The Q Conundrum
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View The Q Conundrum as PDF for free.
More details
- Words: 66,871
- Pages: 184
h
4HE 1UALITY #ONUNDRUM ILLUMINATES BOTH THE ROADBLOCKS AND BETTER PATHS TO A MUCH BETTER PERFORMING HEALTHCARE SYSTEM
v
n !2.)% -),34%). -$ -0( -%$)#!, $)2%#4/2 0ACIlC "USINESS 'ROUP ON (EALTH #()%& 0(93)#)!. -ERCER (EALTH AND "ENElTS
h
h
)N HEALTHCARE QUALITY SHOULD NOT BE A CONUNDRUM )T SHOULD BE AN INEVITABLE OUTCOME 2AISING AWARENESS OF OUR QUALITY CHALLENGES AND HOW TO ADDRESS THEM WILL HELP US GET THERE
v
n -!2'!2%4 /+!.% 02%3)$%.4 .#1!
4HE 1UALITY #ONUNDRUM ADDRESSES A KEY CHALLENGE IN HEALTHCARE QUALITY )T CAPTURES REAL WORLD EXPERIENCES AND SHOULD SERVE AS A VALUABLE RESOURCE TO ANYONE DELIVERING HEALTHCARE
v
n ,/5)3% ,)!.' -$ 3%.)/2 6)#% 02%3)$%.4 1UALITY AND #LINICAL 3YSTEMS 3UPPORT +AISER 0ERMANENTE
h
4HIS EXTRAORDINARY COMPENDIUM OF THE LATEST THINKING RESEARCH AND REAL WORLD EXPERIENCES PROVIDES A COMPREHENSIVE SYSTEMATIC AND VIEW IN THE ONGOING EFFORTS TO IMPROVE THE QUALITY OF HEALTHCARE )TS ALL ENCOMPASSING VIEW OF QUALITY ILLUSTRATED BY A HYPOTHETICAL SCENARIO DESCRIBED FROM THE PERSPECTIVE OF A lCTITIOUS CHRONICALLY ILL PATIENT IS UNIQUE )T DISPELS THE MYTH THAT HIGH QUALITY AND HIGH COST ARE SYNONYMOUS AND HIGHLIGHTS THE ROLE THAT TECHNOLOGY WILL PLAY IN ACHIEVING HIGH QUALITY COST EFFECTIVE HEALTHCARE n -!2# (/,,!.$ 02/'2!- $)2%#4/2 (EALTH 0ROVIDER 2ESEARCH (EALTH )NDUSTRY )NSIGHTS
v
).42/$5#4)/.
#(!04%2
7HY )S 1UALITY A #ONUNDRUM (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
4HE 1UALITY ,ANDSCAPE 2HONDA !RRINGTON "ENJAMIN )SGUR AND (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
1UALITY IN THE 0OST -ANAGED #ARE %RA $ONALD &ETTEROLF -ATRIA (EALTHCARE !LL 1UALITY 2OADS ,EAD TO $ATA (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
4HE (ORIZON "EYOND ()0!! "ALANCING 0RIVACY AND 3ECURITY 7ITH 0ATIENT #ARE 2ICHARD "AICH *EFF &USILE *AMES +OENIG AND #INDY 3MITH 0RICEWATERHOUSE#OOPERS 'LOBAL 0ERSPECTIVES ON 1UALITY 2ACHEL !BBOTT #ARRIE 3CHULMAN AND 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
!CCESSING "ENElTS 4HROUGH THE 7ORKPLACE 1UALITY AND %MPLOYER "ENElT 0LAN $ESIGN "ARRY "ARNETT AND 7ILLIAM 2OSENBERG 0RICEWATERHOUSE#OOPERS
(OW #ORPORATE !MERICA #AN (ELP ,IFT #LINICAL 0ERFORMANCE ! $ISCUSSION 7ITH !RNIE -ILSTEIN AND "OB 'ALVIN
%MPLOYERS 5SE OF (EALTHCARE 1UALITY $ATA "ENJAMIN )SGUR AND #HRISTOPHER +USCHEL 0RICEWATERHOUSE#OOPERS
%MPLOYERS $IRECTIONS IN (EALTHCARE &INANCIAL -ANAGEMENT 3USAN -ARGOLIS AND -ICHAEL 4HOMPSON 0RICEWATERHOUSE#OOPERS
#(!04%2
#(!04%2
0AYING FOR 1UALITY #ARE
4HE 2OLE OF THE 0ATIENT 0ATIENT #HOICE AND !CTIVATION IN (EALTHCARE 2ACHEL !BBOTT 0RICEWATERHOUSE#OOPERS !NNA $IXON +INGS &UND *UDITH (IBBARD 5NIVERSITY OF /REGON
4HE 2OLE OF THE #ONSUMER IN 1UALITY ! $ISCUSSION 7ITH THE 3USAN ' +OMEN &OUNDATION
1UALITY IN )NTEGRATED 4OTAL (EALTH -ANAGEMENT -ARY !NN 3HEA *ACKIE -AZOWAY !NURAG 3HARMA AND $AVID 3ACHS 0RICEWATERHOUSE#OOPERS
)NTEGRATING -EDICAL AND 0RODUCTIVITY -ANAGEMENT *ACKIE -AZOWAY AND -ARY !NN 3HEA 0RICEWATERHOUSE#OOPERS 1UALITY IN -EDICAID 0ROGRAMS 3ANDRA (UNT 0RICEWATERHOUSE#OOPERS
"LOGS AND 3OCIAL -EDIA 4HE .EW #ITIZEN !RBITERS OF (EALTHCARE 1UALITY $MITRIY +RUGLYAK 4HE -EDICAL "LOG .ETWORK
!CHIEVING 0ATIENT #ENTRIC 1UALITY #ARE 4HROUGH 4ECHNOLOGY ! $ISCUSSION 7ITH +AISER 0ERMANENTE
! +EY 3TRATEGY FOR 3OLVING THE (EALTHCARE #RISIS )NTEGRATING 3ICK #ARE AND 7ELL #ARE 3TEPHEN % "ELLER .ATIONAL (EALTH $ATA 3YSTEMS 3ABATINI * -ONATESTI %3 %NTERPRISES
4HE 0AY FOR 0ERFORMANCE ,ANDSCAPE (INDY 3HAMAN AND 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
"LUE #ROSS AND "LUE 3HIELD OF -INNESOTA (EALTHCARE &ACTS¸ ! .EW -ODEL FOR (OSPITAL 2EPORTING "ASED ON #ONSUMER %NGAGEMENT -ARY!NN 3TUMP AND 4AMARA , 9OUNG "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA
1UALITY 0AY FOR 0ERFORMANCE AND THE 2OLE OF #-3 ! $ISCUSSION 7ITH 4RENT (AYWOOD
)MPROVING THE %MERGENCY $EPARTMENT %XPERIENCE 0ATRICIA -ICHAELS AND *UDITH ! 2UNK 0RICEWATERHOUSE#OOPERS
1UALITY AS A "USINESS -ODEL "RETT - (ICKMAN 0RICEWATERHOUSE#OOPERS
-AGNET .URSING 3TATUS $EBORAH !LLBACH 0RICEWATERHOUSE#OOPERS 3HERRY $ANELLO AND 3USAN (OWELL 3T *OSEPHS#ANDLER (EALTH 3YSTEM
! 0ROVIDER ,ED !PPROACH TO 0AY FOR 0ERFORMANCE 4HE .ATIONAL #ARE 4RANSACTION #ONSORTIUM $AVID ,EVY 0RICEWATERHOUSE#OOPERS 0AY FOR 0ERFORMANCE AND "EYOND ! 2ECIPE FOR )MPROVING (EALTHCARE &RAN¥OIS DE "RANTES "RIDGES 4O %XCELLENCE
%VIDENCE "ASED $ECISION 3UPPORT &ROM 0APER TO %LECTRONIC 'REGORY ( $ORN :YNX (EALTH
1UALITY AND (EALTHCARE )NFORMATION 4ECHNOLOGY .ICK "EARD 0RICEWATERHOUSE#OOPERS
)DENTIFYING 1UALITY 0HYSICIAN #ARE
4HE 2OLE OF 2()/S AND /THER #OLLABORATIVES IN 1UALITY "RUCE (ENDERSON 0RICEWATERHOUSE#OOPERS
0HYSICIANS 0ERSPECTIVES ON 1UALITY ! $ISCUSSION 7ITH 'ORDON -OORE $AVID #HIN AND 4IM 7ILSON
#(!04%2
#(!04%2
7ORKING 4OGETHER 0HYSICIANS AND (OSPITALS 0ARTNERING FOR 1UALITY )MPROVEMENT *EFF "OOTH "RETT - (ICKMAN AND "RIAN -ATSON 0RICEWATERHOUSE#OOPERS
)MPROVING (EALTHCARE 1UALITY IN THE 0EDIATRIC !MBULATORY %NVIRONMENT 3HAMITA #HAKRABORTY AND !NTHONY $ 3LONIM #HILDRENS .ATIONAL -EDICAL #ENTER
!CHIEVING 1UALITY 4HROUGH #USTOMER 3ERVICE -ARGARET 3TOVER 0RICEWATERHOUSE#OOPERS
4HE +EY TO )MPROVING 1UALITY 3AVING ,IVES AND 2EDUCING ,AWSUITS $EBORAH ! 4OTO 4HE 'ALLUP /RGANIZATION
%NSURING 6ALUE FROM 0HARMA CEUTICALS AND -EDICAL $EVICES /VERVIEW OF 0HARMA AND ,IFE 3CIENCE 1UALITY )SSUES !NTHONY , &ARINO 0RICEWATERHOUSE#OOPERS
&ROM 2ESEARCH TO 1UALITY 4RANSLATING #LINICAL ,AB 2ESULTS )NTO 0ATIENT #ARE 7ILLIAM - $RACOS -ICHAEL 2 'LICK 'ERRY -C$OUGALL AND "ARBARA 7ALSH 0RICEWATERHOUSE#OOPERS
#(!04%2
$RUG 3AFETY AND 0HARMACOVIGILANCE +ATE -ALONEY AND -ICHAEL -ENTESANA 0RICEWATERHOUSE#OOPERS
"RIDGING #ARE AND 2ESEARCH 4HROUGH (EALTH )NFORMATION 4ECHNOLOGY .ICK "EARD 0RICEWATERHOUSE#OOPERS
)MPROVING THE (OSPITAL %XPERIENCE
#(!04%2
1UALITY AND THE 2EVENUE #YCLE *OSEPH - !LBIAN *IM (ORNE AND "ELLINDA # -INKNER 0RICEWATERHOUSE#OOPERS
#ONCLUSION
5SING 3IX 3IGMA TO )MPROVE 1UALITY IN (EALTHCARE ! 2OUNDTABLE $ISCUSSION
4HE 2OLE OF !CCREDITATION IN 1UALITY 2ICHARD ' "ATTAGLIA AND (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
2ESHAPING (OSPITAL 4HROUGHPUT *OAN $EMING -URPHY 0RICEWATERHOUSE#OOPERS
)MPORTANT .EXT 3TEPS FOR !CHIEVING THE 6ISION 3TEPHEN # 3CHOENBAUM +AREN $AVIS AND !NNE -ARIE * !UDET 2EPRINTED WITH PERMISSION FROM $AVID " .ASH AND .EIL * 'OLDFARBS 4HE 1UALITY 3OLUTION *ONES AND "ARTLETT 0UBLISHERS 3UDBURY -ASS WWWJBPUBCOM
,OOKING "ACK -OVING &ORWARD 2EmECTIONS ON THE 1UALITY #ONUNDRUM BY 0ROFESSORS $ON "ERWICK )NSTITUTE FOR (EALTHCARE )MPROVEMENT 2ICHARD 'ROL 2ADBOUD 5NIVERSITY .IJMEGEN 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
B
COqNUNqDRUM K N N DR M N ! RIDDLE IN WHICH A FANCIFUL QUESTION IS ANSWERED BY A PUN ! PARADOXICAL INSOLUBLE OR DIFlCULT PROBLEM A DILEMMA
1
UALITY HEALTHCARE IS UNDENIABLY IMPORTANT -ANY HEALTH IN DUSTRY LEADERS WOULD GO SO FAR AS TO SAY THAT IT IS IN A STATE OF CRISIS "UT WHY IS IT A CONUNDRUM #ERTAINLY THE 1UALITY #ONUNDRUM HAS SOME OF THE NICE ALLITERATIVE PROPERTIES THAT ONE SEEKS IN A BOOK TITLE "UT THERE WAS MORE INTENT BEHIND OUR CHOICE OF WORDS 1UALITY AND SAFETY STANDARDS ARE CRITICAL TO SUSTAINABILITY 0RICEWATERHOUSE#OOPERS GLOBAL REPORT h(EALTH#AST #REATING A 3USTAINABLE &UTURE v IDENTIlED QUALITY AND SAFETY STANDARDS AS ONE OF SEVEN SUSTAINABILITY FEATURES 4HIS BOOK BUILDS ON THAT REPORT WHICH HIGHLIGHTED THE GROWING IMPORTANCE OF hDElNED AND ENFORCED CLINICAL STANDARDS THAT ESTABLISH MECHANISMS FOR ACCOUNTABILITY AND ENHANCED TRANSPARENCY THEREBY BUILDING CONSUMER TRUSTv;= (OWEVER EMBEDDING QUALITY INTO HEALTH SERVICES TREATMENTS AND PROCESSES PRESENTS A CHALLENGE AND DILEMMA AT MULTIPLE LEVELS !LTHOUGH THE 53 HAS ONE OF THE HIGHEST LIVING STANDARDS IN THE WORLD AND SPENDS MORE THAN ANY OTHER /%#$ NATION ON HEALTHCARE IT RANKS IN THE LOWEST QUARTILE OF COUNTRIES ON EVEN THE MOST BASIC MEASURES OF HEALTH STATUS SUCH AS LIFE EXPECTANCY AT BIRTH AND INFANT MORTALITY;= ! GROWING MILLION INDIVIDUALS n OVER PERCENT OF OUR POPULATION n LACK HEALTH INSURANCE AND HAVE LIMITED ACCESS TO BASIC PREVENTIVE AND PRIMARY CARE SERVICES;= $ESPITE THE PLETHORA OF MEDICAL TECHNOLOGY ADVANCES SOME MIGHT ARGUE EVEN BECAUSE OF THE COMPLEXITY THEY ENGENDER NEARLY HOSPITAL PATIENTS DIE UNNECESSARILY DUE TO
MEDICAL ERRORS AND PEOPLE GET THE RECOMMENDED CARE ONLY PERCENT OF THE TIME;= 2EGIONAL VARIATIONS IN CARE PERSIST WITH NO APPARENT RELATION TO EXPENDITURES 2ECENT SURVEYS INDICATE THAT AN INCREASING PERCENTAGE OF CONSUMERS ARE CONCERNED ABOUT HEALTHCARE SAFETY AND QUALITY !DOPTION OF INFORMATION SYSTEMS THAT COULD WARD AGAINST MISUSE OVERUSE AND UNDERUSE OF MEDICAL SERVICES REMAINS LOW n PERCENT FOR PHYSICIANS AND PERCENT FOR HOSPITALS;= #AROLYN - #LANCY -$ DIRECTOR OF THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY POINTS TO SEVERAL REASONS FOR THE GAPS IN QUALITY h4ODAYS HEALTH CARE SYSTEM IS HIGHLY FRAGMENTED 4HERE ARE MORE INSTANCES THAN WE WOULD LIKE WHEN INFORMATION GETS LOST AND WE ARE LAGGING BEHIND OTHER INDUSTRIES IN THE EFFECTIVE USE OF INFORMATION TECHNOLOGY AS A TOOL FOR QUALITY IMPROVEMENT 7ITHIN HEALTH CARE ORGANIZATIONS WE TOO OFTEN SEE FRAGMENTATION AMONG THE WORK OF DIFFERENT KINDS OF HEALTH CARE PROFESSIONALS !S A RESULT OUR ABILITY TO FUNCTION AS A TEAM IS MORE ASPIRATIONAL THAN REAL 7HAT WE NEED ARE LEADERS WHO CAN ARTICULATE A VISION FOR HOW HEALTH CARE SHOULD BE DELIVERED AND WHO CAN THEN HELP BRING TOGETHER CLINICIANS POLICY MAKERS AND OTHERS TO MAKE THAT VISION A REALITYv -OREOVER CURRENT lNANCIAL INCENTIVES DO NOT TYPICALLY REWARD QUALITY h7E HAVE AN ABSOLUTELY TOXIC lNANCING SYSTEM &INANCING AND ECONOMICS ARE POWERFUL EVERYTHING IS GOING UPHILL AGAINST NON OR MIS ALIGNED INCENTIVES v STATES #HRISTINE + #ASSEL -$ PRESIDENT AND #%/ OF THE !MERICAN "OARD OF )NTERNAL -EDICINE !LTHOUGH NEW PROGRAMS SUCH AS PAY FOR PERFORMANCE AND CONSUMER DIRECTED HEALTH BENElTS ARE BEING DEVELOPED TO INCENT THE PROVISION OF QUALITY CARE AND EMPOWER CONSUMERS TO SELECT HIGH QUALITY PROVIDERS THEIR PENETRATION IN THE MARKET REMAINS MODEST 4HE VAST MAJORITY OF CARE IS PAID THROUGH MECHANISMS THAT REWARD VOLUME RATHER THAN QUALITY h4HERE ISNT A CLEAR lNANCIAL INCENTIVE FOR QUALITY IMPROVEMENT 0EOPLE
(INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
VGXãHRãPT @KHSXã@ãBNMT MCQT L DONT SEE THE CONNECTION BETWEEN ENHANCING PATIENT SAFETY AND IMPROVING THE BOTTOM LINE !BSENT A CHANGE IN lNANCIAL INCENTIVES THROUGH PAY FOR PERFORMANCE AND -EDICARE WERE JUST TINKERING AT THE EDGES v SAYS $AVID " .ASH -$ -"! CHAIRMAN OF THE DEPARTMENT OF HEALTH POLICY *EFFERSON -EDICAL #OLLEGE OF 4HOMAS *EFFERSON 5NIVERSITY 3O ALTHOUGH HIGH QUALITY REMAINS AN AIM IT IS NOT YET A REALITY 0RICEWATERHOUSE#OOPERS CONDUCTED IN DEPTH INTERVIEWS WITH MORE THAN HEALTH EXECUTIVES AND INDUSTRY LEADERS 4HEY WERE UNANIMOUS IN THE VIEW THAT DESPITE DECADES OF WORK ON THE QUALITY ISSUE WE CONTINUE TO FALL SHORT OF OUR ASPIRATIONS AND GOALS !ND THERE WAS NEAR UNIVERSAL AGREEMENT ON THE VIEW THAT THE STATE OF HEALTHCARE QUALITY WILL LIKELY NOT CHANGE SIGNIlCANTLY WITHIN THE NEXT THREE TO lVE YEARS )N SHORT THE HEALTH EXECUTIVES AND LEADERS SAW THE SHORT TERM FUTURE AS hMUCH OF THE SAMEv WITH RESPECT TO QUALITY 1UALITY IS A CONUNDRUM ON ANOTHER LEVEL 7ITH RECENT STUDIES POINTING TO THE MAGNITUDE AND SCOPE OF MEDICAL ERRORS THE QUALITY ISSUE HAS BEEN A MAJOR FOCUS OF ATTENTION )N THE PAST YEARS DOZENS OF ORGANIZATIONS HAVE BEEN DESIGNATED OR
CREATED AT THE NATIONAL LEVEL TO ADDRESS QUALITY SEE %XHIBIT "UT WITH ALL OF THESE PLAYERS ONE MUST WONDER IF THE NOISE TO ACTION RATIO IS TOO HIGH h4HERES A CACOPHONY OF ORGANIZATIONS IN THE QUALITY SPACE 7E NOW KNOW WHAT TO DO 4HERES SO MUCH QUALITY RELATED ACTIVITY ITS BEGINNING TO BOG DOWN UNDER ITS OWN WEIGHT AND COULD BE BETTER ORGANIZED v SAYS $ONALD &ETTEROLF -$ -"! &!#0 VICE PRESIDENT OF THE !MERICAN #OLLEGE OF -EDICAL 1UALITY AND CORPORATE VICE PRESIDENT FOR HEALTHCARE INTELLIGENCE OF -ATRIA (EALTHCARE -ARGARET % /+ANE PRESIDENT OF THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1! A GROUP THAT ACCREDITS HEALTH PLANS BASED ON QUALITY METRICS AGREES h4HE QUALITY COMMUNITY HAS BECOME A QUALITY PROBLEM IN ITS OWN RIGHT #ONFUSION IS AN IMPEDIMENT TO PROGRESS !S THE ENVIRONMENT GETS MORE CONFUSING WERE IN DANGER OF PROVIDERS THROWING UP THEIR HANDS IN FRUSTRATIONv (ELEN $ARLING PRESIDENT OF THE .ATIONAL "USINESS 'ROUP ON (EALTH ."'( STATES h4HERE IS NOT NEARLY ENOUGH STRONG AGGRESSIVE IMPATIENT LEADERSHIP n WHICH IS ESSENTIAL IF WE ARE TO OVERCOME ALL OF THE FORCES WORKING AGAINST SIGNIlCANT CHANGE INERTIA COMPETING PRIORITIES AND SADLY A LACK OF URGENCYv
%XHIBIT /RGANIZATIONS )NVOLVED IN (EALTHCARE 1UALITY
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
VGXãHRãPT @KHSXã@ãBNMT MCQT L 7ITH THE LARGE NUMBER OF ORGANIZATIONS AND LACK OF A DESIGNATED LEADER PROVIDERS ARE FACED WITH MOUNTING REQUIREMENTS FOR PERFORMANCE REPORTING n WITH NO CONSISTENT STANDARDS OR DElNITIONS h7ITH ALL OF THE VARIOUS PAY FOR PERFORMANCE PROGRAMS THERES A MULTIPLICITY OF MANDATES v SAYS 0AUL $ #LEARY 0H$ PROFESSOR OF HEALTHCARE POLICY IN THE DEPARTMENTS OF HEALTHCARE POLICY AND SOCIAL MEDICINE AT (ARVARD -EDICAL 3CHOOL h#URRENTLY THERES CONFUSION ON WHATS THE RIGHT THING TO MEASURE AND WHAT THE FOCUS SHOULD BE (OSPITALS START WORKING ON ONE INITIATIVE AND THEN SWITCH GEARS TO ANOTHER WITHOUT COMPLETING EITHER 4YPICALLY HOSPITALS HAVE A FRAGMENTED REACTIVE APPROACH TO QUALITY 4HEY DONT HAVE A WELL THOUGHT OUT SET OF PRIORITIES AND QUALITY STRATEGIC GOALS TO MOVE THE ORGANIZATION FORWARD v SAYS ,AURA *ACQUIN 2. -"! PRESIDENT OF 0REMIER (EALTHCARE 3OLUTIONS A PROFESSIONAL SERVICES lRM PROVIDING PROJECT MANAGEMENT AND INTERIM STAFF SUPPORT TO HEALTHCARE ORGANIZATIONS IN AREAS INCLUDING DENIAL MANAGEMENT AND PATIENT ACCESS -ARY #OOPER -$ *$ VICE PRESIDENT AND CHIEF QUALITY OFlCER OF .EW9ORK 0RESBYTERIAN (OSPITAL A BED FACILITY WITH MOSTLY MASTERS TRAINED STAFF DEDICATED TO QUALITY AGREES h7ERE PASSIONATE ABOUT QUALITY )TS ENCOURAGED BY THE VERY TOP OF OUR ORGANIZATION AND HELD IN HIGH ESTEEM "UT ) WORRY THAT AS AN INDUSTRY OUR ATTENTION SPAN ON SOME OF THESE EFFORTS ISNT LONG 7HATS IMPORTANT TODAY ISNT NECESSARILY IMPORTANT TOMORROW )TS HARD TO SUSTAIN IMPROVEMENTSv %XHIBIT 2OLES /PPORTUNITIES FOR 1UALITY )MPROVEMENT
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
h4HERES A WILLINGNESS TO EMBRACE THE QUALITY ISSUE FROM MANY QUARTERS WHERE THERE WASNT BEFORE WHICH IS PROMISING "UT THERES A LACK OF CERTAINTY ABOUT WHAT TO DO lRST #ONFRONTING QUALITY IS COMPLEX AND PEOPLE NEED A CLEAR IDEA OF WHERE TO BEGIN 7ITH CLEAR PRIORITIES WE COULD MAKE A LOT MORE PROGRESS v SAYS .#1!S /+ANE !S A REmECTION OF THIS WIDESPREAD SENTIMENT THE )NSTITUTE OF -EDICINE )/- RECENTLY CALLED FOR THE ESTABLISHMENT OF A .ATIONAL 1UALITY #OORDINATION "OARD h)N OUR REPORT ENTITLED @0ERFORMANCE -EASURES !CCELERATING )MPROVEMENT WE RECOMMEND THE ESTABLISHMENT OF A .ATIONAL 1UALITY #OORDINATION "OARD TO PERFORM A VARIETY OF CRUCIAL FUNCTIONS IDENTIFY AND ARTICULATE CONSENSUS GOALS FOR HEALTHCARE CHOOSE EXISTING ANDOR DEVELOP NEW MEASURES OF PERFORMANCE THAT WILL PROMOTE HEALTHCARE QUALITY AND COORDINATE EFFORTS BY PUBLIC AND PRIVATE STAKEHOLDERS TO MAXIMIZE THE RATE AT WHICH PROGRESS IS MADE .O CURRENTLY EXISTING ENTITY CAN PERFORM ALL OF THESE TASKS v STATES *OHN # 2ING -$ DIRECTOR OF THE BOARD ON HEALTHCARE SERVICES OF THE )/- ,ASTLY QUALITY IS A CONUNDRUM BECAUSE WE ARE AT A TURNING POINT 7E HAVE RECOGNITION OF THE ISSUE AND A BASELINE OF ACTIVITIES ESTABLISHED FROM WHICH WE CAN BUILD MOMENTUM AND ACHIEVE SIGNIlCANT RESULTS (OWEVER WITH CONTINUED LACK OF COORDINATION AND STANDARDIZATION WE FACE THE RISK OF FRUSTRATION PARALYSIS AND DIVERSION OF RESOURCES h4HE ISSUE ISNT DOING MORE RESEARCH ABOUT PERFORMANCE MEASUREMENT ITS JUST DOING IT 0EOPLE HAVE TO GET MOVING EVERYBODY HAS WORK TO DO 4HIS IS WORSE THAN WATCHING
VGXãHRãPT @KHSXã@ãBNMT MCQT L 4HE 2OAD 4O (EALTHCARE 1UALITY ! #ONmUENCE OF 3EEMINGLY 5NRELATED #ONNECTIONS "UILDS THE &UTURE 0AST IS PROLOGUE OR SO SAID 3HAKESPEARE 3O IN TERMS OF QUALITY HOW DID WE GET TO THE STATE WERE IN TODAY 7HAT EVENTS HAVE LED US TO OUR CONUNDRUM AROUND QUALITY IN HEALTHCARE (OW WILL THESE EVENTS AFFECT OUR EFFORTS TO DElNE HEALTHCARE IN THE FUTURE )NNOVATION AND CHANGE OFTEN ARE CREATED BY DISPARATE FORCES INmUENCING AN OUTCOME OVER TIME /FTEN AN OBSERVER OF THESE INDIVIDUAL EVENTS WOULD NOT BE ABLE TO CONTEMPLATE THE lNAL OUTCOME 4HE FOLLOWING TIMELINE SHOWS HOW DISCOVERIES EVENTS AND TECHNOLOGIES ALL CONVERGED TO BRING US TO OUR MODERN DAY DEVELOPMENT AND USE OF HEALTHCARE QUALITY n 4HE "ROADSTREET PUMP OUTBREAK GIVES BIRTH TO DATA DRIVEN PUBLIC HEALTH INITIATIVES;= 3OME HAVE CALLED $R *OHN 3NOW THE GREATEST PHYSICIAN OF ALL TIME $URING ONE OF THE WORST OUTBREAKS OF CHOLERA IN ,ONDONS HISTORY 3NOW USED DATA TO MAP THE SOURCE OF THE EPIDEMIC TO A WATER PUMP ON "ROADSTREET 2EMOVING THE PUMP HANDLE SLOWED THE SPREAD OF CHOLERA IN THAT AREA -ODERN EPIDEMIOLOGY AND PUBLIC HEALTH WERE BORN AS WELL AS THE DOCUMENTED USE OF STATISTICAL MAPPING TO IMPROVE HEALTH OUTCOMES -ORE THAN YEARS AGO THE CONCEPT OF USING DATA TO IMPROVE HEALTH QUALITY WAS BORN n 4HE lRST AUTOMOBILE RELIABILITY INFORMATION IS INCLUDED IN #ONSUMER 2EPORTS MAGAZINE;= "ASED ON READERS SURVEYS ON THE FREQUENCY OF AUTOMOBILE REPAIRS THIS MAGAZINE LAUNCHED THE MODERN CONSUMER MOVEMENT 4HE CONSUMER PRODUCT MOVEMENT BASED QUALITY DECISIONS ON ACTUAL DATA AND RELIED ON PURCHASING POWER AND PUBLIC POLICY ACTIVISM TO PROTECT CONSUMERS 4HE MOST UBIQUITOUS SYMBOL OF CONSUMER QUALITY RATINGS ARE THE #ONSUMER 2EPORTS AUTOMOBILE hCOLORED BUBBLESv WHICH DEMOCRATIZED QUALITY RATINGS SO THAT EVERYONE COULD PARTICIPATE IN FACT BASED DECISION MAKING -ANY HEALTHCARE QUALITY ORGANIZATIONS EMULATE THIS CONCEPT OF QUALITY RATINGS BASED ON SURVEY DATA TODAY n 0ATENTS FOR THE INTEGRATED CIRCUIT OR @MICROCHIP ARE lLED;= #OMPUTERS MEDICAL EQUIPMENT AND EVEN SOME COFFEEMAKERS HAVE THEM 4HE MICROCHIP MAKES THE MODERN WORLD RUN n MEDICAL TECHNOLOGY INCLUDED *ACK +ILBY AND 2OBERT .OYCE ARE CREDITED WITH THE INVENTION THAT KICK STARTED THE COMPUTER AGE -ODERN HEALTHCARE IS INTERTWINED WITH TECHNOLOGY AND THE MICROCHIP IS THE BACKBONE OF THE HEALTHCARE TECHNOLOGY CHAIN FROM THE -2) MACHINE TO THE COMPUTER IN THE PHYSICIANS OFlCE 4ODAYS HEALTHCARE
QUALITY DATA IS PROCESSED ON A MICROCHIP INVENTED OVER YEARS AGO n 0RESIDENT ,YNDON "AINES *OHNSON SIGNS THE -EDICARE BILL INTO LAW;= !S PART OF THE 3OCIAL 3ECURITY !CT !MENDMENT -EDICARE CHANGED HEALTHCARE IN !MERICA OVERNIGHT BY CREATING THE LARGEST HEALTH INSURANCE PROGRAM THAT WOULD FUNNEL DOLLARS INTO HOSPITAL CARE (OSPITALS SPROUTED UP EVERYWHERE AND DATA FOLLOWED IN THE FORM OF -EDICARE COST REPORTS (EALTHCARE DATA IS ONE OF THE CORNERSTONES OF HEALTHCARE QUALITY AND THE -EDICARE PROGRAM IS ONE OF THE BIGGEST SOURCES OF DATA &ORTY YEARS AFTER ITS IMPLEMENTATION THE -EDICARE PROGRAM IS USED AS THE lRST NATIONAL PROGRAM FOR PROVIDER QUALITY REPORTING ON KEY METRICS n %DWARD $EMING IS NAMED AS AN HONORARY MEMBER OF THE !MERICAN 3OCIETY FOR 1UALITY;= (E IS CONSIDERED ONE OF THE FATHERS OF THE QUALITY MOVEMENT BECAUSE OF HIS CONTRIBUTION TO THE THEORIES OF PROCESS IMPROVEMENT (IS MOST FAMOUS WORK WAS HELPING TO REBUILD THE *APANESE INDUSTRIAL BASE AFTER 77)) USING STATISTICAL QUALITY CONTROL -ANY OF OUR MODERN DAY PROCESS IMPROVEMENT SYSTEMS INCLUDING 4OTAL 1UALITY -ANAGEMENT AND 3IX 3IGMA ARE BASED ON HIS RESEARCH AND TEACHINGS (EALTHCARE SYSTEMS ARE NOW ADOPTING QUALITY IMPROVEMENT INITIATIVES BASED ON STATISTICAL ANALYSIS n )NSTITUTE OF -EDICINE RELEASES 4O %RR IS (UMAN;= 0ATIENT SAFETY AND QUALITY MOVED TO THE FOREFRONT OF THE PUBLIC DEBATE AFTER THE )/- REPORTED THAT BETWEEN AND PATIENTS DIE EACH YEAR DUE TO MEDICAL ERRORS 4HESE STUNNING NUMBERS MOVED THE DEBATE FROM THE POSITION THAT HEALTHCARE QUALITY IS ABOUT IMPROVING QUALITY TO ONE OF GREATER URGENCY IN SAVING LIVES S n 7ITH MORE THAN YEARS OF CONNECTIONS BETWEEN PEOPLE PROCESS AND TECHNOLOGY HEALTHCARE QUALITY IS BECOMING A REALITY 4HE -EDICARE -ODERNIZATION !CT PAY FOR PERFORMANCE INITIATIVES THE ELECTRONIC MEDICAL RECORD 3IX 3IGMA PROCESS DESIGN REGIONAL HEALTH INFORMATION ORGANIZATIONS AND PROVIDER REPORT CARDS ALL BUILT ON PAST ADVANCES (EALTHCARE QUALITY AND THE DECISIONS THAT ARE MADE BASED ON THAT INFORMATION ARE QUICKLY BECOMING PART OF THE 53 HEALTHCARE SYSTEM 7HAT WILL IT LOOK LIKE IN AND WHAT CONNECTIONS WILL NEED TO BE MADE n "Y "ENJAMIN )SGUR 0RICEWATERHOUSE#OOPERS
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
VGXãHRãPT @KHSXã@ãBNMT MCQT L PAINT DRY v SAYS $ENNIS 3 /,EARY -$ PRESIDENT OF THE *OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS *AMES #ONWAY SENIOR FELLOW OF THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT AND SENIOR CONSULTANT OF THE $ANA &ARBER #ANCER )NSTITUTE SAYS h) WORRY ABOUT SUSTAINABILITY (EALTHCARE HAS A HISTORY OF A @PHILOSOPHY DU JOUR 4HERE ARE SO MANY WAYS FOR PEOPLE TO GET DISTRACTED 7E NEED TO LEARN HOW TO SUSTAIN FOCUSv (E ADDS h7E DONT SUFFER FROM AN ABSENCE OF IDEAS 7E SUFFER FROM AN ABSENCE OF WILL AND EXECUTIONv
4HE SUCCESS OR FAILURE OF ANY QUALITY INITIATIVE ULTIMATELY HINGES ON THE PATIENT CLINICIAN INTERACTION 3OME ARE MORE OPTIMISTIC -ATRIA (EALTHCARES &ETTEROLF SEES THE LARGE NUMBER OF QUALITY ORGANIZATIONS AND ACTIVITIES AS hxNOT NECESSARILY A BAD THING !LL OF THE PIECES n THE KNOWLEDGE TOOLS INFORMATION RESOURCES AND MEASURES n ARE THERE 3O WE CAN BE MORE HOPEFUL ABOUT THE FUTUREv 7HAT CAN HEALTH EXECUTIVES DO TO ENSURE THAT WE GAIN MOMENTUM RATHER THAN ENTER A STATE OF PARALYSIS 4HE GOOD NEWS IS THAT EVERYONE CAN MAKE A DIFFERENCE 1UALITY IS NOT SOMETHING THAT IS CONlNED IN THE IVORY TOWER OR RESTS SOLELY IN THE HANDS OF GURUS 2ATHER IT IS AN ISSUE FOR WHICH EVERY STAFF MEMBER AT EVERY LEVEL IN EVERY HEALTH ORGANIZATION CAN MAKE AN IMPACT (EALTH ORGANIZATIONS FROM EVERY SECTOR OF THE INDUSTRY HAVE A ROLE TO PLAY AS SHOWN IN %XHIBIT 7HEREVER WE LOOK THERE ARE IMPORTANT AND EFFECTIVE ACTIVITIES TO ENHANCE QUALITY WHETHER AT THE GOVERNANCE AND LEADERSHIP LEVEL OR THE FRONT LINE EMPLOYERS WHO PROVIDE THEIR STAFFS WITH INFORMATION ABOUT THE RISK OF MEDICAL ERRORS AND QUALITY OF PROVIDERS HEALTH PLANS THAT SHOW PROVIDERS HOW THEY COMPARE WITH PEERS AND CAN IMPROVE THEIR PERFORMANCE x HOSPITAL BOARD MEMBERS WHO SET POLICIES AND MONITOR PROGRESS AGAINST ANNUAL GOALS x HEALTH ORGANIZATION EXECUTIVES WHO GET A DAILY REPORT ON THE NUMBER OF MEDICAL ERRORS IN THE PAST HOURS AND INVESTIGATE ROOT CAUSES IMMEDIATELY x PHYSICIANS WHO WILLINGLY REPORT THEIR CLINICAL ACTIVITIES AND USE THIRD PARTY RATINGS TO IMPROVE THEIR PERFORMANCE x NURSES WHO LOOK PATIENTS IN THE EYE DURING A CONVERSATION RATHER THAN AT A CLIPBOARD x CASE MANAGERS WHO ACT AS CLINICIANS ARMS AND LEGS TO ASSIST WITH DOCUMENTATION THE REGISTRATION CLERK WHO EXPLAINS THE PATIENTS BILL IN CLEAR SIMPLE LANGUAGE EVEN THE PARKING ATTENDANT WHO LENDS AN ARM TO HELP A PATIENT GET OUT OF THE CAR /UR CHALLENGE IS TO MOBILIZE OUR EFFORTS SUSTAIN OUR FOCUS AND CATALYZE RESULTS 7HERE DO WE GO FROM HERE &ROM 0RICEWATERHOUSE#OOPERS INTERVIEWS THE FOLLOWING MAJOR THEMES EMERGED AS PRACTICAL STEPS THAT HEALTH EXECUTIVES NEED TO TAKE TO ACHIEVE PROGRESS ON QUALITY 3ET ANNUAL QUALITY GOALS AND ESTABLISH PRIORITIES (EALTH EXECUTIVES NEED TO REALIZE THAT THEY CANT DO EVERYTHING AT ONCE
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
BUT THEY NEED TO ESTABLISH TANGIBLE GOALS THAT CLEARLY RELATE TO THEIR ORGANIZATIONAL STRATEGY h7E NEED TO CREATE CULTURES OF SAFETY WITHIN ALL HEALTH ORGANIZATIONS 1UALITY AND SAFETY IMPROVEMENT HAVE TO BE PERSONAL PRIORITIES FOR ALL STAFF "UT WE NEED TO DElNE PRIORITIES FOR WHAT WE WANT THEM TO DO 4HE ANSWER CANT BE @EVERYTHING v SAYS THE *OINT #OMMISSIONS /,EARY $ANA &ARBERS #ONWAY ADDS h&ROM WHAT ) SEE LESS THAN HALF OF ORGANIZATIONS HAVE SPECIlC GOALS FOR QUALITY AND SAFETY -IDDLE MANAGERS ARE OVERWHELMED DEPRESSED AND FRUSTRATED 4HEY DONT KNOW HOW THEIR ACTIVITIES AT A PROCESS LEVEL lT WITH SYSTEM LEVEL TRANSFORMATIONv )NVOLVE BOARD MEMBERS AND SENIOR LEADERSHIP TEAMS IN CLINICAL ISSUES AND QUALITY *UST AS BOARD MEMBERS REGULARLY AND ROUTINELY GET REPORTS ON THE lNANCIAL STATUS OF THE HEALTH ORGANIZATIONS THEY GOVERN THEY ALSO NEED TO RECEIVE QUALITY REPORTS "OARD MEMBERS ARE ULTIMATELY ACCOUNTABLE FOR THE QUALITY OF SERVICES AND PRODUCTS PROVIDED $ANA &ARBERS #ONWAY SAYS h"OARD MEMBERS NEED TO UNDERSTAND THAT THEY ARE ACCOUNTABLE 4HEY HAVE THE PRIVILEGE OF SAYING @9OU WILL 4HEY NEED TO SET EXPECTATIONS AND ESTABLISH FOCUS ALIGNMENT AND RESOURCES n INCLUDING TAKING SOME THINGS OFF THE TABLEv (E GOES ON TO RECOMMEND THAT SENIOR LEADERS ASK THEMSELVES THE FOLLOWING QUESTIONS h7ERE PATIENT ANDOR STAFF SAFETY ISSUES ON THE AGENDA OF OUR LAST TEAM MEETING 7HERE WAS THE PLACEMENT OF THESE ISSUES ON THE AGENDA lRST MIDDLE LAST )S DATA FROM PATIENT AND STAFF SAFETY INDICATORS ROUTINELY REVIEWED AND DISCUSSED !RE SAFETY AGENDA ITEMS FOLLOWED BY ACTION PLANS WITH AN ASSIGNED SENIOR LEADER ACCOUNTABLE FOR FOLLOW UP 7HAT IS THE PERCENTAGE OF TIME THAT THE TEAM SPENDS ON DISCUSSION OF PATIENT CARE ISSUES INCLUDING SAFETY AND OTHER OPERATIONAL MATTERS v 2EALIGN ORGANIZATIONS AND STRUCTURES TO IMPROVE QUALITY 1UALITY INITIATIVES CUT ACROSS )4 ACCESS REGULATORY AND CLINICAL AREAS !NTHONY $ 3LONIM -$ $R0( EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS AT THE #HILDRENS .ATIONAL -EDICAL #ENTER IN 7ASHINGTON $# AND ASSOCIATE PROFESSOR AND VICE CHAIRMAN OF THE DEPARTMENT OF PEDIATRICS AT THE 'EORGE 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE BELIEVES THAT h#%/ SUCCESS IN THE FUTURE WILL NOT JUST BE DEPENDENT ON ACHIEVEMENT OF lNANCIAL METRICS BUT ALSO ON QUALITY AND SAFETY OUTCOMES 3TRATEGIC INITIATIVES WILL BE QUALITY RELATED "OARD MEMBERS WILL ASK QUALITY QUESTIONS !S AN INDUSTRY WE ARE ALREADY STARTING TO SEE THESE CHANGESv (E CONNOTES THE NEED FOR UPWARD AND DOWNWARD COMMUNICATION ACROSS LEADERSHIP AND FRONT LINE STAFF TO A hSPIDER WEBv h7E NEED TO START PAYING ATTENTION TO HOW WE ARE RUNNING INTERFERENCE IN THIS SPIDER WEB 4HE SPIDERS IN THE WEB ARE WHERE HEALTHCARE IS DRIVEN 4HE WORK WITHIN THE WEB IS CRITICAL IN ORDER TO BE SUCCESSFULv 2OBIN * 4HOMASHAUER EXECUTIVE DIRECTOR OF THE #OUNCIL FOR !FFORDABLE 1UALITY (EALTHCARE A NONPROlT ALLIANCE OF HEALTH PLANS NETWORKS AND TRADE ASSOCIATIONS THAT SEEKS TO CATALYZE INDUSTRY COLLABORATION TO SIMPLIFY HEALTHCARE
VGXãHRãPT @KHSXã@ãBNMT MCQT L ADMINISTRATION CONCURS WITH THE NEED TO BRIDGE TRADITIONAL SILOS WITH INFORMATION h7HATS NEEDED IS AN EFlCIENT WAY FOR PLANS TO QUICKLY SECURELY SHARE DATA WITH PROVIDERS ONE THAT BALANCES INTERNAL AND INDUSTRY PRIORITIESv !DOPT CLINICAL INFORMATION TECHNOLOGY 4HE ABILITY TO MEASURE MANAGE AND IMPROVE HEALTHCARE QUALITY REQUIRES CLINICAL INFORMATION 4HOMAS ( ,EE -$ NETWORK PRESIDENT FOR THE "OSTON BASED HOSPITAL SYSTEM 0ARTNERS (EALTH#ARE 3YSTEM STATES h)N MEDICAL SCHOOL ) WAS TAUGHT NOT TO OPEN A 0$2 IN FRONT OF A PATIENT n WE WANTED TO GIVE PATIENTS THE MESSAGE THAT WE KNEW EVERYTHING 4ODAY ITS CLEAR THAT NO ONE CAN KNOW IT ALL &OR SICK COMPLEX PATIENTS IT NEEDS TO BE A TEAM SPORT !S SOME OF MY FRIENDS SAY WE WERE TRAINED TO BE #HUCK 9EAGER BUT WE NEED TO BE *OHN 'LENN .OT IMPROVISE BUT FOLLOW THE RULES -EDICINE IS SO COMPLEX THAT YOU CANT GIVE GOOD CARE TO PATIENTS ALL BY YOURSELF 4HERES TOO MUCH TO DO TOO MUCH TO KNOWv 4ODAYS CLINICIAN NEEDS )4 SOLUTIONS SUCH AS ELECTRONIC MEDICAL RECORDS AND COMPUTERIZED PHYSICIAN ORDER ENTRY SYSTEMS WITH MEDICAL DECISION SUPPORT $EVELOP NEW STAFlNG SKILLS AND CATEGORIES 7E NEED TO BE ABLE TO MANIPULATE ANALYZE AND INTERPRET QUALITY DATA 7E DONT HAVE ENOUGH INDIVIDUALS TRAINED IN CLINICAL ANALYSIS NOW 0ARTICULARLY WITH INCREASED ADOPTION OF INFORMATION TECHNOLOGY WELL SEE MORE AND MORE INFORMATION GATHERING THAT WILL GO INTO A DATA WAREHOUSE THAT WELL NEED TO MINE h)N OUR PROFES SIONAL SCHOOLS WE DONT TEACH PEOPLE ABOUT SYSTEMS THINKING OR TEAMING IN HEALTHCARE YET PERCENT OF THE OPPORTUNITIES TO IMPROVE SAFETY LIE IN SYSTEMS REDESIGN &EW HOSPITALS n LESS THAN PERCENT n HAVE SYSTEM REDESIGN CAPABILITIES OR SYS TEMS ENGINEERS ON STAFF v SAYS THE *OINT #OMMISSIONS /,EARY %XISTING TRAINING PROGRAMS ARE NOT SUFlCIENT TO PREPARE HEALTH PROFESSIONALS FOR THE DEMANDS AHEAD !CCORDING TO *ANET - #ORRIGAN 0H$ -"! PRESIDENT AND CHIEF EXECUTIVE OFlCER OF THE .ATIONAL 1UALITY &ORUM A PRIVATE NOT FOR PROlT MEMBER %XHIBIT 3COPE OF THE 1UALITY #ONUNDRUM
SHIP ORGANIZATION CREATED TO DEVELOP AND IMPLEMENT A NATIONAL STRATEGY FOR HEALTHCARE QUALITY MEASUREMENT AND REPORTING h7E NEED TO DO MORE WITH EDUCATION AND TRAINING OF HEALTH PROFESSIONALS PHYSICIANS NURSES PHARMACISTS 7E WANT THEM TO PRACTICE IN AN INFORMATION RICH ENVIRONMENT USE DECISION SUPPORT TOOLS ENGAGE CONSUMERS AND PRACTICE IN A MULTIDISCI PLINARY MANNER "UT WE DONT TRAIN THEM ACCORDINGLY #URRENTLY WE DONT HAVE ENOUGH CUTTING EDGE PRACTICE SETTINGS FOR TRAIN ING )TS A CATCH v %NGAGE CLINICIANS 4HE SUCCESS OR FAILURE OF ANY QUALITY INITIATIVE ULTIMATELY HINGES ON THE PATIENT CLINICIAN INTERACTION 4HOUGH MANY IN THE MEDICAL COMMUNITY RESISTED ATTEMPTS TO MONITOR AND MEASURE QUALITY PERFORMANCE IN THE PAST THEY ARE GRADUALLY COMING AROUND TO THE INEVITABILITY OF THESE EFFORTS h0HYSICIANS KNOW THAT TRANSPARENCY AND PUBLIC REPORTING IS INEVITABLE )N THE BEST OF CIRCUMSTANCES SUCH DATA CAN PROMPT PERFORMANCE IMPROVEMENT PROGRAMS IN PROVIDER ORGANIZATIONS v STATES $AVID 7 0LOCHER -$ CHIEF MEDICAL OFlCER AND SENIOR VICE PRESIDENT FOR HEALTH MANAGEMENT AND INFORMATICS "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA 2ECRUIT CONSUMER AND PATIENT PARTICIPATION IN QUALITY EFFORTS #ONSUMERS NEED TO TAKE A MORE ACTIVE ROLE (ISTORICALLY THEY HAVE TAKEN QUALITY FOR GRANTED AND LITTLE CLEAR INFORMATION HAS BEEN AVAILABLE TO THEM "UT WITH INCREASED TRANSPARENCY AND REPORTING THEY WILL BECOME MORE ACTIVE ."'(S $ARLING STATES h!S CONSUMERS GET MORE INFORMATION THROUGH RESULTS OF STUDIES REGARDING HOW THEY COULD HAVE BEEN HARMED THEY WILL BECOME MORE CONSERVATIVE ABOUT MEDICAL CARE 4HEIR REACTION TO RECENT SAFETY STUDIES INDICATES THAT PEOPLE ARE PAYING MORE ATTENTION 7ITHIN WEEKS THOUSANDS OF WOMEN DROPPED (24 4HEYRE USING WORD OF MOUTH RATHER THAN DATA TO SELECT PROVIDERS RIGHT NOW BECAUSE THE DATA IS SIMPLY NOT AVAILABLEv %LIZABETH "RADLEY ASSOCIATE PROFESSOR AND DIRECTOR OF THE HEALTH MANAGEMENT PROGRAM WITHIN HEALTH POLICY AND ADMINISTRATION AT THE 9ALE 3CHOOL OF 0UBLIC (EALTH ADDS h4HERE IS A TRANSLATION PROBLEM 7E NEED TO MAKE THE INFORMATION MEANINGFUL FOR PATIENTS AND FAMILIES 4HERE IS A BALANCE ONE CANNOT OVERWHELM PATIENTS WITH DATA BUT ON THE OTHER HAND ONE HAS TO RETAIN ADEQUATE DETAIL TO MAKE THE DATA ACCURATE AND NOT OVERLY GENERALv 2EWARD QUALITY 7HETHER AT A SYSTEM ORGANIZATIONAL DEPARTMENTAL OR AN INDIVIDUAL LEVEL BEHAVIORS THAT PROMOTE QUALITY NEED TO BE REWARDED 1UALITY INCENTIVES CAN ENCOMPASS PAY FOR PERFORMANCE PROGRAMS BETWEEN PAYERS AND PROVIDERS STAFF COMPENSATION DESIGN AND EMPLOYEE RECOGNITION CAMPAIGNS h)T WILL BE THE INCENTIVES THAT DRIVE THE MARKET v ADDS 0AUL !LCALA VICE PRESIDENT AND CHIEF INFORMATION OFlCER OF .ORTHBAY (EALTHCARE 3YSTEMS IN #ALIFORNIA 4HE REMAINDER OF THIS BOOK EXPLORES THESE PRACTICAL APPROACHES IN FURTHER DETAIL ADDRESSING QUALITY AS A MULTIDIMENSIONAL ISSUE THAT IMPACTS PATIENTS AND HEALTH ORGANIZATIONS ACROSS
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
VGXãHRãPT @KHSXã@ãBNMT MCQT L THE INDUSTRY n EMPLOYERS INSURERS PHYSICIANS HOSPITALS AND PHARMACEUTICAL AND LIFE SCIENCE COMPANIES n WITH REPERCUSSIONS FOR lNANCIAL PERFORMANCE CLINICALCARE MANAGEMENT OPERATIONS AND TECHNOLOGY DEVELOPMENT AND INTEGRATION %XHIBIT DEPICTS THE SCOPE OF ISSUES ADDRESSED 4HE BOOK DESCRIBES SELECTED EXAMPLES OF INNOVATIVE QUALITY IMPROVEMENT PRACTICES NOT TO REPRESENT A COMPREHENSIVE SET OF LEADING PRACTICES BUT RATHER TO ILLUSTRATE THE RANGE OF PRACTICAL APPROACHES THAT ARE BEING EMPLOYED BY A VARIETY OF HEALTH ORGANIZATIONS ACROSS THE COUNTRY
%VERY ORGANIZATION AND EVERY INDIVIDUAL IN THE HEALTHCARE INDUSTRY HAS THE POWER TO MAKE A SUBSTANTIAL DIFFERENCE IN HOW PATIENTS ARE TREATED 4HE BOOK IS STRUCTURED AS FOLLOWS )NTRODUCTION ADDRESSES THE CURRENT LANDSCAPE OF HEALTHCARE QUALITY MAJOR PLAYERS CHANGING MODELS DElNITIONS OF QUALITY AND SOURCES OF PERFORMANCE DATA 4HE 2OLE OF THE 0ATIENT FOCUSES ON QUALITY AS VIEWED BY CONSUMERS THE ROLE OF PATIENT ADVOCACY PATIENT CHOICE AND ACTIVATION USE OF THE )NTERNET IN DECISION MAKING AND HOW INCENTIVES CAN MOTIVATE PATIENTS TO MAKE APPROPRIATE CHOICES REGARDING THEIR LIFESTYLE AND HEALTHCARE !CCESSING "ENElTS 4HROUGH THE 7ORKPLACE EXPLORES QUALITY RELATED ACTIVITIES THAT EMPLOYERS ARE BRINGING INTO PLAY SUCH AS CONSUMER ORIENTED BENElT PLAN DESIGN DECISION SUPPORT TOOLS AND VALUE BASED PURCHASING INITIATIVES 0AYING FOR 1UALITY #ARE EXPLORES INSURERS USE OF QUALITY INCENTIVES EMERGING MODELS OF DISEASE MANAGEMENT LEADING PRACTICES IN PROVIDER PROlLING AND PUBLIC REPORTING AND THE IMPACT OF PAY FOR PERFORMANCE )DENTIFYING 1UALITY 0HYSICIAN #ARE LOOKS AT THE CHANGING PHYSICIAN PATIENT RELATIONSHIP CURRENT MODELS FOR COLLABORATION WITH HOSPITALS NEW TRAINING METHODS AND CUSTOMER SERVICE APPROACHES )MPROVING THE (OSPITAL %XPERIENCE DISCUSSES PATIENT ACCESS SAFETY AND SERVICE IN THE HOSPITAL SETTING INCLUDING NEW DIRECTIONS IN ACCREDITATION LEADING QUALITY PRACTICES IN REVENUE CYCLE MANAGEMENT NURSING CARE MODELS USE OF 3IX 3IGMA EMERGENCY DEPARTMENT AND PATIENT CARE THROUGHPUT AND ADOPTION OF CLINICAL INFORMATION TECHNOLOGIES
%NSURING 6ALUE FROM 0HARMACEUTICALS AND -EDICAL $EVICES EXPLORES THE ROLE OF PERSONALIZED MEDICINE IN QUALITY DRUG AND MEDICAL DEVICE SAFETY PHARMACOVIGILANCE AND THE CONVERGENCE OF INFORMATION TECHNOLOGY FOR RESEARCH AND CLINICAL CARE #ONCLUSION SUMS UP WHAT IS ON THE HORIZON AND HOW HEALTH ORGANIZATIONS CAN PREPARE FOR THE FUTURE )N CONCLUSION QUALITY IS A CONUNDRUM BECAUSE IT IS A COMPLEX PROBLEM A SOLUTION WILL REQUIRE DIFFERENT APPROACHES THAN WHAT HAS BEEN TRIED IN THE PAST )F WE ARE TO STAY ON OUR CURRENT COURSE FAILURE TO MAKE PROGRESS BEYOND WHAT HAS ALREADY BEEN ACHIEVED IS LIKELY 7ITH THE HEALTHCARE ENVIRONMENT GROWING MORE COMPLICATED WITH EACH PASSING YEAR THE RISK OF LOSING GROUND IS ALSO POSSIBLE IN THE ABSENCE OF ACCELERATED EFFORTS 4HE GOOD NEWS IS THAT EVERY ORGANIZATION AND EVERY INDIVIDUAL IN THE HEALTHCARE INDUSTRY HAS THE POWER TO MAKE A SUBSTANTIAL DIFFERENCE IN HOW PATIENTS ARE TREATED 7E NOW FACE A TURNING POINT THAT REQUIRES A CONSCIOUS DECISION BETWEEN hBUSINESS AS USUALv AND A NEW MIND SET 4HE NEW PATH IS NOT NECESSARILY EXPENSIVE OR RUGGED "UT IT WILL TAKE A DEDICATED SPIRIT %NDNOTES h(EALTH#AST #REATING A 3USTAINABLE &UTURE v .OVEMBER 0RICEWATERHOUSE#OOPERS 2EINHARDT 5% AND 0 % (USSEY ' & !NDERSON h#ROSS NATIONAL #OMPARISONS OF (EALTH 3YSTEMS 5SING /%#$ $ATA v (EALTH !FFAIRS PP h)NCOME 3TABLE 0OVERTY 2ATE )NCREASES 0ERCENTAGE OF !MERICANS WITHOUT (EALTH )NSURANCE 5NCHANGED 0RESS RELEASE !UGUST 53 #ENSUS "UREAU RETRIEVED *UNE AT HTTPWWWCENSUSGOV 0RESS 2ELEASEWWWRELEASESARCHIVESINCOME?WEALTHHTML -C'LYNN ET AL h.ATIONAL 6ITAL 3TATISTICS 2EPORT v )NSTITUTE OF -EDICINE .EW %NGLAND *OURNAL OF -EDICINE #2- $AILY REPORT POSTED ON HTTPWWWCRM DAILYCOMSTORY XHTML STORY?ID AND ACCESSED !PRIL REPORT OF ()-33 CONFERENCE SURVEY AND &ORRESTER 2ESEARCH 5#,! $EPARTMENT OF %PIDEMIOLOGY HTTPWWWPHUCLAEDUEPI SNOWBROADSTREETPUMPHTML #ONSUMER 2EPORTS HTTPWWWCONSUMERREPORTSORGCROABOUTUS HISTORYINTERACTIVEINDEXHTM )NVENTORS OF THE -ODERN #OMPUTER HTTPINVENTORSABOUTCOMLIBRARY WEEKLYAAHTM #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES HTTPWWWCMSHHS GOV(ISTORY !MERICAN 3OCIETY FOR 1UALITY HTTPWWWASQORGABOUT ASQWHO WE AREBIO?DEMINGHTML )NSTITUTE OF -EDICINE HTTPWWWIOMEDU
@7HEN YOU COME TO A FORK IN THE ROAD TAKE IT n 9OGI "ERRA
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
4HE 1UALITY ,ANDSCAPE 7HILE A NATIONALLY RECOGNIZED DElNITION OF QUALITY HEALTHCARE HAS YET TO EMERGE INNOVATIVE HEALTHCARE ORGANIZATIONS ARE ADOPTING PRINCIPLES AND PRACTICES DESIGNED TO IMPROVE HEALTH OUTCOMES PROCESSES AND PATIENT PERCEPTIONS "Y 2HONDA !RRINGTON "ENJAMIN )SGUR AND (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
@3OCIAL IMPROVEMENT IS ATTAINED MORE READILY BY A CONCERN WITH THE QUALITY OF RESULTS THAN WITH THE PURITY OF MOTIVES n %RIC (OFFER 53 PHILOSOPHER @1UALITY IS *OB n &ORD -OTOR #OMPANY
)
N MEDIEVAL %UROPE CRAFTSMEN WERE ORGANIZED INTO GUILDS THAT WERE RESPONSIBLE FOR PRODUCT AND SERVICE QUALITY RULES /FTEN MASTER CRAFTSMEN MARKED THEIR GOODS WITH A SPECIAL SYMBOL TO PROVE THEIR QUALITY 4HESE MARKS REPRESENTED A GUARANTEE OF REPUTATION AND AN OBLIGATION TO QUALITY FOR MEDIEVAL %UROPEAN SOCIETIES;= &AST FORWARD YEARS AND OUR MASTER CRAFTSMEN ARE NOW PROFESSIONALS SUCH AS DOCTORS AND NURSES WHO FOLLOW PROTOCOLS AND PROCESS GUIDELINES WHILE OUR MARKS OF QUALITY ARE ACCREDITATIONS DATA SCORES AND REPORT CARDS "UT ARE WE SURE THESE MODERN DAY MARKINGS STAND FOR QUALITY HEALTHCARE $O OUR ST CENTURY MEDICAL AND HEALTH ASSOCIATIONS UPHOLD QUALITY STANDARDS TO THE SAME LEVEL AS A TH CENTURY STONE MASONS GUILD !ND DO OUR HEALTH PROFESSIONALS HAVE THE SAME RESPONSIBILITY TO QUALITY AS THE SILVERSMITH WHO ETCHED HIS NAME ON THE BACK OF EVERY ITEM SOLD
.ATIONALLY 2ECOGNIZED $ElNITIONS OF 1UALITY !NSWERS TO THESE QUESTIONS REQUIRE A FRAMEWORK AND DElNITION OF HEALTH QUALITY A DElNITION THAT HAS OFTEN BEEN ELUSIVE TO POLICY MAKERS AND HEALTH INDUSTRY EXECUTIVES 7HILE AN ANALYSIS OF QUALITY DElNITIONS FROM A VARIETY OF HEALTH LEADERS INDICATES
THAT A SINGULAR DElNITION OF QUALITY DOES NOT EXIST A FRAMEWORK OF COMPONENTS DOES EMERGE SEE %XHIBIT )N THE )NSTITUTE OF -EDICINE )/- DElNED QUALITY AS THE hDEGREE TO WHICH HEALTH SERVICES FOR INDIVIDUALS AND POPULATIONS INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES AND ARE CONSISTENT WITH CURRENT PROFESSIONAL KNOWLEDGEv;= )NHERENT IN THIS DElNITION IS THE DESIRE TO DO THE hRIGHTv THING NOT ONLY FOR INDIVIDUALS BUT ALSO FOR THE GREATER POPULATION )N THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21 DElNED HIGH QUALITY HEALTHCARE AT ITS MOST BASIC LEVEL AS hDOING THE RIGHT THING AT THE RIGHT TIME IN THE RIGHT WAY FOR THE RIGHT PERSON 4HE CHALLENGE THAT CLINICIANS AND HEALTH SYSTEM MANAGERS FACE EVERY DAY IS KNOWING WHAT THE RIGHT THING IS WHEN THE RIGHT TIME IS AND WHAT THE RIGHT WAY ISv;= 4HIS DElNITION IS QUITE APROPOS AS MANY HEALTHCARE SECTORS n PROVIDERS PAYERS LIFE SCIENCE AND PHARMACEUTICAL COMPANIES n STRIVE TO DO WHAT IS IN THE BEST INTEREST OF THE PATIENT !LSO IN 4HE .ATIONAL 2OUNDTABLE ON (EALTH #ARE 1UALITY CONVENED BY THE )/- CHARACTERIZED QUALITY PROBLEMS AS hUNDERUSE OVERUSE OR MISUSEv;= 4HEN IN THE )/- IN ITS GROUNDBREAKING PUBLICATION #ROSSING THE 1UALITY #HASM EXPANDED UPON ITS DElNITION TO ARTICULATE SPECIlC AIMS FOR IMPROVING THE HEALTHCARE DELIVERY SYSTEM WHICH IF APPLIED WOULD IMPROVE THE PATIENT EXPERIENCE
2HONDA !RRINGTON -0( IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE CONTRIBUTED TO THE CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS OF HEALTHCARE CONSULTING EXPERIENCE AND SPECIALIZES IN PROJECT MANAGEMENT PROCESS IMPROVEMENT AND PERFORMANCE MEASUREMENT 3HE CAN BE REACHED AT RHONDAARRINGTON USPWCCOM "ENJAMIN )SGUR -0!FF IS THE ASSISTANT DIRECTOR OF 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE (E FOCUSES ON THE DEVELOPMENT OF THOUGHT LEADERSHIP AND RESEARCH INITIATIVES FOR THE lRM AND CLIENTS (E CAN BE REACHED AT BENJAMINISGUR USPWCCOM (INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM ) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGD ãPT @KHSXãK@MCRB@OD %XHIBIT (EALTHCARE 1UALITY $ElNITION n &RAMEWORK AND #OMPONENTS #OMPONENTS 3UBCOMPONENTS 0RIMARY $RIVERS
/UTCOMES ;-AKING THE PATIENT BETTER= #LINICAL /UTCOMES ;)MPROVED (EALTH=
3ERVICE %XPERIENCE ;0ATIENT 3ATISFACTION=
(EALTH 0ROFESSIONALS (EALTH 0ROFESSIONALS +NOWLEDGE #ULTURE AND 4RAINING AND 2ESEARCH
THEREBY MAKING THE CARE RECEIVED SAFER TIMELY EFFECTIVE AND EFlCIENT 4HE )/-S AIMS WERE BUILT UPON SIX CORE PRINCIPLES SAFE EFFECTIVE PATIENT CENTERED EFlCIENT TIMELY AND EQUITABLE
6IEWS OF 1UALITY AT THE @'RASSROOTS ,EVEL 4HE !(21 AND )/- BENCHMARK DElNITIONS INmUENCE THE WAYS IN WHICH MANY HEALTHCARE ORGANIZATIONS OPERATIONALIZE QUALITY WITHIN THEIR INSTITUTIONS 4HE DElNITIONS ALSO PROVIDE IMPETUS FOR PLANNING DEVELOPMENT AND IMPLEMENTATION OF MANY QUALITY IMPROVEMENT EFFORTS 1UALITY EXPERTS BROADLY ACKNOWLEDGE )/- AS THEIR STANDARD DElNITION BY SIMPLY STATING h7HY REINVENT THE WHEEL v -ANY IN THE HEALTHCARE INDUSTRY LOOK TOWARD THESE QUALITY DElNITIONS AS THE MEANS TO PULL PROCESS AND OUTCOME TOGETHER 9ET THE TRANSLATION OF THESE DElNITIONS INTO PRACTICE AMONG HEALTHCARE CONSTITUENTS YIELDS SOMEWHAT DIFFERENT VIEWPOINTS ON QUALITY h(EALTHCARE QUALITY IS A NEVER ENDING PROCESS OF CONTINUOUS IMPROVEMENT n ITS A PROCESS NOT DElNED IN BLACK AND WHITE v SAYS ,EE " 3ACKS -$ PRESIDENT OF !DVOCATE (EALTH 0ARTNERS ONE OF THE LARGEST HEALTHCARE DELIVERY SYSTEMS IN #HICAGO h1UALITY IS THE PERCEPTION OF PERFORMANCE ITS A JUDGMENTAL DETERMINATION IN THE EYE OF THE BEHOLDER v SAYS $ENNIS 3 /,EARY -$ PRESIDENT OF THE *OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS 4HE CLARION CALL FOR PROCESS IMPROVEMENT IS ECHOED BY !NTHONY $ 3LONIM -$ $R0H EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS AT THE #HILDRENS .ATIONAL -EDICAL #ENTER IN 7ASHINGTON $# AND ASSOCIATE PROFESSOR AND VICE CHAIRMAN OF THE DEPARTMENT OF PEDIATRICS AT THE 'EORGE 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE h7E CANT KEEP DOING THINGS IN THE SAME WAY THAT WE ALWAYS HAVE WE MUST THINK CREATIVELY ABOUT THE METHODS THAT WILL DRIVE QUALITY IMPROVEMENT IN OUR ORGANIZATIONS #URRENTLY HOSPITALS ARE NOT INCENTIVIZED TO COLLABORATE AND SHARE INFORMATION BUT OUR PATIENTS AND THEIR FAMILIES ARE GOING TO START DEMANDING ITv (OW CAN WE IMPROVE WHAT WE CANT MEASURE AND HOW CAN WE MEASURE WHAT WE CANT DElNE /R IS QUALITY JUST ANOTHER ONE
0ROCESS ;-AKING THE SYSTEM BETTER=
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
-ETHODS ;'UIDELINES AND 0ROTOCOLS=
)MPROVEMENT ;!NALYSIS AND #HANGE=
$ATA
)NCENTIVES
OF THOSE ATTRIBUTES THAT YOU KNOW WHEN YOU SEE IT !CCORDING TO *OE #ARMICHAEL PRESIDENT OF .2# 0ICKER A MARKET RESEARCH lRM THAT CONDUCTS PATIENT SATISFACTION SURVEYS THERE IS NOT A SINGLE DElNITION h)TS ABOUT HOW THE PATIENT VIEWS THEIR HEALTHCARE EXPERIENCEv 1UALITY IS MORE THAN JUST CLINICAL OUTCOMES h4HE lNAL OUTCOME FOR EVERYONE IS ULTIMATELY DEATH BECAUSE THATS WHAT LIFE ENDS WITH 3O QUALITY HAS TO DO NOT JUST WITH OUTCOMES BUT WITH HOW SATISlED PATIENTS ARE AND THE DEGREE TO WHICH THEYRE ABLE TO CONTINUE WITH THEIR LIFESTYLE v SAYS 2OXANE 4OWNSEND -$ -EDICAID MEDICAL DIRECTOR OF ,OUISIANA $ON &ETTEROLF -$ -"! &!#0 VICE PRESIDENT OF THE !MERICAN #OLLEGE OF -EDICAL 1UALITY AND CORPORATE VICE PRESIDENT OF HEALTHCARE INTELLIGENCE AT -ATRIA (EALTHCARE AGREES THAT EVERYONE HAS THEIR OWN DElNITION h4HE DElNITION DEPENDS ON THE AUDIENCE &OR SOME ITS BETTER SERVICE FOR OTHERS ITS CONFORMANCE TO GUIDELINES AND OF COURSE THERE IS ALWAYS THE MEASURE OF LOWER MORTALITYv
#ONSUMER 6IEWS OF 1UALITY 3O IS QUALITY ABOUT PROCESS OR OUTCOME MEASURES OR PATIENT PERCEPTIONS $ID OUR MEDIEVAL HOMEOWNERS CARE ABOUT THE PROCESS OF BUILDING THE STONE WALL OR THAT THE STONE WALL KEPT THE ROOF SUPPORTED /R WAS THE MOST IMPORTANT ASPECT OF QUALITY THE PERCEPTION OF THE RECIPIENT OF THE STONEMASONS SERVICES )N A WORLD FOCUSED ON CUSTOMER SERVICE WHERE CONSUMERS ARE RECOGNIZING THEIR TRUE INmUENCE ON SUPPLY AND DEMAND TELEVISION PROGRAMMING AND CUSTOMIZATION THERE STILL IS DISCREPANCY IN HOW TO TRANSLATE THIS POWER INTO HEALTHCARE MATTERS 7HERE IS THE VOICE OF THE CONSUMER AND HOW IS IT BEING GALVANIZED TO AFFECT HEALTHCARE DELIVERY #AN CONSUMERS REALLY EFFECT CHANGE 7HAT ARE THEIR PERSPECTIVES ON QUALITY ! SURVEY OF ADULTS CONlRMED THAT NEARLY HALF OF 53 RESIDENTS SAY THEY ARE CONCERNED ABOUT THE SAFETY OF THE MEDICAL CARE THEY AND THEIR FAMILIES RECEIVE AND MORE THAN HALF PERCENT SAY THEY ARE DISSATISlED WITH THE QUALITY OF
SGD ãPT @KHSXãK@MCRB@OD
)T IS REMARKABLE HOW MUCH CONSUMERS CAN ACHIEVE WHO ARE WILLING TO TAKE AN ACTIVE ROLE IN THEIR CARE &URTHER PUBLIC REPORTING OF INFORMATION ON QUALITY AND COSTS WHAT WE OFTEN REFER TO AS TRANS
ACHIEVE PATIENT CENTEREDNESS THE RESULT WOULD BE EFlCIENCIES IN HEALTHCARE DELIVERY BETTER PATIENT PROVIDER RELATIONSHIPS IMPROVED PATIENT OUTCOMES AND HIGHER PATIENT SATISFACTION OVERALL .2# 0ICKER LEVERAGES THE VOICE OF THE CONSUMER THROUGH ITS HOSPITAL PATIENT EXPERIENCE SURVEYS IN WHICH THE FOCUS IS ON IMPROVEMENT RATHER THAN MEASUREMENT .2# 0ICKER HAS IDENTIlED EIGHT DIMENSIONS OF CARE THAT MATTER MOST TO PATIENTS
PARENCY IS MAKING A BIG IMPACT
%MOTIONAL 3UPPORT 0HYSICAL #OMFORT 0ATIENTS 0REFERENCES )NFORMATION AND %DUCATION #ONTINUITY AND 4RANSITION &AMILY AND &RIENDS #OORDINATION OF #ARE !CCESS TO #ARE
HEALTHCARE IN THIS COUNTRY;= !LTHOUGH MOST CONSUMERS STILL RELY ON WORD OF MOUTH FOR HEALTHCARE DECISIONS PERCENT OF ADULTS WHO USE THE )NTERNET LOOK FOR HEALTHCARE INFORMATION AT SOME TIME OR ANOTHER A PERCENT INCREASE FROM 4HE VAST MAJORITY OF CONSUMERS VIEW RESULTS OF THEIR ONLINE HEALTH INFORMATION SEARCHES AS SUCCESSFUL PERCENT AND RELIABLE PERCENT ;= !ND INCREASINGLY PERSONAL REFERRALS AND GENERAL HEALTH CONTENT ARE BEING SUPPLEMENTED WITH PUBLIC REPORTING OF PERFORMANCE METRICS FOR PHYSICIANS AND HOSPITALS IN THE FORM OF hREPORT CARDSv /R IN MANY CASES PATIENTS LOOK UP THEIR PRESCRIPTIONS ONLINE AFTER THEY GET HOME FROM THE PHYSICIANS OFlCE
4HE %RA OF 4RANSPARENCY 7ITH THE ADVENT OF CONSUMERISM AND PATIENT ACTIVATION COLLABORATIVE GROUPS ACROSS THE HEALTHCARE SPECTRUM ARE PUSHING FOR MORE TRANSPARENCY OF INFORMATION FROM HOSPITALS AND PHYSICIANS SO CONSUMERS CAN MAKE INFORMED DECISIONS AND DEMAND QUALITY AT EVERY DOOR n EMERGENCY ROOM PHYSICIANS OFlCE SURGERY CENTER AND PHARMACY !CCORDING TO A SURVEY CONDUCTED BY THE +AISER &AMILY &OUNDATION PERCENT OF THE POPULATION HAS SEEN COMPARATIVE INFORMATION REGARDING HEALTH PLANS HOSPITALS OR DOCTORS .INETEEN PERCENT REPORT ACTUALLY UTILIZING THE INFORMATION TO MAKE HEALTHCARE DECISIONS;= !LTHOUGH THESE NUMBERS MAY SEEM INSIGNIlCANT JUST FOUR YEARS EARLIER IN A SIMILAR STUDY CONDUCTED BY THE FOUNDATION ONLY PERCENT HAD UTILIZED SOME TYPE OF QUALITY INDICATOR ON WHICH TO BASE A HEALTH RELATED DECISION;= -ARIBETH 3HANNON DIRECTOR OF THE HOSPITALS AND NURSING HOMES PROGRAM AT THE #ALIFORNIA (EALTH#ARE &OUNDATION PREDICTS THAT hTHE THREAT OF CONSUMER ENGAGEMENT AND SHEDDING LIGHT ON PERFORMANCE WILL MOTIVATE THE HEALTH SYSTEM TO CHANGE ITSELF 0UBLIC REPORTING WILL BE A STICK FOR PROVIDERS THAT DONT DO WELL BUT A CARROT FOR THOSE THAT DOv #AROLYN - #LANCY -$ DIRECTOR OF THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21 AGREES THAT h)T IS REMARKABLE HOW MUCH CONSUMERS CAN ACHIEVE WHO ARE WILLING TO TAKE AN ACTIVE ROLE IN THEIR CARE &URTHER PUBLIC REPORTING OF INFORMATION ON QUALITY AND COSTS n WHAT WE OFTEN REFER TO AS TRANSPARENCY n IS MAKING A BIG IMPACTv !(21 IS WORKING TO ENGAGE CONSUMERS AND IS PROMOTING SPECIlC STEPS FOR HOSPITAL PATIENTS TO GET SAFER CARE SUCH AS BRINGING A FAMILY MEMBER AND A LIST OF MEDICATIONS 7HILE MORE HEALTHCARE CONTENT IS READILY AVAILABLE A CONSUMERS IDEA OF QUALITY VARIES WITH EACH HEALTHCARE EXPERIENCE 4O TRULY
!CHIEVING 1UALITY 7ITH ALL OF THE VARYING STAKEHOLDERS AND THE MANY PERSPECTIVES ON QUALITY IT IS CLEAR THAT THE DRIVERS OF IMPROVEMENT LIKELY DIFFER ACROSS SECTORS $ESPITE THE COMPLEXITIES THAT MAY EMERGE FROM SO MANY VIEWPOINTS SUCH DIVERSITY CAN BREED INNOVATION AND SPAWN DEMONSTRATION PROJECTS THAT HELP DEFINE LEADING PRACTICES )N THIS SPIRIT MANY ORGANIZATIONS ARE IMPLEMENTING INNOVATIVE IMPROVEMENT PROJECTS ON A NATIONAL OR REGIONAL LEVEL TO MEET THE VARIED GOALS OF QUALITY ! FEW EXAMPLES INCLUDE )NSTITUTE FOR (EALTHCARE )MPROVEMENT )() n )() HELPS ACCELERATE CHANGE BY CULTIVATING PROMISING CONCEPTS FOR IMPROVING PATIENT CARE )TS ,IVES #AMPAIGN;= HAS ENLISTED MORE THAN HOSPITALS IN MAKING SIX CHANGES TO AVOID DEATHS OVER AN MONTH PERIOD 4HE SIX CHANGES ARE DEPLOY RAPID RESPONSE TEAMS AT THE lRST SIGN OF PATIENT DECLINE DELIVER RELIABLE EVIDENCE BASED CARE FOR ACUTE MYOCARDIAL INFARCTION TO PREVENT DEATHS FROM HEART ATTACK PREVENT ADVERSE DRUG EVENTS !$%S BY IMPLEMENTING MEDICATION RECONCILIATION DECREASE THE INCIDENCE OF CATHETER BLOODSTREAM INFECTIONS PREVENT SURGICAL SITE INFECTIONS BY RELIABLY DELIVERING SUCH THINGS AS THE CORRECT PERIOPERATIVE ANTIBIOTICS AT THE PROPER TIME AND PREVENT VENTILATOR ASSISTED PNEUMONIA 4HE CAMPAIGN HAS ALREADY EARNED NOTABLE SUCCESSES &OR EXAMPLE HOSPITALS THAT DEPLOY RAPID RESPONSE TEAMS n EXPERTS WHO CAN BE CALLED TO A PATIENTS BEDSIDE BY A NURSE OR ANY STAFF MEMBER WHO FEELS UNEASY ABOUT A PATIENTS CONDITION n HAVE SHOWN A SIGNIlCANT REDUCTION IN THE NUMBER OF hCODESv CALLED ON PATIENTS 4EAMS ARE LINKED THROUGH BEEPERS AND PHONES THAT HAVE A CODED BUTTON DIRECTED TO THE RAPID RESPONSE TEAM /N THE ISSUE OF !$%S HOSPITALS HAVE BEGUN TO IMPLEMENT MEDICAL RECONCILIATION SYSTEMS THAT COMBINE THE MEDICATION LIST AND ORDER SHEET INTO A SINGLE FORM TO AVOID DUPLICATION AND POTENTIAL ERRORS /NE SUCH HOSPITAL IMPLEMENTED THE
