Managed Healthcare Executive - March 2009 - (Page 14) { S P E CI AL RE PO R T} the Chartered Value Exchanges, says that the complex nature of healthcare and its many players can impede quality. “Doctors don’t have the information they need to make the best informed decisions about their patients’ care,” Dr. Overhage says. “Employers want the same high level of care across providers who treat their patients. Health plans want to be sure that the standards-based measures we are using cut across the entire community. And everyone wants these measures to be fair.” IHIE, based in Indianapolis, runs one of the nation’s most robust clinical messaging systems; more than 4,000 Indianapolisarea physicians are receiving, on average, 1 million messages each month. IHIE reportedly saves its participants a total of $6 million per year by eliminating duplicate tests and administrative costs. Such e orts helped it to earn the HHS Chartered Value Exchange distinction. MARKET CONSIDERATIONS tive initiatives are springing up from drawing boards around the country, the Michigan Health & Hospital Assn. (MHA) continues to draw attention with its blueprint for healthcare quality management. Through an ongoing partnership with patient-safety experts at Johns Hopkins University in Baltimore, MHA gathered the input of various partner groups, including Blue Cross Blue Health (NBCH), hopes to see more of. White says the reimbursement system is in urgent need of improvement and better quality can be achieved through well-placed incentives for providers and consumers. As they take on ever-increasing healthcare costs, employers are becoming savvier about the plans they purchase, he says. However, they need to carve out a more prominent role in quality “One thing that works in Massachusetts may not work in Louisiana.” —Barbra Rabson As the executive director of Massachusetts Health Quality Partners (MHQP) since 1998, Barbra Rabson has witnessed an uptick in regional health partnerships, as well as P4P. While she sees the coalitions making signi cant progress, there also are market considerations. “Every market is di erent, so one thing that works in Massachusetts may not work in Louisiana,” says Rabson, a founding member of the Pittsburghbased Network for Regional Healthcare Improvement, a network of more than 50 regional quality collaboratives. Rabson says that one goal of healthcare quality reform is to leverage the best practices of local quality programs— both nancial and non- nancial incentives—and ultimately integrate those into federal programs. While regional health collabora14 MARCH 2009 Shield of Michigan, to address speci c care-related quality issues. In early 2003, MHA’s Keystone Center for Patient Safety & Quality launched an initiative to reduce errors in intensive care units through the use of best practices. Now present in 120 intensive care centers within 76 Michigan hospitals, the ICU program is credited with avoiding 129,000 hospital stays, saving 1,800 lives and $247 million from March 2004 to March 2008, according to MHA spokesman Kevin Downey. That includes savings associated with lower urinary-catheter infection rates and costly related conditions. Downey says that MHA now is implementing comparable programs that tackle other concerns, such as hospital-associated infections, organ donation procedures, and better surgical processes. That is the type of progress that Dennis White, senior vice president of value based purchasing for the 60,000member National Business Coalition on issues and P4P programs. White also says that while progress on the quality front is being made, business factions and self-interests cannot be eliminated from the equation. “We talk about measurements and distinguishing better practices,” White says. “The pushback on that is pretty substantial. We see hospital mergers taking place; [groups are] buying up multiple hospitals in a given region. We’ve heard horror stories in the hospital contracting world that hospitals are saying ‘you cannot judge us or put out any information about our performance that would put one of our hospitals in a lower tier or we’re all going to cancel your contract.’” The Commonwealth Fund’s Dr. Audet says if a climate of collaboration is forming over the country’s healthcare system, it’s because the current model has become too oppressive, too costly and too troublesome to continue. “Everyone is taking a risk here,” Dr. Audet says. “The crisis is so big that you have to take a risk.” MHE
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