HC4HR

HC4HR: Health CEOs In The Spotlight

Meredith Hughes — Thu, 27 Aug 2009 15:23:00 -0400

As our nation debates health care, we ask ourselves the big questions. How can we get sustainable, affordable, quality coverage for every American? What is possible in health reform, and how can we turn the possible into the actionable? Here at the New America Foundation, we are proud to affiliate ourselves with health care leaders who have answers. The Health CEOs for Health Reform, a diverse coalition of health industry leaders, provide outstanding examples of cooperation, innovation, and high quality health care delivery at low costs.

Here on our Health Policy Program blog, the New Health Dialogue, we've created a video series highlighting presentations of the CEOs and their accomplishments. Each video features a personal interview with or presentation from one of the CEOs or their representatives. Each explains how they have pressed ahead with reforms and improvements in the real world. In case you missed it, here's the round up:

Realigning Incentives: Nicholas Wolter, MD, the CEO of the Billings Clinic presents the Health CEOs proposals for changing the delivery system to end fee-for-service medicine to match payment models with best practices.

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.

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.

Health IT: Patricia Gabow, MD, of Denver Health describes how her organization uses electronic medical records to more effectively manage high blood pressure.

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.

Clinical Excellence: Anthony R. Tersigni, EdD, FACHE, details Ascension Health's gains in clinical outcomes and quality measures that prove rapid change is possible, even for complex systems.

Shared Savings: Wade Rose of Catholic Healthcare West and Mike Johnson of Blue Shield of California describe their organizations' collaborative experiment to share the savings from higher value, lower cost care.

Accountable Care: Donna Katen-Bahensky, the president and CEO of University of Wisconsin Hospital and Clinics, describes her organization's efforts to change the dynamics of modern medicine through the principles of accountable care organizations (ACO).

Since the HC4HR event in June, the CEOs have been out there spreading the story. Here's a quick (partial) round-up of news coverage of the CEOs.

Kaiser Health News talked to Ascension Health President and CEO Anthony R. Tersigni, EdD, FACHE, and Denver Health CEO Patricia A. Gabow, MD, about the current health care reform debate, and what reform will mean for their health systems. We've highlighted both these health systems on our blog, the New Health Dialogue (here and here.)

Checking In With Ascension Health, Largest Catholic Health System | Kaiser Health News | August 18, 2009

Checking In With Denver Health CEO Patricia Gabow On A "Model" Health Care System | Kaiser Health News | August 14, 2009

PBS NewsHour with Jim Lehrer recently featured the Billings Clinic, led by CEO Nicholas Wolter. PBS identified Billings an integrated, multi-specialty, high-performing health system on the level of the Mayo Clinic, the Cleveland Clinic, Geisinger, or Kaiser Permanente.

Mont. Clinic Aims to Deliver Top-quality Care for Less | PBS NewsHour with Jim Lehrer | August 12, 2009

Talk of using cooperatives in health reform has increased recently as the debate over the public plan intensifies. CNN recently highlighted the Group Health Cooperative, led by CEO Scott Armstrong, as a model health system that improves health care quality and efficiency by connecting patients directly to their doctors. Scott Armstrong was also featured on C-SPAN Newsmakers, to discuss the real world consequences of utilizing co-ops in national health reform.

Praise from doctors, patients on health cooperatives | CNN | August 18, 2009

Discussion on Health Care Co-ops | C-SPAN Newsmakers | August 23, 2009

Virginia Mason Medical Center, led by Chairman and CEO Gary Kaplan, MD was featured on the CBS Evening News earlier this summer. CBS examined the way Virginia Mason implemented the Toyota Production System (originally used to manufacture cars) to cut waiting times, connect patients to their doctors, reduce medical errors, and lower costs.

A Carmaker As A Model For A Hospital? | CBS News | June 6, 2009

Lloyd Dean, President and CEO of Catholic Healthcare West and Gary Kaplan, MD, Chairman and CEO of Virginia Mason Medical Center speak out about health reform, demonstrating their role as both local and national leaders in the current debate.