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGD ãPT @KHSXãK@MCRB@OD PROGRAM AND WATCHED ITS !$% RATE DROP FROM TO PER PATIENTS SELECTED;= !NOTHER SUCCESS HAS BEEN IN PREVENTING SURGICAL SITE INFECTIONS )N A YEAR LONG .ATIONAL 3URGICAL )NFECTION 0REVENTION 3)0 0ROJECT SPONSORED BY #-3 AND QUALITY IMPROVEMENT ORGANIZATIONS NATIONWIDE ENABLED HOSPITALS TO REDUCE THEIR INFECTION RATE BY PERCENT -ORE RECENTLY AN )() INITIATIVE COLLABORATIVE PRODUCED ENCOURAGING RESULTS;= +AISER &OUNDATION (EALTH 0LAN n "Y INTEGRATING INFORMATION TECHNOLOGY THE +0 (EALTH#ONNECT INITIATIVE HOPES TO IMPROVE QUALITY ELIMINATE INEFlCIENCIES AND ERRORS PROVIDE COMPLETE ACCESS TO UP TO THE MINUTE MEDICAL RECORDS IMPROVE THE DOCTOR PATIENT RELATIONSHIP AND ENHANCE THE ABILITY TO CONDUCT CLINICAL RESEARCH 4HE +0 (EALTH#ONNECT SYSTEM IS IN PLACE OR CURRENTLY BEING IMPLEMENTED IN ALL OF +AISER 0ERMANENTES EIGHT REGIONS +AISER 0ERMANENTES TWO LARGEST REGIONS .ORTHERN AND 3OUTHERN #ALIFORNIA ARE IMPLEMENTING THE SYSTEM FACILITY BY FACILITY AND WILL COMPLETE IMPLEMENTATION IN ;= )NDIANA (EALTH )NFORMATION %XCHANGE )()% n 4HIS NONPROlT COMPANY WAS FOUNDED BY A UNIQUE COLLABORATION TO CREATE A COMMON SECURE ELECTRONIC INFRASTRUCTURE THAT EXPANDS COMMUNICATION AND INFORMATION SHARING AMONG PARTICIPATING PROVIDERS HOSPITALS PUBLIC HEALTH ORGANIZATIONS AND OTHER HEALTH CARE ENTITIES 4HE EXCHANGE HAS BEEN ROLLING OUT A CLINICAL MESSAGING SERVICE TO PROVIDE ITS MEMBERSHIP WHICH INCLUDES COMMUNITY PHYSICIANS AT HOSPITALS WITH ELECTRONIC ACCESS TO PATHOLOGY LABORATORY RADIOLOGY AND ELECTROCARDIOGRAM REPORTS 4O DATE MORE THAN PERCENT OF THE REGIONS DOCTORS ARE RECEIVING REPORTS FROM THE CLINICAL MESSAGING SERVICE 4HE SERVICE COSTS BETWEEN AND CENTS TO SEND A MESSAGE COMPARED WITH CENTS PER MESSAGE USING THE OLD SYSTEM 4HE INFORMATION IS ALSO MADE AVAILABLE TO DOCTORS VIA AN )()% PORTAL;= #OUNCIL FOR !FFORDABLE 1UALITY (EALTHCARE #!1( n 4HIS HEALTH PLAN COALITION HAS FOCUSED ON TWO QUALITY INITIATIVES OVERUSE OF ANTIBIOTICS AND BETA BLOCKER COMPLIANCE AFTER HEART ATTACK )N ADDITION TO ESTABLISHING A SYSTEM TO MEASURE COMPLIANCE EACH INITIATIVE WAS SUPPORTED BY PROGRAM TOOL KITS AND MATERIALS TO EDUCATE VARIOUS CONSTITUENTS SUCH AS CONSUMERS AND EMPLOYERS 4HE CARDIAC MEASUREMENT EFFORT LED TO ITS INCLUSION AS A (EALTH 0LAN %MPLOYER $ATA AND )NFORMATION 3ET (%$)3 MEASURE !S A RESULT THE GROUP REPORTS A DECREASE IN OVERALL ANTIBIOTIC RATES FROM TO OF PERCENT FOR CHILDREN AND PERCENT FOR ADULTS 4HE RATE OF STREP TESTING IMPROVED BY PERCENT FOR CHILDREN AND PERCENT FOR ADULTS 4HESE TRENDS ARE MEANINGFUL IN RESOLVING ANTIBIOTIC UTILIZATION AND RESISTANCE ISSUES;= #ALIFORNIA (EALTH#ARE &OUNDATION n 4HE #ALIFORNIA (OSPITAL !SSESSMENT AND 2EPORTING 4ASKFORCE #(!24 WHICH IS LED BY RESEARCHERS AT THE 5NIVERSITY OF #ALIFORNIA 3AN &RANCISCOS )NSTITUTE FOR (EALTH 0OLICY 3TUDIES AND SUPPORTED BY THE #ALIFORNIA (EALTH#ARE &OUNDATION PRODUCES
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
A STATEWIDE REPORT CARD ON HOSPITAL PERFORMANCE AND QUALITY &IFTY HOSPITAL PERFORMANCE INDICATORS WERE COLLECTED IN AND IN SPECIlC CLINICAL AREAS SUCH AS CARDIAC CARE MATERNITY PNEUMONIA TREATMENT AND INTENSIVE CARE 4HEY ALSO INCLUDE HOSPITALWIDE OUTCOMES SUCH AS INFECTION CONTROL AND PATIENT EXPERIENCE 4HUS FAR MORE THAN HOSPITALS HAVE AGREED TO PARTICIPATE AND PAY THE COSTS OF DATA COLLECTION 4HE #(!24 IMPLEMENTATION PHASE BEGAN IN !UGUST WITH THE lRST PUBLIC REPORT CARD EXPECTED *UNE ;= )NNOVATION AND LEADING PRACTICES ARE ALSO IN PLACE AT THE GRASSROOTS LEVEL WHERE PATIENT INTERACTION IS DIRECT AND QUALITY IS PUT INTO PRACTICE AT THE POINT OF SERVICE OR DELIVERY !S ILLUSTRATED IN %XHIBIT THERE ARE MANY EXAMPLES OF HOW EACH OF THE )/-S SIX QUALITY AIMS CAN BE ACHIEVED WITHIN INDIVIDUAL HEALTH ORGANIZATIONS
-OVING !HEAD 2EGARDING THE FUTURE WHAT IS BEING DONE ABOUT TEACHING QUALITY TO MEDICAL STUDENTS INTERNS AND RESIDENTS $AVID " .ASH -$ -"! CHAIRMAN OF THE DEPARTMENT OF HEALTH POLICY AT *EFFERSON -EDICAL #OLLEGE OF 4HOMAS *EFFERSON 5NIVERSITY REPORTS THAT THE COLLEGE IS INTEGRATING QUALITY INTO THE CURRICULUM h7E HAVE AN ALL DAY CONFERENCE ON QUALITY FOR THE THIRD YEAR CLASS HAVE INCORPORATED A HEALTH POLICY ELECTIVE AND HAVE TOOLS EG #$S A WEBSITE AND BOOKS ON QUALITY GEARED TOWARDS STUDENTS )TS GREAT WHEN WE GET CONVERTSv !T (ARVARD -EDICAL 3CHOOL IN AN EFFORT TO BETTER TRAIN DOCTORS TO UNDERSTAND ILLNESS FROM THE PATIENTS PERSPECTIVE AND APPRECIATE HOW PATIENTS LIVES AND THE DISJOINTED HEALTHCARE SYSTEM COMPLICATE THEIR CARE THIRD YEAR MEDICAL STUDENTS WILL STAY IN ONE HOSPITAL AND FOLLOW SOME PATIENTS THE ENTIRE YEAR 3TUDENTS ALSO WILL BE REQUIRED TO TAKE ONE SEMESTER CLASSES ON THE EFFECT OF SOCIAL AND ECONOMIC CONDITIONS ON DISEASE MEDICAL ETHICS AND PROFESSIONALISM AND HEALTH POLICY;= 7ITH SO MUCH INNOVATION IN QUALITY SOME COMMON TRENDS ARE CLEARLY STARTING TO EMERGE 0UBLIC ACCOUNTABILITY -ORE TRANSPARENCY OF INFORMATION TO THE CONSUMER AND OTHER HEALTHCARE PROVIDERS IN THE FORM OF hREPORT CARDSv THAT PROlLE AND COMPARE THE PERFORMANCE OF PHYSICIANS AND HOSPITALS WITH WIDE DISSEMINATION AND PUBLIC AVAILABILITY 2EPORTING STANDARDS (OMOGENIZING PROCESS AND OUTCOME MEASURES TO STREAMLINE REPORTING REQUIREMENTS FOR HOSPITALS AND PHYSICIANS WHILE PROVIDING MEANINGFUL INFORMATION TO CONSUMERS IN ORDER TO MAKE RELIABLE HEALTHCARE DECISIONS %VIDENCED BASED MEASURES )NTEGRATING CLINICAL PRACTICE AND RESEARCH TO DEVELOP STANDARDIZED MEASURES THAT CONSIDER THE hREALITY OF PATIENT CAREv AND WHICH ONCE IMPLEMENTED WILL OPTIMIZE PATIENT OUTCOMES AND IMPROVE QUALITY #OLLABORATION )NTEREST GROUPS WORKING TOGETHER TO ADVANCE THE QUALITY AGENDA AND INCORPORATING EXPERTISE FROM VARIOUS HEALTHCARE SECTORS SPECIALTIES AND DISCIPLINES IN BOTH CLINICAL AND NONCLINICAL AREAS
SGD ãPT @KHSXãK@MCRB@OD %XHIBIT %XAMPLES OF THE )/-S 3IX 1UALITY !IMS IN !CTION 3AFE
. EW9ORK 0RESBYTERIAN (OSPITAL HAS A LARGE CENTRAL QUALITY ORGANIZATION WITHIN ITS BED SYSTEM /NE OF ITS QUALITY PROGRAMS IS A PAY FOR PERFORMANCE PROGRAM WITH AN INSURER WHEREBY CARDIAC DIABETES AND VASCULAR DISEASE PATIENTS RECEIVE PHARMACEUTICAL COUNSELING PRIOR TO DISCHARGE WITH THE GOAL OF RECONCILING DIFFERENT PRESCRIPTION ORDERS REDUCING MEDICAL ERRORS ASSOCIATED WITH MULTIPLE PROVIDERS PRESCRIBING AND FACILITATING ONGOING USE OF MEDICATIONS -ARY #OOPER -$ *$ VICE PRESIDENT AND CHIEF QUALITY OFlCER STATES THAT h7E SET ANNUAL GOALS AND HAVE A LOT OF FOCUS ON 2/) SO WE CAN OFTEN DEMONSTRATE BENElTS "UT EVEN BEYOND THE MEASURABLE RESULTS THERES A PERCEPTION AROUND THE HOSPITAL THAT THIS INITIATIVE WOULD BE GOOD TO OFFER TO EVERYONEv
%FFECTIVE
" LUE #ROSS AND "LUE 3HIELD OF -INNESOTA HAS SET UP CENTERS OF EXCELLENCE FOR HIGH RISK PROCEDURES EG BONE MARROW AND ORGAN TRANSPLANTS BARIATRIC CARDIAC SURGERIES AND TIERED PROVIDER NETWORKS 0ROVIDERS ARE SELECTED BASED ON COMPLICATION RATES AND COMPLIANCE WITH SPECIALTY SPECIlC STANDARDS OF CARE h4HERE ARE SOME THAT THINK THAT THE FUTURE WILL BE TRANSPARENCY ALONE AND THAT CONSUMERS WILL USE THE DATA TO GO WHERE THEY WANT v SAYS $AVID 7 0LOCHER -$ CHIEF MEDICAL OFlCER AND SENIOR VICE PRESIDENT FOR HEALTH MANAGEMENT AND INFORMATICS h"UT IT IS MORE THAN LIKELY THAT NETWORKS AND TIERING WILL REMAIN #ONSUMERS LIKE HAVING SOME ASSISTANCE IN EVALUATING QUALITY DATAv
0ATIENT #ENTERED
3 OME PROVIDERS ARE LETTING PATIENTS SCHEDULE TESTS AND VISITS ONLINE WHILE OTHERS ALLOW THEM TO VIEW MOST OF THEIR MEDICAL RECORD 4HOMAS ( ,EE -$ NETWORK PRESIDENT 0ARTNERS (EALTHCARE 3YSTEMS COMMENTS THAT PRACTICES SUCH AS THESE CAN BE hA TREMENDOUS PATIENT SATISlER /NCE THEYVE EXPERIENCED THIS THEYD NEVER GO BACK n NEVER LEAVE THE SYSTEMv
%FlCIENCY
!DVOCATE (EALTH 0ARTNERS CLINICAL INTEGRATION PROGRAM ALIGNS ITS INDEPENDENT COMMUNITY BASED PHYSICIANS EMPLOYED PHYSICIANS AND EIGHT HOSPITALS IN LEADING EDGE TECHNOLOGIES TO COORDINATE CARE DELIVERY 7ITH STRONG COMMITMENT FROM ITS BOARD !DVOCATE GOT NEARLY PERCENT OF PHYSICIANS TO INSTALL HIGH SPEED )NTERNET CONNECTIONS IN THEIR OFlCES STARTING FROM PERCENT IN !CCORDING TO ,EE " 3ACKS -$ h#LINICIANS MOVED PAST COMPLAINING AND RESISTANCE BECAUSE WE TOOK EACH COMPLAINT SERIOUSLY AND ADDRESSED IT 3OMETIMES IT WAS AS SIMPLE AS A TRAINING ISSUEv )N ADDITION TO HOSPITAL BASED SYSTEMS LIKE COMPUTERIZED PHYSICIAN ORDER ENTRY #0/% PHYSICIANS HAVE ELECTRONIC ACCESS TO PATIENT RECORDS LAB AND RADIOLOGY DATA AND DISCHARGE SUMMARIES AS WELL AS ADMINISTRATIVE FUNCTIONS SUCH AS ELIGIBILITY CHECKS AND REFERRALS
4IMELY
.ORTHBAY (EALTHCARE 3YSTEM IS ALSO AGGRESSIVELY TRACKING QUALITY !CCOUNTABILITY FOR QUALITY IS ENFORCED THROUGH THE MANDATORY REPORTING OF PATIENT SATISFACTION AND CORE CLINICAL MEASURES DIRECTLY TO THE BOARD 4O ACHIEVE THIS TRANSPARENCY AND PROVIDE MANAGERS AND CLINICIANS WITH TIMELY INFORMATION .ORTHBAY IS AUTOMATING ITS HOSPITAL OPERATIONS AND MEDICAL RECORDS STARTING WITH #0/% h/UR ORGANIZATION HAS THE RIGHT PERSPECTIVE ABOUT AUTOMATION 7E BELIEVE THAT ITS THE TOOL THAT MUST BE PUT IN PLACE TO ACHIEVE THE DESIRED OUTCOMES "UT ITS NOT JUST THE TECHNOLOGY THAT WILL MAKE IT WORK THERE NEEDS TO BE A CULTURE AND BEHAVIOR CHANGE v STATES 0AUL !LCALA VICE PRESIDENT AND CHIEF INFORMATION OFlCER 4HIS PROCESS IS DRIVEN BY INTEGRATED TEAMS THAT INCLUDE )4 AND END USERS
%QUITABLE
4HE QUALITY IMPROVEMENT PROGRAM AT #HILDRENS .ATIONAL -EDICAL #ENTER #.-# INCLUDES A RESEARCH AND DEVELOPMENT COMPONENT THAT HAS LOOKED AT EQUITY IN THE TREATMENT OF ASTHMA INCLUDING RACIAL DIFFERENCES IN PRESCRIBING PRACTICES AND CONFORMANCE WITH GUIDELINES FOR PATIENTS OF DIFFERENT RACES !NTHONY $ 3LONIM -$ $R0( EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS REMARKS THAT THE HOSPITAL hBENElTS BY IDENTIFYING OPPORTUNITIES TO IMPROVE THE CARE DELIVERED TO OUR PATIENTS AND WE WERE ABLE TO CONTRIBUTE TO THE LITERATURE TO SHARE OUR LEARNING 4HIS PROGRAM LOOKS AT HOW PRACTICES AT #.-# RELATE TO AND CAN INFORM NATIONAL PRACTICEv !DDITIONALLY #.-#S CARE DELIVERY FORUMS PROVIDE AN OPPORTUNITY FOR UNIT BASED CARE DELIVERY TEAMS COMPOSED OF A NURSE MANAGER AND A MEDICAL UNIT DIRECTOR TO GET TOGETHER TO SHARE THE WORK THEY ARE DOING AROUND QUALITY AND TO LEARN FROM EACH OTHER 3LONIM DESCRIBES THESE FORUMS AS hTHE MOST ENERGIZING MEETINGS OF THE WEEK WHERE QUALITY MOVES FROM BOARDROOM TO THE PATIENTSv
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGD ãPT @KHSXãK@MCRB@OD %XHIBIT )NDUSTRY !CHIEVEMENTS IN 1UALITY )NDUSTRY
!CHIEVEMENT
!UTOMOTIVE
7 HEN #ONSUMER 2EPORTS BEGAN RATING *APANESE CARS IN THE S !MERICAN CARMAKERS CONTROLLED MORE THAN PERCENT OF THE MARKET 3LOWLY THE HIGH RANKINGS OF *APANESE CARS STARTED TO ERODE THE MARKET SHARE ENJOYED BY 53 MANUFACTURERS "Y *APANESE CARS WHICH LED THE RATINGS IN TERMS OF VALUE HAD A PERCENT MARKET SHARE;=
%NTERTAINMENT
ILM CAMERAS WERE ONCE THE STANDARD FOR RECORDING AND TRANSMITTING MOVIE IMAGES 4HE STANDARD HAS & EVOLVED TO DISTRIBUTING MOVIES ON COMPUTER DISCS THROUGH DIGITAL MEANS AS OPPOSED TO OUTDATED lLM CANISTERS 4HIS METHOD IMPROVES THE PROJECTION OF lLM QUALITY WHILE PRESERVING THE RECORDED MATERIAL 4HIS REVOLUTION WILL ALSO REDUCE SHIPPING COSTS FOR THE lLM INDUSTRY BY AS MUCH AS BILLION PER YEAR;=
%LECTRIC 5TILITIES
IR POLLUTION CONTINUES TO BE AN ISSUE IN THE ELECTRIC UTILITY INDUSTRY %LECTRIC UTILITIES HAVE SPENT BILLIONS ! OF DOLLARS OVER THE PAST THREE DECADES TO IMPROVE AIR QUALITY )N ADDITION TO AIR QUALITY THE INDUSTRY ALSO SPENDS BILLION TO BILLION PER YEAR ON ENVIRONMENTAL BEST PRACTICES !PPROXIMATELY DIFFERENT TECHNOLOGIES ARE UTILIZED TO REMOVE OR HANDLE POLLUTION;=
!IRLINE
#ONSIDERING THE EFFECTS OF THE 3EPTEMBER ATTACKS ON THE INDUSTRY AIRLINES NEEDED TO STREAMLINE OPERATIONS IN ORDER TO STAY COMPETITIVE /NE SUCH VEHICLE FOR THIS REVITALIZATION IS THE 'LOBAL !IRLINE 1UALITY -ONITOR !1- 4HE !1- PROVIDES QUALITY MEASURES FOR ALL ASPECTS OF SERVICE TO ENSURE THAT QUALITY IS QUANTIlED ON A hSTAND ALONEv BASIS AND hCOMPETITIVE PERFORMANCEv 4HIS IS CRITICAL TO OBTAIN THE DEEPEST UNDERSTANDING AS TO WHERE STANDARDS CAN OR NEED TO BE IMPROVED;=
(OSPITALITY
UALITY DRIVES CONSUMER SATISFACTION AND SECURES MARKET SHARE IN THIS HIGHLY COMPETITIVE SATURATED 1 INDUSTRY #USTOMIZED SERVICE AND EFFECTIVENESS SURVEYS ARE EMPLOYED TO IDENTIFY AREAS OF IMPROVEMENT AND SATISFACTION TO DELIVER VALUE TO THE CONSUMER -ANY HOSPITALITY COMPANIES LINK MANAGERS SALARIES AND INCENTIVES TO THE RESULTS ON GUEST SATISFACTION RATINGS;=
#ONSUMER COMMUNICATION VIGOROUSLY PROMOTING HEALTH CARE LITERACY TO CONSUMERS AND PATIENTS IN A MANNER THAT IS TIMELY EASY TO UNDERSTAND ACCESSIBLE AND MEANINGFUL TO HELP THEM MAKE hINFORMEDv DECISIONS REGARDING NOT ONLY THEIR TREATMENT BUT WITH REGARD TO THE PROVIDERS THAT TREAT THEM 0ROPER INCENTIVES CREATIVELY DEVELOPING INCENTIVES EITHER lNANCIAL OR NONlNANCIAL FOR PHYSICIANS PAYERS AND PATIENTS THAT hREWARDv THE ACHIEVEMENT OF MEASUREMENT GOALS ANDOR CHANGED BEHAVIORS IN ORDER TO ACHIEVE DESIRED OUTCOMES AND IMPROVE QUALITY 4ECHNOLOGY LEVERAGING INFORMATION TECHNOLOGY TO BE THE ENABLER OF TRANSPARENCY AND TO AFFECT THE PROCESS OF CARE THROUGH ENHANCED CONNECTIVITY AND CONCATENATION OF DATA FROM DISPARATE SYSTEMS ON BROADER MORE ENTERPRISE LIKE SCALES EG PERSONAL HEALTH RECORDS OR COMMUNITYREGIONAL HEALTH INFORMATION EXCHANGES WHILE ENSURING DATA QUALITY INTEGRITY AND SECURITY )NNOVATION GIVES RISE TO TRENDS AND THE BEST TRENDS EVOLVE INTO PRACTICE 4HE REAL TEST FOR QUALITY OVER THE NEXT lVE TO YEARS IS TO BUILD A SUSTAINABLE FUTURE IN WHICH CONSENSUS IS ACHIEVED
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
AMONG ALL SECTORS TO RECOGNIZE NOT JUST WHAT QUALITY IS BUT ALSO ITS RELATION TO COST AND ULTIMATELY THE VALUE OF CARE DELIVERED )S IT POSSIBLE FOR HEALTH EXECUTIVES TO MOVE THE QUALITY NEEDLE #AN THERE REALLY BE A SUCCESSFUL WAY TO INTEGRATE AND IMPLEMENT THESE PRINCIPLES 4HE SHORT ANSWER IS YES THERE IS HOPE 0RIVATE INDUSTRY INCLUDING EXAMPLES DESCRIBED IN %XHIBIT HAS DEMONSTRATED HOW THE APPLICATION OF THESE PRINCIPLES CAN EQUATE TO TRANSPARENCY ACCOUNTABILITY AND RELIABLE DECISION MAKING ON BEHALF OF THE CONSUMER AND IMPROVED QUALITY OF SERVICE %NDNOTES 4HE (ISTORY OF 1UALITY n 'UILDS OF -EDIEVAL %UROPE !MERICAN 3OCIETY FOR 1UALITY HTTPWWWASQORGLEARN ABOUT QUALITYHISTORY OF QUALITY OVERVIEWGUILDSHTML #ROSSING THE 1UALITY #HASM 4HE )/- (EALTH #ARE 1UALITY )NITIATIVE HTTPWWWIOMEDU#-3ASPX !(#02 3TRATEGIC 0LAN !GENCY FOR (EALTH #ARE 0OLICY AND 2ESEARCH $ECEMBER HTTPWWWAHRQGOVABOUTSTRATPLN HTMSTRENGTHEN 3TATEMENT ON 1UALITY #ARE 4HE .ATIONAL 2OUNDTABLE ON (EALTH #ARE 1UALITY *ANUARY CONVENED BY THE )NSTITUTE OF -EDICINE A COMPONENT OF THE .ATIONAL !CADEMY OF 3CIENCES
SGD ãPT @KHSXãK@MCRB@OD .ATIONAL 3URVEY OF #ONSUMERS %XPERIENCES WITH 0ATIENT 3AFETY AND 1UALITY )NFORMATION .OVEMBER 4HE +AISER &AMILY &OUNDATION THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY AND THE (ARVARD 3CHOOL OF 0UBLIC (EALTH HTTPWWWKFFORGKAISERPOLLSUPLOAD .ATIONAL 3URVEY ON #ONSUMERS %XPERIENCES 7ITH 0ATIENT 3AFETY AND 1UALITY )NFORMATION 3URVEY 3UMMARY AND #HARTPACKPDF #YBERCHRONDRIACS UPDATE !UGUST 4HE (ARRIS 0OLL h&IVE YEARS AFTER )/- REPORT ON MEDICAL ERRORS NEARLY HALF OF ALL CONSUMERS WORRY ABOUT THE SAFETY OF THEIR HEALTH CARE v .OVEMBER +AISER &AMILY &OUNDATION HTTPWWWKFFORGKAISERPOLLS POMRNRCFM h.ATIONAL SURVEY ON !MERICANS AS HEALTH CONSUMERS !N UPDATE ON THE ROLE OF QUALITY INFORMATION v $ECEMBER +AISER &AMILY &OUNDATION HTTPWWWAHRQGOVDOWNLOADSPUBKFFSUMMARYPDF )NSTITUTE FOR (EALTHCARE )MPROVEMENT ,IVES #AMPAIGN HTTPWWWIHIORG)()0ROGRAMS#AMPAIGN !CCURACY AT %VERY 3TEP 4HE #HALLENGE OF -EDICATION 2ECONCILIATION HTTPWWWIHIORG)()4OPICS0ATIENT3AFETY-EDICATION3YSTEMS )MPROVEMENT3TORIES!CCURACYAT%VERY3TEPHTM 4HE 3TEPS TO 3AFER 3URGERY HTTPWWWIHIORG)()4OPICS0ATIENT3AFETY 3URGICAL3ITE)NFECTIONS)MPROVEMENT3TORIES4HE3TEPSTO3AFER3URGERYHTM 0RICEWATERHOUSE#OOPERS INTERVIEW WITH ,OUISE ,IANG -$ AND 2UTH "RENTARI +AISER 0ERMANENTE -AY
)NDIANA (EALTH .ET "REAKS .EW 'ROUND ON % RECORDS HTTPWWW COMPUTERWORLDCOMPRINTTHIS HTML -EASUREMENT 3TUDY %XECUTIVE 3UMMARY HTTPWWWCAQHORGSAS? MEMBERHTML #ALIFORNIA (OSPITAL !SSESSMENT AND 2EPORTING 4ASKFORCE HTTP WWWCHCFORGTOPICSHOSPITALSINDEXCFM ITEM)$ h,EARNING THE 0ATIENTS 6IEW (ARVARD !LTERS $OCTORS 4RAINING v -ARCH 4HE "OSTON 'LOBE (OUSE #OMMITTEE ON 7AYS AND -EANS STATEMENT OF 2EGINA % (ERZLINGER 0H$ AND .ANCY 2 -C0HERSON 0ROFESSOR (ARVARD "USINESS 3CHOOL "OSTON -ASS *UNE 4ESTIMONY "EFORE THE 3UBCOMMITTEE ON /VERSIGHT OF THE (OUSE #OMMITTEE ON 7AYS AND -EANS AVAILABLE AT HTTPWAYSANDMEANSHOUSEGOVHEARINGSASP FORM MODE VIEWID h$IGITAL 2EVOLUTION 4RANSFORMING %NTERTAINMENT )NDUSTRY SAYS &ILMMAKER v HTTPWWWADVANCEUCONNEDUHTM !DVANCED 4ECHNOLOGY HTTPWWWCAREENERGYCOMTECHNOLOGY UTILITYASP !IRLINE 1UALITY -ONITOR HTTPWWWAIRLINEQUALITYCOMMAINAQM? HTM -EASURING 3ERVICE 1UALITY #USTOMER 3ATISFACTION AND #USTOMER 6ALUE IN THE (OSPITALITY )NDUSTRY HTTPOLDFCSIASTATEEDUHRIMRESEARCH CUSTOMERVALUEASP
@4HE THING IS TO BE ABLE TO OUTLAST THE TRENDS n 0AUL !NKA SINGER SONGWRITER
@)T SEEMS WERE ALWAYS IN TRANSITION AND THAT ITS MORE ABOUT TRENDS THAN IT IS ABOUT WHATS MEANINGFUL n -ARLEE -ATLIN ACTRESS ADVOCATE
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1UALITY IN THE 0OST -ANAGED #ARE %RA )T WILL BE THE CHALLENGE OF THE NEXT SEVERAL DECADES TO KNIT TOGETHER COMPETING SERVICES ORGANIZATIONS AND STRATEGIES INTO A COHERENT ALIGNED SET OF PRINCIPLES THAT WILL TRULY DELIVER QUALITY IN HEALTHCARE "Y $ONALD &ETTEROLF -ATRIA (EALTHCARE @)F YOU WANT QUALITY ACT AS IF YOU ALREADY HAD IT n 7ILLIAM *AMES PHILOSOPHER
1
UALITY HAS BEEN DElNED BY MANY DIFFERENT PEOPLE IN MANY DIFFERENT WAYS INCLUDING CONFORMANCE TO GUIDELINES PATIENT SAFETY CONSUMER IDEALS COST EFFECTIVENESS AND ACCREDITATION ACHIEVEMENT;= .OTIONS ABOUT QUALITY HAVE ALSO CHANGED OVER TIME EVOLVING FROM EARLY hQUALITY ASSURANCEv ACTIVITIES TARGETING POOR SURGICAL OUTCOMES TO MORE CONTEMPORARY SOPHISTICATED APPROACHES OF hCONTINUOUS QUALITY IMPROVEMENT v BORROWING HEAVILY FROM INDUSTRIAL PRINCIPLES AND DEVELOPED WITH INPUT FROM THE EVIDENCE BASED MEDICAL LITERATURE 7ITH A LARGE NUMBER OF QUALITY EXPERTS AND INITIATIVES CURRENTLY IN THE MARKETPLACE IN MANY WAYS WE HAVE EXCEEDED OUR EARLY DREAMS OF MOVING THE QUALITY AGENDA FROM SMALL GROUPS OF EXPERTS INTO THE ENTIRE HEALTHCARE ENVIRONMENT /N THE OTHER HAND THIS PLETHORA OF QUALITY EXPERTS AND ORGANIZATIONS HAS LEFT A NUMBER OF PEOPLE WITH THE FEELING THAT THERE IS IN FACT ORGANIZATIONAL CHAOS AND THAT REAL FORWARD MOVEMENT IN THE PROGRESSION OF MEDICAL QUALITY IS BEING DILUTED OR MISDIRECTED BY THE MANY ORGANIZATIONS COMMITTED TO THAT PATH 7E MIGHT START WITH 7EBSTERS .EW 7ORLD $ICTIONARY DElNITION OF QUALITY WHICH VAGUELY IDENTIlES IT AS hANY OF THE FEATURES THAT MAKE SOMETHING WHAT IT IS CHARACTERISTIC ELEMENT ATTRIBUTEv OR MORE DIRECTLY hTHE DEGREE OF EXCELLENCE WHICH A THING POSSESSESv;= $ElNITIONS OF MEDICAL QUALITY CAN BE EQUALLY VAGUE AND RANGE WIDELY DEPENDING ON THE PERSPECTIVE OF THE INDIVIDUAL OR ORGANIZATION DElNING IT
0AST 'ENERATIONS OF 1UALITY )T IS HELPFUL TO CONSIDER HOW CONCEPTS OF QUALITY IN MEDICINE HAVE EVOLVED OVER THE PAST OR YEARS SEE %XHIBIT )NITIALLY THE hlRST GENERATIONv OF QUALITY WAS LARGELY INSPECTION DRIVEN AND FOCUSED ON SENTINEL EVENT MONITORING ADVERSE OCCURRENCE MONITORING AND PHYSICIAN AND INSTITUTIONAL CREDENTIALING .OON
CONFERENCES WERE HELD AFTER A PATIENT HAD DIED AND FACULTY IN LARGE MEDICAL SCHOOLS QUIZZED THE INTERN AND RESIDENTS AS TO WHAT THEY THOUGHT HAD OCCURRED !T THE INSTITUTIONAL LEVEL ACCREDITATION IN ITS EARLY FORM FOCUSED ON THE ORGANIZATIONS PERFORMANCE OF INSPECTION TYPE ACTIVITIES AND DOCUMENTATION THAT PROCESS ADEQUACY WAS IN PLACE 4HROUGH THE EARLY S A hSECOND GENERATIONv OF QUALITY CAME TO THE FOREFRONT AS AN ERA OCCURRED WHICH EMPHASIZED STATISTICAL QUALITY CONTROL MEASURES BORROWED FROM SIMILAR DEVELOPMENTS IN THE MANUFACTURING ENVIRONMENT 1UALITY GURUS $EMING AND *URAN ;= AS THE EARLY GODS OF INDUSTRIAL QUALITY MANAGEMENT SYSTEMS BECAME HOUSEHOLD NAMES IN HOSPITAL AND QUALITY SYSTEMS 4HOUGHTS ON WHAT QUALITY MIGHT BE IN THE HEALTHCARE ARENA WERE DElNED BY !VEDIS $ONABEDIAN WHO DEVELOPED THE EARLY PHILOSOPHY FOR MEDICAL QUALITY EXPERTS AND 0HILLIP #ROSBY ;= WHO DElNED IT AS CONFORMANCE TO REQUIREMENTS )N THIS PERIOD DIAGNOSIS SPECIlC VARIATIONS IN CARE WERE NOTED AND STUDIED $ETAILED STATISTICS FOR ADMISSION RATES SURGICAL OUTCOMES AND PHARMACEUTICAL PROlLING WERE COMPILED AND ANALYZED FROM NEWLY DEVELOPED DATA INFORMATION WAREHOUSES 3TATISTICS WERE CALCULATED TRENDED AND NOTED WITH RESPECT TO THEIR AVERAGE STANDARD DEVIATION AND ABILITY TO DElNE A NORMAL hBELL CURVEv s)N THE LATE S AND EARLY S A hTHIRD GENERATIONv OF QUALITY BEGAN TO EMERGE AS INDIVIDUALS FACED WITH COMPLEX STATISTICAL PROCESS ANALYSIS WERE REPEATEDLY ASKED TO DElNE WHAT GIVEN THE VARIATION THE CORRECT OUTCOMES SHOULD BE $AVID %DDY DElNED MANY OF THE EARLY (%$)3 QUALITY INDICATORS ON THE BASIS OF THEIR ATTRIBUTES OF RELEVANCE REPRODUCIBILITY FACE VALIDITY AND OTHER SIMILAR CHARACTERISTICS $URING THIS TIME AND AS A RESULT OF THOSE QUESTIONS QUALITY WORKERS BEGAN TO CONSIDER A BROADER DElNITION OF QUALITY OUTSIDE STATISTICAL ANALYSIS OF MEDICAL CLAIMS DATA TO INCLUDE PATIENT SATISFACTION INSTRUMENTS LINKAGES
$ONALD &ETTEROLF -$ -"! IS A &ELLOW IN THE !MERICAN #OLLEGE OF 0HYSICIANS THE !MERICAN #OLLEGE OF 0HYSICIAN %XECUTIVES THE !MERICAN #OLLEGE OF -EDICAL 1UALITY AND THE !CADEMY OF (EALTHCARE -ANAGEMENT (E IS ON THE BOARD OF DIRECTORS OF THE $ISEASE -ANAGEMENT !SSOCIATION OF !MERICAN $-!! AND IS VICE PRESIDENT OF THE !MERICAN #OLLEGE OF -EDICAL 1UALITY $R &ETTEROLF IS CURRENTLY CORPORATE VICE PRESIDENT FOR (EALTH )NTELLIGENCE AT -ATRIA (EALTHCARE )NC A LARGE DISEASE MANAGEMENT ORGANIZATION BASED IN !TLANTA WITH OPERATIONS THROUGHOUT THE 5NITED 3TATES (E CAN BE REACHED AT DON?FETTEROLF MATRIACOM
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
P T@K HSXãHMãSGD ãONRS L @M@FD C B@QD ãD Q@
TO DISABILITY AND ABSENTEEISM RISK INTERVENTION ANALYSIS AND PREVENTIVE SERVICE SATISFACTION 7HILE ALL OF THESE ACTIVITIES HAD BEEN PRESENT BEFORE IT WAS ATTEMPTS TO QUANTIFY AND IMPROVE THEM IN AN ORGANIZED WAY THAT WERE AMONG THE THINGS THAT MANAGED CARE SOUGHT TO BRING TO THE TABLE TO IMPROVE THE QUALITY OF CARE FOR HEALTH PLAN PARTICIPANTS AS WELL AS REDUCE THEIR OVERALL COSTS /UTCOME MEASURES INCLUDED CONVENTIONAL MEDICAL OUTCOMES FUNCTIONAL STATUS AND WELL BEING HEALTH RISK APPRAISAL ANALYSIS SMALL AREA ANALYSIS AND ULTIMATELY THE LINKAGE WITH PREVIOUS WORK ON COSTS THROUGH VARIOUS ITERATIONS AND MODIlCATIONS OF COST EFFECTIVENESS ANALYSIS
)NTO THE 0RESENT $AY )N THE MID S THIS ATTEMPT TO INTEGRATE BROADER GOALS IMPROVE OUTCOMES AND BUILD ANALYTICS SLID IMPERCEPTIBLY TO THE hFOURTH GENERATIONv OF BIG MANAGEMENT SYSTEMS SEE %XHIBIT )F ANALYTICS ARE THE ANSWER TO HEALTHCARE THEN LARGER NUMBERS AND BIGGER SYSTEMS SEEM TO BE THE METHOD FOR DOING SO h)NTEGRATED DELIVERY SYSTEMSv WERE ALL THE RAGE AS CONSULTANTS IN THAT PERIOD DROVE TO CREATE LARGE MULTISPECIALTY GROUP PRACTICES hCOMMUNITY HEALTH INFORMATION NETWORKSv AND OTHER LARGE DATA DRIVEN MANAGEMENT
SYSTEMS TO BETTER INTEGRATE THE DELIVERY SYSTEM AND LINK PHYSICIANS HOSPITALS COMPANIES AND INDIVIDUALS &OR A VARIETY OF REASONS THIS ERA HAS NOT SEEMED TO FULlLL ITS PROMISED EVOLUTION OR WIDELY PREDICTED OUTCOMES BUT TRACES REMAIN !S THESE LARGE ORGANIZATIONS CONTINUED TO ATTEMPT TO EVOLVE AND ORGANIZE CONCERN ON THE PART OF BUSINESS AND PUBLIC ORGANIZATIONS ALSO LED TO THE EVOLUTION OF A LARGE NUMBER OF GOVERNMENTAL AND PSEUDO GOVERNMENTAL ORGANIZATIONS FOCUSED ON EVALUATING THE MANAGEMENT OF THESE PROGRAMS /RGANIZATIONS WERE ENCOURAGED TO OFFER OVERSIGHT PROTECTION FROM POTENTIAL OR FEARED MISDIRECTION OF MANAGEMENT OVER INDIVIDUAL AUTONOMY OR INFORMATION CONlDENTIALITY ,ARGE GOVERNMENT ORGANIZATIONS INCLUDING #-3 !(21 AND STATE DEPARTMENTS OF HEALTH AND INSURANCE EMERGED TO VOICE THEIR OPINIONS 1UASI GOVERNMENTAL PARTICIPATION BY THE )NSTITUTE OF -EDICINE THE .ATIONAL 1UALITY &ORUM AND 02/ AND 1)/ ORGANIZATIONS WERE NOTED AS WELL !CCREDITATION BUREAUCRACIES GREW DRAMATICALLY IN STRENGTH AND INmUENCE AND EXTENDED THEIR INTEREST FROM THEIR CORE FUNCTIONS TO INCLUDE ALL ASPECTS OF HEALTHCARE DELIVERY 4HE *#!(/ .#1! 52!# AND !!(# ORGANIZATIONS BRANCHED BROADLY AND DEVELOPED CONSIDERABLE PSEUDO GOVERNMENTAL STRENGTH IN THE MARKETPLACE AS PURVEYORS
%XHIBIT 4HE 'ENERATIONS OF 1UALITY n S TO %ARLY S 'ENERATION
&OCUS
!TTRIBUTES
&IRST 'ENERATION CIRCA S
)NSPECTION
s 0HYSICIAN INSTITUTIONAL CREDENTIALING s 0ROCEDURE SPECIlC CREDENTIALING s 3ENTINEL EVENT MONITORING s 5-1) TECHNOLOGY ASSESSMENT PROCESS ADEQUACY s !DVERSE OCCURRENCE MONITORING s %XTERNAL ACCREDITATION
3ECOND 'ENERATION CIRCA S
3TATISTICAL 1UALITY #ONTROL
s $IAGNOSIS SPECIlC ADMISSIONS VARIATIONS s 4ARGETED SURGICAL VARIATIONS s 4ARGETED AMBULATORY SURGERY VARIATIONS s 0HYSICIAN STATISTICAL COSTMORTALITY PROlLING s 0HARMACEUTICAL PROlLING
4HIRD 'ENERATION CIRCA LATE S EARLY S
/UTCOME -EASURES
s 3ELECTED CLAIMS BASED OUTCOMES s 0ATIENT SATISFACTION INSTRUMENTS s #LINICAL OUTCOMES MEASURES s 0REVENTIVE SERVICE STANDARD SATISFACTION s $ISEASE SPECIlC PATIENT PERCEPTIONS s ,INKAGE TO DISABILITYABSENTEEISM s ,IFE EVENT RISK INTERVENTION ANALYSIS
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXãHMãSGD ãONRS L @M@FD C B@QD ãD Q@ %XHIBIT 4HE 'ENERATIONS OF 1UALITY n ,ATE S TO 0RESENT 'ENERATION
&OCUS
!TTRIBUTES
&OURTH 'ENERATION CIRCA MID S
-ANAGEMENT 3YSTEMS
,ARGE HEALTHCARE SYSTEMS s )NTEGRATED CARE MANAGEMENT DELIVERY SYSTEMS s -ULTISPECIALTY GROUP PRACTICE s 0(/ 0(#/ )0! #(). AND OTHERS .EW METHODS TOOLS AND CONCEPTS s $ATA DRIVEN INFORMATION SYSTEMS s 3TATISTICAL QUALITY CONTROL SHIFTING THE BELL CURVE #OMPARING ACROSS PLANS HOSPITALS COMPANIES AND INDIVIDUALS s "EST PRACTICE ANALYSIS s $ECISION SUPPORT TOOLS
&IFTH 'ENERATION 0RESENT
0OST -ANAGED #ARE
'OVERNMENT AGENCY PARTICIPATION s #-3 !(21 0SEUDO GOVERNMENTAL PARTICIPATION s .1& )/- 02/S 1)/S !CCREDITATION BUREAUCRACIES s *#!(/ 52!# .#1! !!!(# )NTEGRATED CARE MANAGEMENT DELIVERY SYSTEMS s 0(/ 0(#/ )0! #(). AND OTHERS s (EALTH PLANS (-/S GROUP PRACTICE /THER PLAYERS
OF THE PROPER METHOD OF HEALTHCARE DELIVERY IN THIS hlFTH GENERATIONv OF QUALITY IMPROVEMENT EVOLUTION
! #LUTTERED ,ANDSCAPE @1UALITY IS NEVER AN ACCIDENT IT IS ALWAYS THE RESULT OF INTELLIGENT EFFORT n *OHN 2USKIN AUTHOR POET ARTIST )N THE POST MANAGED CARE ERA WE NOW lND OURSELVES IN A POSITION OF BOTH VICTORY AND UNCERTAINTY #LEARLY DUE TO THE EVOLUTION OF THESE LARGE ORGANIZATIONS THE SYSTEMATIC DELIVERY OF THE QUALITY MESSAGE IS FAR IN EXCESS OF WHAT WAS CONCEIVED BY INDIVIDUAL PROPONENTS OF THE QUALITY MOVEMENT OR YEARS AGO 4HE MESSAGE OF THE IMPORTANCE OF QUALITY HAS BEEN PERVASIVE THROUGHOUT THE HEALTHCARE SYSTEM YET IN MANY WAYS INDIVIDUALS AND ORGANIZATIONS FEEL FRUSTRATED THAT MORE PROGRESS HASNT BEEN MADE 4HERE ARE MANY SELF PROCLAIMED LEADERS OF THE MOVEMENT SOMETIMES WITH CONmICTING GOALS AND DIRECTIONS %XHIBIT ILLUSTRATES A LIST OF ORGANIZATIONS CLAIMING AUTHORITY IN QUALITY AND REPRESENTS A SERIES OF THREE AND FOUR LETTER ACRONYMS THAT COULD GO ON FOR PAGES
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
3PECIlC APPROACHES TO QUALITY HAVE BECOME SPECIALIZED EACH ACQUIRING THEIR OWN FOLLOWING AND TENETS WITH AN INTENSITY SOME HAVE LIKENED TO A CULT &OR EXAMPLE OFTEN WITHIN HEALTH PLANS THE DIRECTOR OF QUALITY BELIEVES HE IS THE ONLY INDIVIDUAL WHO CAN INTERPRET THE LARGE VOLUMES OF QUALITY DIRECTIVES ISSUED BY THE .#1! )T FOLLOWS THAT HEALTH PLANS FACE CLAIMS FROM BENElT MANAGEMENT CONSULTANTS THAT THEIR PROPOSALS DElNE TRUE QUALITY hBEYOND (%$)3v )N ADDITION 3IX 3IGMA PROGRAMS CAN ONLY BE SUPERVISED BY BLACK BELT SPECIALISTS WHO CARRY A UNIQUE SET OF KNOWLEDGE AND TOOLS TO HELP AN ORGANIZATION OPTIMIZE ITS POTENTIAL 3IMILARLY LEADERS CAN BE FOUND IN THE AUTOMOTIVE INDUSTRYS PRODUCTION PROGRAMS DRIVING )3/ CONFORMANCE AND (OSHIN PROCESS PLANNING A METHOD OF STRATEGIC AND OPERATIONAL PLANNING DEVELOPED AND RElNED IN *APAN %ACH OF THE LARGE MAJOR ORGANIZATIONS HAS A LISTING OF hPRIORITY CONDITIONSv 4HE .ATIONAL 1UALITY &ORUM n WITH MEMBER ORGANIZATIONS PLUS OR MINUS n HAS ITS OWN SERIES OF hPRIORITY CONDITIONSv AND OVER hPRIORITY SAFE PRACTICESv WHICH COMPLEMENT BUT DO NOT LINE UP DIRECTLY WITH THE !(21 LIST OF PRIORITY CONDITIONS PRIORITY INDICATORS ETC "USINESS ORGANIZATIONS INCLUDING 4HE ,EAPFROG 'ROUP SIMILARLY HAVE LISTS OF PRIORITY ISSUES TYPES OF MEASURES AND SO ON
P T@K HSXãHMãSGD ãONRS L @M@FD C B@QD ãD Q@ %XHIBIT ,IST OF /RGANIZATIONS &OCUSING ON (EALTHCARE 1UALITY &EDERAL
0UBLIC 0RIVATE
&OUNDATIONS
!GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21
!MBULATORY #ARE 1UALITY !LLIANCE !1!
+AISER &AMILY &OUNDATION
#ENTERS FOR $ISEASE #ONTROL #$#
!MERICAN #OLLEGE OF -EDICAL 1UALITY !#-1
+ELLOGG &OUNDATION
#ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3
!MERICAN (EALTH 1UALITY !SSOCIATION !(1!
2OBERT 7OOD *OHNSON &OUNDATION
.ATIONAL )NSTITUTES OF (EALTH .)(
!SSOCIATION OF (EALTH )NSURANCE 0LANS !()0
4HE #OMMONWEALTH &UND
53 $EPARTMENT OF (EALTH (UMAN 3ERVICES $((3
&OUNDATION FOR !CCOUNTABILITY &!!#4 SUNSET
/THER 'ROUPS
6ETERANS (EALTH !DMINISTRATION 6(!
)NSTITUTE FOR #LINICAL 3YSTEMS )MPROVEMENT )#3)
"USINESS COALITIONS
0HYSICIAN 3PECIALTY 'ROUPS #ONSORTIUMS
)NSTITUTE FOR (EALTHCARE )MPROVEMENT )()
(EALTHCARE CONSULTING lRMS BOUTIQUE AND LARGE
!MERICAN !CADEMY OF &AMILY 0HYSICIANS !!&0
*OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS *#!(/
%MPLOYERS AND LABOR UNIONS
!MERICAN "OARD OF 1UALITY !SSURANCE AND 5TILIZATION 2EVIEW 0HYSICIANS !"1!520
4HE ,EAPFROG 'ROUP
(EALTH INSURERS
!MERICAN #OLLEGE OF 0HYSICIANS !#0
.ATIONAL !SSOCIATION OF #HILDRENS (OSPITALS .!#(
(OSPITALS AND HEALTH SYSTEMS
!MERICAN "OARD OF -EDICAL 3PECIALTIES !"-
.ATIONAL !CADEMY OF 3CIENCES )NSTITUTE OF -EDICINE )/-
0ATIENT ADVOCACY GROUPS
!MERICAN -EDICAL !SSOCIATION n 0HYSICIAN #ONSORTIUM ON 0ERFORMANCE )MPROVEMENT !-!
.ATIONAL "USINESS 'ROUP ON (EALTH
0HARMACEUTICAL COMPANIES
.ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1!
/THER MEDICAL SPECIALTY ASSOCIATIONS !(! !##
.ATIONAL )NITIATIVE FOR #HILDRENS (EALTHCARE 1UALITY .)#(1
,IFE SCIENCES BIOTECHNOLOGY
.ATIONAL 1UALITY &ORUM .1& n .ATIONAL #OMMITTEE FOR 1UALITY (EALTH #ARE .#1(#
,OCALREGIONAL COLLABORATIVES AND COALITIONS
5TILIZATION 2EVIEW !CCREDITATION #OMMISSION 52!#
3URVEY RESEARCH ENTITIES .2# 0ICKER 0RESS 'ANEY
4ECHNOLOGY VENDORS
5NIVERSITIES MEDICAL SCHOOLS SCHOOLS OF PUBLIC HEALTH
4HE NEXT GENERATION IN THE EVOLUTION OF QUALITY WILL NEED TO ADDRESS MANY OF THESE ISSUES 4HERE IS A CACOPHONY OF PLAYERS WITH MANY GURUS IN MANY ORGANIZATIONS AND INTERORGANIZATIONAL POLITICAL STRESSES AROUND WHO WILL DOMINATE VARIOUS QUALITY hSPACESv /FTENTIMES IF YOU SCAN THE BOARDS OF DIRECTORS OF THESE ORGANIZATIONS YOULL SEE THE SAME CAST 7ITH SO MUCH DISSONANCE THERE IS WIDE REACHING CONCERN ABOUT THE REAL IMPACT OF ALL OF THE
EFFORTS OF QUALITY WHICH SEEM IN MANY QUARTERS TO FAIL DESPITE ALL OF THE EFFORT DIRECTED THAT WAY 4HE )/- REPORTS ARE THE BEACONS OF HOPE TO HELP OBJECTIFY THE NEED TO CREATE ORDER FROM THIS DISARRAY 4HE NEXT GENERATION OF QUALITY MUST DElNE AND PRIORITIZE AREAS THAT ARE WORTH PURSUING AND THOSE WHICH ARE NOT !S SCARCITY OF HEALTHCARE RESOURCES AND AN INCREASING POPULATION CONTINUOUSLY STRESS THE HEALTHCARE
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXãHMãSGD ãONRS L @M@FD C B@QD ãD Q@ DELIVERY SYSTEM COST EFFECTIVENESS ANALYSIS WILL EMERGE AS A DRIVING PRINCIPLE BEHIND MEDICAL CARE DELIVERY AND THE FOCUS ON QUALITY &INALLY THE DILUTIONAL EFFECTS OF MULTIPLE ONGOING ACTIVITIES n ALL CLAIMING PRIORITY AND IMPORTANCE n WILL NEED TO BE SORTED OUT BY INDIVIDUALS WORKING IN THE QUALITY lELD 0AY FOR PERFORMANCE ELECTRONIC MEDICAL RECORDS PATIENT SAFETY EMPLOYER COALITION DESIRES CONSUMERISM HIGH DEDUCTIBLE HEALTH PLANS AND THE SHIFT OF BENElT DESIGNS AND RISING MULTICULTURALISM WILL PROVE IMPORTANT VECTORS IN MOVEMENT OF THE QUALITY INITIATIVE IN THE EARLY ST CENTURY
1UALITY AS A MOVEMENT HAS IMPROVED IN MANY AREAS BUT CHANGE TAKES TIME AND PERFECTION TAKES AN ETERNITY 4HE 53 GOVERNMENT AS A VERY IMPORTANT CENTRALIZING AND UNIFYING FORCE HAS EMERGED AS A MAJOR PLAYER AND MAY BE THE ULTIMATE MODEL OF QUALITY WITH THE VARIOUS INITIATIVES THAT ARE EMANATING FROM #-3 'OVERNMENT WILL NEED TO CONTINUE TO BE INTERESTED AND INVESTED IN ORDER FOR STANDARDIZATION TO OCCUR -OST FUTURISTS PREDICT THAT #-3 SPECIlCALLY THE -EDICARE PROGRAM WILL DO MORE IN THE DIRECTION OF ORGANIZING THE QUALITY EFFORTS OF THE NATION AND IN PUBLIC REPORTING OF OUTCOMES AS TRANSPARENCY IS ON THE RISE (EALTH PLANS FACED WITH THE OVERWHELMING NEED FOR CONSUMERISM SEEMED TO BE MOVING TOWARD BECOMING lNANCIAL SERVICE COMPANIES WHILE AT THE SAME TIME FUNCTIONING AS DEVELOPERS AND SUPPORTERS OF QUALITY IN CONSUMERIST PROGRAMS &URTHER IMPROVEMENT IN HEALTHCARE QUALITY IS POSSIBLE /VER THE hNEXT GENERATION v QUALITY WILL NEED TO BE BETTER DElNED PERHAPS AS hVALUEv AND HOW IT IS MEASURED IN TERMS THAT ARE RELEVANT TO THE PATIENT 1UALITY WILL EMPHASIZE ACCESS AND AVAILABILITY OF SERVICES AS WELL AS MORE SOPHISTICATED CONCEPTS AS PURCHASERS OF HEALTHCARE SERVICES FURTHER UNDERSTAND THE IMPORTANCE OF CLINICAL OUTCOMES AND IMPROVED FUNCTIONING OF PATIENTS &URTHERMORE QUALITY INITIATIVES THAT DEMONSTRATE SUSTAINED CLINICAL IMPROVEMENTS WILL NARROW THE GAP BETWEEN RESEARCH AND APPLICATION AND CAN POTENTIALLY OPTIMIZE COSTS )MPROVED PATIENT FUNCTION AS MEASURED BY FUNCTIONAL STATUS AND HEALTH RISK SURVEYS CORRELATE WITH BETTER QUALITY OF LIFE AND IMPROVED WORKFORCE CAPABILITIES .EW MEASURES OF QUALITY ARE AND WILL ALMOST CERTAINLY CHANGE THE APPROACHES OF THE HEALTHCARE INDUSTRY IN CREATING THEM 7E ARE ALREADY SEEING SHIFTS IN THE COMPLEXITY AND SERVICES
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
OF DISEASE MANAGEMENT COMPANIES TO INCLUDE ADVANCED INFORMATICS CAPABILITIES (EALTH PLANS AND DISEASE MANAGEMENT COMPANIES ARE ALSO LOOKING TO DEVELOP A BROADER hWHOLE LIFEv HEALTH ENHANCEMENT APPROACH TO THEIR SERVICE OFFERINGS AS IT BECOMES CLEAR THAT THE TOTAL ECONOMIC COST OF HEALTHCARE IN THE POPULATION CAN BE MANAGED BETTER BY UNDERSTANDING THE HEALTHY AS WELL AS THE SICK SPECTRUM OF THE POPULATION -ORE EMPHASIS ON PREVENTIVE CARE ON A SELF DIRECTED CONSUMER APPROACH TO HEALTH RISK AND SIMILAR CURRENT TRENDS ARE CREATING SIGNIlCANT CORPORATE STRUCTURE AND PRODUCT DESIGN CHANGES
0REPARING FOR THE &UTURE 7HAT SHOULD WE DO )T IS DIFlCULT NOT TO LOSE THE FOREST FOR THE TREES 7E SHOULD NOT CONFUSE MARKET TRENDS OR BUZZ GENERATED BY THIS YEARS EXPERTS WITH WHAT IS CORRECT IN THE APPLICATION OF BASIC PRINCIPLES IN QUALITY MANAGEMENT WHERE THEY STILL WORK 1UALITY AS A MOVEMENT IS NOT DEAD )T HAS IMPROVED IN MANY AREAS BUT CHANGE TAKES TIME AND PERFECTION TAKES AN ETERNITY 4HE FUNDAMENTAL ISSUE IS THAT IT IS NOW DISTRIBUTED WIDELY ACROSS MANY DIFFERENT DIMENSIONS AND ENVIRONMENTS (ENCE THE STATE OF HEALTHCARE QUALITY IS SOMEWHERE BETWEEN CHANGE WITH MANY STAKEHOLDERS LEADING THE CHARGE FROM MANY ANGLES AND EXCELLENCE WHERE MEASUREMENT AND TRANSPARENCY COME FROM A FOCUSED EFFORT AND ONE VOICE REPRESENTS THE MULTIDISCIPLINARY TEAMS WHO WERE THE ARCHITECTS OF THE DESIGN )N A WAY WE HAVE WON MANY BATTLES TO CREATE AN EMPHASIS ON QUALITY BUT WHICH HAVE FORCED THE CHALLENGE FOR THE FUTURE TO TRULY LEAD AND NOT BE JOSTLED ABOUT BY THE "ROWNIAN MOTION OF DIFFUSE POLITICAL INTERESTS 7E OFTEN LIKE TO CHALLENGE OUR STUDENTS BY PROPOSING THE FOLLOWING QUESTION FOR YOUR DINNER DISCUSSION THIS EVENING h4HE PRESIDENT OF THE 5NITED 3TATES COMES TO YOUR HOUSE TO VISIT !S THE REAL LEGACY OF HIS PRESIDENCY HE WANTS TO IMPROVE THE QUALITY OF HEALTHCARE !S YOU lNISH DINNER AND TURN TO DESSERT HE ASKS @7HAT SHOULD ) DO v 7HAT WILL YOU TELL HIM %NDNOTES #OUCH * -$ *$ &!#0% h(EALTH #ARE 1UALITY -ANAGEMENT FOR THE ST #ENTURY v !MERICAN #OLLEGE OF 0HYSICIAN %XECUTIVES 7EBSTERS .EW 7ORLD $ICTIONARY OF !MERICAN %NGLISH 7EBSTERS .EW 7ORLD #LEVELAND AND .EW 9ORK 7ALTON - 4HE $EMING -ANAGEMENT -ETHOD 0ERIGEE "OOKS #ROSBY 0 1UALITY 7ITHOUT 4EARS 4HE !RT OF (ASSLE &REE -ANAGEMENT -C'RAW (ILL
!LL 1UALITY 2OADS ,EAD TO $ATA 3UCCESSFUL IMPLEMENTATION OF NEW TOOLS AND METHODS FOR MEASURING EVALUATING AND DISSEMINATING HEALTHCARE DATA WILL BE STRONGLY INmUENCED BY DATA UTILITY AND ITS RELATIONSHIP TO IMPROVED PATIENT CARE "Y (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
4
HE ADAGE h9OU CANT MANAGE WHAT YOU CANT MEASUREv IS OFTEN REPEATED BY QUALITY GURUS WHEN DISCUSSING HEALTHCARE QUALITY EFFORTS 4HE ONLY WAY TO KNOW WHETHER THE QUALITY OF CARE IS IMPROVING IS TO MEASURE PERFORMANCE 4HERE ARE THREE TYPES OF TOOLS THAT HEALTH ORGANIZATIONS HAVE AT THEIR DISPOSAL TO INmUENCE QUALITY PUBLIC DISCLOSURE OF PERFORMANCE DATA PAYMENT POLICIES AND PERFORMANCE IMPROVEMENT PROCESSES %ACH HINGES ON THE AVAILABILITY OF ACCURATE RELIABLE AND VALID PERFORMANCE MEASURES $ESPITE THE CRITICAL IMPORTANCE OF HAVING VALID INFORMATION DEVELOPMENT OF QUALITY MEASUREMENT STANDARDS REMAINS A WORK IN PROGRESS 4HIS PAPER PROVIDES A HIGH LEVEL SUMMARY OF THE TYPES OF MEASURES AVAILABLE AND THE INNOVATIVE EFFORTS UNDER WAY TO ENHANCE THE AVAILABILITY AND USE OF QUALITY DATA THE ARRAY OF ORGANIZATIONS INVOLVED IN IDENTIFYING DEVELOPING AND DISSEMINATING QUALITY MEASURES AND EXISTING GAPS IN QUALITY DATA AND DEVELOPMENT PRIORITIES FOR THE FUTURE
4YPES OF -EASURES ! LARGE NUMBER OF MEASURES TO ASSESS HEALTHCARE QUALITY ARE AVAILABLE OR UNDER DEVELOPMENT AND THEY ARE GENERALLY CATEGORIZED AS STRUCTURE PROCESS OR OUTCOME MEASURES $ETAILS AND SELECTED EXAMPLES OF EACH ARE DESCRIBED BELOW 'ENERAL FEATURES ARE SUMMARIZED IN %XHIBIT
3TRUCTURE -EASURES !DMINISTRATION/PERATIONS REmECT THE STRUCTURE SYSTEM OR SETTING OF CARE DELIVERY 3OME OF THE MOST COMMON MEASURES ARE THE NUMBER OF BEDS NUMBER OF NURSES PER PATIENT AND ACCREDITATION STATUS 5TILIZATION MEASURES THE FREQUENCY OF SELECTED PROCEDURES INPATIENT ADMISSIONS AND LENGTH OF STAY .UMEROUS RESEARCH STUDIES HAVE DEMONSTRATED THAT HIGHER VOLUMES CORRELATE WITH BETTER OUTCOMES FOR MANY PARTICULARLY HIGH RISK MEDICAL
PROCEDURES 4HE #LEVELAND #LINIC IS ONE PROVIDER THAT REPORTS MULTIPLE UTILIZATION MEASURES ON ITS PUBLIC WEBSITE INCLUDING ITS AVERAGE LENGTH OF STAY THE NUMBER OF HEART TRANSPLANTS ELECTROPHYSIOLOGY CATHETER ABLATION AND OTHER CARDIAC PROCEDURES PERFORMED ANNUALLY AS WELL AS OVER THE LAST FOUR YEARS;= &LORIDA -ASSACHUSETTS 4EXAS .EW *ERSEY 2HODE )SLAND AND /REGON ALL REPORT PROVIDER UTILIZATION ON THEIR PUBLIC WEBSITES &OR EXAMPLE THE 2HODE )SLAND $EPARTMENT OF (EALTH HAS PUBLICLY REPORTED HEALTHCARE QUALITY INFORMATION AND HOSPITAL PERFORMANCE DATA SUCH AS EMERGENCY ROOM UTILIZATION AND INPATIENT LENGTH OF STAY;= /VERALL STATES HAVE GOVERNMENT MANDATES TO REPORT QUALITY INFORMATION TO THE GENERAL PUBLIC;= !ND AS DESCRIBED LATER IN THIS PAPER SEVERAL NATIONAL ORGANIZATIONS SUCH AS #-3 AND *#!(/ PROVIDE INFORMATION TO THE PUBLIC AS WELL 0ATIENT SAFETY MEASURES SPECIlC ACTIONS TO REDUCE MEDICAL ERRORS SUCH AS IMPLEMENTATION OF COMPUTERIZED ORDER ENTRY SYSTEMS AND ESTABLISHMENT OF PROTOCOLS TO REDUCE WRONG SITE OR PROCEDURE ERRORS 4HE ,EAPFROG 'ROUP AN EMPLOYER PURCHASER COALITION GROUP ASSIGNS A h3AFE 0RACTICES 3COREv TO HOSPITALS BASED ON PATIENT SAFETY PRACTICES )TS WEBSITE RANKS HOSPITALS PROGRESS ON hLEAPSv INCLUDING HOSPITAL VOLUME FOR HIGH RISK SURGERY AND NEONATAL INTENSIVE CARE COMPUTERIZED PHYSICIAN ORDER ENTRY AND INTENSIVIST STAFlNG FOR CRITICAL CARE UNITS;=
0ROCESS -EASURES (OSPITAL ORIENTED MEASURES GAUGE THE DEGREE TO WHICH HOSPITALS OFFER CLINICAL INTERVENTIONS AND SERVICES TO PATIENTS #OMMON MEASURES INCLUDE PREVENTIVE SCREENINGS TREATMENT OF CARDIAC DISEASE AND HEART FAILURE DIABETES AND ASTHMA CARE AND MANAGEMENT OF UPPER RESPIRATORY TRACT INFECTIONS (OSPITAL#OMPARECOM A WEBSITE ADMINISTERED BY THE #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3 ALLOWS CONSUMERS TO COMPARE HOSPITALS PERFORMANCE IN PROVIDING RECOMMENDED CARE FOR HEART ATTACKS HEART FAILURE PNEUMONIA AND SURGERY &OR EXAMPLE QUALITY MEASURES FOR HEART ATTACKS INCLUDE THE
(INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@
@#LINICIANS ARE OPEN TO PROFILING IF AND ONLY IF THE DATA ARE PERCEIVED AS VALID 0HYSICIANS IN PARTICULAR LIKE DATA AND IF ONE CAN ASSURE THEM THE DATA ARE VALID THEY WILL RESPOND n %LIZABETH "RADLEY ASSOCIATE PROFESSOR AND DIRECTOR OF THE HEALTH MANAGEMENT PROGRAM WITHIN HEALTH POLICY AND ADMINISTRATION AT THE 9ALE 3CHOOL OF 0UBLIC (EALTH
PERCENTAGE OF PATIENTS PROVIDED BETA BLOCKERS AT ARRIVAL OR DISCHARGE (OSPITALS ALSO REPORT THE PERCENT OF SURGERY PATIENTS WHO RECEIVED ANTIBIOTICS ONE HOUR BEFORE SURGERY A PROCESS THAT REDUCES NOSOCOMIAL INFECTIONS 0HYSICIAN ORIENTED MEASURES REPORT THE DEGREE TO WHICH PHYSICIANS PROVIDE SERVICES TO PATIENTS AND COMPLY WITH SPECIALTY SPECIlC CLINICAL PRACTICE GUIDELINES "ECAUSE OF SAMPLE SIZE CONSTRAINTS AND SOME RESISTANCE FROM PHYSICIANS MOST REPORTING TO DATE HAS BEEN DONE AT THE GROUP LEVEL 0RIORITY (EALTH A HEALTH PLAN BASED IN 'RAND 2APIDS -ICH IS ONE OF THE FEW ORGANIZATIONS THAT PUBLICLY REPORTS PERFORMANCE DATA FOR INDIVIDUAL PRIMARY CARE PHYSICIANS 5SING MEDICAL CLAIMS DATA AUDITS OF MEDICAL REPORTS AND STATE INFORMATION 0RIORITY (EALTH LOOKS AT THE PERCENTAGE OF A PHYSICIANS PATIENTS WHO RECEIVE THE SERVICES IDENTIlED FOR MEASUREMENT EACH YEAR 4ARGETS FOR MOST MEASURES ARE BASED ON TH PERCENTILE PERFORMANCE AGAINST NATIONAL IE (%$)3 BENCHMARKS 0RIORITY (EALTH GIVES PHYSICIANS A SCORE OF FOUR APPLES FOR SUPERIOR PERFORMANCE AGAINST BENCHMARKS 0HYSICIANS WHO SCORE IN THE HIGHEST THIRD OF PERFORMANCE BELOW THE TARGET RATE EARN THREE APPLES ON A MEASURE THE MIDDLE THIRD SCORE TWO APPLES AND THE LOWEST THIRD EARN ONE APPLE (EALTH PLAN MEMBERS CAN USE A PHYSICIAN SEARCH TOOL ON THE WEBSITE TO SORT THE PHYSICIANS ACCORDING TO THEIR NUMBER OF APPLES 4HE SAME LEVEL OF PERFORMANCE THAT EARNS FOUR APPLES ALSO TRIGGERS PAYMENT FOR THE HEALTH PLANS QUALITY BASED PAY FOR PERFORMANCE PROGRAM 0RIORITY (EALTH BELIEVES THAT IT IS IMPORTANT TO TIGHTLY ALIGN TOOLS THAT DRIVE CLINICAL PERFORMANCE IMPROVEMENT;= 0OPULATION BASED MEASURES REmECT CARE FOR ALL PATIENTS WITH A CERTAIN CONDITION OR IN A CERTAIN GEOGRAPHIC LOCATION 4HIS IS TYPICALLY MEASURED BY PAYER &OR EXAMPLE (%$)3 MEASURES FOCUS ON HOW WELL HEALTH PLANS ARE SERVING THE NEEDS OF THEIR ENTIRE MEMBERSHIP /NE MEASURE MIGHT BE BREAST CANCER SCREENINGS 7HILE QUALITY MEASUREMENTS ON INDIVIDUAL PROVIDERS ARE IMPORTANT PAYERS PLAY AN IMPORTANT ROLE IN CREATING THE RIGHT INCENTIVES TO PROVIDE EFlCIENT AND EFFECTIVE CARE 4HEY ALSO CAN CREATE APPROPRIATE INCENTIVES FOR PATIENTS TO REFRAIN FROM EITHER OVER OR UNDERUTILIZING THE SYSTEM 0ATIENT ORIENTED MEASURES ARE AN EMERGING AREA OF QUALITY ASSESSMENT THAT USE hALL OR NONEv DIMENSIONS &OR EXAMPLE ALL OR NONE MEASURES REmECT THE PERCENT OF DIABETES PATIENTS RECEIVING ALL OF THE APPROPRIATE CARE FOR MANAGEMENT OF THEIR CONDITION EG (B!C TESTING LIPID PROlLING RETINAL EXAMINATION
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
FOOT EXAMINATION AND INmUENZA VACCINATION ANNUALLY )N CONTRAST TRADITIONAL POPULATION BASED MEASURES REmECT THE PERCENT OF PATIENTS RECEIVING EACH TEST IE THE PERCENT RECEIVING (B!C TESTING THE PERCENT RECEIVING LIPID PROlLING ETC ! PROVIDER COULD PROVIDE EACH OF THE VARIOUS DIABETES TESTS TO A HIGH PROPORTION OF THE ELIGIBLE PATIENTS BUT STILL MISS ONE OR MORE TESTS FOR THE MAJORITY 4HUS ALL OR NONE MEASUREMENT ENCOURAGES HEALTH PROVIDERS TO THINK AND ACT AS A SYSTEM CONCERNED WITH THE WHOLE SEQUENCE OF CARE AND HANDOFFS NOT ONLY ITS PARTS;=
/UTCOME -EASURES #LINICAL /UTCOMES INCLUDE DISEASE STAGE MORBIDITY AND MORTALITY MEASURES WHICH ARE TYPICALLY ADJUSTED FOR AGE SEVERITY OR OTHER CO DETERMINATES -UCH OF THIS INFORMATION IS AVAILABLE WITHIN INDIVIDUAL HEALTH SYSTEMS OR SELECTED STATES THAT COLLECT CLINICAL DATA &OR EXAMPLE #ALIFORNIAS /FlCE OF 3TATEWIDE (EALTH 0LANNING AND $EVELOPMENT /3(0$ HAS REPORTED CLINICAL OUTCOMES MEASURES FOR SELECT MEDICAL CONDITIONS SINCE )TS MEASURES INCLUDE RISK ADJUSTED DAY MORTALITY RATES AND CLINICAL OUTCOME FOR CORONARY ARTERY BYPASS GRAFT SURGERY AT BOTH THE HOSPITAL AND SURGEON LEVEL;= -OST CLINICAL OUTCOME MEASURES ARE BASED ON COMPLEX RESEARCH MODELS THAT ARE MOST USEFUL TO HEALTHCARE PROFESSIONALS AND PURCHASERS BUT MAY BE DIFlCULT FOR THE AVERAGE CONSUMER TO UNDERSTAND 3ATISFACTION MEASURES PATIENT EMPLOYEE AND PHYSICIAN PERSPECTIVES )N THE PROVIDER SETTING THE #ONSUMER !SSESSMENT OF (EALTHCARE 0ROVIDERS AND 3YSTEMS #!(03 FAMILY OF SURVEYS IS CONSIDERED THE GOLD STANDARD DATA INFORMATION PROGRAM FOR PATIENTS ASSESSMENT OF THE QUALITY OF HOSPITALS AND HEALTH PLANS &OR HOSPITAL SETTINGS MEASURES INCLUDE PATIENT EVALUATIONS OF THEIR COMMUNICATION WITH PHYSICIANS AND NURSES RESPONSIVENESS OF HOSPITAL STAFF CLEANLINESSNOISE LEVEL OF THE PHYSICAL ENVIRONMENT PAIN CONTROL COMMUNICATIONS ABOUT MEDICINE AND DISCHARGE INFORMATION #!(03 IS ALSO DEVELOPING AND TESTING A NEW SURVEY FOR MEASURING AND IMPROVING THE EXPERIENCES OF PATIENTS WITH THEIR PHYSICIANS AND MEDICAL GROUPS INCLUDING PATIENTS PERCEPTIONS REGARDING WHETHER THEY GOT CARE QUICKLY GOT NEEDED CARE HOW WELL PROVIDERS COMMUNICATE AND HOW WELL THE OFlCE STAFF COMMUNICATED -OST INDUSTRY LEADERS EXPECT PATIENT SATISFACTION MEASURES TO GROW IN IMPORTANCE h#ONSUMERS CURRENTLY PLAY A SMALL ROLE IN PERFORMANCE AND QUALITY MEASUREMENT 4HE PREMISE BEHIND #!(03 IS THAT CONSUMERS NEED MORE INFORMATION TO MAKE
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ DECISIONS 7HILE CONSUMERS WILL USE QUALITY INFORMATION MORE IN THE FUTURE THEY DONT USE IT A LOT NOW 9ET HEALTH ORGANIZATIONS BEHAVE AS IF CONSUMERS DO v REMARKS 0AUL $ #LEARY 0H$ PROFESSOR OF HEALTHCARE POLICY IN THE DEPARTMENTS OF HEALTHCARE POLICY AND SOCIAL MEDICINE AT (ARVARD -EDICAL 3CHOOL 4HE HOSPITAL SURVEY IS NOT MANDATORY BUT IS ALREADY VIEWED BY MANY HOSPITALS AS A hVOLUNTARY MANDATEv 5SERS OF #!(03 SURVEY RESULTS INCLUDE PATIENTS AND CONSUMERS QUALITY MONITORS AND REGULATORS PURCHASERS PROVIDER ORGANIZATIONS AND HEALTH PLANS 4HESE INDIVIDUALS AND ORGANIZATIONS USE THE DATA TO INFORM THEIR PURCHASING OR CONTRACTING DECISIONS AND TO IMPROVE THE QUALITY OF HEALTHCARE SERVICES;=
1UALITY $ATA /RGANIZATIONS ! LARGE AND GROWING NUMBER OF FEDERAL AND STATE AGENCIES PUBLIC PRIVATE ALLIANCES AND PRIVATE SECTOR ORGANIZATIONS ARE CURRENTLY INVOLVED IN IDENTIFYING DEVELOPING CERTIFYING IMPLEMENTING AND DISTRIBUTING QUALITY METRICS ! HANDFUL OF STATES ARE BEGINNING TO REPORT VARIOUS QUALITY METRICS 3OME ARE USING THE QUALITY INDICATORS COLLECTED BY -EDICARE SUCH AS ADMINISTRATION OF ANTIBIOTICS BEFORE SURGERY AND BETA BLOCKERS AFTER DISCHARGE /THERS ARE GOING A STEP FURTHER &OR EXAMPLE &LORIDA REPORTS CARDIAC DEATH RATES BY CONDITION
%XHIBIT 'ENERAL 4YPES OF 1UALITY -EASURES 4YPE OF -EASURE
%XAMPLES
3OURCES
!DVANTAGES
3TRUCTURE
6OLUME
!DMINISTRATIVE AND CLAIMS DATA
%ASY AND INEXPENSIVE TO COLLECT ,IMITED IN NUMBER
3TAFlNG LEVELS !CCREDITATION
0ROVIDER SURVEYS
%STABLISHMENT OF PATIENT SAFETY ACTIVITIES
/UTCOME
$O NOT EXIST FOR AMBULATORY CARE
-ORE PREDICTIVE OF SUBSEQUENT 2ARELY REmECT PERFORMANCE OF INDIVIDUAL HOSPITALS PERFORMANCE THAN OTHER MEASURES FOR SOME PROCEDURES OR PROVIDERS EG HIGH RISK SURGERIES 'ENERALLY NOT ACTIONABLE EG A SMALL HOSPITAL OR -OST USEFUL FOR SELECTIVE PHYSICIAN PRACTICE CANNOT REFERRALS AND NETWORK TIERING TURN ITSELF INTO A HIGH VOLUME CENTER
"OARD CERTIlCATION
0ROCESS
/NE MEASURE MAY RELATE TO SEVERAL OUTCOMES
$ISADVANTAGES
!GE APPROPRIATE MAMMOGRAPHY FOR WOMEN
!DMINISTRATIVE AND CLAIMS DATA
!SPIRIN USE FOR PATIENTS WITH CORONARY ARTERY DISEASE
0ROVIDER SURVEYS
2EmECT CARE THAT PATIENTS RECEIVE AND THAT CLINICIANS DELIVER 3UPPORTED BY PROVIDERS !CTIONABLE FOR QUALITY IMPROVEMENT ACTIVITIES
3AMPLE SIZE CONSTRAINTS FOR SOME CONDITIONS ,IMITED UTILITY FOR PROlLING INDIVIDUAL PHYSICIANS OR SMALL PRACTICES OR PAY FOR PERFORMANCE PROGRAMS
'ENERALLY DO NOT REQUIRE RISK ADJUSTMENTS
%XTENT TO WHICH PROCESS MEASURES CORRELATE WITH IMPORTANT OUTCOMES CAN VARY AND IS OFTEN UNKNOWN
2ISK ADJUSTED MORTALITY
-EDICAL CHART REVIEWS
)NTRINSICALLY VALID
3AMPLE SIZE CONSTRAINTS
#OMPLICATION RATES
0ATIENT SURVEYS
.EED FOR RISK ADJUSTMENT
0ATIENT SATISFACTION
!DMINISTRATIVE AND CLAIMS DATA
-EASUREMENT ALONE CAN IMPROVE OUTCOMES
(EALTH STATUS
0ROVIDER SURVEYS 3TATE OR NATIONAL LEVEL CLINICAL REGISTRIES
.OT PARTICULARLY USEFUL FOR MANY AMBULATORY SERVICES WHERE CLEAR OUTCOMES OCCUR INFREQUENTLY OR MUCH LATER THAN THE CARE IS DELIVERED
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ /RGANIZATIONS ACTIVE ON A NATIONAL SCALE INCLUDE THOSE FOUND IN %XHIBIT )N ADDITION TO THESE ORGANIZATIONS A NUMBER OF HEALTH DATA TECHNOLOGY VENDORS SPECIALIZE IN COLLECTION AND MANAGEMENT OF QUALITY DATA 4HEY PROVIDE TIMELY INFORMATION AND IN DEPTH ANALYSIS OF
BOTH PUBLICLY AND PRIVATELY AVAILABLE DATA TO CONSUMERS PROVIDERS HEALTH PLANS AND OTHER INDUSTRY STAKEHOLDERS (OWEVER BECAUSE THEIR DATA AGGREGATION AND REPORTING METHODOLOGIES DIFFER QUALITY RATINGS FOR AN INDIVIDUAL PROVIDER CAN VARY BY VENDOR 3OME OF THE MORE WELL KNOWN COMPANIES ARE PROlLED IN THE !PPENDIX
%XHIBIT .ATIONAL 1UALITY 2ELATED /RGANIZATIONS
/RGANIZATION
3TRUCTURE
$ESCRIPTION
!GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21
&EDERAL AGENCY
!S ONE OF AGENCIES WITHIN THE 53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES !(21 SUPPORTS HEALTH SERVICES RESEARCH THAT WILL IMPROVE THE QUALITY OF HEALTHCARE AND PROMOTE EVIDENCE BASED DECISION MAKING 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWAHRQGOV
!MBULATORY #ARE 1UALITY !LLIANCE !1!
0RIVATE COLLABORATIVE GROUP
)MPROVE HEALTHCARE QUALITY AND PATIENT SAFETY THROUGH A COLLABORATIVE PROCESS IN WHICH KEY STAKEHOLDERS AGREE ON A STRATEGY FOR MEASURING PERFORMANCE AT THE PHYSICIAN OR GROUP LEVEL COLLECTING AND AGGREGATING DATA IN THE LEAST BURDENSOME WAY AND REPORTING MEANINGFUL INFORMATION TO CONSUMERS PHYSICIANS AND OTHER STAKEHOLDERS TO INFORM CHOICES AND IMPROVE OUTCOMES 4HE WEBSITE CAN BE ACCESSED AT HTTPWWW AMBULATORYQUALITYALLIANCEORG
#ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3
&EDERAL AGENCY
!DMINISTERS -EDICARE AND -EDICAID !SSURES HEALTHCARE SECURITY FOR BENElCIARIES 2ECENTLY INITIATED THE QUALITY INITIATIVE IN WHICH HOSPITALS REPORT PERFORMANCE ON QUALITY INDICATORS TO RECEIVE HIGHER REIMBURSEMENT FROM -EDICARE 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWCMSHHSGOV
*OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS *#!(/
)NDEPENDENT NOT FOR PROlT
*#!(/ EVALUATES AND ACCREDITS MORE THAN HEALTHCARE ORGANIZATIONS AND PROGRAMS IN THE 5NITED 3TATES *#!(/ HAS DEEMED STATUS FROM -EDICARE )TS /298¸ INITIATIVE INTEGRATES OUTCOMES AND OTHER PERFORMANCE MEASUREMENT DATA INTO THE ACCREDITATION PROCESS 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWJOINTCOMMISSIONORG
.ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1!
