July/August 2005, In This Issue:

Consumer’s Health Care Guide for Greater Iowa

HPCI and the Iowa Health Buyers Alliance (IHBA) have prepared the Consumer’s Health Care Guide for Greater Iowa prototype to be published later this year. It will be the first in a series of Guides to provide information on health care provider performance, prevention/lifestyle, and other information to help members and their families make better health care choices and to improve their overall health status. The primary audience will be members of HPCI and IHBA who, in turn, will use their internal distribution channels to reach consumers, patients and families across the state and bordering communities. The Guides will be available for use during open enrollment and in other ways.

Individual hospital reporting on patient safety and other performance measures are included such as the 17 Hospital Compare Measures and the Leapfrog Group’s 30 Safe Practices. Hospitals throughout the greater Iowa market area are included.

The prototype is now available for review and consideration for use. Contact the HPCI office.

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Bridging Health Care and the Customer

HPCI is launching a new project aimed at bridging health care and the customer. LEAN Enterprise has great potential to significantly improve productivity in health care as it has in other sectors such as manufacturing. It has driven out cost while improving quality. Focusing on the customer is essential in applying LEAN. Becoming so focused is also a great benefit of LEAN.

Numerous health care providers in Iowa and elsewhere have begun the LEAN journey. At the same time, there are important efforts underway to define and articulate customer expectations and measurements. The bridging project will develop methods and test an operating model to bridge and align the customer to health care organizations engaged in LEAN transformation. There are many benefits in doing this. Among them, the efforts of health care LEAN leaders and those of the external customers will be in better harmony and more synergistic. In the short and long range, bridging health care and the customer is a win-win-win for patients/consumers, health providers, and employers/sponsors/purchasers.

This project identifies an effective vision that is both sensible and appealing with achievable strategies and specific steps. Project objectives include: (1) Determine the measures and metrics used by early adopters of LEAN health care to monitor and improve their processes, (2) Compare information needs of and metrics used by early LEAN health care adopters with the emerging performance measures and standards from organizations including the National Quality Forum, CMS, AHRQ, the Leapfrog Group, and the Consumer Purchaser Alliance, (3) Describe linkages and metrics used in other sectors such as manufacturing as they focus on their customer applying LEAN enterprise principles and tools, and (4) Demonstrate how these linkages, metrics, and other LEAN tools can be applied to the health care industry in order to better bridge to their external customer.

More information is available through the HPCI office.

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Health Care LEAN Best Practices

At the request of the Iowa Hot Team, HPCI is identifying and summarizing LEAN health care best practices in Iowa and across the U.S. These “best practices” are demonstrating that LEAN has great potential to significantly improve productivity and quality in health care as it has in other sectors. John Toussaint, MD, CEO of ThedaCare in Appleton, Wisconsin, believes that “about 70% of what we do is non-value added (waste)”.

ThedaCare is fully engaged in the LEAN transformation. Their goals: (1) We must lower our costs, so that we can lower the price that you pay for our services, and (2) We simultaneously must improve the quality of what we do to world class levels (95 th percentile).

Their new metrics: (1) Quality Performance (95 th Percentile Clinical Services), (2) Financial Performance ($10M/year Cost Reduction), and (3) Worker Satisfaction Performance (Fortune 100 List of Best Employers).

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Iowa Hospitals Respond to National Quality Forum’s 30 Safe Practices

One of HPCI’s priorities is to increase transparency of patient safety, quality and value performance. Last year the National Quality Forum (NQF) issued its consensus report identifying 30 safe practices. Some 100 Iowa hospitals have signed on to participate in the safe practices survey through the Texas Medical Institute of Technology (TMIT). The Iowa Health Care Collaborative is encouraging each Iowa hospital to utilize this web-based survey and resources to address the National Quality Forum’s safe practices. They pointed out the Iowa hospital data will not be shared with Leapfrog, but maintained by TMIT in a secure Iowa database for Iowa Health Care Collaborative and Iowa hospital use.

Congratulations to all involved for their efforts to improve patient safety. This is a good first step. In the future, it is hoped that most, if not all, Iowa hospitals will step up and share this information with their customers and the public at large. Such transparency has proven to be an important catalyst for improvement in health care. Public reporting of comparative hospital information also assists consumers, patients and purchaser decisions regarding where to get the best care.

The Leapfrog Group provides a public reporting mechanism of the National Quality Forum’s 30 Safe Practices. Over 1,000 hospitals across the country are currently reporting their patient safety and quality efforts through the Leapfrog Group.

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HPCI and Iowa Health Buyers Alliance Request Hospital Leapfrog Group Reporting

HPCI and the Iowa Health Buyers Alliance have renewed their requests to the 26 larger Iowa hospitals to complete the 2005 Leapfrog Group Hospital Patient Safety Survey. The hospitals that report will be included in the Consumer’s Health Care Guide for the greater Iowa market area.

