How the DRG Strategy Revolutionized Clinical and Economic Management
Since its foundation in 1985, Clínica Somer has been a pioneer in offering high-complexity health services for Rionegro and Eastern Antioquia. Located in an area of high commercial and business development, the clinic stands out for its commitment to quality and innovation. With first-class infrastructure and unwavering dedication from its staff, Clínica Somer continued to evolve to ensure the best possible care, supported by three fundamental pillars: service humanization, patient safety, and continuous improvement. That’s why, together with Avedian, the leading LATAM startup in Artificial Intelligence solutions for healthcare, they implemented a digital transformation strategy via DRG (Diagnosis Related Groups). We invite you to read about the case and the milestones achieved.
Facing significant challenges in the variability of clinical care and economic management, Clínica Somer implemented the revolutionary Diagnosis Related Groups (DRG) strategy. After 10-12 months of standardizing and organizing historical clinical and economic data, the results were a case of unprecedented success and change.
In less than a year, Clínica Somer Radically Improved its Clinical and Economic Management. How did they do it?
Implementing Improvements in Care Efficiency:
- Resource Optimization: The implementation of DRGs allowed for better organization of clinical resources, reducing unnecessary hospital stays.
- Guideline Updates: We updated clinical practice guidelines, such as in the case of bronchiolitis, achieving more efficient and targeted care.
Reduction of Clinical Variability:
- Process Standardization: The adoption of DRGs standardized clinical processes, reducing variability in medical practice.
- Quality Improvement: We observed greater consistency in clinical outcomes and a reduction in hospital stay times, improving the quality of care.
Improvement in Economic Management:
- Cost Management: The DRG strategy facilitated the identification and monitoring of costs associated with each patient group, allowing for strategic decisions in financial management.
- Financial Efficiency: The identification of inefficient DRGs allowed for more sustainable and efficient economic management.
Reduction of Clinical Variability:
- Process Standardization: The adoption of DRGs standardized clinical processes, reducing variability in medical practice.
- Quality Improvement: We observed greater consistency in clinical outcomes and a reduction in hospital stay times, improving the quality of care.
Negotiation of Rates with Insurers:
- Strengthened Relationships: The successful implementation of DRGs improved relationships with insurers, especially in maternal and perinatal care.
- Favorable Rates: These strengthened relationships resulted in successful negotiations of more favorable rates, reinforcing the clinic’s financial position.
The Case in Numbers:
- Increase in rates for insurers in the maternal-perinatal route by 140% with direct impact on Obstetric and Neonatal DRGs.
- Consumption was standardized after a 2023 with losses in these DRGs, moving from negative to zero profitability with a search for positive values with direct impact starting from April and May 2024.
Acknowledgment and Next Steps
We are proud of the achievements made with Clínica Somer and appreciate the trust placed in AVEDIAN. These successes demonstrate the transformative impact of the DRG strategy on the clinical and economic management of the institution.
Going forward, we will continue working together to identify new opportunities for improvement and expand the use of DRG in other clinical areas. Our goal is to continue optimizing resources and improving the quality of care to ensure the sustainability and continuous growth of Clínica Somer.
Team
Nicolás Abugauch – Operation Manager Avedian
María José Farré – Product Dev Leader LAVs Hosdatia – Avedian
Jader Alexander Osorio Aristizábal
Head of Nursing and Innovation Department
Clínica Somer
Stiven García Gómez
Data Science Coordinator
Clínica Somer
Jorge Mario Arroyave Rojas
Cost Leader
Clínica Somer
More information about Clínica Somer: https://www.clinicasomer.com/
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