Supernova Award Category
The Problem
Sutter Health sought to reduce readmission rates by three percent annually due to changes in federal legislation. These changes compelled hospitals to restructure the way they manage patients to save money and avoid government penalties. Under the Affordable Care Act, the Hospital Readmissions Reduction Program was established. It requires the Centers for Medicare & Medicaid Services (CMS) to reduce payments to hospitals with excess readmissions. As a result, hospitals have sought ways to lower these rates unilaterally. The new legislation requires CMS to account for patient socioeconomic status when calculating readmission penalties.
Other factors being constant, socioeconomic conditions likely have direct and significant impacts on avoidable readmissions. Per capita healthcare costs in the U.S. are the highest in the world and $25 billion in readmissions alone are spent annually. Reducing the number of unnecessary readmissions by even a few percentage points creates vast savings for Sutter Health.
The Solution
By using predictive analytics with Cloudera, Sutter Health took advantage of more unconventional data sources to produce more accurate readmission predictions. Cloudera has the power to ingest unrelated, unstructured and semi-structured data sources, which Sutter Health used to enrich existing medical data.
The results
The readmission predictive models that the Cloudera solutions enabled were very successful at identifying patients at high risk for readmission after an initial hospital stay. Sutter Health was also able to select several data sources for the predictive model it wasn’t previously able to, including EMR from a relational model and additional socioeconomic data such as the cost of housing and the availability of healthcare within the immediate area of Sutter Health hospitals.
Metrics
Using the derived predictions from the analysis that Cloudera solutions enabled, Sutter Health reaped the following savings: reduced 6,000 occurrences of patient readmission; avoided $4 million in potential Medicare penalties; saved approximately $72 million in medical service costs; and Sutter Health improved its hospital rating based on lower readmission rates and increased patient satisfaction scores.
The Technology
Cloudera Enterprise
Disruptive Factor
Because of the Affordable Care Act and subsequent changes to the Social Security Act, Sutter Health both wanted and needed to reduce its hospital readmission rate so it could simultaneously enhance its quality of care as well as reduce the likelihood and amount of any Medicare hospital readmission fines. With Cloudera’s technology solution, the healthcare network was able to achieve success in meeting both metrics. The security, flexibility and maturity of Cloudera solutions have prompted Sutter Health to consider expanding its platform to include even more robust analytics, reporting and mobile apps, helping to drive its strategy of driving forward personalized medicine and evidence-based care.
Shining Moment
In addition to the cost savings, Sutter Health was most proud of reducing 6,000 occurrences of patient readmission, using its resources more efficiently so it could provide extra care to high-risk patients, and of improving its hospital rating based on the lower readmission rate and increased patient satisfaction.