LPACO largely had a high burden of urologic diseases and a prevalence of UTIs leading to hospitalizations. Specifically, five hospital admissions for UTIs (both male and female) that all had prior urinary symptoms (BPH, UTI, incontinence, delayed emptying) were observed over just one weekend. LPACO reviewed the urology consultation obtained on all admissions and pathology, with urinary symptoms (BPH, neurogenic bladder, bladder atony, stone disease, incontinence) recorded in all 5 patients but needed a thorough analysis, backed by data, to validate hypothesis and help reduce avoidable hospital admissions.
How CareJourney Helped
LPACO engaged CareJourney to dive into the data to further elucidate the hypothesis and work collaboratively with the physicians in the ACO to reduce avoidable hospital admits. Based on an analysis of all LPACO paid claims over a one-year window, CareJourney found that patients with at least one urologist visit had decreased utilization of IP admits for UTIs and overall, had a lower PMPY than patients who did not have a visit with a urologist.
CareJourney’s service model includes a member-driven product roadmap to ensure our solutions remain aligned with our members’ needs. The CareJourney team built an impactable admission suite of reports modeled on the Agency for Healthcare Research and Quality’s (AHRQ) Prevention Quality Indicators (PQIs). These reports show both utilization and spend over any selected period of time and allow users to slice the data across levels in their ACO (ACO/TIN/provider) and across patient risk segments. The ACO team leveraged this set of reports to track reductions in impactable admissions for UTIs for their attributed patient population. From Performance Year (PY) 2017 to PY 2018, the ACO realized a 16% reduction in these admissions, leading to a 6% decrease in inpatient PMPY year over year.