Changing the course of care

One of the largest not-for-profit health systems in Texas looked with an eye to the future to not only redefine healthcare, but also to redefine the operational, clinical and financial performance of their health system. To transform the care delivery process and continue providing high-quality care to their patients, they required a comprehensive clinical care process improvement plan to bring greater structure and improved outcomes to their organization.

This heatlth system will be able to deliver improved care to patients after engaging in a robust clinical process improvement plan. KPMG worked onsite in Texas to establish a five-year blueprint for optimization in five key areas: Care Management, Multidisciplinary Care Rounds, Care Redesign, Clinical Documentation Improvement (CDI), and enhancements to utilizing their existing Data and Analytics. Currently in the process of implementation, our client will be able to:

• achieve $195 million in savings

• reengineer care management, including redefined and prioritized roles, processes, tools, training and metrics

• institute multidisciplinary care rounds with standardized communications and coordination among caregivers

• establish clinical care redesign in 12 diagnosis-related groups (DRGs) with a roadmap for clinical variation reduction and improvements in clinical outcome

• reconfigure CDI and Utilization Review departments with established metrics, monitoring, and specialty specific training and tools

• institute a new clinical governance model

• develop a data analytics program for opportunity identification, monitoring, and benefit dashboards.

A Texas leader in healthcare for over 100 years, this organization recognized that to maintain their quality of care and improve their relationships with payers, they needed to reduce their length of stay and cost per case metrics. To achieve these goals, they needed to reorganize and restructure their care delivery system. By bringing a cohesive strategy and structure to their processes, they believed they could improve performance universally, and deliver a higher quality of care for patients.

Embedded in the organization as a trusted advisor, KPMG worked onsite to establish a comprehensive plan for five key areas of the organization. The KPMG team of operational leaders and clinicians from across the country trained clinical teams within the organization through a shared resource model integrating proven methodologies, processes, and tools. With a comprehensive staffing analysis across the entire system, case manager roles,

processes, and tools were redefined and prioritized to more effectively outline priorities and manage and report on care coordination activities.

KPMG and the healthcare leader jointly identified 12 DRGs and launched a clinical redesign for three of these groupings instituting new clinical pathways, order sets, protocols, and metrics. The large not-for-profit is in the process of redesigning the remaining clinical conditions and implementing process changes. Focusing on clinical documentation, monthly coding, and CDI collaboration meetings were established.

As partners, we developed a proprietary analytical tool to examine clinical variation at the physician level. Across all clinical departments, metrics, and dashboards were established to monitor and optimize progress. With the tools in place for true transformation, our client is well on their way to improving patient outcomes through structured processes.

A structure for success adds important insights

The healthcare industry is rapidly changing, and remaining ahead of the curve requires proactive thinking, planning, and actions with respect to regulatory and reimbursement requirements. Historically, healthcare consulting has leveraged technological and procedural improvement models, but now clinical improvement is a key factor to success. Providers are realizing that process improvement experts are no longer solely focused on technology, but bring a wealth of knowledge that can utilize data and analytics to create lasting change across the organization.

Transformational teams require diverse skills

When embarking on large-scale training and transformation projects, relationships matter. Gathering a crossgeography team with the broad and deep expertise in specific fields ensures that all aspects of transformation are covered.