U.S.-Euro­pean part­ner­ships im­prove care on both sides of the At­lantic

Modern Healthcare - - COMMENT - By Dr. Brent James In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­care.com/ op-ed. Send drafts to As­sis­tant Man­ag­ing Ed­i­tor David May at dmay@mod­ern­health­care.com.

The U.S. health­care sys­tem is of­ten com­pared to Euro­pean sys­tems in un­flat­ter­ing terms, yet Euro­pean sys­tems are un­der grow­ing pres­sure to in­crease their care qual­ity and ef­fi­ciency. Many are look­ing to the U.S. for in­no­va­tive, proven so­lu­tions. There is much that we can learn

from each other, and newly formed col­lab­o­ra­tions are pro­vid­ing one ve­hi­cle for that learn­ing.

At In­ter­moun­tain Health­care, my team and I are di­rectly en­gaged in learn­ing part­ner­ships with a num­ber of Euro­pean coun­tries. We are struck by the ex­tent to which our very dif­fer­ent sys­tems are now grap­pling with the same pres­sures, and even mov­ing to­ward each other struc­turally. It’s all the more strik­ing since our sys­tems are so dif­fer­ent. Health­care in the U.S. is based on free mar­kets, while our Euro­pean part­ners rely much more heav­ily on gov­ern­ment con­trols. We share the goal of achiev­ing the Triple Aim: bet­ter care for in­di­vid­u­als, bet­ter health for pop­u­la­tions and lower per capita costs. That is the ba­sis for our col­lab­o­ra­tion.

We also share the pres­sures of ris­ing costs, the need to cover more peo­ple, and grow­ing pub­lic anx­i­ety over who will get which ser­vices and who will pay the bill. Those pres­sures are driv­ing our care de­liv­ery sys­tems to­ward each other. The U.S. has moved in the di­rec­tion of univer­sal health­care cov­er­age, while in France, for ex­am­ple, some pub­lic hos­pi­tals are be­com­ing pri­vate.

The Euro­pean sys­tems are es­pe­cially strong in pop­u­la­tion health and well­ness, a grow­ing fo­cus in the U.S., and Amer­i­can sys­tems are strong in dis­ease man­age­ment. With the grow­ing preva­lence of chronic dis­eases, both strengths be­come in­creas­ingly im­por­tant and in­ter­twined.

That’s where the part­ner­ships have emerged. The French health­care sys­tem has cre­ated a col­lab­o­ra­tion with In­ter­moun­tain’s In­sti­tute for Health Care De­liv­ery Re­search for three pur­poses: first, to cre­ate a sim­i­lar in­sti­tute in France to study and pro­mote best prac­tices; sec­ond, to cre­ate a ver­sion of our Ad­vanced Train­ing Pro­gram in Health Care De­liv­ery Im­prove­ment (ATP) and im­ple­ment that pro­gram na­tion­ally; and third, to en­gage in joint learn­ing op­por­tu­ni­ties—care de­liv­ery re­search— about “best care” strate­gies. We hope to study dif­fer­ences in care de­liv­ery pat­terns across our coun­tries and learn from them, with the aim of im­prov­ing both sys­tems.

The French in­sti­tute will in turn gen­er­ate a Euro­pean ini­tia­tive fo­cused on high value, sim­i­lar to the High Value Health­care Col­lab­o­ra­tive in the U.S. In­ter­moun­tain was one of four found­ing or­ga­ni­za­tions that cre­ated the HVHC, which in­volves some of the largest health­care providers in the na­tion. To­gether, the groups in the col­lab­o­ra­tive study dif­fer­ences in cur­rent prac­tices and out­comes, iden­tify best prac­tices, and jointly con­duct anal­y­sis to find even bet­ter prac­tices.

A sep­a­rate col­lab­o­ra­tion has emerged with the Swedish health sys­tem, which has sent health of­fi­cials (clin­i­cal and ad­min­is­tra­tive) from ev­ery re­gion of the coun­try to bench­mark In­ter­moun­tain’s care-man­age­ment suc­cesses. Swe­den also sends health­care lead­ers to at­tend the ATP and op­er­ates its own very suc­cess­ful “sis­ter” ATP pro­gram in Swe­den. Sim­i­larly, the Swiss health­care sys­tem has sent nu­mer­ous health of­fi­cials to at­tend our pro­gram. Other suc­cess­ful “sis­ter” pro­grams op­er­ate in Canada, Great Bri­tain, Aus­tralia and Ar­gentina.

Th­ese col­lab­o­ra­tions pro­vide an ex­traor­di­nar­ily valu­able op­por­tu­nity to learn from each other. We bring dif­fer­ent ar­eas of ex­per­tise, then merge our learn­ing.

Swe­den, for ex­am­ple, has op­er­ated cen­tral­ized dis­ease-spe­cific, re­searchori­ented, pa­tient registries for almost 20 years. In­ter­moun­tain op­er­ates 58 sim­i­lar registries, in­te­grated into clin­i­cal work­flows and de­signed for care de­liv­ery per­for­mance. Early stud­ies com­par­ing treat­ment of di­a­betes mel­li­tus showed sim­i­lar per­for­mance across six di­a­betes per­for­mance mea­sures, while In­ter­moun­tain did bet­ter in terms of the pro­por­tion of pa­tients who did well across all six mea­sures. This tracked back to data support sys­tems in­te­grated into pri­mary-care prac­tices.

The French, on the other hand, started fo­cus­ing on pop­u­la­tion health 20 years ago and have much to teach us in the pro­mo­tion of well­ness and preven­tion of ill­ness. Their in­sights will be vi­tal, as Amer­i­can provider or­ga­ni­za­tions de­ter­mine how best to en­gage our com­mu­ni­ties in health pro­mo­tion. At In­ter­moun­tain, we en­vi­sion fu­ture joint ef­forts in such ar­eas as di­a­betes man­age­ment, asthma man­age­ment and men­tal-health treat­ment.

The rank­ings that com­pare the U.S. and Euro­pean health­care sys­tems get wide­spread at­ten­tion, but com­par­isons that en­able those sys­tems to share in­sights and learn­ing are far more vi­tal. Those com­par­isons are grow­ing, and health­care de­liv­ery on both con­ti­nents will be bet­ter for it.

Dr. Brent James is chief qual­ity of­fi­cer at In­ter­moun­tain Health­care, based in Salt Lake City.

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