Care Utilization Optimization Tool

Imagine discovering that more than 20% of the medical care provided in your hospital is unnecessary. A study published in PLOS One surveyed physicians across the US. The study revealed that a quarter of tests, over a fifth of prescriptions, and more than a tenth of procedures fall into this category. 

What’s worse is that this inefficiency is not only a quality issue, it’s also a financial burden on hospitals, leading to annual waste costs between $27.2 billion and $78.2 billion.

Such inefficiencies highlight the pressing need for better care utilization measurement. By comparing medical usage across peers, a care utilization optimization tool can pinpoint these variations—helping doctors make more informed decisions and ensuring higher quality, cost-effective care. 

This blog will explore how this technology works. We will also list some of the best care utilization optimization software to help you enhance your clinical workflows, reduce care variation, and lower costs. 

What is a Care Utilization Optimization Tool?

A care utilization tool enhances clinical workflows and reduces care variation by providing clinical insights within the EHR. The software helps minimize unnecessary care variation by benchmarking treatment data and presenting utilization patterns compared to patients with similar conditions.

With a care utilization tool, physicians receive actionable insights directly in their workflow. This enables them to make the best care decisions for their patients, reduce the length of stay, and lower costs. 

Let’s take an example below to understand care utilization optimization in detail:

A patient is in the hospital for pneumonia. Over the course of 3-4 days at the hospital, the patient received 8 different chest x-ray views and 2 CT scans of the chest, was prescribed Combivent and Zosyn, and received 6 CMPs and 2 BMPs.

Now, with a care utilization optimization tool, the doctor would see the average length of stay for the working DRG associated with pneumonia as a benchmark and would realize the patient likely doesn’t need both X-rays and CT scans of the chest. They would also see the much cheaper Albuterol and Amoxicillin for prescriptions and see how many labs had already been ordered to avoid unnecessary poking and costs.

Simply providing doctors with real-time comparisons and alternatives has a huge impact on patient care and cost. 

Why Do Hospitals & Healthcare Institutions Need a Care Utilization Optimization Tool?

A care utilization optimization software has triple-fold benefits that help the doctor, the patient, and the hospital’s bottom line.

Here are some notable benefits for hospitals and healthcare institutions.

1. Improve Care Quality

The tool provides physicians with clear indicators of the value of care that is being delivered. This feedback encourages them to examine their care decisions more thoroughly and ultimately deliver the highest quality care.

2. Improve Patient Outcomes

One significant benefit of a care utilization tool is that it reduces unnecessary care variation. Additionally, it guarantees patients the right care at the right time. This further leads to better health outcomes and fewer readmissions.

3. Streamlines Workflows

A care utilization tool automates operations by streamlining orders, creating care plans, utilizing resources, and minimizing time in the hospital. This reduces the administrative burden on physicians and leads to more efficient use of resources and better coordination of patient care.

4. Real-Time Decision Support

This tool gives physicians real-time visibility into their care patterns compared to peers, promoting accountability and continuous improvement.

5. Reduces Total Cost of Care

A care utilization optimization tool helps hospitals and physicians identify and minimize low-value care. It reduces unnecessary services and treatments, streamlines care delivery and cuts down on waste. This leads to a reduced overall cost of care and significant savings for both patients and healthcare providers.

6. Boost Physician engagement 

More than 90% of physicians report feeling burned out “regularly.” Apart from providing the right patient care, administrative burdens like scheduling, documentation, updating patient records, and compliance reporting eat up their time and leave them overburdened. Care utilization software helps physicians with complete insight into peer-based care patterns. This powers them to make evidence-based decisions without feeling overwhelmed.

Top 5 Care Utilization Optimization Tools

The below care utilization tools and companies help hospitals remove unnecessary care variation and focus on providing the right care. 

1. CareGauge

Topping our list, CareGauge is one of the best care utilization optimization tools that integrates seamlessly into the physician’s workflow in the EHR. It aims to reduce unwarranted clinical variations and optimize hospital costs. The platform presents real-time care utilization feedback and cost information to physicians based on benchmarked treatment data.

Key features:

• • • Real-time feedback: CareGauge integrates seamlessly into the physician’s EHR workflow to provide real-time care utilization feedback. They get a real-time view of care utilization (Imaging, Labs, Medications, etc.), LOS (length of stay), and care costs directly within their EHR workflow. 
    • Non-intrusive design: The tool provides an omnipresent indicator that physicians can choose to interact with for more insights. It avoids disruptive alerts and notifications that interrupt the doctor’s workflow.
    • Cost insights: CareGauge provides detailed insights into the costs of medications, LOS, imaging, labs, and radiology tests. This enables doctors to compare their costs to those of their peers and determine if there’s a wide variance of care delivered. 
    • Visual indicators: The platform uses green, yellow, and red signals to show care utilization. As you enter orders, the gauges update in real time. It shows green when utilization is below expected, yellow when at expected, and red when above expected.