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Iowa Hospitals Publicly Report on 17 Quality Measures

Most Iowa hospitals have now publicly reported on 17 measures of quality. They include eight (8) acute and myocardial infarction (AMI) measures, four (4) measures of heart failure care and five (5) for pneumonia. This information for Iowa and other hospitals across the U.S. can be found here.

“Hospital Compare gives consumers and health care professional’s quality care information to help them make more informed decisions about their health care, while providing stronger rewards and support for high-quality, efficient care in the nation’s hospitals,” said Centers for Medicare and Medicaid (CMS) Administrator Mark B. McClellan, MD, PhD. “Not only are we spending more on our health care, but where we choose to get our care matters more than ever before. Valid, consistent measures of quality care are an important tool to help us make sure we are getting the most for our health care dollars.”

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Iowa Ranking on National Healthcare Quality Report

Recently the Agency of Healthcare Research and Quality (AHRQ) released its 2004 National Healthcare Quality Report. As part of this report, state rankings on selected measures were released. Of the 102 measures, Iowa was above average on 36, average on 48, below average on 18, and 4 were categorized as NA or not available.

Iowa Ranking on Selected* Measures

The following ranking shows how well this State is performing on 14 selected measures of health care quality that are featured in the 2004 National Healthcare Quality Report. This report, mandated by Congress and published annually by AHRQ, is based on a detailed analysis of measures designed to help track health care quality across the Nation. It includes State-level statistics for around 100 of these measures.


National Average***

State Score

State Rank


Percent of adults 50 and older ever receiving flexible sigmoidoscopy or colonoscopy




Percent of adults 50 and older with fecal occult blood test in last 2 years




Colorectal cancer deaths per 100,000 population per year




Heart Disease

Percent of adults who had their blood cholesterol checked in last 5 years




Percent of Medicare heart attack patients with beta blocker prescribed when leaving the hospital




Percent of Medicare heart failure patients with ACE inhibitor prescribed when leaving the hospital




Maternal and Child Health

Percent of women receiving prenatal care in first 3 months of pregnancy




Respiratory Diseases

Percent of adults 65 and older receiving flu vaccine in the last year




Percent of Medicare patients hospitalized for pneumonia who got a blood culture before antibiotics




Percent of Medicare patients hospitalized for pneumonia who got antibiotics within 4 hours




Percent of Medicare patients hospitalized for pneumonia who got the right antibiotics




Nursing Home and Home Health Care

Percent of long-stay nursing home residents who have moderate-to-severe pain




Percent of home health patients who get better at walking or moving around




Percent of home health patients who had to be hospitalized




* These 14 measures were selected because they correspond to quality measures featured in the 2004 National Healthcare Quality Report and have data reported for all 50 States and the District of Columbia.
** Further details on measure specifications are available in the NHQR Measure Specifications Appendix: http://www.qualitytools.ahrq.gov/qualityreport/browse/browse.aspx?id=5011
*** These national averages are consistently calcuated across all measures and differ slightly from those in the National Healthcare Quality Report. For more information, see Methods page.

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HPCI Endorses Consumer and Purchaser Principles for Making Medicare Payments Performance - Sensitive

HPCI joins other members of the Consumer Purchaser Alliance in endorsing a set of principles for making Medicare payments performance-sensitive.

Medicare should lead the way to promoting a market that rewards high-quality, efficient, and patient-centered care through the following principles:

Measure: Medicare should evaluate the performance of each health care provider that bills Medicare, using nationally-endorsed, scientifically-valid, risk-adjusted, and regularly-updated measures that address:

  • Clinical quality (safe, timely and effective care);
  • Efficiency (prices and resource use over time);
  • Equity;
  • Patient experience;
  • Use of quality-enhancing information technology.

Report: Medicare should provide the public and other purchasers with the information on provider performance described above, in a manner that protects patient confidentiality.

Reward: Medicare should phase in a system that differentially pays providers, based on overall performance and improvement.

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2005 Healthcare Costs

The average medical spending for the “typical American family of four” is $12,214 in 2005, according to Milliman’s first annual report measuring healthcare costs under employer sponsored preferred provider organizations (PPOs). The Milliman Medical Index found that the cost increased by 9.1% from 2004, but is down from the 10.1% hike in the previous two years. The family’s annual direct spending on healthcare services - not including employer or employee paid premiums - amounts to $2,035.

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Consumers Reassess Health Care Choice-Cost Trade-Offs

More Americans are willing to limit their choice of physicians and hospitals to save out-of- pocket medical costs, according to a new national study by the Center for Studying Health System Change (HSC).

Between 2001 and 2003, the proportion of working-age Americans with employer health care coverage willing to trade their choice of providers for lower out-of-pocket costs increased from 55% to 59% - after the rate had been stabled since 1997. “A likely explanation for the change in consumer attitudes is that the growing burden of out-of-pocket medical costs is prompting a re-assessment of the choice-cost trade-off,” said Paul B. Ginsberg, PhD, President of HSC, a non-partisan policy research organization funded principally by the Robert Wood Johnson Foundation.

