MUSC, Medtronic celebrate a year of progress and innovations

While today’s health care industry continues to evolve, health care leaders actively seek ways to create clinical interventions that improve health outcomes and provide value-based care to patients. Simply defined, value-based health care strives to deliver the best patient outcomes for the lowest possible cost.

Why is value-based health care needed? In the Palmetto state, more than 3 million residents are affected by at least one chronic disease, like diabetes or high blood pressure. It’s estimated that the lives of more than 21,000 people could be saved annually through better chronic disease management and prevention. Building a value-based health care (VBHC) system is one way to achieve these lifesaving changes.

But how does an academic medical center and comprehensive health system like the Medical University of South Carolina transition from a traditional yet unsustainable fee-for-service health care model to a long-term value-based patient care model? MUSC senior leadership recognized that this was no simple question and an even more complex undertaking.

So to formulate a plan and take action, MUSC turned to the expertise of a like–minded health care industry partner that could apply its experience in value–focused financial business models and help to standardize processes that could transform the delivery of care for South Carolina residents.

Last February, MUSC entered into an important VBHC partnership with Medtronic, a global leader in medical technology, services and solutions. The goal was to help to drive this pioneering transformational change to improve patient care and lower costs.

This five–year VBHC partnership blends Medtronic’s technology expertise and MUSC’s clinical and academic expertise to create a coordinated health care model that will improve the evidence–based adoption of solutions that deliver value while sharing financial accountability. The VBHC model identifies health problems earlier, then streamlines and improves patient care while reducing overall costs.

The partnership is focused first on how medical technology and services can affect four specific areas — enhanced respiratory monitoring, heart failure, vascular disease and improved care for patients requiring breathing support.

MUSC President David J. Cole, M.D., FACS, is pleased with the progress of the partnership over the past year as well as the energy and efforts invested by the teams involved to align the organizations toward the goal of providing high–value, lower–cost health care.

Cole said that the first year working with the Medtronic team has laid a strong foundation for moving value–based health care from the drawing board to operational mode.

“Through this relationship, we are working to leverage our clinical and academic expertise in alignment with Medtronic’s excellence in technology and operations, bringing all these resources to bear to solve issues of critical importance to both of our organizations. Together we can improve outcomes for South Carolina patients and lead the way on value–based health care.”

 

Jan Kuklenski, senior director of Value–Based Healthcare Partnerships at Medtronic, praised the inclusiveness and enterprising values that have evolved over a short period of time.

According to Kuklenski, MUSC and Medtronic followed Medtronic’s Advantaged Ecosystem process that guides the strategy, data, legal, governance and operational aspects of the partnership. Governance committees for data, quality, finance and academia were formed to oversee how programs are selected, built and measured.

“The value–based health care partnership is process driven, with an infrastructure that requires collaboration, communication and trust,” she explained. “Each of the four VBHC programs has high compliance to a robust standardized clinical intervention process engineered for repeatability and scale.”

She further explained that the inclusive and entrepreneurial Medtronic-MUSC culture has developed over time.

“The overall MUSC and Medtronic alignment, willingness to engage and access to resources have been a positive influence on the partnership and progress. The processes we use to create value–based programs are powerful objective tools designed to help MUSC identify and use the right solution for the right patient at the right time.”

 

For the enhanced respiratory monitoring program, Medtronic has considerable expertise deploying this technology across the country, according to Nathanael Hevelone, director of health analytics for Value–Based Healthcare Partnerships at Medtronic. MUSC and Medtronic are conducting enhanced respiratory monitoring designed to identify patients who would most benefit from this monitoring technology by building alerts into MUSC’s electronic medical record to notify clinical staff that monitoring is recommended.

“Automating this evidence–based data into care decision support helps MUSC track both adherence to the care pathway and outcomes over time in this group of patients. It also lets everyone with a stake in the partnership make a true assessment of the value of technology,” Hevelone said.

To reduce respiratory complications in patients receiving intravenous opioids for pain relief, teams are evaluating solutions that can help patients manage pain while reducing risks for unintended difficulties, such as breathing problems. According to Danielle Scheurer, M.D., MUSC Health System chief quality officer, that goal can be complex.

“MUSC is working with Medtronic to standardize a care pathway in patients requiring intravenous opiates, whereby high–risk patients are placed on enhanced monitoring protocols. With such targeted monitoring and intervention, we plan to reduce the risk of unintended complications related to pain medications among hospitalized patients,” said Scheurer.

 

Another of the partnership’s areas of concentration, congestive heart failure, is among the most difficult–to–manage chronic conditions in South Carolina. Applying their expertise to this condition, MUSC and Medtronic teams are working together to risk–stratify these patients to provide targeted evidence-based interventions designed to improve their quality of life.

Ryan J. Tedford, M.D., associate professor of medicine and medical director of cardiac transplantation at MUSC Health, has worked closely with Medtronic teams, using this pathway tool to identify patients who are in need of advanced heart failure therapies or consultation in addition to those at highest risk for readmission.

“This tool will be key as we delegate resources and implement clinical pathways to reduce cost and improve outcomes,” said Tedford.

Led by MUSC director of vascular surgery Ravi Veeraswamy, M.D., and Elizabeth Genovese, M.D., the vascular program partnership has tremendous energy and momentum. The team is working on methods to detect vascular disease earlier in patients to prevent serious effects like lower limb amputations and abdominal aortic aneurysm ruptures. There has been transformative work and close collaboration between MUSC and Medtronic related to identifying patients at risk and working to get these patients the appropriate interventions. This program has the potential to affect care for patients across South Carolina greatly.

 

Matt Turner, chief data officer and associate chief information officer with MUSC Information Solutions, is excited about the meaningful work coming from the heart failure pathway project.

“Our teams are focused on early identification techniques that may predict treatments or therapies that will reduce unnecessary readmissions and improve the quality of life for heart failure patients. Timely monitoring of a rich data fabric for this disease will be critical to driving these improvements.”

The fourth program of the partnership aims to understand and reduce variation and improve care around tracheostomy and mechanical ventilation. MUSC and Medtronic have undertaken detailed data analysis to get a clearer picture of where the variation stems from to guide the next steps.

Coordinating data technology between MUSC’s health system and Medtronic to create data–driven programs requires transparency and teamwork, Turner added. In fact, he said, data serves as a cornerstone in all of the projects.

“Our collaboration with Medtronic has produced a data platform designed to enable safe and secure data exchange and drives clinical programs forward. Both MUSC and Medtronic experts agree upon data elements and metrics of success for each clinical program, and the team developed a reliable data asset that can be utilized for the lifecycle of the project. This level of transparency between partners allows for deeper and more meaningful integration."