UCI Health: Embracing a CMO-CFO partnership

In the summer of 2022, UCI Health — the clinical enterprise of the University of California, Irvine — looked to improve its quality scores, which had recently dropped. Through a partnership between the chief financial officer, chief medical officer, and their teams, and in conjunction with Vizient’s help, the health system has worked to emphasize a collaborative interconnection between quality and finances. The positive results have led to a series of ongoing quality and financial improvements for the health system.

Engaging physicians to alter the case mix index

Prior to the CFO and CMO collaboration, UCI Health’s case mix index didn’t reflect the true complexities and acuity of patients. As a result, reimbursement rates were lower than they should have been. UCI Health’s relatively new CFO, Randolph Siwabessy, knew that his team couldn’t solve the problem alone. He and the CMO, Joseph Carmichael, MD, recognized that if they established a close partnership, their departments could work together to increase scores, which would positively impact quality and finances.

The leaders initially reached out to Vizient for help with addressing their case mix index. The Vizient team provided in-depth process changes, along with education and mentoring that helped transform the level of productivity at UCI Health. Vizient also partnered with the health system’s quality department to improve the correct capture of patient safety incidences.

“You can have CFO and CMO teams that are very siloed and territorial, but our approach overall at UCI Health is not like that,” says Siwabessy, who notes that the two teams ask each other and answer questions honestly, without judgment. “It’s approachable. It’s collaborative.”

The open dialogue between the CFO and CMO teams established a culture of transparency across departments and prompted Dr. Carmichael to suggest a strategy to help physicians better understand the financial department’s efforts.

“We took financial data out of our presentations with them and explained, ‘The great work you do is not adequately represented in the data because we’re just not documenting the severity of illness,’” Dr. Carmichael says. “If we could do that a little better, your service line is going to look a lot better, and the quality of care you’re doing will actually be represented.”

The strategy also aimed to ensure that the physicians were properly recognized when they documented the severity of patients’ conditions. Recognition came in the form of reimbursements, which positively affected the case mix index, as well as patient safety and physician profiling - things that physicians have a personal stake in.

Shifting the substance of case mix index conversations from the financial implications to physicians getting credit for their work had an immediate impact.

“As soon as we changed the focus from being a financial focus to a quality and documentation focus, the responses we have received and the engagement from our physicians have improved significantly,” says Rebecca Cloud-Glaab, vice president, revenue cycle management for UCI Health.

A continued partnership improves patient safety indicators

The UCI Health CFO and CMO teams next chose to address patient safety indicators after determining that the hospital lacked an adequate process to identify patient safety indicator (PSI) cases; physicians had been reporting cases that should not have been included.

“We just weren’t documenting what we were doing, and we were seeing some false positives because we weren’t clearly documenting,” says Cloud-Glaab.

The Vizient team provided training for the quality and finance teams on documentation and querying, which included establishing a framework to educate new residents each year.

“We walked through each PSI and were able to go over the inclusion and exclusion criteria, the definitions behind those - some of the hang-ups that usually come along with this work,” says Chandra Broadwater, director of quality and patient safety for UCI Health. “Having that baseline reference point and creating that foundational understanding was really huge on the quality and safety side.”

Since working with Vizient on this initiative, UCI Health’s Quality and Accountability scores have improved significantly. The health system reported 94 PSIs before Vizient began helping with the issue; it’s reduced PSIs to five in the 2022-2023 fiscal year.

The interpersonal connections between the finance and quality teams have also grown. “We move with the understanding that we rise and fall together,” says Dr. Carmichael. “For the physicians, there’s been an incredible awareness of what they document and the impact it has, and what they don’t document and the impact it has. We’ve seen big drops in PSIs in specific areas. You’ll see that in improvements in our safety rating.”

Expanding the reach of the CFO-CMO partnership

Since embarking on their partnership and with Vizient’s help, UCI Health’s finance and quality teams have learned to communicate more effectively across departments, which has led to significant financial and safety improvements.

“There was a real gap in how we were talking to each other, and those flows have been established,” says Broadwater.

Because of their ongoing collaborative success, the CFO and CMO teams are expanding their relationship to address population health, value-based care and improvements to outpatient clinical documentation, as well as other priorities that may arise over time. The partnership has proven that it’s possible to improve patient safety while also benefiting the bottom line.