0RIVATE NOT FOR PROlT
'ENERATES INFORMATION TO IMPROVE THE QUALITY OF HEALTHCARE TO HELP INFORM CONSUMER AND EMPLOYER CHOICE !CCREDITS HEALTH PLANS THAT MEET CERTAIN QUALITY METRICS 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWNCQAORG
.ATIONAL 1UALITY &ORUM .1&
0RIVATE NOT FOR PROlT
#REATED TO DEVELOP AND IMPLEMENT A NATIONAL STRATEGY FOR HEALTHCARE QUALITY MEASUREMENT AND REPORTING 4HE MISSION OF THE .1& IS TO IMPROVE !MERICAN HEALTHCARE THROUGH ENDORSEMENT OF CONSENSUS BASED NATIONAL STANDARDS FOR MEASUREMENT AND PUBLIC REPORTING OF HEALTHCARE PERFORMANCE DATA THAT PROVIDE MEANINGFUL INFORMATION ABOUT WHETHER CARE IS SAFE EFFECTIVE PATIENT CENTERED EFlCIENT TIMELY AND EQUITABLE 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWQUALITYFORUMORG
0HYSICIAN #ONSORTIUM FOR 0ERFORMANCE )MPROVEMENT
0ROFESSIONAL SOCIETY ASSOCIATION
! GROUP OF CLINICAL AND METHODOLOGICAL EXPERTS CONVENED BY THE !MERICAN -EDICAL !SSOCIATION TO PROVIDE EVIDENCE BASED CLINICAL PERFORMANCE MEASURES AND OUTCOMES REPORTING TOOLS FOR PHYSICIANS AND TO ENSURE THAT ALL COMPONENTS OF THE MEDICAL PROFESSION HAVE A VOICE IN NATIONAL FORUMS SEEKING TO EVALUATE THE QUALITY OF PATIENT CARE 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWAMA ASSNORGAMAPUB CATEGORYHTML
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@
@$IFFERENT HEALTHCARE STAFF NEED DIFFERENT TOOLS 7E NEED A RANGE OF TOOLS AND RE SOURCES TO ADDRESS WHY MEASURES ARE IMPORTANT WHAT THE METRICS MEAN HOW TO UNDERSTAND VARIATION IN DATA BY MARKET SEGMENT AND ASSISTANCE TO INTERPRET OR SEE hCOLORv AROUND NUMBERS n *OE #ARMICHAEL PRESIDENT OF .2# 0ICKER
)NDUSTRY 'ETS THE &IRST 3WING AT 1UALITY 1UALITY ASSESSMENT RESTS WITH INDUSTRY HEALTH ORGANIZATIONS GET THE lRST SWING AT DEVELOPING QUALITY MEASURES )F THEY DO NOT CONNECT GOVERNMENT MAY STEP IN /NE HISTORICAL EXAMPLE OF HOW THE INDUSTRY HAS RESPONDED TO THE NEED FOR QUALITY MEASURES IS THE .#1! WHICH BEGAN ACCREDITING MANAGED CARE ORGANIZATIONS IN 4HE S WERE AN ERA IN WHICH !MERICANS WERE VOICING DOUBTS ABOUT MANAGED CARE AND THE .#1! WAS FORMED AROUND THE NEED FOR STANDARDIZED OBJECTIVE INFORMATION ABOUT THE QUALITY OF HEALTH PLANS 7HILE THE ACCREDITATION IS VOLUNTARY LARGE EMPLOYERS AND HEALTH PLANS EMBRACED THE OPPORTUNITY (%$)3 REPORTS EFFECTIVENESS CARE MEASURES FOR THE MILLION !MERICANS ENROLLED IN .#1! ACCREDITED HEALTH PLANS .#1! REPORTS THAT QUALITY HAS IMPROVED n A TESTAMENT TO MEASURING AND PUBLISHING QUALITY STANDARDS &OR EXAMPLE MEMBERS IN COMMERCIAL HEALTH PLANS ACCREDITED BY .#1! ARE NOW MORE LIKELY TO RECEIVE BETA BLOCKERS AFTER A HEART ATTACK AND CHOLESTEROL MANAGEMENT SEE %XHIBIT ;= 4ODAY A SIMILAR DYNAMIC EXISTS AROUND DRUG SAFETY $ESPITE THE ESTABLISHMENT OF A NEW DRUG SAFETY OVERSIGHT BOARD A -ARCH REPORT FROM THE 53 'OVERNMENT !CCOUNTABILITY /FlCE '!/ CRITICIZED THE &OOD AND $RUG !DMINISTRATION &$! FOR FAILURE TO TAKE STRONG ACTION AGAINST POST MARKET DRUGS THAT APPEAR UNSAFE;= )N PARTICULAR THE REPORT NOTED THE &$!S INABILITY TO ENSURE THAT LONG TERM POST MARKET FOLLOW UP STUDIES ARE CONDUCTED CITING THAT PERCENT OF STUDIES AGREED UPON WERE CARRIED OUT BETWEEN AND 'IVEN RECENT
%XHIBIT #OMMERCIAL 0AYER %FFECTIVENESS #ARE -EASURES
PATTERNS OF BEHAVIOR AND THE ATTENTION CURRENTLY DEVOTED TO THE ISSUE OF DRUG SAFETY THE '!/S lNDINGS COULD REASONABLY INDUCE #ONGRESS TO ENACT LEGISLATION TO ENHANCE THE OVERSIGHT AUTHORITY OF REGULATORY AGENCIES AROUND POST MARKET DRUG SAFETY 4HESE EFFORTS ARE PROMPTING PHARMACEUTICAL COMPANIES TO RETHINK THEIR PROCESSES AROUND DRUG SAFETY "Y VIEWING POST MARKET SAFETY AS A COMPONENT OF A CONTINUUM AND BY PERFORMING ADVANCED DATA MINING AND ANALYTICS ACROSS AN INTEGRATED DATA SET ORGANIZATIONS CAN IMPROVE THEIR SEARCH FOR SAFETY SIGNALS AND MEET THE RENEWED DRUG SAFETY EXPECTATIONS -ANY WOULD ARGUE THAT INDUSTRY KNOWS BEST HOW TO CREATE THE APPROPRIATE QUALITY STANDARDS YET LACKS THE DISCIPLINE TO ADMINISTER THEM "RAD "UXTON DIVISIONAL SENIOR VICE PRESIDENT HEALTHCARE MANAGEMENT FOR (EALTH #ARE 3ERVICE #ORP REMEMBERS WHEN THE "LUES PLANS WERE PUTTING TOGETHER A STATEWIDE HEART NETWORK BASED ON QUALITY AND EFlCIENCY BENCHMARKS /NLY OUT OF HOSPITALS MADE IT INTO THE NETWORK AND WHILE SOME HOSPITAL EXECUTIVES WERE OUTRAGED AT THEIR EXCLUSION OTHERS WERE GRATEFUL h0AYING THE HEALTHCARE DELIVERY SYSTEM ACCORDING TO RESULTS NOT ONLY WILL IMPROVE THE CARE PEOPLE RECEIVE BUT HAS PROVEN IT CAN CONTROL THE TREND v SAYS "UXTON
! #ALL FOR 3TANDARDIZATION AND #OORDINATION 4HE CURRENT ENVIRONMENT HAS RESULTED IN WIDELY DIVERSE QUALITY MEASURES AS WELL AS SIMILAR MEASURES WITH DIFFERENT METHODOLOGIES AND DElNITIONS AND CALLS FROM HEALTHCARE PROFESSIONALS TO CREATE REPORTING STANDARDS !S NOTED BY #HRISTINE + #ASSEL -$ PRESIDENT AND #%/ OF THE !MERICAN "OARD OF )NTERNAL -EDICINE h#URRENTLY WE HAVE A VIRTUAL SOUP OF DIFFERENT MEASUREMENT REQUIREMENTS /UR GOAL IS TO REDUCE THE REDUNDANCY OF THE MEASURING REQUIREMENTSv 2ECOGNIZING THIS NEED QUALITY DATA ORGANIZATIONS ARE ATTEMPTING TO ENSURE CONSENSUS AND ALIGNMENT BY PARTICIPATING IN EACH OTHERS STEERING COMMITTEES AND REVIEW PROCESSES AS DEPICTED IN %XHIBIT h7ERE MOVING BEYOND COMPETING MEASURES AND TOWARDS GETTING PEOPLE AND ORGANIZATIONS TOGETHER TO REACH A CONSENSUS ON WHAT THE STANDARD MEASURES ARE v SAYS (ARVARDS #LEARY "UT THIS CONSENSUS BUILDING REQUIRES EXTENSIVE RESOURCES AND TIME 3OME HAVE ALSO NOTED THAT AS LONG AS CONSENSUS IS UTILIZED TO ESTABLISH QUALITY MEASURES PROGRESS WILL BE IMPEDED
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ %XHIBIT ! #ACOPHONY OF 0LAYERS !CTIVITIES AND -EASURES
3OURCE 0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT )NSTITUTE OF -EDICINE !PPENDIX "
h4HE PROGRESS IS SLOW )T TAKES SIGNIlCANT TIME FOR A MEASURE TO BE DEVELOPED PILOTED TESTED REACH A NATIONAL LEVEL AND BE ENDORSED YET STANDARDIZATION IS IMPORTANT v STATES "ARBARA ! 2UDOLPH 0H$ DIRECTOR OF LEAPS AND MEASURES FOR 4HE ,EAPFROG 'ROUP AN EMPLOYER COALITION FOCUSED ON QUALITY 3EVERAL SOLUTIONS HAVE BEEN SUGGESTED TO ADDRESS THE NEED FOR STANDARDIZATION AND COORDINATION 4HE )/- IN ITS REPORT TITLED h0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT v HAS RECOMMENDED THE CREATION OF A FEDERAL .ATIONAL 1UALITY #OORDINATION "OARD TO DEVELOP STANDARD PERFORMANCE MEASURES AND MONITOR THE NATIONS PROGRESS TOWARD QUALITY GOALS 0RIVATE SECTOR EFFORTS HAVE ALSO BEEN PROPOSED *ANET - #ORRIGAN 0H$ -"! PRESIDENT AND CHIEF EXECUTIVE OFlCER OF THE .1& WOULD LIKE TO MAKE THE ENDORSEMENT PROCESS MORE EFlCIENT
&UTURE 0RIORITIES #LOSING THE 'APS IN 1UALITY )NFORMATION 7HILE THE INDUSTRY IS BEGINNING TO RECOGNIZE THE IMPORTANCE OF TRANSPARENCY IN QUALITY MEASURES MANY GAPS REMAIN 4HE MAJORITY OF QUALITY DATA REPORTED IS IN REGARD TO PATIENTS EXPERIENCES IN HOSPITALS OR WITH HEALTH PLANS 1UALITY DATA REMAINS RELATIVELY
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
LIMITED ON INDIVIDUAL PHYSICIANS NURSING CARE FACILITIES HOME HEALTH AGENCIES PSYCHIATRIC TREATMENT FACILITIES AND AMBULATORY CARE CENTERS -EASUREMENT ORGANIZATIONS CONTINUE TO STRUGGLE WITH HOW TO RISK ADJUST QUALITY PERFORMANCE FOR LOW VOLUME PROVIDERS -OST DATA ARE REPORTED IN AGGREGATE AT THE PHYSICIAN GROUP AND PATIENT POPULATION LEVEL BUT CARE IS PROVIDED BY INDIVIDUAL PHYSICIANS AND TO INDIVIDUAL PATIENTS h7E NEED A PROCESS THAT CUTS ACROSS ALL SPECIALTIES AND IS BASED ON SCIENCE %ACH SPECIALTY IS DEVELOPING ITS OWN MEASURES n AND ONCE YOU GET BEYOND DIABETES ASTHMA ETC THERE IS NO SCIENTIlC AGREEMENT ON WHAT SHOULD BE MEASURED 4HIS LACK OF CLARITY ON WHAT GOOD CARE IS PRESENTS A HUGE PROBLEM THAT MUST BE RESOLVED BASED ON SCIENTIlC EVIDENCE AND MEDICAL KNOWLEDGE v STATES -ARGARET % /+ANE PRESIDENT OF .#1! 0ART OF THE CHALLENGE LIES IN MULTIPLE PERHAPS EVEN COMPETING OBJECTIVES FOR QUALITY DATA 4ODAYS QUALITY METRICS HAVE MANY PURPOSES INCLUDING PUBLIC REPORTING DEVELOPMENT OF PROFESSIONAL STANDARDS lNANCIAL INCENTIVES GOVERNMENTAL OVERSIGHT PROFESSIONAL CERTIlCATION QUALITY IMPROVEMENT AND SELECTIVE REFERRAL NETWORK TIERING h4HERES BEEN SOME PUSHBACK BY PROVIDERS THAT IF THE MEASURE ISNT USEFUL FOR QUALITY IMPROVEMENT PURPOSES ITS NOT A USEFUL MEASURE !S MUCH PROGRESS AS WERE
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ MAKING IN PUBLIC REPORTING THERE IS EQUAL EFFORT TO ELIMINATE MEASURES WHICH ARE MEANINGFUL FOR CONSUMERS 7E NEED TO BE CLEAR THAT THERE ARE MEASURES WHICH MAY NOT BE GEARED TOWARD QUALITY IMPROVEMENT BUT ARE IMPORTANT FOR PUBLIC REPORTING v SAYS ,EAPFROGS 2UDOLPH )N ITS h0ERFORMANCE -EASUREMENTv REPORT THE )/- NOTED THAT MOST PERFORMANCE MEASUREMENT PROJECTS TO DATE HAVE RELIED ON A SMALL SET OF TECHNICAL QUALITY MEASURES DERIVED FROM ADMINISTRATIVE DATA AND FROM PATIENT SURVEYS 4HESE MEASURES DO NOT ANSWER KEY QUESTIONS SUCH AS WHETHER PATIENTS RECEIVED THE FULL SET OF SERVICES AND ONLY THOSE SERVICES FROM WHICH THEY WOULD LIKELY BENElT WHETHER SERVICES WERE PROVIDED IN A TIMELY AND EFlCIENT MANNER AND WHETHER PATIENTS ACHIEVED THE DESIRED SHORT AND LONG TERM OUTCOMES )T NOTED GAPS IN MEASURES OF
7HATS 6ALID )/-S #RITERIA FOR -EASURE 3ELECTION )/- HAS RECOMMENDED A hSTARTER SETv OF HOSPITAL MEASURES AMBULATORY CARE MEASURES AND HEALTH PLAN MEASURES THAT COULD BE USED TO ALIGN PERFORMANCE WITH PAYMENT UNDER THE -EDICARE PROGRAM #RITERIA FOR SELECTION WERE 3 CIENTIlCALLY 3OUND 4HE EVIDENCE BASE IS RELIABLE VALID AND EXPLICIT & EASIBLE 4HE DATA NEEDED FOR A MEASURE ARE IN CURRENT USE AVAILABLE AND EXAMINED FOR THE COST OR BURDEN OF MEASUREMENT ON PROVIDERS ) MPORTANT 4HE MEASURE ADDRESSES A LEADING CAUSE OF DEATH OR DISABILITY OR IS ASSOCIATED WITH HIGH RESOURCE USE AND MUST HAVE AN IMPACT ON HEALTH ! LIGNED -EASURES SHOULD BE DRAWN FROM EXISTING MEASURE SETS AND WITH THE SAME DElNITIONS TO REDUCE REDUNDANCY AND THE BURDEN OF REPORTING # OMPREHENSIVE -EASURES SHOULD BE PART OF A SET TO REmECT QUALITY IN A PARTICULAR AREA OF CARE OR BUNDLED SERVICES OF NECESSARY CARE FOR A GIVEN CONDITION 4HE MEASURE SET SHOULD ADDRESS THE WAY CARE IS DELIVERED AND THE NATURE OF THE QUALITY PROBLEM SOLVED n UNDERUSE MISUSE OR OVERUSE 3OURCE h0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT v #OMMITTEE ON REDESIGNING HEALTH INSURANCE PERFORMANCE MEASURES PAYMENT AND PERFORMANCE IMPROVEMENT PROGRAMS "OARD ON (EALTH #ARE 3ERVICES )NSTITUTE OF -EDICINE
PATIENT CENTERED CARE EQUITY AND EFlCIENCY AS WELL AS MEASURES FOR CHILDREN OR THOSE AT THE END OF LIFE -OST MEASURES FOCUS ON A SINGLE POINT IN TIME AND DO NOT ASSESS CARE ACROSS SETTINGS !ND MOST MEASURES FOCUS ON AN INDIVIDUAL PROVIDERS ACTIONS RATHER
THAN SHARED ACCOUNTABILITY h4HE BARRIERS TO REALIZING OUR VISION ARE NOT SO MUCH AT NATIONAL LEVEL BUT IN DELIVERY SYSTEMS )TS NOT TRIVIAL TO IMPLEMENT COMPOSITE MEASURES THAT CROSS THE DELIVERY SYSTEM 7E NEED NEW RELATIONSHIPS TO SHARE AND LINK DATA AND NEW LINKAGES TO COORDINATE CARE v SAYS .1&S #ORRIGAN !S QUALITY MEASURES BECOME MORE UBIQUITOUS AND POTENT IN THEIR USE AS AGENTS OF CHANGE BOTH INTENDED AND UNINTENDED OUTCOMES MUST BE CONSIDERED )NCREASED AVAILABILITY OF INTEGRATED INFORMATION SYSTEMS WILL BE CRITICAL IN THIS REGARD h4HE NEXT MOVE WILL BE TO DEVELOP INFORMATION SYSTEMS TO SUPPORT CLINICAL CARE FROM WHICH QUALITY INDICATORS CAN BE EXTRACTED IN REAL TIME AND AT MINIMAL COSTS v STATES (ARVARDS #LEARY h)NFORMATION TECHNOLOGY ISNT THE PANACEA BUT ITS THE RATE LIMITED STEP IN MUCH OF WHAT WERE DOING RIGHT NOWv #AROLYN - #LANCY -$ DIRECTOR OF THE !(21 AGREES THAT h4HE SYSTEMS SOLUTIONS ARENT SIMPLE 7E CANT YET REPORT ON QUALITY n EVEN WITHIN HEALTHCARE ORGANIZATIONS THAT HAVE ELECTRONIC HEALTH RECORDS n BY HITTING @& &OR EXAMPLE WE CANT IDENTIFY THE CORRECT DENOMINATOR WITHOUT SOME MANUAL ABSTRACTINGv 4HE BOTTOM LINE IS THAT MORE WORK NEEDS TO BE DONE TO INCREASE THE USEFULNESS OF QUALITY DATA h! CARDINAL PRINCIPLE OF HIGH QUALITY HEALTHCARE IS THAT IT BE PATIENT CENTERED 4HOUGH HEALTHCARE SERVICES INVOLVE MANY DIFFERENT STAKEHOLDERS INCLUDING PROVIDERS INSURERS AND PURCHASERS AND REGULATORS THE FOCUS ULTIMATELY HAS TO BE ON ONE PARTICULAR CONSUMER GROUP n THE PATIENTS v SAYS *OHN # 2ING -$ DIRECTOR OF THE BOARD ON HEALTHCARE SERVICES OF THE )/- *OE #ARMICHAEL PRESIDENT OF .2# 0ICKER A MARKET RESEARCH lRM THAT CONDUCTS PATIENT SATISFACTION SURVEYS AGREES ABOUT THE NEED TO FOCUS ON HOW THE DATA IS USED RATHER THAN MEASUREMENT FOR ITS OWN SAKE h)TS NOT ABOUT MEASUREMENT ITS ABOUT IMPROVEMENT )TS NOT ABOUT COLLECTING DATA ITS ABOUT TRYING TO IMPROVE THE QUALITY OF HEALTHCARE )TS NOT ABOUT A THREE RING BINDER THATS A LAUNDRY LIST OF IMPROVEMENT IDEAS )DEAS NEED TO BE IDENTIlED BY AREAS OF WEAKNESS AND TAILORED TO AN ORGANIZATIONS PERFORMANCEv 5LTIMATELY ITS NOT ABOUT MEASUREMENT FOR MEASUREMENTS SAKE n BUT FOR IMPROVED QUALITY OF CARE
!PPENDIX 3ELECTED $ATA 4ECHNOLOGY 6ENDORS 3UBIMO IS A PRIVATE FOR PROlT COMPANY THAT PROVIDES DECISION SUPPORT TOOLS TO HELP CONSUMERS OBTAIN HEALTHCARE INFORMATION 4HE COMPANY ALSO OFFERS SUPPORT TOOLS FOR HEALTH INSURANCE PURCHASERS 3UBSCRIBERS PAY AN ANNUAL FEE TO HAVE ACCESS TO HOSPITAL COMPARISON TOOLS AND GENERAL PHYSICIAN INFORMATION SUCH AS AGE OFlCE LOCATION AND THE PHYSICIANS MEDICAL SCHOOL 3UBIMO ALLOWS THE USER TO OBTAIN COMPARISON INFORMATION OF HOSPITALS BY INDIVIDUALLY RANKING THE IMPORTANCE OF SELECTED FACTORS AND CHOOSING ONE OF PROCEDURES OR CONDITIONS WITHIN SPECIlC AREAS 4HE WEBSITE CAN BE ACCESSED AT WWW SUBIMOCOM
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ (EALTH'RADES IS A PRIVATE FOR PROlT COMPANY THAT RATES PERFORMANCE FOR ALMOST EVERY HOSPITAL IN THE NATION IN ADDITION TO NURSING HOMES AND HOME HEALTH AGENCIES 4HE WEBSITE ALSO PROVIDES RESEARCH ON PHYSICIANS INCLUDING BOARD CERTIlCATION MEDICAL EDUCATION AND PATIENT SATISFACTION RESULTS 4HE HOSPITAL AND PHYSICIAN REPORTS REQUIRE AN ACCESS FEE 4HE WEBSITE WWW HEALTHGRADESCOM ALSO PROVIDES FREE ACCESS TO HOSPITAL RATINGS ON IN HOSPITAL AND POST HOSPITAL STAY PATIENT MORTALITY FOR DIFFERENT PROCEDURESDIAGNOSES 3OLUCIENT UTILIZES PUBLIC DATA SUCH AS THE -EDICARE 0ROVIDER !NALYSIS AND 2EVIEW DATA SET THE #ENTERS FOR -EDICARE -EDICAID 3ERVICES 3TANDARD !NALYTICAL &ILE AND -EDICARE #OST 2EPORTS 3OLUCIENT PRODUCES A LIST OF THE TOP HOSPITALS IN THE NATION AND BENCHMARKS HOSPITALS BASED ON CLINICAL OUTCOMES CLINICAL PROCESS AND OPERATIONAL MEASURES 3OLUCIENT DATA CAN BE ACCESSED FROM WWWSOLUCIENTCOM 7EB-$ 1UALITY 3ERVICES FORMERLY KNOWN AS (EALTHSCORE 4ECHNOLOGY PROVIDES TWO TOOLS TO ASSIST HEALTH PLAN MEMBERS EMPLOYEES AND PURCHASERS COMPARE HOSPITAL QUALITY 3ELECT 1UALITY #ARE #ONSUMER IS A 7EB BASED TOOL THAT PROVIDES CONSUMERS WITH SEVERITY ADJUSTED CONDITION SPECIlC SIDE BY SIDE COMPARISONS OF ADMINISTRATIVE AND UTILIZATION MEASURES AND CLINICAL OUTCOMES 3ELECT 1UALITY #ARE 0ROFESSIONAL OFFERS MORE IN DEPTH ANALYSIS OF SEVERITY ADJUSTED USING 2$2'S OR !02 $2'S PUBLICLY AVAILABLE DATA TO COMPARE HOSPITAL PERFORMANCE BASED UPON BOTH COST AND QUALITY !(21 QUALITY INDICATORS ,EAPFROG AND #-3 MEASURES ARE ALSO INCORPORATED 4HE WEBSITE CAN BE ACCESSED AT WWWSELECTQUALITYCARECOM (EALTH "ENCHMARKS )NC OFFERS SEVERAL PRODUCTS THAT SUPPORT HEALTH PLANS IN EVALUATING PHYSICIAN AND HOSPITAL QUALITY 4O EVALUATE PHYSICIAN CARE QUALITY (") HAS DEVELOPED MORE THAN QUALITY INDICATORS ACROSS lVE SPECIALTY AREAS )TS &OCUS
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
#ARE (OSPITAL PRODUCT INCLUDES HOSPITAL PERFORMANCE INDICATORS THAT MEASURE HEALTH OUTCOMES PATIENT SATISFACTION AND RESOURCE USE (") UTILIZES A CLINICAL ADVISORY GROUP OF PHYSICIANS AND STATISTICIANS TO DEVELOP A FRAMEWORK THAT PROVIDES A COMPREHENSIVE EVALUATION OF HOSPITAL SYSTEMS AND SERVICES 4HE WEBSITE CAN BE ACCESSED AT WWWHEALTHBENCHMARKSCOM %NDNOTES 1UALITY -EASURES AT THE #LEVELAND #LINIC HTTPWWWCLEVELANDCLINIC ORGQUALITY 2HODE )SLAND $EPARTMENT OF (EALTH 0ERFORMANCE -EASUREMENT AND 2EPORTING ACCESSED -ARCH HTTPWWWHEALTHRIGOVCHIC PERFORMANCE h4HE 3TATE OF THE !RT OF /NLINE (OSPITAL 0UBLIC 2EPORTING ! 2EVIEW OF &IFTY /NE 7EBSITES v ND EDITION *ULY HTTPWWWDELMARVAFOUNDATIONORGNEWS!ND0UBLICATIONSPRESS 2ELEASES??PDF h4HE .ATIONAL 1UALITY &ORUM 3AFE 0RACTICES ,EAP v 4HE ,EAPFROG 'ROUP &ACT SHEET !PRIL HTTPWWWLEAPFROGGROUPORGMEDIA lLE,EAPFROG .ATIONAL?1UALITY?&ORUM?3AFE?0RACTICES?,EAPPDF )NFORMATION PRESENTED AT THE 7ORLD (EALTH #ARE #ONGRESS 7ASHINGTON $# !PRIL AND POSTED ON WWWPRIORITYHEALTHCOM ACCESSED !PRIL HTTPWWWPRIORITY HEALTHCOMSAFETYQUALITYAPPLES .OLAN 4 AND $ - "ERWICK h!LL OR .ONE -EASUREMENT 2AISES THE "AR ON 0ERFORMANCE -ARCH *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP /FlCE OF 3TATEWIDE (EALTH 0LANNING AND $EVELOPMENT (EALTHCARE 1UALITY !NALYSIS $IVISION (EALTH /UTCOMES #ENTER ACCESSED -ARCH HTTPWWWOSHPDCAHWNETGOVHQAD/UTCOMESINDEXHTM #!(03 /VERVIEW HTTPSWWWCAHPSAHRQGOVCONTENTCAHPS/VERVIEW /6%2?)NTROASP h4HE 3TATE OF (EALTH #ARE 1UALITY v .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE 7ASHINGTON $# ACCESSED -AY HTTPWWWNCQAORG$OCS3/(#1?PDF h$RUG 3AFETY )MPROVEMENT .EEDED IN &$!S 0OSTMARKET $ECISION MAKING AND /VERSIGHT 0ROCESS v REPORT TO #ONGRESSIONAL 2EQUESTERS '!/ -ARCH HTTPWWWGAOGOVNEWITEMSDPDF
4HE (ORIZON "EYOND ()0!! "ALANCING 0RIVACY AND 3ECURITY 7ITH 0ATIENT #ARE 0ROVIDERS CAN BALANCE THE NEED FOR PRIVACY WITH THE NEED TO PROVIDE THE BEST POSSIBLE CARE CREATING MEANINGFUL OPPORTUNITIES FOR ONGOING QUALITY IMPROVEMENT THAT ALSO BECOME COMPETITIVE ADVANTAGES "Y 2ICHARD "AICH *EFF &USILE *AMES +OENIG AND #INDY 3MITH 0RICEWATERHOUSE#OOPERS
! -ATTER OF 0ERSPECTIVE )NFORMATION TECHNOLOGY HAS ENHANCED THE PRACTICE OF MEDICINE DRAMATICALLY PARTICULARLY IN RECENT YEARS 0ROVIDERS TODAY HAVE ACCESS TO TREMENDOUS VOLUMES AND TYPES OF INFORMATION AND A REMARKABLE ABILITY TO COMMUNICATE WITH COLLEAGUES AND PATIENTS IN VIRTUAL REAL TIME /BTAINING AND RECORDING PATIENT INFORMATION PLANNING PATIENT CARE INTERPRETING RESULTS AND RESEARCHING NEW MODALITIES ALL BENElT FROM MAXIMIZED USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES BUT THESE TECHNOLOGIES ALSO INCREASE THE POSSIBILITY THAT UNWELCOME PARTIES MAY GAIN ACCESS TO PATIENT INFORMATION 4ECHNOLOGY HAS EMPOWERED MANY TO COLLECT COPIOUS AMOUNTS OF DATA MUCH OF WHICH CAN BE STORED ON AND ACCESSED FROM VARIOUS lXED AND MOBILE DEVICES 4HESE DEVICES CONTINUE TO GROW SMALLER WHILE THEIR STORAGE CAPABILITY INCREASES SUBSTANTIALLY n A GIGABYTE OF DATA CAN COMMONLY BE STORED ON A 53" mASH DRIVE THAT EASILY ATTACHES TO CAR KEYS !LTHOUGH THIS TECHNOLOGY ENABLES GREATER BUSINESS PROCESS mEXIBILITY AND EFFECTIVENESS IT INHERENTLY PRESENTS AN OPPORTUNITY FOR INFORMATION LOSS AND MISUSE 4HE POSSIBILITIES EXTEND WIDELY INCLUDING LAPTOPS STOLEN FROM
AUTOMOBILES MISPLACED BACKUP TAPES AND #$S ERRANT EMAILS HACKERS AND )$ THIEVES AND CARELESS DISHONEST OR DISGRUNTLED EMPLOYEES 4HE RESULTS COULD INCLUDE USE OF AN INDIVIDUALS NAME AND HEALTH INFORMATION TO OBTAIN MEDICAL CARE OR UNSCRUPULOUS PROVIDERS USING PATIENT INFORMATION TO RECEIVE REIMBURSEMENT FOR TESTS AND OTHER SERVICES THAT WERE NEVER PROVIDED !LTHOUGH THE CONmICT BETWEEN OPENNESS AND SECURITY ON THE HEALTH INFORMATION HIGHWAY PRESENTS CHALLENGES IT DOES NOT AND CANNOT CREATE A BARRIER TO QUALITY .EITHER THE (EALTH )NSURANCE 0ORTABILITY AND !CCOUNTABILITY !CT OF ()0!! NOR ANY OTHER REGULATIONS PRECLUDE PROVIDERS FROM IMPLEMENTING QUALITY IMPROVEMENTS THROUGH INFORMATION TECHNOLOGY ! RECENT RULING SUGGESTED THAT ()0!!S GOAL OF PRIVACY SHOULD NOT INTERFERE WITH THE PROVISION OF THE BEST POSSIBLE HEALTHCARE WHEN THE /HIO 3UPREME #OURT RULED THAT THE STATES OPEN RECORDS LAW SUPERSEDES ()0!! )N ITS UNANIMOUS -ARCH DECISION THE COURT FOUND THAT THE #INCINNATI (EALTH $EPARTMENT ERRED BY CITING PERSONAL HEALTH INFORMATION PRIVACY WHEN IT REFUSED TO RELEASE RECORDS ABOUT LANDLORDS AND HOMEOWNERS CITED FOR LEAD PAINT CONTAMINATION ;=
2ICHARD "AICH -"! -3- #)330 #)3- IS A MANAGING DIRECTOR WITH 0RICEWATERHOUSE#OOPERS 0ERFORMANCE )MPROVEMENT PRACTICE (E IS A FORMER #)3/ AND A PUBLISHED AUTHOR (E HAS OVER YEARS EXPERIENCE FOCUSING ON DELIVERING SOLUTIONS WHICH ENABLE ORGANIZATIONS TO EFFECTIVELY AND EFlCIENTLY BALANCE RISK TECHNOLOGY AND DATA MANAGEMENT DECISIONS WITH DATA PROTECTION RISKS REGULATORY COMPLIANCE ISSUES AND SECURITY CONTROLS (E CAN BE REACHED AT RICHBAICH USPWCCOM *EFF &USILE IS A PARTNER WITH 0RICEWATERHOUSE#OOPERS (E HAS NEARLY YEARS OF HEALTHCARE INDUSTRY EXPERIENCE AND IS A LEADER IN THE lRMS 2EGULATORY #OMPLIANCE AND 'OVERNANCE TEAM (E IS ALSO LEADER OF 0W#S ()0!! !DVISORY 3ERVICES PRACTICE AND IS AN ELECTED MEMBER OF THE BOARD OF DIRECTORS FOR THE 7ORKGROUP FOR %LECTRONIC $ATA )NTERCHANGE 7%$) (E CAN BE REACHED AT JEFFFUSILE US PWCCOM *AMES +OENIG #)00 IS A LEADER OF 0RICEWATERHOUSE#OOPERS 0RIVACY 3TRATEGY AND #OMPLIANCE PRACTICE (E HAS AN EXTENSIVE BUSINESS TECHNOLOGY AND LEGAL BACKGROUND AND IS A RECOGNIZED AUTHORITY ON PRIVACY ISSUES IMPACTING HEALTHCARE lNANCIAL SERVICES DIRECT MARKETING AND TECHNOLOGY *AMES PROVIDES GLOBAL PRIVACY AND SECURITY STRATEGY COMPLIANCE AND TRAINING SERVICES FOCUSED ON 2/) DRIVEN SOLUTIONS THAT BALANCE THE GOALS OF BUSINESS WITH RESPECT FOR CONSUMER PRIVACY (E CAN BE REACHED AT JAMESHKOENIG US PWCCOM #INDY 3MITH #)330 IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS 0ERFORMANCE )MPROVEMENT PRACTICE 3HE HAS OVER YEARS EXPERIENCE IN INFORMATION SECURITY INCLUDING STRATEGY DEVELOPMENT RISK ASSESSMENTS TOOL SELECTIONIMPLEMENTATION AND COMPLIANCE PROGRAM DEVELOPMENT 3HE HAS MANAGED REGULATORY COMPLIANCE AND TECHNICAL SECURITY ASSESSMENTS AT "#"3 ORGANIZATIONS HEALTH PLANS HOSPITALS PHARMACEUTICAL COMPANIES DRUGSTORE CHAINS GOVERNMENT AGENCIES BEHAVIORAL HEALTH PROVIDERS AND FOR EMPLOYERS 3HE CAN BE REACHED AT CYNTHIAESMITH USPWCCOM
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
S G Dã GN QHYN MãADXN MCã'( /
ãA@K@MBHMFãOQHU@BXã@MCãRD BT QHSXãVHSGãO @SHD MSãB@QD
@)N THE FUTURE THE DEBATE ABOUT TRANSPARENCY WILL BE OVER WE WILL JUST DO IT 4HERE WILL BE MORE SUCCESS STORIES 7E WILL LOOK BACK AND SAY THAT THE DECISION TO PUBLICLY REPORT PATIENT EXPERIENCE MADE A DIFFERENCE IN PERFORMANCE n *OE #ARMICHAEL PRESIDENT OF .2# 0ICKER 4O BE WELL BALANCED AND EFFECTIVE A PRIVACY AND SECURITY PROGRAM WILL DO AS MUCH TO MAKE INFORMATION AVAILABLE TO APPROPRIATE STAKEHOLDERS AS IT DOES TO MAKE IT UNAVAILABLE TO INAPPROPRIATE
PARTIES ! WELL BALANCED PROGRAM USES A BROAD STRATEGIC AND mEXIBLE FRAMEWORK THROUGH WHICH PROVIDERS CAN INVEST IN INFORMATION TECHNOLOGY TO PROTECT PRIVACY PROMOTE HEALTH AND SAVE LIVES 4HE 53 $EPARTMENT OF #OMMERCE 3AFE (ARBOR IS ONE EXAMPLE OF SUCH A BROAD FRAMEWORK WITH BALANCED ATTRIBUTES 4HESE INVESTMENTS ALSO RETURN lNANCIAL VALUE MANY TIMES OVER )N THE 53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES ESTIMATED INDUSTRYWIDE SAVINGS OF BILLION OVER YEARS FROM IMPLEMENTING TRANSACTION STANDARDS;= 2EGARDLESS OF WHETHER THIS ESTIMATE WAS ACCURATE THERE IS LITTLE DOUBT THAT THE HEALTHCARE INDUSTRY STANDS TO REAP SUBSTANTIAL SAVINGS AND IMPROVEMENTS FROM THE EFFECTIVE USE OF INFORMATION TECHNOLOGY 4HIS WILL PROVE TRUE NOT ONLY FROM AN ADMINISTRATIVE STANDPOINT BUT WILL BE DWARFED BY THE ENHANCEMENTS THAT )4 STANDS TO PROVIDE IN CLINICAL OPERATIONS !SIDE FROM THESE OBVIOUS lNANCIAL BENElTS INVESTMENTS IN PRIVACY AND SECURITY ALSO LEAD TO INCREASED FAITH IN THE COMMUNITY HEALTHCARE SYSTEM MAKING PATIENTS LESS LIKELY TO WITHHOLD CRITICAL INFORMATION OR AVOID CARE BECAUSE OF PRIVACY CONCERNS
!TTRIBUTES OF A "ALANCED &RAMEWORK 4HE h3EVEN 3AFE (ARBOR 0RINCIPLESv;= DEVELOPED BY THE 53 $EPARTMENT OF #OMMERCE INCORPORATE A NUMBER OF PRACTICAL ATTRIBUTES FOR PRIVACY AND SECURITY 7HILE THE AUTHORS ARE NOT ADVOCATING THIS MODEL SPECIlCALLY IT DOES PROVIDE A WIDELY ACCEPTED FRAMEWORK THAT PROVIDES A NICE ILLUSTRATION FOR THE READER .OTICE !N ORGANIZATION MUST NOTIFY INDIVIDUALS ABOUT THE PURPOSES FOR WHICH IT COLLECTS AND USES INFORMATION HOW THEY CAN PROCESS INQUIRIES AND COMPLAINTS THE TYPES OF THIRD PARTIES TO WHICH IT DISCLOSES ITS INFORMATION AND THE OPTIONS AND WAYS IT OFFERS TO LIMIT INFORMATION USE AND DISCLOSURE #HOICE !N ORGANIZATION MUST GIVE INDIVIDUALS THE OPPORTUNITY TO CHOOSE WHETHER THEIR PERSONAL INFORMATION WILL BE DISCLOSED TO A THIRD PARTY USED IN WAYS INCOMPATIBLE WITH ITS ORIGINAL PURPOSE OR USED FOR ANYTHING OTHER THAN THE SPECIlC PURPOSE FOR WHICH THEY AUTHORIZED ITS USE 4HIS IS COMMONLY CALLED hOPTING OUTv )N ADDITION FOR SENSITIVE INFORMATION INDIVIDUALS MUST GIVE THEIR AFlRMATIVE OR EXPLICIT CHOICE hOPTING INv FOR DISCLOSURE OF INFORMATION TO A THIRD PARTY FOR USE IN WAYS INCOMPATIBLE WITH ITS ORIGINAL PURPOSE OR USE FOR ANYTHING OTHER THAN THE SPECIlC PURPOSE FOR WHICH THEY AUTHORIZED ITS USE /NWARD 4RANSFER 4RANSFERS TO 4HIRD 0ARTIES !N ORGANIZATION MUST APPLY THE NOTICE AND CHOICE PRINCIPLES TO DISCLOSE INFORMATION TO A THIRD PARTY )T MAY TRANSFER INFORMATION TO A THIRD PARTY THAT IS ACTING AS ITS AGENT PROVIDED THE THIRD PARTY SUBSCRIBES TO THE 3AFE (ARBOR PRINCIPLES OR HAS ENTERED INTO A WRITTEN AGREEMENT THAT IT WILL PROVIDE AT LEAST THE SAME LEVEL OF PRIVACY PROTECTION AS IS REQUIRED BY THE RELEVANT PRINCIPLES !CCESS )NDIVIDUALS MUST HAVE ACCESS TO THEIR OWN PERSONAL INFORMATION AND BE ABLE TO CORRECT AMEND OR DELETE INACCURATE INFORMATION EXCEPT WHEN THE BURDEN OR EXPENSE OF PROVIDING ACCESS WOULD BE DISPROPORTIONATE TO THE RISKS TO THE INDIVIDUALS PRIVACY OR WHERE PROVIDING ACCESS WOULD VIOLATE THE RIGHTS OF PERSONS OTHER THAN THE INDIVIDUAL 3ECURITY !N ORGANIZATION MUST TAKE REASONABLE PRECAUTIONS TO PROTECT PERSONAL INFORMATION FROM LOSS MISUSE AND UNAUTHORIZED ACCESS DISCLOSURE ALTERATION AND DESTRUCTION $ATA INTEGRITY 0ERSONAL INFORMATION MUST BE RELEVANT FOR ITS INTENDED PURPOSES AN ORGANIZATION SHOULD TAKE REASONABLE STEPS TO ENSURE THAT THE DATA SUITS ITS INTENDED USE AND IS ACCURATE COMPLETE AND CURRENT %NFORCEMENT !N ORGANIZATION MUST PROVIDE READILY AVAILABLE AND AFFORDABLE INDEPENDENT RECOURSE FOR INVESTIGATING AND RESOLVING INDIVIDUAL COMPLAINTS AND DISPUTES AND FOR AWARDING DAMAGES WHERE PROVIDED BY THE APPLICABLE LAW OR PRIVATE SECTOR INITIATIVES )T ALSO MUST HAVE PROCEDURES FOR VERIFYING IMPLEMENTATION OF THE COMMITMENTS IT MAKES TO ADHERE TO THE 3AFE (ARBOR PRINCIPLES AND PROCEDURES FOR REMEDYING PROBLEMS ARISING FROM ITS FAILURE TO COMPLY )T MUST USE SANCTIONS SUFlCIENTLY RIGOROUS TO ENSURE COMPLIANCE
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
S G Dã GN QHYN MãADXN MCã'( /
ãA@K@MBHMFãOQHU@BXã@MCãRD BT QHSXãVHSGãO @SHD MSãB@QD
@7E NEED TO FOLLOW THROUGH ON TRANSPARENCY AND EMBRACE THE INFORMATION AVAILABLE TODAY )TS NOT PERFECT BUT RATHER THAN STRIVE FOR PERFECTION WE NEED TO EMBRACE WHAT WE HAVE AVAILABLE TO US n *OE #ARMICHAEL
4HE "ALANCING !CT 0ROVIDERS INSURERS LITIGATORS AND OTHERS HAVE BEGUN TO REALIZE THE FALLACY OF PRIORITIZING PRIVACY OVER HEALTH SERVICE DELIVERY IN AN INDUSTRY FUNDAMENTALLY FOCUSED ON MAKING PEOPLE HEALTHIER AND KEEPING THEM ALIVE 4HE BALANCE BETWEEN CONlDENTIALITY AND ACCESSIBILITY SHOULD HINGE ON BUSINESS REALITIES AND ON MAKING THE BUSINESS MORE EFlCIENT AND EFFECTIVE TO CREATE VALUE FOR PATIENTS n NOT SOLELY ON REGULATORY REQUIREMENTS 2ESPONSIBLE SHARING OF INFORMATION ENHANCES PRODUCTIVITY DRIVES QUALITY FORWARD AND POSITIONS PRIVACY AS A BENElT RATHER THAN AN IMPOSITION ! COMPLIANCE FOCUS MIGHT ALLEVIATE LEGAL RISKS BUT EFFECTIVE INFORMATION RISK MANAGEMENT INCLUDING A DOCUMENTED EXCEPTION PROCESS MIGHT ULTIMATELY RAISE CONSUMER CONlDENCE AND IMPROVE THE QUALITY OF HEALTHCARE PROVIDED !GGREGATING DATA THROUGH REGIONAL HEALTH INFORMATION ORGANIZATIONS OFFERS SIGNIlCANT OPPORTUNITIES TO IMPROVE QUALITY IN THE COMMUNITY 4HE )NDIANA (EALTH )NFORMATION %XCHANGE FOR
EXAMPLE SHARES ADMINISTRATIVE PATIENT DATA COLLECTED BY SEVERAL HOSPITALS IN THE )NDIANAPOLIS AREA )T INCORPORATES A STRAIGHTFORWARD CONSENT FORM FOR PATIENTS THAT INFORMS THEM ABOUT DATA USE AND ALLOWS THEM TO CHOOSE WHETHER TO HAVE THEIR INFORMATION SHARED WITH THE GROUP 4ECHNOLOGY SAFEGUARDS INFORMATION AS IF IT NEVER hLEFT THE BUILDINGv;= -ANY BUSINESS OPPORTUNITIES BASED ON THIS KIND OF COLLABORATION EXIST TODAY -ANY MORE WILL EMERGE WITHIN THE NEXT FEW YEARS )N ORDER TO ENGAGE AND REAP THE BENElTS HEALTHCARE ORGANIZATIONS NEED TO IMPLEMENT WELL MANAGED MECHANISMS FOR SHARING AND PROTECTING INFORMATION NOW 7HETHER THEIR UNDERLYING DATA INFRASTRUCTURE INVOLVES INTERNAL OUTSOURCED OR SHARED SYSTEMS THEY MUST PUT REASONABLE CONTROLS INTO PLACE TO AFFECT PATIENT CARE POSITIVELY AND CONSEQUENTLY REMAIN COMPETITIVE ,EADING THE WAY IN THE LOCAL MARKET ALSO CAN CREATE NEW BUSINESS OPPORTUNITIES SUCH AS SMALL SUBURBAN HOSPITALS SERVING PRIVACY CONSCIOUS PATIENTS BETTER THAN LARGE METROPOLITAN MEDICAL CENTERS COMBINING BETTER PROVEN OUTCOMES THAT ARE SIGNIlCANTLY LESS EXPENSIVE TO CONSUMERS INSURERS AND EMPLOYERS
! 0RACTICAL !PPROACH /THER INDUSTRIES HAVE IN LARGE PART MOVED BEYOND A FOCUS ON COMPLIANCE OBLIGATIONS IMPOSED BY LAWS AND REGULATIONS AND HAVE STARTED TO INVESTIGATE AND IMPLEMENT STRATEGIC PRIVACY FRAMEWORKS )N CONTRAST SOME PHYSICIANS HOSPITALS AND OTHER TYPES OF PROVIDERS REMAIN SQUARELY FOCUSED ON ()0!! AND ITS REQUIREMENTS AS THE UBIQUITOUS DEFINER OF PRIVACY !S A RESULT OF THIS NARROW FOCUS OPPORTUNITIES TO REALIZE THE
%XHIBIT $ATA ,IFE #YCLE
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
S G Dã GN QHYN MãADXN MCã'( /
ãA@K@MBHMFãOQHU@BXã@MCãRD BT QHSXãVHSGãO @SHD MSãB@QD
VALUE OF A PROVEN WELL BALANCED PRIVACY FRAMEWORK WITH SPECIFIC GUIDING PRINCIPLES MAY BE OVERLOOKED ()0!! IS SIMPLY ONE PART OF THE BROADER FRAMEWORK )N THIS INFORMATION AGE COMPANIES CANNOT AFFORD TO FIND THEMSELVES PERPETUALLY RESPONDING IN A KNEE JERK FASHION TO GOVERNMENT REGULATIONS )T MAKES FAR MORE SENSE TO CREATE A FLEXIBLE PROGRAM WITH A SOLID FRAMEWORK FOR ADDRESSING AND ACCOMMODATING EXISTING AND FUTURE BUSINESS ISSUES AND REGULATIONS 3HIFTING PERSPECTIVES ALLOWS PROVIDERS TO SET REALISTIC EXPECTATIONS BASED ON UNIVERSAL CONCEPTS AND BUSINESS CONSIDERATIONS AND FOLLOW THROUGH WITH BENCHMARKED APPROACHES h$OING THE RIGHT THINGv BY CREATING A SYSTEM THAT DEMONSTRATES GENUINE CONCERN FOR PATIENT SAFETY AND PRIVACY PRESENTS MANY CHALLENGES AND A NEED FOR HARD WORK SUCH AS DOCUMENTING AND MANAGING WHO HAS PROVIDED PERMISSION TO WHOM TO USE WHAT PART OF THEIR HEALTHCARE DATA 4HE LONG TERM BENElTS HOWEVER ARE WORTH THE SHORT TERM PAIN 0ROVIDERS CAN CREATE A COMPREHENSIVE PRIVACY AND INFORMATION RISK MANAGEMENT PROGRAM FROM THIS FOUNDATION THAT CONSIDERS APPLICABLE FEDERAL AND STATE LAWS ENFORCEMENT TRENDS RULES AND REGULATIONS AND GUIDING PRINCIPLES 4HE RESULTING FRAMEWORK ALIGNS PEOPLE PROCESSES AND TECHNOLOGY IN A WAY THAT OUTLASTS THE LATEST hREGULATION OF THE DAYv
6ERSATILITY AND &LEXIBILITY FOR .OW AND THE &UTURE #HANGES TO ()0!! AND THE EVOLUTION OF NEW FEDERAL AND STATE LEGISLATION WILL CONTINUE AS THE 53 GRAPPLES WITH VARYING STATE
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
AND FEDERAL REGULATIONS AND AS THE WORLD WRESTLES WITH GLOBAL INTERCONNECTION /RGANIZATIONS THAT DESIGN VERSATILE AND mEXIBLE INFORMATION RISK MANAGEMENT FRAMEWORKS WILL MOST EFFECTIVELY AND EFlCIENTLY EMBRACE FUTURE DEVELOPMENTS WITH MINIMAL INCREASED COSTS AND ENHANCED QUALITY 2EGARDLESS OF THE STRATEGY CHOSEN THOSE ORGANIZATIONS WILL HAVE DElNED DOCUMENTED AND IMPLEMENTED PROGRAMS AND POLICES TO ADDRESS THE DATA LIFE CYCLE FROM ITS CREATION TO ITS DESTRUCTION %ACH PIECE OF THAT LIFE CYCLE n CREATION MOTION STORAGE ACCESS AND DESTRUCTION SEE %XHIBIT n REQUIRES A DElNED PROGRAM THAT MANAGES PEOPLE AND TECHNOLOGY IN A REALISTIC OPERATIONAL AND APPROPRIATE WAY 4HE PROCESS ONCE STARTED IS ONGOING )NFORMATION RISK MANAGEMENT IS A JOURNEY AND ONE THAT REQUIRES CONTINUAL DILIGENCE 'ETTING THIS BALANCE RIGHT IS CRITICAL TO SUCCESSFULLY ENHANCING )4 INVESTMENTS TO IMPROVE CLINICAL OUTCOMES AND THE PATIENT EXPERIENCE OVER THE LONG TERM %NDNOTES &ERRIS . h()0!! $OESNT 0ROTECT !LL (EALTH )NFORMATION /HIO #OURT 2ULES v 'OVERNMENT (EALTH )4 -ARCH HTTPWWWGOVHEALTHIT COMARTICLE 7EB h0ROTECTING THE 0RIVACY OF 0ATIENTS (EALTH )NFORMATION 3UMMARY OF THE &INAL 2EGULATIONS v (EALTH AND (UMAN 3ERVICES &ACT 3HEET $ECEMBER 53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES HTTPASPEOSDHHSGOVADMNSIMPFINALPVC FACTHTM 3AFE (ARBOR 0RINCIPLES CAN BE ACCESSED AT HTTPWWWEXPORTGOV SAFEHARBORSH?OVERVIEWHTML 4HE )NDIANA (EALTH )NFORMATION %XCHANGE HTTPWWWIHIECOM SERVICESHTM
'LOBAL 0ERSPECTIVES ON 1UALITY 7HILE NATIONAL HEALTHCARE QUALITY IMPROVEMENTS MAY BE MOTIVATED BY COUNTRY SPECIlC POLITICAL OR ECONOMIC DRIVERS REGIONAL APPROACHES AND INNOVATIONS TO QUALITY DELIVERY ARE DEMONSTRATING CROSS BORDER APPLICATIONS
"Y 2ACHEL !BBOTT #ARRIE 3CHULMAN AND 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
0
ATIENTS PHYSICIANS AND POLICY MAKERS AROUND THE WORLD AGREE THAT THERE ARE QUALITY PROBLEMS IN HEALTHCARE AS ILLUSTRATED IN %XHIBIT (OWEVER UNIQUE CULTURAL POLITICAL ECONOMIC AND HISTORIC ENVIRONMENTS MEAN DIFFERENT IMPROVEMENT PRIORITIES IN DIFFERENT COUNTRIES #USTOMIZED SOLUTIONS THAT ACCOUNT FOR VARIOUS lNANCING AND DELIVERY SYSTEMS ARE BEGINNING TO TAKE SHAPE IN DIFFERENT TERRITORIES !S THEY APPROACH THESE SOLUTIONS QUALITY EXPERTS ARE lNDING THAT THE FOLLOWING ISSUES MUST BE ADDRESSED 2ESPONSIBILITIES AND ACCOUNTABILITY -EASUREMENT 0URCHASING AND #ROSS BORDER ASSESSMENT MODELS
2ESPONSIBILITIES AND !CCOUNTABILITY #OUNTRIES AND CULTURES TAKE A VARIETY OF APPROACHES TO ASSIGNING RESPONSIBILITY FOR QUALITY IN HEALTHCARE 4HESE DIFFERENCES OFTEN DEPEND ON THE DEGREE TO WHICH THEY REGARD THE PATIENT AS A CONSUMER #OUNTRIES SUCH AS THE 5NITED 3TATES WHERE MORE THAN HALF OF HEALTHCARE IS PAID FOR BY EMPLOYERS AND PRIVATE HEALTH PLANS TAKE A MARKET ORIENTED APPROACH TO QUALITY MONITORING AND IMPROVEMENT /N THE OTHER HAND IN %UROPES AND !USTRALIAS LARGELY PUBLICLY FUNDED HEALTH SYSTEMS THE QUESTION OF ACCOUNTABILITY IS MORE A POLITICAL ISSUE WITH A STRONG PUBLIC DRIVE AROUND QUALITY )N PARTICULAR FAILURE OF TAX FUNDED HOSPITALS PUTS PRESSURE ON GOVERNMENTS TO INTERVENE;= 2EGARDLESS OF THE lNANCING SOURCE GOVERNMENTS PROFESSIONALS AND PATIENTS ALL HAVE A ROLE IN QUALITY IMPROVEMENT 4HE CURRENT
DEBATE IS AROUND HOW THOSE ROLES ARE CHANGING AND HOW ACCOUNTABILITY IS DETERMINED 4HE S SAW A CULTURAL SHIFT TOWARD GOVERNMENT DRIVEN QUALITY AGENDAS AS OPPOSED TO PROFESSIONAL SELF MONITORING 4HIS WAS TRIGGERED IN PART BY HIGH PROlLE MEDIA SCANDALS IN !USTRALIA AND THE 5NITED +INGDOM THAT EXPOSED MEDICAL ERROR RATES AND UNETHICAL PRACTICES BY INDIVIDUALS ! NEED FOR PUBLIC REASSURANCE LED TO AN INCREASE IN CENTRALLY DRIVEN AGENDAS 4HE GOVERNMENT PRESSURED PROVIDERS TO REFORM THEIR PRACTICES AND VOTERS PRESSURED THE GOVERNMENT TO MONITOR QUALITY 4HE LANDMARK BOOK 4O %RR IS (UMAN ;= HIGHLIGHTED THE SIZE AND SCOPE OF MEDICAL ERRORS IN THE 53 4HE RESULT WAS INCREASED PRESSURE ON PROVIDERS AND AN IMPORTANT ROLE FOR INDEPENDENT ACCREDITATION ORGANIZATIONS RATHER THAN SOLE RELIANCE ON GOVERNMENT REGULATION;= $IFFERING OPINIONS ABOUT THE VARIOUS ROLES OF STAKEHOLDERS IN QUALITY CAME OUT IN 0RICEWATERHOUSE#OOPERS (EALTH#AST RESEARCH;= (EALTH EXECUTIVES IN COUNTRIES WERE ASKED WHICH STAKEHOLDER HAD BEEN MOST SUCCESSFUL IN IMPROVING QUALITY )N THE 53 PATIENT ADVOCACY GROUPS RATED lRST )N %UROPE AND #ANADA PHYSICIANS RANKED HIGHEST )N THE -IDDLE %AST !USTRALIA AND !SIA GOVERNMENT WAS VIEWED AS MAKING THE MOST PROGRESS "ROADLY SPEAKING GOVERNMENTS INmUENCE OVER HEALTHCARE PROVIDERS CAN BE VIEWED AS REGULATION LEGISLATION OR LICENSING ACTIVITIES THAT MANDATE BEHAVIOR DIRECT MANAGEMENT OF HEALTH SYSTEMS IN WHICH THE GOVERNMENT HAS A DIRECT ROLE IN RUNNING THE HEALTH SYSTEM OR INCENTIVES MARKET BASED APPROACHES TO ENCOURAGE CERTAIN BEHAVIOR 'OVERNMENTS IN %UROPE HAVE TAKEN A HYBRID APPROACH TO INmUENCING PROVIDERS BY ENACTING LEGISLATION THAT MANDATES ATTENTION TO QUALITY WHILE BEING NONPRESCRIPTIVE IN THE MECHANISMS &OR EXAMPLE 'ERMANY THE &IFTH 3OCIAL !CT
2ACHEL !BBOTT -3 IS AN EXECUTIVE WITH 0RICEWATERHOUSE#OOPERS 'OVERNMENT AND 0UBLIC 3ECTOR PRACTICE IN ,ONDON 3HE HAS SEVERAL YEARS EXPERIENCE IN THE HEALTHCARE INDUSTRY IN COMMUNICATIONS AND PUBLIC AFFAIRS AND STUDIED INTERNATIONAL HEALTH POLICY AT THE ,ONDON 3CHOOL OF %CONOMICS 3HE CAN BE REACHED AT RACHELEABBOTT UKPWCCOM #ARRIE 3CHULMAN -0! 04 IS A SENIOR MANAGER WITH 0RICEWATERHOUSE#OOPERS ON SECONDMENT IN THE 5+ FROM THE 53 (EALTH )NDUSTRIES PRACTICE 3HE COORDINATES HEALTH INITIATIVES FOR 0W#S 'LOBAL (EALTH SECTOR AND HAS OVER YEARS OF EXPERIENCE IN THE HEALTH INDUSTRY 3HE CAN BE REACHED AT CARRIESCHULMAN UKPWCCOM 4IM 7ILSON -$ IS A FAMILY DOCTOR IN THE 5+ !FTER WORKING AT THE HIGHEST LEVEL IN GOVERNMENT HE MOVED TO 0RICEWATERHOUSE#OOPERS WHERE HE IS SENIOR ADVISOR ON CLINICAL PERFORMANCE IMPROVEMENT (E HAS PUBLISHED EXTENSIVELY ON THE SUBJECTS OF QUALITY AND SAFETY (E CAN BE REACHED AT TIMWILSON UKPWCCOM ) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
F KN A@KãOD QROD BSHU D RãNMãPT @KHSX PUBLICIZING INNOVATIVE BEST PRACTICES SUCH AS IMPROVEMENT IN ARTIlCIAL RESPIRATION FOR INTENSIVE CARE PATIENTS )N TERMS OF PROFESSIONALS GOVERNMENTS ARE INmUENCING QUALITY BY FACILITATING OR MOTIVATING SELF REGULATION )N SEVERAL %UROPEAN COUNTRIES FOR EXAMPLE IN %ASTERN %UROPE AND 3PAIN GROUPS OF PROVIDERS HAVE INITIATED QUALITY ASSESSMENT AND ACCREDITATION SYSTEMS WHICH SUBSEQUENTLY FAILED DUE TO LACK OF GOVERNMENT SUPPORT AND UNIVERSAL APPLICATION (OWEVER INITIATIVES THAT HAVE BEEN TOO hTOP DOWNv HAVE BEEN MET WITH RESISTANCE FROM PROVIDERS WHO MAY VIEW THESE PROGRAMS AS AN ADDITIONAL ADMINISTRATIVE BURDEN )N THE .ETHERLANDS hQUALITY CIRCLESv OF ABOUT HEALTHCARE PROFESSIONALS REVIEW CLINICAL PRACTICE GUIDELINES IN MULTIDISCIPLINARY GROUPS h0EER VISITSv FROM OTHER HEALTHCARE PROFESSIONALS ARE ALSO IMPORTANT IN ENSURING THAT CLINICAL GUIDELINES ARE IMPLEMENTED AND IMPROVEMENTS IN QUALITY ARE ENCOURAGED )N GENERAL A CAREFUL BALANCE BETWEEN CENTRAL GOVERNMENT AUTHORITY AND PROFESSIONAL SELF REGULATION IS NEEDED 4HE .ORWEGIAN -EDICAL !SSOCIATION .-! THE PHYSICIANS PROFESSIONAL TRADE ASSOCIATION STARTED THE "REAKTHROUGH 0ROJECT IN 4HE IDEA FOR THIS PROJECT ORIGINATED FROM THE )NSTITUTE OF (EALTHCARE )MPROVEMENT IN "OSTON AND THE METHOD IS USED IN SEVERAL HOSPITALS ACROSS THE 53 AND %UROPE (EALTHCARE PROFESSIONALS FROM ACROSS .ORWAY ARE CHOSEN TO PARTICIPATE IN QUALITY PROJECTS LASTING SIX TO EIGHT MONTHS ALONG SPECIlC THEMES USING A STRICT FRAMEWORK 4HE .-! IS EAGER TO REPLICATE SUCCESS AND CREATE DISCUSSIONS ABOUT THE RESULTS 4HE EFFORT WILL CONTINUE UNTIL AT WHICH POINT THE LONG TERM RESULTS OF THE PROJECTS WILL BE CONSIDERED !LREADY RESULTS FROM PROJECTS FOCUSING ON INTENSIVE AND PERINATAL CARE HAVE MOTIVATED CHANGES IN PRACTICE 0ATIENTS HAVE AN IMPORTANT ROLE IN QUALITY BUT EXPERTS AGREE THEY NEED MORE INFORMATION TO MAKE DECISIONS %XPERTS SAY PATIENTS OFTEN LACK AN UNDERSTANDING OF MEDICAL INFORMATION AND THE RESULTING CONlDENCE TO MAKE INFORMED %XHIBIT 1UALITY IS A GLOBAL PROBLEM DECISIONS ABOUT THEIR OWN HEALTH AND HEALTHCARE !53 #!. '%2 .: 5+ 53 %VEN WITHOUT CHOOSING THEIR CARE BASED ON QUALITY PATIENTS IN MANY COUNTRIES PLAY AN /VERALL 2ANKING IMPORTANT ROLE IN MONITORING HEALTHCARE QUALITY THROUGH MANDATORY PATIENT SATISFACTION SURVEYS (IGHEST ,OWEST AND COMPLAINTS SYSTEMS !DDITIONALLY PATIENT 0ATIENT 3AFETY ADVOCACY GROUPS ARE IMPORTANT ADVOCATES FOR %FFECTIVENESS HEALTH SYSTEM CHANGE 4HESE GROUPS PRESSURE 0ATIENT #ENTEREDNESS PAYERS FOR NEW TECHNOLOGIES AND MEDICATIONS AND 4IMELINESS PRESSURE PROVIDERS TO IMPLEMENT BEST PRACTICES %FlCIENCY 0ATIENT RIGHTS AND DATA PROTECTION HAVE BEEN %QUITY IMPORTANT TOPICS ON THE QUALITY IMPROVEMENT AGENDA IN 'ERMANY FOR MORE THAN YEARS (EALTH %XPENDITURES PER #APITA 2ECENTLY A LARGE NUMBER OF HOSPITALS HAVE BEEN CERTIlED BASED ON )3/ %&1- ANDOR 3OURCE 4HE #OMMONWEALTH &UND h-IRROR -IRROR ON THE 7ALL !N 5PDATE ON THE +41 A 'ERMAN QUALITY ASSESSMENT SYSTEM 4HIS 1UALITY OF !MERICAN (EALTH #ARE 4HROUGH THE 0ATIENTS ,ENS v !PRIL TREND IN CERTIlCATION AIMS TO IMPROVE EFlCIENCY AND ESTABLISH A HIGH STANDARD OF CARE 'ERMANY
REQUIRES QUALITY ASSURANCE SYSTEMS IN HOSPITALS THAT APPLY TO BOTH ORGANIZATIONAL SYSTEMS AND OUTCOMES BUT IS LIMITED IN ITS DElNITION OF THESE SYSTEMS )N THIS WAY GOVERNMENT POLICY FORCES ATTENTION ON A QUALITY AGENDA BUT ALLOWS MANAGERS AND POLICY MAKERS TO CONSIDER LOCAL NEEDS AND INTERESTS IN DESIGNING THE MOST APPROPRIATE MEANS TO DO SO )N )TALY QUALITY INDICATORS ARE DEVELOPED AT A NATIONAL LEVEL AND IMPLEMENTED LOCALLY BASED UPON SPECIlC REGIONAL NEEDS %VERY HOSPITAL HAS A QUALITY OFlCE AND HEALTHCARE DIRECTOR RESPONSIBLE FOR QUALITY 3IMILARLY IN 3PAIN EACH OF AUTONOMOUS COMMUNITIES REGULATES QUALITY STANDARDS INDEPENDENTLY %ACH REGION DESIGNS INDEPENDENT MECHANISMS FOR HEALTHCARE QUALITY REGULATION WITH SOME PROVIDING lNANCIAL INCENTIVES LINKED TO QUALITY (OWEVER THIS REGIONAL APPROACH CREATES AN OBSTACLE TO DATA SHARING AS THERE ARE NO NATIONAL DElNITIONS OR AGGREGATED DATA SETS )N CONTRAST TO THE DEVOLVED CONTROL OF THE 3PANISH AND )TALIAN HEALTHCARE SYSTEMS CENTRAL REGULATION OF %NGLANDS .ATIONAL (EALTH 3ERVICE .(3 ENABLES THE $EPARTMENT OF (EALTH TO ISSUE QUALITY REPORTS ACROSS THE ENTIRE SERVICE )N THIS WAY NATIONAL STANDARDS CAN MEAN NATIONWIDE QUALITY BUT INEFFECTIVE POLICIES AND PROGRAMS MAY BE MAGNIlED )N THE .ETHERLANDS THE -INISTRY OF (EALTH IS DRIVING THE QUALITY AGENDA WITH INPUT FROM PROVIDERS 4HE 3NELLER "ETER "ETTER &ASTER PROGRAM WAS IMPLEMENTED TO HIGHLIGHT BEST PRACTICES WITH A SPECIlC FOCUS ON SAFETY AND hPATIENT LOGISTICSv OR COMMUNICATION AND TRANSFER PROCESSES BETWEEN DEPARTMENTS ,AUNCHED IN .OVEMBER THE PROGRAM HAS DRAWN ON EXPERTISE FROM OTHER INDUSTRIES AND AIMS TO HELP HEALTHCARE PROFESSIONALS IMPROVE THEIR PERFORMANCE STARTING WITH HOSPITAL AND PRIMARY HEALTHCARE 3NELLER "ETER IS COMPRISED OF THREE CORE ACTIVITIES BENCHMARKS FOR HOSPITALS AND PRIMARY HEALTHCARE INDICATORS FOR SAFER CARE AND A QUALITY INNOVATION AND EFlCIENCY PROGRAM 4HE PROGRAM HAS BEEN SUCCESSFUL IN IDENTIFYING AND
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
F KN A@KãOD QROD BSHU D RãNMãPT @KHSX ALSO HAS STRONG DATA SECURITY LAWS WHICH COMPLICATE EFFORTS TO STRENGTHEN MONITORING SYSTEMS AND INCREASE INFORMATION SHARING BETWEEN HOSPITALS AND PROVIDERS "Y 'ERMAN LAW ALL PUBLIC DATA MUST BE FULLY ANONYMOUS
-EASUREMENT )NTERNATIONAL DEBATE CONTINUES AROUND HOW TO MEASURE QUALITY ESPECIALLY THE USE OF PROCESS VERSUS OUTCOME DATA;= 4HESE CHALLENGES ARE DISCUSSED IN THE PAPER h!LL 1UALITY 2OADS ,EAD TO $ATAv IN THIS BOOK )N REALITY PERFORMANCE INDICATORS ARE GENERALLY DETERMINED BY PRACTICAL CONSIDERATIONS 7HILE HEALTHCARE OUTCOMES ARE A PART OF THE PATIENTS BASIC MEDICAL RECORD DISCRETE PROCESS INFORMATION HAS NOT HISTORICALLY BEEN COLLECTED IN MANY PUBLICLY FUNDED HEALTH SYSTEMS )N CONTRAST THE BILLING AND PAYMENT STRUCTURES IN THE 53 HAVE NECESSITATED EXTENSIVE PROCESS DATA COLLECTION 9ET EVEN IN THE 53 ACCESS AND USE OF PROCESS DATA IS COMPLICATED BY INCONSISTENCIES BETWEEN MEDICAL AND BILLING RECORDS OFTEN MAKING THIS INFORMATION UNUSABLE IN PRACTICAL TERMS )N BOTH INSTANCES IMPROVEMENTS IN ELECTRONIC INFORMATION SYSTEMS ARE NEEDED TO MAKE PROCESS AND CLINICAL OUTCOME DATA MORE ACCESSIBLE )N .ORWAY PHYSICIANS HAVE A LEADERSHIP ROLE IN QUALITY MONITORING 3ELECTED SYSTEM MEASURES LIKE WAITING TIMES INFECTION RATES ACCIDENTS AND NEAR ACCIDENTS AND PATIENT SATISFACTION ARE REPORTED BY ALL HOSPITALS BUT THERE ARE NO NATIONALLY AGREED UPON DElNITIONS FOR CLINICAL QUALITY #LINICAL QUALITY DATA ARE INSTEAD COLLECTED BY GROUPS OF PHYSICIANS WITHIN MEDICAL SPECIALTIES 7HILE PROFESSIONAL COLLABORATION ON CLINICAL QUALITY STUDIES HAS HELPED IDENTIFY BEST PRACTICES NATIONAL STANDARDS FOR COLLECTING CLINICAL DATA ARE NEEDED TO ENABLE BETTER COMPARISON ACROSS PROVIDERS )N THE -IDDLE %AST A RECENT SURVEY OF HEALTHCARE PROVIDERS ACROSS THE REGION IDENTIlED THE NEED FOR IMPROVEMENT IN THE ACCURACY OF MEDICAL RECORDS )T IS THOUGHT THAT THE MAJORITY OF MEDICAL RECORD DOCUMENTATION MAY BE MISCODED 4HIS ALARMING SITUATION WAS ATTRIBUTED TO THE VARIETY OF LANGUAGES USED BY THE WORKFORCE AND A LACK OF )4 INFRASTRUCTURE %XPERTS IN 3AUDI !RABIA SIMILARLY CITE LACKING BROADBAND CAPABILITIES AND PRIMARILY MANUAL RECORD KEEPING PROCESSES AS HINDERING DATA COLLECTION 0OOR AVAILABILITY AND INCONSISTENT DATA QUALITY MAKE MEANINGFUL ANALYSIS DIFlCULT !S $2' STYLE PAYMENT SYSTEMS REPLACE HOSPITAL BUDGETS IN %UROPE AND !USTRALIA THERE IS INCREASING EMPHASIS ON ACCURATE MEDICAL RECORD DOCUMENTATION AND CODING (OWEVER ADVANCED INFORMATION TECHNOLOGY IS NOT A PANACEA AND PROBLEMS WITH MEDICAL RECORD ACCURACY ARE ALSO COMMON IN COUNTRIES WITH MORE SOPHISTICATED )4 INFRASTRUCTURES )N %NGLAND AN AMBITIOUS NATIONAL HEALTH )4 PROJECT CURRENTLY UNDER WAY ACROSS THE .(3 HAS HIGHLIGHTED THE IMPORTANCE OF ACCURATE RECORD KEEPING 4HE 5+ CARDIAC SURGERY COMMUNITY WAS ONE OF THE lRST TO RIGOROUSLY COLLECT AND PUBLISH CLINICAL OUTCOME DATA (OWEVER THE NATIONAL OUTCOMES DATABASE WAS
FOUND TO BE INCOMPLETE AND UNRELIABLE DUE TO INCONSISTENCIES IN REPORTING AND FAILURE IN TRANSFERRING INFORMATION FROM PATIENTS RECORDS;= 4HIS IS ALSO A CONCERN IN THE 53 WHERE DETAILED CLINICAL INFORMATION IS OFTEN RECORDED BY HAND IN PATIENTS MEDICAL RECORDS AND NOT DUPLICATED IN ELECTRONIC BILLING RECORDS )N OTHER WORDS ELECTRONIC DATABASES ARE ONLY AS VALUABLE AS THE QUALITY AND CONSISTENCY OF THE INFORMATION INPUT )N 3PAIN EXPERTS FEEL THAT IMPROVING HEALTHCARE QUALITY IS IMPOSSIBLE WITHOUT A hDIGITAL TRANSFORMATIONv 4HE FOCUS IS ON IMPLEMENTATION OF ELECTRONIC PHARMACY PRESCRIPTIONS AND ELECTRONIC MEDICAL RECORDS !UTONOMOUS COMMUNITIES HAVE LOCAL EFFORTS UNDER WAY TO IMPLEMENT REGIONAL HEALTHCARE NETWORKS 4HE NEXT STEPS WILL BE TO CREATE A hNETWORK OF NETWORKSv COVERING THE ENTIRE NATIONAL TERRITORY AND ENABLING INFORMATION EXCHANGE "ETTER INFORMATION SHARING IS VITAL TO CONTINUITY OF CARE 4HE JUNCTURES BETWEEN PROVIDERS AND SERVICES ARE OFTEN POINTS OF BOTH QUALITY AND EFlCIENCY FAILURES )MPROVING CARE MANAGEMENT OF CHRONIC CONDITIONS IS THE FOCUS OF A PROCESS REDESIGN FOR DISTRICT MEDICAL SERVICES IN *APAN WHICH AIMS TO CLARIFY THE ROLE OF LOCAL GENERAL PRACTITIONERS AND SMALL HOSPITALS IN RELATION TO OTHER PROVIDERS #HRONIC CARE MANAGEMENT IS ALSO A PRIORITY IN )TALY WHERE A THREE YEAR IMPROVEMENT PLAN INCLUDES DEVELOPING A NATIONAL INFORMATION SYSTEM TO ALLOW IDENTIlCATION OF APPROPRIATE CLINICAL PATHWAYS ACCORDING TO PATIENT HISTORY ! QUALITY INITIATIVE BY THE GOVERNMENT OF !USTRALIA TARGETED CHRONIC DISEASE MANAGEMENT 4HE .ATIONAL !CTION 0LAN FOR /STEOARTHRITIS 2HEUMATOID !RTHRITIS AND /STEOPOROSIS LAYS OUT KEY OBJECTIVES FOR QUALITY IMPROVEMENT IN THESE SPECIALTIES -OST RECENTLY THE "ETTER !RTHRITIS #ARE BUDGET INITIATIVE FOR FUNDED QUALITY IMPROVEMENT PROJECTS FOCUSED ON IMPROVED PATIENT ACCESS TO CARE
0URCHASING 4HE 7(/ 7ORLD (EALTH 2EPORT IDENTIlED STRATEGIC PURCHASING AS A POWERFUL TOOL FOR HEALTH SYSTEM IMPROVEMENT )NCREASINGLY GOVERNMENTS IN COUNTRIES WITH LARGELY PUBLICLY FUNDED HEALTH SYSTEMS ARE RECOGNIZING THE POTENTIAL FOR BUILDING PERFORMANCE INDICATORS INTO PURCHASING AND REIMBURSEMENT ACTIVITIES 3WEDEN &INLAND AND 'ERMANY HAVE ADOPTED SOME DEGREE OF PUBLIC SECTOR PURCHASING DESIGNED TO MOTIVATE QUALITY AND QUALITY OF CARE IS A KEY ELEMENT IN PROVIDERS CONTRACTS IN &RANCE )TALY AND THE 5+ 3PECIlCALLY THE 'ERMAN ORGANIZATION h'EM"!v 'EMEINSAMER "UNDESAUSSCHUSS WAS CREATED TO MAKE PURCHASING AND REIMBURSEMENT DECISIONS IN COLLABORATION WITH GOVERNMENT AND PUBLIC INSURERS 3IMILARLY RECENT HEALTH SYSTEM REFORMS INTRODUCED IN THE .ETHERLANDS IN *ANUARY INCLUDE CHANGES TO INSURANCE REIMBURSEMENT PRACTICES WHICH WILL NOW INCLUDE CONSIDERATION OF PROVIDER QUALITY AND EFlCIENCY ! PAY FOR PERFORMANCE BREAST CANCER TREATMENT PROGRAM HAS BEEN SUCCESSFULLY PILOTED AT A 4AIWANESE SPECIALIST CANCER
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
F KN A@KãOD QROD BSHU D RãNMãPT @KHSX HOSPITAL THE +OO &OUNDATION 3UN9AT 3EN #ANCER #ENTER +&39## ! KEY SUCCESS FACTOR WAS DEVELOPING A HOSPITALWIDE DATABASE TO MONITOR AND IMPROVE PATIENT CARE 4HE BREAST CANCER PROGRAM WHICH hENCOURAGES QUALITY RATHER THAN QUANTITY OF CAREv HAS CONTRIBUTED TO ACHIEVING AN PERCENT SURVIVAL RATE AT ALL STAGES AT +&39## 4HE PROGRAM WILL BE EXPANDED NATIONALLY AND +&39## IS COLLABORATING WITH 5#,! AND 2!.$ IN THE 53 TO DEVELOP A #ENTRE FOR (EALTHCARE )MPROVEMENT;=
#ROSS "ORDER !SSESSMENT -ODELS )T IS INCREASINGLY COMMON FOR PATIENTS TO TRAVEL ABROAD FOR HEALTHCARE /FTEN REFERRED TO AS HEALTHCARE TOURISM CROSS BORDER CARE IS NO LONGER LIMITED TO A FEW WEALTHY INDIVIDUALS WITH SPECIALIZED NEEDS (OWEVER THE INCREASE IN CROSS BORDER CARE IS PROMPTING THE NEED FOR CROSS BORDER QUALITY ASSESSMENT MODELS THAT PROVIDE SOME DEGREE OF STANDARDIZATION COMPARABILITY AND RESULTS EVALUATION 4HE %UROPEAN &OUNDATION FOR 1UALITY -ANAGEMENT %&1- A NONPROlT MEMBERSHIP ORGANIZATION ESTABLISHED A GENERIC INDUSTRY MODEL FOR QUALITY ASSESSMENT THAT IS NOW WIDELY USED BY HEALTHCARE ORGANIZATIONS ACROSS %UROPE !S SHOWN IN %XHIBIT THE GENERAL %&1- FRAMEWORK IS COMPRISED OF lVE hENABLER v OR PROCESS RELATED CRITERIA AND FOUR hRESULTS v OR OUTCOME ORIENTED CRITERIA;= 3EVERAL AUTONOMOUS COMMUNITIES IN 3PAIN HAVE ADOPTED THE %&1- SYSTEM AND REVIEWS OF SPECIlC ORGANIZATIONS HAVE BEEN IMPORTANT IN UNDERSTANDING THE MOST APPROPRIATE APPLICATION OF THE MODEL IN THE HEALTH SECTOR 4HIRTY ONE ORGANIZATIONS OF THE "ASQUE (EALTH 3ERVICE WERE STUDIED FOLLOWING PARTICIPATION IN QUALITY ASSESSMENT PROGRAMS USING THE %&1- %XCELLENCE -ODEL 4HE ASSESSMENT FOUND IMPROVEMENT IN PROCESS MEASURES THE MOST DRAMATIC BEING IMPROVEMENTS IN PATIENT SATISFACTION;= 3TANDARDS DEVELOPED BY THE )NTERNATIONAL /RGANIZATION FOR 3TANDARDIZATION )3/ FOR MANAGEMENT SYSTEMS ARE ALSO USED AS THE BASIS OF HEALTH SYSTEM QUALITY ASSESSMENT IN MULTIPLE %UROPEAN COUNTRIES;=
