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Redesigning Care to Lower Episode Costs in Bone Marrow Transplantation
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
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The structure and process has functioned well for 14 months and will continue as FDA approvals begin to emerge to assist with standard of care process adjustments.
114 Redesigning Care to Lower Episode Costs in Bone Marrow Transplantation Laura Adams 1, Diana Patterson 2, Laura Johnston 3, Ning Tang 4, Christine McMurdo 5, Susan Chang 2. 1 Blood and Marrow Transplant Program, Stanford Health Care, Stanford, CA; 2 High Value Care, Stanford Health Care, Palo Alto, CA; 3 Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA; 4 Clinical Effectiveness and High Value Care, Stanford Health Care, Stanford, CA; 5 Financial Planning and Decision Support Services, Stanford Health Care, Palo Alto, CA
Figure 3. Clinical communication plan.
support. Logistical requirements were addressed effectively by each of the subcommittees and organizational resources were mobilized where needed. A new trial startup kit was made available (Figure 2). Specific builds were performed in the EHR. Educational tools were implemented. A highly differentiated and dispersed patient accounting infrastructure prompted general workflow changes. Unique communication pathways were developed and effectively activated during initial patient enrollments and subsequent care (Figure 3).
Increased scrutiny over costs of cancer care has led to the introduction of episode-based payment by federal and commercial insurers. National average billed charges for autologous and allogeneic transplants episodes of care are approximately $375K and $925K, respectively. Through comprehensive analysis of claims data, we identified leading drivers of cost in BMT episodes (which span 30 days before transplant through 60-100 days post-transplant) and cost reduction opportunities. By redesigning care delivery, we can reduce post-transplant admissions and potentially improve the health and patient experience for this population. Objectives: Understand the leading cost drivers in BMT episodes of care. Describe a targeted intervention for redesigning care delivery to reduce post-transplant admissions. Share learnings from our multidisciplinary collaboration to address post-transplant admissions. From September 1, 2013 – February 28, 2015, SHC performed 221 allogeneic and 241 autologous transplants. We analyzed internal claims data to map costs of BMT episodes, including pre-transplant, transplant (index), and posttransplant phases of care using standardized cost categories including room accommodations, medications, medical and surgical supplies, imaging and labs.
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Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
67% of episode cost was associated with pre-transplant and index phases. In both phases, patients’ treatment closely matched defined protocols. Imaging, medications, and blood utilization met clinical indications. The largest opportunity was seen in the post-transplant phase for multiple myeloma patients who received autologous transplants. On average, episodes with post-transplant admissions were 35% more costly than episodes without post-transplant admissions. Many of these patients are admitted 5-9 days after transplant due to neutropenic fever, have short LOS, and receive empiric antibiotics. An estimated 37% of post-transplant admissions, totaling $790,000 in annualized cost, may be prevented with additional outpatient support. A multidisciplinary team proposed redesigning care to safely shift treatment from the inpatient to outpatient setting. Strategies include expanding Infusion Treatment Area and home pharmacy capacity and partnering with home health agencies.
TRANSPLANTATION DATA MANAGEMENT BEST ABSTRACTS
115 New Quality Improvement Plan for Center for International Blood & Marrow Transplant Research (CIBMTR) Data Nicolette Maria Minas, Kathleen Ruehle. Greenebaum Cancer Center, Blood & Marrow Transplant Program, University of Maryland Medical Center, Baltimore, MD Background: The University of Maryland Medical Center’s Blood and Marrow Transplant (BMT) program is committed to continuous improvement. Performance Improvement techniques and Lean philosophies are used
S109
The structure and process has functioned well for 14 months and will continue as FDA approvals begin to emerge to assist with standard of care process adjustments.
114 Redesigning Care to Lower Episode Costs in Bone Marrow Transplantation Laura Adams 1, Diana Patterson 2, Laura Johnston 3, Ning Tang 4, Christine McMurdo 5, Susan Chang 2. 1 Blood and Marrow Transplant Program, Stanford Health Care, Stanford, CA; 2 High Value Care, Stanford Health Care, Palo Alto, CA; 3 Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA; 4 Clinical Effectiveness and High Value Care, Stanford Health Care, Stanford, CA; 5 Financial Planning and Decision Support Services, Stanford Health Care, Palo Alto, CA
Figure 3. Clinical communication plan.
support. Logistical requirements were addressed effectively by each of the subcommittees and organizational resources were mobilized where needed. A new trial startup kit was made available (Figure 2). Specific builds were performed in the EHR. Educational tools were implemented. A highly differentiated and dispersed patient accounting infrastructure prompted general workflow changes. Unique communication pathways were developed and effectively activated during initial patient enrollments and subsequent care (Figure 3).
Increased scrutiny over costs of cancer care has led to the introduction of episode-based payment by federal and commercial insurers. National average billed charges for autologous and allogeneic transplants episodes of care are approximately $375K and $925K, respectively. Through comprehensive analysis of claims data, we identified leading drivers of cost in BMT episodes (which span 30 days before transplant through 60-100 days post-transplant) and cost reduction opportunities. By redesigning care delivery, we can reduce post-transplant admissions and potentially improve the health and patient experience for this population. Objectives: Understand the leading cost drivers in BMT episodes of care. Describe a targeted intervention for redesigning care delivery to reduce post-transplant admissions. Share learnings from our multidisciplinary collaboration to address post-transplant admissions. From September 1, 2013 – February 28, 2015, SHC performed 221 allogeneic and 241 autologous transplants. We analyzed internal claims data to map costs of BMT episodes, including pre-transplant, transplant (index), and posttransplant phases of care using standardized cost categories including room accommodations, medications, medical and surgical supplies, imaging and labs.
S110
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
67% of episode cost was associated with pre-transplant and index phases. In both phases, patients’ treatment closely matched defined protocols. Imaging, medications, and blood utilization met clinical indications. The largest opportunity was seen in the post-transplant phase for multiple myeloma patients who received autologous transplants. On average, episodes with post-transplant admissions were 35% more costly than episodes without post-transplant admissions. Many of these patients are admitted 5-9 days after transplant due to neutropenic fever, have short LOS, and receive empiric antibiotics. An estimated 37% of post-transplant admissions, totaling $790,000 in annualized cost, may be prevented with additional outpatient support. A multidisciplinary team proposed redesigning care to safely shift treatment from the inpatient to outpatient setting. Strategies include expanding Infusion Treatment Area and home pharmacy capacity and partnering with home health agencies.
TRANSPLANTATION DATA MANAGEMENT BEST ABSTRACTS
115 New Quality Improvement Plan for Center for International Blood & Marrow Transplant Research (CIBMTR) Data Nicolette Maria Minas, Kathleen Ruehle. Greenebaum Cancer Center, Blood & Marrow Transplant Program, University of Maryland Medical Center, Baltimore, MD Background: The University of Maryland Medical Center’s Blood and Marrow Transplant (BMT) program is committed to continuous improvement. Performance Improvement techniques and Lean philosophies are used