Lloyd H. Dean: Dare to imagine better, cheaper care | Sacramento Bee | August 19, 2009

Local Leaders Weigh In On Health-Care Reform | Kitsap Sun | August 2, 2009

Additional media coverage is available on the Health CEOs for Health Reform website.

HC4HCR: Checking In With Ascension, Denver Health

Meredith Hughes — Tue, 18 Aug 2009 19:40:00 -0400

This week, Kaiser Health News shined the spotlight on two high-performing health systems. KHN talked to Ascension Health President and CEO Anthony R. Tersigni, EdD, FACHE, and Denver Health CEO Patricia A. Gabow, MD, about the current health care reform debate, and what reform will mean for their health systems.We've highlighted both these health systems on this blog (here, here, here). Read more about them on the Health CEOs for Health Reform site.

Ascension Health is the nation's largest Catholic and largest nonprofit health care system, with over 60 hospitals in 20 states and the District of Columbia. Ascension Health serves patients through a network of services, including acute care services, long-term care, community health services, psychiatric, rehabilitation and residential care.

Dr. Tersigni told KHN that health care reform should feature a strong focus on covering the uninsured, then work on the other important issues facing U.S. health care, improving quality and controlling cost. For many hospitals, the cost of treating the uninsured is a huge strain. Uninsured patients tend to utilize costly emergency room treatment when serious health problems arise, as they lack access to the regular primary care visits that might have prevented the emergency in the first place. KHN reports that Ascension Health's bad debt from treating uninsured and underinsured patients grew by $167 million, or 23 percent over the past year as the economy worsened. He said,

We're concerned with making sure people have insurance rather than the dollar amount. We're taking care of these people anyway. We feel focused on let's get everyone 100% access, 100% covered. Then worry about how to make that work.

Dr. Tersigni is optimistic about reform. He believes we're closer to reform than we've been in over 60 years, and to miss this opportunity would be a tremendous waste.

Denver Health (which KHN points out is just a few hundred miles from the high-performing health community in Grand Junction) is an "integrated" health care network consisting of hospitals, clinics, and other community-based health services, such as correctional care and a 24-hour medical call center. To promote quality and lower cost, Denver Health utilizes health information technology and has followed the "LEAN" model to create a high-value efficient system which, according to Dr. Gabow, emphasizes getting five things right.

...Five rights -- the right physical environment, built for quality and safety and to support employees, patients and families; the right person in the right job; the right communication and culture; the right processes; and the right rewards.

Dr. Gabow believes national health reformers could learn from Denver Health's system's accomplishments. She told KHN,

To date, since 2006, we have saved $27 million by eliminating waste and making all the processes better. We did that without laying off anyone or cutting any care to the uninsured.

Health CEOs for Health Reform is a New America coalition of health industry leaders who believe that health reform is an urgent priority. Their leadership provides positive examples and shows that high quality, sustainable health reform is possible.

HC4HR: A New Model for Accountable Care

Paul Testa — Mon, 10 Aug 2009 21:37:00 -0400

Recently we had the chance to sit down and talk with Donna Katen-Bahensky, the president and CEO of University of Wisconsin Hospital and Clinics and a member of Health CEOs for Health Reform.

In the video below, Katen-Bahensky describes her organization's efforts to change the dynamics of modern medicine through the principles of accountable care organizations (ACO).

The academic medical center operates as part of UW Health -- a consortium of health care related entities that includes the UW School of Medicine and Public Health as well as a commercial health insurance plan and the largest academic, multispecialty physician group in Wisconsin. As such the organization's ACO has had particular success breaking down the silos of care that exist today and encouraging doctors, nurses, pharmacists, and all of the members of the health care continuum to work together as a team as the care for patients.

As Katen-Bahensky notes, this collaborative model has been especially important for primary care -- realigning the incentives to make field more attractive and viable to new doctors. Furthermore the consortium's commitment to the community through programs like the rural residency program, has helped create an environment where nearly two-thirds of the doctors it trains continue to practice in Wisconsin after graduation.