%XHIBIT %&1- %XCELLENCE -ODEL #RITERIA
%NABLERS
,EADERSHIP 0OLICY AND STRATEGY 0EOPLE 0ARTNERSHIPS AND RESOURCES 0ROCESSES
2ESULTS
#USTOMER RESULTS 0EOPLE RESULTS 3OCIETY RESULTS +EY PERFORMANCE RESULTS
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
%STABLISHING QUALITY COMPARISON METHODS IS ESPECIALLY IMPOR TANT IN %UROPE WHERE CROSS BORDER TREATMENT IS BECOMING INCREASINGLY COMMON "ESIDES MEDICAL RECORD KEEPING INCONSISTENCIES IN FUNDING AND PAYMENT DATA ARE PROBLEMATIC AND MAKE MEANINGFUL INTERPRETATION OF %UROPE WIDE STATISTICS SOMEWHAT INCONCLUSIVE 4HE %UROPEAN #OMMISSION HAS RECOMMENDED BETTER METHODS FOR SHARING INFORMATION ABOUT PROVIDERS AND QUALITY ON AN INTERNATIONAL BASIS INCLUDING BETTER USE OF COUNTRY LEVEL DATA TO TRACK DISEASE PATTERNS IN %UROPE;= 4HE /%#$ AND 7(/ HAVE BEEN INVOLVED IN ALIGNING INTERNATIONAL QUALITY INDICATORS 1UALITY INDICATORS IDENTIlED BY AN INTERNATIONAL PANEL OF EXPERTS CONVENED BY THE /%#$ WERE BROKEN DOWN INTO THREE DIMENSIONS IMPACT ON HEALTH IMPORTANCE TO NATIONAL POLICY AND ABILITY OF THE HEALTHCARE SYSTEM TO INmUENCE THE MEASURE /NE OF THE PROBLEMS ENCOUNTERED BY THE /%#$ CARDIAC EXPERT PANEL WAS ISOLATING INDICATORS OF QUALITY IN PRIMARY PREVENTION BECAUSE MEASURES MUST EXTEND BEYOND MEDICAL CARE AND INTO COMMUNITY AND SOCIAL CARE &URTHERMORE MANY MEASURES OF PRIMARY AND SECONDARY CARE COULD NOT BE AGREED ON INTERNATIONALLY AND WHEN THEY WERE UNIVERSAL COULD NOT FEASIBLY BE COLLECTED INTERNATIONALLY;= 3UCH DISAGREEMENT IS A CHALLENGE FOR INTERNATIONAL COLLABORATION "OTH THE %&1- AND )3/ QUALITY ASSESSMENT MODELS ARE IMPORTANT TO HEALTHCARE QUALITY IN THE .ETHERLANDS 4HE $UTCH )NSTITUTE FOR (EALTHCARE )MPROVEMENT BEGAN DEVELOPING COMPREHENSIVE CLINICAL PRACTICE GUIDELINES IN THE EARLY S 'UIDELINES HAVE NOW BEEN DEVELOPED FOR BOTH HOSPITAL AND PRIMARY CARE AND A RANGE OF EDUCATIONAL MATERIALS ARE UPDATED AND DISTRIBUTED REGULARLY TO HEALTHCARE PROFESSIONALS 3PECIlC INDICATORS HAVE BEEN DEVELOPED TO ENABLE BETTER MONITORING OF ADHERENCE TO THESE NATIONAL PRACTICE GUIDELINES 4HE %&1- IS APPLIED AS GENERAL GUIDANCE FOR EXCELLENCE 3PECIlC CERTIlCATION INCLUDING A NATIONAL ACCREDITATION SYSTEM FOR LABORATORIES AND RECENTLY DEVELOPED LABORATORY QUALITY SYSTEMS ARE BASED ON )3/ STANDARDS 4HE 5NITED !RAB %MIRATES IS LEVERAGING BEST PRACTICES TO IMPROVE QUALITY FOR CROSS TERRITORY CARE 4HE GOVERNMENT OF $UBAI HAS CREATED THE $UBAI (EALTHCARE #ITY $(## A REGIONAL EDUCATION RESEARCH AND HEALTHCARE SERVICES CENTER OF EXCELLENCE ! PHYSICAL SITE WITHIN $UBAI IT WILL BE COMPRISED OF MEDICAL TREATMENT AND RESEARCH FACILITIES ESTABLISHED IN COLLABORATION WITH (ARVARD -EDICAL )NTERNATIONAL $(## HAS ESTABLISHED THE h#ENTRE FOR (EALTHCARE 0LANNING AND 1UALITYv WITH (ARVARD TO CREATE A QUALITY MANAGEMENT SYSTEM FOR THE $(## FACILITIES !S A FACILITY THAT EXISTS AND OPERATES OUTSIDE OF AN ESTABLISHED HEALTH SYSTEM $(## PLANNERS HAVE THE OPPORTUNITY TO SHARE INTERNATIONAL BEST PRACTICES AND DEVELOP QUALITY MONITORING AND IMPROVEMENT SYSTEMS DRAWING FROM WIDE INTERNATIONAL EXPERIENCE )N %UROPE SEVERAL COUNTRIES HAVE ENTERED INTO STRUCTURED AGREEMENTS WITH NEIGHBORS TO MEET THE CAPACITY NEEDS OF STRUGGLING PUBLIC SYSTEMS FOR EXAMPLE THE $EPARTMENT OF (EALTH IN %NGLAND HAS CONTRACTED WITH "ELGIUM FOR ORTHOPEDIC SURGERY
F KN A@KãOD QROD BSHU D RãNMãPT @KHSX 4HIS PROCESS HAS BEEN EASED BY RECENT CHANGES TO THE %UROPEAN 5NIONS LEGAL FRAMEWORK ALLOWING PATIENTS REQUIRING TREATMENT AWAY FROM HOME TO EXTEND THEIR NATIONAL HEALTH PLANS WITH THE USE OF %5 INSURANCE CARDS )NITIALLY TRIGGERED BY HIGH PROlLE LAWSUITS %5 INSURANCE ARRANGEMENTS MAKE CARE ABROAD A MORE COMMON EXPERIENCE FOR MANY %UROPEANS 0ATIENTS IN 'ERMANY CROSS INTO 0OLAND TO GET DENTAL CARE AND 5+ RETIREES MOVE TO 3PAIN AND SEND BILLS HOME FOR PAYMENT /PENING PATIENT CHOICE TO BOTH DOMESTIC AND FOREIGN PROVIDERS ALSO HAS THE THEORETICAL POTENTIAL TO DRIVE QUALITY IMPROVEMENT DUE TO COMPETITION )N ,UXEMBOURG PATIENTS CAN EASILY CROSS BORDERS TO RECEIVE CARE IN 'ERMANY "ELGIUM AND &RANCE AND ABOUT ONE QUARTER OF PATIENTS DO AND SERVICES ARE REIMBURSED BY ,UXEMBOURGS MANDATORY HEALTH INSURANCE !S A RESULT THE GOVERNMENT THE INSURANCE FUND AND THE PROVIDERS ARE ALL INTERESTED IN ALIGNING QUALITY INFORMATION SYSTEMS AND RISK MANAGEMENT PROCESSES WITHIN THE COUNTRY AND WITH ITS NEIGHBORS .ATIONAL PERFORMANCE INDICATORS ARE GUIDED BY WIDER %5 POLICY DEVELOPMENTS AND OVER THE NEXT TWO YEARS THE ELECTRONIC MEDICAL RECORD SYSTEM IN ,UXEMBOURG WILL BE ORIENTED TO %5 STANDARDS #ROSS BORDER CARE PRESENTS CHALLENGES FOR FOLLOW UP AND CONTINUITY OF CARE REQUIRING SOPHISTICATED AND COMPREHENSIVE INFORMATION SHARING BETWEEN PROVIDERS ACROSS BORDERS AND IS BASED FOREMOST ON AN INFORMED PATIENT "ELGIUMS SIZE AND HISTORICAL EXPERIENCE WITH LANGUAGES AND WORKFORCES CROSSING BORDERS HAS SIMILARLY MADE CROSS BORDER HEALTHCARE A NATURAL EXPERIENCE /VER THE PAST YEARS PROVIDERS AND INSURERS HAVE TAKEN THE INITIATIVE TO MAKE THIS PROCESS EASIER AND MORE EFlCIENT FOR PATIENTS "ELGIAN HOSPITALS BENElT FROM FOREIGN PATIENTS PAID FOR BY FOREIGN INSURERS AND DIFFERENTIATE THEMSELVES IN SPECIALTIES IN A COMPETITIVE MARKET 3HARED PROTOCOLS ARE IN PLACE BETWEEN THE .ETHERLANDS AND "ELGIUM TO REDUCE TRANSMISSION OF ANTIBIOTIC RESISTANT BACTERIA A CONCERN IN CROSS BORDER CARE 3UCH PATIENT MOBILITY PROMOTES QUALITY IMPROVEMENTS IN BOTH $UTCH AND "ELGIAN HOSPITALS;=
#ONCLUSION )T IS NOT SURPRISING THAT INTERNATIONAL VARIATION IN THE CULTURAL POLITICAL ECONOMIC AND HISTORIC ENVIRONMENTS SURROUNDING HEALTHCARE CREATE AN EQUALLY WIDE VARIETY OF NATIONAL CONCERNS
AND PRIORITIES FOR QUALITY IMPROVEMENT 4HE GLOBAL EXPERIENCES HIGHLIGHTED IN THIS PAPER DEMONSTRATE THESE DIFFERENCES (OWEVER AS VARIABLE AS THESE EXPERIENCES ARE INTERNATIONAL EXPERIENCE ALSO PROVIDES SOME UNIQUE AND INNOVATIVE SOLUTIONS TO QUALITY ISSUES THAT MAY NOT BE EXCLUSIVE TO A REGION OR COUNTRY !S CARE ACROSS BORDERS BECOMES INCREASINGLY COMMON HEALTH SYSTEMS PLANNERS HAVE THE OPPORTUNITY TO BENElT FROM THEIR NEIGHBORS NOT ONLY BY SHARING SERVICES AND PROVIDERS BUT ALSO BY SHARING APPROACHES TO QUALITY MONITORING AND IMPROVEMENT %NDNOTES 3CRIVENS % h!CCREDITATION AND THE REGULATION OF QUALITY IN HEALTH SERVICES REGULATING ENTREPRENEURIAL BEHAVIOR IN %UROPEAN HEALTH CARE SYSTEMS v %DS 3ALMAN "USSE -OSSIALOS %UROPEAN /BSERVATORY "UCKINGHAM 4O %RR IS (UMAN "UILDING A 3AFER (EALTH 3YSTEM )NSTITUTE OF -EDICINE .ATIONAL !CADEMY OF 3CIENCE .ATIONAL !CADEMY 0RESS ,EAPE , , AND $ - "ERWICK -AY h&IVE 9EARS !FTER 4O %RR )S (UMAN 7HAT (AVE 7E ,EARNED v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP h(EALTH#AST #REATING A 3USTAINABLE &UTURE v 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE REPORT .OVEMBER -ANT * h0ROCESS VERSUS OUTCOME INDICATORS IN THE ASSESSMENT OF QUALITY IN HEALTH CARE v )NTERNATIONAL *OURNAL FOR 1UALITY IN (EALTH #ARE PP &INE , ET AL h(OW TO EVALUATE AND IMPROVE THE QUALITY AND CREDIBILITY OF AN OUTCOMES DATABASE VALIDATION AND FEEDBACK STUDY ON THE 5+ #ARDIAC 3URGERY %XPERIENCE v "RITISH -EDICAL *OURNAL P 4AIWAN $EPARTMENT OF (EALTH 4AIWAN (EALTH /UTLOOK 4AIPEI 4AIWAN %UROPEAN &OUNDATION FOR 1UALITY -ANAGEMENT WWWEFQMORG ACCESSED !PRIL 3ANCHEZ % ET AL h! DESCRIPTIVE STUDY OF THE IMPLEMENTATION OF THE %&1- EXCELLENCE MODEL AND UNDERLYING TOOLS IN THE "ASQUE (EALTH 3ERVICE v *OURNAL FOR 1UALITY IN (EALTH #ARE PP *OINT #OMMISSION )NTERNATIONAL WWWJOINTCOMMISSIONORG ACCESSED -AY "ERTINATO , ET AL 0OLICY "RIEF #ROSS "ORDER (EALTH #ARE IN %UROPE %UROPEAN /BSERVATORY "UCKINGHAM -ARSHALL - AND 3 ,EATHERMAN 3 -ATTKE h3ELECTING )NDICATORS FOR THE 1UALITY OF (EALTH PROMOTION 0REVENTION AND 0RIMARY #ARE AT THE (EALTH 3YSTEM ,EVEL IN /%#$ #OUNTRIES v /%#$ (EALTH 4ECHNICAL 0APERS 0ARIS "AETEN 2 h#ROSS BORDER #ONTRACTING IN "ELGIAN (OSPITALS v PAPER PRESENTED FOR THE %00%$ 'ROUP HEARING /BSERVATOIRE SOCIAL EUROPEEN ASBL "RUSSELS
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
0ATIENT #HOICE AND !CTIVATION IN (EALTHCARE 0ATIENTS CAN BECOME EFlCIENT HEALTHCARE CONSUMERS WHEN ARMED WITH THE TOOLS TO ACTIVELY ENGAGE IN THEIR TREATMENT OPTIONS n A CRITICAL STEP TOWARD QUALITY IMPROVEMENT AND COST CONTAINMENT "Y 2ACHEL !BBOTT 0RICEWATERHOUSE#OOPERS !NNA $IXON +INGS &UND *UDITH (IBBARD 5NIVERSITY OF /REGON
)NTRODUCTION 4HE OVERARCHING OBJECTIVE OF MANY HEALTH POLICY PLANNERS IS TO DESIGN SYSTEMS THAT IMPROVE HEALTHCARE QUALITY WHILE CONTAINING COSTS 4O DATE THE MAJORITY OF POLICIES AND PROGRAMS DESIGNED TO ACHIEVE THESE GOALS HAVE FOCUSED ON PROVIDING INCENTIVES TO OR REGULATING INSURERS AND PROVIDERS !N OPPORTUNITY EXISTS TO ENGAGE PATIENTS IN MEETING THESE OBJECTIVES )NCREASINGLY POLICY MAKERS ARE CONSIDERING THE ROLE OF THE PATIENT IN INFORMED DECISION MAKING AND SELF MANAGEMENT OF HIS OR HER OWN HEALTHCARE "UT TO DO SO PATIENTS REQUIRE SKILLS CONlDENCE KNOWLEDGE AND OPPORTUNITIES 4HEORETICALLY A COMPETITIVE PROVIDER MARKET COULD DRIVE IMPROVEMENTS IN QUALITY AND REDUCE COSTS 9ET THIS ASSUMES PATIENTS ACT AS RATIONAL CONSUMERS AND MAKE WELL INFORMED CHOICES )N GENERAL THREE BASIC ELEMENTS ARE NECESSARY FOR PATIENTS TO MAKE EFFECTIVE AND INFORMED CHOICES ABOUT THEIR HEALTHCARE 4HE PATIENT NEEDS OPTIONS FROM WHICH TO CHOSE TIMELY ACCESS TO APPROPRIATE INFORMATION ON WHICH TO BASE THESE CHOICES AND THE PERSONAL RESOURCES AND MOTIVATION TO ENGAGE IN AN ACTIVE DECISION MAKING PROCESS ! HEALTHCARE SYSTEM WITH ADEQUATE PATIENT CHOICE AND AVAILABILITY OF HIGH QUALITY COMPARATIVE INFORMATION ON PROVIDERS MAY STILL FAIL TO PROMOTE QUALITY AND EFlCIENCY THROUGH MARKET MECHANISMS IF PATIENTS ARE NOT ADEQUATELY MOTIVATED AND EQUIPPED TO RECEIVE PROCESS AND APPLY INFORMATION TO THEIR CHOICES 2ESEARCHERS SUGGEST THAT ACTIVATED PATIENTS WITH THE KNOWLEDGE SKILLS AND CONlDENCE TO MANAGE THEIR OWN HEALTH AND HEALTHCARE MAY ALSO BE MORE LIKELY TO ACT AS INFORMED CONSUMERS OF HEALTHCARE SERVICES BY SEEKING INFORMATION AND MAKING CHOICES
AROUND QUALITY AND COST EFFECTIVENESS 0OLICIES AND PRACTICES THAT SUPPORT PATIENT ACTIVATION MAY ENABLE THE POTENTIAL BENElTS OF A PATIENT DRIVEN SYSTEM TO BE REALIZED
/PPORTUNITIES FOR #HOICE 7HATEVER THE TYPE OF CHOICE ENHANCED PATIENT DECISION MAKING IS THOUGHT TO IMPROVE HEALTHCARE OUTCOMES AND PATIENT SATISFACTION 4HE &OUNDATION FOR )NFORMED -EDICAL $ECISION -AKING HAS PUBLISHED RESEARCH SHOWING THAT hWHEN PATIENTS ARE WELL INFORMED AND PLAY A SIGNIlCANT ROLE IN DECIDING HOW THEY ARE GOING TO TREAT OR MANAGE THEIR HEALTH CONDITIONS THINGS WORK OUT BETTERv;= -AKING DECISIONS BASED ON PERSONAL PREFERENCES AND VALUES AND ENGENDERING A COMMITMENT TO TREATMENT REGIMES THEY WERE INVOLVED IN DESIGNING LED BOTH TO GREATER PATIENT SATISFACTION AND IMPROVED TREATMENT OUTCOMES )N SECTORS OF THE HEALTH ECONOMY WHERE PROVIDERS COMPETE FOR PATIENTS PATIENT DECISION MAKING ALSO HAS THE POTENTIAL TO INmUENCE QUALITY AND EFlCIENCY OF HEALTHCARE SERVICES 4HIS REQUIRES THAT PATIENTS HAVE ADEQUATE CHOICE OF AND MOBILITY BETWEEN DOCTORS AND HOSPITALS (OWEVER REAL CHOICE MAY NOT BE POSSIBLE DUE TO LIMITED CAPACITY AND GEOGRAPHIC INEQUALITIES IN ACCESS TO CARE 0ATIENT CHOICE MAY ALSO BE LIMITED BY TRAVEL TIME AND EXPENSE PARTICULARLY FOR LOWER SOCIO ECONOMIC GROUPS AND BY THE CONDITION AND CIRCUMSTANCES OF THE PATIENT 3OME OF THE LIMITATIONS ON OPPORTUNITIES TO CHOOSE WERE HIGHLIGHTED BY EVALUATIONS OF THE PATIENT CHOICE PILOT PROGRAMS IN %NGLAND SEE SIDEBAR h4HE ,ONDON 0ATIENT #HOICE 0ROGRAMMEv
2ACHEL !BBOTT -3 IS AN EXECUTIVE WITH 0RICEWATERHOUSE#OOPERS 'OVERNMENT AND 0UBLIC 3ECTOR PRACTICE IN ,ONDON 3HE HAS SEVERAL YEARS EXPERIENCE IN THE HEALTHCARE INDUSTRY IN COMMUNICATIONS AND PUBLIC AFFAIRS AND STUDIED INTERNATIONAL HEALTH POLICY AT THE ,ONDON 3CHOOL OF %CONOMICS 3HE CAN BE REACHED AT RACHELEABBOTT UKPWCCOM !NNA $IXON IS DEPUTY DIRECTOR OF POLICY AT THE +INGS &UND 3HE HAS CONDUCTED RESEARCH ON INTERNATIONAL HEALTHCARE POLICY ISSUES INCLUDING lNANCING REGULATION AND PATIENT CHOICE AND WORKED AS AN ADVISER TO GOVERNMENTS AND INTERNATIONAL ORGANIZATIONS 3HE WAS AWARDED A (ARKNESS &ELLOWSHIP IN (EALTHCARE 0OLICY BY THE #OMMONWEALTH &UND 3HE CAN BE REACHED AT ADIXON KINGSFUNDORG UK *UDITH (IBBARD $R0H IS A PROFESSOR OF HEALTH POLICY IN THE $EPARTMENT OF 0LANNING 0UBLIC 0OLICY AND -ANAGEMENT AT THE 5NIVERSITY OF /REGON (ER PUBLICATIONS ON CONSUMER DECISION MAKING AND CONSUMER ROLES IN CARE ARE WIDELY READ AND HAVE BEEN INmUENTIAL IN INFORMING HEALTHCARE POLICY 3HE CAN BE REACHED AT JHIBBARD UOREGONEDU
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
O @SHDMSãB GN HBD ã@MCã@BSHU@SHNMãHMãGD @KSGB@QD 4HE ,ONDON 0ATIENT #HOICE 0ROGRAMME (EALTH SYSTEM REFORMS IN THE 5NITED +INGDOM OVER THE PAST YEARS HAVE FOCUSED ON IMPROVING QUALITY AND EFlCIENCY )N THE %NGLISH .ATIONAL (EALTH 3ERVICE .(3 POLICIES HAVE FOCUSED ON THE POTENTIAL FOR CHOICE TO IMPROVE QUALITY AND EFlCIENCY 4HIS REQUIRES THAT MOBILE PATIENTS COMPARE OPTIONS AND MAKE DECISIONS BASED ON QUALITY INFORMATION;= 4HE ,ONDON 0ATIENT #HOICE 0ROGRAMME ,0#0 GAVE PATIENTS ON LONG WAITING LISTS FOR TREATMENT AT ,ONDON HOSPITALS THE OPPORTUNITY TO CHOOSE FASTER TREATMENT AT AN ALTERNATIVE HOSPITAL PROVIDER !S PART OF THE EVALUATION PATIENT DECISION MAKING PROCESSES WERE ANALYZED TO UNDERSTAND HOW DIFFERENT GROUPS OF PATIENTS WEIGHED DIFFERENT FACTORS IN THEIR DECISION MAKING;= 4HE EVALUATION FOUND THAT MOST PATIENTS PERCENT EXERCISED THE OPTION TO CHANGE HOSPITALS WHEN CARE WAS AVAILABLE SOONER ELSEWHERE AND IN DECIDING TO DO SO CONSIDERED THE REPUTATION OF THE NEW HOSPITAL TRAVEL TIME EXPENSE INVOLVED AND THE NEED FOR FOLLOW UP CARE;= 0ATIENTS SURVEYED AFTER PARTICIPATION IN THE ,0#0 REPORTED THAT THE INFORMATION MOST IMPORTANT TO THEM IN DECISION MAKING WAS HOSPITAL LOCATION REPUTATION AND SUCCESS RATES PERTINENT TO THEIR CONDITION OR TREATMENT FOLLOWED BY AN INTEREST IN CLEANLINESS AND RISK OF HOSPITAL ACQUIRED INFECTION;= 4HE ,0#0 WAS AN IMPORTANT PRECURSOR TO THE INTRODUCTION OF PATIENT CHOICE FOR ELECTIVE SURGERY AT THE POINT OF REFERRAL ACROSS THE %NGLISH .(3 IN
)NFORMATION FOR #HOICE )N ORDER TO MAKE AN INFORMED CHOICE THAT lTS WITH PATIENT VALUES AND PREFERENCES PATIENTS NEED THE RIGHT INFORMATION AT THE RIGHT TIME;= $ECISION SUPPORT TOOLS ARE AVAILABLE TO ASSIST PATIENTS IN MAKING CHOICES ABOUT SCREENING TREATMENT OPTIONS AND SELF MANAGEMENT -ARKET BASED APPROACHES TO IMPROVING HEALTHCARE QUALITY AND EFlCIENCY ALSO REQUIRE THAT PATIENTS ACT AS INFORMED CONSUMERS (OWEVER THE COMPLEXITIES AND UNCERTAINTIES OF HEALTHCARE MEAN THAT PUBLIC REPORTING OF PERFORMANCE INDICATORS ALONE MAY NOT BE SUFlCIENT TO ALLOW INFORMED PATIENT CHOICE;= h-ARKET INCENTIVES WILL ONLY HELP TO DRIVE UP QUALITY STANDARDS IF PATIENTS ARE ABLE TO ACT AS DISCERNING CONSUMERSv;= 0ATIENTS MUST HAVE ACCESS TO A SUFlCIENT QUANTITY OF TIMELY AND APPROPRIATE INFORMATION ABOUT THEIR CHOICES &OR PATIENTS TO BE ABLE TO USE SUCH INFORMATION IN DECISION MAKING IT MUST BE BOTH ACCESSIBLE AND PRESENTED IN A WAY THAT SUPPORTS THEIR DECISION MAKING PROCESS %XTENSIVE RESEARCH HAS BEEN CONDUCTED ON INFORMING CONSUMERS 4HIS IS NOW BEING APPLIED IN HEALTHCARE SETTINGS 4HE MEANING OF COMPARATIVE QUALITY DATA TO PATIENTS AND CONSEQUENT IMPACT DEPENDS ON NUMEROUS FACTORS INCLUDING RELEVANCE OF THE MEASURES PUBLICATION FORMAT DATA COLLECTION
METHODOLOGIES AND THE SOURCE OF THE REPORTS;= 0UBLICATIONS OF COMPARATIVE QUALITY INFORMATION ARE FREQUENTLY CRITICIZED FOR ONLY REPORTING THE DATA MOST EASILY ACCESSIBLE AND QUANTIlABLE RATHER THAN THE INFORMATION MOST MEANINGFUL TO PATIENTS;= )NTERNATIONAL EXPERIENCE HAS FOUND THAT PATIENTS ARE OFTEN CONFUSED BY OR SKEPTICAL OF PUBLISHED REPORTS OF COMPARATIVE HEALTH DATA RESORTING TO ADVICE FROM FAMILY FRIENDS AND THEIR PHYSICIANS -OST PATIENTS SURVEYED AS PART OF THE ,0#0 SAID THEY WOULD GO TO THEIR '0 FOR GUIDANCE AND INFORMATION IN CHOOSING A HOSPITAL FOR SURGERY AND A LARGE PORTION REPORTED SEEKING INFORMATION ON THE )NTERNET;= 3TUDIES IN BOTH THE 5+ AND THE 53 FOUND THAT ON THE WHOLE PATIENTS DO NOT ACCESS PUBLISHED DATA WHEN MAKING HEALTHCARE DECISIONS 0ATIENTS IN THE 53 ARE OFTEN SKEPTICAL THAT INFORMATION ON DOCTORS PUBLISHED BY INSURANCE COMPANIES IS SKEWED TO FAVOR LOWER COST PROVIDERS 3IMILAR ISSUES OF TRUST EXIST IN THE 5+ SEE SIDEBAR h0UBLIC 2EPORTING IN %NGLANDv )N THE ABSENCE OF INDEPENDENT COMPREHENSIVE INFORMATION HOSPITAL MARKETING AND ADVERTISING MAY PLAY AN IMPORTANT ROLE IN INFORMING OR AT LEAST ENCOURAGING PATIENT CHOICE )F THIS FORM OF PATIENT INmUENCE IS TO BE AVOIDED APPROPRIATE ACCESSIBLE UNBIASED INFORMATION MUST BE DELIVERED TO PATIENTS;= 4HE INFORMATION AGE POSES NEW CHALLENGES AS WELL AS OPPORTUNITIES FOR HEALTHCARE QUALITY REPORTING;= 4HE )NTERNET IS A POWERFUL TOOL FOR HEALTH INFORMATION DISSEMINATION THAT IS ALREADY WIDELY USED )N A LARGE SCALE PHONE SURVEY OF APPROXIMATELY ADULTS BELOW AGE IN THE 53 PERCENT OF THOSE WITH REGULAR )NTERNET ACCESS REPORTED RETRIEVING DISEASE SPECIlC INFORMATION PERCENT LOOKED FOR INFORMATION ON PROVIDERS OR SERVICE AVAILABILITY AND PERCENT ACCESSED SEXUAL HEALTH INFORMATION;= !S WITH MOST FORMS OF INFORMATION DISSEMINATION INEQUALITIES IN ACCESS MAY RESULT 3TUDIES 0UBLIC 2EPORTING IN %NGLAND )NCREASED PUBLIC REPORTING OF QUALITY AND OUTCOME DATA IS CRITICAL TO THE .(3 REFORM AGENDA BUT SURVEYS HAVE REVEALED THAT WHEN 5+ PATIENTS ARE OFFERED A CHOICE OF PROVIDERS MOST RELY ON THE ADVICE OF THEIR '0;= 0UBLIC REPORTING DID NOT APPEAR IN THE 5+ IN ANY MEANINGFUL WAY UNTIL WITH THE INTRODUCTION OF A RATING SYSTEM FOR .(3 HOSPITALS THE STAR RATING SYSTEM 3URVEYS OF PATIENTS FOLLOWING INITIAL INTRODUCTION OF THE SYSTEM FOUND A GREAT DISTRUST OF GOVERNMENT PROVIDED INFORMATION AS OPPOSED TO INDEPENDENTLY REPORTED QUALITY DATA;= 4HIS LED TO THE INDEPENDENT PUBLICATION OF A SPECIAL NEWSPAPER SUPPLEMENT RANKING 5+ HOSPITALS 4HE ORGANIZATION THAT PUBLISHED THE RANKINGS h$R &OSTER v LATER LAUNCHED A 7EB BASED FORUM PROVIDING COMPARATIVE LOCALIZED INFORMATION ON PROVIDERS 2EPORTS FROM h$R &OSTERv HAVE BEEN POPULAR WITH PATIENTS DUE TO WIDE PUBLICATION AND AN INTERACTIVE REPORTING FORMAT BUT PATIENTS REMAIN SKEPTICAL OF ULTERIOR MOTIVES;=
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
O @SHDMSãB GN HBD ã@MCã@BSHU@SHNMãHMãGD @KSGB@QD SUGGEST THAT LOW INCOME ADULTS AND THE ELDERLY ARE CAPABLE OF lNDING AND USING ONLINE HEALTH INFORMATION TOOLS ONCE ACCESS IS MADE AVAILABLE;=
0RESENTATION OF )NFORMATION FOR #HOICE 0ATIENTS ARE ASKED TO MAKE CHOICES THROUGHOUT THEIR CONTACT WITH THE HEALTHCARE SYSTEM !S WELL AS HELPING PATIENTS UNDERSTAND THEIR CHOICES MOST HEALTH INFORMATION AIMS TO MOTIVATE PATIENTS TO MAKE RATIONAL DECISIONS;= )N MAKING DECISIONS PATIENTS ARE REQUIRED TO PROCESS A DEGREE OF TECHNICAL INFORMATION AND CONDUCT THEIR OWN RISK BENElT ANALYSIS ACROSS THE AVAILABLE OPTIONS;= 4HE WAY INFORMATION IS PRESENTED CAN DETERMINE HOW THAT INFORMATION IS PROCESSED AND USED BY PATIENTS IN DECISION MAKING
#OMBINED -EASURES AND !VERAGES 2ESEARCH ON DECISION MAKING AND INFORMATION PROCESSING HAS FOUND THAT INDIVIDUALS EXPERIENCE A SIGNIlCANT COGNITIVE BURDEN IN THE EFFORT TO INTEGRATE SEVERAL TYPES OF INFORMATION 4OO MUCH INFORMATION MAY IMPEDE ONES ABILITY TO MEANINGFULLY PROCESS ANY OF IT 7HEN PEOPLE ARE FACED WITH A LARGE VOLUME OF INFORMATION OR ARE TRYING TO USE COMPLEX INFORMATION TO INFORM A CHOICE THERE IS A TENDENCY TO MAKE THE PROCESS EASIER BY SIMPLY MAKING THAT CHOICE ON A SINGLE FACTOR (OWEVER IN REDUCING THE BURDEN THEY MAY NEGLECT POTENTIALLY IMPORTANT FACTORS AND IN THE PROCESS MAY COMPROMISE THEIR OWN SELF INTEREST )NFORMED CHOICES CAN BE IMPROVED HOWEVER BY PROVIDING CONSUMERS WITH INFORMATION DISPLAYS THAT MAKE IT EASIER TO UNDERSTAND AND INCORPORATE THE INFORMATION INTO CHOICES &OR EXAMPLE INFORMATION DISPLAYS THAT REDUCE THE COGNITIVE BURDEN TEND TO INCREASE THE USE OF THAT INFORMATION IN CHOICE "Y SUMMARIZING AND INTERPRETING DATA IT TAKES LESS EFFORT FOR THE USER TO UNDERSTAND AND APPLY THAT INFORMATION THAT IS BY DOING SOME OF THE COGNITIVE WORK FOR USERS IT IS ACTUALLY MORE LIKELY TO GET USED $ESIGN AND USE OF DECISION TOOLS MUST CONSIDER THE PATIENT INTENDING TO USE IT 2ESEARCH HAS SUGGESTED THAT OLDER ADULTS ARE LIKELY TO NEED EXTRA ASSISTANCE IN PROCESSING COMPARATIVE HEALTH INFORMATION;= )NDIVIDUAL CHARACTERISTICS SUCH AS AGE LITERACY AND CULTURAL OR SOCIAL FACTORS ARE ALSO CORRELATED WITH THE ABILITY TO PROCESS HEALTH INFORMATION AND TO CARRY OUT COMPLEX DECISION MAKING
#ONTEXTUALIZING $ECISIONS )NFORMATION PRESENTATION TECHNIQUES AND METHODS CAN HELP THE PATIENT CONSIDER THE REAL LIFE IMPLICATIONS OR EXPERIENCE OF A GIVEN CHOICE FOR EXAMPLE THE USE OF SHORT STORIES OR CASE STUDIES RATHER THAN DATA CHARTS AND lGURES )NFORMATION IN A NARRATIVE FORM BECOMES MORE EMOTIONALLY INTERESTING AND CAN BE DELIVERED
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
7ISCONSIN @1UALITY#OUNTS 2EPORT %FFECTIVE INFORMATION DISPLAY AND DISTRIBUTION TECHNIQUES WERE USED IN A COMPARATIVE PERFORMANCE REPORT OF HOSPITALS IN SOUTH CENTRAL 7ISCONSIN;= 4HE !LLIANCE A LARGE EMPLOYER PURCHASING COOPERATIVE IN -ADISON SPONSORED THE h1UALITY#OUNTSv REPORT ON HOSPITAL QUALITY AND SAFETY )N THE REPORT HOSPITALS WERE RANKED AS BETTER THAN EXPECTED FEWER DEATHS AND COMPLICATIONS AS EXPECTED OR WORSE THAN EXPECTED 4HE DATA CAME FROM THE 7ISCONSIN "UREAU OF (EALTH )NFORMATION INPATIENT PUBLIC USE DATA SETS lNDINGS WERE PUBLISHED IN LOCAL NEWSPAPERS SENT TO EMPLOYEES HOMES AND POSTED ONLINE 4HROUGH USE OF THE h1UALITY#OUNTSv REPORT CONSUMERS COULD CONVENIENTLY SEE AT A GLANCE WHICH HOSPITALS WERE HIGHLY RANKED WITH TOP TIER PERFORMERS HIGHLIGHTED BY A COLOR BAND AND DIFFERENT TYPES OF CARE SUCH AS OBSTETRICS AND CARDIAC CARE SHOWN AS WELL 4HE h1UALITY#OUNTSv REPORT WAS THE lRST OF ITS KIND AND HAD A SIGNIlCANT IMPACT ON PATIENT DECISION MAKING DUE IN PART TO ITS EASE OF USE AND WIDE DISTRIBUTION !FTER SEEING THE REPORT RESPONDENTS WERE ABLE TO DESCRIBE WHICH HOSPITALS ACHIEVED A HIGHER OR LOWER RANKING -OST CONSUMERS WHO SAW THE REPORT SAID THEY HAD EITHER SPOKEN TO OTHERS ABOUT IT OR PLANNED TO DO SO (OSPITALS CONCERNED ABOUT THE POTENTIAL IMPACT OF THE REPORT ON THEIR REPUTATION TOOK STEPS TO IMPROVE THEIR PERFORMANCE 4HE lNDINGS INDICATE THAT WHEN PUBLIC REPORTS ARE DESIGNED TO BE HIGHLY EVALUABLE BY CONSUMERS HOSPITALS WERE MOTIVATED TO IMPROVE THEIR PERFORMANCE;=
EFFECTIVELY WITH WELL STRUCTURED COMPUTER AIDED DECISION TOOLS THAT BREAK DOWN COMPLEX PROCESSES AND EXPERIENCES 4HE &OUNDATION FOR )NFORMED -EDICAL $ECISION -AKING HAS DESIGNED SEVERAL TOOLS AND DECISION AIDS SPECIlCALLY FOR COMMON CONDITIONS SUCH AS HEART DISEASE PROSTATE AND BREAST CANCER
$ISPLAYING )NFORMATION 4HE VISUAL PRESENTATION OF INFORMATION IS IMPORTANT TO HELPING PATIENTS MAKE WELL INFORMED DECISIONS 3TUDIES HAVE FOUND THAT THE COGNITIVE EFFORT REQUIRED TO PROCESS HEALTHCARE INFORMATION CAN BE FURTHER REDUCED BY DISPLAYING DATA IN SUCH A WAY AS TO HELP THE USER INTERPRET IT SUCH AS USING SYMBOLS THAT INDICATE WHAT IS hGOODv AND WHAT IS NOT IE USING SYMBOLS TO INDICATE GOOD AND POOR OPTIONS $ELIVERING INFORMATION IN AN EVALUATIVE MANNER CONVEYS hGOODBADv EMOTIONAL MEANING ! LARGE BODY OF CONTROLLED STUDIES HAS CONlRMED THE BENElT OF EVALUATIVE DISPLAYS OF INFORMATION /NE STUDY FOUND THAT BY PROVIDING CONSUMERS WITH VISUAL CUES SUCH AS STAR RATINGS OF QUALITY AND ORDERING SIMILARLY PRICED OPTIONS BY STAR RATING WITHIN EACH COST STRATA PATIENTS WERE MORE LIKELY TO CHOSE HIGHER QUALITY
O @SHDMSãB GN HBD ã@MCã@BSHU@SHNMãHMãGD @KSGB@QD OPTIONS EVEN WHEN THEY COST MORE THAN THOSE WHO DID NOT GET THE INFORMATION IN AN EVALUABLE FORMAT #OLOR HIGHLIGHTING OF TOP PERFORMERS WITHIN EACH CATEGORY HAS ALSO BEEN FOUND TO BE EFFECTIVE IN HELPING PATIENTS CHOOSE HIGHER PERFORMING HOSPITALS SEE %XHIBIT
0ATIENT !CTIVATION ! PATIENT LED HEALTH SYSTEM REQUIRES THAT INDIVIDUALS ARE MOTIVATED TO ACT AS DECISION MAKERS IN THEIR OWN HEALTHCARE AND EXERCISE CHOICE OF PROVIDERS AND HEALTHCARE OPTIONS 4HE CAPACITY OF PATIENTS TO MANAGE THEIR OWN HEALTH AND HEALTHCARE HAS BEEN RELIABLY MEASURED WITH THE 0ATIENT !CTIVATION -EASURE 0!- ;= 5SING THIS MEASURE PATIENTS SCORING HIGH IN ACTIVATION IE WITH THE KNOWLEDGE SKILLS AND CONlDENCE TO MANAGE ONES HEALTH WERE MORE LIKELY TO ENGAGE IN HEALTHY BEHAVIORS AND SELF MANAGEMENT;=
4HE 0!- HAS BEEN SPECIlCALLY DEVELOPED AND TESTED WITH PEOPLE WITH CHRONIC CONDITIONS $IABETES PATIENTS SCORING HIGH IN ACTIVATION WERE MORE LIKELY TO SELF MANAGE THEIR CONDITION WITH TECHNIQUES SUCH AS JOURNAL KEEPING 3IMILARLY ACTIVATED ARTHRITIS PATIENTS WERE MORE LIKELY TO EXERCISE AND AMONG THOSE WITH HIGH CHOLESTEROL ACTIVATED PATIENTS WERE MORE LIKELY TO ADHERE TO A LOW FAT DIET;= )T IS ESPECIALLY USEFUL TO UNDERSTAND HOW PATIENT ACTIVATION AS MEASURED BY THE 0!- CAN IMPROVE SELF MANAGEMENT AND SELF CARE BECAUSE PATIENTS WITH COSTLY LONG TERM CONDITIONS HAVE A HIGH FREQUENCY OF CONTACT WITH MANY FACETS OF THE HEALTH SYSTEM AND ARE AT INCREASED RISK OF ADVERSE EVENTS DUE TO COMMUNICATION FAILURES 4HESE PATIENTS ARE OFTEN REQUIRED TO TAKE MULTIPLE MEDICATIONS APPROPRIATELY AND MONITOR AND IMPLEMENT HEALTH AND LIFESTYLE CHANGES;= .EW RESEARCH IS CONSIDERING THE POSSIBILITY THAT ACTIVATED PATIENTS ARE MORE LIKELY TO ACT AS INFORMED CONSUMERS OF HEALTHCARE SERVICES BY SEEKING INFORMATION AND MAKING CHOICES BASED ON QUALITY AND COST EFFECTIVENESS
%XHIBIT @1UALITY#OUNTS USES SYMBOLS TO REDUCE COGNITIVE BURDEN 7HAT THE SYMBOLS MEAN &EWER MISTAKES COMPLICATIONS AND DEATHS THAN EXPECTED !VERAGE NUMBER OF MISTAKES COMPLICATIONS AND DEATHS -ORE MISTAKES COMPLICATIONS AND DEATHS THAN EXPECTED 2EGIONAL (OSPITALS
3URGERY
.ON 3URGERY
(IP+NEE
#ARDIAC
-ATERNITY
(OSPITAL !
(OSPITAL "
(OSPITAL #
(OSPITAL $
NA
(IP+NEE
#ARDIAC
-ATERNITY
#OMMUNITY (OSPITALS
3URGERY
.ON 3URGERY
(OSPITAL &
(OSPITAL '
(OSPITAL (
(OSPITAL )
(OSPITAL *
(OSPITAL +
(OSPITAL ,
(OSPITAL -
NA
(OSPITAL .
(OSPITAL /
(OSPITAL 0
NA
(OSPITAL 1
NA
2EPRODUCED WITH PERMISSION FROM (IBBARD * AND 0ETERS % h3UPPORTING )NFORMED #ONSUMER (EALTH #ARE $ECISIONS v !NNUAL 2EVIEW OF 0UBLIC (EALTH 6OL
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
O @SHDMSãB GN HBD ã@MCã@BSHU@SHNMãHMãGD @KSGB@QD
3UMMARY AND #ONCLUSION #URRENT RESEARCH WITH CHRONIC CONDITION PATIENTS IS REVEALING THAT ACTIVATED PATIENTS WITH THE KNOWLEDGE SKILLS AND CONlDENCE TO ENGAGE IN SELF MANAGEMENT CAN HAVE AN IMPORTANT IMPACT ON THEIR OWN TREATMENT OUTCOMES )F INDIVIDUAL HEALTH OUTCOMES CAN BE IMPROVED IN THIS WAY IT IS POSSIBLE THAT THE SAME PATIENTS MAY BE ABLE TO APPLY SKILLS AND RESOURCES TO DECISIONS ABOUT PROVIDERS ACTING AS INFORMED CONSUMERS OF HEALTH SERVICES 2ATIONAL INFORMED BEHAVIOR BY PATIENTS IS THE CRITICAL ELEMENT TO DRIVING EFlCIENCY AND CONTAINING COSTS IN A MARKET BASED APPROACH TO IMPROVEMENT THROUGH PATIENT CHOICE )N THIS WAY IT IS POSSIBLE THAT PATIENT CHOICE MAY NOT ONLY IMPROVE HEALTH OUTCOMES ON THE INDIVIDUAL LEVEL BUT PLAY A KEY ROLE IN CONTAINING COSTS AND INCREASING EFlCIENCY ON A SYSTEM LEVEL 0ATIENTS ARE THE LAST UNTAPPED RESOURCE IN THE HEALTHCARE SYSTEM "Y PROVIDING THE TOOLS AND RESOURCES THEY NEED TO MAKE BETTER DECISIONS PATIENTS CAN BECOME AGENTS OF CHANGE IN IMPROVING THE QUALITY OF THEIR CARE %NDNOTES h&OUNDATION 0ROCEDURES FOR $EVELOPMENT OF $ECISION !IDS v &OUNDATION FOR )NFORMED $ECISION -AKING "OSTON 2OSENTHAL - ET AL h0AYING FOR 1UALITY 0ROVIDERS )NCENTIVES FOR 1UALITY )MPROVEMENT v (EALTH !FFAIRS PP "URGE 0 ET AL ,ONDON 0ATIENT #HOICE 0ROJECT %VALUATION 2!.$ %UROPE #OULTER ! AND . LE -AISTRE , (ENDERSON h0ATIENTS %XPERIENCE OF #HOOS ING 7HERE TO 5NDERGO 3URGICAL 4REATMENT v 0ICKER )NSTITUTE ,ONDON +EMPER $ AND - -ETTLER h)NFORMATION 4HERAPY 0RESCRIBED )NFORMATION AS A 2EIMBURSABLE -EDICAL 3ERVICE v #ENTER FOR )NFORMATION 4HERAPY
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
+LEIN 2 h-ODELS OF -AN AND -ODELS OF 0OLICY v -ILBANK -EMORIAL &UND 1UARTERLY PP -ARSHALL - . AND 0 ' 3HEKELLE 2 ( "ROOK 3 ,EATHERMAN h$YING TO +NOW 0UBLIC 2ELEASE OF )NFORMATION ABOUT 1UALITY OF (EALTH #ARE v 3ANTA -ONICA 2!.$ -ARSHALL - AND 0 3HEKELLE ( $AVIES 0 3MITH h0UBLIC 2EPORTING ON 1UALITY IN THE 5NITED 3TATES AND THE 5NITED +INGDOM v (EALTH !FFAIRS PP ,LOYD ) h4HE "IG 3ELL 7HY ITS 4IME FOR (OSPITALS TO -ARKET 4HEMSELVES v /CTOBER (EALTH 3ERVICE *OURNAL PP "ATES $ AND ! 'AWANDE h4HE )MPACT OF THE )NTERNET ON 1UALITY -EASUREMENT v (EALTH !FFAIRS PP "RODIE - ET AL h(EALTH )NFORMATION THE )NTERNET AND THE $IGITAL $IVIDE v (EALTH !FFAIRS PP #OULTER ! AND 2 .YE 3 0OLLARD h7HAT 0ATIENTS 2EALLY 7ANT v 0OPULUS ,ONDON -AGEE ( AND , $AVIS ! #OULTER h0UBLIC 6IEWS ON (EALTHCARE 0ERFORMANCE )NDICATORS AND 0ATIENT #HOICE v *OURNAL OF THE 2OYAL 3OCIETY OF -EDICINE VOL PP 'USTAFSON $ ET AL h#ONSUMERS AND %VALUATION OF )NTERACTIVE (EALTH #OMMUNICATION !PPLICATIONS v !MERICAN *OURNAL OF 0REVENTIVE -EDICINE PP (IBBARD * AND % 0ETERS h3UPPORTING )NFORMED #ONSUMER (EALTH #ARE $ECISIONS v !NNUAL 2EVIEW OF 0UBLIC (EALTH VOL %MPLOYER (EALTHCARE !LLIANCE #OOPERATIVE h1UALITY #OUNTS #ON SUMER )NFORMATION FOR "ETTER (EALTH #ARE v -ADISON 7ISCONSIN (IBBARD * AND * 3TOCKARD - 4USLER h(OSPITAL 0ERFORMANCE 2EPORTS )MPACT ON 1UALITY -ARKET 3HARE AND 2EPUTATION v (EALTH !FFAIRS PP (IBBARD * h)MPROVING 1UALITY AND /UTCOMES BY 3UPPORTING 0ATIENT !CTIVATION v 5NIVERSITY OF /REGON (IBBARD * ET AL h$EVELOPMENT OF THE 0ATIENT !CTIVATION MEASURE CONCEPTUALIZING AND MEASURING ACTIVATION IN PATIENTS AND CONSUMERS v (EALTH 3ERVICES 2ESEARCH VOL P
1! 4HE 2OLE OF THE #ONSUMER IN 1UALITY ! $ISCUSSION 7ITH THE 3USAN ' +OMEN &OUNDATION "REAST CANCER PATIENTS RECEIVE RELATIVELY HIGH QUALITY CARE AND THE QUALITY SEEMS TO BE IMPROVING ACCORDING TO RECENT STUDIES &OR EXAMPLE A 2AND #ORP STUDY SHOWED THAT WHILE !MERI CANS RECEIVE RECOMMENDED CARE ONLY PERCENT OF THE TIME BREAST CANCER PATIENTS FARED MUCH BETTER RECEIVING RECOMMENDED CARE PERCENT OF THE TIME SEE %XHIBIT ;= -ORE RECENTLY 2AND #ORP RESEARCHERS FOUND EVEN BETTER NEWS FOR BREAST CANCER PATIENTS /N AVERAGE PATIENTS WITH BREAST CANCER RECEIVED PERCENT OF GENERALLY RECOMMENDED CARE BASED ON QUALITY CARE MEASURES ESTABLISHED BY THE RESEARCH TEAM;= (OW HAS CONSUMER INVOLVEMENT PLAYED A PART IN THIS "REAST CANCER PATIENTS ARE A VOCAL AND ACTIVE GROUP 4O EXPLORE THE ROLE OF PATIENTS IN ENHANCING QUALITY 0RICEWATERHOUSE#OOPERS SPOKE WITH $IANE "ALMA DIRECTOR OF PUBLIC POLICY AND #HERYL 0ERKINS -$ SENIOR CLINICAL ADVISOR FOR THE 3USAN ' +OMEN "REAST #ANCER &OUNDATION &OR NEARLY YEARS THE 3USAN ' +OMEN "REAST #ANCER &OUNDATION HAS BEEN A GLOBAL LEADER IN THE lGHT AGAINST BREAST CANCER THROUGH ITS SUPPORT OF INNOVATIVE RESEARCH AND COMMUNITY BASED OUTREACH PROGRAMS 7ORKING THROUGH A NETWORK OF 53 AND INTERNATIONAL AFlLIATES AND EVENTS LIKE THE +OMEN 2ACE FOR THE #URE¸ THE +OMEN &OUNDATION IS lGHTING TO ERADICATE BREAST CANCER AS A LIFE THREATENING DISEASE BY FUNDING RESEARCH GRANTS AND SUPPORTING EDUCATION SCREENING AND TREATMENT PROJECTS IN COMMUNITIES AROUND THE WORLD 0RICEWATERHOUSE#OOPERS (OW DO YOU DElNE QUALITY OF CARE FOR PATIENTS AND CONSUMERS #HERYL 0ERKINS 4HE BEST DElNITION IS EVIDENCE OF ADHERENCE TO THE STANDARDS OF BREAST CANCER CARE THAT EXIST ACROSS THE 5NITED 3TATES 7E ALSO AGREE THAT THERE IS A PERSONAL COMPONENT AS WELL AN ACCESS COMPONENT $IANE "ALMA 4HE POINT IS WE HAVE DIFlCULTY DElNING IT BECAUSE WE CANT DElNE IT THE SAME WAY FOR EVERY PATIENT #ERTAINLY YOU HAVE TO LOOK AT THE STANDARDS OF BREAST CANCER CARE BUT YOU ALSO HAVE TO LOOK AT IT SUBJECTIVELY n WHATS IMPORTANT TO THE PATIENT WHAT ARE THEIR NEEDS AND ARE THOSE NEEDS MET 0W# 7HAT IS THE ROLE OF THE PATIENT IN MANAGING AND ENHANCING QUALITY OF CARE #0 4HEY SHOULD BE AS INFORMED AND EDUCATED AS THEY CAN ABOUT THEIR MEDICAL DIAGNOSIS AND THE NUANCES OF THEIR OWN PARTICULAR BREAST CANCER THEIR TREATMENT OPTIONS AND THE OUTCOMES THEY CAN EXPECT )N ADDITION TO BEING INFORMED THEY CAN ASK QUESTIONS SEEK SECOND OPINIONS AND BE AN ADVOCATE FOR CHANGE WHEN THEY RUN INTO SITUATIONS THAT ARE LESS THAN OPTIMAL $" 7E ENCOURAGE OUR CONSTITUENTS TO MAKE THEIR VOICES HEARD BY ADVOCATING FOR VARIOUS LEGISLATIVE AND REGULATORY CHANGES THAT HAVE A POTENTIAL TO ENHANCE THE QUALITY OF CARE FOR BREAST
CANCER PATIENTS 0ATIENTS CAN ALSO BECOME EDUCATED ABOUT THEIR SPECIlC DISEASE UNDERSTAND THE CONCEPT OF PERSONALIZED MEDICINE AND WHAT THAT MEANS FOR BREAST CANCER TREATMENT LEARN THE QUESTIONS THAT NEED TO BE ASKED AND DEMAND MORE FROM THEIR INSURANCE COMPANIES )TS REALLY ABOUT BEING PROACTIVE IN THEIR HEALTHCARE AND MAKING SURE THAT THEY HAVE ALL THE ANSWERS TO THEIR VARIOUS QUESTIONS THAT WOULD FACTOR INTO THEIR HEALTHCARE DECISIONS 0W# 7HAT KINDS OF INFORMATION DO CONSUMERS NEED #0 0EOPLE NEED TO UNDERSTAND AS A hWELL PATIENTv WHAT THEIR PERSONAL RISK FACTORS ARE THEIR FAMILY HISTORY AND THE KINDS OF SCREENING THAT ARE RECOMMENDED FOR THEM )F THEY ARE DIAGNOSED WITH BREAST CANCER KNOWING THE PATHOLOGY OF THEIR CANCER WILL HELP THEM UNDERSTAND THEIR TREATMENT OPTIONS 4HERE ARE MANY DIFFERENT KINDS OF BREAST CANCER AND WERE INCREASINGLY LEARNING ABOUT THE NEED FOR INDIVIDUALIZED TREATMENT APPROACHES $" 0ATIENTS NEED TO KNOW WHAT RESOURCES THEY WILL HAVE FOR DEALING WITH SIDE EFFECTS WHAT KIND OF MEDICAL SUPPORT IS AVAILABLE AND HOW TO GET IT THEIR INSURANCE COVERAGE AND LONG TERM SURVIVOR ISSUES THAT MAY COME AS A CONSEQUENCE OF SOME OF THE TREATMENTS !S THE SCIENCE CHANGES THEY NEED TO KEEP ABREAST OF NEW OPTIONS THAT ARE UNFOLDING EVERY DAY FOR PATIENTS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! 0W# 7HAT DOES THE +OMEN &OUNDATION DO TO HELP PATIENTS MAKE DECISIONS AND SORT THROUGH THE INFORMATION THATS OUT THERE #0 7E PROVIDE A VARIETY OF EDUCATIONAL MATERIALS TRANSLATED INTO SEVERAL LANGUAGES 0EOPLE LEARN AND COMMUNICATE IN INDIVIDUAL WAYS 3O WE USE DIFFERENT APPROACHES ELECTRONIC PRINT INTERACTIVE ONE ON ONE SUPPORT CHAT ROOMS ON OUR WEBSITE 7E ALSO HAVE COMMUNITY AFlLIATES WHERE PATIENTS CONNECT AT THE LOCAL GRASSROOTS LEVEL 4HE APPROACH DEPENDS ON THE INDIVIDUAL ITS PERSONAL $" ! h4ALK TO 9OUR $OCTORv SECTION ON OUR WEBSITE IDENTIlES QUESTIONS THAT PATIENTS CAN USE IN AN OFlCE VISIT 7HILE WE HAVE COMPREHENSIVE INFORMATION ON OUR WEBSITE NOT EVERYONE HAS ACCESS TO THE )NTERNET AND SO OUR AFlLIATE NETWORK PLAYS A SIGNIlCANT ROLE IN REACHING AND EDUCATING MEMBERS OF THEIR LOCAL COMMUNITIES 7EVE ALSO DEVELOPED AN ELECTRONIC ADVOCACY NETWORK CALLED hE #HAMPIONSv THAT IS COMPRISED OF ABOUT ONLINE ADVOCATES WHO THROUGH OUR WEBSITE CAN CONTACT THEIR MEMBERS OF #ONGRESS ON SPECIlC ISSUES 7E HAVE A NUMBER OF AFlLIATES PARTICIPATING IN THAT PROGRAM SO WE ARE PROVIDING A STRUCTURE AND PRACTICAL WAYS FOR OUR CONSTITUENTS AFlLIATES AND THE GENERAL PUBLIC TO MAKE A DIFFERENCE IN BREAST CANCER POLICY 7E TRY TO MAKE IT AS SIMPLE AS POSSIBLE AND THE INFORMATION THAT WE INCLUDE IN OUR LETTERS IS WRITTEN IN VERY LAY FRIENDLY LANGUAGE SO THAT ALMOST ANYONE CAN UNDERSTAND IT 7E ALSO HAVE A h4ELL A &RIENDv COMPONENT TO OUR ONLINE COMMUNICATIONS WHICH ALLOWS US TO SHARE OUR BREAST CANCER MESSAGES WIDELY 4HIS HAS ALLOWED US TO RECRUIT TENS OF THOUSANDS OF NEW ADVOCATES AND GENERATE MORE SUPPORT
0W# !S A RESULT OF THE FOUNDATIONS EFFORT HOW DO YOU THINK QUALITY OF CARE HAS CHANGED FOR BREAST CANCER PATIENTS AND SURVIVORS #0 4HE OVERARCHING CHANGE OVER TIME HAS BEEN AWARENESS AND ACCESS TO TREATMENT THAT WOMEN DIDNT HAVE TO YEARS AGO !S A RESULT MORTALITY IS DECREASING AS SCREENING IS INCREASING AND CANCER IS BEING DIAGNOSED AT AN EARLIER STAGE 4HERE ARE OVER MILLION BREAST CANCER SURVIVORS ALIVE IN THIS COUNTRY TODAY 7E KNOW WE STILL HAVE ACCESS AND DISPARITY ISSUES BUT AWARENESS IS OUT THERE AND ITS CONTINUING TO MAKE A DIFFERENCE IN EARLY DIAGNOSIS $" 4HE +OMEN &OUNDATION HAS INVESTED MORE THAN MILLION IN RESEARCH EDUCATION SCREENING AND TREATMENT FUNDING SINCE ITS INCEPTION 7HEN THE FOUNDATION WAS STARTED IN THE TERM hBREAST CANCERv WAS NEVER SPOKEN ON THE mOORS OF THE (OUSE AND 3ENATE .OW hBREAST CANCERv IS SPOKEN FREELY BOTH ON #APITOL (ILL AND IN THE GENERAL PUBLIC AND ITS NOT SOMETHING TO BE EMBARRASSED ABOUT !S A WHOLE ) THINK OUR CULTURE HAS SHIFTED 0W# 7HAT KINDS OF RESEARCH HAS THE FOUNDATION HELPED TO SUPPORT $" 7E HAVE THREE PRIMARY FUNDING CATEGORIES BASIC CLINICAL AND TRANSLATIONAL RESEARCH 7E ARE ALSO FUNDING MORE DIRECTED RESEARCH PROPOSALS #0 7E ARE ALSO INTERESTED IN LOOKING AT NEW WAYS TO DO RESEARCH BECAUSE THE CLINICAL TRIALS AND DRUG DISCOVERY AND APPROVAL TAKE SO LONG AND PATIENTS ARE GOING THROUGH LIFE AND DEATH EXPERIENCES
%XHIBIT (EALTHCARE 1UALITY 2ECOMMENDED #ARE /N AVERAGE !MERICANS RECEIVE RECOMMENDED CARE ONLY OF THE TIME "REAST CANCER PATIENTS FARE MUCH BETTER THAN MOST 0ERCENT OF 2ECOMMENDED #ARE 2ECEIVED
/VERALL
"REAST #ANCER
(IP (YPER #ORONARY !STHMA $IABETES &RACTURE TENSION (EART $ISEASE
3OURCE % -C'LYNN ET AL h4HE 1UALITY OF (EALTH #ARE $ELIVERED TO !DULTS IN THE 5NITED 3TATES v 4HE .EW %NGLAND *OURNAL OF -EDICINE *UNE
1 5! , ) 4 9 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
0W# (OW CAN WHAT YOU HAVE DONE FOR BREAST CANCER BE LEVERAGED BY OTHER CONSUMER ADVOCACY GROUPS OR TO OTHER DISEASE TYPES TO ENGAGE AND ACTIVATE PATIENTS $" 7E OFTEN RECEIVE CALLS FROM OTHER DISEASE GROUPS BECAUSE OF THE FOUNDATIONS UNIQUE MODEL 7E ARE NOT A SERVICE PROVIDER 2ATHER WE FUND SERVICES 7E HAVE DOMESTIC AFlLIATES IN STATES ACROSS THE COUNTRY THAT PROVIDE MUCH NEEDED DOLLARS FOR EDUCATION SCREENING AND TREATMENT PROGRAMS AIMED AT lLLING THE GAPS IN THEIR LOCAL COMMUNITIES 7E ALSO HAVE THREE INTERNATIONAL AFlLIATES 4HE FOUNDATION RECEIVES CLOSE TO REQUESTS EVERY YEAR FROM PEOPLE WHO WANT TO ESTABLISH AN AFlLIATE 7E ARE VERY DELIBERATE IN DETERMINING WHEN AND WHERE AFlLIATES ARE ESTABLISHED 3INCE WE STRIVE NOT TO BE DUPLICATIVE A COMMUNITY NEEDS ASSESSMENT IS REQUIRED BEFORE WE ENTER INTO ANY AFlLIATE AGREEMENT )F SOMEONE ELSE IN THE COMMUNITY IS DOING IT AND DOING IT WELL WE WONT GO THERE BUT WE WILL FUND THEM 4HATS WHAT MAKES +OMEN UNIQUE "REAST CANCER ADVOCATES ARE A VERY VOCAL
1! GROUP 4HEY HAVE LEARNED HOW TO ORGANIZE THEY ARE VERY EFFECTIVE ADVOCATES AND THEY HAVE DONE A VERY GOOD JOB OF PERSONALIZING THE BREAST CANCER MESSAGE )TS BEEN A CRITICAL FACTOR IN GETTING THE SUPPORT THAT WEVE BEEN ABLE TO GET FOR THIS DISEASE
! SYSTEM OF ELECTRONIC MEDICAL RECORDS WILL PLAY AN IMPORTANT ROLE IN ENSURING THE DELIVERY OF QUALITY PATIENT CARE ESPECIALLY AS WE MOVE TOWARDS MORE PERSONALIZED MEDICINE 0W# !RE THERE OTHER CHANGES THAT YOUD LIKE TO SEE MADE AT THE NATIONAL LEVEL TO ENHANCE QUALITY $" 7E HAVE TO DO A BETTER JOB OF PROVIDING INTEGRATED CARE 7E NEED DOCTORS TO COMMUNICATE WITH ONE ANOTHER LOOK AT THE PATIENT COMPREHENSIVELY AND RENDER CARE ACCORDINGLY 0ATIENTS ALSO NEED BETTER COMMUNICATION FROM THEIR PHYSICIANS ! SYSTEM OF ELECTRONIC MEDICAL RECORDS WILL PLAY AN IMPORTANT ROLE IN ENSURING THE DELIVERY OF QUALITY PATIENT CARE ESPECIALLY AS WE MOVE TOWARDS MORE PERSONALIZED MEDICINE )F WE DO IT WELL SO THAT THE PRIVACY OF PATIENTS IS SUFlCIENTLY PRESERVED ELECTRONIC MEDICAL RECORDS COULD HELP EASE THE SUBSTANTIAL BURDEN ON CANCER PATIENTS OF HAVING TO ROUTINELY TRACK DOWN THEIR MEDICAL RECORDS 4HE AMOUNT OF TIME AND ENERGY THIS TAKES ESPECIALLY IN COMPLEX MEDICAL CASES SUCH AS CANCER IS EXORBITANT AND CAN BE A MAJOR CHALLENGE FOR VERY ILL PATIENTS 4HE LACK OF ELECTRONIC MEDICAL RECORDS MAY ALSO RESULT IN INACCURACIES IN A PATIENTS MEDICAL HISTORY #0 4HERE ARE ALSO THE ISSUES OF ACCESS AND DISPARITY AND THAT IMPACTS QUALITY ACROSS THE BOARD FOR PATIENTS )T WONT DO ANY GOOD TO HAVE THE BEST TECHNOLOGIES AND THE BEST TREATMENTS IF WE CANT GET THEM TO THE PATIENTS #OSTS OF THE TECHNOLOGIES AND DRUGS ARE BARRIERS TO A LOT OF PEOPLE !ND WE NEED MORE STANDARDIZATION IN PRACTICES SO THAT PEOPLE IN THE RURAL COMMUNITIES AND LARGER CITIES AND TEACHING INSTITUTIONS GET THE SAME STANDARDS OF CARE
0W# 7HERE DO YOU THINK WELL BE IN THE NEXT THREE TO lVE YEARS WITH RESPECT TO QUALITY #0 !S WE MOVE INTO THE FUTURE WELL SEE MORE INDIVIDUALIZED CARE AND TARGETED TREATMENTS &OR EXAMPLE RIGHT NOW WE HAVE DRUGS FOR PATIENTS WHO ARE ESTROGEN RECEPTOR POSITIVE VERSUS ESTROGEN RECEPTOR NEGATIVE (ERCEPTIN¸ WHICH IS FOR PATIENTS WITH (ER POSITIVE CANCER IS HAVING AN IMPACT ON SURVIVAL AND RECURRENCE RATES !S WE UNDERSTAND MORE ABOUT BREAST CANCER WELL SEE MORE TREATMENTS THAT ARE SPECIlCALLY TAILORED TO THE INDIVIDUAL TYPE OF BREAST CANCER $" "REAST CANCER IS A DISEASE OF AGING PATIENTS AND THE INmUX OF BABY BOOMERS TO THE PATIENT POPULATION COULD HAVE MAJOR IMPLICATIONS FOR ACCESS TO BREAST HEALTH AND BREAST CANCER QUALITY CARE 0W# 7HERE DO YOU THINK WELL BE IN ANOTHER YEARS 7ILL THE SITUATION BE SUBSTANTIALLY DIFFERENT BY THEN #0 !S WE MOVE TOWARDS MORE INDIVIDUALIZED MEDICINE WE HAVE TO MAKE SURE THAT THE HEALTHCARE SYSTEM CAN SUPPORT IT 7E ARE NOT THERE YET !ND WELL NEED RESEARCH TO SUPPORT IT 4HE STUDY POPULATION IS GOING TO BE SMALLER AND THE DRUGS ARE GOING TO BE AIMED AT A SMALLER GROUP OF PEOPLE 3O THE WHOLE PROCESS OF CLINICAL TRIALS IS GOING TO BE IMPACTED $" !S MORE PEOPLE SURVIVE LONGER WE NEED TO BETTER UNDERSTAND THE LONG TERM IMPACT OF BREAST CANCER AND BREAST CANCER CARE ON PATIENTS 4HERE ARE NUMEROUS HEALTH RELATED ISSUES STEMMING FROM SURGERY RADIATION AND CHEMOTHERAPY THAT WE AS CANCER PATIENTS OFTEN FACE 4HIS INCLUDES CHRONIC BACK AND OTHER PAIN CAUSED BY SCAR TISSUE CHEMO BRAIN ESTROGEN AND PROGESTERONE DEPRIVATION INFERTILITY ISSUES BONE LOSS AND NUMEROUS OTHER ISSUES THAT NEED TO BE MORE THOROUGHLY CONSIDERED n %NDNOTES -C'LYNN % ET AL *UNE h4HE 1UALITY OF (EALTH #ARE $ELIVERED TO !DULTS IN THE 5NITED 3TATES v 4HE .EW %NGLAND *OURNAL OF -EDICINE 0RESS RELEASE -AY h.ATIONAL 3TUDY ON #ANCER #ARE 1UALITY 3HOWS -AJORITY OF 0ATIENTS !RE 2ECEIVING 2ECOMMENDED 3TANDARDS OF #ARE v ACCESSED FROM WWWKOMENORG
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
"LOGS AND 3OCIAL -EDIA 4HE .EW #ITIZEN !RBITERS OF (EALTHCARE 1UALITY %XPLOSIVE GROWTH IN SOCIAL TECHNOLOGIES IS TRANSFORMING HEALTHCARE CONSUMERS DECISION MAKING PROCESSES (EALTHCARE ORGANIZATIONS MUST DElNE THEMSELVES IN SOCIAL MEDIA OR BE PREPARED TO FACE THE CONSEQUENCES
"Y $MITRIY +RUGLYAK 4HE -EDICAL "LOG .ETWORK
4HE 2OAD TO 4RANSPARENCY (EALTHCARE CONSUMERISM IS ON THE MARCH 4RANSFORMATION OF hTRADITIONAL PATIENTSv INTO hHEALTHCARE CONSUMERSv READY TO QUESTION HEALTHCARE INSTITUTIONS IS WELL UNDER WAY 4HE NEED FOR HEALTHCARE ORGANIZATIONS TO RESPOND AND ADAPT IS WIDELY ACKNOWLEDGED BY INDUSTRY LEADERS 4HE PACE AND SUCCESS OF THESE CHANGES DEPENDS ON PUTTING TRANSPARENT RELIABLE AND TRUSTWORTHY INFORMATION IN THE HANDS OF CONSUMERS 4HIS INFORMATION INCLUDES AVAILABILITY RELEVANCE QUALITY AND PRICING OF HEALTHCARE SERVICES HEALTHCARE PROVIDERS AND lNANCING PLANS 5NTIL RECENTLY THE PROGRESS TOWARD TRANSPARENCY RELIED SOLELY ON THE WILLINGNESS OF HEALTHCARE ORGANIZATIONS TO DISCLOSE THIS INFORMATION AND THE GOVERNMENTS ABILITY TO MANDATE 0REDICTABLY THE MOVEMENT HAS BEEN SLOW DUE TO THE INSTITUTIONAL AVERSION TO CHANGE "UT IN THE NEW RULES OF THE GAME ARE EMERGING
"LOGS AND 3OCIAL -EDIA ! .EW &ORCE 4HE hSECOND COMINGv OF THE )NTERNET DUBBED 7EB OR hREAD WRITE 7EB v EMPOWERS INDIVIDUALS TO BYPASS INSTITUTIONAL BARRIERS BY FREELY SHARING INFORMATION ONLINE 4HE NEW hSOCIAL TECHNOLOGYv ALREADY IRREVOCABLY TRANSFORMED NEWS POLITICS TECHNOLOGY AND ENTERTAINMENT INDUSTRIES (EALTHCARE IS THE NEXT SECTOR TO FEEL THE IMPACT WHICH IS ONLY STARTING TO FULLY TAKE SHAPE 4O UNDERSTAND WHAT IS HAPPENING LET US START WITH DElNITIONS 3OCIAL MEDIA IS THE BROADEST TERM COVERING THE FULL RANGE OF INDIVIDUAL PUBLISHING AND GLOBAL COMMUNICATION TECHNOLOGIES "LOGGING IS A SOCIAL MEDIA FORMAT STRUCTURED AS A PUBLIC PERSONAL DIARY OPEN TO LARGELY UNCENSORED COMMENTS AND INTERLINKING AND READILY ACCESSIBLE THROUGH 7EB SEARCH ACROSS THE GLOBE !CCORDING TO 4ECHNORATI WWWTECHNORATICOM THE LARGEST BLOG TRACKING SERVICE SEE %XHIBIT THE NUMBER OF BLOGS HAS GROWN EXPLOSIVELY FROM VIRTUALLY ZERO IN TO OVER MILLION IN !UGUST ;= 4HIS EXCLUDES RELATED FORMS OF PUBLIC SOCIAL MEDIA FOR EXAMPLE COMMUNITIES LIKE -Y3PACECOM MILLION PLUS MEMBERS #LASSMATESCOM MILLION PLUS AND &RIENDSTER COM MILLION PLUS TO NAME A FEW 4HE BLOGGING CONSUMERS ARE INCREASINGLY SPEAKING UP ON HEALTHCARE ISSUES SOME DEDICATING THEIR ENTIRE BLOGS TO DISSECTING SPECIlC TOPICS 0UBLICLY SHARING UNVARNISHED THOUGHTS
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
ON HEALTHCARE QUALITY RANKS HIGH ON THE BLOGGING HEALTHCARE CONSUMERS LIST OF INTERESTS 7ANT TO SEE AN INDICATION 4HE #%/ OF A LEADING PHARMA INDUSTRY ASSOCIATION RECENTLY REMARKED THAT HE IS MORE WORRIED ABOUT BLOGGERS IMPACT ON PHARMA THAN THE &$!S (E WAS REFERRING TO PATIENTS WHO CAN PUT THE REPUTATIONS OF DRUG COMPANIES ONLINE BY SHARING THEIR EXPERIENCES WITH THEIR MEMBERS PRODUCTS WITHOUT HAVING TO ASK ANYONES PERMISSION OR GET THROUGH THE EDITORIAL PROCESS OF TRADITIONAL PUBLICATIONS %VERY HEALTHCARE INSTITUTION MUST GET READY FOR THIS TYPE OF SCRUTINY
#ITIZEN (EALTHCARE %XPERTS -EET $IABETES -INE 4O ILLUSTRATE HOW BLOGGERS ARE BECOMING THE NEW OPINION LEADERS CONSIDER THE EXAMPLE OF !MY 4ENDERICH !MY WRITES $IABETES -INE DUBBED A h0ATIENT 4HOUGHT ,EADER "LOGv IN A RECENT COMPREHENSIVE REPORT ON HEALTH AND MEDICAL BLOGGING h4HE %MERGING (EALTHCARE "LOGOSPHERE 7HAT )S )T 7HY $OES )T -ATTER v BY %NVISION 3OLUTIONS ,,# A HEALTHCARE MARKETING COMMUNICATIONS CONSULTANCY WWWENVISIONSOLUTIONSNOWCOM $IAGNOSED WITH 4YPE DIABETES IN -AY !MY DECIDED TO START A BLOG TO CHRONICLE HER JOURNEY OF COPING WITH HER CHRONIC CONDITION AND SHARE THIS EXPERIENCE FOR THE BENElT OF FELLOW DIABETICS 4HE BLOGS NAME h$IABETES -INEv WWWDIABETESMINE COM SEE %XHIBIT WAS CHOSEN TO REmECT THE MISSION OF hBECOMING THE GOLDMINE OF DIABETES RELATED INFORMATIONv 4HROUGH WORD OF MOUTH OF HER READERS AND WITH THE HELP OF 'OOGLE SEARCH THE BLOG TOOK OFF AND DEVELOPED A LOYAL FOLLOWING &OR !MY THE EXPERIENCE OF WRITING A BLOG AND GETTING READERS COMMENTS AND SUPPORT IS THERAPEUTIC &OR HER READERS MANY OF WHOM ARE FELLOW DIABETICS IT IS A PEER TO PEER SOURCE OF PRACTICAL AND EXPERIENTIAL INFORMATION TOLD hAS IT ISv WITHOUT SPIN 7HAT DO THE DIABETES BLOGGERS LIKE !MY HERALD FOR THE HEALTHCARE INDUSTRY INCLUDING DRUG MAKERS DEVICE MANUFACTURERS AND OF COURSE THE PROVIDERS .OTHING LESS THAN A REVOLUTION IN THE HEALTHCARE DECISION MAKING PROCESS DRIVEN BY SHIFTING SOURCES OF AUTHORITY AND TRUST )F YOU ARE INVOLVED IN PROVIDING DIABETES CARE TAKE NOTE 0EOPLE HAVE ALWAYS MADE MOST OF THEIR HEALTHCARE DECISIONS
A KNF R ã@MCãR N B H@K ãLDCH@ãSGD ãMD VãBHSHY D Mã@QAHSD QRãNE ãGD @KSGB@QD ã PT @KHSX
%XHIBIT 4OTAL .UMBER OF "LOGS -ARCH n *ULY
3OURCE 4ECHNORATI HTTPWWWSIFRYCOMALERTSARCHIVESHTML
BASED ON ADVICE FROM THEIR FRIENDS FAMILY AND PHYSICIANS "UT BEFORE THE AGE OF BLOGS AND SOCIAL MEDIA WE HAVE BEEN LIMITED TO CONSULTING ONLY A HANDFUL OF PEOPLE WE COULD SHAKE HANDS WITH WHO WERE UNLIKELY TO HAVE THE DEPTH OF SPECIALIZED KNOWLEDGE 4HIS NECESSITATED RELIANCE ON THE hOFlCIALv SOURCES OF INFORMATION WHOSE AUTHORITY WAS HARD TO CHALLENGE WITH CONlDENCE .OWADAYS INQUIRING DIABETICS CAN EASILY lND $IABETES -INE ASSESS BLOGS TRUSTWORTHINESS BY THE LENGTH OF PUBLICATION AND THE READER FEEDBACK AND GET THE hSTRAIGHT SCOOPv ON WHAT IS AND IS NOT WORKING FOR THEIR PEER GROUP !CCORDING TO !MY BLOGGING CONlRMED HER NOTION THAT DOCTORS DO NOT KNOW EVERYTHING AND THE BEST SOURCE OF INFORMATION ON HOW TO MANAGE HER CONDITION ARE PEOPLE LIKE HER COOPERATING TO HELP ONE ANOTHER !MYS FAME OF BEING A LEADING DIABETES BLOGGER IS TRANSLATING INTO TRADITIONAL MEDIA 3HE IS COMPLETING HER BOOK +NOW 9OUR .UMBERS /UTLIVE 9OUR $IABETES TO BE PUBLISHED IN EARLY AND BASED TO A LARGE EXTENT ON MATERIALS PREVIOUSLY DISCUSSED ON HER BLOG
/RGANIZING THE 0OWER OF 3OCIAL -EDIA 4HE -EDICAL "LOG .ETWORK 7HILE THE POTENTIAL OF BLOGS AND SOCIAL MEDIA IN HEALTHCARE IS ENORMOUS MAKING GOOD ON THEIR FULL PROMISE TO CONSUMERS PROFESSIONALS AND ORGANIZATIONS REQUIRE A NEW MEDIA ECOSYSTEM
4HE -EDICAL "LOG .ETWORK WWWHEALTHVOICESCOM IS THE WORLDS lRST AND LARGEST ONLINE COMMUNITY OF HEALTH AND MEDICAL BLOGGERS 4HE VISION IS TO HELP BUILD BRIDGES BETWEEN HEALTHCARE BLOGGERS THE AUDIENCE AND THE INDUSTRY SEE %XHIBIT 4-".S CURRENT AND FUTURE SERVICES ARE TAILORED FOR THE INDIVIDUAL CONSUMERS AND PROFESSIONALS WHILE DESIGNED TO HELP HEALTHCARE ORGANIZATIONS ADAPT TO THE NEW ENVIRONMENT OF HEALTHCARE TRANSPARENCY AND TRUST (ELPING hNEWCOMERSv TO THE HEALTHCARE BLOGOSPHERE DISCOVER AND ENGAGE THE TOP MEDICAL BLOGGERS FROM ANYWHERE ON THE )NTERNET IS PART OF 4-".S GROWING PORTFOLIO OF OFFERINGS 4-". IS RAPIDLY GROWING INTO A hMAGNET HUBv ATTRACTING HEALTHCARE BLOGGERS WHO ARE LOOKING FOR AN EFFECTIVE CLEARINGHOUSE TO INCREASE THEIR REACH AND lND THEIR LOYAL AUDIENCES 4-". IS ALSO THE lRST PROFESSIONAL HEALTHCARE PUBLICATION PRODUCED IN BLOG FORMAT BY MULTIPLE AUTHORS 4HIS APPROACH COMBINES THE BEST OF OPENNESS AND AUTHENTICITY INDIVIDUAL BLOG AUTHORS BRING WITH THE PREDICTABILITY OF hFEATURED COLUMNv TITLES HELMED BY AUTHORITATIVE SUBJECT MATTER EXPERTS 4-".S FORMULA OF hBLOGGER FREEDOM MEETS EDITORIAL CULTIVATIONv IS MATCHED WITH THE GOAL OF ULTIMATELY COVERING EVERY SUBSTANTIVE HEALTHCARE TOPIC OF OUR TIMES !S THESE PLANS CONTINUE TO UNFOLD 4-". ALONG WITH PARTNERS PLANS TO SHOWCASE THE ROLE SOCIAL MEDIA WILL PLAY IN HEALTHCARE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
