A Process for Identifying and Implementing BMT Value-Based Care Initiatives: Cleveland Clinic Experience

The Patient Protection and Affordable Care Act (PPACA) of 2010 changed rules on how Medicare pays hospitals with the intent on improving healthcare quality. Provider performance such as readmission or infection rates, patient satisfaction surveys, and patient outcomes now impact reimbursement rates. The concept is that the payment for health care services should reflect value, not volume. The Blood & Marrow Transplant (BMT) program at the Cleveland Clinic, not unlike other BMT programs, has a robust quality program which provides rigorous, disciplined measurement and improvement of quality. We also complete a detailed cost analysis on each transplant patient annually. In the present healthcare environment, our historical methods of process improvement and cost reduction are not enough. The Taussig Cancer Institute developed a new process for creating and approving value-based care initiatives. Each department in the Institute formed a committee. The BMT program’s committee includes the medical director, quality information officer, staff physician, clinical pharmacist, clinical manager, quality manager, reimbursement specialist, social worker, and administrator. The committee meets monthly to brainstorm on new initiatives, create project plans, and work through the projects. All project plans are presented by the administrator and approved through the Institute’s Project Governance committee. This level of review provides direction and allocates resources for the project plan. Each project plan includes the typical components inclusive of a problem statement, key metrics, scope, assumptions, constraints, milestones, and project team members and stakeholders. A value based project portfolio is maintained and updates on the projects are presented to the Institute’s Value-Based committee. The most recent projects include: Moving the infusion of high dose melphalan for autologous transplants from inpatient to the outpatient setting followed by the hospital admission Penicillin skin testing for all patients who report a penicillin or cephalosporin allergy prior to transplant to ensure the most efficacious and cost effective therapy can be utilized Early discharge for multiple myeloma autologous BMT patients that meet specific criteria Changing the use of fosaprepitant for olanzapine in the autologous patient population Transitioning multiple myeloma autologous transplants from inpatient to outpatient Reviewing all standard orders and minimizing any unnecessary standard tests and labs Developing care paths to establish standards for patient care Drug utilization review The new process has provided our program additional structure for creating and working through potential value-based initiatives along with getting much desired visibility and support by our Institute.