Agile Global Health Blog

Agile Global Health’s clinical metrics guide NHIF cardiac program effectiveness, efficiency, and growth

Aug 23, 2017 / Agile Global Health

North Carolina, USA – August 23, 2017: At the end of the National Hospital Insurance Fund (NHIF) cardiac program’s ninth month in operation, program implementer Agile Global Health delivered the initiative’s first comprehensive report on key clinical performance indicators.

The two most critical indicators being measured among cardiac program patients at each participating hospital are mortality and unscheduled readmissions (patients who are treated and discharged, but within 30 days of discharge must be readmitted due to some kind of complication). Earlier this month, Agile Global Health reported aggregated, anonymous data on these two metrics to the NHIF, allowing the program funder to see how the pool of hospitals participating in the project is performing, but without identifying individual hospital or physician performance. At the same time, Agile provided each hospital with a report showing its own performance compared with the pooled data for all participating facilities.

“The clinical metrics that Agile is now providing are being applied directly in support of Kenya’s healthcare vision,” said Morgan Darwin, Agile’s CEO. “The country is working to increase medical self-sufficiency, so that in the future Kenyans are able to receive any kind of procedure or treatment they require without crossing national borders. The cardiac program’s clinical metrics bring reflected rigor to hospital improvement, with data driving forward the changes that enhance care quality and delivery, save lives, and create a sustainable health system.”

The NHIF cardiac program’s existence, as well as its application of clinical metrics, are both visionary endeavors. “I don’t think anything like this has happened before in Africa, certainly not in East Africa,” said Dr. Rainer Hilgenfeld, Agile’s Chief Medical Officer. “Even among western hospitals, there are many that don’t leverage the insights of clinical performance analysis to improve processes and outcomes. NHIF’s adoption of clinical metrics to guide the cardiac surgery program is simply revolutionary.”

While the importance of metrics for process improvement is well-established in the realms of finance and administration, their use in clinical settings is only decades old. “Whoever is paying for care has the right to know what is happening with their money,” explained Dr. Hilgenfeld. Regular clinical metrics measurement and reporting adds accountability for hospitals to be the most effective stewards possible of the resources invested in them. But simply calculating a mortality or unscheduled readmission rate at one institution doesn’t show the hospital, or the payer, whether that rate is good or bad; to critically evaluate performance, comparable metrics must be available. And in the highly competitive healthcare market, many hospitals would prefer not to measure their performance at all for fear those data could be leaked and become punitive. “That’s the problem this program really solves: Agile Global Health is a neutral third party, trusted by hospitals and the NHIF (funder) alike to collect, analyze, and interpret clinical metrics at the individual hospital and program-wide levels. Because data confidentiality is protected within our company and our Orsalus technology platform, hospitals can now compare themselves, anonymously, against the whole group of participating facilities without fear of leaking. And the NHIF can identify areas of success and opportunity within the program, but without labeling any hospital ‘best’ or ‘worst.’”

Agile Global Health has meticulously tracked unscheduled readmissions and mortality data, among other clinical metrics, at each hospital over the cardiac program’s first nine months. Now that the program has sufficient historical longevity, the company will report quarterly on these metrics, giving the NHIF and participating hospitals a regular performance snapshot that enables timely, actionable adjustments to program processes.

Even with the advent of clinical metrics reporting as part of the cardiac program, Agile Global Health insists that the maturing initiative remains in its early stages. “What we are doing now is finding patients who already have cardiac damage – patients who for example have rheumatic heart disease (RHD) and whose increasingly damaged heart valves will usually cause death in their twenties or thirties if no intervention takes place. We are helping hospitals and the government identify these patients. Then we take them under management, meaning we triage them, direct them to hospitals, and assign an appropriate priority for surgery or other intervention based on the urgency of the case. In a structured way, we lead them to life-saving surgery,” said Dr. Hilgenfeld. “But a problem is that the artificial heart valves that these patients have implanted require blood thinning, and this means that female patients who undergo such procedures are no longer able to deliver children naturally. We save these people who would otherwise die young, and they can become productive members of society, but we can’t help women overcome this consequence of cardiac surgery.

“So ‘secondary prevention’ is the next stage. This is where we want to identify RHD sufferers through screening early enough that it is still possible to treat the disease with a simple monthly penicillin shot and thus move affected women beyond child-bearing age before they eventually need surgery.” The potential impact is staggering: the 3% incidence of RHD among Kenya’s more than one million annual births means that secondary prevention could restore to Kenyan society and economy over 30,000 healthy, productive individuals each year, lives which are currently being limited or cut short due to late detection of cardiac disease. And the ultimate goal? “To eradicate RHD from the country, as has been done in the west,” Dr. Hilgenfeld asserted. “This is primary prevention, and achieving it will be a long-term project involving nationwide education programs and other actions. But with the vision and support of the Kenyan government and NHIF, and the professional program management and data collection and analysis brought by Agile Global Health, there is no reason Kenya can’t be next to erase RHD from its population.”

Plans are already underway to shift cardiac care focus toward secondary prevention by rolling out a comprehensive national screening program, with Agile Global Health managing patients who enter the program this way as appropriate. The company will also track how, over time, early screening reduces need among Kenyans for more invasive cardiac treatment.

“This is an ambitious, achievable expansion of Kenya’s commitment to cardiac care,” said Mr. Darwin. “As the NHIF’s surgery program nears its one-year anniversary, we at Agile are proud to be supporting a data-driven approach to the program’s future, as well as laying the groundwork to assist preventative efforts.”

For more information on the NHIF cardiac program, and on all Agile Global Health’s applied clinical data measurement and management services, Agile invites you to visit its website.

Agile Global Health

Agile Global Health (operating as A&K Global Health in select countries) is an Agile Health Systems company and a worldwide leader in realizing transparent, affordable, effective and innovative solutions to complex healthcare delivery challenges. We listen to local and national healthcare leaders in every country where we work, and then support their vision to improve their national health system’s accessibility, quality, and clinical outcomes. For patients, we connect you with the right care for your needs, from facilitating quality local and regional treatment to coordinating international medical travel; for healthcare funders and providers, we optimize your organizational impact by introducing transparency, control and customization to the medical, financial and experiential aspects of your clients’ medical journey. Contact us today to learn how we can support you.

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