A KNF R ã@MCãR N B H@K ãLDCH@ãSGD ãMD VãBHSHY D Mã@QAHSD QRãNE ãGD @KSGB@QD ã PT @KHSX %XHIBIT $IABETES -INE 7EBSITE
"LOGGING HERALDS A REVOLUTION IN THE HEALTHCARE DECISION MAKING PROCESS DRIVEN BY SHIFTING SOURCES OF AUTHORITY AND TRUST THROUGH ONLINE SERVICES THAT BRING TOGETHER HEALTHCARE BLOGGERS CONSUMERS PROFESSIONALS AND INSTITUTIONS 4HESE SERVICES INCLUDE EDUCATION OFFERINGS TO HELP HEALTHCARE ORGANIZATIONS DEVELOP AND IMPLEMENT BLOGGING STRATEGIES 4-". IS ALSO CONDUCTING THE lRST GLOBAL RESEARCH STUDY OF BLOGGER OPINIONS COPRODUCED WITH %NVISION 3OLUTIONS HTTP WWWENVISIONSOLUTIONSNOWCOM
#ALLING !LL (EALTHCARE ,EADERS )F YOUR ROLE INVOLVES HEALTHCARE STRATEGY OR MARKETING SITTING ON THE SIDELINES OF THE BLOGGING REVOLUTION IS NO LONGER AN OPTION )F YOU DO NOT MAKE A CONSCIOUS EFFORT TO DElNE YOURSELF IN SOCIAL
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
MEDIA ON YOUR OWN TERMS PREPARE FOR OTHERS TO lLL THE VOID 4HIS INCLUDES THE PATIENTS THE PHYSICIANS THE COMPETITORS AND THE FORMER EMPLOYEES 4HE LARGER YOUR ORGANIZATION IS THE MORE LIKELY YOU ARE TO ATTRACT SCRUTINY ONLINE .O WONDER PHARMACEUTICAL COMPANIES ARE THE lRST ONES TO REALLY FEEL THE IMPACT "UT THE IMPERATIVE TO PREPARE AND RESPOND TO THE GROWTH OF OPEN MEDIA EQUALLY APPLIES TO HOSPITALS HEALTH PLANS MEDICAL DEVICE MANUFACTURERS AND PHYSICIAN GROUPS 4AKE INSPIRATION FROM HIGH TECH INDUSTRY LEADERS SUCH AS -ICROSOFT 3UN -ICROSYSTEMS 9AHOO AND 'OOGLE WHO SPONSOR CORPORATE BLOGS SUPPORT hUNOFlCIALv BLOGGING ACTIVITIES BY EMPLOYEES AND ENGAGE IN OTHER FORMS OF SOCIAL MEDIA 4HE POSITIVE PUBLICITY AUTHENTIC WORD OF MOUTH AND THE NEW hINSTITUTIONAL HUMAN FACEv THAT FOLLOW ARE HARD TO REPLICATE BY TRADITIONAL MARKETING %NDNOTE 4ECHNORATICOM HTTPWWWSIFRYCOMALERTSARCHIVESHTML ACCESSED 3EPTEMBER
A KNF R ã@MCãR N B H@K ãLDCH@ãSGD ãMD VãBHSHY D Mã@QAHSD QRãNE ãGD @KSGB@QD ã PT @KHSX %XHIBIT 4HE -EDICAL "LOG .ETWORK 7EBSITE
$MITRIY +RUGLYAK n #%/ #OMMUNITY 3TEWARD 4RUSTED-$ .ETWORK $MITRIY +RUGLYAK IS #%/ #OMMUNITY 3TEWARD OF 4RUSTED-$ .ETWORK HTTPTRUSTEDMD SOCIAL NETWORKING SERVICE DESIGNED TO EMPOWER TRUST BASED RELATIONSHIPS BETWEEN HEALTHCARE CONSUMERS PROFESSIONALS AND ORGANIZATIONS (E CHAIRS THE (EALTHCARE "LOGGING 3UMMIT HTTPTRUSTEDMDCONFERENCE WHICH IS THE PREMIER CONFERENCE ON HEALTHCARE BLOGS AND SOCIAL MEDIA HELD ONCE IN AND PLANNED THREE TIMES IN $MITRIY ALSO ORIGINATED (EALTH4RAIN THE h/PEN (EALTHCARE -ANIFESTOv HTTPTRUSTEDMDMANIFESTO WHICH LAID OUT A SET OF COMMON SENSE GUIDELINES FOR BLOG AND SOCIAL MEDIA ADOPTION BY HEALTHCARE ORGANIZATIONS AND GARNERED NUMEROUS ENDORSEMENTS $MITRIY IS PASSIONATE ABOUT THE POTENTIAL OF OPEN ONLINE COMMUNITIES TO IMPROVE HEALTH AND WELLNESS FOR CONSUMERS AND PRACTICE ENVIRONMENT FOR HEALTHCARE PROFESSIONALS !S A MILESTONE TO THAT VISION 4RUSTED-$ .ETWORK HAS ALREADY BECOME THE WORLDS LARGEST COMMUNITY OF HEALTH AND MEDICAL BLOGGERS 0RIOR TO 4RUSTED-$ $MITRIY HELD A VARIETY OF PRODUCT DEVELOPMENT AND MARKETING POSITIONS IN THE 3ILICON 6ALLEY (E CAN BE REACHED AT DKRUGLYAK TRUSTEDMD
4RUSTED-$ .ETWORK 4RUSTED-$ .ETWORK IS A SOCIAL NETWORKING SERVICE DESIGNED TO EMPOWER TRUST BASED RELATIONSHIPS BETWEEN HEALTHCARE CONSUMERS PROFESSIONALS AND ORGANIZATIONS &REE MEMBERSHIP OFFERS INDIVIDUALS PERSONAL PUBLISHING SEARCH COMMUNICATION AND REPUTATION MANAGEMENT TOOLS (EALTHCARE ORGANIZATIONS CAN SPONSOR PRIVATE SPACES AROUND COMMON INTERESTS AND AFlLIATIONS TO ENGAGE AND RECRUIT THEIR MEMBERSHIP 2EGISTER FOR FREE MEMBERSHIP TODAY #ONTACT $MITRIY +RUGLYAK 0HONE %MAIL DKRUGLYAK TRUSTEDMD 7EB HTTPTRUSTEDMD # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
! +EY 3TRATEGY FOR 3OLVING THE (EALTHCARE #RISIS )NTEGRATING 3ICK #ARE AND 7ELL #ARE )NTEGRATING SICK CARE AND WELL CARE IS AN ESSENTIAL STRATEGY FOR TRANSFORMING THE BROKEN !MERICAN HEALTHCARE INDUSTRY TO A VALUE BASED SYSTEM THAT PROVIDES HIGH QUALITY COST EFFECTIVE CARE
"Y 3TEPHEN % "ELLER .ATIONAL (EALTH $ATA 3YSTEMS 3ABATINI * -ONATESTI %3 %NTERPRISES
)NTRODUCTION (EALTHCARE IN THE 5NITED 3TATES IS IN CRISIS 4HERES A QUALITY CHASM ;= A KNOWLEDGE VOID ;= A HEALTH INFORMATION TECHNOLOGY GAP ;= A LEADERSHIP ABYSS;= AND A RIFT BETWEEN hSICK CAREv AND hWELL CAREv 4O SOLVE OUR HEALTHCARE CRISIS;= WE MUST TRANSFORM THE CURRENT SYSTEM BY MAKING FUNDAMENTAL CHANGES TO KEY POLICIES AND PRACTICES 4HIS TRANSFORMATION WOULD CHANGE !MERICAN HEALTHCARE FROM AN INEFlCIENT AND ERROR PRONE SYSTEM TO A VALUE BASED SYSTEM THAT SUPPORTS AND REWARDS HIGH QUALITY n AND AFFORDABLE CARE WHICH IS DELIVERED IN A SAFE TIMELY EFlCIENT AND COST EFFECTIVE MANNER )T WOULD BE ACCOMPLISHED USING A HIGH lDELITY;= HEALTHCARE MODEL THAT OFFERS lNANCIAL INCENTIVES AND HEALTH INFORMATION TECHNOLOGIES TO COLLABORATING NETWORKS OF PRACTITIONERS RESEARCHERS PATIENTS CONSUMERS HEALTH PLANS AND EMPLOYERS WHOSE EFFORTS INCLUDE INTEGRATING SICK CARE AND WELL CARE 4HESE NETWORKS WOULD REDUCE HEALTHCARE COSTS AND IMPROVE CARE QUALITY THROUGH #ONTINUAL LEARNING AND KNOWLEDGE BUILDING !DVANCED DECISION SUPPORT AND INFORMATION SHARING 5SE OF EVOLVING EVIDENCE BASED GUIDELINES 6ALUE BASED COMPETITION AND )NTEGRATED COORDINATED MULTIDISCIPLINARY CARE 3INCE IT IS BEYOND THE SCOPE OF THIS PAPER TO EXAMINE EVERY ASPECT OF THE SOLUTION WE PROPOSE WE WILL FOCUS OUR DISCUSSION ON SICK CARE AND WELL CARE INTEGRATION
$ElNING 3ICK #ARE 7ITH THE 3ICK #ARE $ELIVERY 4REE 4HE 3ICK #ARE $ELIVERY 4REE lGURE SEE %XHIBIT DEPICTS KEY COMPONENTS OF A PATIENT CENTERED ;= EVIDENCE BASED ;= PERSONALIZED;= SICK CARE DELIVERY MODEL &OLLOWING IS A DESCRIPTION OF THE TREE
2OOTS (EALTH 0ROBLEMS OF 0OPULATION 4HE lRST COMPONENT OF THIS SICK CARE APPROACH IS REPRESENTED BY THE ROOTS WHICH COMPRISE SIX CATEGORIES OF PHYSICAL AND PSYCHOLOGICAL PROBLEMS INCLUDING DISEASES ILLNESSES DYSFUNCTIONS AND TRAUMAS !CUTE HEALTH PROBLEMS ARE CHARACTERIZED BY SUDDEN ONSET AND SHORT DURATION WHICH PROGRESS RAPIDLY AND REQUIRE URGENT CARE !N ACUTE MYOCARDIAL INFARCTION HEART ATTACK AND A SERIOUS ACCIDENT VICTIM ARE EXAMPLES 3UBACUTE HEALTH PROBLEMS ARE DISTINGUISHED BY ABRUPT ONSET BUT HAVE LONGER DURATION OR CHANGE LESS RAPIDLY THAN ACUTE PROBLEMS %XAMPLES INCLUDE POST OPERATIVE CARE COMPLEX WOUND MANAGEMENT AND REHABILITATION FOR STROKE #HRONIC HEALTH PROBLEMS HAVE INDElNITE DURATION WHICH MAY PERSIST WITH VIRTUALLY NO CHANGE OVER TIME OR WHICH MAY LEAD TO COMPLICATIONS $IABETES DEPRESSION CONGESTIVE HEART FAILURE HEPATITIS AND ASTHMA ARE EXAMPLES 0HYSIOLOGICAL HEALTH PROBLEMS CONSIST OF ILLNESSES AND DYSFUNCTIONS IN ANY PART OF THE BODY
3TEPHEN % "ELLER 0H$ IS A LICENSED PSYCHOLOGIST PRACTITIONER RESEARCHER WRITER KNOWLEDGE MANAGEMENT EXPERT INFORMATION TECHNOLOGY INVENTOR SOFTWARE ARCHITECT AND PROGRAMMER AND ANALYTIC MODEL BUILDER (E IS PRESIDENT AND #%/ OF .ATIONAL (EALTH $ATA 3YSTEMS )NC A COMPANY THAT CREATES INNOVATIVE HEALTH INFORMATION TECHNOLOGIES AND IS A PRINCIPAL OF THE 0ATIENT (EALTH )NFORMATION .ETWORK 0(). #ONSORTIUM (E CAN BE REACHED AT SBELLER NHDSCOM 3ABATINI * -ONATESTI IS PRESIDENT OF %3 %NTERPRISES )NC A CONSULTING BUSINESS FOCUSING ON PROJECT MANAGEMENT SYSTEM INTEGRATION AND )4 TRAINING (E HAS OVER YEARS EXPERIENCE AS AN OPERATIONS MANAGER AND AN )4ENTERPRISE TRANSFORMATION SPECIALIST (IS COMPANY IS A PRINCIPAL OF THE 0(). #ONSORTIUM (E CAN BE REACHED AT SMONATESTI GMPEXPRESSNET
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD %XHIBIT 3ICK #ARE $ELIVERY 4REE %VIDENCE "ASED 0ATIENT #ENTERED #ARE 0EOPLE 0LACES AND 0ROCESSES
3OURCE .($3 %3 %NTERPRISES
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD
4HIS PROCESS REQUIRES A BIOPSYCHO SOCIAL @WHOLE PERSON APPROACH TO CARE WHERE BODY MIND SPIRIT AND ENVIRONMENT ARE ALL CONSIDERED IMPORTANT AND HANDLED ACCORDINGLY 0SYCHOLOGICAL HEALTH PROBLEMS CONSIST OF EMOTIONAL MENTAL OR BEHAVIORAL DISTURBANCES AND DISORDERS -IND "ODY "IOPSYCHOSOCIAL HEALTH PROBLEMS ARE RELATED TO THE INTERACTION BETWEEN PHYSIOLOGICAL AND PSYCHOLOGICAL FACTORS
4RUNK 3ICK #ARE $ELIVERY -ODELS 4HE NEXT COMPONENT ENCOMPASSES THE lVE SICK CARE DELIVERY MODELS WHICH ARE REPRESENTED BY THE 3ICK #ARE $ELIVERY 4REE TRUNK SHOWN IN %XHIBIT )NPATIENT #ARE FOCUSES ON TREATING PATIENTS IN HOSPITALS NURSING HOMES AND OTHER INPATIENT FACILITIES /UTPATIENT #ARE FOCUSES ON TREATING PATIENTS IN PROVIDERS OFlCES CLINICS AND OTHER OUTPATIENT FACILITIES -EDICAL"ODILY #ARE FOCUSES ON DELIVERY OF EMERGENCY MEDICAL CARE EG ACCIDENT VICTIMS INFECTIONS POISONING ETC AND NON EMERGENCY MEDICAL AND NON MEDICAL BODILY CARE EG ELECTIVE SURGERY CHIROPRACTIC DENTAL VISION ETC 0SYCHOLOGICAL #ARE FOCUSES ON DELIVERY OF MEDICALPSYCHIATRIC AND NON MEDICALPSYCHOLOGICAL CARE FOR MENTAL EMOTIONAL COGNITIVE AND BEHAVIORAL PROBLEMS "IOPSYCHOSOCIAL)NTEGRATIVE #ARE FOCUSES ON DELIVERY OF INTEGRATIVE MIND BODY CARE FOR PROBLEMS HAVING PHYSIOLOGICAL AND PSYCHOLOGICAL CAUSES OR CONSEQUENCES
"RANCHES #ATEGORIES OF 0EOPLE AND 0LACES 4HE BRANCHES OF THE 4REE DEPICT THE PEOPLE AND PLACES INVOLVED WITH SICK CARE 0ATIENTS AND THEIR &AMILIES ARE THE RECIPIENTS OF THE CARE (EALTHCARE 0ROFESSIONALS INCLUDING PROVIDERS AND RESEARCHERS ACROSS THE ENTIRE HEALTHCARE CONTINUUM DELIVER THE CARE OR STUDY THE OUTCOMES 0LACES 3ICK #ARE IS $ELIVERED INCLUDE HOSPITALS CLINICS PRIMARY CARE PHYSICIANS OFlCES SPECIALISTS OFlCES LABORATORIES AND ANY OTHER PLACES SICK CARE IS RENDERED
&LOWERS 3ICK #ARE 0ROCESSES 3ICK CARE DELIVERY PROCESSES FOCUS ON DIAGNOSING AND TREATING HEALTH PROBLEMS &LOWERS REPRESENT THE INPATIENT AND OUTPATIENT CARE PROCESSES )NPATIENT CARE PROCESSES FOR PHYSICAL AND PSYCHOLOGICAL HEALTH PROBLEMS INCLUDE EMERGENCY ROOMTRAUMA CENTER
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
CARE OBSTETRICS TESTS AND EXAMINATIONS ELECTIVE SURGERY AND PSYCHIATRIC CARE FOR SEVERELY DISTURBED PATIENTS /UTPATIENT CARE PROCESSES FOR PHYSICAL AND PSYCHO LOGICAL HEALTH PROBLEMS INCLUDE TESTS AND TREATMENTS FOR PHYSICAL AND PSYCHOLOGICAL PROBLEMS DURING OFlCE VISITS TO PRIMARY CARE PHYSICIANS AND SPECIALISTS AS WELL AS TO AMBULATORY CLINICS AND OTHER SUCH FACILITIES 4HESE SICK CARE DELIVERY PROCESSES ARE PATIENT CENTRIC AND UTILIZE EVOLVING EVIDENCE BASED PRACTICE GUIDELINES TO )MPROVE OUTCOMES CONTINUOUSLY %MPOWER HEALTHCARE CONSUMERS TO MAKE KNOWLEDGEABLE DECISIONS ABOUT THEIR OWN CARE BY BEING ACTIVE PARTICIPANTS IN A SHARED DECISION MAKING PROCESS 4REAT THE hWHOLE PERSON v BOTH PHYSICALLY AND PSYCHOLOGICALLY 4AILOR CARE TO EACH PERSONS SPECIlC NEEDS AND PREFERENCES #OORDINATE CARE AND FACILITATE COOPERATIVE COMMUNICATIONS ACROSS ALL PROVIDERS &OSTER COLLABORATION BETWEEN PRACTITIONERS AND RESEARCHERS -AXIMIZE SAFETY AND EFlCIENCY AND !SSURE PATIENT PRIVACY
"EES (EALTH )NFORMATION 4ECHNOLOGY 3UPPORTING 3ICK #ARE 4HE BEES ILLUSTRATE THE HEALTH INFORMATION TECHNOLOGIES NEEDED TO SUPPORT SICK CARE )MPORTANT SOFTWARE INCLUDES TOOLS FOR A DIAGNOSTIC DECISION SUPPORT B TREATMENT SELECTION AND PLAN OF CARE GENERATION DECISION SUPPORT C PLAN OF CARE EXECUTION ASSISTANCE VIA REMINDERS PROMPTS AND ALERTS HELPING TO AVOID ERRORS AND OMISSIONS AND OPTIMIZE WORK mOWS D CARE COORDINATION ACROSS MULTIPLE PROVIDERS INCLUDING CASE MANAGERS E OUTCOME DATA COLLECTION AND ANALYSIS F RESEARCH CLINICAL AND lNANCIAL MODEL DEVELOPMENT AND KNOWLEDGE MANAGEMENT G BUSINESS INTELLIGENCE AND H PROTECTING POPULATIONS IN EMERGENCIES SUCH AS EPIDEMICS AND BIOTERRORISM
$ElNING 7ELL #ARE 7ITH THE 7ELL #ARE $ELIVERY 4REE 4HE 7ELL #ARE $ELIVERY 4REE lGURE SEE %XHIBIT DEPICTS A COMMUNITY COLLABORATION APPROACH FOR IMPROVING HEALTH OUTCOMES AND REDUCING COST THROUGH CONSUMER EDUCATION AND WELLNESS PROGRAMS;= WHICH HELP PREVENT SERIOUS ILLNESSES AND COMPLICATIONS AND INCREASE PEOPLES WELL BEING AND QUALITY OF LIFE 4HIS WELL CARE APPROACH COMPLEMENTS AND AUGMENTS SICK CARE
2OOTS (EALTH 3TATUS OF 0OPULATIONS 4HE ROOTS OF THE 7ELL #ARE $ELIVERY 4REE REPRESENT THE lVE WELL CARE POPULATIONS (EALTHY POPULATIONS HAVE NO IDENTIlED HEALTH RISK
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD %XHIBIT 7ELL #ARE $ELIVERY 4REE #OMMUNITY #OLLABORATION FOR 7ELLNESS 0EOPLE 0LACES AND 0ROCESSES
3OURCE .($3 %3 %NTERPRISES # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD
4HIS INTEGRATED CARE STRATEGY PROMISES TO IMPROVE PEOPLES HEALTH AND REDUCE HEALTHCARE COSTS TO A GREATER DEGREE THAN EITHER SICK CARE OR WELL CARE ALONE
!T 2ISK POPULATIONS ARE PEOPLE WHO ARE AT RISK OF BECOMING ILL DUE TO THEIR PHYSICAL CONDITION EG OBESITY BEHAVIORS AND LIFESTYLE EG SMOKING ALCOHOL CONSUMPTION GENETIC PREDISPOSITIONS OR LIVING AND WORKING ENVIRONMENTS #HRONIC POPULATIONS ARE PEOPLE WITH CHRONIC CONDITIONS SUCH AS DIABETES FOR WHICH THERE IS AMPLE POTENTIAL FOR COMPLICATIONS AND WORSENING HEALTH #ATASTROPHIC ILLNESS POPULATIONS ARE PEOPLE WHO HAVE RECEIVED EMERGENCY TREATMENT EG ACCIDENT VICTIMS INFECTIONS POISONING OR INPATIENT TREATMENT OF SERIOUS MEDICAL INCLUDING PSYCHIATRIC CONDITIONS %ND OF ,IFE POPULATIONS ARE PEOPLE WHO HAVE NO HOPE OF RECOVERING THEY WILL ONLY GET WORSE AND DIE
4RUNK 7ELL #ARE $ELIVERY -ODELS 4HE FOUR WELL CARE DELIVERY MODELS ARE REPRESENTED BY THE TRUNK 0REVENTIVE -AINTENANCE FOCUSES ON DELIVERING PRIMARY PREVENTION SUCH AS PHYSICAL ACTIVITY NUTRITION STRESS RELIEF VACCINATIONS ETC THAT HELP PEOPLE AVOID HEALTH PROBLEMS AS WELL AS PROMOTING PEAK PERFORMANCE AND SECONDARY PREVENTION FOR AT RISK PERSONS TO PREVENT RECURRENCES OF HEALTH PROBLEMS SUCH AS AVOIDING RECURRENT CORONARY ARTERY DISEASE EVENTS IN A PERSON WITH A HISTORY OF THE ILLNESS 2ECOVERY2EHABILITATION FOCUSES ON ADHERENCE COMPLI ANCE TO DOCTORS ORDERS TO FOSTER RECOVERY REHABILITATION AND COMPLICATION AVOIDANCE FOR PATIENTS HAVING CHRONIC OR CATASTROPHIC HEALTH PROBLEMS #OMPASSIONATE (OME #ARE FOCUSES ON MAKING PEOPLE NEAR END OF LIFE AS COMFORTABLE AS POSSIBLE IN A SUPPORTIVE ENVIRONMENT WHERE THEY HAVE DIGNITY AND FAMILY SUPPORT &RAUD 0REVENTION IS USED FOR ALL POPULATIONS AND FOCUSES ON ASSURING THAT THE WELL CARE PROGRAMS ARE COMPLIANT WITH REGULATIONS AND THAT CARE IS RENDERED WITH INTEGRITY
"RANCHES #ATEGORIES OF 0EOPLE AND 0LACES 4HE BRANCHES DEPICT THE PEOPLE AND PLACE INVOLVED WITH WELL CARE #ONSUMERS 0ATIENTS AND THEIR &AMILIES ARE THE RECIPIENTS OF WELL CARE (EALTHCARE 0ROFESSIONALS ARE THOSE WHO DELIVER WELL CARE n INCLUDING WELLNESS COACHES SUCH AS SPECIALLY TRAINED PHYSICIAN ASSISTANTS NURSE PRACTITIONERS HOME HEALTH AIDES PERSONAL TRAINERS AND OTHER PRACTITIONERS n AS WELL AS RESEARCHERS WHO STUDY CARE OUTCOMES
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
0LACES WHERE 7ELL #ARE IS $ELIVERED INCLUDE WELL CARE FACILITIES COMMUNITY BASED ORGANIZATIONS WORKPLACES AND PRIMARY CARE PHYSICIANS OFlCES
&LOWERS 7ELL #ARE 0ROCESSES 4HE mOWERS REPRESENT THE WELL CARE DELIVERY PROCESSES WHICH ARE ASSOCIATED WITH THE WELL CARE DELIVERY MODELS 2ECOVERY2EHABILITATION AND 0REVENTIVE -AINTENANCE INCLUDE PROCESSES FOR A ONGOING RISK AND HEALTH STATUS ASSESSMENTS B ONGOING GENERATION OF PERSONAL HEALTH PLANS IDENTIFYING ANY RISK FACTORS PEOPLE MAY HAVE AS WELL AS PRIMARY AND SECONDARY PREVENTION PLANS OF ACTION IE HEALTH DIRECTIVES C HEALTH EDUCATION PRESENTING CONCRETE UNDERSTANDABLE ACTION STEPS AND PSYCHOLOGICAL COUNSELING FOR DEALING WITH PHYSICAL PROBLEMS AND PSYCHOLOGICAL STRESSORS D COMPLIANCE MOTIVATION INVOLVING ENCOURAGING AND REMINDING PEOPLE TO DO THE THINGS THAT WILL HELP THEM IMPROVE THEIR OWN HEALTH E ACCESS TO HEALTH COACHES FOR HEALTH INFORMATION AND ADVICE F OUTCOME STUDIES USED IN CONTINUOUS QUALITY IMPROVEMENT FEEDBACK LOOPS G COORDINATING CARE FOR PATIENTS WITH CATASTROPHIC HEALTH PROBLEMS SO MULTIDISCIPLINARY TEAMS CAN WORK TOGETHER EFFECTIVELY H PROMOTING ENVIRONMENTAL AND WORKPLACE SAFETY AND I ENCOURAG ING LIFESTYLE AND ATTITUDINAL CHANGES FOR PEAK PERFORMANCE #OMPASSIONATE (OME #ARE INCLUDES PROCESSES FOR HELPING INDIVIDUALS OBTAIN HOME CARE NURSING AND HOMEMAKING ASSISTANCE ARRANGES FOR TRANSPORTATION TO AND FROM DOCTOR APPOINTMENTS AND ADDRESSES THE PSYCHOLOGICAL SOCIAL AND SPIRITUAL WELL BEING OF PATIENTS AND FAMILIES &RAUD 0REVENTION HAS PROCESSES THAT HELP DETECT FRAUD BY ANALYZING THE SERVICES RENDERED IN LIGHT OF THE HEALTH STATUS ASSESSMENTS AND OUTCOMES
"EES (EALTH )NFORMATION 4ECHNOLOGY 3UPPORTING 7ELL #ARE 4HE BEES ILLUSTRATE THE HEALTH INFORMATION TECHNOLOGIES THAT SUPPORT WELL CARE 4HE SOFTWARE APPLICATIONS NEEDED INCLUDE TOOLS FOR A COLLECTING AND ANALYZING DATA FROM HEALTH RISK ASSESSMENTS AND HEALTH STATUS MONITORING B PERSONAL HEALTH PLAN CREATION USING EVIDENCE BASED WELL CARE GUIDELINES C PERSONAL HEALTH PLAN DELIVERY ASSISTANCE VIA REMINDERS PROMPTS AND ALERTS TO IMPROVE COMPLIANCE WITH PREFERRED INTERVENTIONS D COMMUNITY HEALTH PLAN DEVELOPMENT SHOWING HOW ORGANIZATIONS AND NEIGHBORHOODS CAN SUPPORT THE HEALTH OF INDIVIDUALS E RESEARCH AND KNOWLEDGE MANAGEMENT AND F BUSINESS INTELLIGENCE
)NTEGRATING 3ICK #ARE 7ELL #ARE (AVING DElNED THE BASIC COMPONENTS OF SICK CARE AND WELL CARE WE NOW TURN OUR ATTENTION TO THE ISSUE OF INTEGRATION )NSTEAD OF VIEWING SICK CARE AND WELL CARE AS TWO SEPARATE AVENUES IN THE ROAD TO HEALTH THE SOLUTION WE PROPOSE CALLS
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD FOR DELIVERING BOTH IN AN INTEGRATED CARE DELIVERY SYSTEM 4HIS PROCESS INVOLVES A NEW KIND OF COORDINATION AND COLLABORATION BETWEEN A MEDICAL AND RELATED SICK CARE PRACTITIONERS FOCUSED ON THE DIAGNOSIS AND TREATMENT OF HEALTH PROBLEMS AND B WELL CARE PRACTITIONERS FOCUSED ON PREVENTION RECOVERY AND WELL BEING AS WELL AS PEAK PERFORMANCE )T REQUIRES A BIOPSYCHOSOCIAL hWHOLE PERSONv APPROACH TO CARE WHERE BODY MIND SPIRIT AND ENVIRONMENT ARE ALL CONSIDERED IMPORTANT AND HANDLED ACCORDINGLY;= 4HIS INTEGRATED CARE STRATEGY PROMISES TO IMPROVE PEOPLES HEALTH AND REDUCE HEALTHCARE COSTS TO A GREATER DEGREE THAN EITHER SICK CARE OR WELL CARE ALONE BECAUSE IT PROVIDES A SENSIBLE WAY TO KEEP PEOPLE HEALTHIER LONGER RECOVER FROM ILLNESS AND DYSFUNCTION MORE QUICKLY AND AVOID COMPLICATIONS OF CHRONIC DISEASE )T IS THEREFORE A CRUCIAL COMPONENT FOR SOLVING THE HEALTHCARE CRISIS BY REDUCING OVERALL EXPENDITURES (AVING A PATIENT PROFILE THAT INCLUDES A FULL MIND BODY WORK UP ALONG WITH AN INDIVIDUAL PLAN OF CARE FOCUSED ON KEEPING THE INDIVIDUAL HEALTHY SUPPLIES ESSENTIAL INFORMATION THAT ENABLES THE SICK CARE PRACTITIONER TO BETTER UNDERSTAND AND TREAT THE ROOT CAUSES OF ACUTE SUBACUTE AND CHRONIC AILMENTS USING CONVENTIONAL ALLOPATHIC APPROACHES AS NECESSARY
)N ADDITION THIS INFORMATION HELPS THE WELL CARE PRACTITIONER WORK WITH CLIENTS TO PREVENT HEALTH PROBLEMS AND RECURRENCES USING ECONOMICAL COMPLEMENTARY AND ALTERNATIVE NON ALLOPATHIC INTERVENTIONS "OTTOM LINE "Y INTEGRATING SICK CARE AND WELL CARE AS PER THE PROPOSED SOLUTION THE RESULT WOULD BE A REDUCTION IN OVERALL HEALTHCARE COSTS AN IMPROVEMENT IN HEALTH OUTCOMES AND AN INCREASE IN PEOPLES QUALITY OF LIFE AND PRODUCTIVITY 4HIS IS A VITAL STEP TOWARD SOLVING THE CURRENT HEALTHCARE CRISIS %NDNOTES HTTPWWWNASEDUONPIWEBEXTRANSFWEBCHASM 4HE FOLLOWING REFER TO PAGES LISTED IN THE TABLE OF CONTENTS AT HTTP WELLNESSWIKISPACESCOM 4HE +NOWLEDGE 6OID 4HE ()4 'AP 0ROBLEMS 2ELATING TO 0ROVIDER -OTIVATION AND (OW TO 3OLVE 4HEM 4HE #URRENT 3ITUATION 4ACTIC n )NCREASE (EALTHCARE &IDELITY 4ACTIC n &OCUS ON #ONSUMER #ENTERED 5NIVERSAL (EALTHCARE 4ACTIC n )MPROVE #ARE 1UALITY WITH %VIDENCE "ASED 0RACTICE 'UIDELINES 4ACTIC n $ELIVER 0ERSONALIZED #ARE 4ACTIC n /FFER #ONSUMER %DUCATION AND 7ELLNESS 0ROGRAMS 4ACTIC n $ELIVER "IOPSYCHOSOCIAL (EALTHCARE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1UALITY AND %MPLOYER "ENElT 0LAN $ESIGN !S HEALTHCARE COSTS CONTINUE TO SKYROCKET EMPLOYERS ARE EXPLORING NEW FRONTIERS IN BENElT DESIGN THAT ACTIVATE EMPLOYEES AND IN TURN INCREASE QUALITY
"Y "ARRY "ARNETT AND 7ILLIAM 2OSENBERG 0RICEWATERHOUSE#OOPERS
(EALTHY 7ORKERS FOR A (EALTHY "OTTOM ,INE "ECAUSE THE EDUCATED !MERICAN WORKER HAS COME TO EXPECT COMPREHENSIVE HEALTH BENElTS THE ABSENCE OR INADEQUACY OF A PROGRAM HINDERS A COMPANYS ABILITY TO ATTRACT AND RETAIN THE BEST PERSONNEL /NE OF THE GOALS OF A QUALITY PLAN IS TO REDUCE ABSENTEEISM AND IMPROVE PRODUCTIVITY &OR THIS REASON EMPLOYERS ARE INCREASINGLY MOTIVATED TO DESIGN EMPLOYEE BENElT PLANS THAT EMBRACE QUALITY TO KEEP EMPLOYEES HEALTHY MOTIVATED AND HIGH PERFORMING
4HE %VOLUTION OF "ENElT 0LANS (ISTORICALLY EMPLOYERS HAVE FOCUSED ON PROVIDING COMPETITIVE HEALTHCARE COVERAGE AT A REASONABLE COST "EFORE THE ADVENT OF MANAGED CARE BENElT PLANS WERE TYPICALLY STRUCTURED TO PAY FOR ANY LICENSED PROVIDER WITH THE ASSUMPTION THAT THE GOVERNMENT AS LICENSOR WOULD ENFORCE QUALITY %MPLOYERS WERE MORE INVOLVED IN THE INTRICACIES OF DETERMINING THE SCOPE AND LEVEL OF BENElTS IN HEALTH BENElT PLANS THAN IN MAKING SURE THE PLANS ENCOURAGED EMPLOYEES TO SEEK OUT QUALITY DOCTORS AND HOSPITALS /NE REASON FOR THIS FOCUS WAS A RELUCTANCE TO GET INVOLVED IN EMPLOYEES PERSONAL HEALTHCARE MATTERS (OWEVER PERHAPS THE MOST IMPORTANT REASON FOR SHYING AWAY FROM QUALITY OF CARE ISSUES WAS THE ABSENCE OF REAL MEASURES TO GUIDE THEM !S MANAGED CARE EVOLVED DURING THE S INSURERS NEGOTIATED FINANCIAL ARRANGEMENTS WITH HOSPITALS AND DOCTORS AND LISTED THEM IN hNETWORKv DIRECTORIES %MPLOYEES RECEIVED MORE BENEFITS IF THEY USED A PHYSICIAN LISTED IN THE DIRECTORY YET QUALITY CONSIDERATIONS WERE LIMITED TO ENSURING THAT THE PHYSICIANS LICENSING AND CERTIFICATION CREDENTIALS WERE IN ORDER 4IMES HAVE CHANGED $URING THE PAST YEARS THE PRESS HAS REPORTED ALARMING STUDIES ABOUT RATES OF MEDICAL ERRORS &OR EXAMPLE IN THE )NSTITUTE OF -EDICINE REPORTED THAT BETWEEN AND !MERICANS DIE ANNUALLY FROM MEDICAL ERRORS
n MORE PEOPLE THAN FROM BREAST CANCER !)$3 OR MOTOR VEHICLE ACCIDENTS;= )N THE #HICAGO 4RIBUNE REPORTED THAT POORLY TRAINED OR OVERWORKED NURSES WERE RESPONSIBLE FOR THE DEATHS OF PATIENTS AND INJURIES SINCE )T ALSO DESCRIBED AN ANALYSIS OF MILLION STATE AND FEDERAL COMPUTER RECORDS THAT INDICATED HOSPITALS WERE SACRIlCING PATIENT SAFETY FOR A BETTER BOTTOM LINE;= 2ECOGNIZING THE NEED TO ENCOURAGE IMPROVED QUALITY AND NOT JUST MEET MINIMUM STANDARDS IN THEIR HEALTH PLAN NETWORKS EMPLOYERS CREATED COALITIONS SUCH AS 4HE ,EAPFROG 'ROUP 4HE GOAL OF THESE GROUPS IS TO LAUNCH INITIATIVES THAT CREATE BREAKTHROUGH IMPROVEMENTS IN SAFETY QUALITY AND AFFORDABILITY BY MOBILIZING EMPLOYER PURCHASING POWER %MPLOYERS SUCH AS THOSE IN THE 0ACIlC "USINESS 'ROUP ON (EALTH HAVE ALSO RESPONDED BY LOOKING AT NEW BENElT PLAN DESIGNS TO INCREASE QUALITY
#ONTROLLING #OSTS )NCREASING 6ALUE /NE CHALLENGE IN CREATING SUCCESSFUL BENElT PLANS IS lNDING A WAY TO BE INNOVATIVE WITHOUT INCREASING COSTS !CCORDING TO A STUDY BY THE 'OVERNMENT !CCOUNTABILITY /FlCE '!/ RISING BENElT COSTS ARE FORCING PRIVATE EMPLOYERS AND EMPLOYEES TO MAKE DIFlCULT TRADE OFFS BETWEEN WAGES AND BENElTS 4HE LONG STANDING TRADITION OF EMPLOYER SPONSORED HEALTH BENElTS CAN NO LONGER BE SUSTAINED MOSTLY BECAUSE PRODUCTIVITY GROWTH WILL NOT LIKELY SUPPORT ESCALATING HEALTH INSURANCE COSTS 4HE '!/ STUDY TRACKED PRIVATE EMPLOYERS WAGES AND BENElTS FROM TO AND FOUND THAT REAL WAGES GREW BY PERCENT BUT WERE ECLIPSED BY BENElT COSTS WHICH GREW BY PERCENT;= 2ISING COSTS MAKE IT DIFlCULT FOR EMPLOYERS AND EMPLOYEES TO AFFORD HEALTHCARE MUCH LESS FOCUS ON QUALITY IN BENElT DESIGN )N RECENT YEARS THE PERCENTAGE OF WORKERS COVERED BY EMPLOYER SPONSORED HEALTH INSURANCE HAS DECLINED PARTICULARLY FOR SMALL EMPLOYERS "ETWEEN AND THE PERCENTAGE OF WORKERS COVERED BY SMALL EMPLOYERS THREE TO WORKERS DECLINED FROM TO PERCENT -EANWHILE COVERAGE AT LARGE lRMS OR MORE WORKERS HELD STEADY;= ,ARGER COMPANIES
"ARRY "ARNETT IS A PRINCIPAL WITH 0RICEWATERHOUSE#OOPERS AND HAS BEEN WORKING IN THE EMPLOYEE BENElTS HEALTHCARE ARENA FOR YEARS (E HAS A WEALTH OF EXPERIENCE IN WORKING WITH EMPLOYERS TO HELP THEM ESTABLISH THEIR EMPLOYEE HEALTHCARE STRATEGY (E CAN BE REACHED AT BARRYBARNETT USPWCCOM 7ILLIAM 2OSENBERG -(3! IS A DIRECTOR IN 0RICEWATERHOUSE#OOPERS (EALTHCARE PRACTICE 7ITH YEARS OF EXPERIENCE IN PUBLIC HEALTH GROUP HEALTH INSURANCE AND CONSULTING HE ADVISES LARGE EMPLOYERS HEALTH PLANS AND PHARMACEUTICAL COMPANIES (E CAN BE REACHED AT WILLIAMROSENBERG USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
P T@K HSXã@MCãD LOKNXD QãAD MD E HSãOK@MãCD RHFM HAVE THE RESOURCES TO EXPERIMENT WITH NEW BENElT DESIGNS THAT INCREASE QUALITY OF CARE WHILE MAINTAINING OR REDUCING COST LEVELS 4HEY ALSO HAVE THE PURCHASING POWER TO INmUENCE HEALTH PLANS DOCTORS AND HOSPITALS UNLIKE SMALLER COMPANIES THAT LACK THE CLOUT TO INmUENCE THE HEALTHCARE DELIVERY SYSTEM 4O DATE WORKERS HAVE LARGELY BEEN SHIELDED FROM THE COST OF MEDICAL CARE WHICH MAY CONTRIBUTE TO INAPPROPRIATE UTILIZATION )N TERMS OF CONSUMER SPENDING MEDICAL CARE CONSUMED PERCENT OF CONSUMER EXPENDITURES IN n THE EXACT SAME PERCENTAGE AS IN -OREOVER THE PERCENT OF CONSUMER EXPENDITURES ON MEDICAL CARE HAS VARIED LITTLE IN THE INTERIM;= !LTHOUGH HEALTHCARE SPENDING HAS ACCELERATED CONSIDERABLY THE AMOUNT THAT CONSUMERS SPEND RELATIVE TO OTHER ITEMS SUCH AS CARS CLOTHING OR HOUSING HAS INCREASED ABOUT THE SAME AMOUNT IN THEIR BUDGETS 4HE DIFFERENCE HAS BEEN PAID BY EMPLOYERS AND GOVERNMENT
4HE !CTIVATED #ONSUMER "ETTER AND MORE USEFUL CONSUMER INFORMATION IS CRITICAL TO A NEW PUSH TOWARD CONSUMERISM IN HEALTHCARE BENElT DESIGN 4ODAYS FORWARD THINKING COMPANIES ARE CRAFTING PLANS THAT ENCOURAGE EMPLOYEES TO BE BETTER CONSUMERS BY PURCHASING HEALTHCARE AS THEY WOULD OTHER IMPORTANT ITEMS THROUGH IMPROVED AWARENESS AND EDUCATION !LTHOUGH PROPONENTS DIFFER ON THE EXTENT TO WHICH HEALTHCARE CAN WORK LIKE OTHER MARKETS MOST EXPERTS AGREE ON THE DIRECTION OF DESIRABLE CHANGE 0RESIDENT "USH RECENTLY EMPHASIZED THE BENElTS OF BECOMING MORE INVOLVED h0EOPLE ARE ABLE TO SHOP BASED UPON PRICE AND QUALITY IN ALMOST EVERY ASPECT OF OUR LIFE WITH THE EXCEPTION OF HEALTHCAREv;= 3ARA #OLLINS 0H$ SENIOR PROGRAM OFlCER FOR THE 0ROGRAM ON THE &UTURE OF (EALTH )NSURANCE AT 4HE #OMMONWEALTH &UND AND +AREN $AVIS 0H$ PRESIDENT OF 4HE #OMMONWEALTH &UND RECENTLY TESTIlED BEFORE #ONGRESS 4RANSPARENCY AND BETTER PUBLIC INFORMATION ON COST AND QUALITY ARE ESSENTIAL FOR THREE REASONS TO HELP PROVIDERS IMPROVE BY BENCHMARKING THEIR PERFORMANCE AGAINST OTHER PROVIDERS TO ENCOURAGE PRIVATE INSURERS AND PUBLIC PROGRAMS TO REWARD QUALITY AND EFlCIENCY AND TO HELP PATIENTS MAKE INFORMED CHOICES ABOUT THEIR CARE;= #OLLINS AND $AVIS ALSO NOTED THAT hxIT IS UNREASONABLE TO EXPECT THAT INFORMATION ON PRICES TOTAL BILLS TOTAL COSTS TO PATIENTS AND INSURERS AND QUALITY WILL CAUSE THE HEALTHCARE MARKET TO PERFORM LIKE MARKETS FOR OTHER GOODS AND SERVICESv;= 4HIS IS THE CASE FOR A VARIETY OF REASONS INCLUDING FOR EXAMPLE THAT PATIENTS WILL NEVER HAVE THE SAME AMOUNT OF INFORMATION DOCTORS HAVE AND SOME HEALTHCARE DECISIONS ARE MADE UNDER EMERGENCY CONDITIONS 7HILE ONLY MILLION !MERICANS ARE CURRENTLY IN CONSUMER DIRECTED PLANS COMPARED WITH MILLION IN OTHER PRIVATE PLANS MANY INDUSTRY OBSERVERS EXPECT ENROLLMENT IN THESE NEW BENElT DESIGNS TO INCREASE /PPONENTS OF CONSUMER DIRECTED PLANS CLAIM THEY SIMPLY SHIFT COSTS FROM EMPLOYERS TO CONSUMERS 4HERE ARE HOWEVER ADVANTAGES TO INVOLVING EMPLOYEES lNANCIALLY IN MANAGING HEALTHCARE BENElTS !CCORDING TO A LANDMARK STUDY PUBLISHED BY THE 2!.$ #ORP IN THE S PEOPLE WILL CONSUME
MORE HEALTHCARE SERVICES WHEN CARE IS FREE AND FAR LESS WHEN THEY SHARE COSTS;= 0ROBLEMS CAN ARISE WHEN CONSUMERS FAIL TO DISTINGUISH BETWEEN DISCRETIONARY AND NONDISCRETIONARY CARE AS THEY REDUCE THEIR CONSUMPTION OF HEALTHCARE SERVICES &OR THIS REASON CONSUMER DIRECTED PLANS MUST BE CAREFULLY DESIGNED TO ENSURE THAT WORKERS n PARTICULARLY THOSE WITH CHRONIC DISEASE ANDOR LOWER INCOME n DO NOT FOREGO NECESSARY CARE
#REATIVE 0LAN $ESIGNS 0ROGRESSIVE COMPANIES ARE EXPERIMENTING WITH A VARIETY OF PLANS THAT MOTIVATE EMPLOYEES TO BECOME MORE INVOLVED IN MAKING HEALTHCARE CHOICES 4HESE PROGRAMS MIGHT INCLUDE CASH PAYMENTS OR DISCOUNTS ON SERVICES OR PREMIUMS 3OME EMPLOYERS PROVIDE INCENTIVES AND REWARDS FOR HEALTHY BEHAVIORS SUCH AS SMOKING CESSATION NUTRITIONAL COUNSELING AND HEALTH SCREENINGS 4HEIR GOAL IS TO ENCOURAGE EMPLOYEES TO BE MORE RESPONSIBLE FOR THEIR OWN HEALTH /THERS ARE REDUCING OUT OF POCKET COSTS FOR PRESCRIPTION DRUGS FOR CONDITIONS SUCH AS DIABETES SO THAT EMPLOYEES WILL BE MORE LIKELY TO TAKE NEEDED MEDICATIONS AND AVOID EXPENSIVE COMPLICATIONS #OMPANIES ARE EXPERIMENTING WITH BENElT PLAN DESIGNS AND DISEASE MANAGEMENT FOR ASTHMA HYPERTENSION AND MENTAL HEALTH AND DEPRESSION AS WELL
)NCENTIVES AND 0ENALTIES 3OME COMPANIES USE INCENTIVES TO ACTIVATE EMPLOYEES WHILE OTHERS USE PENALTIES FOR EXAMPLE CHARGING SMOKERS HIGHER PREMIUMS THAN NONSMOKERS )NCENTIVE PROGRAMS MIGHT INVOLVE REWARDING EMPLOYEES FOR COMPLETING A HEALTH RISK APPRAISAL AND THEN TAILORING CONDITION MANAGEMENT PROGRAMS AROUND THE RESULTS /R IT MIGHT MEAN CONTRIBUTING EXTRA MONEY TO A HEALTH REIMBURSEMENT ARRANGEMENT (2! BASED ON WHETHER WORKERS REACH CERTAIN GOALS SUCH AS LOSING A SPECIlED AMOUNT OF WEIGHT SUBJECT TO COMPLIANCE WITH ()0!! AND OTHER NONDISCRIMINATION RULES !S THESE PROGRAMS ARE QUITE NEW EMPLOYERS NEED TO ENSURE THEY COMPLY WITH APPLICABLE REGULATIONS AND CONTRACT WITH VENDORS THAT DEMONSTRATE A SUCCESSFUL TRACK RECORD IN ADMINISTRATION 4HE VERY BEST APPROACH TAILORS INCENTIVES THAT lT THE UNIQUE NEEDS OF THE POPULATION AND THE CULTURE OF AN ORGANIZATION 4O BE SUCCESSFUL BOTH INCENTIVE AND PENALTY BASED PROGRAMS NEED TO INFORM EMPLOYEES FULLY ABOUT THEIR RESPONSIBILITIES AND THE POSITIVE OUTCOMES OF PARTICIPATION -ANY COMPANIES ARE USING ONLINE TOOLS TO DISSEMINATE THIS PROGRAM INFORMATION 4HESE TOOLS MAY BE AS SOPHISTICATED AS A COMPANY HEALTHCARE PORTAL OR AS SIMPLE AS REFERRING EMPLOYEES TO AN EXTERNAL WEBSITE /THER COMPANIES USE WELLNESS COACHES OR NURSES TO PROMOTE BEHAVIOR MODIlCATION AND PROVIDE EDUCATION ABOUT DISEASE CONDITIONS 3OME EMPLOYERS ARE ALSO LEVERAGING RESOURCES IN SURROUNDING COMMUNITIES TO AUGMENT EMPLOYEE HEALTH BENElTS &OR EXAMPLE A COMPANY MIGHT PROVIDE AN INCENTIVE FOR STRESSED EMPLOYEES TO TAKE YOGA CLASSES OR mEX TIME TO VISIT A GYM OR GO RUNNING ,ARGE EMPLOYERS IN A CAMPUS SETTING MAY BUILD A lTNESS CENTER FOR EMPLOYEE USE )N THIS WAY HEALTHY BEHAVIORS BECOME PART OF EMPLOYEES LIFESTYLES # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXã@MCãD LOKNXD QãAD MD E HSãOK@MãCD RHFM
4IERED .ETWORKS )N ANOTHER INNOVATIVE BENElT PLAN DESIGN CALLED THE hTIERED NETWORK v HEALTH PLANS SELECT NETWORK PHYSICIANS BASED ON COST EFFECTIVENESS AND CLINICAL QUALITY 4IERED NETWORKS PROVIDE EMPLOYEES WITH lNANCIAL INCENTIVES TO CHOOSE MORE COST EFFECTIVE hHIGH PERFORMINGv DOCTORS AND HOSPITALS /NE OF THE COUNTRYS LARGEST INSURERS LAUNCHED A TIERED NETWORK IN AS A WAY TO CUT EMPLOYER COSTS AND OFFER MEMBERS MORE INFORMATION ABOUT PHYSICIANS AND THE COST OF MEDICAL CARE 4HE HEALTH PLAN CONSIDERS THE PHYSICIANS WHO BELONG TO THE NETWORK AS THE HIGHEST PERFORMERS AMONG THEIR SPECIALIST PEERS BASED ON COST AND QUALITY !N EMPLOYEE COULD CHOOSE FOR EXAMPLE TO SEE A NETWORK SPECIALIST FOR A LOWER CO PAYMENT OR PAY MORE TO SEE A DOCTOR WHO IS STILL IN THE NETWORK BUT NOT PART OF THE PROGRAM 4HE IDEA BEHIND THIS APPROACH IS THAT WORKERS WILL BUY INTO MORE RESTRICTIVE NETWORKS IN EXCHANGE FOR LOWER COSTS;=
(EALTH 3AVINGS !CCOUNTS )N A RECENT 3TATE OF THE 5NION ADDRESS FROM 0RESIDENT "USH HE PROPOSED STRENGTHENING HEALTH SAVINGS ACCOUNTS (3!S TO ENSURE INDIVIDUALS AND SMALL BUSINESS EMPLOYEES ARE ABLE TO BUY INSURANCE WITH THE SAME ADVANTAGES OF PEOPLE WORKING FOR LARGER EMPLOYERS "USH ALSO PROMISED TO DO MORE TO MAKE THIS COVERAGE PORTABLE SO WORKERS CAN SWITCH JOBS WITHOUT HAVING TO WORRY ABOUT LOSING THEIR INSURANCE;= 4HE (3! IS A TAX ADVANTAGED SAVINGS VEHICLE AVAILABLE TO TAXPAYERS TO PAY FOR CURRENT AND FUTURE MEDICAL EXPENSES SUCH AS INSURANCE DEDUCTIBLES AND CO INSURANCE "OTH EMPLOYEES AND EMPLOYERS CAN DEPOSIT FUNDS INTO AN (3! BUT TOTAL DEPOSITS CANNOT EXCEED FEDERAL LIMITS &UNDS NOT USED IN AN (3! CARRY OVER EACH YEAR AND REMAIN IN THE ACCOUNT UNLIKE mEXIBLE SPENDING ACCOUNT &3! BALANCES WHICH REQUIRE EMPLOYEES TO hUSE IT OR LOSE ITv;= ! PERSON MUST BE COVERED BY A QUALIlED HIGH DEDUCTIBLE HEALTH PLAN ($(0 TO BE ELIGIBLE TO MAKE DEPOSITS INTO AN (3! ($(0 PREMIUMS COST LESS THAN PREMIUMS FOR TRADITIONAL COVERAGE PRIMARILY BECAUSE OF THE MUCH HIGHER DEDUCTIBLES (IGH DEDUCTIBLES CAUSE PATIENTS TO THINK TWICE BEFORE SEEKING CARE BECAUSE THE MONEY TO PAY FOR CARE COMES OUT OF THEIR OWN POCKETS 4HINKING TWICE BEFORE GETTING CARE IS ONE STEP TOWARD MAKING HEALTHCARE MORE LIKE THE MARKET FOR OTHER GOODS AND SERVICES (3!S ARE STRICTLY REGULATED BY THE 53 4REASURY AND LACK THE mEXIBILITY OF OTHER TYPES OF CONSUMER DIRECTED HEALTH PLANS 4ODAY INNOVATIVE COMPANIES ARE ALSO OFFERING (2!S WHICH ARE SIMILAR TO (3!S BUT ARE MORE mEXIBLE AND APPEAL TO DIFFERENT TYPES OF EMPLOYERS /NE AREA OF INTEREST IS USING (2!S AS A VEHICLE TO REWARD DESIRED BEHAVIORS &OR EXAMPLE A COMPANY MIGHT REWARD AN EMPLOYEE FOR ENROLLING IN A WEIGHT LOSS OR DISEASE MANAGEMENT PROGRAM BY ADDING MONEY TO AN EMPLOYEES (2! #RITICS CLAIM HOWEVER THAT ($(0S WITH OR WITHOUT (3!S OR (2!S MAY DRIVE UP MEDICAL COSTS BECAUSE PEOPLE FACING A DOCTOR OFlCE VISIT RATHER THAN A CO PAYMENT MAY SKIP THE VISIT ENTIRELY POTENTIALLY SIDESTEPPING NECESSARY CARE BEFORE A DISEASE OR INJURY BECOMES MORE SERIOUS AND COSTLY TO TREAT !S EVIDENCE EMERGES ON THESE ISSUES PLAN SPONSORS ARE RESPONDING BY COVERING PREVENTIVE OR CHRONIC CARE ON A lRST DOLLAR
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
BASIS 5LTIMATELY THE GOAL IS TO PROVIDE INCENTIVES THAT REINFORCE PERSONAL RESPONSIBILITY FOR ONES OWN HEALTH WHILE CONTINUING TO PROVIDE ATTRACTIVE BENElTS
7HAT ,IES !HEAD (EALTHCARE BENElT DESIGN IS CURRENTLY A HOTBED OF CREATIVITY AND INNOVATION )N DESIGNING BENElTS TODAY THE BIGGEST CHALLENGE AHEAD IS BUILDING HIGH QUALITY PLANS THAT REINFORCE BETTER HEALTH BEHAVIORS AND CURB HEALTHCARE COSTS !CTIVATING CONSUMERS OFFERS PROMISE IN CONTROLLING COSTS BY MAKING EMPLOYEES MORE ACCOUNTABLE FOR THE HEALTHCARE DOLLARS THEY SPEND /THER STRATEGIES INCLUDE INCENTIVES ANDOR PENALTIES OFTEN IN COMBINATION WITH (2!S TO ENCOURAGE EMPLOYEE WELLNESS OR PARTICIPATION IN DISEASE MANAGEMENT PROGRAMS 4IERED NETWORKS OFFER AN ADDITIONAL OPTION TO ENCOURAGE COST EFFECTIVENESS AND QUALITY OF PHYSICIANS AND HOSPITALS )N THE PAST COMPANIES WERE RELUCTANT TO PUSH THE ENVELOPE ON QUALITY BENElT PLANS BECAUSE THEY DID NOT WANT TO INTERFERE WITH PERSONAL HEALTH DECISIONS (OWEVER RISING HEALTHCARE COSTS HAVE CAUSED TODAYS LEADING EMPLOYERS TO EXPLORE NEW BENElT PLAN DESIGNS THAT PROMOTE AN INVOLVED HEALTHY WORKFORCE %NCOURAGING EMPLOYEE INVOLVEMENT IN SUPPORT PROGRAMS AND CREATING A SHARED INTEREST IN VALUE BASED CONSUMPTION VARIES ACROSS EMPLOYERS AND IS A WORK IN PROGRESS (OWEVER ONE THING IS CERTAIN -UCH EXCITEMENT IN EXPERIMENTATION AND INNOVATION LIES AHEAD %NDNOTES h4HE #HASM IN 1UALITY 3ELECT )NDICATORS FROM 2ECENT 2EPORTS v )NSTITUTE OF -EDICINE HTTPWWWIOMEDU ID "ERENES - * h.URSING -ISTAKES +ILL )NJURE 4HOUSANDS v 3EPTEMBER 4HE #HICAGO 4RIBUNE HTTPWWWCHICAGOTRIBUNECOMNEWS SPECIALSCHI NURSING STORY CTRACK CSET TRUE h%MPLOYEE #OMPENSATION %MPLOYER 3PENDING ON "ENElTS (AS 'ROWN &ASTER 4HAN 7AGES $UE ,ARGELY TO 2ISING #OSTS FOR (EALTH )NSURANCE AND 2ETIREMENT "ENElTS v &EBRUARY 5NITED 3TATES 'OVERNMENT !CCOUNTABILITY /FlCE 2EPORT TO #ONGRESSIONAL 2EQUESTERS HTTPWWWGAOGOVHIGHLIGHTSDHIGHPDF h%MPLOYER (EALTH "ENElTS !NNUAL 3URVEY v 4HE +AISER &AMILY &OUNDATION AND (EALTH 2ESEARCH AND %DUCATIONAL 4RUST 3EPTEMBER P HTTPWWWKFFORGINSURANCEUPLOADPDF 0EAR 2 h!-! TO $EVELOP -EASURE OF 1UALITY OF -EDICAL #ARE n 0ACT 7ITH #ONGRESS (AS -EDICARE ,INK v &EBRUARY 4HE .EW 9ORK 4IMES 0RICEWATERHOUSE#OOPERS h"EHIND THE .UMBERS n -EDICAL #OST 4RENDS FOR v /CTOBER ANALYSIS BASED ON #ONSUMER %XPENDITURE $ATA n "UREAU OF ,ABOR AND 3TATISTICS AND .ATIONAL (EALTH %XPENDITURE $ATA n #ENSUS "UREAU AVAILABLE AT WWWPWCCOMHEALTHCARE #OLLINS 32 AND + $AVIS h4RANSPARENCY IN (EALTH #ARE 4HE 4IME HAS #OME )NVITED 4ESTIMONY %NERGY AND #OMMERCE #OMMITTEE v -ARCH 3UBCOMMITTEE ON (EALTH 53 (OUSE OF 2EPRESENTATIVES (EARING ON h7HATS THE #OST 0ROPOSALS TO 0ROVIDE #ONSUMERS WITH "ETTER )NFORMATION !BOUT (EALTHCARE 3ERVICE #OSTS v P AVAILABLE AT WWWCMWFORG )BID P +EELER % " h%FFECTS OF #OST 3HARING ON 5SE OF -EDICAL 3ERVICES AND (EALTH v 3UMMER *OURNAL OF -EDICAL 0RACTICE -ANAGEMENT PP 4HOMAS 3 , h!ETNA TO 2ANK 3PECIALISTS BY #OST 1UALITY v !UGUST %AST "AY "USINESS 4IMES HTTPWWWBIZJOURNALSCOM EASTBAYSTORIESSTORYHTML #OCHEO 3 h#AN (3!S ADD !PPLES TO THE 5SUAL $EPOSIT 0IE v !"! "ANKING *OURNAL PP
1! (OW #ORPORATE !MERICA #AN (ELP ,IFT #LINICAL 0ERFORMANCE ! $ISCUSSION 7ITH !RNIE -ILSTEIN AND "OB 'ALVIN %MPLOYERS ARE NOT ALWAYS THE lRST THING TO COME TO MIND WHEN DISCUSSING CLINICAL PERFORMANCE BUT CERTAIN EMPLOYERS HAVE DEVOTED SUBSTANTIAL RESOURCES TO THIS ISSUE !S A RESULT THEY HAVE MADE NATIONAL HEADLINES AND MAJOR STRIDES IN FOCUSING THE DEBATE ON HOW TO MEASURE AND PAY FOR HIGH QUALITY AND EFlCIENT CARE 4O DISCUSS HOW EMPLOYERS CAN INmUENCE HEALTHCARE PERFORMANCE TODAY AND IN THE FUTURE 0RICEWATERHOUSE#OOPERS INTERVIEWED TWO OF THE MOST INmUENTIAL CORPORATE LEADERS ON THIS TOPIC !RNIE -ILSTEIN -$ -0( IS MEDICAL DIRECTOR AT THE 0ACIlC "USINESS 'ROUP ON (EALTH A 3AN &RANCISCO BASED BUSINESS COALITION OF OF #ALIFORNIAS LARGEST EMPLOYERS ! FOUNDING BOARD MEMBER OF 4HE ,EAPFROG 'ROUP HE IS ALSO A -%$0!# COMMISSIONER AND CHIEF PHYSICIAN AT -ERCER (EALTH "ENElTS ! .EW %NGLAND *OURNAL OF -EDICINE ARTICLE ON PRIVATE HEALTH INSURANCE DESCRIBED HIM AS A hPIONEERv IN EMPLOYER EFFORTS TO ADVANCE QUALITY "OB 'ALVIN -$ IS DIRECTOR OF GLOBAL HEALTH AT 'ENERAL %LECTRIC '% '% WAS A FOUNDING MEMBER OF BOTH 4HE ,EAPFROG 'ROUP AND "RIDGES 4O %XCELLENCE TWO EMPLOYER LED EFFORTS DESIGNED TO IMPROVE QUALITY AND SAFETY IN HEALTHCARE 'ALVIN IS ALSO DIRECTOR OF HEALTHCARE VALUE INITIATIVES FOR THE (EALTH #ARE 0OLICY 2OUNDTABLE OF THE (2 0OLICY !SSOCIATION 4HE ASSOCIATION REPRESENTS CHIEF HUMAN RESOURCE OFlCERS OF MORE THAN LARGE EMPLOYERS AND THE ROUNDTABLE WAS FORMED SPECIlCALLY TO FOCUS ON HEALTHCARE COST AND QUALITY ISSUES 0RICEWATERHOUSE#OOPERS 7HAT DO YOU THINK ABOUT THE CURRENT STATE OF QUALITY IN THE 53 HEALTHCARE INDUSTRY "OB 'ALVIN 7E HAVE A BETTER SENSE OF QUALITY THAN IN THE PAST BECAUSE THERE ARE MORE METRICS AVAILABLE ) THINK THERES A GROWING COMFORT AMONG ALL SECTORS THAT YOU CAN ACTUALLY MEASURE THIS STUFF 4HAT ALL BEING SAID THE LEVEL OF QUALITY AND ) INCLUDE EFlCIENCY AS PART OF QUALITY IS FAR FAR BELOW WHERE IT SHOULD BE AND IMPROVING IT REPRESENTS A MAJOR OPPORTUNITY TO MAKE CARE MORE AFFORDABLE !RNIE -ILSTEIN &RAMED IN INDUSTRIAL TERMS !MERICAN HEALTHCARE QUALITY RELIABILITY STANDS AT TO 3IGMA )N ANY GIVEN INTERACTION IN THE HEALTHCARE SYSTEM THE CHANCE THAT YOULL GET EVIDENCE BASED TREATMENT AND WONT BE EXPOSED TO AN IMPLEMENTATION ERROR IS ROUGHLY PERCENT 0W# )S THERE ANY MOVEMENT TOWARD IMPROVING THIS !- 9ES HOWEVER THE RATE OF ASCENT IS VERY SLOW 4HE CURRENT IMPLICIT STRATEGY IS TO IMPROVE A VERY SHORT LIST OF PERFORMANCE MEASURES THAT MIGHT CONSTITUTE PERCENT OF WHAT WED NEED TO ATTAIN RELIABLE QUALITY OF CARE 7E NEED A SOLUTION THAT IS
BETTER SCALED TO THE MAGNITUDE OF THE PROBLEM MOVES QUICKLY TO RISK ADJUSTED OUTCOME MEASURES AND ADDRESSES STRUCTURAL NECESSITIES LIKE ROUTINE USE OF INDUSTRIAL ENGINEERS AND INTEROPERABLE ELECTRONIC HEALTH RECORDS WITH ROBUST DECISION SUPPORT FUNCTIONALITY 0W# 7HAT IS THE ROLE OF EMPLOYERS IN ENHANCING QUALITY "' %MPLOYERS HAVE TWO ROLES 4HE BIGGEST IS THAT SINCE THEYRE MAJOR PURCHASERS OF HEALTHCARE THEY CAN HELP SEND MESSAGES TO THE MARKET &OR EXAMPLE EMPLOYERS COULD ONLY CONTRACT WITH HEALTH PLANS THAT ARE DRIVING QUALITY BY USING INCENTIVES INFORMATION AND CHOICE 3ECONDLY THERES A COMMITMENT TO KEEPING EMPLOYEES HEALTHIER ) DOUBT WHETHER THIS WILL IMPACT HEALTHCARE COSTS BUT ITS IMPORTANT TO HAVE A MORE PRODUCTIVE WORKPLACE !LTHOUGH THERES A LOT GOING ON MOST EMPLOYEES ARE NOT CHANGING THEIR BEHAVIOR YET %MPLOYERS FAILURE TO FULLY EXERT THEIR POWER IS A MAJOR REASON FOR THE PROBLEMS THE HEALTHCARE SYSTEM IS IN TODAY ! WEAK BUY SIDE IN A COMPETITIVE SYSTEM IS A RECIPE FOR UNDER PERFORMANCE 4HERE ARE MANY REASONS FOR THIS FAILURE n SENIOR
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! MANAGEMENT AMBIVALENCE ABOUT TACKLING A COMPLEX TOPIC WITHOUT A SHORT TERM RETURN INADEQUATE RESOURCES IN THE BENElT DEPARTMENTS A LACK OF INTEREST IN ANYTHING OUTSIDE OF CORE PRODUCTS ETC ,ARGE EMPLOYERS CAN BE CATALYSTS BUT THEY NEED TO DO IT SO THAT THEY CAN LEVERAGE HEALTH PLANS AND THEN HAVE -EDICARE FOLLOW THE ;BEST= PRACTICES #HANGING CONSUMER BEHAVIOR IS A LONG TERM PROCESS BUT EMPLOYERS NEED TO ACT WITH A SENSE OF URGENCY IN THE SHORT TERM
)N COMPETITIVE INDUSTRIES THE SPOILS GO TO THE CUSTOMER AND THE PERFORMANCE LEADERS (OWEVER POORLY PERFORMING !MERICAN PHYSICIANS ARE NOT PREPARED TO ACCEPT THE PAIN EXPERIENCED BY POORLY PERFORMING AIRLINES OR CAR MAKERS !- 4HE MAJORITY ARE ON THE SIDELINES !CTIVE STRATEGIC EMPLOYERS ARE USING THREE TOOLS PERFORMANCE TRANSPARENCY AMONG PHYSICIANS AND HOSPITALS TIERED OR NARROW PROVIDER NETWORKS AND ZERO SUM RElNEMENTS OF THE PHYSICIAN PAYMENT SYSTEM SO THAT BETTER PERFORMANCE IS BETTER PAID WITHOUT ACCELERATING AMBIENT -$ INCOME GROWTH RATES 4RANSPARENCY IS SIMPLEST AND IT SHOULD BE THE lRST STEP 4IERED OR NARROW NETWORKS CAN BE DONE FOR EMPLOYERS BY HEALTH PLANS AND DOESNT REQUIRE COOPERATION FROM PROVIDERS 7ORKERS IN LOWER WAGE INDUSTRIES ARE MORE WILLING TO RESTRICT ACCESS TO A NARROWER NETWORK OF PROVIDERS IN EXCHANGE FOR MORE AFFORDABLE PREMIUMS AND POINT OF SERVICE COSTS !LTERED PHYSICIAN PAYMENT SYSTEMS ARE MORE DIFlCULT BECAUSE THEY REQUIRE PHYSICIAN CONSENSUS AND SIGNIlCANT ADMINISTRATIVE COMPLEXITY 7HAT IS A FAIR DIVISION OF THE SPOILS OF IMPROVED CLINICAL EFlCIENCY )N COMPETITIVE INDUSTRIES THE SPOILS GO TO THE CUSTOMER AND THE PERFORMANCE LEADERS (OWEVER POORLY PERFORMING !MERICAN PHYSICIANS ARE NOT PREPARED TO ACCEPT THE PAIN EXPERIENCED BY POORLY PERFORMING AIRLINES OR CAR MAKERS 0W# 7HAT IMPACT DO UNIONS HAVE "' )N THE INDUSTRIES IN WHICH THEY HAVE A LARGE PRESENCE THEY HAVE A LOT OF POTENTIAL TO EFFECT CHANGE )N GENERAL THOUGH UNIONS LOOK AT BENElTS AS A COMPENSATION ISSUE AND NOT FROM THE PERSPECTIVE OF WHAT THEYRE GETTING FROM THEIR DOLLARS WITH RESPECT TO QUALITY (OWEVER FOR THE 53 WORKFORCE AS A WHOLE FOR EVERY UNIONIZED PERSON THERE ARE NINE WHO ARE NOT 0W# %XECUTIVES INTERVIEWED IN A RECENT 0W# "AROM ETER SURVEY SEE A STRONG LINK BETWEEN THEIR COMPANIES HEALTH PLANS EMPLOYEE HEALTH STATUS AND EMPLOYEE PRODUCTIVITY 7HAT ARE YOUR VIEWS REGARDING THIS lNDING "' (EALTHIER EMPLOYEES ARE MORE PRODUCTIVE WITHOUT A DOUBT 4O THE EXTENT THAT THE COMPANYS BENElTS AND HEALTH PLANS FOCUS ON MANAGING DISEASE BETTER AND KEEPING PEOPLE HEALTHY THERE
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
IS A CLEAR LINK ) DO THINK HOWEVER THAT MOST DATA SHOW THAT EMPLOYERS ARE JUST PART OF A MUCH LARGER PUBLIC HEALTH EFFORT WHICH DRIVES IMPROVEMENTS IN POPULATION HEALTH ) THINK EMPLOYERS MAY BE OVERLY OPTIMISTIC ABOUT THEIR ABILITY TO IMPACT LIFESTYLE CHOICES "EHAVIORS ARE NOT EASY TO CHANGE ITS NOT EASY TO GET SOMEONE TO LOSE WEIGHT OR QUIT SMOKING 0LUS IF YOU LOOK CLOSELY AT THE DATA STRESS IS THE MAJOR FACTOR DRIVING PRODUCTIVITY LOSS AND IT IS HARDEST TO MANAGE THIS 4HE VAST NUMBER OF THE STUDIES ON THIS ISSUE n MANY OF WHICH ARE METHODOLOGICALLY DISAPPOINTING n ARE DONE BY COMPANIES SELLING PRODUCTS OR BY ENTHUSIASTS ,IFESTYLE BEHAVIORS CONTRIBUTE TO HEALTHCARE COSTS BUT THE QUESTION IS n WHAT IS THE EMPLOYERS ROLE HERE !- )TS AN IMPORTANT OBSERVATION )T SIGNALS THE FACT THAT CURRENT BENElT PLANS ARE MANAGED WITH AN OVERLY NARROW DASHBOARD )TS OBVIOUS ON ITS FACE THAT MAKING DECISIONS ON HEALTH BENElTS WITHOUT REGARD TO THE IMPACT ON EMPLOYEE HEALTH STATUS PRODUCTIVITY OR SATISFACTION IS NOT DEFENSIBLE OR IN SHAREHOLDERS INTERESTS .EVERTHELESS ITS OFTEN THE CASE !S (2 INFORMATION SYSTEMS ARE IMPROVED SO THAT EMPLOYERS CAN MORE EASILY SEE THE LINK BETWEEN HEALTH BENElTS PLANS EMPLOYEE HEALTH AND WORKFORCE CONTRIBUTION TO ENTERPRISE PROlTABILITY THIS WILL CHANGE 2IGHT NOW THE LINKS ARE TOO THEORETICAL TO ENGAGE MOST EMPLOYERS 0W# )N 0W#S SURVEY HEALTHCARE WAS RANKED LAST AMONG SEVERAL INDUSTRIES BEHIND CARS COLLEGES ELEC TRONICS AND HOTELS AS PROVIDING THE BEST DATA FOR CON SUMERS TO MAKE DECISIONS 7HATgS YOUR OPINION ON THIS "' ) AGREE /NE OF THE BIGGEST NEEDS WE HAVE IS TO PROVIDE INFORMATION AND MEET THE CONSUMERS WHERE THEY ARE 4O HELP THIS EMPLOYERS SHOULD CREATE A hNEW ,EAPFROGv BASED ON MEANINGFUL INFORMATION FOR CONSUMERS 7E DONT HAVE ANYONE LIKE ;PERSONAL lNANCE EXPERT= 3UZE /RMAN AND ITS BECOMING CLEARER THAT PEOPLE NEED A PERSONAL TOUCH WHEN IT COMES TO HEALTHCARE DECISIONS 4HERE ARE A SMALL NUMBER OF PEOPLE WHO MAKE DECISIONS BASED ON INFORMATION GATHERED THROUGH THE )NTERNET MOST OTHERS RELY ON THEIR DOCTORS 4HE NEXT STEP ONCE WEVE DEVELOPED CONSUMER FRIENDLY INFORMATION IS TO INCENTIVIZE PEOPLE TO USE IT 5NLESS WE TIE THE USE OF THIS INFORMATION TO SPECIlC lNANCIAL INCENTIVES AS IS THE CASE IN THE INDUSTRIES YOU MENTIONED IN YOUR QUESTION WE WONT SEE THE TYPE OF USAGE THAT WILL CHANGE THE SYSTEM !- )TS CORRECT )N ADDITION TO MORE PERFORMANCE MEASUREMENTS WE NEED MORE EMPHASIS ON ACTIVE CONSUMER DECISION SUPPORT TO USE THE MEASURES SUCCESSFULLY 4HE MAJORITY OF TODAYS PERFORMANCE MEASUREMENTS ARE ON WEBSITES THAT MOST PEOPLE DONT USE #ONSUMERS NEED MORE HELP &OR EXAMPLE ONE NATIONAL HEALTH PLAN HAS A TELEPHONE ROBOT THAT IS CONTINUOUSLY SCANNING 0"- INFORMATION TO IDENTIFY ENROLLEES WHO CAN SWITCH TO DRUGS THAT WILL COST THEM LESS )T CALLS SUCH ENROLLEES TELLS THEM WHAT THEY COULD SAVE AND SHOWS THEM HOW TO GO TO THE WEBSITE TO INITIATE CHANGE 4HE OPPORTUNITY COMES TO THEM 4HIS SYSTEM COULD BE EXPANDED TO SUPPORT EASIER SWITCHES TO BETTER PERFORMING PROVIDERS OR LINKAGE TO SELF MANAGEMENT RESOURCES #ONSUMERS NEED MORE HELP (EALTHCARE IS COMPLICATED
1! %MPLOYERS DONT HAVE THAT MUCH IMPACT IF THEY JUST FOCUS ON THEIR SPECIFIC POPU LATIONS BUT THEY CAN BE VERY EFFECTIVE CATALYSTS DRIVING CHANGE THROUGH THE HEALTH PLANS WITH WHOM THEY CONTRACT AND ULTIMATELY -EDICARE 0W# 7HAT WILL THE STATE OF QUALITY BE IN THREE TO lVE YEARS "' )T DEPENDS &OR EVERY COMPANY THAT IS PROGRESSIVE IN THIS AREA THERE ARE MANY MORE THAT ARE hASLEEP AT THE WHEELv -Y SENSE IS THAT THERE WILL BE SOME GAINS IN SOME AREAS BUT THE PACE OF INNOVATION AND COMPLEXITY IS SO FAST IN MEDICINE THAT ) FEAR WE WILL FALL BEHIND %MPLOYERS DONT HAVE THAT MUCH IMPACT IF THEY JUST FOCUS ON THEIR SPECIlC POPULATIONS BUT THEY CAN BE VERY EFFECTIVE CATALYSTS DRIVING CHANGE THROUGH THE HEALTH PLANS WITH WHOM THEY CONTRACT AND ULTIMATELY -EDICARE !- 4HERE WILL BE MODERATE IMPROVEMENT ON A SMALL SUBSET OF QUALITY MEASURES ! FEW ADVANCED PROVIDERS WILL BEGIN TO BREAK AWAY FROM THE PACK VIA )4 INVESTMENTS AND INDUSTRIAL ENGINEERING ASSISTANCE 4HEYLL DEMONSTRATE QUALITY AND COST IMPROVEMENTS THAT ARE hOFF THE CHARTv -UCH DEPENDS ON WHAT -EDICARE DOES BECAUSE THERE ARE UNDERAPPRECIATED SYNERGIES BETWEEN -EDICARE AND THE PRIVATE SECTOR 4HE PRIVATE SECTOR HAS MORE
mEXIBILITY 7HEN EXEMPLARY BOLDER ADVANCES BY THE PRIVATE SECTOR GET RESULTS THEY SURFACE WITHIN #-3 AND #ONGRESS AND AFFECT -EDICARE POLICY 0RIVATE SECTOR LEADERS BOOST THE GOVERNMENTS POLITICAL COURAGE TO MAKE CHANGES 3UBSEQUENT -EDICARE ADVANCES THEN HELP ENABLE FURTHER PRIVATE SECTOR ADVANCES 0W# (OW CAN EMPLOYERS WORK WITH OTHER SECTORS OF THE INDUSTRY "' 7HEN PURCHASERS AND PROVIDERS WORK IN COLLABORATION IT HAS A BIG IMPACT )4 ADOPTION COULD MAKE THE BIGGEST IMPACT ON QUALITY IN THE NEXT SEVERAL YEARS %VEN THOUGH IT WOULD COST A LOT THERES A STRONG 2/) 4HE EXECUTIVE BRANCH HAS SHOWN REAL LEADERSHIP IN PUSHING FOR INTEROPERABILITY AND REGIONAL HEALTH INFORMATION ORGANIZATIONS 2()/S (OWEVER THE lNANCING PROBLEM STILL HASNT BEEN CRACKED AND IT WILL BE THE BIG BARRIER /NE WAY EMPLOYERS COULD HELP IS BY PRESSURING HEALTH PLANS TO DIRECT PERFORMANCE BONUSES AROUND )4 !- 'EOGRAPHICALLY CONCENTRATED EMPLOYERS CAN BEGIN TO BUILD CLOSER BUSINESS PARTNERSHIPS WITH PHYSICIANS AND HOSPITALS WHO ARE READY TO ENGAGE IN MAJOR )4 ENABLED CLINICAL PROCESS REDESIGN !LL EMPLOYERS CAN AND SHOULD USE MORE 7ASHINGTON $# POLITICAL CAPITAL TO ENCOURAGE #ONGRESS AND THE ADMINISTRATION TO TRANSFORM -EDICARE INTO A LEADER IN PROVIDER PERFORMANCE TRANSPARENCY AND PERFORMANCE SENSITIVE PROVIDER SELECTION AND PAYMENT .EITHER -EDICARE NOR THE PRIVATE SECTOR IS STRONG ENOUGH TO CATALYZE HEALTH INDUSTRY TRANSFORMATION ALONE n
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
%MPLOYERS 5SE OF (EALTHCARE 1UALITY $ATA ! CORPORATE WELLNESS STRATEGY THAT PROVIDES EMPLOYEES WITH BETTER HEALTHCARE QUALITY DATA EDUCATION AND INCENTIVES CAN ADVANCE EXECUTIVE GOALS OF INCREASED WORKPLACE PRODUCTIVITY AND REDUCED HEALTH BENElT COSTS
"Y "ENJAMIN )SGUR AND #HRISTOPHER +USCHEL 0RICEWATERHOUSE#OOPERS
!
