A col­lab­o­ra­tive ef­fort

Group formed to de­ter­mine best care prac­tices

Modern Healthcare - - The Week In Healthcare - Paul Barr

Six hos­pi­tals and health sys­tems and the Dart­mouth In­sti­tute for Health Pol­icy and Clin­i­cal Prac­tice are hop­ing to quicken the pace of health­care qual­ity im­prove­ment for the coun­try with the for­ma­tion of a qual­ity col­lab­o­ra­tive ef­fort un­veiled last week.

The group plans to sys­tem­at­i­cally de­ter­mine best care prac­tices for some com­mon and ex­pen­sive con­di­tions, and then share that in­for­ma­tion with the rest of the coun­try in a Health­care, Salt Lake City; and Mayo Clinic, Rochester, Minn.

To ar­rive at their am­bi­tious goals, the par­tic­i­pants in­tend to swap data on out­comes, qual­ity and costs, a level of shar­ing that could raise an­titrust con­cerns if the or­ga­ni­za­tions are viewed as com­peti­tors fix­ing prices. “We’re keep­ing an eye very much on an­titrust prin­ci­ples to make sure we’re well within those guide­lines,” said Dart­mouth-Hitch­cock spokesman Rick Adams . He added that the group’s mem­bers see on av­er­age from $16,000 to $24,000 each.

To­tal knee re­place­ment is a good can­di­date to be in­cluded in fu­ture fed­eral bun­dled pay­ment pro­grams, and this in­for­ma­tion could in­form that ef­fort, said James We­in­stein, a physi­cian who is di­rec­tor of the Dart­mouth In­sti­tute. We­in­stein was a key player in the for­ma­tion of the group, which has its roots in a col­lab­o­ra­tion be­tween Dart­mouth, In­ter­moun­tain and Mayo that be­gan 12 years ago, par­tic­i­pants said.

The idea is to pub­licly pro­vide a set of stan­dards of care for use by any in­ter­ested par­ties, in­clud­ing the CMS, pri­vate in­sur­ers and em­ploy­ers, We­in­stein said.

Early next year, the group will an­a­lyze best prac­tices in care for di­a­betes and heart fail­ure. Round­ing out the list of other pro­ce­dures to be an­a­lyzed are: asthma, de­pres­sion, la­bor and de­liv­ery, spine surgery and weight-loss surgery.

The back­ers of the group be­lieve that swift ac­tion is needed given the changes oc­cur­ring un­der health re­form, and clin­i­cians are in the best po­si­tion to pro­mote that ac­tion. “We be­lieve that true health­care re­form will come out of the front lines,” said Brent James, chief qual­ity of­fi­cer at In­ter­moun­tain Health­care and ex­ec­u­tive di­rec­tor of the In­ter­moun­tain In­sti­tute for Health Care De­liv­ery Re­search.

The six mem­bers alone serve an es­ti­mated pa­tient pop­u­la­tion of 10 mil­lion peo­ple. The mem­bers of the ini­tial group were cho­sen for their di­ver­sity in terms of lo­ca­tion, the types of pa­tients they serve and pay­ers of the care, par­tic­i­pants said. For ex­am­ple, Den­ver Health serves a large num­ber of Med­i­caid pa­tients in an ur­ban set­ting, while oth­ers deal more with pri­vate in­sur­ers and Medi­care, some in more sub­ur­ban or ru­ral fa­cil­i­ties. About 30 more providers are seek­ing to join the group, and ex­pan­sion is planned. By start­ing with six large par­tic­i­pants and even­tu­ally in­clud­ing other sites, the col­lab­o­ra­tive ef­fort can cre­ate mo­men­tum to ap­ply some of these best prac­tices na­tion­ally, said Robert Stroebel, chair­man of Mayo Clinic’s di­vi­sion of pri­mary-care in­ter­nal medicine.

Get­ting broad par­tic­i­pa­tion to work given the va­ri­ety of providers out there may prove chal­leng­ing at points, said one qual­ity ex­pert, Janet Corrigan, pres­i­dent and CEO of the stan­dards-set­ting Na­tional Qual­ity Fo­rum. Nev­er­the­less, she said she wel­comes the ef­fort. “This is very much what we need to be do­ing at this time,” Corrigan said. The group’s fo­cus on an­a­lyz­ing an en­tire episode of care is im­por­tant, as is the par­tic­i­pants’ ex­pe­ri­ence with health in­for­ma­tion technology, she said.

One ques­tion mark is how the par­tic­i­pants will split the tab for their col­lec­tive work. A spokesman for Dart­mouth said that re­mains un­der dis­cus­sion.

The par­ent or­ga­ni­za­tion of Den­ver Health Med­i­cal Cen­ter, above, is par­tic­i­pat­ing in the col­lab­o­ra­tive ef­fort along with five other hos­pi­tals and sys­tems.

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