HPCI News March, 2006

In this Issue

$125,000 Grant Awarded to Iowa Health Buyers Alliance

The Iowa Health Buyers Alliance, co-sponsored by HPCI, recently received a $125,000 grant to support its programs and initiatives. Among other things, the money will be used to publish and distribute a series of Consumers' Health Guides for greater Iowa. The Alliance is an association of health purchasers who have come together to identify, evaluate, recommend and provide access to cost-effective high performance policies, practices, providers and products for its members. Supporting better health, better health care and better value is its shared goal.

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HPCI Priorities for 2006/2007

  1. Conduct and support projects to increase transparency of health information on cost, quality and patient safety. Meaningful comparative performance information assists purchasers and consumers with wise decision making. Transparency has also proven to be an important catalyst for needed change and improvement in health care.
    • Work with the Iowa Healthcare Collaborative.
    • Leverage and support national resources such as the Consumer/Purchaser Disclosure Project, the National Quality Forum, the Business Roundtable founded Leapfrog Group, Agency for Health Care Research and Quality (AHRQ) and the eValue8 health plan/provider system evaluation tool.
  2. Empower, Inform and Engage Consumers and Patients ("Consumerism")
    • Publish and distribute the Consumers' Health Guide series for Greater Iowa.
    • Research and report on plan design changes including health savings accounts (HAS).
    • Peruse holistic approach to wellness and health literacy.
  3. Engage and support Lean enterprise efforts to drive out cost and improve quality
    • Recognize and encourage Lean transformation in Iowa's health industry.
    • Describe, communicate and encourage the adoption of Lean enterprise and supply-chain management methods for managing employee health and productivity.
    • Seek partners and resources to conduct the Bridging Demonstration Project: Bridging Health Care and the Customer---Connect and Resonate.
  4. Carry-out education, research and communications
    • Publish HPCI News six times per year with distribution to over 500 Iowa leaders.
    • Hold state-wide Health Buyers Conference
    • Partner with groups for greater impact, i.e. the Iowa Health Buyers Alliance, the Iowa Healthcare Collaborative, and the Iowa Coalition for Innovation and Growth.
    • Conduct research on key health issues at the state and local levels.
    • News media communications.
  5. Serve as a resource to HPCI members/investors.

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"Health Care is Local":
Leapfrog is a National Model with a Regional Approach to Change

The Leapfrog Group provides a public reporting vehicle for the 30 Safe Practices of the National Quality Forum (NQF). Recently, the Leapfrog Group announced the addition of three new regional roll-outs (RRO's) this year bringing the total number of Leapfrog roll-out markets to 31.


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First Annual Iowa Patient Safety Conference - March 7, 2006 Des Moines Marriott

The first Iowa Patient Safety Conference will be held on March 7th at the Des Moines Marriott in downtown Des Moines. The program includes a presentation by the Texas Medical Institute of Technology on the National Quality Forum's (NQF) 30 Safe Practices in Iowa. The conference is sponsored by the Iowa Health Care Collaborative.

To register or to find out more information go online to: www.ihaonline.org

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Tom Evans, M.D. appointed IHC President/CEO

Recently Tom Evans, MD, of Des Moines, was appointed the President/CEO of the Iowa Health Care Collaborative (IHC). The IHC is a partnership for quality, patient safety and value co-sponsored by the Iowa Medical Society and the Iowa Hospital Association.

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Health Spending Projections through 2015: Changes on the Horizon

Growth in national health spending is projected to slow in 2005 to 7.5%, from a peak of 9.1% in 2002. Private health insurance premiums are projected to slow to 6.5% in 2005, with a rebound expected in 2007. Health spending is expected to consistently outpace Gross Domestic Product (GDP) over the coming decade, accounting for 20% of GDP by 2015.

Source: Health Affairs, February 2006. Go to: www.healthaffairs.org for more information.

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Hospital Leaders Turning
to Consumer-Directed Health Plans for Their Own Staff

Omaha's Alegent Health Care is now offering five different consumer-directed health plan options in addition to their more traditional PPO plan. During November, 2005 open enrollment, 79% of the hospital's employees chose one of the consumer-directed plans.

Wayne Spencer, CEO of Alegent Health Care, explained the approach is in response to a question from local business leaders "so what are you doing to solve the (cost) problem?" Spencer wants Alegent's 8,400 employees to be more active in their health care decisions, and in the process he hopes to save the Alegent money. "This approach is so different, it is revolutionary," he says. "I feel very passionately that while it may not be a silver bullet for solving the cost problem, it comes close." Alegent spent 36.5 million dollars on health care coverage in 2005.

Employees can see on the health system's intranet what the most common procedures cost. "They will be able to compare the cost of a call to a nurse hotline, for example, to an emergency room visit," Spencer says. "It is one step removed from true pricing, but it gives them information on their options and gives them knowledge to make choices."

