Allina Health COO Dominica Tallarico on Improving Patient Throughput

Minnesota-based Allina Health has been partnering with population health company Navvis on hospital throughput and capacity by optimizing patient flow and tightening relationships with skilled nursing facilities. Dominica Tallarico, chief operating officer at Allina, recently spoke with Healthcare Innovation about efforts to improve clinical operations at the 12-hospital health system. 

Healthcare Innovation: Before we dive into patient throughput optimization, could you tell us a little about your role at Allina? 

Tallarico: I’ve been in my role for about 15 months now, and my responsibilities are for basically the clinical operations of the organization, which includes all of the acute and ambulatory clinical support areas — so pharmacy and laboratory facilities, imaging, all of those areas throughout the organization, in addition to enterprise reporting capabilities that I share with our chief strategy officer in IT.

HCI: Had you come up from within the organization, or did you come to Allina from somewhere else?

Tallarico: I’m a newbie. I actually worked for Advocate Healthcare for 19 years. I ran Illinois operations for the system, and before that I worked in academics, which was at Loyola Health system for 12 years.

HCI: I understand Allina has been working with Navvis on patient throughput and capacity management. Could you talk a little bit about the types of bottlenecks that they are helping you address and what’s causing them? Is the focus on transitions of care?

Tallarico: Yes. During the pandemic we saw this bottleneck, as you call it, of huge demand for acute care, right? So many people were sick with COVID or other conditions, so the demand was rising for inpatient admissions. At the same time, we did not have a place to transition patients to their post-acute setting. Many of the post-acute providers were either short-staffed or they were closed. They had COVID outbreaks, etc. At the height of this situation, we had about 180 patients waiting. That’s like the size of a small or mid-sized community hospital waiting to be transitioned to a post-acute setting. That creates backlogs and people boarding in the ED, and there’s no bed open. So you’ve got inpatients bedded in the ED and even in post-surgical spaces.

We really needed to figure out how to fix this situation. Part of it is just internal workings of care management, with the hospitalists and the team coming together to work on patient flow and throughput, but for this specific issue of post-acute needs, we partnered with Navvis, which has a good deal of experience in this space. They had done some work with SSM Health. 

Our focus was on the post-acute setting. How do we develop these direct relationships? We looked at who would be good partners in the market from a quality and safety standpoint and where we want to send our patients. Then we work to set up the processes in the system that would more effectively identify during the patient stay that they were going to need a post-acute setup, and then work with that post-acute partner. We reserved beds at these locations. At one point, we had about 20 beds in the community where we pre-paid to have a bed reservation for our patients, and then worked effectively to transition those patients to those locations. It also created a good connection point in terms of monitoring the quality of care and then transitioning the patient from that post-acute setting back into Allina Health after that episode of care, whether it was Allina Home Health or other care that they might need. 

HCI: Some health system execs have told me they struggle to gain visibility about what’s happening with their patients once they leave the hospital. Have you worked on improving the communication or data sharing with the post-acute providers or created your own post-acute care network?

Tallarico: We do have liaisons with those post-acute settings, so we can closely monitor because we also want to make sure that the patients are getting the right care at the right place at the right time and avoid those readmissions. I think that navigation is a key component, and it’s all about relationships. So there are weekly meetings that happen between our post-acute network of providers and our care team so that we can proactively manage workflows, processes, and patient care issues or resource issues that might arise. It’s not just about having those beds reserved; it’s about the relationships and the workflows and processes that you put in place. And it’s a very robust program. It started out as something small, and it was really being re-engineered but now I’d say it’s a much more well-oiled machine.

HCI: Is part of what Navvis brings to the table anything technology-related like a software solution, or is it really their expertise and consulting or both?

