The U.S. healthcare system is in need of a new way of designing and implementing care, one that maximizes patient value by achieving the best possible outcomes at the lowest cost. Well-designed and well-targeted care coordination has the potential to do just this. Today and from this point forward, Tampa General Hospital is in the care coordination business. Chief executive officers everywhere—both within and outside of the healthcare industry—can leverage the fundamental principles of care coordination to streamline their processes, improve outcomes and redefine their value propositions. Because care coordination is wholly focused on how to best use the tools and resources available to deliver value for the person an organization was built to serve, it is a model for how every business should strive to operate.
What does care coordination require? A 360-degree, consumer-friendly approach to patient-centered care. More specifically, this model services the medical and nonmedical needs that impact the health of the individual. Armed with technology and the appropriate communication tools across care settings, care coordination allows providers to anticipate patient needs and potential red flags.
Through care coordination, organizations can intervene to improve care quality and drive outcomes by providing the appropriate treatment when and where it is needed—from the ambulatory to acute to post-acute settings—to care for not only those patients with immediate health needs but also those with chronic conditions.
Driving Care
Tampa General Hospital/Florida Health Science Center has begun to invest, plan and implement care coordination across the ambulatory, acute and post-acute settings. Tampa General/Florida Health Sciences Center, a 1,040-plus-bed academic medical system with over 125 locations and facilities, provides the ideal laboratory for implementing and examining the effectiveness of coordinated care. It is a microcosm of the industry, representing the future composite of healthcare systems in terms of size and scope. All care settings converge into one care system with the patient at the center; however, specific strategies to drive care coordination are unique to each setting.
For example, in the ambulatory setting, the organization uses a robust nurse navigator program at Tampa General Diagnostic Center, Sun City, Fla. This multipurpose facility, which houses a diagnostic clinic, urgent care facility, primary care practice, diagnostic imaging and a laboratory, was specifically designed to support patients without existing connections to local care providers, allowing them to walk into the facility (without an appointment) to receive a diagnostic work-up by a physician.
From there, a nurse navigator coordinates all needed follow-up medical care and helps access support services. They assist with appointments, answer specific clinical questions, explain medication, facilitate transportation and logistics, and help link patients to the right providers, essentially serving as a patient’s healthcare “sherpa.” Additionally, the navigator is embedded in the community and can access additional support services that help improve patients’ existing health and serve to offset social determinants of health such as access to fresh food. Ultimately, by establishing a path of coordinated care, inefficiencies and potential roadblocks are removed.
The in-patient acute hospital setting uses the hospital command center, CareComm, for predictive analytics and artificial intelligence applications to help optimize minute-to-minute patient care operations and care coordination with real-time actionable information. An example of this work is to combat and manage sepsis, a leading cause of U.S. inpatient hospital deaths and hospital readmittance.
For over 10 years, Tampa General has been working hard to reduce the impact of sepsis in the hospital, making slow and steady improvement. By leveraging the CareComm command center to develop an early warning and management system for sepsis, Tampa General decreased its average sepsis mortality to 6.2%—significantly lower than the national average of 24%. The early death rate was nearly halved from 6.1% to 3.1%, which accounts for more than 50 lives saved within just six months of implementation. However, with the proper information early enough, outcomes can be dramatically improved, as early recognition and rapid treatment are the interventions proven to reduce morbidity, mortality and length of stay in sepsis patients.
In 2022, the organization began working with the CareComm sepsis tile, a diagnostic dashboard comprised of technological innovation that focuses both on the early detection of patients at risk for sepsis and subsequent monitoring of management protocols for patients that acquire the disease. The tile uses real-time patient data and applies a rule-based algorithm to monitor 16 risk criteria for sepsis. At-risk patients are prioritized and presented for further evaluation by the trained rapid response team, a group of multidisciplinary medical professionals who are trained and focused on monitoring and treating sepsis.
Once a patient has been diagnosed with sepsis, they are placed “on the bundle,” a small set of evidence-based practices that have been proven to improve patient outcomes when performed collectively and reliably. The patients continue to be monitored via the tile to ensure appropriate treatments are ordered and dispensed promptly for the best possible outcomes. The rapid response team interfaces with front-line clinical staff to streamline the delivery of lifesaving interventions, including antibiotics and fluids.
The CareComm sepsis tile relies on predictive analytics, AI and implementing data into real-time action. It also requires the dedication, investment and engagement of the clinical staff. Tampa General Hospital’s clinical team has embraced the CareComm sepsis tile, and the results achieved have been dramatic. From FY 2019 through FY 2021, average mortality rate from sepsis was 9.2%. Since focusing on this alignment work, average sepsis mortality dropped to 7.6%, and in the fourth quarter of FY 2022, since the sepsis tile went live, average sepsis mortality has decreased to 6.2%.
Investment in Access
For care coordination to work effectively, as is the case for the nurse navigator program and CareComm, a significant investment in both people and technology is required to ensure access to data, resources, people, workflows and systems of communication to facilitate a continuous and frictionless system of care.
Tampa General’s next step in coordinating care across the system and establishing an access hub through which information flows and care coordination is fully realized is to move beyond the traditional call center to leverage technology into an integrated experience center. The retail industry has done this quite effectively with customer relationship management systems.
As such, Tampa General is developing a consumer connection experience that will link all significant touchpoints for a patient throughout their care journey within the system using one platform and integrated digital tools. Here, products and services will become seamlessly integrated, making the user (both patient and provider) experience highly intuitive and easy to navigate, and the access to care and services more readily available and less prone to roadblocks.
Continuous innovation that challenges the status quo, empowers patients to play an active role in their care, and enables our team members to deliver high-quality care will continue to be a key strategic priority for Tampa General. In applying this model for care coordination, the bar is raised for what both patients and providers can expect from their experiences receiving and delivering care.
John Couris is president and CEO, Florida Health Sciences Center/Tampa General Hospital, Research Fellow at University of South Florida Muma College of Business, and an ACHE Member.