Consumer-directed plans are rare among hospitals to date, whose mission is to provide care to the uninsured and under-insured has frequently undermine their own financial health. Alegent leaders are betting their mission and financial health can thrive under this so-called consumerism.

Spencer doesn't believe his role as a business leader conflicts with his role as a provider. "Consumers are happier when they are in control. It won't be just a price decision for them," he says. "A real substantial opportunity exists to address life style. I really see people taking the same level of interest in health care that they do in other types of decisions."

Source: February 2006 Hospitals and Health Networks.

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Pay for Performance (P4P) Pilot Leads to a New Care Model

Note: HPCI is pleased to present the following pilot project report submitted by Mercy Clinics, Inc. of Des Moines.

The current primary care delivery system was designed in the 1960's for acute episodic care such as colds, injuries, and chest pain. The health care system has done a poor job of addressing advances in treatments for chronic disease such as diabetes and high blood pressure. A 2003 study in the New England Journal of Medicine found that only 55% of evidence based recommended care was being provided to patients. The reason for this is not that doctors lack the information or desire to do the right thing but that they work in a system that makes it impossible to consistently do the right thing. The biggest barriers are:

  1. Time - It would take a primary care doctor greater than 24 hours a day to provide all the recommended care for the usual panel of 2500 patients.
  2. Reimbursements system - Doctors are paid for quantity and not quality. There is no extra reimbursement for a doctor who takes extra time and expense to make sure all needed interventions are being done.

Wellmark and four Mercy Clinics addressed this by participating in a pilot P4P program that offered a financial reward if performance goals were met for patients with diabetes and high blood pressure. The diabetes goals were:

  1. Blood sugar control measured by the A1c blood test
  2. Cholesterol control measured by the LDL (bad cholesterol) blood test
  3. Kidney disease screening by a urine Microalbumin (MicAlb) test
  4. Blood pressure (BP) control measured at the office visit.

To achieve these goals Mercy Clinics adopted a new Chronic Care Model delivery system. All Wellmark patients with diabetes and hypertension were entered into a disease registry and their goals were tracked. A new position of Care Coach was created to proactively contact patients who the registry identified as overdue for care or not meeting goals. Other system changes included guidelines to standardize care, standing orders so nurses could arrange tests, and a checklist office visit form to ensure all interventions were done at each visit.

The P4P program was very well received by patients and was so successful that all 25 providers in the pilot met every goal. The results were far better than the HEDIS 90th percentile benchmarks for health plans, as shown in the graph below. Many published studies have documented that meeting these goals leads to better patient outcomes such as reduced heart attacks and strokes as well as reduced overall costs. The program has now spread to all 14 Mercy Clinic primary care offices.


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New to Stores: "See a Nurse in Aisle 5"

Hy-Vee and other retailers, including Target and Wal-Mart, are opening drop-in clinics. According to reports, a physician's assistant or nurse practitioner will diagnose and treat common ailments -- such as pink eye and strep throat -- and offer pregnancy tests and other assessments. West Des Moines based Hy-Vee has clinics in Davenport and Omaha and is considering others including the Des Moines area and Cedar Rapids.

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"Solucient Top Hospitals" and "Health Grades - The Quality Experts"
Who Are They and What Do the Ads Mean?

Numerous advertisements have appeared in the Des Moines Register and elsewhere pointing out that certain Iowa hospitals are among the "top 100 hospitals" for cardio-vascular care according to Solucient. Others advertise that Health Grades say "we are in the top 2% of hospitals in the nation for patient safety."

Health Grades describe itself as the leading health care rating organization, providing ratings and profiles of hospitals, nursing homes and physicians to consumers, corporations, health plans and hospitals. In preparing the patient safety to distinguish hospital award, Health Grade used the Medicare Provider Analysis and Review (Med PAR) data from the Centers for Medicare and Medicaid Services (CMS) which contains the inpatient records for Medicare patients.

Solucient describes itself as "a market leader in providing tools and vital insights to health care managers used to improve the performance of their organizations." Solucient's customers include providers, pharmaceutical companies and payers including employers and managed care organizations. The data used in the "100 top hospitals: cardiovascular benchmarks for success" studies came from Solucient's private data base and the publicly available MedPAR data sent. While some would describe the methodology as "a black box", Solucient says "they work to ensure that the measures and methodologies are fair, consistent and telling."

For more information go to www.solucient.com andwww.healthgrades.com.

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Health Literacy

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (definition of health literacy - Healthy People 2010). This capacity, in all three of its dimensions, is recognized as increasingly important by HPCI, its members and supporters, and other major stakeholders. Some have established the goal of implementing a holistic approach towards employee wellness and health literacy programs.

HPCI will be featuring articles and relevant information on all three components of health literacy: How to:

  1. obtain
  2. process and
  3. understand basic health information and services needed to make appropriate health decisions.