Tallarico: I think it’s both. As a partner to you as an organization, they can offer an array of services. We leaned heavily on the expertise and consulting, but also the pre-designed workflows and processes so that we didn’t have to start from scratch. They knew what worked. They had tested it in other markets and with other colleagues, integrated health delivery systems like ourselves with similar challenges. We found that really valuable. Sometimes when you start from scratch, you’re really trying to design and you don’t know best practices. We were able to adopt those best practices, tweak them for Allina Health’s environment, and then quickly get these programs stood up. And the results have been dramatic. We went from about 180 patients waiting for post-acute transition to now having, on average, maybe 20. Our length of stay has dramatically improved. When I first entered the organization, I’d say that our length of stay was near six days on average, and now we’re about at four and a half days. So we’ve dramatically improved access and capacity to the organization. 

It’s not just the patients who were coming into the ED; At Alina Abbot Northwestern and our other metro facilities, we weren’t able to take those transfers in for people who needed higher acuity cardiovascular or neuroscience care, etc. And now we have opened up that capacity, and it’s very easy to transfer into Allina. 

HCI: Another challenge we hear people talk about is patients coming into the emergency room with behavioral health issues, and there are not enough behavioral health beds to send them to. Is that an issue you deal with, too?

Tallarico: The shortage of behavioral health and mental health and addiction services is a national issue. I was actually pleasantly surprised coming to Allina Health at how robust our offering of services are and the number of beds that we have in the system for mental health and addiction. I would say, there are never going to be enough beds.  A major pinch point is the community-level services. You think about transitioning patients out of their acute episode. Where do they go? In Minnesota we have a deficit of those transitional services. I think on average, at least 400 patients in the Twin Cities are waiting to be transitioned out of a mental health acute care setting into the community with no place to go. So it does create those bottlenecks.

HCI: Besides doing the right thing for patient care, is this patient flow improvement going to be reflected in reimbursement for Allina or how you do in value-based care arrangements?

Tallarico: I think it pays off in multiple ways. It is really is about quality, safety and patient experience. I think all of us would say we prefer not to be in the hospital if we don’t need to be. We have a hospital-at-home program and have actually extended it to SNF care at home. So we have multiple levers that we could pull to make sure we can transition the patient. And it’s all about getting them home. Home first is our mentality. How do we keep people healthy? How do we get them home first? 

As we were able to reduce length of stay and the crowding, we were able to grow the enterprise and take care of more lives in the Twin Cities and even outside the Twin Cities, where we’re a regional destination at Allina Abbot Northwestern. We didn’t really have to add more staff because we were using the staff and the beds and the resources we had, and we were able to treat more people. 

You mentioned value-based care. We are very much embracing value-based care arrangements, and quality metrics. We want to decrease inpatient utilization, ED and SNF utilization, and get the patient to appropriate care. For all those things, I feel like it’s a win for everybody, and the economics work, because it really is good for the patient, good for the communities that we serve and then economically it created efficiencies.

HCI: I’ve talked to other health system leaders who said they were starting to work on SNF-at-home but they weren’t sure if the reimbursement was there yet.

Tallarico: It’s not totally there. There are programs and services that you can put in place, and the reimbursement doesn’t always catch up right away. However, we’ve really worked with our local payer community. They’re willing to acknowledge that this level of care can help avoid the transition to the post-acute setting. We can do this in the home with amped-up services. We do have more progressive payers in Minnesota, who can see not only the economics, but the outcomes and the patient experience through that.

HCI: Are there any other population health areas that Allina is working on with Navvis?

Tallarico: They have helped us to set up a practice optimization program in our ambulatory care setting. We are working with our primary care physicians, supporting them in the care that they deliver to our patients. We are providing education to all of our primary care physicians and advanced practice clinicians in the ambulatory setting on the right care and care conditions, and how best to treat those and identify those, and then the mechanics of what the patients need, so that we can drive down chronic care exacerbations, care more for the patient in the ambulatory setting or through digital, virtual care. We’re seeing our quality metrics really improve. We piloted this at about nine sites, and we are going to scale it across our 65 primary care sites by the end of the year.