I have had the privilege of being the founding chairman of two organizations in the state of Wisconsin which are now considered national models by many leaders. The Wisconsin Collaborative for Healthcare Quality (www.wchq.org) is a unique non-profit focused on reporting all payor all patient quality data on a range of indicators. It was one of the CMS pilot sites for better quality information and it is part of the value exchange established by former HHS Secretary Leavitt.
The Wisconsin Health Information Organization (www.whio.org) is a non-profit focused on reporting resource utilization on physician groups through an administrative claims data base which is built on data contributed by the health plans in the state.
These organizations would not exist if it weren’t for the collaborative leadership of many individuals representing insurance companies,providers,employers,and state government.
Read the following third party assessments of how we actually did it.
The Medicare payment system is fundamentally flawed. It penalizes efficient providers delivering better quality. It incents over utilization and the building of over capacity. In this paper we begin to document the immediate things that must change if we are going to incent high quality, low cost care with appropriate utilization. See attached document for further details.MedPac_whitepaper_1209
We have been working with Senator Kohl to introduce this amendment for some weeks now. It is great to be able to announce that he has done so. It is imperative for us to gather data on methods of improvement that are working in U.S. healthcare and we know applying lean to healthcare is one of them. The network will be able to act as a model to show that reducing cost and improving quality is possible by using a well defined system transformation methodology.
Read the amendment below. It is midway down the second column.
I participated in a roundtable of distinguished health care experts convened by The Institute of Medicine to discuss cutting the health care bill in America by 10% or over 400 billion dollars by 2018. Read on to see what we discussed and concluded.
Harvard researchers, employee benefits administrators, physicians, health plan executives, and improvement experts gathered at the National Academy of Sciences in Washington on Dec. 15 and 16th to discuss the nation’s health care cost crisis. We reviewed reams of data that had been presented over three workshops the IOM hosted in 2009. At the September workshop I presented data from the work of the Healthcare Value Leaders Network.
The purpose of the meeting was to obtain expert opinion in addition to literature review to better understand how likely it is the nation could actually reduce health care expenses by 400 billion dollars over 10 years. I believe we can do better than this and have said as much on this blog and in peer reviewed journal articles we have published. At the end of the day most of us felt 10 % was quite possible and we were able to categorize where we thought we could obtain it. The IOM will be posting comments on this work in the next few days www.iom.edu but the following is a compendium of what we were working off of and what we felt was possible. I should make it clear to the readers this does not represent any official opinion of the IOM or even a consensus of the roundtable members. It really is just the beginning of the very tough discussions we are going to need to have in this country if we are are really going to bend the cost curve.
The first document lists the members of the roundtable.The second document describes three scenarios written by the IOM’s Pierre Yong M.D. based on 2009 workshop presentations with dollar figures attached to each strategy for cost improvement based on the presenters data or experience. Each strategy is described in more detail under the scenario. Finally, at the end of the document is the preliminary conclusion of the roundtable which is summarized by me on what the priorities should be to reduce cost and estimates of what cost improvement could be obtained.
This is a terrific presentation by front line nurse Jamie Guth who works on the Collaborative Care Unit at ThedaCare.
ThedaCare and Collaborative Care was one of three organizations chosen by the Commonwealth Fund as best practice in North America for innovation related to multidisciplinary team development. Thirty-one organizations were initially screened with three chosen. One of ThedaCare’s front line nurses was chosen to represent the team. The following is Jamie Guth’s presentation at the 21st IHI National Forum on December 9, 2009. The presentation slides are attached below as well.IHI Dec presentation
In his plenary speech yesterday in Orlando, Don Berwick the CEO of the Institute for Healthcare Improvement recognized eight organizations as delivering remarkably better performance. Four of them are members of the Healthcare Value Leaders Network.
Cedar Rapids was identified as major example of a community where low cost high quality care was being delivered. Both Mercy Hospital and St. Luke’s( Iowa Health System) are part of the Health care Value Leaders Network.
In addition, Gundersen Lutheran in LaCrosse and ThedaCare in Appleton were highlighted in terms of efficiency of care. Also mentioned were Denver Health and Virginia Mason both of which have been on the lean journey as well.
Go to Paul Levy’s blog and get a summary of the speech. (See link below.)
This article points out the seven issues to watch in the ensuing health debate.The issues are: public option,abortion,health insurance excise tax,prescription drugs,affordability,insurance exchanges,and Medicare cuts.
Isn’t it interesting that removing waste from the care delivery system isn’t mentioned any where. I assume that by cutting Medicare spending by several hundred billion dollars that legislators are saying to the delivery industry “get more efficient or perish”. Problem is most hospitals and doctors don’t have a clue how to become more efficient.
Please visit the Health Care Value Leaders Network and join the few that are anticipating these cuts and see what they are doing to get ready.
The following article clearly expresses what we have been espousing for months: without focus on care delivery reform costs will go up,regulation will increase, and innovation at the level of care provision will be stymied.
Dr. Flier explains what is really happening in Massachusetts which is that costs are rapidly rising to the point that the state’s payment commission has decreed a new payment model must be implemented now and that it most likely will be some form of capitation. This in itself is not necessarily bad or wrong but the speed at which it must be implemented due to the cost crisis does not allow for thoughtful and careful pilots to understand what would work best.
These new payment models cannot be implemented at a federal level.Massachusetts will have a hard enough time achieving consensus but getting the whole nation to consensus is impossible? It’s time for our legislators to step back and take a hard look at what they are about to do. A new insurance mandate for all without the necessary reform of the payment process or the care delivery system will only add a trillion dollars of cost over the next 10 years.
Group Health has made terrific strides in their quest to build a culture of continuous improvement using lean.
The HCVLN met in Seattle on Nov. 5th and 6th and visited Group Health of Puget Sound. What a great experience seeing the progress Group Health has made in their Lean implementation. We visited sites where executives and managers had standard work for leading improvement. We observed visual control boards focused on quality, staffing, and service.At Group Health there is a palpable difference in the way staff and physicians think and act about delivering care to patients. We observed a humility and respect for patients and each other which is at the root of the new culture.
So what? Group Health has recently published the answer to this question in the American Journal of Managed Care September issue.Their redesign of primary care using lean has achieved a 30% reduction in E.R. visits as well as an 11% reduction in ambulatory sensitive admissions .(These are admissions from an outpatient clinic that could have been avoided if appropriate resources were available to care for the patient in an ambulatory setting.) The 2 year follow-up data will be released shortly but promise to show even more remarkable improvement.
These results as well as ThedaCare’s results reported in Health Affairs in September and other published results are making it clear that the methodology to radically change health care is finally upon us. It’s not easy and it’s not just a project. It involves changing each and every person from the CEO to the administrative assistant but those organizations that change can produce improvements in cost and quality never before dreamed of.
Congratulations Group Health, keep it up, the world is watching! .
