March 2010

Pace of Care Begins with Care Management

Like a stock car accelerating around the track, the Pace of Care project is gaining momentum in the market-based organizations that work with Beth O’Brien, senior vice president of operations. Pace of Care is a rapid-cycle performance improvement initiative designed to decrease variation and to improve operational outcomes, clinical outcomes and patient satisfaction. “Pace of Care is exciting because you can have significant results in a short time,” said Jim Hobson, president and chief executive officer of Memorial Health Care System, Chattanooga, TN, executive sponsor of the Pace of Care initiative. “It speeds the process of gathering the expertise of the market-based organizations, finding best practices and standardizing to them. It also involves the people closest to the work to ensure that we are thorough and don’t skip any steps.” Pace of Care has the potential to touch every aspect of providing the right care, to the right patient, at the right time and in the right place. The Pace of Care core team decided to start with care management, which spans much of the patient experience. After review and discussion, the team selected the care management process at St. Vincent Health System, Little Rock, AR, as a model. St. Vincent had redesigned its care process model in June 2009, and the program’s metrics show excellent progress. “We have a downward trend in length of stay and an upward trend in our case mix index,” said Nina Boies, director of special initiatives at St. Vincent. “We reduced inpatients on observation status from 27 percent to 18.5 percent. Readmissions are well under two percent. All this tells us that patients are here because they really need to be, are receiving the correct care and are being discharged at the right time.” To help Memorial, as well as Saint Clare’s Health System, Denville, NJ, and St. Joseph Medical Center, Towson, MD, implement the St. Vincent model, the team developed a “blue book” that covers the process from start to finish. The term was coined by Deb Mohesky, vice president of finance for the O’Brien operations team. “It was fun to have a chance to work on something that helps guide patient care at the front end,” said Mohesky. “Finance is usually more involved on the back end, when clinical performance hits the income statement. There’s no question that when patients are evaluated, cared for and discharged in the right way, it helps ensure that care is correctly compensated.” Pace of Care is now expanding to encompass hospitalist programs. “We’re discussing how hospitalists work with care managers and how they can best share information with each other,” said Cary Ward, MD, chief medical officer for Saint Elizabeth Health Services, Lincoln, NE, and hospitalist consultant to CHI. After that, the team will bring pharmacists into the project. Boies will present a poster session on St. Vincent’s care management model – one of only 25 presentations chosen from 100 submissions – at the American Case Management Association Conference, April 8-11 in San Antonio, TX. For more information, contact Deb Mohesky,, or Jim Hobson,