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Health Care Account Offers Prescription for Big Savings

The June 12 th issue of the Des Moines Register included an article entitled “Health-care Account Offers Prescription for Big Savings”. It pointed out that money earns interest, can be rolled over and, upon death, passed on to a beneficiary. “If you have ever lost money in your medical flexible-spending account at year’s end or feel you’re paying too much for medical insurance you don’t use, a health savings account may be the answer. Health savings accounts, created for people under 65 who are not on Medicare, allow individuals and employers to make tax free contributions to savings accounts ear marked for medical costs.”

Unlike flexible-spending accounts, money in an HSA earns interest and can be rolled over from year to year. More Iowa employers are offering an HSA type health plan to their employees and dependents. The number of Americans covered by such plans has more than doubled over the last year.

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Health Savings Account (HSA) Brochure

The Treasury Department has issued a brochure on health savings accounts (HSA). Directed at consumers, the brochure describes: who can have an HSA; what high deductible health plans are; how much an individual may contribute to an HSA; what medical expenses qualify under an HSA; the advantages of HSA’s; and companies that provide HDHP coverage. Go to: www.treas.gov

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Iowa Hospitals Participate in 100K Lives Campaign

Over half of Iowa hospitals are joining thousands of other hospitals across the U.S. in a commitment to implement changes in care that have been proven to prevent avoidable deaths. The target is to extend or save 100,000 lives by June 2006. The Institute for Health Care Improvement (IHI) is focusing on the following six changes:

  • Deploy rapid response teams at the first sign of patient decline.
  • Deliver reliable, evidence-based care for acute myocardial infarction to prevent deaths from heart attack.
  • Prevent adverse drug events by implementing medication reconciliation.
  • Prevent central line infections by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle.”
  • Prevent surgical site infections by reliably delivering the correct preoperative antibiotics at the proper time.
  • Prevent ventilator-associated pneumonia by implementing the “Ventilator Bundle,” another series of interdependent, scientifically grounded steps.

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Turning the Corner on Quality

Donald M. Berwick, MD, Institute for Health Care Improvement

Speaking at a recent meeting at the Agency for Health Care Research and Quality (AHRQ), Dr. Berwick pointed out that most health care providers want to improve their health care quality and too many do not know how. He noted that the AHRQ, the Business Roundtable founded Leapfrog Group and others are “turning on the lights” and showing us how we are doing. These lights show the gaps…the chasm that exists. Dr. Berwick pointed out that internal comparison show embarrassing gaps in all six national aims with the exception perhaps of timeliness. (Note: the six aims are: 1) safe, 2) effective, 3) patient-centered, 4) timely, 5) efficient and 6) equitable).

Dr. Berwick made the following points:

  • It is hard to see and improve when one cannot measure, but not impossible (can observe). Measurement is a battle, but not the war.
  • The next cycle is how to change. All improvement is through change, but not all change is improvement. He doesn’t believe that public reporting and competition by itself will do it. Also, the movement towards pay-for-performance is tedious and at best a transition strategy. Providers need help. Incentives to try harder won’t do it as a primary method.
  • Find successful methods for positive change. Part of this is knowledge. Also, need R & D on how to do it better (role of AHRQ). Need to reach-out and work with those who are trying. Involves transparency, of course, but also need leaders who have the courage to go where they need to go. Set goals of where they need/want to go. These goals must be owned by board of trustees of health care organizations. Need consequences for progress and future effort, but most of all need technical help at the process level, not just the science level.
  • Need to discover the new systems of care. The six aims of the Institute of Medicine are good as are the ten rules, but these rules are hard to do.
  • Need to apply absolute use of knowledge. Need to get to the 97th percentile, if not 100%.
  • Beginning to turn the corner with such efforts as the 100,000 Lives Campaign.

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Mirror, Mirror, on the Wall:

Looking at the Quality of American Health Care through the Patient’s Lens

A report from the Commonwealth Fund that examines how well the health system works from the perspective of patients confirms what several other recent studies have shown – that the U.S. performs worse than its peer nations on several dimensions of quality. According to the report four other industrialized nations – Australia, Canada, New Zealand, and the United Kingdom – scored better than the U.S. on safety, efficiency, effectiveness, and equity, while the U.S. ranked second to last on measures of “patient-centered” care. The U.S. did, however, have the shortest waits for hospitalization and elective surgery and placed second (to New Zealand) on prompt access to primary care physicians and specialists.

“While the U.S. spends the most on health care of any country, we are not getting commensurate value from the view of patients,” said Fund President Karen Davis, the report’s lead author. “We have the most highly skilled health professionals and most advanced medical technology, yet our system doesn’t ensure that patients fully benefit from this wealth of resources”.

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