UW Hospital and Clinic's integrated approach has produced significant clinical and quality achievements as well. Like Denver Health, it has used health IT to improve the quality of care for patients -- particularly in the ICU. Like Ascension Health, UW Hospital and Clinics has focused on measuring and improving clinical outcomes. The health system consistently performs above national benchmarks for patient satisfaction and its post surgical mortality rates are especially impressive.

In part because of the way we finance graduate medical education, academic medical centers like UW Hospital and Clinics face an incentive structure that is like fee for service on steroids. Thus, like all of the members of Health CEOs for Health Reform, UW Hospital and Clinic's willingness to change its business model is courageous. Furthermore, its ability to do so while improving the quality of care it delivers and creating a system that values primary care is actually attractive to doctors, is proof that changes we need as a nation are not just possible but already in practice.

HC4HR: Sharing the Savings From Health Reform

Paul Testa — Tue, 21 Jul 2009 15:18:00 -0400

We've been running a series of posts on the Health CEOs for Health Reform, highlighting innovative models of integrated care, health IT, comparative effectiveness, and clinical excellence.

Today, we examine a collaboration being developed between payers, providers, and health plans in California to share in the savings of higher quality, lower cost care. Tomorrow, we'll wrap-up the series by looking at how these real-world experiences can be translated into practical policies for health reform.

In the video below, Wade Rose of Catholic Healthcare West and Mike Johnson of Blue Shield of California describe a pilot project being developed with the Hill Physicians Group and the California Public Employees Retirement System (CalPERs).

It's an experiment in shared savings. Beginning in 2010, Catholic Healthcare West, Blue Shield of California and the Hill Physicians Group have agreed to hold health care costs for CalPERs members living in the Sacramento area at or below their 2009 levels. They will do this while maintaining their commitments to quality care and patient satisfaction. If they deliver quality care in 2010 at rates less than their 2009 levels, the organizations will share in the savings. If costs rise above their 2009 levels, each organization will share the responsibility for a part of that burden.

The project is an encouraging example of how we can realign incentives within our system toward a more integrated model of care. Currently the interest of insurers, hospitals, doctors, and employers are often at odds. One group's savings is another group's loss. Under a model of shared savings, stakeholders have a reason to work together to deliver high value health care. Already there are more than 100 different initiatives being developed to improve quality and reduce costs. They're looking at ways to:

Improve coordination of care following patient discharge from hospitals to reduce complications and readmissions
Expand patient participation in disease management and complex case management programs
Promote palliative care
Increase the use of generic drugs
Minimize physician practice variation

What makes this project even more relevant is the nature of its participants. Blue Shield of California has more than 3.4 million members in California. CalPERs, which provides benefits to 1.6 million state, school and local public employees, retirees and their families, is Blue Shield's biggest customer and the second biggest purchaser of health care in the state. Catholic Healthcare West is the largest private health care system in the state and Hill Physicians Medical Group is one of the nation's largest independent physician associations. (For more on Hill Physicians, check out the work of our colleague, Tom Emswiler, here and here, who's studied the group extensively as part of a project between the New America Foundation and the Commonwealth Fund).

These are not tiny players. As Wade Rose noted in his presentation, Catholic Healthcare West represents the way most health care is currently delivered in the U.S. As Rose says, "We are the reason there needs to be health care reform."

The outcomes from this project, therefore, are not exceptions to the rule, but rather proof that real change can happen within our existing system. Already, this past June, CalPERs reported the lowest increase in overall premiums in 14 years -- and that's before the project is fully off the ground. If they can do it in California, we can do it as a nation.

HC4HR: Saving Lives Through Clinical Excellence

Alex Mazerov — Fri, 17 Jul 2009 15:21:00 -0400

Today we'll share more of the innovative work being done by the Health CEOs for Health Reform by taking a look at Ascension Health’s Clinical Excellence initiative.

