Making business less risky

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Making business less risky
Making business less risky

More than ever, providers face the risk of reputation-wrecking lawsuits, survey deficiencies, poor satisfaction scores and a host of other potentially damaging results.

The good news is that the effective, consistent use of data – and, especially, the implementation of predictive analytics – can allow facilities to be more strategic in managing risks.

“Having data that is reliable and comparable helps you understand how well your processes are addressing those areas,” said Matt Salmon, PT, MHP, MBA, chief operating officer, SALMON Health and Retirement.

Breaking through barriers

The adoption of advanced data utilization and predictive analytics in the senior living segment is indeed a positive development, both from a quality and risk perspective. While the goal of predictive analytics is not to determine exact outcomes, experts generally agree that their role in curbing risks can be significant.

“Data utilization and predictive analytics can be used to improve overall outcomes. If you have an opportunity to boost your odds of success -- whether in business or in the care and assistance of someone's life, and you can accomplish that in a cost-effective manner -- you have a professional obligation to do so,” reasoned Andrew Carle, executive-in-residence, assistant professor and director of George Mason University's senior housing administration program.

Making that connection hasn't always been easy, however. Among senior living's biggest obstacles, Carle continued, is establishing culture change that recognizes the need, capability and responsibility of combining analytics with caring on the frontline, not to mention, showing corporate and executive staff empirical evidence of its value. “We're really just beginning to utilize the power of information in senior living. It reminds me of my early days as a hospital administrator in the 1980s when we really just began to understand the concept of quality improvement through larger-scale data analysis,” he said. “The barriers then were similar to what we see now in this sector.”

Comprehensive, focused and user-friendly data analytics and decision support services are helping senior living operators overcome those obstacles, however. Several years ago, SALMON Health and Retirement turned to PointRight for its web-based solutions to measure risk and ensure excellence in clinical processes, decision-making and outcomes. PointRight's RADAR report – a clinical and risk management tool that measures resident outcomes that may impact quality and litigation or potential liability claims – has played a key role in helping the organization reduce risks and improve quality.

Among RADAR's core benefits, Salmon noted, is its ability to help organizations gain a better grip on quality measures.

“The clinical data helps us make better decisions during our ‘At Risk' meetings,” he said. “We make better care decisions, not just in terms of better care plans, but actual improvements in how we provide care.” To tap RADAR's full potential, each facility's conference room was wired for Internet access to allow the reports to be accessed in real time. SALMON Health and Retirement then leverages the data at a facility level to drive and measure the quality improvement process. Further, the data is tapped at an executive level to identify trends across all locations.

RADAR consists of a series of descriptive scores and predictive scales derived directly from the MDS 3.0. The report details resident risk factors and characteristics related to each of the scales, and also assists corporate compliance efforts by supporting the allocation of resources based upon resident conditions.

Proactive pay-off

Some believe that predictive analytics shines brightest in its ability to help providers adopt a more forward-looking approach to clinical decision-making and risk management.

“It's the ability to use risk assessments and risk profiles, and then tag residents for a number of factors, such as hospitalization, falls, pressure ulcers, cognitive ability, activities of daily living and so on,” said Stephanie Papoulis, corporate counsel for Senior Care Group.

Papoulis relies on the RADAR tool to provide an at-a-glance snapshot of each facility's quality assurance and risk profiles, which then allows her to determine trends and, when necessary, increase education and training. If, for example, data show a particular facility is experiencing a higher prevalence of falls, she'll promptly partner with the vice president of clinical affairs to determine the cause and conduct in-services and other interventions to reverse the trend.

“I believe that if you can't pull up a snapshot of where your facilities are in regard to risk, you won't be able to make strides with quality assurance and risk [management],” Papoulis said.

Of course, such benchmarking capabilities extend beyond individual organizations. Because RADAR captures data directly from MDS 3.0 scores and predictive scales, it allows facilities to compare their data to other facilities in the state. That can pay big dividends in the event of a lawsuit, according to Carle. He reasoned that a plaintiff's attorney may try to convince a jury that the community in question is the only one to experience negative outcomes and injuries.

“If you can show your incidences of falls are significantly lower and outcomes significantly better than those experienced by the industry, for example – let alone, those experienced by seniors living at home – then you can educate the jury on the larger truth.”

While predictive analytics is particularly effective in allowing providers to proactively mitigate risks through targeted training, benchmarking and improved clinical decision-making, providers have found it can be equally valuable in helping them manage risks retroactively. As Papoulis explained, if a facility is facing a lawsuit, it can go back and use the data from MDS to substantively support the outcome.

“What's great about predictive analytics is that you can use the data two different ways – to predict looking forward and also by looking back. We've been able to use that data to look back and actually show, through MDS, that a resident improved while under our care and that the risk factors actually decreased. Obviously, having that type of information gives us a real advantage,” Papoulis noted.


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