB exceptions went from 132 to 0.
A major component of McLaren’s success is its monthly user group meeting. Ten different sites are represented, with a “super user” from each. During these meetings, a member from the marketing team brings an educational storyboard to the table demonstrating change (such as the lipids example). Additionally, posters such as “Pause the Draws” reinforce the importance of ongoing utilization awareness.
According to McLaren Chief Medical Officer of Laboratory Services Dr. Dennis Spender: “Effective utilization programs begin with internal buy-in and are reliant on pinpointing key metrics and providing an infrastructure for change. We are now able to continually identify areas of opportunity and benchmark our performance across locations. At the same time, by delivering the right test to the right patient, the end result is better patient care and higher patient sentiment.”