OF GLOBAL HEALTH AT 'ENERAL %LECTRIC NOTES THAT h7E ;EMPLOYERS= T A TIME WHEN THE NATION FACES DETERIORATING HEALTH FROM HAVE A BETTER SENSE OF QUALITY THAN IN THE PAST BECAUSE THERE ARE OBESITY AND OTHER BEHAVIORAL ISSUES ALMOST ONE IN lVE MORE METRICS AVAILABLE ) THINK THERES A GROWING COMFORT AMONG EXECUTIVES SAY THE HEALTH STATUS OF THEIR WORKFORCE HAS IMPROVED ALL SECTORS THAT YOU CAN ACTUALLY MEASURE THIS STUFFv ! GROWING OVER THE PAST TWO YEARS 4HIS IS ONE OF THE MORE REMARKABLE RESULTS NUMBER OF COMPANIES IS CONSIDERING OR OFFERING THEIR EMPLOYEES OF THE SURVEY BY THE 0RICEWATERHOUSE#OOPERS -ANAGEMENT INFORMATION ON HEALTHCARE QUALITY "AROMETER AND THE lRMS (EALTH 2ESEARCH )NSTITUTE (OW COULD SUCH IMPROVEMENT BE ACHIEVED !CCORDING TO THE SURVEY A MAJORITY OF THOSE EMPLOYERS REPORTING HEALTHIER EMPLOYEES 7HAT )S "EING $ONE OFFERED EMPLOYEE PROGRAMS OR INCENTIVES FOR A HEALTHY LIFESTYLE %MPLOYERS HAVE MIXED THOUGHTS ABOUT THEIR HEALTHCARE QUALITY AND PROVIDED INFORMATION ON HEALTHCARE 4HIS TWO PRONGED DATA 7HEN ASKED IF THEY BELIEVE THEIR PRESENT QUALITY DATA IS APPROACH n OF PROVIDING INCENTIVES AND INFORMATION n IS BECOMING RELIABLE EASY TO ACCESS INTERPRET AND ACT ON THE MOST FREQUENT PART OF A CORPORATE WELLNESS STRATEGY )N FACT TWO THIRDS OF EXECUTIVES SURVEYED BELIEVE THAT THE DESIGN OF THEIR $ESPITE THE IMPORTANCE OF THE INDUSTRY HEALTHCARE RANKED LAST COMPANIES HEALTH BENElT PLANS HAS A CONNECTION %XHIBIT IN HAVING GOOD QUALITY DATA FOR CONSUMERS TO THE OVERALL HEALTH STATUS OF THEIR EMPLOYEES 4HESE lNDINGS ARE BASED ON A SURVEY OF 7HICH INDUSTRIES DO COMPANIES VIEW AS HAVING GOOD QUALITY TOP EXECUTIVES AT LARGE 53 BASED MULTINATIONAL DATA THAT HELP CONSUMERS MAKE RELIABLE DECISIONS COMPANIES RELEASED BY 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER AND THE lRMS (EALTH 2ESEARCH )NSTITUTE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER IS A QUARTERLY SURVEY OF TOP EXECUTIVES IN LARGE 53 BASED MULTI NATIONAL BUSINESSES 4HE NEED FOR GOOD DATA ON QUALITY IN HEALTHCARE WAS A STRONG THEME IN THE SURVEY )F EMPLOYEES NEED TO BE RESPONSIBLE CONSUMERS THEY NEED GOOD INFORMATION (OWEVER EMPLOYERS SAID THAT OTHER INDUSTRIES ARE MUCH BETTER THAN HEALTHCARE IN PROVIDING QUALITY DATA SEE %XHIBIT 4HE !UTO #ONSUMER #OLLEGES (OTELS (EALTHCARE ELECTRONICS 5NIVERSITIES RESTAURANTS HEALTHCARE INDUSTRY RANKED LAST AMONG lVE OTHER INDUSTRIES FOR PROVIDING GOOD QUALITY DATA 3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY 4HE IMPORTANCE OF QUALITY DATA IS GROWING AMONG EMPLOYERS 2OBERT 'ALVIN -$ DIRECTOR
"ENJAMIN )SGUR -0!FF IS THE ASSISTANT DIRECTOR OF 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE (E FOCUSES ON THE DEVELOP MENT OF THOUGHT LEADERSHIP AND RESEARCH INITIATIVES FOR THE lRM AND CLIENTS (E CAN BE REACHED AT BENJAMINISGUR USPWCCOM #HRISTOPHER +USCHEL -! IS AN ASSOCIATE WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E RECEIVED A "! FROM "RANDEIS 5NIVERSITY IN IN ECONOMICS AND AN -! IN INTERNATIONAL ECONOMICS AND lNANCE FROM THE "RANDEIS )NTERNATIONAL "USINESS 3CHOOL IN (E CAN BE REACHED AT CHRISTOPHERMKUSCHEL USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
DLO KNXDQR ãT RD ãNE ãGD @KSGB@QD ãPT @KHSXãC@S@ %XHIBIT $O COMPANIES BELIEVE THEIR PRESENT QUALITY DATA IS RELIABLE EASY TO ACCESS INTERPRET AND ACT ON
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
%XHIBIT %MPLOYERS SEE A STRONG CORRELATION BETWEEN HEALTHCARE BENElT DESIGN EMPLOYEE HEALTH STATUS AND EMPLOYEE PRODUCTIVITY 0ERCENTAGE THAT BELIEVES THEIR COMPANIES HEALTHCARE BENElT DESIGN CONNECTS TO OVERALL EMPLOYEE HEALTH STATUS
0ERCENTAGE THAT BELIEVES THEIR EMPLOYEES HEALTH STATUS CONNECTS TO EMPLOYEE PRODUCTIVITY
9ES A GREAT DEAL OR SOMEWHAT -AY OR MAY NOT .O NO CONNECTION
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
ANSWER WAS hA MIXED BAGv SEE %XHIBIT /N THE POSITIVE SIDE MORE EXECUTIVES ANSWERED hYESv THAN hNOv VERSUS PERCENT 4HIS IS AN AREA THAT SOME EMPLOYERS ARE EXPLOITING WITH GREAT SUCCESS &OR EXAMPLE MANY COMPANIES ARE STARTING TO UTILIZE QUALITY DATA TO IDENTIFY HEALTH ISSUES THAT ARE SIGNIlCANT TO THEIR EMPLOYEES WHICH IN TURN HELP TO TARGET APPROPRIATE MEASURES AND PROGRAMS TO COMBAT THESE ISSUES 4HROUGH THIS AND OTHER INNOVATIVE PROGRAMS THE COMPANIES MAY BE ABLE TO DRASTICALLY REDUCE THE INmATIONARY COSTS OF HEALTHCARE PER WORKER !CCORDING TO THE SURVEY THE CORRELATION BETWEEN HEALTHCARE BENElT DESIGN EMPLOYEE HEALTH STATUS AND EMPLOYEE PRODUCTIVITY IS STRONG 3EVENTY SIX PERCENT OF RESPONDENTS AGREED THAT THEIR EMPLOYEES HEALTH STATUS CONNECTS TO EMPLOYEE PRODUCTIVITY 7HILE THIS MAKES INTUITIVE SENSE WHAT IS MORE STRIKING IS THAT ALMOST TWO THIRDS OF EMPLOYERS ALSO BELIEVE THAT THEIR COMPANIES HEALTHCARE BENElT DESIGN PLANS CONNECT TO OVERALL EMPLOYEE HEALTH STATUS INCLUDING PERCENT WHO SEE A GREAT CONNECTION AND PERCENT WHO SEE A PARTIAL ONE /NLY PERCENT BELIEVE THERE IS NO CONNECTION SEE %XHIBIT ! STRONG MAJORITY PERCENT OF EMPLOYERS SURVEYED CLAIM TO PROVIDE CHOICES IN HEALTH PLANS &URTHERMORE ALMOST A QUARTER EXPECT TO GIVE EMPLOYEES MORE CHOICES OVER THE NEXT TO MONTHS 2EGARDING THE TYPES OF CHOICES OFFERED PERCENT PROVIDE OPTIONS WITH DIFFERENT COST AND COVERAGE OPTIONS ALLOWING EMPLOYEES TO BETTER lND A PROGRAM THAT MEETS THEIR SPECIlC NEEDS AND BUDGET LIMITATIONS /VER PERCENT PROVIDE CHOICES WITH HEALTH SAVINGS ACCOUNTS AND MORE THAN HALF OFFER CHOICES FROM DIFFERENT INSURANCE COMPANIES !N ADDITIONAL PERCENT OFFER OTHER CHOICES AS WELL SEE %XHIBIT 4HE POSITIVE NEWS FROM EMPLOYERS RECOGNIZING THE UPSIDES OF HAVING STRONG BENElTS PLANS AND TRANSPARENT DATA NEEDS TO BE TEMPERED BY OTHER ANSWERS TO THE SURVEY &OR EXAMPLE FOR THOSE COMPANIES THAT PROVIDE PROGRAMS AND INCENTIVES TO MAINTAIN WELLNESS MORE THAN HALF DESCRIBED THE PROGRAMS AND INCENTIVES THEY OFFER TO EMPLOYEES AS MODERATE TO AVERAGE AND OVER A QUARTER DESCRIBE THEIR PROGRAMS AS LIMITED #OST REMAINS THE MOST IMPORTANT FACTOR IN DESIGNING EMPLOYEE BENElT PLANS ACCORDING TO THE SURVEY SEE %XHIBIT (OWEVER NEARLY PERCENT OF EMPLOYERS RANKED hCLINICAL OUTCOMESv AS IMPORTANT A SIGN THAT THEYRE LOOKING FOR VALUE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
DLO KNXDQR ãT RD ãNE ãGD @KSGB@QD ãPT @KHSXãC@S@ FROM HEALTHCARE SPENDING "Y TAKING INTO ACCOUNT OTHER MEASURES SUCH AS THE AVAILABILITY OF HEALTHCARE QUALITY DATA CURRENTLY PERCENT CONSIDER THIS A PRIORITY COMPANIES MAY BE ABLE TO REDUCE COSTS THROUGH IMPROVING EMPLOYEE HEALTH h4HERE IS AN IMPORTANT DISCONNECT BETWEEN THE MEASURES USED TO EVALUATE BENElTS PROGRAMS AND THOSE USED BY #&/S FOR lNANCIAL PERFORMANCE v NOTES $R 4HOMAS 0ARRY PRESIDENT OF )") h"Y THEIR NATURE lNANCIAL EXECUTIVES RESPOND TO THE NUMBERS 5NTIL BENElTS MANAGERS EXPRESS PROGRAM PERFORMANCE IN lNANCIAL TERMS FEW #&/S WILL UNDERSTAND THE FULL CONTRIBUTION OF MANAGING HEALTHCARE FOR ABSENCE AND DISABILITY MANAGEMENT DISEASE MANAGEMENT AND WELLNESS PROGRAMS TO THE BOTTOM LINEv;= !ND WHAT IS THE TYPE OF HEALTHCARE QUALITY DATA THAT COMPANIES VIEW AS IMPORTANT !CCORDING TO THE SURVEY APPROXIMATELY THREE QUARTERS OF RESPONDENTS VIEWED DRUGS AS IMPORTANT FOLLOWED BY HEALTH SYSTEMS AT PERCENT )NDIVIDUAL HOSPITALS INDIVIDUAL PHYSICIANS AND MEDICAL DEVICES COMPLETED THE SURVEY ANSWERS PERCENT PERCENT AND PERCENT RESPECTIVELY SEE %XHIBIT 2ECOGNIZING THE IMPORTANCE OF DATA ABOUT PERCENT OF RESPONDENTS ARE CONSIDERING INCREASING THE QUALITY AND SCOPE OF HEALTHCARE DATA THAT THEY ACQUIRE FOR INTERNAL USE AND FOR THEIR EMPLOYEES 4HIS IS AN AREA THAT HAS ROOM FOR IMPROVEMENT *UST SHY OF PERCENT OF COMPANIES ARE PROVIDING HEALTHCARE DATA TO EMPLOYEES /F THOSE THAT DO PERCENT TRACK HOW SATISlED THEIR EMPLOYEES ARE WITH THAT DATA SEE %XHIBIT
2ECOMMENDATIONS AND #ONCLUSION "Y MAKING BETTER DECISIONS EMPLOYEES CAN DRIVE DOWN HEALTHCARE COSTS HOWEVER IN ORDER TO MAKE THE DECISIONS EMPLOYEES NEED TOOLS n IN THE FORM OF INFORMATION n TO MAKE INFORMED DECISIONS 3EVERAL AVENUES CAN BE PURSUED TO PROVIDE BETTER INFORMATION ON HEALTHCARE QUALITY #OLLABORATE TO IMPROVE ALIGNMENT /PENING UP CHANNELS FOR COLLABORATION AMONG STAKEHOLDERS EMPLOYERS PAYERS lNANCIAL INSTITUTIONS AND EMPLOYEES CAN ALIGN INCENTIVES AND PROCESSES TO ACHIEVE RESULTS 0ROMOTE TRANSPARENCY %NCOURAGE PHYSICIANS HOSPITALS AND OTHER PROVIDERS TO PUBLISH PRICES AND QUALITY INDICATORS WORKING TO PROMOTE COMPARABILITY AND STANDARDIZATION OF RELEVANT METRICS )NCREASE COMMUNICATION )MPLEMENT TARGETED COMMUNICATIONS TO IMPROVE THE AMOUNT AND QUALITY OF HEALTH QUALITY AND COST INFORMATION PROVIDED TO EMPLOYEES WHEN THEY NEED IT
%XHIBIT OF EMPLOYERS ARE PROVIDING CHOICES IN HEALTH PLANS OF THESE ALMOST A QUARTER EXPECT TO GIVE EMPLOYEES MORE CHOICES OVER THE NEXT MONTHS )F THEY PROVIDE CHOICES WHAT OPTIONS DO COMPANIES PROVIDE EMPLOYEES IN HEALTHCARE PLANS
7 DIFF COST COVERAGE OPTIONS
&ROM DIFF INSURANCE COMPANIES
/THER
7 (3!S
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
%XHIBIT #OST REMAINS THE TOP PRIORITY FOR DESIGNING A HEALTH PLAN WHILE AVAILABILITY OF QUALITY DATA IS LAST 7HAT ARE COMPANIES TOP PRIORITIES IN DESIGNING EMPLOYEE HEALTHCARE PLANS 3CALE OF WITH BEING A TOP PRIORITY AND BEING A LOW PRIORITY
#OST
-EAN
1UALITY OF %ASE OF #HOICE OF 1UALITY OF #LINICAL !VAILABILITY PLANS SERVICE TO OUTCOMES OF DATA RE SERVICE FOR ADMIN QUALITY (2 DEPT EMPLOYEES CLAIMS
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
D L O KNX D Q R ã T R D ã N E ã G D @ K S G B @ Q D ã P T @ K H S X ã C @S@
!LTER FOCUS FROM COST TO VALUE 2ATHER THAN FOCUSING PRIMARILY ON COST THE FOCUS MUST SHIFT TO VALUE EFlCIENCY QUALITY OF OUTCOMES AND THE IMPACT ON PRODUCTIVITY $EVELOP DISCIPLINE IN EXECUTION #URRENTLY THERE IS SIGNIlCANT ACTIVITY WITHOUT SIGNIlCANT RESULTS #HANGES THEREFORE NEED TO BE EXECUTED WITH A MEASURABLE RIGOR AND ACCOUNTABILITY TO ENSURE THAT THE ACTIVITY TAKING PLACE IS FRUITFUL 4HIS PAPER WAS PUBLISHED AS A 0RICEWATERHOUSE #OOPERS (EALTH"RIEF IN *UNE 4HE (EALTH"RIEF CAN BE ACCESSED AT WWWPWCCOMHEALTHCARE
%NDNOTE
%XHIBIT $RUGS AND HEALTH SYSTEMS WERE THE TOP TWO TYPES OF QUALITY DATA RESPONDENTS VIEWED AS IMPORTANT 7HAT TYPES OF HEALTHCARE QUALITY DATA DO COMPANIES VIEW AS IMPORTANT
3MART0ROS h#&/S 2ECOGNIZE ,INK "ETWEEN (EALTH "ENElTS 0RODUCTIVITY AND 0ROlTS v HTTPWWWPRONET COMXXML
$RUGS
(EALTH SYSTEMS
)NDIVIDUAL HOSPITALS
)NDIVIDUAL PHYSICIAN
-EDICAL DEVICES
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
%XHIBIT !BOUT OF RESPONDENTS ARE CONSIDERING INCREASING THE QUALITY AND SCOPE OF HEALTHCARE DATA THAT THEY ACQUIRE FOR INTERNAL USE AND FOR THEIR EMPLOYEES ,OOKING AHEAD OVER THE NEXT MONTHS ARE EMPLOYERS CONSIDERING INCREASING THE QUALITY AND SCOPE OF HEALTHCARE DATA THAT
.OT CERTAIN
.OT CERTAIN
.O
.O
9ES
9ES
THEY ACQUIRE AND PROVIDE FOR INTERNAL USE
THEIR COMPANIES PROVIDE TO THEIR EMPLOYEE WORKFORCE
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
%MPLOYERS $IRECTIONS IN (EALTHCARE &INANCIAL -ANAGEMENT "Y MOVING FROM NEAR TERM @COST OF CARE ANALYSIS TO A BROADER PERSPECTIVE ON @DRIVERS OF HEALTH EMPLOYERS CAN REALIZE SIGNIlCANT IMPROVEMENTS IN EMPLOYEE HEALTH AND WORKPLACE PRODUCTIVITY
"Y 3USAN -ARGOLIS AND -ICHAEL 4HOMPSON 0RICEWATERHOUSE#OOPERS
)NTRODUCTION 0OOR QUALITY CAN BE EXPENSIVE 4HE -IDWEST "USINESS 'ROUP ON (EALTH IN COLLABORATION WITH THE *URAN )NSTITUTE ;= ESTIMATED THAT PERCENT OF THE COST OF HEALTHCARE BILLION PER YEAR CAN BE ATTRIBUTED TO POOR QUALITY INCLUDING THE RESULT OF OVERUSE MISUSE AND WASTE 2EGARDLESS OF THE HIGH COST PAID BY EMPLOYERS GOVERNMENT AND CONSUMERS POOR HEALTH OUTCOMES REMAIN )NDIRECT COSTS SUCH AS THE IMPACT ON WORKFORCE PRODUCTIVITY REPRESENT AN ADDITIONAL TO PERCENT OF THE NATIONAL HEALTH BILL;= $ESPITE THE WELL DOCUMENTED INTERRELATIONSHIP BETWEEN COST AND QUALITY MANY EMPLOYERS AND HEALTH PLANS HAVE FAILED TO ADEQUATELY INTEGRATE QUALITY MANAGEMENT INTO THE OVERALL lNANCIAL MANAGEMENT OF THEIR PLANS 4HIS DISCONNECT EXISTS FOR MANY REASONS INCLUDING COMPLEXITIES IN MEASURING QUALITY (OWEVER AS THE INDUSTRY MOVES FROM MANAGING THE COST OF CARING FOR SICK PEOPLE TO POPULATION BASED HEALTHCARE MANAGEMENT A MORE SOLID CONNECTION BETWEEN QUALITY AND lNANCIAL MANAGEMENT IS NEEDED TO IMPROVE PLANNING AND ACCOUNTABILITY 7HILE STILL A WORK IN PROGRESS THIS MORE INTEGRATED VIEW OF QUALITY PERFORMANCE AND lNANCIAL MANAGEMENT CAN SUPPORT A MORE DISCIPLINED AND SUSTAINABLE APPROACH TO IMPROVING HEALTH AND HEALTHCARE VALUE AND PERFORMANCE 4HIS PAPER PRIMARILY FOCUSES ON THE POINT OF VIEW OF PURCHASERS SINCE THEY ULTIMATELY HOLD THE RISK AND HAVE THE MOST AT STAKE lNANCIALLY (EALTH PLANS AND PROVIDERS WILL HAVE SOME PARALLELS AND DIFFERENCES IN HOW THEY VIEW lNANCIAL MANAGEMENT IN THIS CONTEXT DUE TO DIFFERENT lNANCIAL MOTIVATIONS )MPROVING lNANCIAL PERFORMANCE REQUIRES AN UNDERSTANDING AND MANAGEMENT OF THE DRIVERS THAT IMPACT HEALTH RISK AND COSTS )N QUALITY MANAGEMENT THE GOAL IS TO MANAGE AND REDUCE VARIATIONS IN THE RISK PROlLE OF THE POPULATION AND LESSEN OTHER DRIVERS OF HEALTHCARE COSTS
#URRENT 3TATE n 2ETROSPECTIVE &INANCIAL -ANAGEMENT )N THE 5NITED 3TATES THE PURCHASERS OF HEALTHCARE ARE PRIMARILY EMPLOYERS GOVERNMENT AND CONSUMERS 4YPICALLY THE MAJORITY OF MIDSIZE AND LARGE COMPANIES HAVE DESIGNED THEIR OWN BENElT PLANS SELF FUNDED THEM AND CONTRACTED WITH PAYERS FOR ADMINISTRATIVE SERVICES 7HILE HEALTH BENElTS COSTS ARE TYPICALLY THE SECOND OR THIRD LARGEST EXPENDITURE IN THESE ORGANIZATIONS THE lNANCIAL MANAGEMENT OF THEIR HEALTH PROGRAMS IS LESS SOPHISTICATED THAN THAT OF THEIR CORE BUSINESSES !LTHOUGH OVERSTATED ONE MIGHT VIEW THE TRADITIONAL FOCUS ON COSTS BY BOTH PURCHASERS AND PAYERS AS PREDICATED ON hPEOPLE GET SICKv AND hPROVIDERS TREATv &INANCIAL MANAGEMENT WITHIN THIS BASIC FRAMEWORK IS TO MINIMIZE THE COSTS OF THOSE TREATMENTS THROUGH NEGOTIATION OF PROVIDER FEES COORDINATION OF CARE AND REDUCTIONS IN ADMINISTRATIVE COSTS #ONSEQUENTLY TRADITIONAL VIEWS OF lNANCIAL MANAGEMENT FREQUENTLY FOCUSED ON PER CAPITA COSTS BY TYPE OF SERVICE WITH A POTENTIAL ADDED BREAKDOWN OF UNIT COSTS AND UTILIZATION RATES BY TYPE OF SERVICE AS WELL AS COST OF ADMINISTRATION
#OST OF #ARE -IND SET n &OCUSING ON ,AGGING )NDICATORS 4/4!, #/34 5.)4 #/34 8 54),):!4)/. 4HIS lNANCIAL FOCUS HAS BEEN SHORT SIGHTED FOCUSING SOLELY ON THE COST OF CARE AND NOT THE DRIVERS OF HEALTH 4HE SYSTEM HAS NOT REWARDED DISCIPLINE IN EXECUTION OR FOCUSED ON BEING PROACTIVE AND OBTAINING VALUE 4HE OPPORTUNITY IS TO GET BACK TO BASICS n UNDERSTANDING THE DRIVERS IN HEALTHCARE COSTS DEVELOPING METRICS THAT ACCURATELY MEASURE BOTH THE DRIVERS AND OUTCOMES AND USING THE METRICS TO EXECUTE INTEGRATED SYSTEMS OF CARE THAT LEAD TO IMPROVEMENTS IN HEALTH WELL BEING AND PRODUCTIVITY
3USAN -ARGOLIS -0( IS A DIRECTOR IN 0RICEWATERHOUSE#OOPERS 'LOBAL (UMAN 2ESOURCE !DVISORY 3ERVICE PRACTICE 3HE FOCUSES ON ASSISTING BOTH EMPLOYERS AND HEALTH PLANS IN DESIGNING IMPLEMENTING AND EVALUATING HEALTH BENElT PROGRAMS 3HE HAS OVER YEARS OF INDUSTRY EXPERIENCE WORKING ON DEVELOPING NEW STRATEGIES TO MANAGE COSTS AND IMPROVE QUALITY 3HE CAN BE REACHED AT SUSAN MARGOLIS USPWCCOM -ICHAEL 4HOMPSON A PRINCIPAL WITH 0RICEWATERHOUSE#OOPERS HAS OVER YEARS OF EXPERIENCE IN HEALTHCARE AND EMPLOYEE BENElTS AND CONSULTS WITH MAJOR EMPLOYERS AND HEALTH PLANS ON INTEGRATED HEALTH WELLNESS AND CONSUMERISM AND HEALTHCARE SUPPLY CHAIN MANAGEMENT STRATEGIES (E IS A &ELLOW OF THE 3OCIETY OF !CTUARIES AND SERVES AS ONE OF 0W#S NATIONAL THOUGHT LEADERS FOR HEALTHCARE CONSUMERISM STRATEGIES 0RIOR TO JOINING 0W# IN -IKE SERVED AS AN EXECUTIVE WITH A MAJOR HEALTH PLAN IN BOTH NATIONAL AND REGIONAL LEADERSHIP CAPACITIES (E CAN BE REACHED AT MICHAELTHOMPSON USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
DLO KNXDQR ãCHQDB SHN MRãHMãGD @KSGB@QD ãE HM@MBH@KãL@M@FD L D MS RATHER THE BY PRODUCT OF A NUMBER OF FACTORS ALONG A CONTINUUM )DENTIFYING THE DRIVERS OF COST REQUIRES (EALTH 3YMPTOMS (EALTHCARE 2EIMBURSEMENT UNDERSTANDING AND DRILLING DOWN AT EACH OF THESE "EHAVIORS $ISEASES 3ERVICES 2EWARDS POINTS ALONG THE SPECTRUM STARTING WITH HEALTH 2ISKS #ONDITIONS 4REATMENTS BEHAVIORS AND RISK FACTORS &INANCIAL BENElTS MANAGEMENT CAN NO LONGER LIMIT ITS FOCUS TO ANALYZING CLAIMS EXPERIENCE YEAR OVER YEAR TO IDENTIFY THE &UTURE 3TATE n 0ROACTIVE &INANCIAL LEADING DIAGNOSTIC CATEGORIES OR SERVICES OR FOCUSING ON HIGH -ANAGEMENT n %VALUATING (EALTH COST CLAIMANTS 4HE ABILITY TO EFFECTIVELY MANAGE PLAN PERFORMANCE 2ISKS AND $RIVERS WILL DEPEND ON THE ABILITY TO IDENTIFY AND MANAGE ROOT CAUSES 4HE NEW APPROACH TO MANAGING HEALTHCARE BENElTS INCORPORATES &INANCIAL MANAGEMENT NOW BECOMES AN EXECUTIVE DASHBOARD OF THE WHOLE POPULATION NOT JUST EMPLOYEES AND DEPENDENTS WHO LEADING AND LAGGING INDICATORS ALLOWING ROOT CAUSE IDENTIlCATION USE SERVICES )T ALSO HAS BOTH SHORT AND LONG TERM GOALS WHICH -ETRICS THAT HELP IN BETTER UNDERSTANDING RESOURCE CONSUMPTION FREQUENTLY INVOLVE ALIGNING INCENTIVES ! HEALTHCARE PROGRAM THAT IN THE CONTEXT OF UPSTREAM HEALTH AND HEALTHCARE DRIVERS ARE HAS QUALITY AT ITS CORE REQUIRES A MORE LONGITUDINAL INTEGRATED AND CURRENTLY BEING FOCUSED UPON #LAIMS DATA ARE NO LONGER RELIED MULTIDIMENSIONAL lNANCIAL MANAGEMENT PERSPECTIVE ON TO INFER POTENTIAL DRIVERS INSTEAD METRICS AND DATA SOURCES 7E NEED TO RECOGNIZE THAT TOTAL HEALTHCARE COSTS ARE NOT WHICH ARE MORE VALID AND TIMELY ARE BEING UTILIZED &OR EXAMPLE SIMPLY A FUNCTION OF UNIT COSTS AND THE NUMBER OF SERVICES BUT IDENTIFYING HIGH CHOLESTEROL AS A RISK FACTOR IN THE POPULATION HELPS TO IDENTIFY ONE OF THE ROOT CAUSES OF CARDIOVASCULAR DISEASE A LEADING HEALTHCARE AND DISABILITY COST %XHIBIT )DENTIFYING 2OOT #AUSES OF (EALTH #OSTS %XHIBIT ,EADING )NDICATOR AND /UTCOME -IND SET
(EALTH 3YSTEM $RIVERS
(EALTH "EHAVIORS 2ISKS
3YMPTOMS $ISEASES #ONDITIONS
(EALTHCARE 3ERVICES 4REATMENTS
2EIMBURSE MENTS 2EWARDS
!SSESS 3EGMENT -ETRICS
0REVENTION 7ELLNESS -ETRICS
0OPULATION (EALTH -ETRICS
%PISODES OF #ARE $ATA
#OST 5TILIZATION
#ONNECTING THE $OTS n )NTEGRATING THE $ATA 4HERE ARE MULTIPLE DATA SOURCES FOR INFORMATION AT EACH POINT ALONG THE SPECTRUM HEALTH PLAN VENDORS EG CLAIMS BASED DATA SPECIALTY VENDORS EG HEALTH RISK ASSESSMENTS BIOMETRIC TESTING RESULTS
%XHIBIT %XECUTIVE $ASHBOARD FOR (EALTH -ANAGEMENT -EASUREMENT #ATEGORIES
0REVENTION 7ELLNESS
0OPULATION (EALTH
%PISODES OF #ARE
#OST 5TILIZATION
%XAMPLES OF -ETRICS
-EMBERS WHO HAVE HIGH CHOLESTEROL -EMBERS WITH BODY MASS INDEX "-) PERCENT
0REVALENCE OF DIABETES )NCIDENCE OF LOW BACK CONDITIONS
4OTAL COST OF TREATING GLAUCOMA RESULTING FROM DIABETES
4OTAL COST OF TREATING BREAST CANCER
0ER CAPITA HEALTH COSTS
3HORT TERM AND LONG TERM DISABILITY COSTS
DAYS ABSENT
$ATA 3OURCES
(EALTH RISK ASSESSMENTS
/N SITE BIOMETRIC TESTING
)NTEGRATED ELECTRONIC MEDICAL RECORDS
2EADINESS TO CHANGE PROlLES COLLECTED THROUGH COACHES
)NTEGRATED CLAIMS AND
)NTEGRATED CLAIMS AND ELIGIBILITY DATA ELIGIBILITY DATA
2ESULTS OF PREDICTIVE MODELING
-EDICAL MANAGEMENT ACTIVITY DATA RELATED TO GAPS AND OPPORTUNITIES
%LECTRONIC MEDICAL RECORDS
,AB TESTING
.URSELINE AND CUSTOMER SERVICE PROlLES
0HYSICIANPROVIDER PROlLES FOR EFFECTIVE AND EFlCIENT CARE
)NTEGRATED CLAIMS AND ELIGIBILITY DATA
!BSENTEEISM COSTS
$ISABILITY AND WORKERS COMPENSATION COSTS
#OSTS OF PRESENTEEISM
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
DLO KNXDQR ãCHQDB SHN MRãHMãGD @KSGB@QD ãE HM@MBH@KãL@M@FD L D MS AND DATA PROVIDED BY THE EMPLOYER EG ABSENTEEISM DATA )NTEGRATING AND AGGREGATING THE DATA ACROSS MULTIPLE DATA SOURCES AND VENDORS TO PERFORM A NEEDS ASSESSMENT OF THE VARIOUS POPULATION SEGMENTS CAN HELP IDENTIFY OPPORTUNITIES FOR QUALITY IMPROVEMENT AND ULTIMATELY BETTER MANAGE lNANCIAL PLAN PERFORMANCE !NALYZING THE INTERRELATIONSHIPS BETWEEN THE HEALTH DRIVERS AND HEALTH AND PRODUCTIVITY OUTCOMES CAN HELP TO BUILD THE BUSINESS CASE FOR INTERVENTIONS &URTHERMORE THE DATA CAN BE STRATIlED TO BETTER IDENTIFY MEDICALLY AT RISK POPULATION SEGMENTS AND FOCUS INTERVENTIONS BASED ON A COMBINATION OF RISK AND SEVERITY OF ILLNESS DEMOGRAPHICS LOCATION SOCIAL FACTORS ETC
%XHIBIT !SSESSING /UTCOMES &ROM 6ARIOUS )NTERVENTIONS )DENTIlCATION !CTIVITY
(EALTH 0ROGRAMS
(EALTH )MPROVEMENT
#OST 2EDUCTIONS
s 7EB HITS s OF REFERRALS s OF CALLS s 0REDICTIVE MODELING s (EALTH RISK ASSESSMENTS
s (EALTH RISK OR CONDITION PREVALENCE BY POPULATION SEGMENT s !DOPTION RATES OF EVIDENCE BASED BEST PRACTICES
s 0OSITIVE TRENDING TRACKING OF POPULA TION HEALTH BEHAVIORS HEALTH STATUS s $ESIRED MIGRATION OF POPULATION BETWEEN STRATIlCATION LEVELS s $ECREASE IN NUMBER OF RISK FACTORS AND RESULTING COMORBIDITY FACTORS s $ECREASE IN PREVA LENCE OF CONDITIONS SUCH AS DIABETES AND CORONARY ARTERY DISEASE s $ECREASE IN PROGRESSION OF HEALTH RISK SUCH AS METABOLIC SYNDROME
s 2EDUCTION IN CLAIMS OR PREMIUMS FOR MEDICAL DISABILITY AND WORKERS COMPENSATION s )MPROVEMENTS IN PRODUCTIVITY EG REDUCED ABSENTEEISM AND PRESENTEEISM s 2EDUCTION IN ATTRITION
)NTERVENTION $EVELOPMENT AND !SSESSMENT 7HILE THE BASELINE DATA PROVIDE A MODEL OF THE CURRENT STATE THERE NEEDS TO BE A PARALLEL MODEL THAT DESCRIBES AND ASSESSES OUTCOMES FROM VARIOUS INTERVENTIONS THAT MAY TAKE PLACE SEE %XHIBIT )N MODELING THE EFFECT OF CARE MANAGEMENT INTERVENTIONS THE IMPACT MUST BE ASSESSED BASED ON THE PREVALENCE AND INCIDENCE OF DISEASE IN THE TARGET POPULATION THE PERCENTAGE OF THE TARGET POPULATION IDENTIlED REACHED AND ENGAGED AND LASTLY THE PERCENTAGE OF THE POPULATION COMPLYING WITH THE PROGRAMS OBJECTIVES
$EVELOPING A -ULTIYEAR &INANCIAL -IND SET !FTER METRICS ARE IDENTIlED BUDGETS AND GOALS CAN BE ESTABLISHED WITH A MULTIYEAR ORIENTATION 4HE GAP BETWEEN CURRENT PERFORMANCE AND THE OBSERVED hBEST PRACTICEv CAN BE DElNED AS THE OPPORTUNITY OR hENTITLEMENTv !S INTERVENTIONS ARE DEVELOPED AND MEASURABLE GOALS ESTABLISHED TO IMPROVE PERFORMANCE THEY CAN BE INTEGRATED INTO AN OVERALL THREE TO lVE YEAR lNANCIAL PLAN 7HILE THE MEASUREMENT OF IMPACT IS IMPERFECT THE ADVANTAGE OF THIS APPROACH IS THAT IT FORCES A RATIONAL DISCUSSION OF THE LIKELIHOOD OF SUCCESS THE ANTICIPATED TIME FRAME OF IMPACT THE INTERRELATIONSHIPS BETWEEN THE DRIVERS AND THE lNANCIAL OUTCOMES AND THE POTENTIAL INTERDEPENDENCIES OF VARYING INTERVENTIONS 0ERFORMANCE AND ACCOUNTABILITY CAN THEN BE ASSESSED AGAINST THE LEADING INDICATORS ON A REAL TIME BASIS AND ESTIMATED FOR DOWNSTREAM lNANCIAL IMPACT ON THE lNANCIAL PLAN
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
!N %XAMPLE OF !DOPTION ! "ROAD 0ERSPECTIVE ON $RIVERS OF (EALTH #ONSIDER THE EMPLOYER WHO THROUGH THE RESULTS OF THE HEALTH RISK ASSESSMENT COMPLETED BY PERCENT OF EMPLOYEES LEARNS THAT THE WORKFORCE HAS A HIGH PERCENTAGE OF MEMBERS WHO ARE OBESE 4HE HEALTH RISK ASSESSMENT DATA ARE CORROBORATED BY THE RESULTS OF ON SITE BIOMETRIC TESTING WHICH SHOWS A HIGH PERCENTAGE OF THE POPULATION WITH HIGH BODY MASS INDEXES 3TRATIFYING THE DATA THE EMPLOYER LEARNS THAT THE RISK FACTOR SEEMS TO BE MOST PREVALENT AMONG MALES AGE 4HE EMPLOYER AND ITS VENDOR ESTABLISH A NUMBER OF INTERVENTIONS AROUND REDUCING THE RATE OF OBESITY IN THE AT RISK POPULATION SUCH AS ESTABLISHING A FREE ON SITE WEIGHT LOSS PROGRAM PROVIDING HEALTHIER CHOICES IN THE CAFETERIA AND VENDING MACHINES AND PROVIDING TELEPHONIC PERSONAL COACHES TO HELP GUIDE MEMBERS TOWARD ACHIEVING THEIR WEIGHT LOSS GOALS 0RIOR TO BEGINNING THE INTERVENTIONS THE EMPLOYER SETS A BASELINE FOR THE PREVALENCE OF OBESITY AND PREDICTED ASSOCIATED COSTS INCLUDING HEALTHCARE OBESITY INCREASES THE DOWNSTREAM RISK OF DIABETES DISABILITY AND PRODUCTIVITY COSTS !SSESSING THE IMPACT OF THE INTERVENTIONS AND IDENTIFYING IMPROVEMENT OPPORTUNITIES NECESSITATES METRICS AT EACH POINT ALONG THE CARE CONTINUUM INCLUDING THE NUMBER OF AT RISK MEMBERS P EOPLE REFERRED SELF REFERRED OR THROUGH HEALTH RISK ASSESSMENT RESULTS FOR COACHING PARTICIPANTS IN THE PROGRAM AND PEOPLE WHO COMPLY WITH THE PROGRAM ,ASTLY THE EMPLOYER MEASURES THE IMPACT ON TOTAL COSTS -EASUREMENT SHOULD OCCUR PERIODICALLY DUE TO THE TIME SOME TIMES REQUIRED TO MODIFY AND SUSTAIN BEHAVIOR CHANGES
DLO KNXDQR ãCHQDB SHN MRãHMãGD @KSGB@QD ãE HM@MBH@KãL@M@FD L D MS %XHIBIT $ElNING THE /PPORTUNITY 'AP
#URRENT 0ERFORMANCE VS "EST /BSERVED %NTITLEMENT
0OPULATION (EALTH 2ISK #OHORTS
%PISODES OF #ARE
4YPE OF 3ERVICE
0ERCENT OF 0OPULATION #OST 0ER )NDIVIDUAL #OST 0ER 3ERVICE
#OST 0ER %PISODE 3EVERITY OF )LLNESS &REQUENCY
5NIT #OSTS 3ERVICES 0-0-
0URCHASERS AND 0AYERS n 3IMILARITIES $IFFERENCES AND /PPORTUNITIES
LEVEL OF COLLABORATION AND MUTUAL ACCOUNTABILITY WILL ULTIMATELY STRENGTHEN THE lNANCIAL PERFORMANCE OF THE PLAN
#ONCLUSION
4HE MOVE TOWARD A QUALITY BASED APPROACH TO MANAGING HEALTHCARE DEMANDS THAT THE lNANCIAL MANAGEMENT OF PERFORMANCE CHANGE !NALYZING OR TRACKING COST AND UTILIZATION INDICATORS IS NOT ENOUGH 4HE BAR NEEDS TO BE RAISED TO INCORPORATE OUTCOMES OF CARE HEALTH RISK AND ACTIVITY INDICATORS AT EACH POINT ALONG THE HEALTHCARE SPECTRUM )T IS JUST AS IMPORTANT TO THE lNANCIAL HEALTH OF A PLAN TO TRACK THE RISK FACTORS NUMBER OF SMOKERS OBESITY ETC AND PERFORM A NEEDS ASSESSMENT OF THE POPULATION AS IT IS TO TRACK HOW MANY HOSPITAL ADMISSIONS THERE WERE IN A GIVEN TIME PERIOD 4HE NEED TO TAKE A LONGER VIEW IN MEASURING PLAN PERFORMANCE IS ALSO CRITICAL #HANGING BEHAVIOR TAKES TIME AND REQUIRES DIFFERENT EXPECTATIONS THAN EVALUATING THE EFFECT OF INCREASING COPAYS )T IS BOTH A CHALLENGE AND AN OPPORTUNITY TO INCORPORATE THE hCAREv ELEMENT INTO THE lNANCIAL MANAGEMENT OF PLAN PERFORMANCE !N INTEGRATED APPROACH TO HEALTH AND lNANCIAL MANAGEMENT WILL ALSO HELP TO CREATE THE COMMON GROUND AMONG EMPLOYERS HEALTH PLANS AND PROVIDERS THAT WILL BE ESSENTIAL FOR A SUSTAINABLE QUALITY HEALTH SYSTEM
7HILE THE FOCUS OF THIS PAPER HAS BEEN ON EMPLOYERS IT IS WORTH NOTING SOME OF THE SIMILARITIES AS WELL AS DIFFERENCES IN MOTIVATIONS AND lNANCIAL MANAGEMENT BETWEEN PAYERS AND PURCHASERS 5NDERSTANDING THEIR RESPECTIVE ROLES PRESENTS AN OPPORTUNITY TO REALIGN THE INCENTIVES AND IMPROVE THE QUALITY AND lNANCIAL MANAGEMENT OF THE DELIVERY OF HEALTHCARE 4HERE IS AN OPPORTUNITY TO DEVELOP GREATER COMMON GROUND BETWEEN PAYERS AND PURCHASERS BY ESTABLISHING MORE COLLABORATIVE AND LONGER TERM RELATIONSHIPS AND ALIGNING INCENTIVES AND ACCOUNTABILITIES THAT LEVERAGE THE RELATIVE STRENGTHS OF EACH TO ULTIMATELY LEAD TO A MORE PROGRESSIVE APPROACH TO PERFORMANCE AND lNANCIAL MANAGEMENT !LIGNING INCENTIVES CAN PROVIDE DESIRED RETURNS FOR THE VARIOUS POPULATION SEGMENTS &OR EXAMPLE FOR THE WELL AND hWORRIED WELLv SEGMENTS INCENTIVES FOR HEALTH RISK ASSESSMENT PARTICIPATION PROVIDE RICH %NDNOTES DATA FOR MINING AND EARLY IDENTIlCATION OF RISK FACTORS v2EDUCING THE #OST OF 0OOR 1UALITY (EALTH #ARE 4HROUGH 2ESPONSIBLE )T IS TIME TO MOVE BEYOND THE TRADITIONAL APPROACH OF ESTABLI 0URCHASING ,EADERSHIP v !PRIL ND PRINTING 4HE -IDWEST SHING hPERFORMANCE GUARANTEESv THAT PENALIZE HEALTH PLANS FOR "USINESS 'ROUP ON (EALTH IN #OLLABORATION WITH THE *URAN )NSTITUTE )NC FAILURE TO MEET MINIMUM QUARTERLY ADMINISTRATIVE METRICS %MPLOYERS AND THE 3YVERN 'ROUP )NC WWWMBGHCOM AND PAYERS NEED TO DEVELOP AND IMPLEMENT NEW METRICS THAT )BID PROVIDE INCENTIVES THAT REmECT BOTH SHORT AND %XHIBIT %MPLOYER VS 0AYER 0ERSPECTIVES LONG TERM PLAN OBJECTIVES AROUND MANAGING THE %MPLOYERS 0AYERS HEALTH OF THE POPULATION (EALTH 2ISK %MPLOYEE POPULATION IS A GIVEN CANNOT #AN MANAGE RISK THROUGH TARGETED &OR EXAMPLE THESE METRICS SELECT FOR A DIFFERENT RISK PROlLE &OCUS IS OUTREACH AND CARE MANAGEMENT OR MIGHT INCLUDE INCREASING ON IMPROVING HEALTH RISK OVER TIME THROUGH CHARGING FOR IT THROUGH HIGHER PREMIUMS PARTICIPATION IN A CHRONIC POPULATION HEALTH MANAGEMENT PROGRAMS n VERY CONSCIOUS OF RISK SELECTION OBSTRUCTIVE PULMONARY 4IME &RAME (ISTORICALLY SHORTER TERM MIND SET BUT 3HORTER TERM MIND SET DUE TO DISEASE MANAGEMENT PRO SHIFTING TO LONGER TERM VIEW n TARGETING HIGHER MEMBER TURNOVER AND GRAM FROM TO HEALTHCARE SPENDING TRENDS ONE YEAR TERM COVERAGE PERCENT IN YEAR ONE 3TAKEHOLDER (AVE MOST INmUENCE ON hCONSUMERSv n (AVE TRADITIONALLY FOCUSED MORE ON AND TO PERCENT IN )MPACT EMPLOYEES AND DEPENDENTS LITTLE IMPACT hPROVIDERSv n SHIFTING FOCUS TOWARD YEAR TWO OR INCREASING ON PROVIDERS CONSUMERS BUT RELATIONSHIP IS THE PERCENTAGE OF THE LESS INTIMATE POPULATION THAT HAS ANNUAL PHYSICALS AND DEVELOPING #OST 4ARGETS &OCUSING ON HEALTHCARE COSTS AS WELL AS &OCUSING ON HEALTHCARE COSTS BUSINESS PRODUCTIVITY JOINT PLANS THAT WILL LEAD TO SUCH SUCCESSES 4HIS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1UALITY IN )NTEGRATED 4OTAL (EALTH -ANAGEMENT 4HOUGH MEDICAL MANAGEMENT FUNCTIONS ARE EVOLVING IN MANY COMPANIES THE SKILL TO FULLY EMBRACE A CULTURE OF COMPLETE INTEGRATION AND DELIVER THE INNOVATION REQUIRED TO TRULY UNLEASH QUALITY ACROSS THE HEALTHCARE CONTINUUM REMAINS ILLUSIVE
"Y -ARY !NN 3HEA *ACKIE -AZOWAY !NURAG 3HARMA AND $AVID 3ACHS 0RICEWATERHOUSE#OOPERS
*
OE 3MITH A YEAR OLD MALE COVERED BY A HEALTH INSURANCE PLAN HAS A HISTORY OF ASTHMA AND A PACK A DAY CIGARETTE HABIT THAT HAS BEEN TOUGH TO BREAK )N ADDITION TO ROUTINE CHECKUPS WITH HIS PRIMARY CARE PHYSICIAN 0#0 *OE VISITS THE HOSPITAL FREQUENTLY FOR ASTHMA mARE UPS WHEN A NEBULIZER FAILS TO CORRECT HIS BREATHING -ANY PLAYERS IN ADDITION TO *OES 0#0 ARE INVOLVED IN HIS HEALTHCARE (E SEES HOSPITAL PHYSICIANS AND NURSES WHEN HIS ASTHMA mARES UP ! PHARMACIST lLLS HIS MEDICATIONS AND CUSTOMER SERVICE REPRESENTATIVES AT HIS HEALTH PLAN HELP WHEN HE HAS QUESTIONS ABOUT COVERAGE !LL THESE PEOPLE WORK TO KEEP *OE HEALTHY .EVERTHELESS *OES HEALTH IS NOT IMPROVING AND THE COSTS TO INSURE HIM ARE CONTINUALLY CLIMBING )N A SUPPOSEDLY MODERN HEALTHCARE SYSTEM *OE FAILS TO RECEIVE HIGH QUALITY INTEGRATED CARE
"ETTER COMMUNICATION AND COORDINATION ACROSS ALL PROGRAMS IS STILL HOWEVER REQUIRED TO DEAL WITH MEMBERS WHO HAVE MULTIPLE COMORBIDITIES AND RISK FACTORS )N ADDITION ADVANCED ANALYTICAL AND REPORTING CAPABILITIES WITH A FOCUS ON QUALITY ASSESSMENT AND PERFORMANCE MEASUREMENT ARE REQUIRED TO OBTAIN A TRUE PICTURE OF HOW THE HEALTH OF PATIENTS IS PROGRESSING 4ODAY MOST MANAGEMENT INFORMATION SYSTEMS DO NOT TALK TO EACH OTHER AND COMPOUND THE PROBLEM WITH DISPARATE DATA SOURCES THAT INHIBIT PROPER INFORMATION SHARING AND INTEGRATION 0AYERS HAVE RECOGNIZED THE SIGNIlCANT BENElTS TO BE REALIZED BY A MORE INTEGRATED APPROACH TO CARE MANAGEMENT
4HE .EED FOR )NTEGRATED 4OTAL (EALTH -ANAGEMENT
!CROSS THE HEALTHCARE INDUSTRY EMPLOYERS PAYERS AND PROVIDERS ARE REALIZING THE NEED FOR A COMPREHENSIVE PATIENT CENTRIC APPROACH 4HE MODEL IS REPRESENTED BY A HEALTHCARE CONTINUUM IN WHICH MANAGEMENT OF BOTH THE MEMBERS AND THE WHOLE POPULATION IS REALIZED )NTEGRATING EPISODIC CARE MANAGEMENT WITH POPULATION HEALTH MANAGEMENT AND WELLNESS WOULD CREATE BETTER ACCESS TO TIMELY AND QUALITY HEALTH INFORMATION FOR ALL INVOLVED IN CARE DELIVERY INCLUDING THE PATIENT +EY COMPONENTS OF AN INTEGRATED TOTAL HEALTH MANAGEMENT MODEL ARE DEPICTED IN %XHIBIT !CCORDING TO 52!# AN INDEPENDENT NONPROlT ORGANIZATION THAT PROMOTES HEALTHCARE QUALITY THROUGH ACCREDITATION AND CERTIlCATION THE PERCENTAGE OF MEDICAL MANAGEMENT DEPARTMENTS
-EDICAL MANAGEMENT PROGRAMS TRADITIONALLY FOCUSED ON UTILIZATION MANAGEMENT TECHNIQUES WITH LIMITED EMPHASIS ON QUALITY AND RELATIVELY LITTLE FOCUS ON WELLNESS AND PREVENTION OR DISEASE MANAGEMENT 4HIS HOWEVER HAS CHANGED AS BED DAYS FALL TO ALL TIME LOWS -ANY OF THE EXISTING HEALTH MANAGEMENT PROCESSES HAVE SWITCHED FROM REACTIVE SUCH AS AUTHORIZING AND MANAGING HOSPITAL STAYS TO PROACTIVE CASE MANAGEMENT AND DISEASE MANAGEMENT PROGRAMS THAT HELP MEMBERS AVOID HOSPITALIZATION ALTOGETHER 4HIS EVOLUTION IS ILLUSTRATED IN %XHIBIT
!N %MERGING !PPROACH
-ARY !NN 3HEA -(3! IS A PRINCIPAL IN 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE -ARY !NN HAS OVER YEARS EXPERIENCE IN THE HEALTHCARE INDUSTRY 3HE WORKS WITH HEALTHCARE PAYERS AND SPECIALIZES IN PERFORMANCE IMPROVEMENT ACROSS THE AREAS OF MEDICAL MANAGEMENT PROVIDER CONTRACTING ADMINISTRATION AND CLAIM OPERATIONS 3HE CAN BE REACHED AT MARYANNSHEA USPWCCOM *ACKIE -AZOWAY 2. IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE FOCUSES ON QUALITY AND PROCESS IMPROVEMENT FOR MANAGED CARE ORGANIZATIONS AND HAS YEARS OF EXPERIENCE WORKING WITHIN HEALTH MANAGEMENT PROGRAMS FOR PAYERS 3HE ALSO ASSISTS THE EMPLOYERS IN EVALUATING AND CHOOSING HEALTH MANAGEMENT PROGRAMS FOR THEIR EMPLOYEE BENElT PLANS 3HE CAN BE REACHED AT JACKIEMAZOWAY USPWCCOM !NURAG 3HARMA -$ -(! -3 IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E HAS OVER lVE YEARS OF EXPERIENCE WORKING AS PROJECT MANAGER AND SUBJECT MATTER EXPERT IN THE AREAS OF MEDICAL MANAGEMENT AND CLINICAL INFORMATICS FOR NATIONAL AND REGIONAL PAYERS ACROSS THE COUNTRY (E CAN BE REACHED AT ANURAGSHARMA USPWCCOM $AVID 3ACHS ,#37 IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E HAS OVER YEARS COMBINED EXPERIENCE IN HEALTHCARE DELIVERY AND MANAGEMENT WORKING IN BOTH PROVIDER AND PAYER SETTINGS $AVID UNIQUELY APPLIES HIS CLINICAL AND BUSINESS ACUMEN IN PROVIDING ADVANCED SOLUTIONS TO HEALTH PLANS HOSPITALS EMPLOYERS AND OTHER HEALTHCARE PROVIDERS (E CAN BE REACHED AT DAVIDSACHS USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
P T@K HSXãHMãHMSDFQ@SD CãSNS@KãGD @KSGãL@M@FD L D MS %XHIBIT -EDICAL MANAGEMENT MODELS ARE EVOLVING
5TILIZATION -ANAGEMENT
2EFERRAL -ANAGEMENT 0RIOR !UTHORIZATION0RECERTIlCATION #ONCURRENT 2EVIEW $ISCHARGE 0LANNING #ASE -ANAGEMENT 2ETROSPECTIVE 2EVIEW!PPEALS 0HARMACY -ANAGEMENT
1UALITY -ANAGEMENT
# LINICAL 1UALITY )NDICATOR -ONITORING # REDENTIALING AND 2ECREDENTIALING $ ELEGATION /VERSIGHT
0OPULATION -ANAGEMENT
7ELLNESS 0ROGRAMS $EMAND -ANAGEMENT $ISEASE -ANAGEMENT
%XHIBIT )NTEGRATED 4OTAL (EALTH -ANAGEMENT 0ROGRAM #OMPONENTS
7ELLNESS 0REVENTION (EALTH 2ISK !SSESSMENT (EALTH )NFORMATION 0ATIENT %DUCATION 2ISK -ODIlCATION
%PISODIC #ARE -ANAGEMENT
0OPULATION (EALTH -ANAGEMENT
&OCUSED 0RECERTIlCATION 0RE ADMISSION %DUCATION 2EDUCED 5NWARRANTED 6ARIATION &OCUSED #ONCURRENT 2EVIEW $ISCHARGE 0LANNING 0OST $ISCHARGE /UTREACH
0ROACTIVE )DENTIlCATION 0ATIENT 3TRATIlCATION #ASE -ANAGEMENT #ONDITION -ANAGEMENT
#LINICAL &INANCIAL /UTCOMES WITH INTEGRATED CASE DISEASE AND UTILIZATION MANAGEMENT FUNCTIONS ROSE FROM PERCENT IN TO PERCENT IN #OMPANIES WITH INTEGRATED CASE AND UTILIZATION MANAGEMENT STAFF GREW FROM TO PERCENT DURING THE SAME TIME FRAME;= 4RUE INTEGRATION CAN BE ACHIEVED ONLY IF ALL THE STAKEHOLDERS OF THE CARE MANAGEMENT hVALUE CHAINv ARE ALIGNED EMPLOYERS
MEMBERS PAYERS PROVIDERS AND VENDORS !LIGNMENT OF INCENTIVES IS REQUIRED TO HARNESS THE MAXIMUM YIELD FROM MULTIPLE INTERDISCIPLINARY STAKEHOLDERS %MPLOYERS SHOULD COLLABORATE WITH PAYERS TO DESIGN PROGRAMS AND PROVIDE INCENTIVES FOR PARTICIPATION AND INVOLVEMENT IN CARE MANAGEMENT AND WELLNESS PROGRAMS 3OME EMPLOYERS OFFER CASH REWARDS FOR COMPLETION OF
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXãHMãHMSD FQ@SD CãSNS@KãGD @KSGãL @M@FD LD MS HEALTH RISK ASSESSMENTS AND OTHERS WAIVE COPAYS AND DEDUCTIBLES FOR CERTAIN CHRONICALLY ILL PATIENTS WHO CANNOT AFFORD THE DRUGS THAT CAN KEEP THEM STABLE -EMBERS SHOULD NOT ONLY BE MOTIVATED TO TAKE CONTROL OF THEIR CARE BUT ALSO BE EDUCATED TO MAKE INFORMED AND WISE DECISIONS RELATED TO THEIR HEALTH 0AYERS SHOULD FOCUS ON KEEPING THE MEMBER WELL IN ADDITION TO IDENTIFYING THE NEEDS AND RISK FACTORS BEFORE AN ACUTE EVENT HAPPENS 0AYERS SHOULD COLLABORATE WITH PROVIDERS TO SHARE DATA AND INFORMATION THAT THE PAYER MAY HAVE THAT THE PROVIDER DOES NOT HAVE 0AYERS SHOULD ALSO RECEIVE EVIDENCE BASED INFORMATION FROM PROVIDERS AND REWARD PHYSICIANS AND HOSPITALS THAT HAVE A FOCUS ON POSITIVE HEALTH MANAGEMENT OUTCOMES AND CREATE VALUE BASED COMPETITION AMONG STAKEHOLDERS
)MPROVED #LINICAL 1UALITY )MPROVED CLINICAL QUALITY IS A NATURAL BENElT OF INTEGRATED TOTAL HEALTH MANAGEMENT 4HE GOAL OF AN INTEGRATED TOTAL HEALTH MANAGEMENT PROGRAM IS TO IDENTIFY MEMBERS BEFORE THEIR HEALTH STATUS SPINS OUT OF CONTROL AND ASSURE THAT APPROPRIATE INTERVENTIONS ARE PUT IN PLACE EITHER BEFORE AN EPISODE OCCURS OR AT THE BEGINNING OF AN ILLNESS EVENT -EMBERS ARE TO BE IDENTIlED AT AN EARLY STAGE OF RISK SO THAT SECONDARY PREVENTION PRACTICES MAY BE ADOPTED AND COMPLICATIONS AVOIDED &OR EXAMPLE EMPLOYING EARLY INTERVENTIONS FOR A MEMBER WITH EARLY METABOLIC DISEASE CAN DELAY OR PREVENT THE PROGRESSION TO DIABETES AND ITS RELATED COMPLICATIONS &OR *OE 3MITH BETTER COLLABORATION AND EARLY INTERVENTION SUCH AS A SMOKING CESSATION PROGRAM EARLY IN HIS MEMBERSHIP COULD HAVE GIVEN HIM THE EDUCATION NEEDED TO PREVENT ACUTE EXACERBATIONS OF HIS ASTHMA 4HIS WOULD HAVE KEPT *OE HEALTHIER IN THE LONG TERM AND REDUCED THE CHANCE OF COMPLICATIONS OR COMORBIDITIES SUCH AS LUNG CANCER *OE WOULD HAVE SHOWN UP TO WORK REGULARLY AND BEEN MORE PRODUCTIVE AN ADDED BENElT FOR HIS EMPLOYER
#ARE %FlCIENCY /UTCOMES -ARKET DRIVERS FOR AN INTEGRATED TOTAL HEALTH MANAGEMENT MODEL ARE ALSO ECONOMIC CENTERING ON MORE PRODUCTIVE WORKERS AND LESS EXPENSIVE HEALTH SERVICES )N THE *OE 3MITH EXAMPLE A HEALTH RISK ASSESSMENT COULD HAVE TRIGGERED INTERVENTION BY A WELLNESS COACH TO HELP *OE QUIT SMOKING REDUCE THE CHANCE OF CHRONIC ASTHMA AND DECREASE HIS HOSPITAL VISITS &OR BOTH *OE AND HIS EMPLOYER WHO SHARES IN HIS INSURANCE COSTS PREVENTION OF ACUTE EXACERBATIONS AND FEWER HOSPITALIZATIONS AND %2 VISITS DRIVE DOWN INSURANCE PREMIUMS SO EARLY PREVENTION OR DETECTION IS lNANCIALLY BENElCIAL TO BOTH )NTEGRATED TOTAL HEALTH MANAGEMENT IS DESIGNED TO KEEP MEMBERS ON THE WELL SIDE OF THE CURVE )F THEY GO TO THE hSICKv SIDE OF THE CONTINUUM THEY COULD QUICKLY BE BROUGHT BACK TO A STABLE CONDITION USING FEWER EXPENSIVE MEDICAL SERVICES
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
%MPLOYERS ALSO WIN WITH THIS APPROACH AS GREATER EFlCIENCIES ENABLE PROGRAM IMPROVEMENTS THAT REACH MORE MEMBERS EARLIER IN THE DISEASE PROCESS ALLOWING FOR BETTER CONTROL OF CLAIMS DOLLARS )N TURN EMPLOYERS SPEND LESS AND REALIZE MORE PROlT TO CONTRIBUTE TO OTHER EMPLOYEE BENElTS
%VOLVING 4OWARD AN )NTEGRATED 4OTAL (EALTH -ANAGEMENT -ODEL 4HE SUCCESSFUL EVOLUTION TOWARD AN INTEGRATED TOTAL HEALTH MANAGEMENT MODEL REQUIRES FOUR COMPONENTS ! CLEAR VISION AND COMMITMENT TO THAT VISION )NTEGRATION OF DISPARATE DATA SOURCES INTO ACTIONABLE INFORMATION !LIGNMENT OF RESOURCES TO PROACTIVELY LEVERAGE THE POWER OF INTEGRATED INFORMATION AND #OORDINATION AND COMMUNICATION ACROSS THE VARIOUS STAKEHOLDERS PAYERS PROVIDERS EMPLOYERS VENDORS AND MEMBERS #OORDINATION BETWEEN TRADITIONAL MEDICAL MANAGEMENT PROGRAMS UTILIZATION MANAGEMENT CASE MANAGEMENT AND DISEASE MANAGEMENT IS JUST THE BEGINNING )NTEGRATED TOTAL HEALTH MANAGEMENT INVOLVES INTEGRATION OF THESE MEDICAL MANAGEMENT COMPONENTS ALONG WITH WELLNESS AND PREVENTION PHARMACY BEHAVIORAL HEALTH AND IN THE IDEAL MODEL DISABILITY AND WORKERS COMPENSATION MANAGEMENT FROM A PEOPLE PROCESS TECHNOLOGY AND CULTURAL PERSPECTIVE 4HE INTEGRATION HAS TO OCCUR WITH INTERNAL CONSTITUENTS AS WELL AS EXTERNAL CONSTITUENTS
6ISION ! HEALTH PLAN MUST HAVE A CLEAR VISION OF WHAT INTEGRATED TOTAL HEALTH MANAGEMENT MEANS TO THEM AS AN ORGANIZATION 4HE VISION MAY VARY FROM ONE ORGANIZATION TO THE NEXT )T WILL DEPEND ON ITS BOOK OF BUSINESS FULLY INSURED VERSUS ADMINISTRATIVE SERVICES ONLY GEOGRAPHY PRODUCT LINE MIX ETC !LTHOUGH ALL HEALTH PLANS HAVE STAFF ALLOCATED TO HEALTH MANAGEMENT TASKS THE MEDICAL MANAGEMENT TEAM RARELY HAS THE ABILITY TO CHAMPION ITS VALUE AND MEASURE ITS RESULTS ON AN ONGOING BASIS &OR THIS REASON SUCCESS WITHIN AN ORGANIZATION DEMANDS A COMMITMENT FROM THE TOP ! DEDICATED PROACTIVE STAFF HELPS BUT WILL NOT LIKELY ACHIEVE LONG TERM SUCCESS BY ITSELF )N ORDER FOR AN INTEGRATED TOTAL HEALTH MANAGEMENT APPROACH TO WORK THE VISION MUST COME FROM INNOVATIVE LEADERS WHO HAVE A BIG PICTURE VIEW OF THE FINANCIAL AND QUALITY BENEFITS TO BE GAINED ACROSS THE ORGANIZATION AND ACROSS THE STAKEHOLDERS !LIGNMENT OF PERFORMANCE GOALS AND INCENTIVES WITH THE STRATEGY IS CRITICAL TO ITS SUCCESS !WARENESS AND INTERNALIZATION OF THE SHARED VISION CUSTOMER CENTRIC STRATEGY AND CULTURAL VALUES NEEDED TO EXECUTE THE MODEL IS A NECESSITY !N INTEGRATED
P T@K HSXãHMãHMSD FQ@SD CãSNS@KãGD @KSGãL @M@FD LD MS TOTAL HEALTH MODEL REQUIRES SEVERAL NEW SKILLS AND COMPETENCIES AND A PLAN TO CLOSE THE TALENT AND RESOURCE GAP
!CTIONABLE )NFORMATION #REATING A CENTRALIZED DATA REPOSITORY IMPROVES ACCESS FOR HEALTH MANAGEMENT STAFF TO TRULY SHARE INFORMATION ! CASE MANAGER SHOULD HAVE ACCESS TO A MEMBERS COMPLETE INFORMATION FROM A SINGLE SOURCE 4HE COMPLETE VIEW SHOULD INCORPORATE INFORMATION FROM VARIOUS DATA SOURCES SUCH AS MEDICAL AND PHARMACY CLAIMS LAB BIOMETRIC AND DENTAL DATA AS WELL AS DATA FROM HEALTH RISK ASSESSMENTS CASE AND DISEASE MANAGEMENT PROGRAMS WELLNESS PROGRAMS AND THE RESULTS OF THE PREDICTIVE MODELING ACTIVITIES !DDITIONALLY THIS VALUABLE INFORMATION SHOULD BE COMMUNICATED TO THE PHYSICIAN TREATING THE MEMBER )NFORMATION SHARING IS ESPECIALLY IMPORTANT TO IDENTIFY POSSIBLE GAPS IN MEMBER CARE -OST HEALTH PLANS ARE RICH IN DATA BUT POOR IN INFORMATION 4HEY HAVE NOT YET FULLY DEVELOPED THE CAPABILITY OF MINING THE DATA TO ENABLE PREDICTIVE MODELING &OR EXAMPLE BY ESTABLISHING A PROCESS OF ANALYZING THE DATA HEALTH PLANS COULD PREDICT WHICH SERVICES MEMBERS WILL NEED AND CONDUCT PATIENT ASSESSMENTS AND PLAN INTERVENTIONS ACCORDINGLY 4HE DATA WOULD THEN REQUIRE MANIPULATION TO SHOW THE RESULTS OF THESE EFFORTS AS WELL AS THEIR IMPACT ON TRENDS AND QUALITY OF CARE 4HE IDEAL SYSTEM WOULD INTEGRATE DISABILITY DATA INTO THE PAYER DATABASE AND POPULATE A PERSONAL HEALTH RECORD THAT CAPTURES NOT ONLY THE MEDICAL EPISODES BUT ALSO THE LOST WORK TIME INFORMATION 4HIS WOULD PRESENT A MORE COMPLETE PICTURE OF MEMBERS EPISODES OF ILLNESS TO THOSE WHO ARE HELPING MEMBERS REACH A STATE OF WELLNESS &OR HEALTH PLAN MEMBERS AN INTEGRATED TOTAL MODEL OFFERS A SINGLE ADVOCATE TO HELP NAVIGATE THE COMPLEXITIES OF THE HEALTHCARE SYSTEM AND GAIN A BETTER UNDERSTANDING OF MEDICAL CONDITIONS AND TREATMENTS %FFECTIVE PAYER PROVIDER COLLABORATION IS A REQUIREMENT FOR THE REALIZATION OF THE OUTCOMES
2ESOURCE !LIGNMENT /NCE INFORMATION ANALYSIS HAS OCCURRED RESOURCES SHOULD BE ORGANIZED TO FOCUS ON DELIVERING PROGRAMS AND SERVICES THAT CAN MAINTAIN HEALTH AND MINIMIZE EPISODES OF ILLNESS $ATA ANALYSES CAN BE SLICED BY CUSTOMERS TO FACILITATE DEVELOPMENT AND IMPLEMENTATION OF CUSTOMER SPECIlC INTERVENTIONS STREAMLINING RESOURCES TO FOCUS ON ACTIONABLE ACTIVITIES VERSUS ASSUMING THAT ONE PROGRAM CAN MEET THE NEEDS OF ALL CUSTOMERS 4HROUGH AN INTEGRATED TOTAL HEALTH MANAGEMENT APPROACH PAYERS CAN REDUCE INTERNAL STAFF REDUNDANCY AND SERVICE DUPLICATION WHILE IMPROVING CAPACITY AND THE QUALITY OF SERVICE PROVIDED 4HE STAFFS VISION IS SHIFTED TO THINK ABOUT CUSTOMER VALUE "ECAUSE HEALTH MANAGEMENT PROGRAMS ALSO FEATURE A GREAT DEAL OF OVERLAP IT MAY BE MORE APPROPRIATE TO MEASURE AGGREGATE TRENDS AND THEN GIVE CREDIT TO ALL STAKEHOLDERS NOT JUST A SINGLE DEPARTMENT
#OORDINATION AND #OMMUNICATION )N THE PAST PROVIDERS AND PAYERS WERE RELUCTANT PARTNERS IN DISEASE MANAGEMENT PROGRAMS AND IN THE DAY TO DAY WORK OF CASE MANAGEMENT 0ROVIDERS SOMETIMES SAW DISEASE MANAGEMENT PROGRAMS AS INTRUSIVE AND DID NOT IMMEDIATELY TRUST PAYER INFORMATION 0AYERS HAVE ONLY JUST BEGUN TO REACH OUT TO ESTABLISH PROVIDER ADVISORY COMMITTEES AIMED AT ESTABLISHING A DIALOGUE AROUND THE BENElTS OF INTEGRATION 4HE POWER OF INFORMATION CAN DRAMATICALLY IMPACT THE PROVIDERS ABILITY TO DELIVER QUALITY CARE TO PATIENTS !CCESS TO THE SAME DATA A PAYER TRACKS EG PRESCRIPTION RElLLS CONSULTING PHYSICIAN VISITS AND DATA FROM CLAIMS THAT POINT TO MULTIPLE PROVIDERS TREATING A PHYSICIANS PATIENT OF WHICH HE SHE MAY BE UNAWARE ALLOWS A PROVIDER TO ADJUST TREATMENT PLANS AS NEEDED TO MEET A PATIENTS HEALTHCARE NEEDS /NE OF THE WAYS THAT PAYERS ARE BREAKING DOWN BARRIERS WITH PROVIDERS IS THROUGH PAY FOR PERFORMANCE PROGRAMS THAT PROVIDE BOTH lNANCIAL AND NONlNANCIAL INCENTIVES TO IMPROVE THE QUALITY AND EFlCIENCY OF HEALTHCARE SERVICES )NCENTIVES ARE ALSO OFFERED TO MEMBERS BY EMPLOYERS TO ENCOURAGE PARTICIPATION IN HEALTH AND WELLNESS PROGRAMS "Y ENCOURAGING EMPLOYEES TO ATTEND GROUP WEIGHT LOSS MEETINGS FOR EXAMPLE AN EMPLOYER COULD POTENTIALLY HEAD OFF EXPENSIVE DIABETES RELATED HEALTH COSTS /FFERING OPPORTUNITIES FOR EXERCISE SUCH AS DISCOUNTED RATES AT A lTNESS CENTER OR A COMPANY GYM IS A STRATEGY EMPLOYED BY SOME COMPANIES TO TRIM HEALTHCARE COSTS RESULTING FROM UNHEALTHY LIFESTYLES )NFORMATION SHARING IS KEY TO IDENTIFYING POSSIBLE GAPS IN MEMBER CARE )N A COLLABORATIVE ENVIRONMENT CASE MANAGERS NOTIFY PHYSICIANS ABOUT INCONSISTENCIES IN PATIENT DATA SUCH AS HEALTH RISK ASSESSMENT INFORMATION &OR EXAMPLE MOST PHYSICIANS DO NOT HAVE TIME TO SCREEN FOR DEPRESSION HOWEVER THE PRESENCE OF MENTAL HEALTH ISSUES CAN AFFECT MEDICAL OUTCOMES "Y ALERTING PHYSICIANS TO THIS KIND OF INFORMATION CASE MANAGERS HELP PATIENTS TO BE TREATED PROACTIVELY )NFORMATION SHARING ALSO MUST OCCUR INTERNALLY AND WITH OUTSOURCED VENDOR PROGRAMS 4RIGGERS FROM MULTIPLE SOURCES LIKE CUSTOMER SERVICE WORKSITE WELLNESS PROGRAMS HOUR NURSELINES ETC MUST BE INCORPORATED IN THE CASE lNDING ALGORITHMS
,OOKING !HEAD 4HE EMERGING PARADIGM OF INTEGRATED TOTAL HEALTH MANAGEMENT PROMISES TO UNITE ALL PLAYERS IN THE HEALTHCARE INDUSTRY IN A COLLABORATIVE ENVIRONMENT CENTERED ON THE WHOLE PATIENT AND THE WHOLE POPULATION )MPROVEMENTS IN BOTH lNANCIAL AND QUALITY OUTCOMES AWAIT 0AYERS AND PROVIDERS CAN ACHIEVE THIS INNOVATIVE CHANGE BY PUTTING A DISCIPLINED APPROACH INTO PLAY TO MAKE THE INTEGRATED TOTAL HEALTH MANAGEMENT VISION A REALITY AND CONTRIBUTE TOWARD A SUSTAINABLE HEALTHCARE SYSTEM %NDNOTE h$ESPITE "ARRIERS -#/S )NTEGRATE #ASE $ISEASE 5TILIZATION -ANAGEMENT &UNCTIONS v -ARCH -ANAGED #ARE 7EEK
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
)NTEGRATING -EDICAL AND 0RODUCTIVITY -ANAGEMENT !S GREATER RATES OF CHRONIC DISEASE KEEP EMPLOYEES OUT OF WORK IN RECORD NUMBERS AND TAKE A TOLL ON PRODUCTIVITY INNOVATIVE EMPLOYERS ARE CREATING INTEGRATED PROGRAMS TO IMPROVE THE QUALITY OF EMPLOYEE HEALTH
"Y *ACKIE -AZOWAY AND -ARY !NN 3HEA 0RICEWATERHOUSE#OOPERS
)
N THE WORKPLACE THE TERM hLOST TIMEv DOES NOT REFER TO A CLOCK THAT TICKS TOO SLOWLY OR A FEW MOMENTS STOLEN FROM A BUSY DAY )NSTEAD THE PHRASE IS USED BY COMPANIES TO DESCRIBE REAL LOSSES IN PRODUCTIVITY DUE TO EMPLOYEE HEALTH ISSUES ,ABOR TIME LOST DUE TO HEALTH REASONS COSTS !MERICAN COMPANIES APPROXIMATELY BILLION PER YEAR ACCORDING TO A STUDY BY THE #OMMONWEALTH &UND A FOUNDATION THAT WORKS TO IMPROVE HEALTHCARE QUALITY AND COVERAGE;= )MPROVED MANAGEMENT OF LOST TIME OFFERS A SIGNIlCANT OPPORTUNITY FOR COMPANIES TRYING TO REDUCE MEDICAL COSTS AND IMPROVE PRODUCTIVITY (OWEVER IT IS ONLY WHEN COMPANIES UNDERSTAND WHERE AND WHY THEY LOSE TIME THAT THEY CAN BEGIN TO EXPLORE THIS OPPORTUNITY 4ODAYS COMPLICATED HEALTHCARE DELIVERY AND lNANCING SYSTEM MAKES IT DIFlCULT FOR EMPLOYERS TO EFlCIENTLY INTEGRATE THEIR DISABILITY WORKERS COMPENSATION AND HEALTHCARE PROGRAMS INTO A SEAMLESS EFlCIENT SYSTEM OF CARE !S A RESULT LOST TIME BECOMES A PROBLEM THAT IS DIFlCULT TO MEASURE AND SOLVE
!BSENTEEISM COSTS EMPLOYERS MORE THAN JUST LOST WAGES #OMPANIES MAY HAVE TO PAY ANOTHER EMPLOYEE OVERTIME TO COVER THE ABSENT WORKER AND A LESS SKILLED SUBSTITUTE MAY NOT ALWAYS DELIVER THE SAME QUALITY OF WORK !LSO EXTRA ADMINISTRATIVE TIME IS REQUIRED TO SECURE REPLACEMENT EMPLOYEES OR REASSIGN WORK TO REMAINING EMPLOYEES 0RESENTEEISM OR WORKERS ON THE JOB WHOSE PRODUCTIVITY IS IMPAIRED BECAUSE OF ILLNESS OR OTHER MEDICAL CONDITIONS ALSO CONTRIBUTES TO LOST TIME ,AST YEAR THE *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION REPORTED THAT DEPRESSION COST 53 EMPLOYERS BILLION A YEAR IN REDUCED PERFORMANCE AT WORK;= AND THAT PAIN FROM PROBLEMS SUCH AS ARTHRITIS HEADACHES AND BACK PROBLEMS COST NEARLY BILLION;= 5NLIKE DISABILITY CLAIMS OR ABSENTEEISM WHICH ARE RELATIVELY EASY TO MEASURE PRESENTEEISM IS FAIRLY NEBULOUS )T IS EASY TO BENCHMARK WHEN EMPLOYEES FAIL TO SHOW UP FOR WORK BUT DIFlCULT TO MEASURE HOW A MEDICAL CONDITION MAY HINDER PERFORMANCE
4HE 0ROBLEM OF ,OST 4IME
4HE )MPACT ON 1UALITY
)N ADDITION TO LOST TIME DUE TO DISABILITY WORKERS TAKE TIME OFF BECAUSE OF ACCIDENTS ILLNESS LACK OF JOB SATISFACTION PERSONAL PROBLEMS lNANCIAL MARITAL SUBSTANCE ABUSE CHILD CARE ETC TRANSPORTATION PROBLEMS AND STRESS RELATED ILLNESSES SUCH AS DEPRESSION !CCORDING TO lNDINGS OF THE ANNUAL ##( 5NSCHEDULED !BSENCE 3URVEY 53 EMPLOYERS ARE STILL STRUGGLING TO lND EFFECTIVE SOLUTIONS THAT KEEP HEALTHY WORKERS ON THE JOB 4HE SURVEY REPORTED THAT THE RATE OF UNSCHEDULED ABSENTEEISM HAD CLIMBED TO A lVE YEAR HIGH OF PERCENT;= ,AST YEAR THE RATE OF UNSCHEDULED ABSENTEEISM BARELY BUDGED HOWEVER THE AVERAGE PER EMPLOYEE RATE ROSE TO COSTING SOME LARGE EMPLOYERS MORE THAN MILLION PER YEAR;=
-OST 53 COMPANIES JUGGLE A ROSTER OF VENDORS TO MANAGE THEIR EMPLOYEE BENElT NEEDS 5NFORTUNATELY EACH OPERATES INDEPENDENTLY !N EMPLOYEE HEALTH PLAN IS MANAGED BY ONE INSURER 3HORT TERM DISABILITY IS EITHER COVERED IN HOUSE OR BY A THIRD PARTY ADMINISTRATOR ,ONG TERM DISABILITY AND WORKERS COMPENSATION ARE ALSO MANAGED SEPARATELY ! SINGLE EMPLOYEE MAY HAVE MULTIPLE INSURANCE CLAIMS SCATTERED AMONG SEVERAL INSURERS BECAUSE THERE IS NO CENTRALIZED SYSTEM FOR BENElTS MANAGEMENT !LL OF THESE PLAYERS COLLECT MEDICAL DATA SEPARATELY RESULTING IN REDUNDANT RECORD KEEPING &RAGMENTED CASE MANAGEMENT ALSO OCCURS RESULTING IN INEFlCIENT UTILIZATION AND INCREASED SPENDING AS COORDINATION EFFORTS INEVITABLY OVERLAP
*ACKIE -AZOWAY 2. IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE FOCUSES ON QUALITY AND PROCESS IMPROVEMENT FOR MANAGED CARE ORGANIZATIONS AND HAS YEARS OF EXPERIENCE WORKING WITHIN HEALTH MANAGEMENT PROGRAMS FOR PAYERS 3HE ALSO ASSISTS EMPLOYERS IN EVALUATING AND CHOOSING HEALTH MANAGEMENT PROGRAMS FOR THEIR EMPLOYEE BENElT PLANS 3HE CAN BE REACHED AT JACKIEMAZOWAY USPWCCOM -ARY !NN 3HEA -(3! IS A PRINCIPAL IN 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE -ARY !NN HAS OVER YEARS EXPERIENCE IN THE HEALTHCARE INDUSTRY 3HE WORKS WITH HEALTHCARE PAYERS AND SPECIALIZES IN PERFORMANCE IMPROVEMENT ACROSS THE AREAS OF MEDICAL MANAGEMENT PROVIDER CONTRACTING ADMINISTRATION AND CLAIM OPERATIONS 3HE CAN BE REACHED AT MARYANNSHEA USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
HMSDF Q@SHMF ãLDCHB@Kã@MCãOQNCT BSHU HSXãL@M@FD L D MS $ElNITIONS 3HORT AND ,ONG TERM $ISABILITY 3HORT TERM DISABILITY INSURANCE PAYS A SALARY REPLACEMENT BENElT WHEN AN EMPLOYEE HAS A NON WORK RELATED DISABILITY BECAUSE OF AN ACCIDENT ILLNESS OR PREGNANCY 4HE EMPLOYER DETERMINES THE BENElT AMOUNT THE DAY BENElTS BEGIN AND THE MAXIMUM PERIOD FOR WHICH BENElTS ARE PAYABLE 3HORT TERM DISABILITY TYPICALLY COVERS AN EMPLOYEE FOR UP TO SIX MONTHS 3OME COMPANIES SELF INSURE MEANING THEY COVER THE COST OF PAYING THESE EMPLOYMENT BENElTS 2EGARDLESS OF WHETHER THEY SELF INSURE SOME EMPLOYERS OFTEN OUTSOURCE THE DAY TO DAY ADMINISTRATION OF THE PROGRAM ,ONG TERM DISABILITY INSURANCE USUALLY BEGINS AFTER THE SHORT TERM DISABILITY COVERAGE PERIOD ENDS COVERING A PORTION OF THE SALARY IF AN EMPLOYEE IS OUT OF WORK FOR AN EXTENDED PERIOD 4HE MAJORITY OF COMPANIES FULLY INSURE LONG TERM DISABILITY OUTSOURCING MANAGEMENT OF THE MEDICAL EPISODE CLAIMS PAYMENT AND PROCESSING AND COORDINATION OF THE EMPLOYEES TIME OFF 7ORKERS #OMPENSATION 7ORKERS COMPENSATION INSURANCE PAYS BENElTS REQUIRED UNDER A STATES WORKERS COMPENSATION LAW FOR MEDICAL CARE AND PHYSICAL REHABILITATION OF INJURED WORKERS )T ALSO REPLACES LOST WAGES IF WORKERS ARE HURT DURING WORK RELATED ACTIVITIES 3TATE LAWS WHICH VARY FROM STATE TO STATE GOVERN THE AMOUNT OF BENElTS PAID AND OTHER COMPENSATION PROVISIONS ! COMPANY MUST ABIDE BY LAWS IN EACH STATE WHERE IT HAS WORKERS SO FOR A LARGE CORPORATION WITH OFlCES ACROSS THE COUNTRY AN OUTSIDE WORKERS COMPENSATION SPECIALIST IS OFTEN THE BEST CHOICE TO ADMINISTER THESE CLAIMS
3EVERAL PROVIDERS MAY SERVE ONE MEMBER $UE TO STATE REGULATIONS A WORKER MAY SEE ONE SET OF HEALTH PLAN DOCTORS AND A DIFFERENT PHYSICIAN GROUP FOR A WORKERS COMPENSATION INJURY 4HIS ADDS ANOTHER LAYER OF PAYERS AND PROVIDERS TO AN INCREASINGLY COMPLEX NETWORK 4HE LACK OF FULLY INTEGRATED TECHNOLOGY SYSTEMS ALSO PREVENTS EFFECTIVE COORDINATION ,ACK OF INTEGRATED DATA PREVENTS EMPLOYERS AND PAYERS FROM SHARING INFORMATION THAT COULD BE LEVERAGED TO SPOT TRENDS WHICH COULD AID IN PLANNING AND DECISION MAKING )N ADDITION TO ADMINISTRATIVE INEFlCIENCY EMPLOYEE CARE SUFFERS #ONSIDER A FEMALE EMPLOYEE DIAGNOSED WITH BREAST CANCER WHO UNDERGOES A MASTECTOMY (ER DOCTOR WORKS WITH THE MEDICAL MANAGEMENT TEAM FROM HER COMMERCIAL HEALTH PLAN TO KEEP HER OUT OF WORK FOR TWO MONTHS TO ALLOW HER TO FULLY RECOVER FROM RECONSTRUCTIVE SURGERY AND BEGIN HER CHEMOTHERAPY AND RADIATION TREATMENTS ! DISABILITY MANAGEMENT NURSE IS ALSO HANDLING THE CASE AND CONVINCES THE PHYSICIAN TO ALLOW THE WOMAN TO GO BACK TO WORK PART TIME !FTER RETURNING TO WORK THE EMPLOYEE IS
FREQUENTLY ABSENT BECAUSE OF SCHEDULED TREATMENTS 7HILE AT WORK SHE FEELS NAUSEOUS AND FATIGUED FROM CHEMOTHERAPY SO SHE IS PRODUCTIVE ONLY HALF THE TIME )N THIS CASE THE LACK OF COORDINATION BETWEEN THE MEDICAL AND THE DISABILITY MANAGEMENT CASE MANAGERS HAS RESULTED IN A POOR HEALTHCARE EXPERIENCE FOR THE MEMBER A NONPRODUCTIVE EMPLOYEE RETURNING TO THE WORKFORCE DUPLICATION OF EFFORTS BETWEEN THE TWO NURSES AND INEFFECTIVE AND CONmICTING COMMUNICATION WITH THE TREATING PHYSICIAN !S ANOTHER EXAMPLE A GROUP OF )4 SYSTEMS DEVELOPERS MAY BE SUFFERING FROM FREQUENT ON THE JOB MIGRAINES WHICH MAY BE FROM LONG HOURS SPENT IN FRONT OF THEIR COMPUTERS )N THE CURRENTLY FRAGMENTED BENElTS MANAGEMENT SYSTEM THIS GROUP WOULD LIKELY NOT BE IDENTIlED AS HAVING A WORK RELATED HEALTH ISSUE DUE TO THE ABSENCE OF A DOCTORS DIAGNOSIS 0RODUCTIVITY FOR THIS GROUP MAY BE LOW BUT WOULD TYPICALLY NOT BE MEASURED THE COMPANY WOULD NOT REALIZE PERFORMANCE WAS BELOW PAR )F MULTIPLE EMPLOYEES WERE SEEING PHYSICIANS FOR MIGRAINES IT IS PROBABLE THAT THE INDIVIDUAL CLAIM DOLLARS PAID WOULD NOT TRIGGER A MANAGEABLE EVENT WITHIN PAYERS CLAIMS ORGANIZATIONS 4HE EMPLOYER WOULD NOT REALIZE THAT IN AGGREGATE THIS GROUP OF EMPLOYEES WAS CONTRIBUTING TO LOW PRODUCTIVITY IN THEIR DEPARTMENT 4HE INABILITY TO ANALYZE DATA AND TARGET THE CAUSES OF WORKER HEALTH PROBLEMS PREVENTS PROACTIVE MANAGEMENT 4HUS THE COST OF LOST TIME CONTINUES TO RISE NEGATIVELY IMPACTING BOTTOM LINE PROlT MARGINS AND THE ABILITY FOR MANY COMPANIES TO STAY COMPETITIVE IN A GLOBAL MARKETPLACE 53 WORKERS HAVE ALWAYS ENJOYED GENEROUS HEALTHCARE BENElTS FROM THEIR EMPLOYERS COMPARED TO THE REST OF THE WORLD HOWEVER THESE BENElTS ARE BECOMING INCREASINGLY EXPENSIVE AND DIFlCULT TO SUPPORT
4HE 3OLUTION )NTEGRATED "ENElTS -ANAGEMENT !N INTEGRATED BENElTS AND PRODUCTIVITY MANAGEMENT APPROACH WOULD DRIVE DOWN THE COSTS OF LOST TIME WHILE INCREASING THE QUALITY OF EMPLOYEE HEALTHCARE !S ILLUSTRATED IN %XHIBIT AN IDEAL PROGRAM WOULD MERGE AN EMPLOYEES MEDICAL RESULTS FROM HEALTH PLAN CLAIMS WITH DISABILITY RECORDS TO DETERMINE EXACTLY HOW MUCH TIME AND MONEY ARE BEING SPENT ON EMPLOYEE HEALTH ISSUES &OR EXAMPLE IF AN EMPLOYER SUSPECTED A HIGH INCIDENCE OF EMPLOYEE BACK PAIN TIME LOST FROM BACK INJURY AND RECORDS KEPT BY THE HEALTH PLAN THE SHORT TERM DISABILITY ADMINISTRATOR THE LONG TERM DISABILITY INSURER AND THE WORKERS COMPENSATION CARRIER WOULD BE ANALYZED AS AGGREGATED DATA )MAGINE TAKING THIS FURTHER BY FOLDING IN ABSENTEEISM DATA FROM EMPLOYEES WHO LEFT WORK FOR PHYSICAL THERAPY OR RECORDS OF WORKERS WHO WERE LESS PRODUCTIVE ON THE JOB DUE TO BACK PAIN 3O WHAT CAN A COMPANY DO TO MOVE TOWARD AN INTEGRATED BENElTS MANAGEMENT APPROACH
,INK THE 0AYERS 3OME INSURERS ARE ALREADY INTEGRATING PRODUCTS IN AN ATTEMPT TO HELP EMPLOYERS BETTER MANAGE BENElTS 3OME HAVE BEGUN PACKAGING MEDICAL DISABILITY PHARMACY AND BEHAVIORAL HEALTH
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
HMSDF Q@SHMF ãLDCHB@Kã@MCãOQNCT BSHU HSXãL@M@FD L D MS
%XHIBIT )NTEGRATING -EDICAL AND $ISABILITY -ANAGEMENT