In 2003, Ascension Health, the nation’s largest nonprofit health care system, introduced a system-wide “Call To Action” to provide excellent clinical care. Committing to a transformational goal to provide “Healthcare that works, healthcare that is safe, and healthcare that leaves no one behind,” Ascension set out to eliminate all preventable injuries or deaths within five years -- by July 2008.

As Ascension Health President and CEO Anthony Tersigni describes in the video below, the results were nothing short of remarkable, far surpassing initial expectations.

Bringing together providers and other stakeholders from its nationwide healthcare network, Ascension identified eight "Priorities for Action" to improve quality and provide excellent clinical care. The primary metric its design team settled on was mortality reduction. Ascension estimated that, before it put its bold clinical transformation agenda into action, 15 percent of all deaths occurring in patients not admitted for end-of-life care were preventable -- corresponding to 900 lives throughout the Ascension network that could be saved each year.

Ascension also focused its quality improvement efforts on the Joint Commission National Patient Safety Goals, perinatal safety, serious falls, pressure ulcers (commonly known as bed sores), surgical complications, healthcare-associated infections, and adverse drug events.

To meet the goal of completely eliminating facility-acquired pressure ulcers, for instance, Ascension adopted a uniform scoring tool to assess a patient's risk. Its providers implemented a system-wide standardized plan of care called the SKIN bundle. SKIN stands for “Surface Selection,” which refers to having the appropriate bedding surface for patients, “Keep them Turning,” which involves patient mobility and positioning, “Incontinence Management,” and “Nutrition Support.” Ascension also began an ongoing education program regarding pressure ulcer elimination. (Pressure ulcers are not minor skin irritants. They can kill.)

Ascension Health’s quality improvement initiatives prevented more than 1500 deaths. The incidence of pressure ulcers dropped significantly to a rate 95 percent lower than national estimates. Compared to national averages, the system experienced a reduction in birth trauma of 77 percent and a reduction in neonatal mortality of 81 percent. Ascension’s hospital readmission rate of 9 percent is half the national average.

As Tersigni explained in the video, Ascension Health’s success in improving outcomes and patient safety proves that rapid change is possible.

The ability of a system the size and scope of Ascension Health to reach such performance levels in providing healthcare that is safe in just five years is proof that rapid improvements in clinical quality of care, patient satisfaction, better and health, and efficient resource use are in fact possible.

HC4HR: Merck Promotes Quality and Value for Patients With Diabetes

Meredith Hughes — Thu, 16 Jul 2009 13:00:00 -0400

When she spoke to us at the Health CEOs for Health Reform event recently, Merck's Senior Director of Public Policy, Jane Horvath, presented her response to two very important questions. Why does Merck, one of the world's largest pharmaceutical companies, believe that delivery system reforms are possible? And what has Merck done that demonstrates that change is possible?

To learn about Merck's pilot plan to promote value and quality in health care, check out the video below, or keep reading.

Better Diabetes Management

Earlier this year, Merck (a pharmaceutical company) and CIGNA (one of the largest health insurers in the U.S.) announced a partnership based around an innovative claim: they could lower costs while improving health care quality. If you've been following our other posts on the Health CEOs for Health Reform and what they've accomplished, this idea may sound familiar.

As a part of the deal, Merck agreed to offer Januvia and Janumet, two oral diabetes medications, at a discounted price if patients showed improvement while taking them. These drugs, in conjunction with diet and exercise, help patients to manage their blood sugar levels. If Cigna reviews the A1C lab results of patients with type 2 diabetes at the end of the year and find values have improved, Merck will increase the discounts on these drugs. (In a lab test, A1C levels can indicate a patient's average blood sugar levels over time.) This doesn't just apply to drugs produced by Merck. Any patient taking an oral anti-diabetic medication who shows improvement will trigger a discount for Cigna.

