Case Study 1: Reducing Total Medical Expense (TME)

Challenge:
By some estimates, 30-40 percent of all U.S. healthcare system utilization and costs are wasteful and unnecessary. Physicians, nurses and business leaders across the industry all agree that costs are too high and the opportunities to reduce utilization are many.

Actions Taken/Approach to Solutions:
At Beth Israel Deaconess Care Organization, powerful health information technology tools were used to identify categories in which every healthcare dollar was spent in its global payment contracts. Very specific opportunities to improve care that also reduced utilization were prioritized. In Radiology, providers were educated to avoid C-T scans of joints prior to orthopedic referral and MRI scans were not ordered from the Emergency Department. Our analysis of provider practice pattern variations resulted in initiatives to decrease unnecessary endoscopies for GERD and unnecessary referrals to ENT for scoping for chronic sinusitis. In pharmacy, vigorous brand-to-generic conversions were highly successful.

Results:
In each of these categories, we observed improved and reduced patterns of unnecessary utilization resulting in higher quality care at a lower cost. (Actual numbers for these changes are proprietary; therefore, are not provided.)

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