GOOD NEWS: Two Case Studies on Health Care That Works

If we've learned one thing about health reform since the early 1990s, it's that it's not just about coverage. Quality counts. And quality can and should be cost effective. 

This blog post begins a series based on New America's research on successful quality innovations. Specifically, we looked at how two institutions have identified challenges, arrived at solutions, and spread knowledge quickly. The research is part of a series of case studies on high-performing health care oganizations sponsored by The Commonwealth Fund.

We'll go into more detail in the next few days about the Baylor Health Care System in Dallas/Fort Worth and the Hill Physicians Medical Group in northern California. But first a little reminder about the dimensions of the quality challenge.

As we've learned from the Institute of Medicine and others, quality problems reveal themselves in many ways: tens of thousands of deaths each year due to medical errors, a 19th century record-keeping system, and uneven outcomes across our country. The American people are taking notice, ranking quality as one of their top five health care concerns.

Some of this failure stems from the slow diffusion of innovation in health care. Typically, new standards in evidence-based medicine take 17 years to reach most patients once generally accepted. It is encouraging, though, that the stimulus bill provided $1.1 billion to help the government and other payers become smarter buyers through comparative effectiveness research—and even the AMA backs the general idea of such research, despite some concerns about the specifics. 

To address the quality issue and specifically examine ways to diffuse innovations more quickly, New America's Health Policy Program Director Len Nichols and I embarked on a journey two years ago to find examples of institutions that are improving patient care. We focused on Hill Physicians, an independent practice association in northern California and the Baylor system in Dallas.  

The two organizations are quite different but yielded many of the same lessons. The most important lesson: it is  vital to align with physicians. The four areas that each organization partners with physicians in are trust, payment, culture change, and management. Board involvement is also critical, and both organizations make continuous improvement a priority. 

For further reading on disseminating innovations in health care, please see "The Science of Spread: How Innovations in Care Become the Norm" by Thomas Bodenheimer, M.D. and "Disseminating Innovations in Health Care" by Donald M. Berwick, MD, MPP. Both tell the story of the life-saving lemon that took hundreds of years to reach patients in need.