Comparative Effectiveness Research

Merck and Cigna's deal is performance based -- the better patients taking drugs do, the cheaper the pills. Adherence is a big deal for diabetics. Even the smallest slip up in following through with treatment can have serious health consequences down the road. Simpler (and cheaper!) prevention and disease management strategies such as exercise, diet, and taking medication on time can help protect diabetics from more serious (and costly) health complications such as heart or kidney disease, stroke, or nerve damage. Cigna told Reuters, "medicine adherence programs have helped diabetics reduce emergency room and other hospital visits by 50 percent for those reaching blood-sugar goals, and reduced diabetes-related costs by 24 percent."

According to Horvath, Merck decided a number of years ago that it should support comparative effectiveness research. CER is "an effective and rational tool and information set by which to optimize coverage policy and treatment decisions," said Horvath. By offering discounts on drugs that work, Merck is promoting a health care system that rewards quality, value, and well...health. In a press release, both Merck and CIGNA agreed that "aligning all of the incentives behind improving the health of individuals is one of the most effective ways to achieve long-term health improvement."

HC4HR: How a Safety Net Hospital Unleashed the Power of Health IT

Paul Testa — Wed, 15 Jul 2009 12:38:00 -0400

The story we are about to tell you is probably not what automatically comes to mind when you hear "safety-net hospital."

On Monday, we continued our series of posts on the Health CEOs for Health Reform by looking at how more integrated models of care can deliver higher quality at lower costs.

Today, we'll see how Denver Health -- an urban safety net institution for Denver and the Rocky Mountain Region -- has established a highly integrated system that consistently delivers high-value care to vulnerable population. Health IT and electronic medical records are key to their success, as Patricia Gabow, MD, Denver Health's CEO explains in the video below:

Denver Health is a complex system providing a whole host of services. Just to name a few, there's the 911 ambulance and trauma system; a Disproportionate Share Hospital (the busiest hospital in Colorado); eight federally qualified health centers; the county public health department; 12 school-based clinics; as well as an HMO which serves Medicaid, SCHIP, Medicare and commercial patients. And, as Dr. Gabow will tell you, what makes all these moving parts work together for Denver Health is the commitment to health IT. Their imaged, electronic medical record ties it all together. It lets doctors communicate with doctors -- for example, a doctor in the ER can easily bring up a list of all the medications an unconscious patient's primary care physician has prescribed. It helps doctors communicate with patients, developing treatment plans and following up on adherence.

Health IT has helped Denver Health manage complex chronic diseases, like diabetes or asthma. As Dr. Gabow noted, 61 percent of their hypertensive patients have their blood pressure under control compared to a national average of 34 percent. Denver Health has 92 percent of its one-year-old patients fully immunized. Furthermore, consistent and constructive use of health IT has enabled Denver Health to eliminate ethnic disparities in areas like cancer screenings and diabetes management.

What makes this all the more impressive, is that Denver Health is a true safety-net institution. It serves 150,000 patients annually, of which 78 percent are minorities, 50 percent are uninsured, and 85 percent are below 185 percent of the Federal Poverty Level. Since 1991, it has provided $3.4 billion in uncompensated care for the uninsured -- with $360 million in uncompensated care projected this year. Yet each year they manage to stay profitable, by providing high-value care in an integrated system. If Denver Health can do it, so can we.

HC4HR: Lowering Cost While Improving Patient Care

Meredith Hughes — Mon, 13 Jul 2009 14:39:00 -0400

Today, we continue our series of posts on the Health CEOs for Health Reform -- a New America Foundation coalition of industry CEOs and physicians committed to improving our health system.

Gary S. Kaplan, MD is the Chairman and CEO of the Virginia Mason Medical Center in Seattle, Washington. With Dr. Kaplan's leadership and the implementation of the Virginia Mason Production System, Virginia Mason has become one of the top-rated hospitals in the United States. To see Virginia Mason in action, check out the video below:

Virginia Mason Production System

In an earlier post, Dr. Kaplan reminded us that "Nearly half the $2.6 trillion in the U.S. health-care system is waste... More than a trillion dollars...adds no value for patients and sometimes even causes harm."

