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HC4HR: What We Know and What We Need to Do in Health Care

Recently, Health CEOs for Health Reform -- a New America Foundation coalition of industry CEOs and physicians committed to improving our health system -- held a briefing on Capitol Hill (video here, summary here) to release its recommendations for transforming health care in the U.S.

In the video above, Nicholas Wolter, MD, the CEO of the Billings Clinic provides an insightful overview of the bold changes proposed in the white paper, Realigning U.S. Health Care Incentives to Better Serve Patients and Taxpayers -- from ending fee-for-service medicine to matching payment models with best practices.

In the coming days, we'll be posting more highlights from the event and examining in detail some of the innovative work that's already going on. Real world examples from payers, providers, and pharmaceutical companies illustrate that reform isn't just possible, it's happening. The results are real and their potential impact is huge for health care as whole. In particular, we'll elaborate on the following:

  • Medical Homes: Scott Armstrong, MBA, the president and CEO of the Group Health Cooperative describes his organization's success rebuilding its staffing model to support a medical home.
  • Shared Savings: Wade Rose of Catholic Healthcare West and Mike Johnson of the Blue Shield of California describe their organizations' collaborative experiment to share the savings from higher value, lower cost care.
  • Integrated Care: Gary Kaplan, MD, chairman and CEO of the Virginia Mason Medical Center describes his organization's experience developing a more coordinated model of care based on Toyota's methods of lean production.
  • Comparative Effectiveness: Jane Horvath of Merck & Co., Inc. describes her company's views on this research and details one current project looking at oral diabetes medication.
  • Health IT: Patricia Gabow, MD, of Denver Health describes how her organization uses electronic medical records to more effectively manage high blood pressure.
  • Clinical Excellence: Anthony R. Tersigni, EdD, FACHE, details Ascension Health's impressive gains in clinical outcomes and quality measures that prove rapid change is possible, even for complex systems.

Today, we are featuring innovations at Wolter's Billings Clinic -- a non-profit medical foundation with more than 3,500 employees serving Montana and surrounding rural states. Wolter is a strong physician leader in the health reform debate. In his presentation, he asserted that providers "have a responsibility to step up to the plate, to deliver care differently, and to be conscious of cost and quality." His call has credibility because as the CEO of an organization whose clinics serve close to 150,000 patients a year, Wolter has firsthand experience of what works -- and what doesn't -- in health care.

The Billings Clinic has had particular success reducing hospital-acquired infections and using telemedicine to care for rural populations.

Hospital-Acquired Infections (HAI) can be costly, and indeed, deadly. The U.S. spends about $4.5 billion a year treating an average of 2 million cases, including about 90,000 fatalities. These infections are also, to a large degree, preventable. The Billings Clinic has saved more than $1 million by reducing hospital-acquired infections. Since 2005, they've been able to reduce MRSA infections (a type of drug resistant bug) by more than 80 percent using an approach called Positive Deviance. The approach focuses on engaging all the stakeholders in a community -- patients, visitors, and volunteers, as well as doctors, nurses and healthcare technicians. These "touchers," whether they know it or not, can each play a role in the spread of infections. Their awareness and participation then is a crucial component for preventing infections.

The approach focuses on coordinating two main processes:

  1. Active Surveillance -- gathering data on rates of prevalence and infection as well as things like hand-washing (one of the biggest and easiest ways to prevent HAIs)
  2. Implementing Positive Deviance Tools of Engagement -- programs which engage all stakeholders in developing and implementing solutions that help bridge the gap between clinical data and behavioral change.

These changes are not easy, but with the right approach, as the chart below illustrates (click on it to open a larger version in a new window), dramatic results are possible in very short periods of time:




Telemedicine can be an important tool for providing access to high quality care for patients in rural or underserved areas. At an event this past spring on the Wireless Future of Health IT, Thelma McClosky Armstrong, the director of Telemedicine and Outreach at Billings, described her organization's work with the Eastern Montana Telemedicine Network (EMTN). Serving more than 3,000 patients, the program saves an estimated $1 million in out-of-pocket expenses. Using video conferencing, doctors can provide both medical and mental health services. Medication assistance programs (helping eligible patients fill out paperwork for financial support) and disease management education (for complex conditions like diabetes) are also provided.

Check back tomorrow and next week, as we examine more examples of what works in health care!