MP57-05 INTEGRATED CARE WITHIN a LARGE PUBLIC HEALTHCARE SYSTEM IMPROVES EFFICIENCY AND REDUCES COSTS ASSOCIATED WITH KIDNEY STONE MANAGEMENT

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes II (MP57)1 May 2024MP57-05 INTEGRATED CARE WITHIN a LARGE PUBLIC HEALTHCARE SYSTEM IMPROVES EFFICIENCY AND REDUCES COSTS ASSOCIATED WITH KIDNEY STONE MANAGEMENT Cecilia Wada, Aaron A. Laviana, Tarah Woodle, Parth Patel, Jeremy Blumberg, Jamal Nabhani, Benjamin Waterman, and Jonathan Bergman Cecilia WadaCecilia Wada , Aaron A. LavianaAaron A. Laviana , Tarah WoodleTarah Woodle , Parth PatelParth Patel , Jeremy BlumbergJeremy Blumberg , Jamal NabhaniJamal Nabhani , Benjamin WatermanBenjamin Waterman , and Jonathan BergmanJonathan Bergman View All Author Informationhttps://doi.org/10.1097/01.JU.0001009420.83948.eb.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the Los Angeles County Department of Health Services (LAC-DHS)—the second-largest public healthcare system in the country—clinical integration allows specialists and primary care providers (PCPs) to collaboratively provide urologic care. We utilized time-driven activity-based costing (TDABC) to compare the cost of kidney stone diagnosis, workup, and management with clinical integration compared with traditional care pathways. METHODS: Clinical Integration: Specialty-Primary Care Workgroup Development of Expected Practices: The LAC-DHS pursued clinical integration by instituting primary care empanelment, electronic consultation (eConsult), and collaborative Specialty-Primary Care Workgroups that generate "Expected Practices." The PCP then delivers several aspects of specialty care, especially diagnosis, workup, and initial medical management. Process mapping and Costing: We interviewed and observed teams of physicians and staff to gain an understanding of workflow practices and the personnel, space, materials, and devices required for stone care in the two models. We created process maps that outline the entire arc of care, and utilized TDABC to calculate the all-inclusive costs of kidney stone management with and without clinical integration. RESULTS: Figure 1 displays the process map and costs for patients with kidney stones managed before and after the development of clinical integration. Total urologist time needed to manage a patient with kidney stones was 71 minutes without clinical integration, compared with 36 minutes with integration. The number of steps needed to arrive at operating room booking was 14 minutes with integration and 19 minutes without it. The total cost of kidney stone treatment per episode in the integrated pathway was $499.04, compared with $699.81 in the non-integrated route, a difference of 29%. In the integrated pathway, the predominant cost saver was the elimination of redundant urology visits ($124.80). Additional savings stemmed from improved workflows from PCPs to urologists. CONCLUSIONS: Clinical integration reduced the cost of kidney stone management. In resource-constrained environments, integrated care pathways provide financial and clinical benefit for patients and health systems. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e938 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Cecilia Wada More articles by this author Aaron A. Laviana More articles by this author Tarah Woodle More articles by this author Parth Patel More articles by this author Jeremy Blumberg More articles by this author Jamal Nabhani More articles by this author Benjamin Waterman More articles by this author Jonathan Bergman More articles by this author Expand All Advertisement PDF downloadLoading ...