In 2002, the Virginia Mason Medical Center in Seattle, Washington, began implementing a program designed to reduce cost while improving quality, safety, and efficiency. Today, the hospital estimates it has saved $11 million, decreased waiting times, and increased productivity and safety. They call their strategy the Virginia Mason Production System (VMPS) and model it after the Toyota Production System. (Yes -- you read that correctly, they modeled their health care delivery system after a Japanese auto manufacturer).

Why Toyota? The idea behind the Toyota Production System is that those closest to the work are the best qualified to figure out the most efficient way to get the work done. All work should add value. In the case of cars, it means every task on the assembly line should be relevant to the final goal: producing a safe, affordable car. In health care, it means that clinicians and caregivers are spending all of their time caring for patients, rather than doing other tasks that don't add value to the patients' health or experience in the hospital.

The benefits include:

Patients spend more time with providers, and VMPS tools and processes help providers deliver the best possible care with zero defects.
Patients benefit from greater safety, fewer delays in seeing physicians for care, and more timely results and treatments.
VM staff benefit by having less rework and greater opportunities to care for patients -- one of the primary reasons many choose health care as a profession.
The organization benefits because it operates more efficiently. Ultimately, savings are reinvested to support VM's mission to improve patient health and well-being.

Working with Employers

Dr. Kaplan cites a challenge from employers to reduce costs and increase quality as one source of inspiration for the success of VMPS. In 2004, Virginia Mason began work with several employers, such as Starbucks, Costco, Boeing and Microsoft, and the insurer Aetna to analyze and reform their health care delivery system into what Dr. Kaplan calls marketplace collaboratives. To create marketplace collaboratives, Virginia Mason works with stakeholders and utilizes the Toyota production principles to "deconstruct" and then reconstruct the delivery of care. Each collaborative focuses on a specific issue, such as back pain and migraines, and works on making the treatment less expensive, more efficient, and of higher quality. (Stop and think about that one for a moment -- care that's cheaper and better?)

The Washington Post gives an example of a marketplace collaborative in action. Back pain was a common complaint among Starbucks employees. In response, the employees' doctors often recommended an MRI. MRIs usually don't yield much useful information about the source of back pain, but they do yield a lot of profit to Virginia Mason. The marketplace collaborative solution for patients with back pain was to start them on physical therapy first, rather than wait for a costly -- and often useless -- MRI. Aetna helped Virginia Mason compensate for the lost MRI revenue by upping reimbursement for physical therapy. "Today, the majority of Starbucks employees with back trouble return to work within 48 hours," Dr. Kaplan told the Post.

In a video presentation at the Health CEOs event, Dr. Kaplan reiterated the values and goals of his organization,

At Virginia Mason, we are committed to reducing the cost of care, and this work and commitment is energized by our demonstration that it is truly possible. We know the pathway to affordability is the pathway of safety, quality, and prompt access to care. I invite all of you, policymakers, health plans, employers, and patients to join with us in this important work.

More details about the Health CEOs and their recommendations for delivery system reform are available in this white paper.

HC4HR: Better Care at Lower Costs with Medical Homes

Paul Testa — Thu, 09 Jul 2009 20:27:00 -0400

There's a scene in the 1996 movie Independence Day where Harvey Fierstein (right), trapped in traffic trying to escape the shadow of an ominous alien ship, calls his doctor's office. Informed that Dr. Katz is not available, Fierstein screams "For $300 an hour, you can put me through to his house in the Hamptons!"

Had Fierstein been a patient with access to Group Health Cooperative's medical homes, his doctor could have called him, reminded him to take his blood pressure medication and scheduled a date for a follow-up visit.

On Wednesday, we began a series of blog posts that will highlight the innovative work being done by members of Health CEOs for Health Reform -- a New America Foundation coalition of industry CEOs and physicians committed to improving our health system.

Today, we'll examine the innovations in primary care made by the Group Health Cooperative -- a consumer-governed, integrated health care system covering over 600,000 individuals and delivering care in one of the largest integrated group practices in the Pacific Northwest. In the video below, Group Health president and CEO, Scott Armstrong, MBA, explains why his organization decided to adopt a medical home model for primary care, how they restructured their system, and the impressive results that followed.