COVERAGE TOGETHER TO GAIN SOME OF THE COST AND QUALITY BENElTS OF A MORE INTEGRATED APPROACH &OR EXAMPLE ONE LARGER INSURER HAS COUPLED A CHRONIC CARE MANAGEMENT PROGRAM WITH ITS DISABILITY PRODUCT THAT FOCUSES ON THE CONDITIONS THAT ARE THE LEADING CAUSE OF DISABILITY EG HEART DISEASE "Y FOCUSING ON CONTROLLING CHRONIC CONDITIONS ITS CUSTOMERS CAN DIRECTLY IMPACT THE NUMBER AND LENGTH OF DISABILITY CLAIMS AND THE ASSOCIATED MEDICAL COSTS REGARDLESS OF WHO IS PROVIDING THE HEALTH INSURANCE PROGRAM 4HE INSURER ALSO HAS DEVELOPED ON SITE DISABILITY MANAGEMENT THAT IT OFFERS AS PART OF ITS FULLY INSURED LONG TERM COVERAGE FOR EMPLOYERS WHO WANT TO RETAIN CONTROL OF ADMINISTERING THEIR SICK LEAVE OR SHORT TERM DISABILITY PROGRAMS )T HAS SEEN A REDUCTION IN SHORT TERM DISABILITY DURATIONS AND LONG TERM DISABILITY CLAIMS AS CASE MANAGEMENT NURSES ARE ABLE TO IDENTIFY SHORT TERM DISABILITIES THAT REQUIRE INTENSIVE CASE MANAGEMENT 4HE ONUS IS ON EMPLOYERS WHO DO NOT CHOOSE A PACKAGED PLAN FROM AN INNOVATIVE INSURER TO TAILOR AN INTEGRATED MANAGEMENT PLAN THAT TIES IN ALL PLAYERS AND ALLOWS DATA SHARING 4HEY CAN MAKE THIS HAPPEN BY INSISTING ON BETTER COORDINATION BETWEEN THE GROUP HEALTH PLAN AND DISABILITY VENDORS THROUGH IMPROVED COLLABORATION AS WELL AS CONNECTED TECHNOLOGY SYSTEMS AND DATA THAT ALLOW THE EMPLOYER TO IDENTIFY TRENDS IN MEDICAL CONDITIONS ACROSS CARRIERS AND PROGRAMS
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
'ATHER AND !NALYZE THE $ATA (ISTORICALLY BENElTS DATA HAVE BEEN MANAGED IN SEPARATE INFORMATION SILOS (EALTH AND WORKERS COMPENSATION FREQUENTLY ARE MANAGED WITHIN TWO DIFFERENT DEPARTMENTS OF AN EMPLOYER WITH THE WORKERS COMPENSATION MANAGED IN THE RISK MANAGEMENT AREA AND THE HEALTH BENElTS MANAGED THROUGH HUMAN RESOURCES OR THE BENElTS MANAGEMENT AREA 4HIS HAS FRAGMENTED THE VIEW OF KEY DRIVERS OF BOTH HEALTH AND PRODUCTIVITY ACROSS THE ORGANIZATION "Y AGGREGATING CLAIMS DATA A PAYER WOULD BE ABLE TO ANALYZE INFORMATION AND WORK CLOSELY WITH AN EMPLOYER TO DESIGN PROGRAMS THAT WOULD POSITIVELY IMPACT THE KEY EMPLOYEE HEALTH DRIVERS 4ODAY RELEVANT EMPLOYEE CLAIMS DATA PRODUCTIVITY METRICS AND MEMBER AND WORKFORCE SELF REPORTED DATA CAN BE SYNTHESIZED TO IDENTIFY ROOT CAUSES OF EMPLOYEE HEALTH ISSUES /NCE CLAIMS DATA HAVE BEEN AGGREGATED EMPLOYERS CAN WORK WITH PAYERS TO ANALYZE THE INFORMATION TO DETERMINE KEY EMPLOYEE HEALTH DRIVERS 4HESE DATA VARY BY DEMOGRAPHICS INDUSTRY AND GEOGRAPHY &OR EXAMPLE COMPANIES NEED TO RECOGNIZE THAT DEPRESSION IS THE LEADING CAUSE OF DISABILITY IN WOMEN;= !GE ALSO PLAYS A FACTOR (ALF OF !MERICANS AGED TO HAVE HIGH BLOOD PRESSURE n A MAJOR RISK FACTOR FOR HEART DISEASE AND STROKE n AND TWO IN lVE ARE OBESE ACCORDING TO h(EALTH 5NITED 3TATES v THE GOVERNMENTS ANNUAL REPORT TO THE PRESIDENT AND #ONGRESS ON !MERICAN HEALTH;= "Y PAYING ATTENTION TO EMPLOYEE DIFFERENCES COMPANIES CAN USE THIS INFORMATION TO IMPLEMENT CREATIVE WORKPLACE SOLUTIONS TO PREVENT OR LESSEN THE EFFECTS OF HEALTH ISSUES ON PRODUCTIVITY
#REATIVE 7ORKPLACE 3OLUTIONS !N EMPLOYER WITH A GREATER PERCENTAGE OF FEMALE WORKERS COULD FOR EXAMPLE IMPLEMENT DEPRESSION SCREENING TO HELP WOMEN lND WAYS TO COPE WITH DEPRESSION AND PREVENT IT FROM IMPACTING WORK TIME #OMPANIES WITH MANY EMPLOYEES OVER THE AGE OF COULD IMPROVE THE CAFETERIA MENU AND PROVIDE FREE NUTRITIONAL COUNSELING TO OVERWEIGHT WORKERS TO REDUCE THE RISK OF DIABETES AND HEART DISEASE "Y IMPLEMENTING PROACTIVE DISEASE MANAGEMENT PROGRAMS EMPLOYERS CAN REDUCE THE INCIDENCE OF EXPENSIVE TREATMENTS LATER ON 3OME COMPANIES ARE MAKING HEADWAY ON GATHERING THESE DATA HOWEVER ONE OF THE MOST SIGNIlCANT MISSING PIECES TO DATE HAS BEEN PRESENTEEISM INFORMATION (OW MANY FULL TIME WORKERS ARE ACTUALLY FUNCTIONING AT CAPACITY (OW MANY OTHERS ARE GIVING A SIX HOUR WORKDAY INSTEAD OF EIGHT BECAUSE OF CHRONIC OR EPISODIC AILMENTS SUCH AS MIGRAINES ASTHMA BACK PAIN DEPRESSION OR GASTROINTESTINAL PROBLEMS
HMSDF Q@SHMF ãLDCHB@Kã@MCãOQNCT BSHU HSXãL@M@FD L D MS )NNOVATIVE INSURERS ARE HELPING COMPANIES BETTER UNDERSTAND TIME LOST ON THE JOB FROM CHRONIC AILMENTS &OR EXAMPLE !ETNA RECENTLY LICENSED THE 7ORK ,IMITATION 1UESTIONNAIRE 7,1 FROM 4UFTS .EW %NGLAND -EDICAL #ENTER TO HELP EMPLOYERS BETTER UNDERSTAND EMPLOYEE HEALTH STATUS AND TO HELP WORKERS IMPROVE THEIR OWN HEALTH AND PRODUCTIVITY %MPLOYEES COMPLETE THE QUESTIONNAIRE INDEPENDENTLY TO MEASURE THE EFFECTS OF CHRONIC HEALTH CONDITIONS AFFECTING JOB PERFORMANCE 4HE DATA RESULTING FROM THE 7,1 SHOULD HELP EMPLOYERS WORK WITH PROVIDERS AND DISABILITY MANAGERS TO GAUGE THE MAGNITUDE AND EFFECT THAT CERTAIN HEALTH RELATED ISSUES SUCH AS ARTHRITIS HEADACHES AND BACK PROBLEMS HAVE IN THE WORKPLACE;= )MPROVED DATA ANALYSIS HELPS EMPLOYERS CREATE TARGETED ACTION PLANS TO REDUCE HEALTHCARE COSTS AND INCREASE WORKPLACE PERFORMANCE &OR EXAMPLE A STUDY FOUND THAT ONE QUARTER OF ALL ALLERGY SUFFERERS IN A BANKS CALL CENTER DID NOT TAKE ALLERGY MEDICATION WHICH WAS REmECTED AS A PERCENT REDUCTION IN PRODUCTIVITY DURING PEAK RAGWEED POLLEN SEASON 4HE COMPANY CONCLUDED THAT PROVIDING ALLERGY SUFFERERS WITH NON SEDATING ANTIHISTAMINES AT PER WEEK WOULD COST LESS THAN THE A WEEK LOSS IN PRODUCTIVITY PER WORKER;= )N ORDER TO DEVELOP CREATIVE SOLUTIONS BOTH PAYERS AND EMPLOYERS NEED TO BE mEXIBLE AND BUILD RESOURCEFUL INTERVENTION PROGRAMS TO MEET EMPLOYEE NEEDS ! COMPANY THAT ANALYZED ENOUGH DATA TO DISCOVER THAT A GREAT DEAL OF WORKERS JOB TIME WAS SPENT AT DOCTOR APPOINTMENTS COULD WORK WITH ITS HEALTH PLAN TO EXPAND THE NETWORK OF PROVIDERS IN THE GEOGRAPHIC AREA SURROUNDING THE WORKPLACE /R PERHAPS IT COULD CONSIDER REIMBURSING FOR PHYSICIAN OR NURSE TELEPHONIC CONSULTATIONS TO CUT TIME SPENT TRAVELING TO DOCTORS OFlCES ! COMPANY NOTICING A SPIKE IN BACK PAIN CLAIMS MIGHT ASK THE HEALTH PLAN TO ADD CHIROPRACTIC CARE AS A COVERED SERVICE OR PERHAPS PAY FOR MASSAGE THERAPY THROUGH A HEALTH REIMBURSEMENT ACCOUNT )NTEGRATED BENElTS MANAGEMENT PROVIDES ADVANTAGES ACROSS THE BOARD %MPLOYERS WIN WITH HEALTHIER EMPLOYEES IMPROVED MORALE AND INCREASED BUSINESS PERFORMANCE BASED ON BETTER QUALITY PRODUCTS AND SERVICES 0AYERS ALSO WIN BECAUSE THEY CAN INCREASE MEMBERSHIP REDUCE COSTS AND CREATE A COHESIVE RELATIONSHIP WITH EMPLOYERS BY OFFERING INTEGRATED SERVICES -EMBERS HAVE THE MOST TO GAIN BY RECEIVING BETTER QUALITY HEALTHCARE
4HE 0ROMISE OF )NTEGRATION &RAGMENTED BENElTS MANAGEMENT WILL FADE INTO THE PAST AS MORE EMPLOYERS SEE THE ADVANTAGES TO BE GAINED BY COORDINATING CARE AROUND EACH WORKER ! CONNECTED SYSTEM n ONE IN WHICH HEALTH AND DISABILITY INSURERS SHARE CASE MANAGEMENT EFFORTS AND DATA n IS THE INEVITABLE WAY OF THE FUTURE FOR COMPANIES SEEKING TO REDUCE HEALTHCARE COSTS AND BOOST EMPLOYEE PRODUCTIVITY )N ADDITION TO CONNECTING PAYERS AND THEIR PROCESSES SUCCESSFUL EMPLOYERS WILL MAKE DATA SHARING AND ANALYSIS A PRIORITY TO BUILD CREATIVE SOLUTIONS THAT BOOST WORKPLACE PERFORMANCE AND DELIVER A BETTER QUALITY OF EMPLOYEE HEALTHCARE
%NDNOTES $AVIS + ET AL h(EALTH AND 0RODUCTIVITY !MONG 53 7ORKERS v !UGUST 4HE #OMMONWEALTH &UND HTTPWWWCMWFORGUSR?DOC? DAVIS?HLT?PRODUCTIVITY?USWORKERSPDF h&OURTEENTH !NNUAL ##( 5NSCHEDULED !BSENCE 3URVEY v ##( )NCORPORATED HTTPWWWCCHCOMPRESSNEWSHASP h&IFTEENTH !NNUAL ##( 5NSCHEDULED !BSENCE 3URVEY #OSTLY 0ROBLEM OF 5NSCHEDULED !BSENTEEISM #ONTINUES TO 0ERPLEX %MPLOYERS v /CTOBER HTTPWWWCCHCOMPRESSNEWS HASP 3TEWART 7 & ET AL h#OST OF ,OST 0RODUCTIVE 7ORK 4IME !MONG 53 7ORKERS WITH $EPRESSION v *UNE *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION 3TEWART 7 & ET AL h,OST 0RODUCTIVE 4IME AND #OST $UE TO #OMMON 0AIN #ONDITIONS IN THE 53 7ORKFORCE v .OVEMBER *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION -URRAY # * , AND ! $ ,OPEZ EDS h4HE 'LOBAL "URDEN OF $ISEASE AND )NJURY 3ERIES 6OLUME ! #OMPREHENSIVE !SSESSMENT OF -ORTALITY AND $ISABILITY FROM $ISEASES )NJURIES AND 2ISK &ACTORS IN AND 0ROJECTED TO v #AMBRIDGE -ASS 4HE (ARVARD 3CHOOL OF 0UBLIC (EALTH ON BEHALF OF THE 7ORLD (EALTH /RGANIZATION AND THE 7ORLD "ANK (ARVARD 5NIVERSITY 0RESS HTTPWWWNIMHNIHGOVPUBLICAT BURDENCFM h(EALTH 5NITED 3TATES WITH #HARTBOOK ON 4RENDS IN THE (EALTH OF !MERICANS v $ECEMBER 0(3 #ENTERS FOR $ISEASE #ONTROL AND 0REVENTION PP h!ETNA AND 4UFTS .EW %NGLAND -EDICAL #ENTER TO (ELP %MPLOYERS -EASURE ,INK "ETWEEN (EALTH AND 0RODUCTIVITY v -ARCH HTTPWWWAETNACOMNEWSPR?HTM (EMP 0 h0RESENTEEISM !T 7ORK n "UT /UT OF )T v /CTOBER (ARVARD "USINESS 2EVIEW P
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1UALITY IN -EDICAID 0ROGRAMS .EW APPROACHES SUCH AS PAY FOR PERFORMANCE MAY IMPROVE THE QUALITY OF CARE FOR -EDICAID PATIENTS
"Y 3ANDRA (UNT 0RICEWATERHOUSE#OOPERS
3OME "ACKGROUND ON -EDICAID &OR MILLION LOW INCOME !MERICANS -EDICAID PROVIDES lNANCING FOR HEALTHCARE AND LONG TERM CARE SERVICES MORE THAN ANY OTHER SINGLE HEALTHCARE PROGRAM IN THE 53;= -EDICAID HOWEVER FACES SERIOUS lNANCIAL THREATS THAT ENDANGER THE HEALTH OF !MERICAS POOREST CITIZENS 4HE FEDERAL GOVERNMENT ESTIMATES NEARLY MILLION PEOPLE LACK COVERAGE;= IF -EDICAID FUNDING WERE CUT OR CAPPED THE NUMBER OF UNINSURED WOULD RISE DRAMATICALLY &OR THIS REASON HEALTHCARE ADVOCATES AND LEGISLATORS ARE LOOKING AT CREATIVE WAYS TO CONTROL THE GROWTH IN -EDICAID SPENDING WITHOUT COMPROMISING HEALTHCARE SERVICES -EDICAID IS EXPENSIVE COSTING TAXPAYERS APPROXIMATELY BILLION IN ;= 4O KEEP EXPENDITURES IN LINE WITH TAX REVENUES AND TO IMPROVE PATIENT OUTCOMES STATE -EDICAID AGENCIES HAVE BEGUN TO IMPLEMENT QUALITY STANDARDS TO INCREASE EFlCIENCY STREAMLINE OPERATIONS AND REDUCE SPENDING
-EDICAID AND -ANAGED #ARE !PPLYING MANAGED CARE PRINCIPLES TO -EDICAID IS ONE WAY PRACTITIONERS HAVE ATTEMPTED TO DELIVER QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER )N STATES BEGAN SETTING UP -EDICAID MANAGED CARE PROGRAMS TO ALLOW LOW INCOME RECIPIENTS GREATER EXPOSURE TO QUALITY HEALTHCARE SERVICES !T THE ONSET THESE PROGRAMS WERE PRIMARILY FOCUSED ON RECIPIENTS OF !ID TO &AMILIES WITH $EPENDENT #HILDREN NOW KNOWN AS 4EMPORARY !ID TO .EEDY &AMILIES OR 4!.& (OWEVER STATES NOW APPLY THE MANAGED CARE CONCEPT MORE WIDELY INCLUDING PEOPLE WITH SPECIAL NEEDS 7HEN A STATE CONTRACTS WITH A MANAGED CARE PLAN PAYMENTS ARE BASED ON A MONTHLY CAPITATION RATE PER -EDICAID ENROLLEE SIMILAR TO PAYING A PREMIUM FOR A COMMERCIAL MEMBER 4HESE RATES REFERENCE A SET OF HISTORICAL DATA AND HELP DETERMINE WHAT WILL BE PAID TO THE HEALTH PLAN )NCREASINGLY THESE PAYMENTS ARE ENHANCED BASED ON COMPLIANCE WITH A SET OF PERFORMANCE OBJECTIVES THAT SUPPORT PREVENTIVE CARE OR DISEASE MANAGEMENT
PROGRAMS 0LANS THAT MEET THESE CRITERIA MAY BE ELIGIBLE TO RECEIVE BONUSES
1UALITY "ARRIERS )NCORPORATING QUALITY INTO -EDICAID MANAGED CARE POSES CHALLENGES ON SEVERAL FRONTS &IRST THE BASIC PROGRAM STRUCTURE INVOLVES LIMITED OR NO COST SHARING AT THE POINT OF PURCHASE BY THE INDIVIDUAL !LTERNATIVELY MANY COMMERCIAL HEALTH PLANS USE TIERED COST SHARING TO PROVIDE INCENTIVES FOR MEMBERS TO USE PARTICULAR PROVIDERS AND QUALITY RANKINGS MAY BE ONE CRITERION USED TO DETERMINE THE LEVEL OF COPAYMENT 0ROVIDERS ARE ASSIGNED TO DIFFERENT LEVELS BASED UPON HOW WELL THEY PERFORM AND THEIR COMPENSATION "ECAUSE COST SHARING DIFFERENTIALS ARE LIMITED AND OFTEN UNENFORCEABLE IN -EDICAID PEOPLE CANNOT BE CHANNELED TOWARD SPECIlC PROVIDERS BASED ON DIFFERENCES IN COST SHARING SO OTHER APPROACHES TO DIRECTING INDIVIDUALS TO HIGH QUALITY PROVIDERS MUST BE CONSIDERED -EDICAID ALSO LACKS THE LEVERAGE OF COMMERCIAL HEALTH PLANS BECAUSE PROVIDER PAYMENT RATES ARE GENERALLY THE LOWEST OF ANY PAYMENT SOURCE !LTHOUGH THIS IS NOT TRUE IN EVERY PROGRAM AREA NAMELY PRESCRIPTION DRUGS -EDICAID IS USUALLY CONSIDERED TO BE THE LOWEST PAYER OVERALL !S A NATIONAL AVERAGE -EDICAID PAYS ONLY PERCENT OF WHAT -EDICARE PAYS FOR THE SAME SERVICES;= &OR THIS REASON SOME PHYSICIANS AVOID TAKING -EDICAID RECIPIENTS OTHERS VIEW CARING FOR THESE PATIENTS AS A COMMUNITY SERVICE 'EOGRAPHY ALSO MAKES IT DIFlCULT TO CHOOSE QUALITY PROVIDERS -EDICAID RECIPIENTS ARE TYPICALLY FOUND DISPROPORTIONATELY IN URBAN CENTERS BUT ALSO LIVE IN RURAL AREAS AND EACH GROUP FACES CHALLENGES IN ACCESSING CARE &OR EXAMPLE WHILE PERCENT OF !MERICANS LIVE IN RURAL AREAS ONLY PERCENT OF !MERICAN PHYSICIANS PRACTICE THERE ;= PRESENTING OBVIOUS ACCESS PROBLEMS &OR -EDICAID RECIPIENTS IT MAY BE EVEN MORE DIFlCULT TO OBTAIN ACCESS BECAUSE OF LOW PAYMENT RATES )N URBAN AREAS THERE ARE MANY PROVIDERS BUT WITH AN ABUNDANCE OF PATIENTS AVAILABLE TO DOCTORS -EDICAID PATIENTS SOMETIMES
3ANDRA (UNT -0! IS A PRINCIPAL WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE HAS MORE THAN YEARS EXPERIENCE PROVIDING CONSULTING SERVICES TO STATE HEALTHCARE PROGRAMS FOR LOW INCOME POPULATIONS WITH A PARTICULAR EMPHASIS ON -EDICAID MANAGED CARE AND OTHER WAIVER PROGRAMS 3HE CAN BE REACHED AT SANDRASHUNT USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
P T@K HSXãHMãLD CHB@HCãOQNFQ@LR HAVE DIFlCULTY lNDING PROVIDERS WHO WILL ACCEPT -EDICAID PAYMENT AMOUNTS
@4O WHAT EXTENT DO YOU HOLD THE PHYSICIAN ACCOUNTABLE 7HO IS ACCOUNTABLE 0HYSI CIANS ARE INmUENTIAL AND A GATEWAY TO CER TAIN BEHAVIORS SUCH AS VIOLENCE ALCOHOL ABUSE SMOKING AND OBESITY 4HE PHYSI CIAN EXAM OFFERS AN OPPORTUNITY TO CHANGE BEHAVIOR BUT IS ONLY WORTH DOING IF PHYSI CIANS HAVE THE TRAINING TOOLS AND TIME TO INmUENCE PATIENT BEHAVIOR n 0AUL $ #LEARY 0H$ (ARVARD -EDICAL 3CHOOL
0AYING FOR 0ERFORMANCE !LTHOUGH INCENTIVE BASED REIMBURSEMENT ALSO CALLED hPAY FOR PERFORMANCE v HAS BEEN AROUND FOR SOME TIME ON THE COMMERCIAL SIDE -EDICAID IS JUST BEGINNING TO ENDORSE THESE PROGRAMS TO CREATE MORE VALUE FOR DOLLARS SPENT &OR EXAMPLE THE STATE OF -ASSACHUSETTS RECENTLY INTRODUCED LEGISLATION THAT WILL PAY OUT MILLION TO HOSPITALS AND DOCTORS IN FOR IMPROVING CARE TO DIABETIC AND HEART DISEASED -EDICAID PATIENTS TO REDUCE HOSPITAL VISITS 0HYSICIANS WILL ALSO RECEIVE BONUSES FOR LIMITING THE USE OF EXPENSIVE IMAGING AND FOR REDUCING DISPARITY IN DELIVERY AND OUTCOMES OF PATIENT CARE;= -ORE THAN PERCENT OF -EDICAID BENElCIARIES ARE ENROLLED IN PRIVATE MANAGED CARE PLANS ;= AND THE MAJORITY OF PAY FOR PERFORMANCE EFFORTS ARE BEING MADE AT THE PLAN LEVEL 7ITH THESE PROGRAMS -EDICAID HOLDS MANAGED CARE PLANS ACCOUNTABLE FOR THE QUALITY OF SERVICES PROVIDED TO MEMBERS THROUGH SPECIlC PERFORMANCE CRITERIA SUCH AS PROVIDING PREVENTIVE CARE OR DISEASE MANAGEMENT )F THE PLANS MEET THE CRITERIA THEY ARE PAID THEIR USUAL PREMIUM PLUS A BONUS 4O MEET THE CRITERIA PLANS MAY EXTEND PAY FOR PERFORMANCE BY PASSING ALONG BONUSES TO DOCTORS FOR PRESCRIBING GENERIC DRUGS OR GIVING PATIENTS mU SHOTS (OSPITALS MIGHT SIMILARLY BE REWARDED FOR MEETING PERFORMANCE TARGETS &ACED WITH A lSCAL CRISIS THE STATE OF #ALIFORNIA DEVELOPED A PROGRAM USING lVE QUALITY MEASURES AND TWO MEASURES OF SAFETY NET PARTICIPATION TO IDENTIFY HIGH PERFORMING AND EFlCIENT HEALTH PLANS -EDICAID BENElCIARIES IN COUNTIES WHO DID NOT CHOOSE A HEALTH PLAN FOR THEMSELVES WERE AUTOMATICALLY ENROLLED IN ONE OF THE HIGH PERFORMING PLANS !N ANALYSIS PREPARED BY THE #ALIFORNIA (EALTH#ARE &OUNDATION AN INDEPENDENT GROUP COMMITTED TO IMPROVING #ALIFORNIAS HEALTHCARE DELIVERY AND lNANCING SYSTEMS CONCLUDED THAT AS A RESULT OF THE NEW PERFORMANCE BASED PLAN ASSIGNMENT ALGORITHM -EDI #AL MANAGED CARE ENROLLEES
WOULD BE ASSIGNED TO A BETTER HEALTH PLAN IN THE lRST YEAR AS ASSESSED BY SEVEN PERFORMANCE INDICATORS THAN THEY WOULD HAVE BEEN ASSIGNED OTHERWISE;= "EGINNING IN *ULY ,OUISIANA WILL START ITS lRST -EDICAID PAY FOR PERFORMANCE PROGRAM TO DRIVE ADOPTION OF ELECTRONIC MEDICAL RECORDS AND IMPROVE IMMUNIZATION RATES IN TODDLERS 4HE STATE IS ENHANCING PRIMARY CARE PHYSICIANS MONTHLY MANAGEMENT FEES BY CENTS PER MEMBER PER MONTH PMPM IF THEY ADOPT A CLINICAL INFORMATION SYSTEM AND REPORT ELECTRONICALLY AND IF THEY PARTICIPATE IN A PROGRAM THAT PROVIDES FREE VACCINES FOR LOW INCOME CHILDREN 0HYSICIANS WILL GET A CENT PMPM INCREASE IF THEY REACH THE TARGET VACCINATION RATE AND WILL GET A PMPM INCREASE IF THEY ACHIEVE A STRETCH GOAL &OR EXAMPLE A PHYSICIAN WHO TREATS -EDICAID RECIPIENTS COULD EARN OF ADDITIONAL REVENUE PER MONTH;=
0REVENTIVE #ARE IN !CTION -ANY OF THE PAY FOR PERFORMANCE -EDICAID PROGRAMS HAVE EVOLVED AROUND PREVENTIVE CARE 0REVENTIVE CARE IS BASED ON THE PREMISE THAT SPENDING MONEY UP FRONT ON PATIENT CARE WILL REAP RICH REWARDS LATER IN THE FORM OF REDUCED EMERGENCY CARE SERVICES (EALTH PLANS ARE COMPENSATED IN THE FORM OF BONUSES OR INCENTIVES PAID BY -EDICAID FOR IMPROVING THE RATE OF PREVENTIVE CARE WHILE THE STATES BENEFIT FROM LOWER TREND RATES )N 3EPTEMBER THE LARGEST PAY FOR PERFORMANCE EFFORT TO IMPROVE THE HEALTH OF BABIES AND TEENS WAS LAUNCHED IN #ALIFORNIA;= 4HE ,OCAL )NITIATIVE 2EWARDING 2ESULTS ,)22 PROJECT INVOLVED SEVEN HEALTH PLANS AND WAS PART OF A THREE YEAR NATIONAL INITIATIVE BY THE 2OBERT 7OOD *OHNSON &OUNDATION AND THE #ALIFORNIA (EALTH#ARE &OUNDATION TO TEST WHETHER PERFORMANCE INCENTIVES WOULD IMPROVE HEALTHCARE QUALITY 4HE SPECIlC PROJECT GOAL OF THE ,)22 WAS TO IMPROVE QUALITY AND ACCESS TO PREVENTIVE -EDICAID SERVICES BY INCREASING THE NUMBER OF WELL BABY VISITS AND ANNUAL ADOLESCENT VISITS #HILDREN COVERED UNDER -EDICAID ARE OFTEN TARGETED FOR PREVENTIVE CARE BECAUSE THEY TEND TO BE AT HIGHER RISK FOR SEVERAL ILLNESSES INCREASED INFANT MORTALITY AND DEVELOPMENTAL DELAYS 4HEY ARE ALSO MORE LIKELY TO SUFFER FROM LEAD POISONING AND ASTHMA COMPLICATIONS !S THESE CHILDREN MATURE THEY MAY CONFRONT SEXUALLY TRANSMITTED DISEASE SUBSTANCE ABUSE AND TEEN PREGNANCY 7ITHOUT CONSISTENT PREVENTIVE HEALTH SERVICES THESE CHILDREN WHO REPRESENT HALF OF THE -EDICAID POPULATION MAY FACE SERIOUS HEALTH PROBLEMS;= 4HE ,)22 PROJECT ADDRESSING THIS ISSUE PAID OUT MILLION INVOLVED PHYSICIANS AND AFFECTED BABIES TEENS AND PARENTS &IVE OF THE SEVEN PLANS SUCCEEDED IN IMPROVING THE RATE OF WELL BABY VISITS WITH INCREASES OF TO PERCENT 4EEN DOCTOR VISITS INCREASED FROM TO PERCENT AT SIX OF THE SEVEN PLANS 4HE ,)22 PROJECT CONCLUDED THAT PAY FOR PERFORMANCE CAN HELP -EDICAID IMPROVE PATIENT HEALTHCARE WITHOUT INCREASING EXPENDITURES;=
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXãHMãLD CHB@HCãOQNFQ@LR
@4HE QUALITY OF CARE MEASURES GENER ALLY DO NOT FOCUS ON ACCESS AS AN INDI CATOR OF QUALITY BUT ACCESS TO SERVICES IS AN ESSENTIAL ASPECT OF THE QUALITY OF OUR HEALTHCARE SYSTEM )F PATIENTS CANNOT ACCESS CARE NO MATTER HOW GOOD IT IS THEN THE SYSTEM IS FAILING %LIZABETH "RADLEY 9ALE 3CHOOL OF 0UBLIC (EALTH
0ROGRESS IN $ISEASE -ANAGEMENT /VER THE PAST SEVERAL YEARS STATES HAVE BEGUN TO CONTRACT WITH DISEASE MANAGEMENT COMPANIES TO IMPLEMENT PROGRAMS IN ASTHMA MANAGEMENT DIABETES MANAGEMENT AND CHRONIC OBSTRUCTIVE HEART AND PULMONARY DISEASE -ANY ARE SIMILAR TO PROGRAMS USED BY COMMERCIAL PLANS EXCEPT THAT THE -EDICAID POPULATION TENDS TO HAVE HIGHER RATES OF THESE DISEASES &ROM THIS STANDPOINT -EDICAID PROGRAMS OFFER HIGH POTENTIAL FOR YIELDING CONSIDERABLE SAVINGS #ONTRACTS ARE TYPICALLY SOLD TO THE STATES ON A BUDGET NEUTRAL BASIS AND THE MANAGEMENT COMPANIES GET PAID BY DEMONSTRATING A REDUCTION IN TREND &OR EXAMPLE !RKANSAS OFlCIALS REPORTED SOME SUCCESS FROM A YEAR LONG PROGRAM INVOLVING A GROUP OF PARTICIPANTS WHO WERE REQUIRED TO UNDERGO A ONE HOUR ASSESSMENT FOLLOWED BY HOURS OF GROUP OR INDIVIDUAL EDUCATIONAL SESSIONS 0ARTICIPANTS WERE TAUGHT HOW TO CONTROL THEIR DISEASE THROUGH BLOOD GLUCOSE MONITORING SELF EXAMS EXERCISE HEALTHY FOOD CHOICES AND IMPROVED COOKING HABITS 4HE STUDY FOUND THAT COUPLING SELF MANAGEMENT WITH NUTRITION EDUCATION CAN REDUCE RESOURCE UTILIZATION WITHIN A YEAR AND WILL PROBABLY IMPROVE DIABETES OUTCOMES OVER TIME AT LITTLE OR NO INCREMENTAL COST 2ESEARCHERS REPORTED THAT THE ESTIMATED SAVINGS IN DIABETES RELATED COSTS PROJECTED FROM OBSERVED PREPOST BLOOD GLUCOSE LEVELS WERE FOR EACH PERSON WHO COMPLETED THE PROGRAM OVER THREE YEARS 4HIS LARGELY OFFSET PROGRAM COSTS OF PER INITIAL PROGRAM PARTICIPANT RESULTING IN A NET COST PER PARTICIPANT OF OVER THREE YEARS 4HE RESEARCHERS CONCLUDED THAT IF REDUCTIONS IN DIABETES RELATED COSTS PERSIST BEYOND THREE YEARS THE PROGRAM MIGHT BE COST SAVING 4HE PROGRAM IS PROJECTED TO REDUCE DIABETES RELATED MORTALITY BY PERCENT AND MICROVASCULAR DISEASE EVENTS BY PERCENT OVER YEARS AMONG THOSE WHO COMPLETE IT;= 4HE $EPARTMENT OF (EALTH AND (OSPITALS IN ,OUISIANA OPERATES A -EDICAID #OMMUNITY#!2% QUALITY PROGRAM TO IMPROVE USE OF APPROPRIATE MEDICATIONS FOR CHILDREN WITH ASTHMA 4HEY ORIGINALLY PLANNED TO EDUCATE THE STAFF IN #OMMUNITY#!2% PRACTICES TO
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
PROVIDE EDUCATION FOR THEIR PATIENTS (OWEVER THEY FOUND THAT MORE HELP WAS NEEDED TO OBTAIN ACCEPTANCE OF THE PROGRAM .OW NURSES IN EACH OF NINE DESIGNATED REGIONS WITHIN THE STATE PROVIDE EDUCATIONAL SERVICES TO CHILDREN FAMILIES AND CAREGIVERS 3INCE INCEPTION OF THE PROGRAM THEY HAVE SEEN THE USE OF APPROPRIATE MEDICATIONS FOR TO YEAR OLDS WITH ASTHMA RISE FROM PERCENT IN THE lRST QUARTER OF TO PERCENT BY THE FOURTH QUARTER 4HE COMBINED RATE FOR TO YEAR OLDS WENT FROM TO PERCENT &OR ADULT -EDICAID RECIPIENTS THE DEPARTMENT HAS STARTED TELEPHONIC INTERVENTION WITH ASTHMA PATIENTS WHO HAVE BEEN IN THE %2 AT LEAST TWICE IN THE LAST SIX MONTHS AND HAS IMPLEMENTED A HOUR NURSE HELP LINE TO GIVE PATIENTS AN ALTERNATIVE TO THE EMERGENCY DEPARTMENT AS A lRST LINE OF DEFENSE IN THE EVENT OF PROBLEMS !LTHOUGH THE TELEPHONIC ASTHMA INTERVENTION PROGRAM IS STILL TOO NEW TO REPORT RESULTS IT ENROLLED OVER RECIPIENTS ,OUISIANA IS ALSO EXPERIMENTING WITH THE USE OF CLINICAL DECISION SUPPORT FOR MANAGING DIABETES IN THE -EDICAID POPULATION &OR PROVIDERS WITH LOW RATES OF HEMOGLOBIN TESTING NURSES DO CHART AUDITS PROVIDE EDUCATION AND OFFER A CLINICAL DECISION SUPPORT TOOL THAT LISTS REMINDERS OF WHAT EACH PERSON WITH DIABETES NEEDS n HEMOGLOBIN !C TESTED CHOLESTEROL CHECKED ETC 4HE STATE IS TESTING RESULTS OF CHART AUDITS VERSUS AUDITS AND EDUCATION VERSUS AUDITS EDUCATION AND DECISION SUPPORT FOR DIABETES MANAGEMENT 4HIS PROGRAM IS ALSO NEW BUT HAS HAD GOOD RECEPTION FROM PHYSICIANS;= 0ARTNERS (EALTHCARE 3YSTEM THE PARENT ORGANIZATION OF -ASSACHUSETTS 'ENERAL (OSPITAL AND "RIGHAM AND 7OMENS (OSPITAL HAS ALSO EXPERIMENTED WITH DISEASE MANAGEMENT AMONG -EDICAID RECIPIENTS TO DELIVER INTENSE PERSONALIZED CARE TO THE PERCENT OF PATIENTS WHO ACCOUNT FOR PERCENT OF ALL THEIR COSTS !LTHOUGH THEY ARE COMPENSATED FOR -EDICAID PATIENTS RATES ARE WELL BELOW ACTUAL COSTS SO DISEASE MANAGEMENT IS BEING PRACTICED IN AN EFFORT TO AVOID UNNECESSARY ADMISSIONS 4HE DISEASE MANAGEMENT TEAM IDENTIlES HIGH RISK PATIENTS AND EMAILS PHYSICIANS TO GIVE THEM THE OPTION OF NOT REFERRING IDENTIlED PATIENTS TO THE PROGRAM ONLY PERCENT OF PHYSICIANS OPT OUT .EXT NURSES CALL THE PATIENTS AND PERFORM AN ASSESSMENT 4HEY THEN EMAIL FEEDBACK TO PHYSICIANS ABOUT ISSUES UNCOVERED DURING THE INITIAL CALL )N THIS WAY THE NURSING TEAM ACTS AS CASE MANAGERS TO QUICKLY IDENTIFY PATIENTS WHO DO NOT UNDERSTAND DOCTORS INSTRUCTIONS 3O FAR 0ARTNERS (EALTHCARE HAS RECEIVED EXCEPTIONALLY POSITIVE INTERNAL AND EXTERNAL FEEDBACK ABOUT THE PROGRAM;=
5SING )NCENTIVES TO )NCREASE 0ATIENT #OMPLIANCE &ACTORS SUCH AS TRANSIENCE LANGUAGE BARRIERS LACK OF TRANSPORTATION AND WORK SCHEDULES OFTEN RESULT IN -EDICAID RECIPIENTS MISSING APPOINTMENTS 0ROVIDERS HAVE SAID THAT
P T@K HSXãHMãLD CHB@HCãOQNFQ@LR BONUSES SPUR THEM TO PERFORM OUTREACH ACTIVITIES TO UNDERSERVED POPULATIONS 0ATIENTS MAY ALSO NEED INCENTIVES "ECAUSE lNANCIAL INCENTIVES ARE VIEWED AS hINCOME v EXTRA MONIES RECEIVED BY -EDICAID BENElCIARIES CAN INCREASE THEIR INCOME ENOUGH TO BE DENIED ELIGIBILITY 3TATES MUST TYPICALLY APPROVE MEMBER INCENTIVES SOME INCLUDE -EDICAID INCENTIVE REGULATIONS IN THEIR MANAGED CARE CONTRACTS &OR EXAMPLE IN THE ,)22 PROJECT STATE APPROVALS WERE SECURED FOR THE 3AN &RANCISCO (EALTH 0LAN TO USE BOTH MOVIE TICKETS AND AN OUTREACH EFFORT INTO HIGH SCHOOLS TO INCREASE ADOLESCENT DOCTOR VISITS 2ESULTING DATA FOR THESE EFFORTS SHOWED ADOLESCENT WELL CARE RISE FROM TO PERCENT;=
-EASURING 0ERFORMANCE 7HEN MEASURING PERFORMANCE STANDARDIZED MEASURES ENSURE THAT FAIR COMPARISONS MAY BE MADE BETWEEN DIFFERENT ORGANIZATIONS (EALTH 0LAN %MPLOYER $ATA AND )NFORMATION 3ET (%$)3 IS A STANDARDIZED TOOL THAT MEASURES THE PERFORMANCE OF IMPORTANT ASPECTS OF CARE AND SERVICE AMONG HEALTH PLANS AND CAN BE USED TO MEASURE -EDICAID PROGRAM PERFORMANCE &OR EXAMPLE (%$)3 DATA WERE USED IN THE ,)22 PROJECT TO EVALUATE THE SUCCESS OF THE ADOLESCENT OUTREACH PROGRAM (%$)3 DATA WERE ALSO USED TO MEASURE THE NUMBER OF WELL BABY AND ADOLESCENT DOCTOR VISITS IN THE DIFFERENT HEALTH PLANS 3TANDARDIZED MEASUREMENTS LIKE (%$)3 PROVIDE A PLATFORM FOR COLLABORATION BETWEEN PAYERS AND PROVIDERS AND RAISE AWARENESS OF -EDICAID QUALITY INITIATIVES 4HIS HELPS SECURE BUY INS FROM PROVIDERS WHICH IS CRITICAL TO THE SUCCESS OF PAY FOR PERFORMANCE IN THE -EDICAID SYSTEM 7ITH LOW PAYMENT RATES AND PHYSICIAN SHORTAGES IN RURAL AREAS IT CAN BE DIFlCULT TO BUILD A RELIABLE PROVIDER NETWORK (%$)3 AND OTHER MEASUREMENTS MAKE PROVIDERS AWARE OF THE PERFORMANCE GAP THAT EXISTS IN TREATING -EDICAID PATIENTS )N THE ,)22 PROJECT FOR EXAMPLE THE 3AN &RANCISCO (EALTH 0LAN SENT PAYMENTS TO PHYSICIANS ACCORDING TO GOALS MET ALONG WITH A VOIDED CHECK WITH THE AMOUNT THE PROVIDER COULD HAVE RECEIVED IF PERFORMANCE HAD BEEN BETTER;=
4HE &UTURE OF 1UALITY IN -EDICAID !S THE POPULATION CONTINUES TO GROW IT IS UNREALISTIC TO EXPECT THAT -EDICAID WILL BE ABLE TO CUT BACK ON SPENDING 4HE ALTERNATIVE THEN LIES IN INCREASING THE QUALITY OF -EDICAID INTERACTIONS TO DECREASE THE COST OF LONG TERM CARE AND HELP PATIENTS LIVE LONGER HEALTHIER LIVES 7HILE PROVIDERS HAVE A STRONG DESIRE TO INCREASE THE QUALITY
OF CARE FOR -EDICAID ENROLLEES THEY FACE CHALLENGES FROM LOW REIMBURSEMENT AND THE COMPLEXITIES OF TREATING THESE PATIENTS 0AY FOR PERFORMANCE PROGRAMS SHOW A GREAT DEAL OF PROMISE BY PROMOTING THE CONCEPT OF PREVENTIVE CARE AND BY ENSURING THAT -EDICAID RECIPIENTS HAVE GREATER ACCESS TO A QUALITY NETWORK OF PROVIDERS !LTHOUGH PROGRESS STILL NEEDS TO BE MADE STATES CAN HELP BY TAKING ON MORE ADMINISTRATIVE DUTIES TO SUPPORT QUALITY INITIATIVES SUCH AS FACILITATING DISEASE MANAGEMENT PROGRAMS OR PROVIDING MORE OPERATIONAL SUPPORT TO THE HEALTH PLANS &UNDAMENTAL TO THIS APPROACH IS MEASURING PROVIDER PERFORMANCE TO ENSURE THAT QUALITY CRITERIA ARE BEING MET #OMMUNICATING PERFORMANCE RESULTS WILL REMIND PROVIDERS OF THE INCREASING NEED FOR QUALITY TREATMENT #OMMERCIAL PAY FOR PERFORMANCE PROGRAMS WILL CONTINUE TO BE THE MODEL FOR STATES IN THEIR EFFORTS TO INCREASE QUALITY AND CONTROL RISING COSTS -EDICAID HAS A GREAT DEAL OF INCENTIVE TO SUCCEED IN EFFORTS TO IMPROVE QUALITY AS STATES TAKE ON INCREASING RESPONSIBILITY FOR THE lNANCING AND DELIVERY OF CARE TO THOSE !MERICANS WHO NEED IT MOST %NDNOTES +AISER #OMMISSION ON -EDICAID AND THE 5NINSURED 4HE -EDICAID 0ROGRAM AT A 'LANCE 4HE (ENRY * +AISER &AMILY &OUNDATION -AY HTTPWWWKFFORGMEDICAIDUPLOADPDF )BID )BID !MERICAN !CADEMY OF 0EDIATRICS 53 -EDICAID &ACTS WWWAAPORG ADVOCACYWASHINGELECTIONSMFS?USPDF 2%35,43 4HE &ACTS ON (EALTH $ISPARITIES WWWRESULTSORGWEBSITE ARTICLEASP ID +OWALCZYK , h(EALTH ,EGISLATION 0UTS %MPHASIS ON 0AY FOR 0ERFORMANCE v !PRIL "OSTON 'LOBE (IGHSMITH . AND * 2 2OTHSTEIN h#(#3 "RIEF 2EWARDING 0ERFORMANCE IN -EDICAID -ANAGED #ARE v -ARCH #ENTER FOR (EALTHCARE 3TRATEGIES WWWCHCSORG 0UTTING 1UALITY TO 7ORK 2EWARDING 0LAN 0ERFORMANCE IN -EDI #AL -ANAGED #ARE #ALIFORNIA (EALTH#ARE &OUNDATION -AY HTTP WWWCHCFORGDOCUMENTSPOLICY0UTTING1UALITY4O7ORK2EPORTPDF 0RICEWATERHOUSE#OOPERS INTERVIEW WITH 2OXANE ! 4OWNSEND -$ -EDICAID -EDICAL $IRECTOR FOR ,OUISIANA -AY /EHLMANN 0 h#(#3 "RIEF 7ORKING WITH -EDICAID 0LANS TO )MPROVE 0REVENTIVE #ARE 3ERVICES FOR #HILDREN v -AY #ENTER FOR (EALTHCARE 3TRATEGIES WWWCHCSORG h!GGRESSIVE $IABETES %DUCATION 0ROGRAM -AKES 0OSITIVE )MPACT ON (EALTH OF -EDICAID 0ATIENTS v *UNE -EDICAL .EWS $AILY HTTPWWWMEDICALNEWSTODAYCOMMEDICALNEWSPHP NEWSID 0RICEWATERHOUSE#OOPERS INTERVIEW WITH 4HOMAS ( ,EE -$ NETWORK PRESIDENT FOR 0ARTNERS (EALTHCARE 3YSTEM !PRIL
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! !CHIEVING 0ATIENT #ENTRIC 1UALITY #ARE 4HROUGH 4ECHNOLOGY ! $ISCUSSION 7ITH +AISER 0ERMANENTE +AISER 0ERMANENTE +0 IS THE 53 LARGEST INTEGRATED HEALTHCARE ORGANIZATION "ASED IN /AKLAND #ALIF THE NONPROlT ORGANIZATION SERVES MILLION MEMBERS IN NINE STATES AND 7ASHINGTON $# +AISER 0ERMANENTE (EALTH#ONNECT4- IS THE NATIONS SINGLE LARGEST HEALTH INFORMATION TECHNOLOGY EFFORT ! MULTIBILLION DOLLAR INITIATIVE FOCUSED ON USING A COMMON SOFTWARE SYSTEM AND PROVIDING REAL TIME MEDICAL INFORMATION FOR ALL +AISER 0ERMANENTE REGIONS AND FACILITIES THE SYSTEMWIDE PROJECT HAS BEEN UNDER WAY SINCE AND IS EXPECTED TO BE FULLY IMPLEMENTED BY THE END OF )N ADDITION +AISER 0ERMANENTE RECENTLY LAUNCHED A PILOT PROGRAM CALLED h4HE ST #ENTURY #ARE )NNOVATION 0ROJECT v WITH THE GOAL OF TRANSFORMING THE PRIMARY CARE ENABLED BY +0 (EALTH#ONNECT AND FURTHERING EFFORTS TO DELIVER CARE IN A MORE PATIENT CENTRIC MANNER %NHANCING QUALITY HAS AN IMPORTANT ROLE IN THIS SYSTEM ACCORDING TO +AISERS EXECUTIVES 4O UNDERSTAND WHAT THE SYSTEM HAS LEARNED TO DATE 0RICEWATERHOUSE#OOPERS INTERVIEWED ,OUISE ,IANG -$ SENIOR VICE PRESIDENT FOR QUALITY AND CLINICAL SYSTEMS SUPPORT AND 2UTH "RENTARI PROGRAM MANAGER ABOUT THE +0 (EALTH#ONNECT 0ROGRAM
0RICEWATERHOUSE#OOPERS (OW DOES +AISER 0ERMANENTE DElNE QUALITY ,OUISE ,IANG 4HERE ISNT A SIMPLE ANSWER 7E NOW TALK ABOUT BIG 1 QUALITY WHICH HAS lVE ELEMENTS CLINICAL OUTCOMES SERVICE RISK MANAGEMENT RESOURCE STEWARDSHIP AND PATIENT SAFETY )N THE PAST IF YOU SAID QUALITY PEOPLE ASSUMED YOU MEANT ONLY CLINICAL OUTCOMES )F YOU MEANT SERVICE YOU TALKED ABOUT SERVICE SEPARATELY 4HE CURRENT DElNITION INCLUDES ALL THE ELEMENTS THAT MEMBERS OR PATIENTS CARE ABOUT )TS BEEN SOMEWHAT OF A MARKETING TOOL TO SEPARATE SAFETY FROM QUALITY RECENTLY AND FOR THE LIFT THAT IT HAS PROVIDED TO SAFETY ) APPLAUD IT BUT ) THINK ITS AN ARTIlCIAL DISTINCTION 0W# 4HE DIFFERENTIATION BETWEEN CLINICAL AND SERVICE QUALITY SEEMS TO BE A STICKY ISSUE 9OU GO OUT TO THE PATIENT AND YOU TALK ABOUT QUALITY AND THE lRST THING THEY COME BACK WITH IS SERVICE 3O HOW DO YOU GET TO THE ACTUAL CLINICAL PART IN TERMS OF MEASUREMENT ,, 4HE EXPERIENCE HAS BEEN FRUSTRATING BECAUSE SO FAR IT DOES NOT APPEAR THAT CONSUMERS MAKE CHOICES BASED ON CLINICAL QUALITY 7E HAVE NOT lGURED OUT HOW TO PROVIDE CLINICAL OUTCOME DATA THAT IS MEANINGFUL TO PATIENTS 3O HOW DO YOU MAKE CLINICAL INFORMATION MEANINGFUL 7HEN ) ARRIVED AT +AISER 0ERMANENTE
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
WE WERE DESCRIBING CLINICAL QUALITY IN THE USUAL WAY 7HEN WE TALKED ABOUT DIABETES WE TALKED ABOUT THE HEMOGLOBIN !CS 7ELL WHAT IS A HEMOGLOBIN !C WHY DOES IT MATTER AND WHO SHOULD CARE ;)T IS A BLOOD GLUCOSE TEST FOR DIABETES MANAGEMENT AMONG OTHER THINGS= 7E BEGAN OVERHAULING CHRONIC DISEASE REPORTS SO THEY REmECT OUTCOMES THAT ARE MEANINGFUL TO EVERYONE )NSTEAD OF TALKING ABOUT HEMOGLOBIN !CS WE ARE TALKING ABOUT AMPUTATIONS AVOIDED 9OU DONT NEED A MEDICAL DEGREE TO UNDERSTAND WHY THAT IS IMPORTANT AND WHAT DIRECTION THAT OUGHT TO BE GOING )F YOU WANT PEOPLE TO PAY ATTENTION YOU HAVE TO PUT IT IN TERMS THEY UNDERSTAND *UDGING BY PEOPLES BEHAVIOR QUALITY MEASUREMENT IS NOT MEANINGFUL YET )F IT WERE THEY WOULD BE MAKING CHOICES DIFFERENTLY 0W# +0 (EALTH#ONNECT USES TECHNOLOGY TO ENABLE COMMUNICATION BETWEEN THE CLINICIAN AND THE PATIENT (OW DO YOU REIMBURSE A CLINICIAN FOR TIME SPENT ON NEW MODES OF COMMUNICATION ,, 4HE STRENGTH OF A HEALTHCARE SYSTEM LIKE +AISER 0ERMANENTE IS THAT THE VAST MAJORITY OF OUR PATIENTS ARE STILL LARGELY PREPAID SO WE CAN lGURE OUT WHAT MAKES THE MOST SENSE FOR THEIR CARE AND DO IT 4HEREFORE WE HAVENT NEEDED TO MAKE CHANGES TO CLINICIAN REIMBURSEMENT AS WE HAVE OFFERED NON VISIT OPTIONS TO PATIENTS
1! 2UTH "RENTARI /UR TEAMS ARE LOOKING AT ALTERNATIVES TO THE FACE TO FACE VISIT 7ITH +0 (EALTH#ONNECT WE CAN DO A FOLLOW UP WITH A PATIENT THAT SAVES THE PATIENT THE COMMUTE AND THE PARKING HASSLE #LINICIANS CAN HAVE THE CONVERSATION WRITE THE NOTE WRITE ANY FOLLOW UP ORDERS IF NECESSARY AND BE DONE AT THE END OF THE TELEPHONE CONVERSATION 0ART OF WHAT WERE DOING WITH THE TECHNOLOGY IS LOOKING AT OUTREACH TO OUR MEMBERS AND BUILDING CAPACITY WITHIN THE DAY )F A CLINICIAN IS JUST DOING THE URGENT OFlCE WORK THEN HOW DO WE DO ALL THE OTHER OUTREACH WORK (OW DOES THAT RELATE TO ELECTRONIC CARE ) DONT THINK ANYBODY KNOWS THE RIGHT COMBINATION FOR HEALTH SERVICES PROVIDED VIA THE TELEPHONE OFlCE OR AN E VISIT 7ERE LOOKING AT WHAT REALLY MAKES SENSE AND WHEN WE NEED TO BRING THE PATIENT IN FOR THAT PHYSICAL EXAM 4HE OTHER TENET IS TRYING TO GIVE THE PATIENT THE CHOICE AROUND HOW THEY WANT TO HAVE INTERACTIONS $O THEY WANT TO COME IN $O THEY WANT E VISITS $O THEY WANT TELEPHONE VISITS OR GROUP VISITS
/UR PHYSICIANS HAVE CHOSEN +AISER 0ERMANENTE BECAUSE WE ARE EVIDENCE BASED AND THEY WANT TO HAVE THE FLEXIBILITY TO DO WHAT MAKES SENSE 4HE TECHNOLOGY MAKES IT EASIER TO HAVE THE CORRECT INFORMATION IMMEDIATELY AVAILABLE SO ONE OF THE THINGS WERE DESIGNING RIGHT NOW IS AN AUGMENTA TION TO THE MEDICAL RECORD )TS CALLED
AND IF THE PHYSICIANS ATTITUDE IS h4HIS IS GREAT ) CAN SHOW YOU HOW YOUR GLUCOSE IS DOING BECAUSE THE COMPUTER LETS ME CREATE A CHART RIGHT HERE 3O LETS TALK ABOUT WHAT THIS MEANS FOR YOU v THEN PATIENTS ARE VERY PLEASED WITH THE ELECTRONIC MEDICAL RECORD 4HE KEY DRIVER TO CLINICIAN ADOPTION AND SATISFACTION IS NOT NECESSARILY RELATED TO THE CLASSIC CLINICIAN DEMOGRAPHICS )TS TRUE THAT IF YOU GREW UP USING COMPUTERS ITS A LITTLE BIT EASIER AND ) THINK THAT SOME OF THE YOUNGER GENERATION IS MORE USED TO MULTITASKING 2EADING THE INFORMATION IN THE COMPUTER FORMATTING ASKING QUESTIONS LISTENING TO THE PATIENTS ANSWERS AND THEN RECORDING THE INFORMATION IS PRETTY COMPLICATED 7E DEVELOP SPECIAL TRAINING ON HOW TO HELP CLINICIANS WITH THAT WHILE MAINTAINING FOCUS ON THE PATIENT 2" /NE OF THE THINGS THAT WE HAVE ON THE HORIZON IS ONLINE PROXY ACCESS TO MEDICAL RECORDS BY ADULT CHILDREN FOR THEIR SENIOR PARENTS )TS A MAJOR SUPPORT TO HELP YOUR PARENTS BY BEING ABLE TO SEE WHAT THE DOCTOR IS REALLY SAYING /BVIOUSLY THAT REQUIRES LEGAL PERMISSION BUT THE SOFTWARE GIVES US THAT ABILITY AND THAT ADULTS hCHILDv CAN BE ANYWHERE IN THE COUNTRY 4HEY DONT HAVE TO BE A +AISER 0ERMANENTE MEMBER ,, /UR CORE PRINCIPLE IS THAT ITS THE PATIENT WHO DECIDES 7E NEVER WANT TO BE IN THE POSITION OF SAYING h9OU SHOULD HAVE A PHONE VISIT v OR h9OU SHOULD HAVE SECURE MESSAGING v IF THATS NOT YOUR CHOICE /UR GOAL IS TO INCREASE THE MENU OF CHOICES FOR PATIENTS AND WE BELIEVE STRONGLY THAT SECURE MESSAGING ;EMAIL= AND E VISITS ARE MOST APPROPRIATE IN THE CONTEXT OF AN ESTABLISHED RELATIONSHIP
0W# )S THIS LED BY THE TECHNOLOGY OR DOES THE TECHNOL OGY ENABLE THE THINKING AROUND THE INNOVATION 2" 4HATS SOMETHING WE STRUGGLE WITH -Y PERSPECTIVE IS THAT IT HAS TO BE DRIVEN BY OPERATIONAL LEADERS )F THE TECHNOLOGY FOLKS TRY TO DRIVE IT ITS NOT GOING TO BE SUCCESSFUL )NNOVATION IS OFTEN CREATED FROM THE GROUND UP BECAUSE CHANGE MANAGEMENT IS A HUGE THING 7E HAVE LOTS OF CONVERSATIONS IN THE ORGANIZATION AROUND WHETHER +0 (EALTH#ONNECT IS A TOOL A FOUNDATION OR hWHAT IS ITv )T IS A MAJOR CHANGE THOUGH FOR THE ORGANIZATION AND FOR MIDDLE MANAGEMENT
0W# )S +0 (EALTH#ONNECT AN ENABLER FOR MORE FOCUS ON EVIDENCE BASED MEDICINE ,, /UR PHYSICIANS HAVE CHOSEN +AISER 0ERMANENTE BECAUSE WE ARE EVIDENCE BASED AND THEY WANT TO HAVE THE mEXIBILITY TO DO WHAT MAKES SENSE 4HE TECHNOLOGY MAKES IT EASIER TO HAVE THE CORRECT INFORMATION IMMEDIATELY AVAILABLE SO ONE OF THE THINGS WERE DESIGNING RIGHT NOW IS AN AUGMENTATION TO THE MEDICAL RECORD )TS CALLED hCONTEXT SPECIlC SEARCHv 7HEN YOURE IN THE EXAM ROOM WITH A PATIENT AND YOU HAVE A PATIENT AND YOU WANT TO LOOK FOR A SPECIlC ARTICLE OR INFORMATION YOU DONT WANT TO BE SEARCHING THROUGH THE ENTIRE WEBSITE 3O WEVE DEVELOPED A FEATURE WHICH WILL SEARCH AND BRING FORWARD THE MOST LOGICAL INFORMATION BASED ON THE CLINICAL INFORMATION IN THE CHART 7E WANT TO MAKE IT AS EASY AS POSSIBLE SO THERE REALLY ISNT ANY BARRIER /UR CARE MANAGEMENT INSTITUTES MOTTO IS h-AKE THE RIGHT THING EASY TO DOv %VERYTHING WE PUT IN THE SYSTEM IS DEVELOPED APPROVED AND ADOPTED BY OUR MEDICAL GROUP LEADERSHIP
0W# 3TICKING WITH THAT THEME OF TECHNOLOGY AND IN TERACTION WITH THE PATIENT +AISER HAS WORKED WITH THE COMPUTER AS THE THIRD PERSON IN THE ROOM AND YOU PUT TOGETHER SOME PRETTY DETAILED HELPFUL HINTS ON HOW TO WORK WITH A PATIENT AND THE COMPUTER 7HAT ARE SOME LESSONS LEARNED ,, 7E HAVE FOUND THAT SUCCESSFUL ACCEPTANCE IS NOT ACTUALLY DRIVEN BY PATIENTS 4HE KEY DETERMINANT IS THE PHYSICIANS ATTITUDE
0W# 4HE 53 HEALTHCARE SYSTEM PAYS FOR VOLUME NOT QUALITY AND THATS SOMETHING THAT WEVE BEEN WRESTLING WITH FOR A LONG TIME 7HEN AND HOW DO YOU THINK WE WILL START PAYING FOR QUALITY AND NOT VOLUME ,, 7E NEED TO DECIDE WHETHER WE ARE GOING TO PAY FOR ACTUAL OUTCOMES OR PAY FOR PROCESS MEASURES 3O MUCH IS DRIVEN OFF ADMINISTRATIVE DATA AND THAT IS A PROBLEM BECAUSE ADMINISTRATIVE DATA HAS LONG BEEN KNOWN TO HAVE DRAWBACKS IN TERMS OF WHAT IT
@CONTEXT SPECIFIC SEARCH
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! 7HATS VERY CLEAR IS THAT WHEN PATIENTS HAVE REAL INFORMATION THE KIND OF INFOR MATION THAT CLINICIANS HAVE THEY MAKE BETTER DECISIONS 4HEY MAKE MORE IN FORMED DECISIONS AND THEY ARE HAPPIER WITH THE OUTCOME ESPECIALLY WHEN THE OUTCOME IS LESS THAN IDEAL BECAUSE THEY BELIEVE THEY HAD THE FACTS CONSID ERED THE RISKS AND MADE A CHOICE REALLY REmECTS )F WERE GOING TO MOVE THE SYSTEM AND GET THE BEST VALUE WE OUGHT TO BE PAYING FOR ACTUAL CLINICAL OUTCOMES !T THE END OF THE DAY DID THE PATIENT LIVE LONGER $ID HE HAVE A BETTER LIFE )TS AN ARGUMENT FOR ELECTRONIC MEDICAL RECORDS ;%-2S= SO WE CAN EASILY MEASURE CLINICAL OUTCOMES 7HEN ARE WE GOING TO GET THERE ) THINK AS LONG AS HEALTH PLANS ARE THE MAJOR SOURCE OF DATA AND THEYRE RELIANT ON ADMINISTRATIVE DATA WERE GOING TO BE PAYING FOR THE WRONG THINGS 5NTIL WE HAVE SIGNIlCANT ADOPTION OF %-2S WERE GOING TO BE SWIRLING AROUND LIKE WE HAVE FOR THE LAST OR YEARS ) ALSO THINK THAT IF PAYERS WANT TO USE THEIR LEVERAGE THEY CAN IN FACT BE THE CARROT FOR THE INVESTMENT IN %-2S 0W# 0ART OF WHAT WERE TALKING ABOUT IS DEMYSTIFY ING HEALTHCARE FOR THE PATIENT n GETTING A LANGUAGE WHERE THEY CAN UNDERSTAND THEIR CHOICES 7HAT IS THE PATIENTS ROLE 3HOULD WE EXPECT SOMETHING DIFFERENT FROM THE PATIENT ,, 7E HAVE AS AN INDUSTRY BY AND LARGE ONLY LEVERAGED HALF OF A TWO PARTY RELATIONSHIP 7HATS VERY CLEAR IS THAT WHEN PATIENTS HAVE REAL INFORMATION THE KIND OF INFORMATION THAT CLINICIANS HAVE THEY MAKE BETTER DECISIONS 4HEY MAKE MORE INFORMED DECISIONS AND THEY ARE HAPPIER WITH THE OUTCOME ESPECIALLY WHEN THE OUTCOME IS LESS THAN IDEAL BECAUSE THEY BELIEVE THEY HAD THE FACTS CONSIDERED THE RISKS AND MADE A CHOICE 7E NEED TO EQUIP PATIENTS TO UNDERSTAND THEIR HEALTH AND THEIR HEALTHCARE OPTIONS 4HATS ONE OF THE THINGS WERE TESTING IN OUR ST #ENTURY #ARE )NNOVATION 0ROJECT /NE OF THE CORE THEMES IS h(OME IS THE HUBv 4HE KEY MESSAGE IS THAT THE PATIENT IS IN OUR FACILITIES ONLY A COUPLE HOURS A YEAR %VEN VERY SICK PATIENTS ARENT WITH US THAT OFTEN 3O WHAT ABOUT ALL THAT OTHER TIME 4HE ONLY PEOPLE WHO CAN HAVE AN EFFECT ON THAT ARE NOT US BUT THE PATIENT AND THEIR FAMILY 5NLESS WE ARE PAYING ATTENTION TO SUPPORTING THEM IT IS VERY HARD TO SIGNIlCANTLY IMPROVE OUTCOMES )F YOU LIVE WITH YOUR DISEASE DAYS A YEAR YOU KNOW A LOT MORE ABOUT DETAILED SPECIlCS THAN A CLINICIAN WHO MAY HAVE MORE TECHNICAL INFORMATION BUT WHO SEES YOU FOR AN HOUR AND ONLY GETS A SLIVER OF INFORMATION ABOUT WHAT ALL THE ISSUES ARE !N ASTHMATIC KNOWS WHAT THE TRIGGERS TO HIS DISEASE ARE (E KNOWS HOW IT FEELS (E KNOWS WHAT TIPS HIM OVER AND HE KNOWS
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
HOW TO PREVENT ATTACKS 7EVE NEVER TAPPED INTO THAT KNOWLEDGE AND PARTNERSHIP EFFECTIVELY !S A START TO LEVERAGE PATIENTS IN IMPROVING OUTCOMES WE HAVE DEVELOPED A BROCHURE THAT WEVE GIVEN PATIENTS GOING INTO THE HOSPITAL TO EXPLAIN SOME OF OUR SAFETY PROCESSES AND PROCEDURES 4HEY ARE PROVIDED INFORMATION ABOUT WHAT THEY SHOULD EXPECT AND INSTRUCTED THAT IF ITS NOT HAPPENING THEY NEED TO SPEAK UP &OR EXAMPLE IF SOMEONE IS ABOUT TO EXAMINE YOU AND YOU HAVE NOT SEEN THEM WASH THEIR HANDS YOU SHOULD ASK -AYBE THEY WASHED THEM RIGHT OUTSIDE THE ROOM BUT WHAT WERE DOING IS ASKING THE PATIENT TO HELP ENSURE THE BEST CLINICAL OUTCOMES 0W# 7HAT HAS BEEN THE REACTION OR THE IMPRESSIONS OF CLINICIANS TO THAT !RE THEY READY FOR MORE EMPOW ERED CONSUMERS ,, )TS IMPERATIVE THAT WE MAKE IT CLEAR WHAT THE EXPECTED BEHAVIORS AND ACTIONS ARE WITH THE CLINICIANS lRST )TS A TIMING ISSUE n ARE WE READY TO BE CHALLENGED IF NEED BE BY OUR PATIENTS /UR HEAD OF SAFETY WANTS TO DO WHAT SOME AUTOMOBILE COMPANIES HAVE DONE FOR YEARS n HE WANTS ANY PATIENT TO BE ABLE TO hSTOP THE LINEv ) THINK ITS A VERY PROVOCATIVE IDEA BUT WERE NOT QUITE READY (OWEVER WE ARE READY FOR PATIENTS TO BE ASSERTIVE AND WE THINK THAT ENGAGING THE PATIENT IS VERY IMPORTANT TO IMPROVING CLINICAL OUTCOMES 0W# 7HAT OTHER TYPES OF QUALITY RELATED INNOVATIONS IS +AISER 0ERMANENTE INVOLVED IN ,, 7E ARE DEVELOPING THE ABILITY TO PORT INFORMATION FROM THE PATIENTS ONLINE HEALTH RISK ASSESSMENT INTO THE ELECTRONIC MEDICAL RECORD WITH THEIR PERMISSION 7E WILL DESIGNATE SPECIlC INFORMATION WHICH CAN TRIGGER VARIOUS RESPONSES ON OUR PART BASED ON INFORMATION FROM THE RISK ASSESSMENT !DDITIONALLY WE WILL BE DEVELOPING AN ORGANIZATIONWIDE FUNCTIONAL STATUS INSTRUMENT TO REmECT PATIENT CENTERED NEEDS &INALLY WE ARE DEVELOPING AN INTEGRATED TOOL TO REmECT ALL OF A PARTICULAR PATIENTS CLINICAL ISSUES 2IGHT NOW WE HAVE SEPARATE DIABETIC AND CARDIAC REGISTRIES 2" 7E CAN MISS ISSUES BECAUSE WERE NOT CONNECTED AND WE DONT SEE IT IN THAT LONGITUDINAL WAY 7E SEE IT IN A SPECIALTY AN EPISODE A HOSPITALIZATION ,, &OR EXAMPLE OUR DIABETIC AND CARDIAC REGISTRIES MAY HIGHLIGHT A PATIENTS DIABETIC PROBLEM FOR THE CLINICIAN OR NURSE AND THEN SOME TIME LATER THEIR CARDIAC PROBLEM 7E WANT TO DEVELOP AN INTEGRATED CARE RECOMMENDATION CUSTOMIZED FOR INDIVIDUAL PATIENTS CONSIDERING ALL OF THEIR CLINICAL ISSUES 0W# (OW DO YOU PLAN INNOVATIONS ,, 7E PICK EARLY ADOPTERS AND GIVE THEM APPROPRIATE SUPPORT AND OPPORTUNITY )N OUR ST #ENTURY #ARE )NNOVATION 0ROJECT THEY HAVE TIME DURING THEIR WORKDAYS TO MEET AS TEAMS AND lGURE OUT WHAT CHANGES THEYRE GOING TO MAKE 7EVE GIVEN THEM ANALYTIC SUPPORT SO THAT THEY DONT HAVE TO DO THEIR OWN DATA COLLECTION AND ANALYSIS 4HE WHOLE PRINCIPLE IS CREATING SUPPORT AND PERMISSION TO TRY ANYTHING 7E HAVE CREATED SPACE BY GIVING RESOURCES LEADERSHIP SUPPORT AND EXPERT ADVISORS n
4HE 0AY FOR 0ERFORMANCE ,ANDSCAPE ! DRAMATIC INCREASE IN THE NUMBER OF PAY FOR PERFORMANCE PROGRAM SPONSORS MARKS A SIGNIlCANT SHIFT TOWARD ALIGNMENT OF QUALITY CARE AND SERVICE REIMBURSEMENT n A KEY DRIVER OF FUTURE lNANCIAL CLINICAL AND QUALITY IMPROVEMENTS
"Y (INDY 3HAMAN AND 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
7
HEN THE )NSTITUTE OF -EDICINE WHICH ADVISES THE NATION ON SCIENCE AND HEALTH POLICY MATTERS RECOMMENDED THAT PROVIDERS AND PAYERS hBETTER ALIGN QUALITY WITH REIMBURSEMENT v THE EARTH DIDNT MOVE IMMEDIATELY;= "UT THE SHIFT WAS UNDER WAY SETTING UP A DRAMATIC CHANGE IN HOW HEALTH SERVICES AND TREATMENTS ARE PAID !CCORDING TO A STUDY CONDUCTED BY -ED 6ANTAGE THE NUMBER OF PAY FOR PERFORMANCE PROGRAM SPONSORS HAS SIGNIlCANTLY INCREASED 4HIRTY lVE PROGRAMS WERE IN PLACE IN IN IN AND BY 4HESE PROGRAMS ARE ESTIMATED TO COVER MORE THAN MILLION BENElCIARIES;= "Y MANY INDICATIONS THE HEALTHCARE INDUSTRY IS APPROACHING A SURGE IN QUALITY REPORTING AND PAY FOR PERFORMANCE INITIATIVES 2ESEARCH REVEALS THAT PERCENT OF HEALTH LEADERS THINK PAY FOR PERFORMANCE MODELS WILL BE THE NORM FOR HEALTHCARE DELIVERY IN THE NEXT lVE TO YEARS;= !T ITS CORE PAY FOR PERFORMANCE ENCOURAGES QUALITY AND PATIENT SATISFACTION THROUGH PAYMENT INCENTIVES 5LTIMATELY PAY FOR PERFORMANCE IS INTENDED TO DRIVE LASTING AND MEANINGFUL IMPROVEMENTS IN lNANCIAL CLINICAL AND SATISFACTION PERFORMANCE #OMMON ELEMENTS OF THESE PROGRAMS INCLUDE %VIDENCE BASED CLINICAL MEASURES 0ATIENT SAFETY MEASURES 0ATIENT SATISFACTION MEASURES %FlCIENCY MEASURES )NFORMATION TECHNOLOGY INFRASTRUCTURE &INANCIAL INCENTIVES AND 0AYMENT CALCULATIONS ! PAY FOR PERFORMANCE NATIONAL STANDARD DOES NOT EXIST SO PLANS VARY IN THE METHODS USED TO MEASURE AND REWARD QUALITY /NE HEALTH PLANS PAY FOR PERFORMANCE SCORECARD IS SHOWN IN %XHIBIT 4HIS SCORECARD FROM "LUE #ROSS AND "LUE 3HIELD OF )LLINOIS COULD BE DESCRIBED AS A hBEST OF BREEDv IN THAT IT COMBINES MEASURES FROM SEVERAL SOURCES ! PROVIDERS SCORE WILL DETERMINE THE LEVEL
OF INCREASE RECEIVED IN THE FOLLOWING YEARS NEGOTIATION WITH THE PLAN h7E HAVE WORKED COLLABORATIVELY WITH PROVIDERS TO DEVELOP A PROGRAM THAT REWARDS SUPERIOR PERFORMANCE !S A RESULT WE ARE SEEING IMPROVEMENTS IN THE OVERALL QUALITY OF CARE v SAID "RAD "UXTON DIVISIONAL SENIOR VICE PRESIDENT HEALTH CARE MANAGEMENT FOR (EALTH #ARE 3ERVICE #ORP WHICH OPERATES "LUE #ROSS AND "LUE 3HIELD PLANS IN )LLINOIS .EW -EXICO /KLAHOMA AND 4EXAS (E CONTINUES h!BOUT EIGHT YEARS AGO WE STARTED MEASURING OUTCOMES FOR MEMBERS IN OUR (-/ 7E LOOKED AT (%$)3 RESULTS AND TIED IT TO AN INCENTIVE POOL AND REPORTED THE RESULTS TO OUR MEMBERS 2ESULTS IMPROVED BY OVER PERCENT IN SOME CASESv -OREOVER THE PAY FOR PERFORMANCE MOVEMENT IS A RELATIVELY RECENT ONE WITH THE OLDEST PROGRAMS DATING BACK ONLY FOUR YEARS !ND DIFFERENT GEOGRAPHIC REGIONS VARY IN THEIR IMPLEMENTATION OF AND READINESS FOR PAY FOR PERFORMANCE DEPENDING ON THE DEGREE OF PAYER AND PROVIDER CONSOLIDATION AND EXISTENCE OF AN INFORMATION TECHNOLOGY BACKBONE TO SUPPORT DATA COLLECTION AND REPORTING SEE %XHIBITS AND ! FEW OF THE LARGER MORE ESTABLISHED PAY FOR PERFORMANCE PROGRAMS HAVE STARTED TO YIELD RESULTS "RIDGES 4O %XCELLENCE "4% n &OUNDED IN BY A NOT FOR PROlT COALITION OF LARGE EMPLOYERS "4% INCLUDES THREE SUBCOMPONENTS THAT PROVIDE BONUSES TO PHYSICIANS WHO MEET CRITERIA IN DIABETES CARE CARDIOVASCULAR CARE AND PATIENT CARE MANAGEMENT 0ARTICIPATION IS VOLUNTARY FOR PHYSICIANS AND THE PROGRAM REQUIRES PHYSICIANS TO PASS ASSESSMENTS ESTABLISHED BY THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE 5NLIKE MOST PAY FOR PERFORMANCE PROGRAMS THAT PULL DATA FROM INSURANCE CLAIMS THE PROGRAM USES DATA OBTAINED FROM MEDICAL CHARTS 4HE PHYSICIAN OFlCE PROGRAM REWARDS PHYSICIANS ON ELEMENTS SUCH AS PATIENT ACCESS AND COMMUNICATION ELECTRONIC PRESCRIBING INTEROPERABILITY OF ELECTRONIC SYSTEMS PERFORMANCE REPORTING AND IMPROVEMENT 4OP PERFORMING PHYSICIANS RECEIVE A PERCENT INCREASE IN REIMBURSEMENT FOR THE
(INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM 4IM 7ILSON -$ IS A FAMILY DOCTOR IN THE 5NITED +INGDOM !FTER WORKING AT THE HIGHEST LEVEL IN GOVERNMENT HE MOVED TO 0RICEWATERHOUSE#OOPERS WHERE HE IS SENIOR ADVISOR ON CLINICAL PERFORMANCE IMPROVEMENT (E HAS PUBLISHED EXTENSIVELY ON THE SUBJECTS OF QUALITY AND SAFETY (E CAN BE REACHED AT TIMWILSON UKPWCCOM # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGDãO @X ENQ OD QE NQL @MBD ãK@MCRB@OD %XHIBIT "LUE #ROSS AND "LUE 3HIELD OF )LLINOIS !NNUAL (OSPITAL 0ROlLE (OSPITAL 2ESULTS ,EAPFROG )#5 0HYSICIAN 3TAFlNG )03 3TANDARD 3UBMISSION OF SURVEY TO ,EAPFROG FOR PUBLIC REPORTING 0ROGRESS TOWARD MEETING THE ,EAPFROG )03 STANDARD ,EAPFROG #OMPUTER 0HYSICIAN /RDER %NTRY #0/% 3TANDARD 3UBMISSION OF SURVEY FOR PUBLIC REPORTING 0ROGRESS TOWARD MEETING THE ,EAPFROG #0/% STANDARD .ATIONAL 1UALITY &ORUM 3AFE 0RACTICES 3UBMISSION OF SURVEY TO ,EAPFROG ON SAFE PRACTICES OR PARTICIPATION IN 4EXAS -EDICAL )NSTITUTE OF 4ECHNOLOGY TEST BED AND SUBMISSION OF SURVEY WITH PERMISSION TO RELEASE QUARTILE TO "#"3), 0ROGRESS TOWARD MEETING THE ,EAPFROG .1& SAFE PRACTICES STANDARD (OSPITAL -EMBER 3URVEY /VERALL SATISFACTION COMPOSITE SCORE BASED ON / VERALL HOW WOULD YOU RATE THE QUALITY OF CARE YOU RECEIVED IN THE HOSPITAL DURING YOUR STAY %XCELLENT OR 6ERY 'OOD 7 OULD YOU RETURN TO THIS HOSPITAL FOR CARE IN THE FUTURE $ElNITELY 9ES OR 0ROBABLY 9ES ( OW LIKELY WOULD YOU BE TO RECOMMEND THIS HOSPITAL TO A FRIEND OR RELATIVE $ElNITELY 2ECOMMEND OR 0ROBABLY 2ECOMMEND %DUCATION AND #OORDINATION OF #ARE #OMPOSITE 3CORE 4HIS SCORE IS BASED ON THE FOLLOWING QUESTIONS 2 ATE YOUR INVOLVEMENT WITH DECISION MAKING ABOUT YOUR CARE %XCELLENT OR 6ERY 'OOD 2 ATE THE EDUCATION YOU WERE GIVEN ABOUT YOUR MEDICAL CONDITION %XCELLENT OR 6ERY 'OOD & OR MEMBERS RECEIVING MEDICATION RATE THE EDUCATION YOU RECEIVED ABOUT YOUR MEDICATIONS %XCELLENT OR 6ERY 'OOD & OR MEMBERS THAT RECEIVED DIAGNOSTIC TESTS RATE THE EXPLANATION OF WHAT WOULD HAPPEN DURING YOUR TESTS %XCELLENT OR 6ERY 'OOD & OR MEMBERS THAT RECEIVED WRITTEN DISCHARGE INSTRUCTIONS RATE YOUR UNDERSTANDING OF THESE INSTRUCTIONS %XCELLENT OR 6ERY 'OOD & OR MEMBERS UNDERGOING SURGERY RATE THE EDUCATION YOU RECEIVED ABOUT THE PURPOSE AND RISKS OF YOUR SURGERY %XCELLENT OR 6ERY 'OOD $ ID YOU RECEIVE EDUCATION ABOUT ANY NEW MEDICATIONS PRESCRIBED 9ES $ ID YOU RECEIVE INSTRUCTIONS FOR A FOLLOW UP VISIT TO YOUR PHYSICIAN 9ES %FlCIENCY 5TILIZATION EFlCIENCY 4HE RATIO OF ACTUAL !,/3 TO PREDICTED !,/3 BASED ON -ILLIMAN 53! 7ELL -ANAGED -ODEL FOR THE HOSPITALS CASE MIX IS REPORTED !DMINISTRATIVE EFlCIENCY 0 ERCENT OF "#"3), CLAIMS SUBMITTED ELECTRONICALLY . UMBER OF PAPER CLAIMS THAT ARE DUPLICATE )NQUIRIES ( OSPITAL HAS 4(). /NLINE ( OSPITAL INQUIRY TO CLAIMS RATIO !(21 )NDICATORS 3ELECTED INFECTIONS DUE TO MEDICAL CARE 0OSTOPERATIVE PULMONARY EMBOLISM OR DEEP VEIN THROMBOSIS 0OSTOPERATIVE RESPIRATORY FAILURE 0OSTOPERATIVE SEPTICEMIA /BSTETRIC TRAUMA n VAGINAL DELIVERY WITHOUT INSTRUMENT $ECUBITUS ULCER !CCIDENTAL PUNCTURE OR LACERATION &AILURE TO RESCUE )NPATIENT QUALITY INDICATORS MORTALITY RATES FOR ACUTE MYOCARDIAL INFARCTION CONGESTIVE HEART FAILURE ACUTE STROKE GASTROINTESTINAL HEMORRHAGE HIP FRACTURE PNEUMONIA
-AX 0OINTS 0OSSIBLE
0OINTS %ARNED
#ONTINUED ON THE NEXT PAGE
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
SGDãO @X ENQ OD QE NQL @MBD ãK@MCRB@OD %XHIBIT CONTINUED "LUE #ROSS AND "LUE 3HIELD OF )LLINOIS !NNUAL (OSPITAL 0ROlLE 0HYSICIAN 3URVEY /VERALL QUALITY OF CARE 0HARMACY PROVIDES MEDS CORRECTLY !DEQUACY OF NUMBER OF NURSES !CCURACY OF PROCESSING DOCTOR ORDERS 1UALITY OF DISCHARGE PLANS 4IMELY IMPLEMENTATION OF ORDERS 4IMELINESS OF IMAGELAB REPORTS MEETS NEEDS FOR CLINICAL DECISIONS (OSPITAL TAKES APPROPRIATE STEPS TO PROTECT SAFETY OF PATIENTS 2. STAFF HAS NECESSARY CLINICAL SKILLS TO PROVIDE APPROPRIATE CARE FOR SPECIlC UNITS IN WHICH THEY WORK (OSPITAL 1UALITY !LLIANCE #-3 *#!(/ !CUTE -YOCARDIAL )NFARCTION !SPIRIN AT ARRIVAL !SPIRIN PRESCRIBED AT DISCHARGE !#% INHIBITOR FOR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION "ETA BLOCKER AT ARRIVAL "ETA BLOCKER PRESCRIBED AT DISCHARGE 0#) WITHIN MINUTES OF ARRIVAL !DULT SMOKING CESSATION ADVICECOUNSELING (EART &AILURE ,EFT VENTRICULAR FUNCTION ASSESSMENT !#% INHIBITOR FOR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION $ISCHARGE INSTRUCTIONS !DULT SMOKING CESSATION ADVICECOUNSELING 0NEUMONIA /XYGENATION ASSESSMENT 0NEUMOCOCCAL VACCINATION STATUS !DULT SMOKING CESSATIONADVICE COUNSELING )NITIAL ANTIBIOTIC WITHIN HOURS AFTER ARRIVAL -OST APPROPRIATE INITIAL ANTIBIOTIC "LOOD CULTURES PERFORMED BEFORE lRST ANTIBIOTIC RECEIVED IN HOSPITAL 3URGICAL )NFECTION 0REVENTION 0REVENTIVE ANTIBIOTIC HOUR BEFORE INCISION 0REVENTIVE ANTIBIOTIC STOPPED WITHIN HOURS AFTER SURGERY 3TRUCTURAL )NDICATORS 0ERCENTAGE OF PHYSICIANS ON MEDICAL STAFF WHO ARE BOARD CERTIlED !CCREDITATION STATUS 0ARTICIPATION IN 3TATE AND .ATIONAL 1UALITY )MPROVEMENT )NITIATIVES %XTRA #REDIT IE !MERICAN (EART !SSNS 'ET WITH THE 'UIDELINES !## DATABASE 343 DATABASE )() ,IVES #AMPAIGN 4/4!, 0/33)",% 0/).43
SUBSET OF THEIR PATIENTS THAT ARE INVOLVED IN THE PROGRAM #URRENTLY THE "4% PROGRAM SERVES PATIENTS ACROSS DIFFERENT MARKETS;= !S OF &EBRUARY THE PROGRAM HAD AWARDED APPROXIMATELY MILLION TO PARTICIPATING PHYSICIANS;= /N AN ANNUAL BASIS THE COST FOR DIABETIC CARE BY A PARTICIPATING ENDOCRINOLOGIST WAS LESS WITH MOST OF THE SAVINGS FROM A REDUCTION IN INPATIENT COSTS;= )NTEGRATED (EALTHCARE !SSOCIATION )(! n ! CONSORTIUM OF SEVEN LARGE #ALIFORNIA HEALTH PLANS AND MEDICAL GROUPS THE )(! PROGRAM IS THE LARGEST PAY FOR PERFORMANCE PROGRAM IN THE COUNTRY )(! USES A QUALITY SCORECARD STRUCTURE THAT COVERS THREE BROAD CATEGORIES CLINICAL QUALITY PATIENT SATISFACTION AND INFORMATION TECHNOLOGY )4 INVESTMENT WHICH ACCOUNT FOR PERCENT
(OSPITAL 2ESULTS
-AX 0OINTS 0OSSIBLE
0OINTS %ARNED
PERCENT AND PERCENT OF THE TOTAL SCORE RESPECTIVELY;= %IGHTY SEVEN PERCENT OF THE GROUPS REPORTING ALL CLINICAL MEASURES IMPROVED THEIR OVERALL CLINICAL SCORE BY AN AVERAGE OF PERCENTAGE POINTS BETWEEN AND ;= )(!S PERFORMANCE RESULTS HAVE SHOWN A CORRELATION BETWEEN )4 AND CLINICAL SCORES )(! FOUND THAT PHYSICIAN GROUPS THAT RECEIVED FULL CREDIT ON )4 MEASURES HAD CLINICAL SCORES THAT WERE ABOUT NINE PERCENTAGE POINTS HIGHER THAN MEDICAL GROUPS THAT SHOWED NO EVIDENCE OF )4 ADOPTION;= )N THE ORGANIZATION PAID OUT MILLION TO PHYSICIANS WHO MET QUALITY STANDARDS;= #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3 n #-3 HAS TWO MAJOR HOSPITAL PAY FOR PERFORMANCE INITIATIVES UNDER WAY THE (OSPITAL 1UALITY )NITIATIVE AND THE 0REMIER (OSPITAL 1UALITY
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGDãO @X ENQ OD QE NQL @MBD ãK@MCRB@OD %XHIBIT 0AY FOR 0ERFORMANCE 2EADINESS 2ANKING
.OTE 4HIS MAP IDENTIlES PAY FOR PERFORMANCE READINESS OF THE LARGEST METROPOLITAN STATISTICAL AREAS IN THE 53 BASED ON POPULATION SIZE 4HOSE AREAS WITH A HIGHER DEGREE OF CONSOLIDATION AMONG THEIR HEALTH PLANS HOSPITALS AND PHYSICIANS ACCORDING TO DATA OBTAINED FROM (EALTH,EADERS -3! 2EPORTS AND AN ESTABLISHED INFORMATION TECHNOLOGY INFRASTRUCTURE IE THEY WERE IN )NTELS RANKING OF THE TOP WIRELESS CITIES OBTAINED AT HTTPWWWINTELCOMPERSONALWIRELESSUNWIREDCITIESINDEXHTM WERE RATED AS MORE READY FOR PAY FOR PERFORMANCE
)NCENTIVE $EMONSTRATION 0ROJECT 5NDER THE (OSPITAL 1UALITY )NITIATIVE ELIGIBLE HOSPITALS CAN RECEIVE THEIR FULL ANNUAL UPDATE UNDER THE INPATIENT PROSPECTIVE PAYMENT SYSTEM IF THEY SUBMIT DATA ON QUALITY MEASURES FOR ACUTE MYOCARDIAL INFARCTION HEART FAILURE AND PNEUMONIA THESE ARE THE SAME MEASURES THAT FORM THE hSTARTER SETv OF THE VOLUNTARY REPORTING EFFORT ESTABLISHED BY THE (OSPITAL 1UALITY !LLIANCE /THERWISE ELIGIBLE HOSPITALS THAT DO NOT PARTICIPATE IN THE INITIATIVE BY REPORTING THE REQUIRED DATA BY THE ESTABLISHED DEADLINES WILL RECEIVE A PERCENTAGE POINT REDUCTION IN THEIR ANNUAL -EDICARE PAYMENT UPDATE )N HOSPITALS NOT REPORTING ON AN EXPANDED SET OF MEASURES WILL RECEIVE A PERCENTAGE POINT REDUCTION IN THEIR PAYMENT UPDATE;= #-3 SECOND HOSPITAL INCENTIVE PROGRAM THE 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION 0ROJECT BEGAN IN AND INVOLVES MORE THAN HOSPITALS 0REMIER A NATIONAL GROUP PURCHASING ORGANIZATION MANAGES THE PROJECT WHICH COLLECTS DATA ON MORE THAN QUALITY MEASURES RELATING TO ACUTE MYOCARDIAL INFRACTION HEART FAILURE CORONARY ARTERY BYPASS GRAFT PNEUMONIA AND HIP AND KNEE REPLACEMENT (OSPITALS SCORING IN THE TOP PERCENT FOR A GIVEN SET OF QUALITY MEASURES RECEIVE A PERCENT -EDICARE PAYMENT BONUS FOR THE ASSOCIATED $2' 4HOSE SCORING IN THE NEXT HIGHEST PERCENT RECEIVE A PERCENT BONUS ! lRST YEAR REPORT /CTOBER TO 3EPTEMBER OF THE DEMONSTRATION SHOWED THAT THE QUALITY OF CARE PROVIDED BY PARTICIPATING HOSPITALS IMPROVED SIGNIlCANTLY IN EACH OF THE lVE
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
CLINICAL AREAS 4HE GREATEST IMPROVEMENTS WERE IN PNEUMONIA WHERE THE OVERALL AVERAGE COMPOSITE QUALITY SCORE #13 RATE INCREASED PERCENT 4HE LOWEST CHANGE IN THE #13 WAS A PERCENT INCREASE IN ACUTE MYOCARDIAL INFARCTION 4HE DEMONSTRATION IS CURRENTLY IN ITS THIRD YEAR AND HOSPITALS IN THE BOTTOM PERCENT MUST EXCEED A QUALITY SCORING THRESHOLD OR BE SUBJECT TO REDUCTIONS OF OR PERCENT OF THEIR #-3 REIMBURSEMENT;= !DDITIONAL PAY FOR PERFORMANCE PROJECTS OPERATED BY #-3 INCLUDE THE 0HYSICIAN 'ROUP 0RACTICE $EMONSTRATION WHICH BEGAN IN !PRIL WITH LARGE PHYSICIAN GROUPS AND THE #HRONIC #ARE )MPROVEMENT PILOT PROGRAM THAT IS TESTING A POPULATION BASED MODEL OF DISEASE MANAGEMENT )N THE LATTER PROVIDERS RECEIVE A MONTHLY PER BENElCIARY FEE FOR MANAGING CHRONICALLY ILL BENElCIARIES WITH ADVANCED CONGESTIVE HEART FAILURE ANDOR COMPLEX DIABETES 4HE -EDICARE -ODERNIZATION !CT --! MANDATES ADDITIONAL PROGRAMS THAT #-3 WILL IMPLEMENT IN THE FUTURE 4HE -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION --! SECTION IS A THREE YEAR PAY FOR PERFORMANCE PROGRAM WITH SMALL AND MEDIUM SIZED PHYSICIAN PRACTICES TO PROMOTE THE ADOPTION AND USE OF HEALTH INFORMATION TECHNOLOGY TO IMPROVE THE QUALITY OF PATIENT CARE FOR CHRONICALLY ILL -EDICARE PATIENTS 4HE -EDICARE (EALTH #ARE 1UALITY $EMONSTRATION --! SECTION IS A lVE YEAR PROGRAM IN WHICH PHYSICIAN GROUPS INTEGRATED HEALTH SYSTEMS AND REGIONAL COALITIONS ENHANCE QUALITY BY IMPROVING
SGDãO @X ENQ OD QE NQL @MBD ãK@MCRB@OD %XHIBIT -ARKETS -OST 2EADY FOR 0AY FOR 0ERFORMANCE AND 3OME OF 4HEIR !CTIVITIES -3! "OSTON -!
