Nearly 20 years ago, one of the founders of the Evidence Based Medicine (EBM) discipline, David Sackett, described EBM this way: “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Much like apologetics is used in defending ones position about their religious faith, EBM is used to challenge clinical thought on patient care. This model asks care providers “Why?” do they want to treat a patient with any given approach when it’s contrary to the evidence? It breaks with the status quo and asks providers to defend why they believe what they believe.
Save Blood, Saves Lives
Case in point, Nature Magazine (an international weekly journal of science) wrote a great article in March 2015 titled: “Evidence Based Medicine: Save blood, Save Lives”. The article discusses how transfusions are one of the most overused treatments in modern medicine, which cost billions of dollars (waste) and is a significant risk to the patient. It illustrates how a California hospital wanted to cut cost and EBM suggested fewer transfusions might be the answer. What they did was very simple and subtle, but very effective. Whenever a physician attempted to order blood and the lab results indicated that the patient should be healthy enough to get by without a transfusion, the physician would see an alert appear on their screen that gently reminded them of the guidelines and requested further justification for the order. That seems reasonable, right?
The results were dramatic – transfusions dropped by 24% over the subsequent four year period. This saved $1.6MM in purchasing cost alone, but as the transfusion rates dropped, so did the mortality rates, average length of stays and the number of patients who had to be readmitted within 30 days of a transfusion.
Evidence Based Medicine: Asking Doctors to Think Twice
This example is but one of a thousand different procedures that take place on a daily basis in healthcare. This initiative did not lower the quality of care or adversely impact the patient’s health – it improved it. In this example, like much in life, “less is more”. It subtly ask the physician to defend their belief and when they took to the time to reflect on the matter, they realized they were ordering blood out of habit rather based on medical necessity.
Improved Health – Better Outcomes – Lower Cost
As risk underwriters, we have few opportunities to impact patient care outside of Medical Management (usually called Precertification or Utilization Review). This is the one area that we can have a meaningful impact on our block of business, just by asking our Medical Management questions. “Why are we Precerting procedures that do not meet medical necessity? If care could be safely provided in a physician’s office with equally effective results, why are we approving it on an outpatient basis when it cost 50% more (chemo is a good example)? Why aren’t we sending the covered members to Centers of Excellence (COEs)”? Ironically, the better quality providers generally charge less than the ones with poor medical outcomes. Less lawsuits?
But this is what we do, we’re not your typical MGU. Evidence based medicine has empowered us to ask questions about how can we maintain or improve care while improving outcomes and lowering cost. We have the expertise and experience to dive into the weeds of how the groups we underwrite are managed while keeping our eyes on the big picture of creating products and services that are practical and sustainable. Give us a shot….let’s have a conversation.
