How Lightbeam and Motive help St. Luke’s connect clinician-level appropriateness to specialty network cost and utilization
Health systems, ACOs, and other risk-bearing provider organizations have more information than ever about cost, utilization, quality, and risk. But one question often goes unanswered: Did the patient need the care they received?
That is a different question from asking how much the care cost or how often it was delivered. Higher cost and utilization may be warranted, particularly when a clinician is treating a sicker patient population. The opportunity lies in identifying costs associated with care that do not align with the evidence-based standards of care. These are impactable costs, and they are actionable.
How clinican-level appropriateness measurement identifies impactable cost
Lightbeam Health Solutions and Motive Medical Intelligence are working together to help healthcare organizations identify and act on impactable cost. Lightbeam brings clinical, claims, cost, and utilization data together across a population. Motive’s Practicing Wisely clinician-level performance measurement platform adds individual clinician-level appropriateness measurement to determine whether the care delivered is aligned with the evidence and identifies the clinical decisions that are driving impactable cost.
Clinical decisions made at the point of care can have a significant impact on healthcare cost, utilization, and quality. Yet clinician performance measurement has traditionally focused on primary care, leaving health systems, ACOs, and other risk-bearing organizations with far less insight into specialty care, even as they take on greater responsibility for total patient cost and performance. Without that visibility, it is difficult to know which specialists are delivering high-value, evidence-based care and which clinical decisions are driving potentially avoidable costs.
“Organizations have no shortage of data, but the real value comes from being able to connect that information in a way that helps teams understand where they can take action,” said Mike Hoxter, Chief Technology Officer of Lightbeam Health Solutions. “Clinician-level appropriateness measurement gives risk-bearing providers another important piece of that picture. It helps them see where care may be unnecessary or where low-value care is being delivered, so they can focus their efforts where they have the greatest opportunity to improve outcomes and reduce cost.”
How St. Luke’s is applying appropriateness measurement in specialty care
St. Luke’s Health System is a not-for-profit, locally governed regional health system based in Boise, Idaho, with eight hospitals and more than 200 clinics serving communities across southern Idaho, eastern Oregon, and northern Nevada. The system is using Practicing Wisely through the Lightbeam-Motive partnership to examine clinical appropriateness in specialties with high cost and utilization, including cardiovascular disease, ophthalmology, orthopedic surgery, and nephrology. Motive is conducting clinician-level performance measurement across these specialty areas, analyzing the data, and working with St. Luke’s to review the findings and prioritize opportunities, starting with orthopedic surgery.
In orthopedics, St. Luke’s was already examining orthopedic surgery and imaging utilization related to knee osteoarthritis and low back pain. Practicing Wisely added another layer of insight by evaluating the clinical decisions behind that utilization. For example, one analysis considered whether performed knee arthroplasties were supported by the evidence, whether appropriate imaging and conservative therapies had been considered, and how those practice patterns varied among clinicians.
Practicing Wisely also looked at the use of computer-assisted surgical navigation in total knee arthroplasty. This approach adds cost and may help facilities complete more procedures, but the evidence reviewed did not show that it improves patient outcomes. Utilization data can show how often this approach is used. Appropriateness measurement provides the clinical context St. Luke’s needs to determine whether its use represents an opportunity to change clinical practice behavior or take operational or contracting action.
The specific nature of the intelligence can lead to more productive conversations and actionable strategies. Rather than simply telling a physician or service line that its care is “high cost,” leaders can point to the specific clinical decisions and cases behind the finding and work through them together.
The Practicing Wisely methodology is built to support exactly that kind of conversation. It is evidence-based and transparent, comparing closed claims data with standards of care published by national medical societies, attributing findings to the individual clinician responsible for care decisions, and excluding cases that cannot be measured with confidence. Each measure is accompanied by a documentation guide so physicians can review the clinical rationale behind a finding rather than take a score at face value. The platform evaluates every clinician across each measure for which they have a sufficient number of qualifying cases, identifying both overuse, when services are performed without appropriate clinical indications, and underuse, when evidence-based care is not delivered. Performance is then compared with Motive’s Range of Better Practice, national benchmarks, and relevant peer groups, giving health system leaders a defensible basis for discussion.
“The Practicing Wisely orthopedics analysis gave us a clearer view of where variation in care was occurring and where we had an opportunity to take a closer look,” says Dani Jones, Chief Operating Officer, St. Luke’s Health Network. “That clinician-level insight helps us better understand what is driving variation and will inform the conversations and decisions we make with our physicians and across the network.”
How clinician-level insights guide targeted action
The purpose of the joint Lightbeam-Motive solution is not just to deliver another performance score. It is to help organizations understand what drives cost and utilization patterns, isolate the portion of those costs that is impactable, and pinpoint where intervention is likely to make a difference. Depending on the finding, that may mean physician education, a referral pathway change, an operational improvement, or a contracting discussion.
Cost and utilization measures show where variation exists. Clinician-level appropriateness measurement, grounded in evidence-based clinical criteria, helps organizations determine whether that variation represents an opportunity to improve care and address impactable cost or simply reflects the needs of a sicker patient population. Together, these insights give risk-bearing provider organizations a more precise basis for deciding where and how to intervene.
Learn how Motive’s Practicing Wisely can help your organization identify and address impactable cost.
