Best Practice Models Show Us the Future of American Health Care

When futurists discuss the kind of health care system the United States needs, they imagine a patient-centered system that focuses on value for patients, providers, and purchasers that produces the best outcomes at the lowest cost. For those lucky people who attended last week’s day-long conference co-sponsored by Kaiser Permanente and the Alliance for Community Health Plans, they learned that dreamed-of future is today’s reality in several communities across the country. Leaders from around the United States came to Washington to celebrate the publication of a terrific new book, “Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs,” and hear from the organizations profiled – four of whom are ACHP members – about how they achieve the results that earned their inclusion.

“This book tells your story so that others can learn how to follow your lead,” said Maureen Bisognano, President and CEO of the Institute for Healthcare Improvement, who co-authored the book with Charles Kenney, a former journalist and noted author. The profiled organizations exhibit “visionary leadership, commitment, and new ideas,” she added. Kenney called these organizations “game changers” who through a “grassroots movement are transforming a bloated, ponderous health care system.”

As I said in my remarks at the conference, while there is certainly discord among policymakers about our health care system, “there are many areas where there is little or no disagreement, where there is consensus and common purpose.  Chief among these is the absolute necessity that we work together to continue to evolve health care delivery so that it focuses on and achieves the vital aims of better care, better health, and lower costs.”

News from CMS

The nearly 200 people attending the forum hosted at Kaiser Permanente’s Center for Total Health heard from leaders of eight of the organizations profiled in the book as well as Jonathan Blum, the deputy administrator of the Centers for Medicare & Medicaid Services (CMS) and director of the Medicare program. Blum praised the organizations present for their “pioneering work” that is helping the rest of the health care system become the “value-based system we need to become.” Blum said CMS is focused on improving Medicare across the board to emphasize the Triple Aim mantra of “better health, better care, and lower costs.” As part of that focus, CMS is creating incentives for:

  • Reduced hospital readmissions within 30 days of discharge
  • Making sure beneficiaries receive care in safer, patient-centered systems
  • Integration of services
  • Greater accountability
  • Rewards for providers for quality and value

Blum discussed the recent introduction of Pioneer Accountable Care Organizations (ACOs) and the use of payment rewards and incentives in the Medicare Advantage program for those plans that achieve high scores on Medicare’s 5-star rating system.  He also noted a continued migration of Medicare beneficiaries from traditional fee-for-service Medicare into Medicare Advantage. Today, 27 percent of people on Medicare have chosen to enroll in an MA plan “and I expect that will continue to grow,” Blum said.

6 Slides in 6 Minutes

Presenters were asked to hone in on the core elements of their programs by limiting themselves to “six slides in six minutes.” As in health care, it’s really surprising and refreshing to see how much information can be shared when we focus on value instead of volume. Among the highlights (ACHP member plans are underlined):

HealthPartners CEO Mary Brainerd said her organization has made the Triple Aim their strategic plan since the release in 2001 of the landmark report by the Institute of Medicine, “Crossing the Quality Chasm.” By focusing on patients with chronic conditions, HealthPartners has improved performance on quality measures and reduced their costs so that they are 10 percent below Minnesota’s statewide average. A conservative estimate suggests that spreading HealthPartners’ best practices throughout the nation has the potential to save $2 trillion over the next decade. Brainerd reported that in 2004, only 5 percent of their diabetes patients were well-managed. Today that number is 43 percent and “we are determined to drive that higher.”

Leaders from Seattle-based Virginia Mason Medical Center and Intel, one of the largest employers in that market, reported on their work to make care “better, faster, and more affordable.” Adoption of the Toyota Production System has helped to eliminate waste, reduce patient waiting time, and help patients return to function and work. Intel’s Pat McDonald praised the market collaboration that has made these results possible. She has now become one of the nation’s leading advocates for health care delivery system improvement.

CareOregon CEO Dave Ford discussed the challenges of improving care value for a Medicaid patient population and the successes they have had by partnering with provider organizations in their market to drive value. Ford said their focus is on population health.  “We’ve moved from a model . . . [in which we were] just an economic intermediary whose job was to collect money from the purchasers and pay it to providers to [being] an organization that focuses on improvement,” Ford said.

At Bellin Health in Green Bay, WI, a total health model has helped to improve the health scores of its employees by 10 percent while reducing the cost of its employee health coverage by 15 percent over an eight-year period, saving over $13 million. Bellin is an integrated health care delivery system that includes Bellin Medical Group with ninety-three primary care physicians and Bellin Hospital, a 167-bed acute care facility. Bellin has worked with the employees of 2,500 companies—and is on-site at 74 locations. Utilizing a health risk assessment tool, Bellin sought to increase employees’ health knowledge. A 2009 Commonwealth Fund survey of companies using the Bellin menu of on-site services indicated that average health care costs for these firms were 21 percent below the national average.

Anthony DiGioia from the University of Pittsburgh Medical Center discussed the work of the Patient-Centered Family Practice, which is dedicated to making sure care is focused on the patient and their family. Dr. DiGioia’s work is centered on patients needing hip or knee replacements, and the results are remarkable. The average length of stay for a total knee replacement was 2.9 days, versus the national average of 3.8 days. For hip replacements the average length of stay was 2.5 days, versus 4.9 days for the national average. Further, 92 percent of patients were discharged directly from hospital to home and 99 percent of patients reported that pain was not an impediment to physical therapy.

Finally, Kaiser Permanente’s Jack Cochran and John August profiled their organizations team-based approach to care to spread innovations and improvements. And as the book notes, at Kaiser technology is an essential element of success. “The organization operates on a technology platform matched by few others in health care anywhere in the world—in size, scope, and capability.”

Sharing the Joy

Participants were able to spend time with each of these experts in a series of breakout sessions before coming back together at the end of the day. The authors agreed that the day had been extremely useful in a variety of ways. Said Kenney, “The transformation of American health care has begun.  Give yourselves some credit for making it happen.”  Added IHI’s Bisognano: “Writing this book was a tremendous joy. The reason we came together today was to share that joy.”

-Patricia Smith
President and CEO, ACHP