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Lean Health Care - HPCI Features More Successes Using Lean in the Health Sector

HPCI is featuring successes using Lean in the health care sector. This is the third listing in the series. Numerous health care providers in Iowa and elsewhere are now engaged in the Lean transformation, with great results. Iowa successes are being featured along with those of others. Congratulations to all engaged in the Lean journey.

  • Stopping MRSA (methicillin resistant staphylococcus aureus) Infections: An 85% reduction in the MRSA infection rate in the inpatient surgery unit was achieved. The VA Pittsburg Healthcare System, 4-west inpatient surgery reduced its rate to near zero (0.38 per thousand patient days) in 2004. Now the main VA hospital and long term care facility, and units elsewhere in the region, are aiming to eliminate MRSA transmission. Note: MRSA is on the rise and associated with increased mortality, length of stay and hospital costs across the U. S. The U. S. has the world's second highest MRSA rate (only Japan has more). 30-50% of clinical cultures that is positive for staphylococcus aureus are now methicillin resistant.

    Contact: Naida Grunden, Director of Communications, PRHI, 412-535-0292, Ext. 114, ngrunden@prhi.org.
  • Ventilator Associated Pneumonia: Reduced from 30 to 5 cases of ventilator associated pneumonia which in turn reduced cost ($40,000 each) and prevented deaths (3-4 patients).

    Contact: Virginia Mason Medical Center, Seattle, Washington
    Gary S. Kaplan, MD, Chairman and CEO
  • Hospital Facilities: Saved $6 million dollars in planned capital investment; freed 13,000 square feet of space; cut inventory costs by $360,000 and reduced staff walking by 34 miles per day.

    Contact: Virginia Mason Medical Center, Seattle, Washington
    Gary S. Kaplan, MD, Chairman and CEO
  • Hyperbaric Medicine: By applying the principles of VMPS, particularly continuous flow, the Rapid Process Improvement Workshop team determined a process that allowed the new Center for Hyperbaric Medicine to be constructed in current hospital space rather than requiring a new building as originally planned. Implementing continuous flow increases patient quality and safety because patient transport will not have to occur between the hospital and a separate hyperbaric unit. The Result: Increased patient quality and safety; savings of $2 million.

    Source: Virginia Mason Medical Center
  • Heart Center Echo Lab: Objectives were to:
    1. Improve patient and staff satisfaction by reducing cycle time and reducing wait time for special procedures
    2. increase capacity for removing process waste, and
    3. Improve productivity without impacting patient safety. The results included reducing the cycle time by 50% from 120 minutes to 61 minutes; increasing the number of specials per day by 50% from 4 to 6; reduced the next available appointment from 2 to 3 weeks to the same day.

      University of Iowa Hospitals and Clinics, Iowa City, Iowa, Ann Madden Rice.
  • Emergency Treatment Center: Improvement focus was on the patient experience in an emergency treatment center from check-in through receiving treatment and leaving the department. The Kaizen Rapid Process Improvement Event resulted in a 32% increase in patient seen by provider within 30 minutes from 72% to 95%; length of stay greater than 4 hours was reduced by 38% from 16% to 10%; and average length of stay was reduced by 26% from 162 minutes to 120 minutes.

    University of Iowa Hospitals and Clinics, Iowa City, Iowa, Ann Madden Rice.
  • Comprehensive Cancer Clinic - Infusion Therapy Suite: This event focused on patient experience from check-in in the cancer clinic through receiving treatment in the Infusion Therapy Suite. Results included: reducing patient wait time by 69% on average from 32 minutes to 10 minutes; over all length of stay decreased by 21% from 235 minutes to 186 minutes with no additional staffing; the through-put was increased 38%, increased in capacity from 42 patients per day to 68 patients per day with existing staff; and staff travel distance decreased by 90% from 900 feet traveled per patient to 90 feet.

    University of Iowa Hospitals and Clinics, Iowa City, Iowa, Ann Madden Rice.
  • Computer Assisted Protocols: Reaped $22 million dollars in savings with new found efficiencies such as fewer readmissions for cardiac patients, fewer adverse drug events and fewer neonatal ICU stays. Found that up to 95% of each patient encounter can be standardized. "The trick is we got to savings not by withholding or short-changing care; but from actively pursuing better care."

    Intermountain Health Care, Salt Lake City, UT, Brent James, MD, Vice-President for Medical Research.
  • Flow of Patients from Cardiologist's Office to Diagnostic Lab: Reduced from 2,743 minutes to 64 minutes the time from initial diagnosis in cardiologist's office to treadmill exams.

    Cindy Jimmerson, www.leanhealthcarewest.com for Community Medical Center, Missoula, MT.
  • Neo-natal Intensive Care Unit Isolates: Saved $42,000 in rental equipment per year with improvements making the rental isolates unnecessary.

    Cindy Jimmerson, www.leanhealthcarewest.com for Community Medical Center, Missoula, MT.

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