With Congress considering private sector health insurance cooperatives as a possible alternative to a public health insurance option, Group Health has drawn national attention. As Armstrong told The New York Time's Kevin Sack recently:

There's a kind of accountability to the patients in our system ... And when you bring the principles of a cooperative to bear, patients feel responsibility for holding the system together and for their own health.

Features of Group Health make it quite unusual, even within the finite world of insurance cooperatives. Yet the lessons from Group Health's experience in revamping its primary care model can be applied to our health care system as a whole.

Group Health started its transformation after seeing within its own network of providers the kind of variations in cost and quality of health care documented across the U.S. by the Dartmouth Atlas and Atul Gawande. In January 2007, it started a medical home pilot at its Factoria Medical Center. Now Group Health plans to introduce the medical home model in all its medical centers by 2010. What follows are some key points to take away from Group Health's experiences:

Strengthening the patient-doctor relationship:

One of the hallmarks of a medical home model -- however you define it -- is that it strives to give doctors more time. Medical homes give doctors more time to spend with patients and more time to do the kinds of things that can keep people healthy but are generally not reimbursed (or reimbursed poorly) under current payment models. Group Health expanded its primary care staff by 30 percent, allowing it to: reduce physician panel sizes (the number of patients under each doctor's care); increase multidisciplinary teams of doctors, physician assistants, nurses, medical assistants, and clinical pharmacists; and extend appointment times from 20 minutes to 30.

More Coordination and Better Communication

In his presentation during a recent HC4HR briefing on Capitol Hill, Armstrong described his own experience, as a patient, with Group Health's medical home model. He received an email one morning saying his lab reports had come. Using Group Health's electronic medical record, he was able to securely access the results online. To his disappointment, he saw that his cholesterol was too high. A few hours later, Armstrong got a call from his doctor, telling him, yes, the cholestoral was still too high. Not only had the doctor already adjusted the medication, the prescription had been sent to the pharmacy (e-prescribing) and the new meds would be mailed to Armstrong in the next couple of days. Efficient, fast, and convenient.

Rapid Change and Real Results

Group Health's efforts have paid off. Relative to baseline estimates, ER visits for patients in Group Health's medical home dropped by almost 30 percent. Avoidable hospital admissions declined by 11 percent. Those savings alone, Armstrong argued, can more than pay for the investments needed in primary care. Overall quality measures increased, as did employee satisfaction. Group Health's vice president for primary care, Michael Erikson, believes the reductions in turnover and recruitment costs for physicians and other clinical staff may save the organization up to $2 million a year. Based purely on the testimonies posted by real doctors to Group Health's medical home blog, Erikson maybe on to something. Patricia Boiko, a family practice physician, writes:

Two years ago, I was at wits end. When I entered a room with a patient my first words were always, "Sorry, I am running late". I was frustrated at the lack of time to look up issues or call consults while the patient was in the room. I was always back logged with results and getting answers to patients.

That all has changed. Gradually over the last two years, I have arrived! I walked into each room today within 15 minutes of the appointment time, completely prepared for the visit. I prepped the MA [medical assistant] with all the things that would aide the efficient and complete care of each [patient] before they were seen. I called a consultant today who was too busy to discuss a case with me and preferred me to refer the [patient]. I called another consultant who was able to give me advice over the phone as to how to work up the patient. The patient was happy not to have to see another doctor and is on her way to appropriate diagnosis and treatment. I am not backlogged with calls, labs, or consultations. The work gets done today and the rework is at a minimum. I am truly happy in the practice and able to tell patients how great the GH Medical Home system is.

Check back next week, as we examine more examples of what works in health care and check out this Health CEOs for Health Reform white paper for practical policies that can transform health care in America.

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

Paul Testa — Wed, 08 Jul 2009 20:19:00 -0400

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:

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)
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!