How better data and AI can reduce lengthy hospital stays and save costs

Alpine Health’s integrated platform helps hospitals save money by preventing extended patient stays in hospitals using a combination of artificial intelligence and rules-based engines to surface potential discharges earlier in the process. By providing resources and workflows to help case managers better analyze and transition patients between care settings, Alpine strives to accomplish their mission to help hospitals serve vulnerable populations with love and care.

Humberto, great to meet with you today. To kick it off, we’re discussing the pressing issue of managing costs of medically complex patients. Why has this issue become top of mind for hospitals?

Glad to be here. I can tell you. Post Covid, inpatient acuity levels have continued to climb, and hospitals are being filled with increasingly complex patients and difficult to treat populations. The “Length of Stay Index” has become one of the leading metrics for hospital administrators who are looking to manage costs. In the Covid-era, over 400,000 medical personnel left the field, and the majority has not returned, increasing the challenges of an overburdened system. Today, upwards of 20% of hospital beds are occupied by patients who are clinically fit to be discharged, however social determinants of health such as financial constraints, complex family expectations, lack of transportation,  criminal history, or inadequate home support, makes it difficult to transition them to the next place of care. Although length of stay has remained static, costs per day have risen- to the tune of 20% from 2009 to 2018. And with staff shortages, increased expenses, and decreased budgets, revenues are squeezed even further.

Unnecessary extended days in the hospital may lead to increased hospital-acquired patient complications and increased costs for healthcare systems. In addition, prolonged LOS may

negatively affect both patient and staff experience, not to mention quality scores. 

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Got it. So this is a critical topic today. How are decision-makers thinking about approaching the problem? 

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That’s a great question. In most hospitals, key leadership, such as the president, general counsel, CMO, CNO, and VP of Case Management, meet on a regular basis to review each complex case, and they’d tell you that is the most grueling hour on their calendars. And although hospital systems have implemented best practices and gold standards, they still face the challenges of critical staff shortages. The holy grail is better managing patients who present a higher risk during admission to stay past their estimated discharge date. These patients come in with a number of existing factors that need to be quickly assessed in order to understand the best way to manage that patients’ potential care coordination plan. Reducing the length of stay for these patients is the best way to move the needle on overall cost metrics. It’s the low-hanging fruit. 

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How are these decisions carried out today?

Today, hospitals rely  on Case Managers to properly assess and manage the discharge plan for complex patients. This individual has two resources today: the data in the electronic health record system, and his or her tribal knowledge of risk factors and possible solutions. 

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For example:

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After a fall, a bariatric patient is admitted into the hospital for surgery and may be required to be transferred to a skilled nursing facility. A Case Manager will be assigned to the patient if the bed nurse encounters any complexities, such as the patient not having insurance, having no family support, suffering from dementia, or even living too far from the nearest SNF, that persons’ basic medical information and recent health history as well as any notes made by the last few practitioners. Other than that, the Case Manager has the information she observes first-hand and what on-site caregivers and relatives tell her. Once the patient is recovering from surgery, the Case Manager may be alerted that this patient lives up two flights of stairs. Now, a new workstream pops up ensuring accessible accommodations. This is a simple example, but imagine several of these long-stay risk factors popping up? With better information upfront, the Case Manager could work directly with the family to coordinate accessible accommodations, or worked directly with a post-acute care facility with available beds for that patient. 

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It sounds like the Case Manager’s decisions have a major effect on potential length of stay for these patients. 

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They do- and it’s an incredibly stressful job. They are in a constant state of firefighting today. Case managers are expected to have knowledge of insurance, medical protocol, and all the likely risk factors for extended length of stay– it’s too much for one person. There is a multitude of different inputs and there is an actual person on the other end of these decisions. The burn out rate is high, and training new Case Managers is a time consuming and expensive process. 

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You've spent a lot of time in your career working with healthcare data and trying to find ways to save money for healthcare organizations. How does Alpine health fit into solving this problem for hospitals, and helping out Case Managers?  

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The gap is obvious in this case. If Case Managers had information outside of the 4 walls of the hospital, they could make better decisions. I see two things that are needed to better equip Case Managers with the best information upfront: 

1. We need a broader scope of potential risk factors for complex patients. This has to include factors that will affect a patients’ ability to be discharged, including legal status, mobility issues, affordability of catheter supplies, etc. 
2. We need to use machine learning to interpret the valuable information contained in notes written by nurses and doctors. If we can quickly lift valuable information from these notes and use that data to support our risk assessment, we can start acting quickly to mitigate preventable long stays. 

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Alpine Health is doing exactly this. Today, we have built a software tool that integrates with Epic and gathers patient data, practitioner notes, and publicly available data gathered from outside the hospital 4 walls to present a risk factor to the Case Manager. 

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We have several major health systems waiting to pilot how Alpine Health can reduce extended days and we are looking forward to empowering Case Managers to make better decisions for both the patient and the hospital.

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‍If you’re interested in learning more about how Alpine Health can elevate hospital care coordination and improve GMLOS index using AI-driven discharge management technology, feel free to reach out at info@alpinehealth.io or visit them at https://alpinehealth.io.