Lo­cal lab­o­ra­to­ries

Qual­ity, cost-cut­ting ex­per­i­ments abound in cities, re­gions

Modern Healthcare - - Opinions Commentary - Anne Weiss

Like pol­i­tics, all health­care is lo­cal, and that’s why dur­ing this po­lit­i­cal sea­son in Wash­ing­ton, it’s worth­while to ob­serve lo­cal lab­o­ra­to­ries where re­form hap­pens ev­ery day. That’s what took me to Madi­son, Wis., re­cently, where the Wis­con­sin Col­lab­o­ra­tive for Health­care Qual­ity brought to­gether a di­verse group— physi­cians, hos­pi­tals, health plans and em­ploy­ers—to work on a crit­i­cal is­sue: How can we get bet­ter value from the $2.3 tril­lion the U.S. spends an­nu­ally on health­care?

The col­lab­o­ra­tive is a leader in im­prov­ing qual­ity and cost-ef­fec­tive­ness. I watched as it bit off a small part of the prob­lem: to see if doc­tors, in­sur­ers, em­ploy­ers and qual­ity-mea­sure­ment ex­perts could be­gin com­bin­ing num­bers on qual­ity and cost to mea­sure ef­fi­ciency in a way that would help providers de­liver bet­ter care at lower cost and help pay­ers make bet­ter pur­chas­ing de­ci­sions. Any­one who has fol­lowed such dis­cus­sions knows they can be con­tentious, but this one was civil and pro­duc­tive, with clear recog­ni­tion that the par­tic­i­pants can set an ex­am­ple for the na­tion’s health­care sys­tem.

No mat­ter what hap­pens in Wash­ing­ton, it will re­quire ef­forts like th­ese to tackle the in­ef­fi­cien­cies in our sys­tem, which by some es­ti­mates ac­count for nearly one-third of all spending. Without bet­ter tools to mea­sure and re­duce waste, pol­i­cy­mak­ers can­not ex­tend care to mil­lions of Amer­i­cans who go without.

The col­lab­o­ra­tive is one of 15 state-or com­mu­nity-based or­ga­ni­za­tions work­ing with the Robert Wood John­son Foun­da­tion’s Align­ing Forces for Qual­ity, also known as AF4Q, ini­tia­tive launched in 2006. AF4Q joins those who get care, give care and pay for care to lift qual­ity and ef­fi­ciency in their com­mu­ni­ties. Our hope is not only to bring last­ing change to the 15 mar­kets but also to de­velop na­tional mod­els for re­form.

The heart of the pro­gram is a three­p­ronged ef­fort to im­prove qual­ity of care in doc­tors’ offices and hos­pi­tals; to mea­sure and pub­licly re­port on the qual­ity of care; and to en­gage con­sumers in mak­ing in­formed choices about their health and health­care. We are also work­ing to re­duce racial and eth­nic in­equities in care and en­hance the role of nurs­ing.

In some com­mu­ni­ties, unit­ing con­sumers, doc­tors, hos­pi­tals, in­sur­ers and em­ploy­ers was a feat in it­self. Con­sider, for in­stance, the Puget Sound Health Al­liance in Seat­tle. In busi­ness since 2004, the al­liance con­sid­ered its first victory the sim­ple act of bring­ing to­gether di­verse stake­hold­ers—many of whom had never sat at the same ta­ble—around a com­mon goal of im­prov­ing health and health­care. It was es­pe­cially im­por­tant for com­pa­nies that buy health in­sur­ance for their em­ploy­ees to sit down with the doc­tors. For many, it was the first time they didn’t have to speak with each other over the head of an in­sur­ance com­pany.

Over time, the group found it was eas­ier to forge agree­ments at the lo­cal level than at the state or fed­eral lev­els. With sup­port from AF4Q, the group pub­lished three Com­mu­nity Checkup re­ports on health­care qual­ity in the Seat­tle re­gion, us­ing 21 mea­sures rang­ing from whether di­a­betes care was ad­e­quate to whether pa­tients with lower back pain were get­ting un­nec­es­sary imag­ing.

Key to putting to­gether the Seat­tle group was Ron Sims, at the time the ex­ec­u­tive of Wash­ing­ton’s King County (and now in the Obama ad­min­is­tra­tion), who used his clout to get com­pet­ing in­ter­ests to come to­gether.

Fed­eral pol­i­cy­mak­ers cite po­ten­tial sav­ings from pre­vent­ing avoid­able hospi­tal read­mis­sions. The Com­mu­nity Health Al­liance of Hum­boldt-Del Norte is work­ing on this in Cal­i­for­nia. Nurses help keep pa­tients from be­ing read­mit­ted to the hospi­tal by mak­ing sure th­ese pa­tients fol­low their pre­scribed care af­ter treat­ment. In­no­va­tions like th­ese have cut read­mis­sion rates sub­stan­tially—to 8% from 10% in the first year.

Or con­sider a ground­break­ing ini­tia­tive to ask pa­tients about their doc­tors. Two of the 15 AF4Q groups, the Kansas City Qual­ity Im­prove­ment Con­sor­tium and the Healthy Mem­phis Com­mon Ta­ble, joined Con­sumers’ Check­book/the Cen­ter for the Study of Ser­vices in a pi­lot pro­gram to sur­vey pa­tients on the care they re­ceive.

This wasn’t just pa­tients com­plain­ing about whether the chairs were comfortable at their doc­tor’s of­fice. The sur­vey asked ques­tions de­vel­oped by the U.S. Agency for Health­care Re­search and Qual­ity and en­dorsed by the Na­tional Qual­ity Fo­rum, such as how well the doc­tor lis­tens and how easy it is to get an ap­point­ment. Stud­ies show there is a re­la­tion­ship be­tween what pa­tients say about their care in this care­fully de­signed sur­vey and their doc­tors’ clin­i­cal out­comes. It dif­fers in im­por­tant ways from the types of open-ended user sur­veys (restau­rant-rater Za­gat, for in­stance, is do­ing one of th­ese) that can an­tag­o­nize doc­tors, who den­i­grate them as pop­u­lar­ity con­tests.

The com­mu­ni­ties de­fused crit­i­cism by rat­ing a doc­tor only on a suf­fi­cient num­ber of re­sponses. In Kansas City, for ex­am­ple, the sam­ple was 58 pa­tients per doc­tor for more than 700 doc­tors. And doc­tors could re­view the rat­ings be­fore the in­for­ma­tion went on­line. You can see the re­sults for both com­mu­ni­ties and Den­ver (the third par­tic­i­pant) at check­book.org/pa­tient­cen­tral.

For more in­for­ma­tion on re­forms oc­cur­ring right now in com­mu­ni­ties across the coun­try, even as Congress de­bates over­haul­ing the sys­tem, go to forces4qual­ity.org.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.