Quality

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:

Newspapers are abuzz with the daily drama of health politics. But we're also seeing good news -- stories highlighting health care success stories. High performing health systems across the U.S. show us that our goals for health reform -- high quality, low cost, and coverage for all Americans -- are possible. And in a reformed health care system with better and more sensible incentives and payment systems, we'll see even more innovation. These health systems might not be launching anyone into space, but they are caring for people, a job that requires just as much precision and thoughtfulness. They've got "the right stuff.'

Group Health Cooperative and Kaiser Permanente Northwest. Both health systems drew attention recently when Sen. Kent Conrad (D-ND) proposed co-ops as an alternative to a public health insurance option. The key to their success is spending more money up front on primary and preventative care, rather than waiting for health problems to become more serious and more costly, reports The Portland Oregonian. (We at New America have also worked with Group Health on Health Care CEOs for Health Care Reform.)

When you have a chance, get the grandparents away from watching those blood-pressure raising town halls on their televisions, and tell them this. Health reform is not about chopping Medicare. It's about making it better. And saving lives.

A test program now in its fourth year has shown how it can work. Hospitals that do a great job get rewarded. Those with a poor performance, get penalized. 

Premier, Inc., a health care alliance based in North Carolina, released the results of year four of their landmark Medicare demonstration project this week. You might remember last year I blogged about year three, one of the first instances of a pay-for-performance initiative enforcing financial penalties on low-performing providers. I even got a tiny mention on Modern Healthcare (free registration required).

Year four again brought good news about higher quality. BNA says:

With so much  ruckus over what's in the House health reform bill, what's not actually in the bill and what imaginary horrors it will bring about , we'd like to highlight a feature not getting much attention -- namely a push to reduce or eliminate health disparities.

Here are some of the highlights from the House Tri-Committee bill, HR 3200:

• Medicare will reimburse for "culturally and linguistically appropriate services" to promote access for Medicare beneficiaries with limited English proficiency. (NOTE: This is not a codeword for covering illegal immigrants, as some  foes of reform have contended).
• Reducing health disparities would be an explicit goal in the HHS Secretary's national priorities for quality improvement in health care.
• The Secretary of HHS and the Institute of Medicine would look at how providers utilize cultural and linguistic support services, design a demonstration program to pay for these services, and study the impact on reducing health disparities.
• Establish a CDC grant program for community-based prevention and wellness. Significantly, "At least 50% of these funds must be spent on implementing services whose primary purpose is to reduce health disparities."

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.

In a standard office visit,  Dr. William Zafirau might not have discovered that "Mrs. S" had trouble handling the metered dose inhaler she needed for her chronic obstructive pulmonary disease.

On an old-fashioned house call, Dr. Zafirau had more time with his elderly patient. Time to talk. Time to observe. He learned that the arthritis in her hands made it hard for her to manipulate the inhaler.  He switched her to a nebulizer, and arranged pain relief and physical therapy for her arthritis. She's breathing better now despite her COPD. She is in less pain. She gets out more.

"You learn by being in a patient's home," Dr. Zafirau, a geriatrician at Summa Health System in Akron, OH,   explained in a telephone conversation this week. "You have a whole new level of honesty. There isn't the power differential that exists in the office. Plus it's a lot harder for patients to hide things from you. They want to be polite and not bother you. They don't lie, but it's not full disclosure."

From Portsmouth to Belgrade to Grand Junction, President Obama hit the road last week, bringing the case for health reform directly to the American people.

Hitting back against some of the more offensive lies about health reform, Obama used the forums to define the debate on his own terms. He focused on individuals, using their stories and struggles to illustrate how health reform will benefit all Americans. This more personal focus has been hammered home, from the president's Saturday address to his op-ed in The New York Times this past weekend:

There are four main ways the reform we're proposing will provide more stability and security to every American.

This weekend, President Obama traveled to Grand Junction, CO to promote health reform. As we've mentioned before, both on this blog and in our recent paper, Grand Junction, Colorado: A Health Community That Works, Grand Junction spends less but delivers higher quality care than most other U.S. communities.

As New America's Len Nichols told The Los Angeles Times, Grand Junction is "a great example for the nation...They have managed to contain the natural impulses of excessive competition and the medical arms race...Everybody's looking into this."

The health community in Grand Junction is well-coordinated and pursues many strategies to deliver patients high quality care while keeping costs down. Politics Daily provides a good run-down, but here are some highlights:

Grand Junction, CO, is the high-quality, low-cost flip side of McAllen, Texas in Atul Gawande's recent New Yorker article. New America's health policy team just published a case study on how Grand Junction's health care system evolved (full paper here, summary here), and what the rest of our country can learn from it. We gave you an overview on our blog Thursday. Now we're going to look at how the community uses health IT to create quality and value.

We all know that health IT in and of itself isn't a cure-all. But it's hard to fix health care without smart use of health IT across the community.

One of the unusual features about the Colorado community is that the main health plan (Rocky Mountain Health Plans) pays a "blended rate" to physicians. That means it's a similar rate for private insurance, Medicare, and Medicaid. Doctors thus don't have any incentive to cherry-pick better paying privately insured patients, and shun the poor. Everybody gets care. The community benefits.

McAllen, Texas, became a buzzword for high health care spending after Atul Gawande's recent New Yorker article. Less attention was paid to Grand Junction, Colorado, which that same article held out as a model of high-quality, low-cost care. President Obama plans to visit Grand Junction and see for himself this weekend.

How did Grand Junction become one of the nation's highest performing health care communities? We had heard about Grand Junction months ago, and began wondering about that ourselves. So for the last few months some of the New America health team has been studying the data, and talking to participants. We just released the case study: "Grand Junction, Colorado: A Health Community that Works."

You can read a summary here or the full paper here. Today and tomorrow on the blog, we'll l share some of the highlights.