MultiCare finds costs savings by guiding doctors in best practices

In the wake of the COVID-19 pandemic, the MultiCare health system sought to find ways to lower costs.

Arun Mathews, MD, regional chief medical officer of MultiCare, says an initiative to focus on best practices is reducing costs while preserving quality in patient care.

Arun T. Mathews, MD, regional chief medical officer at MultiCare, says the health system wanted to find ways to “gently” guide doctors to follow best practices and consider less expensive treatment options that still addressed the needs of patients. He points to the “Choosing Wisely” initiative from the American Board of Internal Medicine, which aims to help avoid unnecessary tests and treatments.

MultiCare partnered with IllumiCare, a technology firm, on a program offering suggestions on tests and treatments that align with best practices but can also reduce costs. So far, the effort has produced savings of more than $2.5 million, Mathews says. MultiCare, based in Tacoma, Wash., operates 13 hospitals and more than 300 healthcare locations in the Pacific Northwest.

Clinicians can still make the call on the best treatments for the patients. But doctors have utilized the guidance, and Mathews says the system is reducing expenses while maintaining high-quality care of patients.

“We use the power of evidence-based medicine to help us define treatments that may be similarly efficacious, but one may be significantly more expensive than another, to uncover tests that may not actually result in significant changes to medical decision-making or tests, such as imaging tests or lab tests that might not be efficacious or actually, paradoxically harmful to the patient,” Mathews says.

In a recent interview with Chief Healthcare Executive®, he explains the development of the program, getting support from clinicians, and where the program has succeeded.

Giving a nudge

MultiCare focused on pharmacy and laboratory orders in its initial efforts to lower costs, Mathews says. IllumiCare’s technology ties into MultiCare’s electronic health records. MultiCare uses Epic’s electronic health records, but Mathews says IllumiCare’s platform works with other health record systems.

IllumiCare’s software ties into the American Board of Internal Medicine’s database to offer guidance on the best practices for procedures, along with other databases. The system will offer clinicians suggestions on less expensive options for treatments, tests or procedures.

Since initiating the program, MultiCare has found opportunities to use less expensive but equally effective antibiotics, Mathews says. He also says some savings are found in moving from IV treatments to oral treatments.

Plus, MultiCare has helped reduce the excessive use of blood tests, which can add costs and potentially cause problems for patients, Mathews says. Patients who are subjected to blood tests too often can run the risk of developing hospital-based anemia.

“You can reduce their circulating blood volume because of the repetitive blood tests that you're doing,” Mathews says. “So just little things like that, I think helped us kind of nudge in a better care direction.”

Mathews stresses that MultiCare isn’t trying to dictate treatment plans to doctors, but to give them the best information to make the right decisions for patients.

“I'm very sensitive to the fact that the medical decision-making process, and the decision to order a medication or a lab, is a sacred event,” Mathews says. “That's why people go to medical school and understand differential diagnoses and management and evidence-based practice. So that is a sacred thing that we are potentially gently trying to influence. And so our goal was always just to make sure that the best practice information is readily available.”

MultiCare’s physicians can make the call on medication or treatment that’s more expensive if it’s in the patient’s best interest, Mathews says. The health system allows for clinical variation that fits a patient’s unique needs, but he says the goal is to align to best practices as much as possible.

“We will always support you in that regard,” he says. “This is about kind of trimming the fat off the edges of experiential practice, getting us closer to that central line of appropriate clinical variation.”

Dealing with ‘alert fatigue’

When MultiCare initially launched the program, it took some time for physicians to adjust. Initially, Mathews says many clinicians were taking time to open alerts and to read the suggestions, but they weren’t regularly adjusting care plans.

Mathews says MultiCare leaders met and talked with doctors who discussed the numerous steps involved in reviewing the alerts and potentially making changes. The system’s physicians also talked about “alert fatigue,” which Mathews says can contribute to clinician burnout.

After consulting with doctors, MultiCare instituted a clinical stewardship quality improvement metric, which essentially created a shared savings program.

“So if the physician decides to agree with the alert and does the additional work of changing their practice to support the patient's care, they would actually get credit for that part of that savings that is resulted for both the patient, the practice, the health system, etc.,” Mathews says. “And that was the transformative concept.”

With those changes, physician engagement with the alerts increased significantly. Mathews says the collaborative work with physicians in developing and refining the program has been a key to the early success.

“I think the magic word is partnership,” he says.

While MultiCare has focused on best practices and reducing costs in tests and treatments where feasible, Mathews says he’s encouraged that those steps aren’t hurting patient care. So far, he says there’s been no negative impact on hospital readmissions or patient experience scores.

Mathews hopes to see continued savings and better care with the program. In addition to reducing costs for MultiCare, he hopes the effort will reduce costs for patients.

“In this world of high deductible health care plans, we are seeing more and more costs gently roll over to patients,” he says. “And the more thoughtful we are at the point of ordering, the less those unnecessary costs might kind of fill up a deductible for a patient, or where they have to pay that amount before they actually get access to their insurance coverage.”

Ultimately, Mathews says the effort is aimed at giving patients better care.

“Stewardship actually ties into good medicine,” he says.