Seeking Solutions for The Healthcare Challenge

Disruptive Innovation for better care, better health, lower costs, and profitability

Imagine a hypothetical hospital group (the Glendale ACO) treats COPD patients. Last year, they had a 29% readmit rate and were fined $6.5 million by the CMS. The ACO did not qualify for share of savings, so they set up a Readmission Reduction Team to review their COPD cases. Glendale was determined to reduce or eliminate their readmits. They trained community PCPs, nurses, RTs, and care managers. In other words, they went full-court-press on this issue.

In their analysis of the 21 readmits, the patients’ profiles were essentially no different than those that were not readmitted. This excluded compliance, smoking, pets, and smog as contributing factors. =This was truly a mystery.

Disruptive Innovation: When More of the Same is NOT Enough

It became obvious that reviewing all the expected interventions and approaches were not enough to determine the factor(s) causing the readmits for these 21 mystery patients.

Enter the Disruptive Innovation Approach. The physical locations of each mystery readmit were superimposed on a map of the city. Non-medical factors such as regional weather, transportation load data, road networks, and terrain were then layered on top of the map. It was discovered that an interstate bisected the ACO service area with diesel trucks traveling this highway. COPD patients are affected by both of the elements of air pollution, ozone, and particulates. Critically, they are especially sensitive to particulates. The finer the particles, the more likely they are to trigger a COPD acute exacerbation. On this Interstate, most of the pollutant particles come from diesel engines. Those particles are fine and ultrafine. Almost all of the mystery readmits lived close to this highway.

Disruptive Innovation: One Healthcare Solution

Glendale developed a standard education and assistance program for all COPD patients who lived near either side of the Interstate. They encouraged these patients to do four things when the Air Quality Index was high: 1) run errands early in the morning; 2) avoid outdoor exertion; 3) stay indoors in general as much as possible; and 4) make the indoor environment as clean as possible by increasing weather stripping and using the highest-quality filters in air conditioning and heating systems.

Over the next six months Glendale reduced its COPD 30-day readmits. The special intervention for patients close to the interstate began to show significant results: only eight patients who lived near the highway were readmitted within 30 days since the intervention began.

The disruptive approach can be applied to other healthcare challenges and succeeds by:
1. Integrating patient and hospital data together with non-medical factors, and
2. Providing a fact-based objective means to discover solution options.

Attending the National Association of ACOs (NAACOS) conference? Please come visit us at Table #19. We will demonstrate our Disruptive Innovation approach to healthcare.

© Baldwin H. Tom CMC

Leave a Comment