2. Agathos

Agthos Health is another platform that focuses on reducing clinical variation in hospitals and primary care settings. It offers tools that help physicians understand how their practice patterns compare to their peers. 

Key features:

• • • Physician engagement: Agathos delivers trusted data to individual physicians through a mobile platform. It allows doctors to compare their practice patterns with those of their peers, enhancing their engagement with existing reporting systems.
    • Comprehensive clinical data: The platform offers a full clinical data pipeline including clinically-vetted practice-level metrics and recent patient examples. It also covers multiple specialties and provides benchmarking.
    • Support during EHR downtime: Agathos ensures patient communication, scheduling, and procedure continuity during EHR downtime. It uses a modernized data pipeline with row-level security, mitigating financial impacts and maintaining patient safety. 

3. Illumicare

IllumiCare is a care utilization tool that provides care enhancement data directly within the provider’s workflow. It guides physicians by “nudging” them to make cost-effective and efficient care decisions. It covers multiple aspects of care including cost savings, care gap closure, length of stay reduction, and trial recruitment.

Key features:

• • • Actionable suggestions: The platform offers alerts/notifications to physicians, promoting cost-effective and efficient care decisions. These suggestions help reduce unnecessary orders, close care gaps, shorten the length of stay, and support clinical trial recruitment.
    • Cost details: Compared to physician peers, the platform provides detailed insights into your medical usage (imaging, labs, medicine, tests, etc.). This information empowers them to make more informed and cost-effective decisions for patient care.
    • Enrollment: Illumicare provides tools that present clinical trial options that match patient profiles. This feature simplifies and accelerates the trial enrollment process.

4. Stanson Health (Premier)

Stanson Health’s Clinical Decision module provides evidence-based guidance to the physicians at the point of care. It integrates with the EHR seamlessly. The platform aims to enhance healthcare efficiency, reduce administrative burdens, and improve patient outcomes.  

Key features:

• • • Clinical decision support: The platform allows the development, deployment, and monitoring of clinical decision-support interventions at scale. It ensures the CDS is effectively integrated and continuously optimized within all workflows.
    • Content library: The system includes a comprehensive library of evidence-based interventions. These interventions are designed to be timely and relevant, providing physicians with actionable insights to influence clinical outcomes positively.
    • Choosing wisely initiative: Stanson supports the national Choosing Wisely campaign, which aims to reduce unnecessary tests and procedures. It helps promote conversations between clinicians and patients about certain interventions’ necessity and potential harm, encouraging more appropriate and evidence-based care.
    • Advanced analytics: Stanson utilizes advanced analytics to identify and reduce unnecessary care. This help lower healthcare costs and minimize patient harm. The analytics provide insights into care patterns and highlight areas where clinical practices can be improved.

5. Vizient

Vizient Inc. is a healthcare performance improvement company. It collaborates with a network of hospitals and healthcare organizations to enhance care quality, reduce costs, and improve operational efficiency. Its expense management solution helps healthcare institutions manage and reduce expenses through advanced insights and strategic management. Similarly, its care delivery excellence solutions help hospitals improve their clinical operations and patient care. 

Key features:

• • • Care delivery: The company implements frameworks to prevent patient harm and improve care quality by fostering a healthy culture, learning systems, and strong leadership. 
    • Spend management: It integrates expertise, purchasing strategies, and technology to optimize procurement processes, ensuring cost-effective purchasing and inventory management.
    • Pharmacy management: Utilizes data-driven insights and best practices to enhance pharmacy operations, reduce medication costs, and improve performance.

Clinical Variation Software

Delivering excellent patient care is more than important; hospitals are also striving to improve their margins. Reducing unwarranted clinical variation is one of the best ways to improve patient outcomes, optimize healthcare resources, and reduce costs. It can help healthcare organizations navigate the complexities of modern healthcare delivery and achieve better patient outcomes.

Amongst all the above platforms, CareGauge, an EHR-integrated software, stands out for its unique and comprehensive features that still empower doctors to make the best decisions for their patients. It provides real-time data to physicians about care utilization, costs, and the effectiveness of certain treatments at the point-of-care. All of this is done in a very carefully designed, non-intrusive way. 

Book a customized demo to discover how CareGauge can help you optimize your clinical and financial resources.