0OPULATION
#HARLOTTE .# #OLUMBUS /( $ENVER #/ +ANSAS #ITY -/ -ILWAUKEE 7) -INNEAPOLIS -. 3ACRAMENTO #!
3AN $IEGO #!
3AN &RANCISCO #!
0AY FOR 0ERFORMANCE 0ROGRAMS "RIDGES 4O %XCELLENCE -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION (-/ "LUE 'ROUP 0ERFORMANCE )NCENTIVE 0ROGRAM 1UALITY )NCENTIVES 2EWARDING 2ESULTS "RIDGES 4O %XCELLENCE #HARLOTTE (EALTH #ARE #OLLABORATION 0ROJECT "RIDGES 4O %XCELLENCE "RIDGES 4O %XCELLENCE 0HYSICIAN 'ROUP 0ARTNERS 0ROGRAM %MPLOYEE 'ROUP (EALTH "ENElT 0ROGRAM "RIDGES 4O %XCELLENCE /UTCOMES 2ECOGNITION 0ROGRAM )NTEGRATED (EALTHCARE !SSOCIATION -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION 00/ 0HYSICIAN 1UALITY AND )NCENTIVE 0ROGRAM )NTEGRATED (EALTHCARE !SSOCIATION -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION 00/ 0HYSICIAN 1UALITY AND )NCENTIVE 0ROGRAM )NTEGRATED (EALTHCARE !SSOCIATION -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION 00/ 0HYSICIAN 1UALITY AND )NCENTIVE 0ROGRAM
PATIENT SAFETY REDUCING VARIATIONS IN UTILIZATION BY APPROPRIATE USE OF EVIDENCE BASED CARE AND BEST PRACTICE GUIDELINES ENCOURAGING SHARED DECISION MAKING AND USING CULTURALLY AND ETHNICALLY APPROPRIATE CARE 5+ &AMILY $OCTOR #ONTRACT n )N WHAT HAS BEEN DESCRIBED AS THE LARGEST PAY FOR PERFORMANCE EXPERIMENT IN THE WORLD FAMILY PRACTITIONERS NOW RECEIVE BONUSES FOR ACHIEVING CERTAIN QUALITY METRICS; = 4HE CONTRACT WAS GROUNDBREAKING IN MANY WAYS INSTEAD OF BEING ON THE LIST OF AN INDIVIDUAL DOCTOR PATIENTS WERE REGISTERED WITH THE WHOLE PRACTICE TEAM !S WITH THE PREVIOUS CONTRACT MOST PAYMENTS STEM FROM THE NUMBER OF PATIENTS ON A PRACTICE LIST (OWEVER UNDER THE NEW CONTRACT THE NUMBER IS WEIGHTED FOR SOCIOECONOMIC STATUS AGE AND SEX OF THE PATIENTS )N ADDITION INCOME CAN BE BOOSTED BY AS MUCH AS PERCENT DEPENDING ON ACHIEVEMENT OF DIFFERENT INDICATORS FOR SPECIlC CHRONIC DISEASES LIKE DIABETES CORONARY HEART DISEASE AND ASTHMA !T THE LOWEST END OF THE SCALE POINTS ARE AWARDED FOR SIMPLE THINGS LIKE HAVING A DISEASE REGISTRY -ORE POINTS ARE AWARDED FOR PROCESS MEASURES LIKE TAKING BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION 4HE HIGHEST POINTS ARE AWARDED FOR PROXY OUTCOME MEASURES LIKE SUCCESSFULLY CONTROLLING BLOOD PRESSURE BELOW A TARGET IN A SIGNIlCANT NUMBER OF THE TARGET GROUP )N ALL PRACTICES CAN GAIN POINTS WITH EACH POINT BEING WORTH AROUND AND THEN MULTIPLIED UP OR DOWN ACCORDING TO THE NUMBER OF PATIENTS WITH EACH CHRONIC DISEASE A PREVALENCE FACTOR 4HE RESULTS HAVE BEEN IMPRESSIVE WITH MOST PRACTICES ACHIEVING MORE THAN POINTS AND MANY ACHIEVING THE MAXIMUM 4HE POSITIVE INTERPRETATION IS THAT MORE PATIENTS WILL GET EVIDENCE BASED CARE AND HEALTH INEQUALITIES WILL NARROW 4HE CONTRACT HAS LED TO A PERCENT PAY RAISE FOR MANY PHYSICIANS 4HE MAGNITUDE OF THE CHANGE CAUGHT THE GOVERNMENT BY SURPRISE BECAUSE THE BUDGET EXPECTED PRACTICES TO ACHIEVE AROUND
POINTS !S A RESULT THE CONTRACT WAS RECENTLY RENEGOTIATED WITH A SLIGHTLY DIFFERENT POINT SYSTEM AND A TWO YEAR PAY FREEZE %NDNOTES h#ROSSING THE 1UALITY #HASM ! .EW (EALTH 3YSTEM FOR THE ST #ENTURY v )NSTITUTE OF -EDICINE .ATIONAL !CADEMY 0RESS h0ROVIDER PAY FOR PERFORMANCE NATIONAL STUDY RESULTS v -ED 6ANTAGE AVAILABLE AT HTTPWWWMEDVANTAGEINCCOM0DF-6? ?00?.ATIONAL?3TUDY?2ESULTS %XEC?3UMMARYPDF ()-33 6ANTAGE 0OINT 3URVEY *ANUARY HTTPWWWBRIDGESTOEXCELLENCEORG ACCESSED ON "RIDGES 4O %XCELLENCE %XECUTIVE 3UMMARY &EBRUARY &EBRUARY HTTPWWWBRIDGESTOEXCELLENCEORGBTEPDF%XECUTIVE? 3UMMARY?&EBRUARY??2EPORT? PDF "RIDGES 4O %XCELLENCE HTTPWWWBRIDGESTOEXCELLENCEORGPDF 4HESIS?COMPLETE? ?EDITPDF !DVANCING 1UALITY 4HROUGH #OLLABORATION 4HE #ALIFORNIA 0AY FOR 0ERFORMANCE 0ROGRAM ! 2EPORT ON THE &IRST &IVE 9EARS AND A 3TRATEGIC 0LAN FOR THE .EXT &IVE 9EARS &EBRUARY HTTPWWWIHAORG WPPDF )BID )BID h3IDEBAR (EALTH 'ROUPS 5SE )4 TO )MPROVE 0ATIENT #ARE v #OMPUTERWORLD &EBRUARY HTTPWWWCOMPUTERWORLDCOM DATABASETOPICSBUSINESSINTELLIGENCESTORY HTML h2EPORTING (OSPITAL 1UALITY $ATA FOR !NNUAL 0AYMENT 5PDATE v #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES HTTPWWWCMSHHS GOV(OSPITAL1UALITY)NITS?(OSPITAL2(1$!05ASP4OP/F0AGE ACCESSED -AY #ENTERS FOR -EDICARE -EDICAID 3ERVICES #-3 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION 0ROJECT n 0ROGRAM /VERVIEW AND +EY &INDINGS FROM 9EAR /NE !PRIL HTTPWWWITPREMIERINCCOM ALLQUALITYHQIRESOURCES(1)WHITEPAPER PDF 2OLAND - h,INKING PHYSICIANS PAY TO THE QUALITY OF CAREnA MAJOR EXPERIMENT IN THE 5NITED +INGDOM . %NGL * -ED 3EPTEMBER PP 7ILSON 4 AND - 2OLAND # (AM h4HE CONTRIBUTION OF GENERAL PRACTICE AND THE GENERAL PRACTITIONER TO .(3 PATIENTS v * 2 3OC -ED VOL PP n # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
"LUE #ROSS AND "LUE 3HIELD OF -INNESOTA (EALTHCARE &ACTS¸ ! .EW -ODEL FOR (OSPITAL 2EPORTING "ASED ON #ONSUMER %NGAGEMENT 2ETHINKING QUALITY METRICS FROM THE CONSUMERS POINT OF VIEW MEANS USING FAMILIAR LANGUAGE FORMATS AND TOOLS TO SUPPORT INFORMED PARTICIPATION IN THE HEALTHCARE DECISION MAKING PROCESS
"Y -ARY!NN 3TUMP AND 4AMARA , 9OUNG "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA
/
VER THE PAST DECADE AN INCREASING AMOUNT OF ATTENTION HAS BEEN PAID TO PERFORMANCE MEASUREMENT OF THE 5NITED 3TATES HEALTHCARE SYSTEM PARTICULARLY IN THE FORM OF hREPORT CARDSv 5NTIL RECENTLY MOST EFFORTS TO GATHER AND DISTRIBUTE INFORMATION ON QUALITY OF CARE HAVE CENTERED ON THE HEALTH PLAN OR ORGANIZATIONAL ACCREDITATION REQUIREMENTS 7HILE THESE EFFORTS PROVIDE READY INFORMATION FOR HEALTHCARE PROFESSIONALS CONSUMERS ARE LEFT WITH LITTLE OR NO QUALITY INFORMATION ABOUT HEALTHCARE PROVIDERS WHETHER INDIVIDUAL PHYSICIANS CLINICS HOSPITALS OR NURSING HOMES #ONSUMERS NEED QUALITY INFORMATION SPECIlCALLY DESIGNED TO ASSIST IN THE HEALTHCARE DECISION MAKING PROCESS; = 4HIS ARTICLE DESCRIBES A NEW CONSUMER INFORMATION TOOL DESIGNED TO MEET THAT NEED (EALTHCARE &ACTS WWWHEALTHCAREFACTSORG $EVELOPED BY "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA (EALTHCARE &ACTS IS FUELED BY THE IDEA THAT INCREASED CONSUMER PARTICIPATION IN HEALTHCARE MEANS MOVING TOWARD THE IDEA OF hBEST lTv AND hVALUEv FOR INDIVIDUAL CONSUMERS )NSTEAD OF EMPLOYERS HEALTH PLANS OR GOVERNMENT DETERMINING WHICH PROVIDERS ARE hBESTv AND SUBSEQUENTLY STEERING CONSUMERS TO THOSE PROVIDERS (EALTHCARE &ACTS INFORMS THE CONSUMERS EQUIPPING THEM TO MAKE THE lNAL DECISION (EALTHCARE &ACTS CURRENTLY PROVIDES INFORMATION FOR HOSPITALS IN -INNESOTA AND ,OUISIANA AND A PRIMARY CLINIC VERSION IN -INNESOTA WAS INTRODUCED IN !UGUST 7E ENVISION (EALTHCARE &ACTS AS AN EVER GROWING SUITE OF INFORMATIONAL TOOLS TO HELP CONSUMERS CHOOSE AMONG THE FULL RANGE OF HEALTHCARE PROVIDERS ACROSS THE 5NITED 3TATES
(OSPITAL 2EPORT #ARDS (EALTHCARE &ACTS IS NOT THE lRST ATTEMPT TO PROVIDE INFORMATION ABOUT HEALTHCARE QUALITY TO CONSUMERS "OTH FEDERAL AND STATE AGENCIES HAVE ATTEMPTED TO PRESENT CONSUMERS WITH A VARIETY OF INFORMATION REGARDING QUALITY AND MORTALITY; = )N EACH CASE CONSUMERS DID NOT USE THE INFORMATION !FTER FOUR YEARS OF PUBLISHED RISK ADJUSTED MORTALITY RATES FOR EVERY HOSPITAL SURGEON AND SURGICAL GROUP PERFORMING OPEN HEART SURGERY IN 0ENNSYLVANIA ONLY PERCENT OF PATIENTS SURVEYED KNEW THE INFORMATION EXISTED PRIOR TO SURGERY LESS THAN PERCENT REPORTED THAT THE INFORMATION HAD MADE AN IMPACT ON THEIR SELECTION OF PROVIDER;= #ONSUMERS ALSO DID NOT RESPOND TO SIMILAR INFORMATION MADE AVAILABLE BY THE STATE OF .EW 9ORK ;= .O CLEAR DIFFERENCE IN MARKET SHARE FOR HIGH OR LOW MORTALITY RATE HOSPITALS OCCURRED AFTER THE RELEASE OF THE INFORMATION;= )N CONTRAST TO MORE SPECIlC INFORMATION ABOUT MORTALITY RATES SOME HOSPITAL PERFORMANCE REPORTING HAS RATED HOSPITALS OVERALL OR BY CONDITION OR PROCEDURE )NTERNET SITES SUCH AS (EALTH'RADESCOM 53.EWSCOM AND #AL(OSPITALSORG PRESENT SUMMARIZED RATINGS OF HOSPITALS USING DATA FROM A RANGE OF SOURCES INCLUDING -EDICARE BILLING DATA AND PATIENT SURVEYS 7HILE THIS METHOD PROVIDES CONSUMERS WITH INFORMATION THAT MAY PROVE USEFUL TO SOME EXTENT CONSUMERS ARE OFTEN FORCED TO WADE THROUGH VOLUMES OF INFORMATION OR ARE PROVIDED WITH SUMMARY SCORES BUT WITH NO MEANS OF OBTAINING MORE SPECIlC INFORMATION ABOUT THE FACILITY
-ARY!NN 3TUMP 2. "3 IS SENIOR VICE PRESIDENT AND CHIEF INNOVATION OFlCER "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA AND PRESIDENT #ONSUMER !WARE ! PASSIONATE ADVOCATE FOR HEALTHCARE REFORM SHE HAS ENGAGED EMPLOYERS HEALTHCARE PROVIDERS AND POLICY MAKERS IN VIEWING HEALTHCARE FROM THE CONSUMERS PERSPECTIVE AND ENCOURAGING INNOVATIONS IN THE DELIVERY OF HIGH QUALITY AFFORDABLE HEALTHCARE 3HE CAN BE REACHED AT -ARY!NN?3TUMP BLUECROSSMNCOM 4AMARA , 9OUNG 0H$ IS A RESEARCH CONSULTANT FOR #ONSUMER !WARE AND A HEALTHCARE BLOGGER 3HE PREVIOUSLY SUPPORTED A VARIETY OF PRIVATE STATE AND COMMUNITY HEALTH SYSTEMS INCLUDING THE 4ERRITORY OF 'UAM PROVIDING PROGRAM DEVELOPMENT AND EVALUATION SERVICES 3HE CAN BE REACHED AT 4AMARA?,?9OUNG BLUECROSSMNCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
AK TDãB QN R R ã@MCãAK TDãRGHD KCãNE ãL HMMD RNS@ãGD @KSGB@QD ãE@BSR Ø !LTHOUGH STUDIES INDICATE THAT CONSUMERS HAVE NOT FOUND EARLY ATTEMPTS AT HOSPITAL PERFORMANCE REPORTS USEFUL CONSUMERS DO IN FACT HAVE AN APPETITE FOR MORE INFORMATION ON HEALTHCARE PROVIDERS; = 7HILE THAT INFORMATION TENDS TO COME PRIMARILY FROM FRIENDS AND FAMILY CONSUMERS DO INDICATE AN OPENNESS TO RECEIVING RELIABLE HEALTHCARE QUALITY INFORMATION FROM AN EXTERNAL SOURCE AS WELL; = )N FACT A THIRD OF ADULTS SEEKING ONLINE INFORMATION ABOUT HEALTHCARE SAY THAT THE INFORMATION DOES HAVE AN INmUENCE ON SUBSEQUENT HEALTHCARE DECISIONS;= 4HESE lNDINGS SUGGEST ROOM FOR INNOVATION IN PROVIDER PERFORMANCE REPORTING AND EVIDENCE THAT IF PRESENTED WELL AND ACCOMPANIED BY EDUCATIONAL EFFORTS NEW TOOLS WILL BE FAVORABLY RECEIVED BY CONSUMERS
%XHIBIT (EALTHCARE &ACTS¸
#ONTEXT #ONSUMER %NGAGEMENT 2ECOGNIZING THE TRUE IMPORTANCE OF CONSUMER ENGAGEMENT AND EMPOWERMENT THE (EALTHCARE &ACTS DEVELOPMENT TEAM WORKED TO CREATE A TOOL THAT TRULY REmECTS CONSUMER NEEDS 4HE IDEA OF THE CONSUMERPATIENT AS KEY STAKEHOLDER IS NOT A NEW CONCEPT BUT THE RECENT )NSTITUTE OF -EDICINE )/- REPORT h#ROSSING THE 1UALITY #HASM v SOLIDIlED THE IMPORTANCE OF RECOGNIZING THE PATIENTS CENTRAL ROLE IN DElNING AND EVALUATING QUALITY HEALTHCARE;= 4HE )/- lNDINGS INDICATE THAT THE HEALTHCARE SYSTEM NEEDS TO VIEW ITSELF THROUGH THE EYES OF THE PATIENT !S SUCH ANY USEFUL INFORMATIONAL TOOL MUST BE ABLE TO MEET PATIENTS AT THEIR LEVEL ! TRULY EFFECTIVE TOOL WILL INCLUDE THE ITEMS OF MOST INTEREST TO CONSUMERS AND REmECT CONSUMER HEALTH LITERACY IN THE LEVEL OF COMPLEXITY AND THE OVERALL DESIGN )N AN ATTEMPT TO RESPOND CONSTRUCTIVELY TO CONSUMER RESEARCH lNDINGS AND KEEP THE ULTIMATE GOAL OF CONSUMER ENGAGEMENT IN MIND WE ADOPTED SEVERAL OPERATING PRINCIPLES (EALTHCARE &ACTS MUST BE RECOGNIZABLE AND INVITING AND NOT INTIMIDATING ACCOMPANIED BY EDUCATION AND OTHER CONSUMER AWARENESS TO MAXIMIZE IMPACT PLATFORM INDEPENDENT AND DELIVERABLE THROUGH A VARIETY OF CHANNELS BASED ON WHAT CONSUMERS WANT TO KNOW NOT WHAT WE CAN MEASURE PRESENTED IN A hBEST lTv FORMAT AND NOT AS A PRESCRIPTIVE REPORT CARD AND ABLE TO SUPPORT AN ENTIRE DECISION MAKING PROCESS
2ECOGNIZABLE AND )NVITING (EALTHCARE &ACTS IS PATTERNED AFTER THE SIMPLE RECOGNIZABLE INFORMATION TEMPLATE FOUND ON EVERY FOOD AND BEVERAGE PRODUCT SOLD IN THE 5NITED 3TATES SEE %XHIBIT 4HE .UTRITION &ACTS LABEL IS A FAMILIAR LAYOUT AND CONSUMERS HAVE BEEN SUCCESSFULLY USING IT SINCE ;= 4HE CONCISE ABBREVIATED FORMAT KEEPS CONSUMERS FROM BEING INUNDATED WITH INFORMATION AND LIMITS THE CONTENT TO NO MORE THAN ONE PAGE WITH ADDITIONAL PAGES FOR EDUCATION ON THE TOOL INCLUDING DElNITIONS
4HE USE OF THE NUTRITION LABEL ALSO ALLOWED THE (EALTHCARE &ACTS TEAM TO CAPITALIZE ON THE EASE OF COMPARISON THAT THE .UTRITION &ACTS LABEL AFFORDS 3INCE CONSUMERS HAVE GROWN ACCUSTOMED TO USING .UTRITION &ACTS INFORMATION IN COMPARING SIMILAR PRODUCTS (EALTHCARE &ACTS PROVIDES A SIMILAR EASE OF USE
%DUCATION AND !WARENESS ! CRITICAL COMPONENT OF CONSUMER CHOICE IS EDUCATION (ISTORICALLY CONSUMERS HAVE GENERALLY NOT UNDERSTOOD QUALITY INFORMATION WHICH SUGGESTS THAT NEW INITIATIVES MUST BE MUCH MORE PROACTIVE IN EDUCATING THE INTENDED AUDIENCE;= #OMPREHENSION DRIVES SALIENCE CONSUMERS TEND TO DISCOUNT INFORMATION THEY DO NOT UNDERSTAND; = (EALTHCARE &ACTS CONTAINS SEVERAL PAGES OF CONSUMER EDUCATION INCLUDING A CONSUMER FRIENDLY DESCRIPTION OF ALL METRICS "LUE #ROSS LAUNCHED A NONTRADITIONAL MARKETING CAMPAIGN THAT INCLUDED ACTORS DRESSED IN HOSPITAL GOWNS WALKING THROUGH THE SKYWAYS OF DOWNTOWN -INNEAPOLIS IN THE CROWDS AT AN ."! BASKETBALL GAME AND AT VARIOUS GROCERY STORES 4HE hGOWN WALKERSv HANDED OUT MINI CEREAL BOXES WITH A SAMPLE (EALTHCARE &ACTS ON ONE SIDE AND A COLORFUL CARTOON DRAWING ON THE OTHER THE BOXES CONTAINED A (EALTHCARE &ACTS REFRIGERATOR MAGNET AND BROCHURE 4HE NONTRADITIONAL MARKETING EFFORTS HELPED STIMULATE INTEREST IN (EALTHCARE &ACTS IN A NEW EYE CATCHING WAY -ORE STANDARD MARKETING EFFORTS SUCH AS NEWSPAPER AND RADIO ADVERTISEMENTS WERE CONDUCTED AS FOLLOW UPS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
AK TDãB QN R R ã@MCãAK TDãRGHD KCãNE ãL HMMD RNS@ãGD @KSGB@QD ãE@BSR Ø
0LATFORM )NDEPENDENT (EALTHCARE &ACTS WAS DESIGNED TO BE PLATFORM INDEPENDENT ABLE TO BE DISTRIBUTED THROUGH THE 7EB OR IN HARD COPY 7HILE THE )NTERNET SERVES AS A NATURAL HOME FOR (EALTHCARE &ACTS WWW HEALTHCAREFACTSORG NOT ALL CONSUMERS HAVE READY ACCESS OR FEEL COMFORTABLE USING THAT MEDIUM !S SUCH WE ENSURED THAT (EALTHCARE &ACTS WAS DEPLOYABLE IN HARD COPY AND AVAILABLE THROUGH PARTICIPATING HOSPITALS INCLUDED IN EMPLOYEES HEALTH PLAN OFFERINGS AND SHARED AS PART OF A NEW ENROLLEES BENElT PACKAGE 7ITHIN THE ONLINE VERSION THE USER HAS READY ACCESS TO A VAST AMOUNT OF INFORMATION IN A RELATIVELY UNCLUTTERED FORMAT AND IS ABLE TO DRILL DOWN FOR MORE SPECIlC INFORMATION (EALTHCARE &ACTS LINKS TO OTHER COMPLEMENTARY SITES AND PROVIDES A RELATIVE EASE OF UPDATING AND DISTRIBUTING OF INFORMATION
"Y KEEPING THE HEALTH PLAN IN THE BACK GROUND THE INFORMATION WILL SPEAK FOR ITSELF AND "LUE #ROSS WILL SERVE AS AN @INFOMEDIARY NOT AN ARBITER OF WHERE PATIENTS SEEK CARE "ASED ON #ONSUMER &EEDBACK 4HE (EALTHCARE &ACTS TEAM CONVENED DOZENS OF CONSUMER DESIGN GROUPS WHERE CONSUMERS EXPERIENCED MOCK UPS OF THE TOOL AND GAVE EXTENSIVE FEEDBACK &OR EACH ITEM THE TEAM ASSESSED THE LEVEL OF COMPREHENSION AND EDITED OR REMOVED CONFUSING ITEMS AND ITEMS OF NO INTEREST TO CONSUMERS #ONSUMERS CONSISTENTLY EXPRESSED THEIR OWN UNIQUE PERSPECTIVE ABOUT HOW INTERESTING AND RELEVANT INFORMATION IS WHEN IT COMES TO HEALTHCARE CHOICES THOSE IDEAS WERE OFTEN QUITE DIFFERENT FROM THOSE OF HEALTHCARE hINSIDERSv !S A RESULT THE TEAM INCORPORATED NEW ITEMS SPECIlCALLY REQUESTED BY CONSUMERS &OR EXAMPLE CONSUMERS REQUESTED A h.EIGHBORHOOD 3AFETY 3CORE v TO GIVE AN IDEA OF THE STATE OF THE NEIGHBORHOOD IN WHICH THE HOSPITAL IS LOCATED #ONSUMERS ALSO WANTED TO KNOW THE PERCENT OF HOSPITAL BEDS LOCATED IN PRIVATE ROOMS AND THAT INFORMATION WAS ALSO INCORPORATED
@"EST &IT 0HILOSOPHY !S MENTIONED ABOVE THE NEWEST WAVE OF HOSPITAL REPORTING OFTEN PRODUCES RATINGS FOR HOSPITALS BASED ON A LETTER GRADE OR ONE TO FOUR STARS SUGGESTING THAT THERE IS A hBESTv HOSPITAL 2ATINGS CAN BE CONFUSING ESPECIALLY IF THEY ARE CONTRADICTORY $UE TO DIFFERENCES IN METHODOLOGIES RATINGS ACROSS DIFFERENT HOSPITAL PROlLES CAN APPEAR INCONSISTENT OR CONTRADICTORY &OR EXAMPLE IN A RECENT LIST OF TOP 53 HOSPITALS 53 .EWS AND 7ORLD 2EPORT LISTED THE -AYO HOSPITALS AS .O IN ORTHOPEDICS /LMSTED -EDICAL #ENTER ALSO IN 2OCHESTER -INN WAS NOT LISTED !NOTHER SOURCE OF QUALITY INFORMATION (EALTH'RADESCOM GAVE -AYO
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
HOSPITALS ONE STAR IN THE AREA OF TOTAL KNEE REPLACEMENT SURGERY WHILE /LMSTED RECEIVED THREE STARS IN THE SAME PERIOD OF TIME 0ERHAPS MORE IMPORTANTLY THOUGH RATINGS FAIL TO GIVE THE IMPRESSION THAT THERE ARE ASPECTS OF A PROVIDERS PRACTICE THAT MIGHT APPEAL TO PEOPLE DIFFERENTIALLY AND INmUENCE INDIVIDUAL DECISIONS TO SEEK CARE h"EST lTv IS MORE IN LINE WITH A PHILOSOPHY OF PATIENT CENTERED CARE RESPECTING THE VALUES AND PREFERENCES OF INDIVIDUAL PATIENTS AS SUGGESTED BY THE )/- REPORT /NE ITEM ON (EALTHCARE &ACTS FOR EXAMPLE IS THE HOSPITALS RELIGIOUS AFlLIATION 3OME FOCUS GROUP MEMBERS INDICATED THAT THEY WOULD SEEK SERVICES FROM A RELIGIOUS INSTITUTION WITH NEAR DISREGARD FOR ANY OTHER INFORMATION LISTED ABOUT THAT HOSPITAL
"LUE #ROSS AS @)NFOMEDIARY (EALTHCARE &ACTS IS NOT A MARKETING VEHICLE PROMINENTLY FEATURING "LUE #ROSS (EALTHCARE &ACTS DOES NOT CONTAIN DATA ON "LUE #ROSS MEMBERS ONLY 4HE ONLY ITEM ON (EALTHCARE &ACTS THAT PERTAINS SOLELY TO "LUE #ROSS MEMBERSHIP IS THE hPRICEv COMPONENT WHICH WE DEVELOPED INTERNALLY USING ADMINISTRATIVE DATA ALL OTHER ITEMS ARE SELF REPORTED BY THE HOSPITALS ON THEIR ENTIRE BOOK OF BUSINESS "LUE #ROSS POSITION AS A LARGE HEALTH PLAN WITH PRE EXISTING RELATIONSHIPS ALLOWED THE (EALTHCARE &ACTS TEAM TO ENGAGE PROVIDERS COLLECT DATA AND DISTRIBUTE THE INFORMATION TO THE PUBLIC "Y KEEPING THE HEALTH PLAN IN THE BACKGROUND THE INFORMATION WILL SPEAK FOR ITSELF AND "LUE #ROSS WILL SERVE AS AN hINFOMEDIARY v NOT AN ARBITER OF WHERE PATIENTS SEEK CARE
-ARKET 2ESPONSE (EALTHCARE &ACTS IS ENVISIONED AS A SUITE OF INFORMATIONAL TOOLS THAT HELP CONSUMERS CHOOSE HEALTHCARE PROVIDERS 7ITH THE ADVENT OF CONSUMER DIRECTED ANDOR TIERED BENElT PRODUCTS THAT EMPLOYERS ARE ANTICIPATING OFFERING IN THE FUTURE LARGE EMPLOYEE GROUPS HAVE RESPONDED FAVORABLY TO (EALTHCARE &ACTS AS IT PROVIDES EMPLOYEES INFORMATION ON PROVIDERS BEFORE THEY CRITICALLY NEED IT (EALTHCARE &ACTS IS A TOOL THAT CAN EASE CONSUMERS INTO THINKING ABOUT ALL THE CHOICES THEY HAVE TO MAKE WHEN MORE OF THEIR OWN DOLLARS ARE AT STAKE 4HE HOSPITALS AND CLINICS INCLUDED IN (EALTHCARE &ACTS ALSO RESPONDED FAVORABLY /UR APPROACH FROM THE BEGINNING WAS TO BE AS COLLABORATIVE AS POSSIBLE FROM GARNERING SUPPORT AT THE EXECUTIVE LEVEL TO WORKING WITH QUALITY IMPROVEMENT AND CLINICAL STAFF ON THE DATA DElNITIONS FOR THE ITEMS CONTAINED IN (EALTHCARE &ACTS 0ROVIDERS WERE READY TO THINK ABOUT THEMSELVES FROM THE CONSUMERS POINT OF VIEW AND DESCRIBE THEIR VALUE /NE -INNEAPOLIS HOSPITAL EXECUTIVE CALLED (EALTHCARE &ACTS A hCLEAR START v NOTING THAT PHYSICIANS hFAILED TO DELIVER SOMETHING THE PUBLIC COULD USE AND NOW ITS BEING DELIVERED FOR USv;= 4HE INTENTION IS THAT TO THE GREATEST EXTENT POSSIBLE PROVIDERS WILL VIEW THE (EALTHCARE &ACTS EFFORT AS A PARTNERSHIP AND TAKE OWNERSHIP OF IT PERHAPS EVEN USING THE (EALTHCARE &ACTS SHEET AS MARKETING MATERIAL
AK TDãB QN R R ã@MCãAK TDãRGHD KCãNE ãL HMMD RNS@ãGD @KSGB@QD ãE@BSR Ø
(EALTHCARE &ACTS MAY ALSO SERVE AS A CATALYST FOR INTERNAL CHANGES WITHIN HOSPITALS AS THEY BEGIN TO COMPARE THEMSELVES WITH THEIR PEERS 4HE HOPE IS THAT (EALTHCARE &ACTS MAY ALSO SERVE AS A CATALYST FOR INTERNAL CHANGES WITHIN HEALTHCARE PROVIDERS AS THEY BEGIN TO COMPARE THEMSELVES WITH THEIR PEERS /NE STATED PURPOSE OF PROVIDER REPORTING IS TO SPUR QUALITY IMPROVEMENT WITHIN THE PROVIDER ORGANIZATION INDEED SOME BELIEVE THAT PROVIDER ORGANIZATIONS BENElT THE MOST FROM PERFORMANCE DATA BECAUSE OF INTERNAL PROCESS AND OUTCOMES IMPROVEMENTS THAT ORGANIZATIONS ARE ABLE TO MAKE UPON COMPARING THEMSELVES TO A BENCHMARK;= !S PROVIDERS COMPARE THEIR SERVICE MIX TO THAT OF THEIR COMPETITORS THEY MAY CHOOSE TO NARROW THEIR SERVICE OFFERINGS POSITIONING THEMSELVES AS A CENTER OF EXCELLENCE IN A PARTICULAR AREA SUCH AS HEART CARE !LTERNATIVELY THEY MAY CHOOSE TO ADD TO THEIR CURRENT OFFERINGS FOR EXAMPLE ADDING A PAIN MANAGEMENT PROGRAM TO BE MORE COMPETITIVE !FTER A CONSUMER REPORT ON HOSPITALS IN -ISSOURI WAS PUBLISHED HOSPITALS THAT DID NOT OFFER CERTAIN BABY CARE SERVICES SUCH AS AN INFANT CAR SEAT PROGRAM AND BREAST FEEDING EDUCATION IMPLEMENTED SUCH SERVICES;= 7HEN THE STATE OF .EW 9ORK PUBLISHED THE MORTALITY DATA FOR OPEN HEART SURGERY MENTIONED EARLIER CONSUMERS MAY NOT HAVE BEEN SUBSTANTIALLY IMPACTED BUT EVIDENTLY THE PRACTITIONERS WERE; = )N THE FOLLOWING THREE YEARS .EW 9ORK HAD THE COUNTRYS LOWEST MORTALITY OPEN HEART SURGERY MORTALITY RATES (OPEFULLY SIMILAR CHANGES WILL HAPPEN HERE
#ONCLUSION (EALTHCARE &ACTS ADDRESSES THE GROWING DEMAND AND NEED FOR HEALTHCARE TRANSPARENCY )N ORDER TO EMPOWER CONSUMERS TO MAKE INFORMED DECISIONS WHEN SELECTING A HEALTHCARE PROVIDER OR HEALTH PLAN EVALUATING TREATMENT OPTIONS OR PLANNING A PROCEDURE (EALTHCARE &ACTS ATTEMPTS TO VIEW QUALITY FROM THE PATIENT PERSPECTIVE "Y PROVIDING INFORMATION CONSUMERS INDICATE IS IMPORTANT TO HEALTHCARE DECISIONS IN A FORMAT THAT IS ACCESSIBLE AND UNDERSTANDABLE TO THE INTENDED AUDIENCE "LUE #ROSS OF -INNESOTA HAS PUT A STAKE IN THE GROUND FOR A NEW WAY TO APPROACH PERFORMANCE REPORTING !S CONSUMERS BECOME EVER MORE INFORMATION SAVVY (EALTHCARE &ACTS WILL EVOLVE TO MEET THOSE NEEDS %NDNOTES ,UBALIN *3 AND , $ (ARRIS +OJETIN h7HAT $O #ONSUMERS 7ANT AND .EED TO +NOW IN -AKING (EALTH #ARE #HOICES v -EDICAL #ARE 2ESEARCH AND 2EVIEW SUPP PP
3HALLER $ ET AL h#ONSUMERS AND 1UALITY $RIVEN (EALTH #ARE ! #ALL TO !CTION v (EALTH !FFAIRS PP 3CHAUFmER ( ( AND * + -ORDAVSKY h#ONSUMER 2EPORTS IN (EALTH #ARE $O 4HEY -AKE A $IFFERENCE v !NNUAL 2EVIEW OF 0UBLIC (EALTH PP -ARSHALL - . ET AL h4HE 0UBLIC 2ELEASE OF 0ERFORMANCE $ATA 7HAT $O 7E %XPECT TO 'AIN ! 2EVIEW OF THE %VIDENCE v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP -ENNEMEYER 34 -! -ORRISEY AND ,: (OWARD h$EATH AND 2EPUTATION (OW #ONSUMERS !CTED 5PON (#&! -ORTALITY )NFORMATION v )NQUIRY PP 3CHNEIDER %# AND ! - %PSTEIN h5SE OF 0UBLIC 0ERFORMANCE 2EPORTS ! 3URVEY OF 0ATIENTS 5NDERGOING #ARDIAC 3URGERY v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP )BID *HA ! + AND ! - %PSTEIN h4HE 0REDICTIVE !CCURACY OF THE .EW 9ORK 3TATE #ORONARY !RTERY "YPASS 3URGERY 2EPORT #ARD 3YSTEM v (EALTH !FFAIRS PP #HASSIN -2 h!CHIEVING AND 3USTAINING )MPROVED 1UALITY ,ESSONS FROM .EW 9ORK 3TATE AND #ARDIAC 3URGERY v (EALTH !FFAIRS PP h.ATIONAL 3URVEY ON !MERICANS AS (EALTH #ARE #ONSUMERS !N 5PDATE ON THE 2OLE OF 1UALITY )NFORMATION v 4HE +AISER &AMILY &OUNDATION !GENCY FOR (EALTH #ARE 2ESEARCH AND 1UALITY -ENLO 0ARK #! +AISER &AMILY &OUNDATION 2OBINSON 2 AND - "RODIE h5NDERSTANDING THE 1UALITY #HALLENGE FOR (EALTH #ONSUMERS 4HE +AISER!(#02 3URVEY v *OINT #OMMISSION *OURNAL ON 1UALITY )MPROVEMENT PP h#ONSUMER $EMAND FOR #LINICAL 1UALITY 4HE 'IANT !WAKENS v $ELOITTE AND 4OUCHE )RVING 4EXAS 6(! "AKER , 4 ( 7AGNER 3 - 3INGER AND - + "UNDORF h5SE OF THE )NTERNET AND E MAIL FOR (EALTH #ARE )NFORMATION 2ESULTS FROM A .ATIONAL 3URVEY v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP h#ROSSING THE 1UALITY #HASM ! .EW (EALTH 3YSTEM FOR THE 4WENTY lRST #ENTURY v )NSTITUTE OF -EDICINE 7ASHINGTON .ATIONAL !CADEMY 0RESS HTTPWWWCFSANFDAGOV^LRDTPAWARDHTML %PSTEIN ! - h0UBLIC 2ELEASE OF 0ERFORMANCE $ATA ! 0ROGRESS 2EPORT &ROM THE &RONT v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP (IBBARD * h5SE OF /UTCOME $ATA BY 0URCHASERS AND #ONSUMERS .EW 3TRATEGIES AND .EW $ILEMMAS v *OURNAL FOR 1UALITY IN (EALTH #ARE PP 3MITH 3$ h"LUE #ROSS )SSUING (OSPITAL 2EPORT #ARD v 4HE "USINESS *OURNAL -INNEAPOLIS3T 0AUL #HASSIN - 2 h!CHIEVING AND 3USTAINING )MPROVED 1UALITY ,ESSONS FROM .EW 9ORK 3TATE AND #ARDIAC 3URGERY v (EALTH !FFAIRS PP h4HE 0REDICTIVE !CCURACY OF THE .EW 9ORK 3TATE #ORONARY !RTERY "YPASS 3URGERY 2EPORT #ARD 3YSTEM v (EALTH !FFAIRS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! 1UALITY 0AY FOR 0ERFORMANCE AND THE 2OLE OF #-3 ! $ISCUSSION 7ITH 4RENT (AYWOOD -ANY INDUSTRY OBSERVERS VIEW PAY FOR PERFORMANCE PROGRAMS AS HAVING TREMENDOUS POTENTIAL TO IMPROVE THE QUALITY OF HEALTHCARE 4HE #ENTERS FOR -EDICARE -EDICAID 3ERVICES #-3 BY VIRTUE OF ITS LARGE NUMBER OF ENROLLEES HAS A LARGE INmUENCE ON THE HEALTHCARE lNANCIAL INCENTIVES IN GENERAL AND PAY FOR PERFORMANCE SPECIlCALLY #-3 HAS SEVERAL MAJOR PAY FOR PERFORMANCE INITIATIVES UNDER WAY AND PLANNED INCLUDING THE (OSPITAL 1UALITY )NITIATIVE AND THE 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION 0ROJECT n AS DESCRIBED IN THE PAPER IN THIS BOOK h4HE 0AY FOR 0ERFORMANCE ,ANDSCAPEv 0RICEWATERHOUSE#OOPERS RECENTLY SPOKE WITH 4RENT (AYWOOD -$ *$ DEPUTY CHIEF CLINICAL OFlCER OF THE /FlCE OF #LINICAL 1UALITY AND 3TANDARDS AT THE #ENTERS FOR -EDICARE -EDICAID 3ERVICES REGARDING THE STATE OF QUALITY AND #-3 PAY FOR PERFORMANCE PROGRAMS
0RICEWATERHOUSE#OOPERS 7HEN YOU THINK ABOUT HEALTH CARE QUALITY IN ITS CURRENT STATE HOW FAR DO YOU THINK WEVE COME 4RENT (AYWOOD ) THINK WERE STILL IN OUR EARLIER PHASES DESPITE THE FOUNDATION THAT HAS BEEN LAID &IRST YOU NEED THE DEVELOPMENT OF HEALTH RESEARCH AND THATS BEEN THE FOCUS 7HERE WERE STARTING TO MOVE IS TO DETERMINE hSO WHAT DOES THAT MEAN v .OW THAT WE THINK WERE ABLE TO DElNE QUALITY HOW ARE WE GOING TO ACTUALLY UTILIZE THAT ACROSS THE ACTIVITIES OF THE MARKETPLACE WHETHER THAT BE QUALITY REPORTING 1) ACTIVITIES OR PAY FOR PERFORMANCE !LL OF THIS IS SOMEWHAT IN ITS INFANCY 7E HAVE A LOT TO LEARN 7ERE IN THE EARLY PHASES BUT ITS POSITIVE THAT WERE HAVING THIS FOCUS ON QUALITY WHERE WE DIDNT BEFORE 3O ) AM OPTIMISTIC ABOUT WHERE WERE HEADED 0W# 7HO DO YOU THINK ARE SOME OF THE FRONT RUNNERS THAT ARE DRIVING THAT NEW PERSPECTIVE ON QUALITY 4( 7ELL OBVIOUSLY ) WORK AT #-3 SO )M BIASED x 4HE REASON WHY )M SOMEWHAT BIASED TOWARDS #-3 IS NOT JUST BECAUSE ) WORK HERE BUT BECAUSE ONE OF THE BENElTS OF THE PUBLIC SECTOR GETTING INTO THE ACT IS THAT WE CAN SET STANDARDS ! LOT OF THINGS HAPPEN AT THE LOCAL LEVEL BUT WHEN IT COMES TIME TO ACTUALLY SET STANDARDS AND ALLOW FOR SOME MOVEMENT TO OCCUR YOU ARE REALLY COMING BACK 4HE REASON WHY PEOPLE ASKED -EDICARE TO TAKE THE LEAD ON SOME FACTORS IS BECAUSE OF OUR ABILITY TO BRING SOME STANDARDIZATION TO THE PROCESS AND GET EVERYONE TO UNDERSTAND
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
WHERE WERE HEADED COLLECTIVELY 3O THATS PROBABLY THE UNIQUE ASPECT OF WHAT -EDICARE CAN BRING TO THESE DIFFERENT ACTIVITIES BOTH AS A PURCHASER AND IN TERMS OF OUR ACTIVITIES WITH OUR BENElCIARY POPULATION (OWEVER NO MATTER WHERE YOU GO YOURE GOING TO HEAR PEOPLE TALK ABOUT THE WORK THAT THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT "RIDGES 4O %XCELLENCE ,EAPFROG 'ROUP .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE *OINT #OMMISSION ON THE !CCREDITATION OF (EALTHCARE /RGANIZATIONS !MERICAN -EDICAL !SSOCIATION AND .ATIONAL 1UALITY &ORUM HAVE DONE WITH RESPECT TO THE MEASUREMENT ACTIVITY AND HOW THAT REALLY HELPED TO ALSO BUILD THE LANDSCAPE 4HE )NSTITUTE OF -EDICINE WITH THEIR CONTINUED REPORTING FOCUS ON MEDICAL ERRORS IN h#ROSSING THE 1UALITY #HASMv AND SETTING UP THE ANNOUNCEMENT OF PRIORITY AREAS REALLY TOOK ON A LEADERSHIP ROLE IN DElNING QUALITY %VEN THE #OMMONWEALTH &UND 2OBERT 7OOD *OHNSON #ALIFORNIA (EALTHCARE %NDOWMENT AND OTHER PHILANTHROPIC ORGANIZATIONS HAVE REALLY SUPPORTED A LOT OF THEIR RESEARCH IN THIS PARTICULAR AREA 9OU ALSO HAVE OUR SISTER AGENCY !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21 WHICH AGAIN HAS FUNDED A LOT OF EVIDENCED BASED RESEARCH IN THIS PARTICULAR AREA TO HELP LAY THE INFRASTRUCTURE 3O YOULL ;OFTEN HEAR OF= !(21 WHICH HELPED ;WITH= THE RESEARCH AND QUALITY )N ADDITION YOU MAY HAVE REGIONAL COALITIONS TARGETING QUALITY SUCH AS THE -ASSACHUSETTS (EALTHCARE 1UALITY 0ARTNERS AND THE )NTEGRATED (EALTHCARE !SSOCIATION IN #ALIFORNIA 2IGHT NOW YOU HAVE A LOT OF PEOPLE THAT ARE LEADING
1! 0AY FOR PERFORMANCE IS REALLY A WAY TO ALIGN OUR PAYMENT AND FINANCIAL INCENTIVES TO SUPPORT OUR PROFESSIONAL GOALS )N DESIGNING THE PROGRAMS THERE ARE A LOT OF ISSUES INVOLVED 0W# 3PECIlCALLY HOW CAN #-3 INmUENCE IMPROVEMENTS IN QUALITY 4( 7E HAVE MORE LEVERS WHEN IT COMES TO QUALITY THAN A LOT OF OTHER ORGANIZATIONS 7E HAVE SEVEN DIFFERENT LEVERS THAT WE CAN PULL TO REALLY MOVE THE QUALITY AGENDA FORWARD TECHNICAL ASSISTANCE OR QUALITY IMPROVEMENT IN THE ORGANIZATION REWARDS VIA PERFORMANCE IE PAY FOR PERFORMANCE PUBLIC RECOGNITION ACTIVITIES INCLUDING PUBLIC REPORTING OF INFORMATION AND HIGHLIGHTING KEY PEOPLE COVERAGE DETERMINATIONS THAT IMPACT QUALITY AND PROVIDE ACCESS TO HIGHER QUALITY SERVICES KEY PARTNERSHIPS WITH EXTERNAL STAKEHOLDERS REGULATIONS AND CERTIlCATION THAT SET CONDITIONS OF PARTICIPATION AND RESEARCH AND DEMONSTRATION 0W# 7HAT ARE THE OBJECTIVES OF #-3 PAY FOR PERFORMANCE DEMONSTRATIONS 4( 4HERE ARE A LOT OF DIFFERENT THINGS MIXED UP IN THE TERM hPAY FOR PERFORMANCEv "UT AT THE END OF THE DAY WHAT WERE NORMALLY TALKING ABOUT IS ALIGNING OUR PAYMENT OF lNANCIAL INCENTIVES TO SUPPORT OUR PROFESSIONAL ASPIRATIONS OF QUALITY IN HEALTH OUTCOMES 3O THE REASON WHY WE HAVE SO MANY DIFFERENT LEVERS IS BECAUSE THERE ARE A LOT OF DIFFERENT THINGS IN THE SYSTEM THAT WE CAN DO TO ACTUALLY TRY TO ACCOMPLISH THAT GOAL THAT ALIGNMENT )TS VERY STRAIGHTFORWARD 0AY FOR PERFORMANCE IS REALLY A WAY TO ALIGN OUR PAYMENT AND lNANCIAL INCENTIVES TO SUPPORT OUR PROFESSIONAL GOALS )N DESIGNING THE PROGRAMS THERE ARE A LOT OF ISSUES INVOLVED &IRST YOU ALWAYS HAVE TO HAVE THE MEASURES 9OU THEN MUST HAVE A DATA INFRASTRUCTURE PROCESS FOR THE COLLECTION OF THAT INFORMATION )N ADDITION THE RECIPIENT OF THE DATA MUST HAVE A COMPATIBLE INFRASTRUCTURE SO THAT THEY CAN ACTUALLY SEE THE INFORMATION /N THE BACK END YOU MAY HAVE SOME PROCESS TO VERIFY AND VALIDATE IT !ND THEN lNALLY YOU NEED TO LINK THAT TO SOME PAYMENT AND CUT THE CHECK 3O IF NOTHING ELSE ALL OF OUR EFFORTS ARE REALLY PUTTING IN PLACE THE INFRASTRUCTURE AND TESTING DIFFERENT PORTIONS OF THOSE ACTIVITIES ACROSS THE BOARD 6ARIOUS PORTIONS OF OUR PROJECTS FOCUS ON DIFFERENT ASPECTS OF THE INFRASTRUCTURE DEPENDING UPON THE DESIGN "UT ITS REALLY GETTING A LOT OF THAT INFRASTRUCTURE IN PLACE AND TESTING SOME OF THAT INFRASTRUCTURE 0W# (OW WERE THE INCENTIVES IN THE PAY FOR PERFORMANCE PILOTS ESTABLISHED 4( !T MINIMUM THERE ARE THREE DIFFERENT WAYS TO REWARD SOMETHING 9OU CAN REWARD RELATIVE QUALITY YOU CAN REWARD
ABSOLUTE THRESHOLDS OR YOU CAN REWARD IMPROVEMENT -OST GROUPS UNDERSTAND RELATIVE QUALITY PRETTY EASILY 4HAT IS HOW WE TAKE OUR BOARD EXAMINATIONS 9OU LOOK AROUND THE ROOM AND SEE IF THERE ARE THREE PEOPLE YOU CAN BEAT 4HATS RELATIVE QUALITY IRRESPECTIVE OF WHO WAS SMART OUTSIDE THE ROOM BUT JUST RELATIVE TO SOME DElNED PEER GROUP 4HE 0REMIER DEMONSTRATION HAS THAT TYPE OF DESIGN 4HE ABSOLUTE THRESHOLD IS THE SECOND MODEL WHICH THE 0HYSICIAN 'ROUP $EMONSTRATION HAS 4HEN QUALITY IMPROVEMENT IS THE THIRD ONE THAT A LOT OF PEOPLE ARE ALSO FOCUSING ON WHICH IS HOW WELL DID ) DO IN COMPARISON TO MY OWN HISTORICAL BENCHMARKING AND WHETHER OR NOT YOU SHOULD MAKE PAYMENT FOR THAT 3O THESE ARE ALL THE PUBLIC POLICY OPTIONS THAT PEOPLE ARE LOOKING AT FOR A VARIETY OF REASONS 3OME ARE LOOKING AT THOSE JUST FROM THE IMPACT FOR THOSE DIRECTLY INVOLVED BUT ALSO IN TERMS OF WHAT IS THE BIGGEST BENElT TO THE PUBLIC AT LARGE )N OTHER WORDS IF YOU LOOK AT JUST ABSOLUTE THRESHOLDS MAYBE YOURE GOING TO ONLY INCENTIVIZE THOSE PEOPLE THAT ARE ALREADY DOING WELL BUT MAYBE YOU SHOULD INCENTIVIZE IMPROVEMENT INSTEAD n THATS WHERE WERE HAVING A LOT OF THE LOW QUALITY 3OME SUCH AS -ED0AC ARE RECOMMENDING COMBINING ABSOLUTE THRESHOLDS AND QUALITY IMPROVEMENT 0W# &OR THE 0REMIER DEMONSTRATION SPECIlCALLY WHAT WERE THE OBJECTIVES AND THE RESULTS TO DATE 4( 7ITH 0REMIER ONE OF THE THINGS THAT WE WANTED TO DO IS TO EXPLORE HOW THIS CAN BE DONE #AN WE GET BEYOND THE MEASURES THAT HOSPITALS REPORTED AT THE TIME #AN WE ALSO INCLUDE OUTCOME MEASURES AND NOT JUST PROCESS MEASURES 4HEN lNALLY DOES A lNANCIAL INCENTIVE FOR REPORTING HAVE THE TYPE OF IMPACT THAT ACTUALLY SHOWS SOME MOVEMENT 3O WHAT THE 0REMIER DESIGN DID WAS TO ALLOW US TO TEST THAT !LSO THE NOTION WAS THAT BY GETTING ALL THOSE HOSPITALS TOGETHER WE WOULD BE ABLE TO SHARE LESSONS LEARNED n AKIN TO WHAT !(21 DOES WITH PRACTICE LEARNING NETWORKS WHERE YOU ESTABLISH A COMMUNITY FOR THOSE HOSPITALS TO LEARN FROM OTHER HOSPITALS 7E ARE ALREADY SEEING IMPROVEMENTS ACROSS ALL THE CLINICAL CONDITIONS 7E ALREADY SAW CLEAR IMPROVEMENTS IN YEAR ONE AND THAT IS GOING TO BE THE TREND IN YEAR TWO AND ULTIMATELY IN YEAR THREE AS WELL 0W# 7HAT ISSUES AND UNANSWERED QUESTIONS ARE COMING UP IN YOUR EXPERIENCE WITH THE PAY FOR PERFORMANCE PROJECTS TO DATE 4( 3OME DATA ISSUES THAT WERE TRYING TO WORK THROUGH ARE GOING TO HAVE AN IMPACT LONG TERM &OR INSTANCE ONE ISSUE THAT IS GOING TO COME UP DOWN THE ROAD ABOUT PAY FOR PERFORMANCE IS HOW DO YOU REALLY WEIGHT WHAT YOU DO FOR OUTCOMES AND PROCESS MEASURES (OW DO YOU AGGREGATE THAT DATA AND HOW DO YOU WEIGHT IT APPROPRIATELY 4HERE WILL CONTINUE TO BE LESSONS LEARNED ALSO AROUND HOW FAR YOU NEED TO GO WITH A PARTICULAR MEASURE )N OTHER WORDS IF THE THRESHOLD IS SUCH THAT IN ORDER TO GO FROM BEING IN THE TOP TWO DECILES YOUVE GOT TO GO FROM TO IS THAT THE TYPE OF BEHAVIOR WE WOULD WANT TO INCENTIVIZE OR DO WE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! NEED TO CONSIDER OTHER WAYS OF GETTING AT THAT TYPE OF ISSUE )S IT WORTH THE RESOURCES JUST TO MOVE PERCENT
&ROM A PUBLIC PERSPECTIVE STANDPOINT WHAT WE REALLY WANT TO DO IS NOT LIMIT YOUR CHOICES BUT INCREASE THOSE CHOICES BY ACTUALLY HAVING MORE QUALITY PROVID ERS OUT THERE FOR YOU TO SELECT FROM 3O THAT IS WHY IT CONTINUES TO BE IMPORTANT THAT WE FOCUS ON QUALITY IMPROVEMENT ACTIVITY AND DISSEMINATING BEST PRACTICE INFORMATION SO THAT WE REALLY DO EXPAND CHOICES FOR BENElCIARIES AND NOT NECES SARILY LIMIT CHOICES BY SAYING THAT THERE ARE ONLY ONE OR TWO DOCS THAT CAN REALLY PERFORM THIS WELL 4HERE IS ALSO GOING TO BE THE ISSUE OF WHAT TO DO WHEN THERE ARE A BUNCH OF MEASURES WITHIN A PARTICULAR CONDITION AND SAY HYPOTHETICALLY FOUR OUT OF lVE MEASURES ARE PRETTY EQUAL BUT THEN THERE IS ONE MEASURE WHERE THERE WAS VARIATION "Y DEFAULT THAT ONE IS GOING TO BE WEIGHTED MORE BECAUSE THAT IS WHERE THE VARIATIONS ARE 3O WHEN YOU SEE THAT TYPE OF ISSUE THEN THE QUESTION BECOMES WHETHER THAT IS THE TYPE OF MEASURE YOU WANT TO HAVE THAT TYPE OF IMPACT OR NOT ! BIGGER ISSUE IS TO MAKE CERTAIN THAT THERE ARE NO UNINTENDED CONSEQUENCES 7E NEED TO MAKE CERTAIN THERE ARE NOT PERVERSE INCENTIVES TO SELECT FOR CERTAIN PATIENT POPULATIONS OR TO SELECT FOR CERTAIN GEOGRAPHIC LOCALES OR TO EVEN CONSIDER STRUCTURAL ISSUES ABOUT THE WAY IN WHICH PRACTICES MAY BE DESIGNED &OR EXAMPLE LARGER GROUP PRACTICES HAVE MORE RESOURCES AND INFRASTRUCTURE WHILE SMALLER PRACTICES THAT ARE TRYING TO DO THE RIGHT THING TO SERVE UNDERSERVED COMMUNITIES WOULD HAVE A HARD TIME TRYING TO CREATE THE SAME LEVEL OF INFRASTRUCTURE TO SUPPORT THE PAY FOR PERFORMANCE PROGRAMS 7ERE STILL WORKING THROUGH ALL OF THESE TYPES OF ISSUES WITH THESE DEMONSTRATIONS
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
0W# !S WE LOOK TO THE FUTURE WE ALSO ARE FACING A SHORTAGE OF CLINICAL MANPOWER 3O WE HAVE AN ISSUE AIMED AT TRYING TO DIRECT PEOPLE MORE TOWARD THE QUAL ITY PROVIDERS (OW DO WE RECONCILE THAT WITH ACCESS ESPECIALLY IN AN ENVIRONMENT WHERE WERE FACING A SUPPLY SHORTAGE 4( 7HAT WE REALLY WANT TO DO IS TO NOT NECESSARILY SAY THIS IS THE ONE AND ONLY PLACE THAT YOU REALLY SHOULD GO FOR THIS PROCEDURE BUT INSTEAD LOOK AT HOW WE CAN ACTUALLY MAKE EVERYONE A HIGHER QUALITY PROVIDER &ROM A PUBLIC PERSPECTIVE STANDPOINT WHAT WE REALLY WANT TO DO IS NOT LIMIT YOUR CHOICES BUT INCREASE THOSE CHOICES BY ACTUALLY HAVING MORE QUALITY PROVIDERS OUT THERE FOR YOU TO SELECT FROM 3O THAT IS WHY IT CONTINUES TO BE IMPORTANT THAT WE FOCUS ON QUALITY IMPROVEMENT ACTIVITY AND DISSEMINATING BEST PRACTICE INFORMATION SO THAT WE REALLY DO EXPAND CHOICES FOR BENElCIARIES AND NOT NECESSARILY LIMIT CHOICES BY SAYING THAT THERE ARE ONLY ONE OR TWO DOCS THAT CAN REALLY PERFORM THIS WELL 4HE OTHER ISSUE ALONG THOSE LINES IS THAT IF WE CAN FOCUS ON PREVENTION AND EVEN SELF CARE FOR BENElCIARIES WE CAN ADDRESS ACCESS ISSUES )F THE BENElCIARIES ARE MORE EDUCATED AND MORE ACTIVATED ABOUT THEIR OWN PARTICULAR CONDITION PARTICULARLY FOR SOME CHRONIC CONDITIONS THEY CAN SELF MANAGE SOME OF THEIR CARE VERSUS REQUIRING HANDS ON INVOLVEMENT OF HIGH LEVEL SKILLED CLINICIANS 0W# 7HERE DO YOU THINK WE WILL BE WITH RESPECT TO QUALITY IN THE NEXT lVE TO YEARS 4( ) DElNITELY THINK WE WILL HAVE GONE BEYOND THIS PRELIMINARY TRIAL PHASE 7E STILL HAVE A LOT TO LEARN ) JUST THINK lVE YEARS IS NOT A LONG TIME WHEN YOURE TALKING ABOUT RESEARCHING HEALTHCARE SERVICES AND IMPLEMENTING WHAT WEVE LEARNED 7E WOULD HAVE TO COMPLETE THIS EARLIER TRAINING PHASE CONTINUE THE QUALITY MOVEMENT AND OBVIOUSLY HAVE PUBLIC SUPPORT 7E WANT TO HAVE ALL THAT ACTIVITY 4HE ONLY BIG UNKNOWN IS JUST HOW STABLE OR UNSTABLE THE COST DOLLARS WILL BE AS IT DICTATES WHERE WE GO 3O IF WE CONTINUE TO HAVE RUNAWAY COSTS THEN THE FOCUS ON QUALITY IS ALWAYS GOING TO BE SOMEWHAT AT RISK 7EVE GOT TO MAKE CERTAIN THAT WE FOCUS ON PREVENTION AND BETTER OUTCOMES TO REALLY DEAL WITH SOME OF THIS HIGH UTILIZATION ) THINK WE HONESTLY HAVE A WAYS TO GO EVEN lVE YEARS FROM NOW BUT WELL HAVE MOST OF THE ANSWERS ON WHAT HAS WORKED AND WHAT HASNT NECESSARILY WORKED n
1UALITY AS A "USINESS -ODEL 7HILE ARGUMENTS CONTINUE OVER THE COST EFFECTIVENESS OF QUALITY IMPROVEMENT INITIATIVES FOR SOME DISEASES AND CONDITIONS THE BUSINESS MODEL ALREADY EXISTS IN THE TREATMENT OF THE NATIONS .O KILLER CARDIOVASCULAR DISEASE "Y "RETT - (ICKMAN 0RICEWATERHOUSE#OOPERS
4
HE ESTIMATED DIRECT AND INDIRECT COSTS OF CARDIOVASCULAR DISEASES #6$ INCLUDING STROKE IN THE 5NITED 3TATES IN WERE BILLION;= !CCORDING TO CURRENT ESTIMATES APPROXIMATELY MILLION 53 RESIDENTS HAVE AT LEAST ONE #6$ OR CONDITION SUCH AS HIGH BLOOD PRESSURE 4HAT TOTAL INCLUDES AN ESTIMATED MILLION WITH HIGH BLOOD PRESSURE MORE THAN MILLION WITH CORONARY HEART DISEASE AND MILLION HEART ATTACK SURVIVORS )N ADDITION MILLION 53 RESIDENTS ARE LIVING WITH THE AFTERMATH OF STROKE THE LEADING CAUSE OF LONG TERM SERIOUS DISABILITY AND ANOTHER MILLION HAVE HEART FAILURE;= ! -ARCH STUDY IN 4HE .EW %NGLAND *OURNAL OF -EDICINE REPORTED THAT OVERALL PATIENTS RECEIVED LESS THAN PERCENT OF RECOMMENDED CARE FOR CHRONIC AND ACUTE CONDITIONS 0ATIENTS ARE GETTING ABOUT HALF THE CARE THAT GUIDELINES INDICATE THEY NEED;= #6$ WHICH INCLUDES CORONARY ARTERY DISEASE HEART ATTACK HEART FAILURE AND STROKE IS A LEADING CAUSE OF HOSPITAL ADMISSIONS 0OOR QUALITY #6$ CARE CAN BE DEBILITATING FOR A PATIENT BUT IT CAN ALSO SEVERELY IMPACT INSTITUTIONS 3TUDIES HAVE SHOWN THAT PATIENTS WHO ARE NOT TREATED TO GUIDELINES STANDARDS ARE MORE LIKELY TO BE READMITTED;= 4HIS IS A PARTICULAR CONCERN FOR INDIVIDUALS WITH HEART FAILURE THE LEADING CAUSE OF HOSPITALIZATION IN THE ELDERLY AND A FREQUENT CAUSE OF COSTLY READMISSION )N ONE STUDY OF CARDIOVASCULAR CARE IN SIX %UROPEAN COUNTRIES CHRONIC HEART FAILURE PATIENTS WHOSE TREATMENT MOST CLOSELY FOLLOWED GUIDELINES FOR DRUGS SUCH AS !#% INHIBITORS BETA BLOCKERS AND SPIRONOLACTONE A hWATER PILLv USED TO TREAT HIGH BLOOD PRESSURE AND mUID RETENTION CAUSED BY VARIOUS CONDITIONS INCLUDING HEART DISEASE HAD LESS THAN HALF THE RATE OF HOSPITALIZATIONS OVER SIX MONTHS AS DID PATIENTS WHOSE TREATMENT HAD THE LOWEST ADHERENCE TO GUIDELINES VERSUS PERCENT;=
4HE 6ALUE OF 1UALITY $ATA IS BEGINNING TO ACCRUE IN SUPPORT OF QUALITY AS A GOOD BUSINESS MODEL NOT JUST FROM A COST BUT ALSO A BENElTS STANDPOINT (IGH
QUALITY OFTEN RESULTS IN BETTER OUTCOMES IMPROVED OPERATING EFlCIENCIES SHORTENED AVERAGE LENGTH OF STAYS !,/3 AND REDUCED READMISSIONS )N THIS PAY FOR PERFORMANCE WORLD OF EDUCATED HEALTHCARE CONSUMERS WHO VOTE WITH THEIR FEET QUALITY CARE CAN ALSO TRANSLATE INTO INCREASED MARKET SHARE (OSPITALS WITH HIGHER QUALITY EXCEL FROM A BUSINESS STANDPOINT &OR EXAMPLE 3OLUCIENTS 4OP (OSPITALS LIST WHICH IDENTIlES TOP PERFORMING HOSPITALS ON QUALITY AND lNANCIAL METRICS FOUND THAT ITS BENCHMARK HOSPITALS DID SIGNIlCANTLY BETTER COMPARED WITH THEIR PEERS IN SEVERAL AREAS INCLUDING THE PERCENT LOWER MORTALITY AND PERCENT LOWER COMPLICATION RATES 4HE BENCHMARK HOSPITALS ALSO HAD PERCENT SHORTER !,/3 PERCENT LOWER EXPENSES PER DISCHARGE AND MORE THAN THREE TIMES THE PROlTABILITY VERSUS PERCENT COMPARED WITH THEIR NON BENCHMARK PEERS )N ADDITION BENCHMARK HOSPITALS HAD INCREASED GROWTH OF PERCENT COMPARED WITH A SLIGHT INCREASE IN GROWTH OF PERCENT FOR NON BENCHMARK PEERS;= (EART AND BLOOD VESSEL DISEASE REPRESENTS AN ENORMOUS SEGMENT OF HEALTHCARE EXPENDITURES AS WELL AS A PROMISING POTENTIAL LEVER FOR REDUCING COSTS 4HIS ISSUE WILL UNDOUBTEDLY GET MORE ATTENTION IN LIGHT OF THE RECENT -EDICARE TRUSTEES REPORT PREDICTING THE EXHAUSTION OF THE -EDICARE (OSPITAL )NSURANCE 4RUST &UND BY TWO YEARS EARLIER THAN THE PREVIOUS YEARS ESTIMATE;= )N THE !MERICAN (EART !SSOCIATION !(! PROJECTED A LARGE INCREASE IN #6$ HOSPITAL ADMISSIONS DUE TO THE AGING 53 POPULATION )N RESPONSE THE !(! AND THE AFlLIATED !MERICAN 3TROKE !SSOCIATION SET A GOAL TO REDUCE #6$ DEATH DISABILITY AND RISK FACTORS BY PERCENT BY ROUGHLY THE TIME THE lRST BABY BOOMERS WILL RETIRE h4HE !(! ESTIMATES THAT IT COULD ACHIEVE AT LEAST TWO THIRDS OF ITS GOAL OF A PERCENT REDUCTION IN CORONARY HEART DISEASE DEATH DISABILITY AND RISK FACTORS IF MOST HOSPITALIZED PATIENTS WERE TREATED ACCORDING TO GUIDELINES v SAID 7ARREN 3KEA 0H$ NATIONAL DIRECTOR OF THE !MERICAN (EART !SSOCIATIONS PERFORMANCE AND DECISION SUPPORT STRATEGIES
"RETT - (ICKMAN -"! #0! IS A PARTNER IN 0RICEWATERHOUSE#OOPERS !DVISORY 3ERVICES AND NATIONAL LEADER OF THE (EALTH )NDUSTRIES 3TRATEGY AND 0LANNING PRACTICE (E HAS MORE THAN YEARS OF EXPERIENCE IN THE HEALTHCARE INDUSTRY INCLUDING ALIGNING INCEN TIVES PARTNERSHIPS AND JOINT VENTURES BETWEEN HOSPITALS AND PHYSICIANS (E IS ALSO A #ERTIlED 0UBLIC !CCOUNTANT LICENSED IN )LLINOIS AND )NDIANA (E CAN BE REACHED AT BRETTMHICKMAN USPWCCOM
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXã@Rã@ãAT RHMD RRãLNCD K
'ET 7ITH THE 'UIDELINES n !N !PPROACH FOR )MPROVING #ARDIAC #ARE )N RESPONSE THE !(! DEVELOPED 'ET 7ITH THE 'UIDELINES3- '74' A 7EB BASED TOOL FOR IN HOSPITAL MEDICAL MANAGEMENT AND QUALITY IMPROVEMENT THAT FOLLOWS A PATIENT FROM INTAKE TO DISCHARGE -ORE THAN HOSPITALS ACROSS THE COUNTRY ARE USING ONE OR MORE OF THE MODULES WHICH STEM FROM EVIDENCE BASED GUIDELINES FROM THE !(!S COMPENDIUM OF 3CIENTIlC 'UIDELINES AND 3TATEMENTS (OSPITALS THAT HAVE IMPLEMENTED THE PROGRAM REPORT MEASURABLE IMPROVEMENTS IN PATIENT OUTCOMES AND OFTEN INCREASED OPERATIONAL EFlCIENCIES DUE TO BETTER OPERATIONAL WORK mOW CONTINUITY OF CARE AND LOWER OPERATING COSTS '74' CONSISTS OF THREE MODULES CORONARY ARTERY DISEASE WHICH INCLUDES ACUTE HEART ATTACK AND ISCHEMIC HEART DISEASE '74' #!$ HEART FAILURE '74' (& AND STROKE '74' 3TROKE !T THE CENTER OF '74' IS THE 0ATIENT -ANAGEMENT 4OOL4- WHICH GIVES HOSPITALS MUCH OF THE POWER OF ELECTRONIC MEDICAL RECORDS ON A 7EB BASED LOW COST SYSTEM THAT REQUIRES NO OUTLAYS FOR SOFTWARE -OST OF THE DATA CAN BE ENTERED THROUGH A SIMPLE POINT AND CLICK INTERFACE &OR EXAMPLE WHEN A PATIENT ARRIVES IN THE %2 HOSPITAL STAFF CAN USE THE SIMPLE INTERFACE TO ENTER DATA ON MEDICAL HISTORY n PRIOR HEART ATTACK DIABETES SMOKING ETC n AND CURRENT PRESCRIPTIONS SUCH AS CHOLESTEROL LOWERING DRUGS !FTER THE PATIENT IS DIAGNOSED WITH A CARDIOVASCULAR CONDITION SUCH AS CORONARY ARTERY DISEASE STROKE OR HEART FAILURE THE PROGRAM PROVIDES SPECIlC PROMPTS CHECKLISTS AND DECISION SUPPORT FOR MEDICAL STAFF AT EVERY STAGE OF THE HOSPITAL EXPERIENCE 4HE PROGRAM IS DESIGNED TO PROVIDE AN INDIVIDUAL APPROACH BASED ON A PATIENTS MEDICAL HISTORY AND RISK FACTORS HIGH CHOLESTEROL HIGH BLOOD PRESSURE ETC THAT REmECTS THE MOST CURRENT EVIDENCE BASED GUIDELINES THAT SCIENTIlC RESEARCH HAS SHOWN TO HAVE THE BEST PATIENT OUTCOMES &ROM THERE '74' PROVIDES PATIENT SPECIlC PROMPTS CHECKLISTS AND DECISION SUPPORT FOR MEDICAL STAFF AT EVERY STEP OF THE HOSPITAL EXPERIENCE TO HELP HOSPITALS ENSURE THAT EACH PATIENTS CARE MEETS GUIDELINES FROM THE !(! AND !MERICAN #OLLEGE OF #ARDIOLOGY 4HE INTERFACE IS UPDATED WHENEVER THE GUIDELINES ARE REVISED !T DISCHARGE THE PROGRAM GENERATES EDUCATIONAL MATERIALS FOR PATIENTS WHICH ENABLES HOSPITAL STAFF TO TAKE ADVANTAGE OF THE hTEACHABLE MOMENTv 2ESEARCH HAS SHOWN THAT PATIENTS ARE MOST LIKELY TO CHANGE BEHAVIORS AND COMPLY WITH GUIDELINES FOLLOWING A MEDICAL CRISIS )N ADDITION A DISCHARGE LETTER IS GENERATED TO A PATIENTS PRIMARY CARE PHYSICIAN TO COMPLETE THE COMMUNICATIONS LOOP '74' CAN BE USED BY HOSPITALS TO SUBMIT DATA REQUIRE MENTS TO #-3 AND *OINT #OMMISSION ON THE !CCREDITATION OF
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
(EALTHCARE /RGANIZATIONS )N ADDITION FOR INTERNAL ANALYSIS AND QUALITY IMPROVEMENT INITIATIVES HOSPITAL STAFF CAN ACCESS REAL TIME HOSPITAL SPECIlC AND PEER GROUP AGGREGATE BENCH MARKING REPORTS THAT CAN BE PRINTED OR DOWNLOADED FOR INCORPORATION IN PRESENTATIONS OR TO TRACK THE PROGRESS OF QUALITY IMPROVEMENT INITIATIVES "ECAUSE THE PROGRAM WAS CREATED TO MEET THE !(!S HEALTH IMPROVEMENT GOALS RATHER THAN AS A REVENUE GENERATING VENTURE THE THREE MODULES '74' #!$ '74' (& AND '74' 3TROKE EACH COST ABOUT ANNUALLY 4HE REST OF THE PROGRAM COMES AT NO EXTRA CHARGE TO A HOSPITAL )MPLEMENTATION COSTS ARE FAIRLY INSIGNIlCANT -ANY HOSPITALS ARE ABLE TO IMPLEMENT THE PROGRAMS WITHOUT ADDING STAFF SIMPLY BY REALIGNING DUTIES !NALYSIS SHOWS THAT EVEN IN A WORST CASE SCENARIO IN WHICH A HOSPITAL WOULD ADD ONE STAFF POSITION n A MEDICAL DIRECTORSHIP n AND HOLD ONE WORKSHOP TO EXPLAIN THE PROGRAM AND GET THE CROSS DISCIPLINED TEAM ORIENTED THE COST TO IMPLEMENT ALL THREE MODULES IS LESS THAN %XAMPLE 4ECHNOLOGYLICENSING ALL MODULES 3TAFF EMPLOYEE 0HYSICIAN LEADERSHIP 7ORKSHOP 4OTAL )N ADDITION TO TRAINING MODULES AVAILABLE ON THE WEBSITE THE !(! PROVIDES STEP BY STEP GUIDELINES ON HOW TO FORM A MULTIDISCIPLINARY TEAM THAT LEADS EACH HOSPITALS '74' PROGRAM AND PROVIDE WORKSHOPS WITH #-% CREDITS FOR HOSPITAL STAFF h7E TEACH HOSPITALS TO USE THE DATA AND REPORTS TO MONITOR THEIR PROCESSES AND REPORT ON HOW THEY ARE DOING TO MEET THEIR BENCHMARKS 7E HELP THEM RE ENGINEER THEIR PROCESSES AND THE PROGRAM LETS THEM REPEATEDLY MEASURE TO SEE IF THE CHANGES ARE MAKING A DIFFERENCE v 3KEA SAID h7HEN A HOSPITAL DOES A GOOD JOB ON '74' IT IS USUALLY DUE TO THE '74' LEADERSHIP TEAM CHANGING THE INSTITUTIONS CULTURE SO THAT EVERYONE IS ACCOUNTABLE FOR PATIENTS BEING DISCHARGED ACCORDING TO THE GUIDELINES 7E HAVE HEARD OF A HOSPITAL WARD CLERK IN ESSENCE TACKLING THE CHIEF OF MEDICINE WHO WAS ATTEMPTING TO LEAVE ON A &RIDAY NIGHT BECAUSE A PATIENT DID NOT RECEIVE A KEY THERAPY v 3KEA SAID
4RANSITIONING TO 0AY FOR 0ERFORMANCE -ORE COMMERCIAL PAYERS ARE ADDING '74' TO THEIR PAY FOR PERFORMANCE SCORECARDS )N ADDITION '74' HAS HELPED MANY HOSPITALS PREPARE FOR THE PAY FOR PERFORMANCE 00 MODEL THAT OFTEN REQUIRES IMPROVED COMPLIANCE 4HE STAKES AND THE MONEY ARE INCREASING &OR INSTANCE THE MORE THAN PARTICIPANTS IN THE 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION RECENTLY SHARED IN A PERCENT MARKET BASKET ADJUSTMENT OR INCREASE IN -EDICARE PAYMENTS GIVEN TO THE TOP PERCENT OF HOSPITALS;= h4WO PERCENT DOESNT
P T@K HSXã@Rã@ãAT RHMD RRãLNCD K SOUND LIKE MUCH BUT SOME HOSPITAL EXECUTIVES TOLD ME THEIR PAYOUTS WERE APPROACHING SEVEN lGURES ANNUALLY v 3KEA SAID )N THIS AGE OF TRANSPARENCY WHEN FORMERLY PROPRIETARY INFORMATION ON QUALITY IS MOVING ONTO THE )NTERNET AND CONSUMERS ARE BEING ENCOURAGED TO USE IT TO GUIDE THEIR HEALTHCARE CHOICES THE LINK BETWEEN OUTCOMES AND lNANCIAL PERFORMANCE IS UNDENIABLE (IGHER QUALITY CAN LEAD TO INCREASED MARKET SHARE WHICH CAN RESULT IN HIGHER VOLUME AND INCREASED MARGINS /NE LARGE HOSPITAL CHAIN WITH A 001UALITY CONTRACT WITH A NATIONAL PAYER REALIZED A PERCENT VOLUME INCREASE COMPARED TO A PERCENT VOLUME LOSS FOR NONPARTICIPANTS %XPERIENCE WITH THIS PROGRAM HAS ILLUSTRATED THE IMPORTANCE OF THE FOLLOWING ISSUES IN IMPLEMENTING QUALITY PROGRAMS # 3UITE AS ,EADERSHIP 6OICE 4HE EASIEST WAY TO EFFECT CHANGE IS THROUGH A TEAM APPROACH !LIGN ALL LEVELS OF YOUR ORGANIZATION AROUND THE SAME GOAL BY MAKING QUALITY A CLEAR FOCUS -ANY ON THE CLINICAL mOOR ARE ENERGETIC PATIENT ADVOCATES WHO ARE PASSIONATE ABOUT QUALITY CARE (ARNESS THAT ENERGY AND PASSION /F COURSE THERE ARE ALWAYS SOME PEOPLE IN ANY ORGANIZATION WHO RESIST CHANGE OF ANY KIND 4HATS WHY IT IS CRUCIAL FOR THE # SUITE TO SET THE TONE 4HEN LEADERS AT EVERY LEVEL CAN BE ENLISTED TO HELP LEAD THE CHANGE 0HYSICIAN )NVOLVEMENT AND !LIGNMENT 0HYSICIANS DO NOT RESPOND WELL TO A TOP DOWN APPROACH (OWEVER BECAUSE THEY TEND TO BE NATURAL LEADERS THEY OUGHT TO BE INVOLVED FROM THE START IN ANY QUALITY INITIATIVE (OSPITALS MUST PARTNER WITH PHYSICIANS ON MANY LEVELS TO CREATE A SUSTAINABLE HEALTHCARE SYSTEM 00 FORCES INSTITUTIONS TO ALIGN INCENTIVES FOR PHYSICIANS BUT IT MUST BE DONE CAREFULLY TO AVOID VIOLATING REGULATIONS ,EADERSHIP MEANS MAKING MAJOR STRIDES IN MEDICAL STAFF RELATIONS AND FUTURE ALIGNMENT IN THE FORM OF QUALITY AND PERFORMANCE INITIATIVES IS GROWING RAPIDLY AND PRODUCING SIGNIlCANT AND SUSTAINABLE BENElTS #ULTURE OF 1UALITY AND 4RANSPARENCY n 0UBLISH OR 0ERISH 4HE MOVE TO TURN CONSUMERS INTO EDUCATED HEALTHCARE SHOPPERS AND THE RISE OF 7EB BASED REPORTING IS FUELING THE DRIVE TO GREATER TRANSPARENCY "EING AVERAGE IS NOT GOOD ENOUGH IF THE NEAREST COMPETITOR IS ABOVE AVERAGE AND IT IS AVAILABLE FOR EVERYONE TO SEE )T IS NOT ENOUGH TO IMPROVE QUALITY /NCE THAT GOAL IS ACCOMPLISHED LET THE WORLD KNOW BY INCLUDING SUCCESSES IN MARKETING #ONTINUOUS 1UALITY )MPROVEMENT AND 0ROCESS 2EDESIGN 3TANDARDIZATION MEANS ELIMINATING VARIABILITY 3TANDARDIZATION IS A CRUCIAL STEP ON THE ROAD TO SUSTAINABILITY )F THERE ARE A DOZEN PHYSICIANS DOING THE SAME PROCEDURE A DOZEN DIFFERENT WAYS THERE IS A PROBLEM %VIDENCE BASED MEDICINE SUGGESTS THAT PATIENTS TREATED IN A STANDARD WAY BASED ON THE EVIDENCE WILL RECEIVE THE BEST OUTCOMES #ONSTANTLY MEASURE EVALUATE AND RElNE 0ROCESSES ARE ALSO IMPORTANT TO CONSIDER 0ROCESSES THAT NO LONGER WORK SHOULD BE RE ENGINEERED AND THOSE THAT DO lNE TUNED
$ATA $ATA $ATA AND -ORE $ATA /NCE THE SYSTEMS ARE STANDARDIZED AND THE DATA ARE COLLECTED IT IS NECESSARY TO RE EVALUATE AND RElNE THEM IN A QUALITY IMPROVEMENT APPROACH TO PATIENT CARE 4HE SYSTEM WILL NEVER BE STATIC IT WILL CONSTANTLY EVOLVE 4HE STANDARDS THEMSELVES WILL CONTINUE TO TRANSFORM AND ORGANIZATIONS WITH THE BEST TEAMS WILL BE BETTER POSITIONED TO RIDE THE WAVES OF HEALTHCARE CHANGE
! #HALLENGE AND AN /PPORTUNITY #6$ IS THE LEADING CAUSE OF DEATH AND DISABILITY IN THIS COUNTRY RESULTING IN STAGGERING COSTS 9ET THIS CHALLENGE IS ALSO AN OPPORTUNITY BECAUSE OF MOUNTING EVIDENCE THAT HOSPITALS WITH THE HIGHEST QUALITY ALSO EXCEL FROM A BUSINESS STANDPOINT '74' CAN BE VIEWED AS A METAPHOR FOR THE 53 HEALTHCARE SYSTEM 7HEN PATIENTS ARE DISCHARGED AFTER SURVIVING HEART ATTACKS THE PROGRAM TAKES ADVANTAGE OF THAT TEACHABLE MOMENT 4HE 53 MEDICAL SYSTEM IS ALSO EXPERIENCING A CRISIS )T HAS BEEN ASSAILED FOR PROVIDING HAPHAZARD POOR QUALITY CARE AT A VERY HIGH PRICE &OR 53 HOSPITALS THIS IS ANOTHER TEACHABLE MOMENT 4HE TAKE HOME MESSAGE 1UALITY IS JUST GOOD BUSINESS 3MART HOSPITAL SYSTEMS AND THEIR EXECUTIVES ARE HEEDING THAT MESSAGE '74' CAN BE USED IN A QUALITY INITIATIVE THAT SHIFTS RESPON SIBILITY FROM A FEW TO EVERYONE 4HE RESULT OF MAKING EVERYONE RESPONSIBLE FOR TREATING TO GUIDELINES IS THAT PATIENTS AND THEIR HOSPITALS WILL BE HEALTHIER 4HIS PAPER WAS PREPARED WITH THE ASSISTANCE OF $EBORAH 7ORMSER %NDNOTES 4HOM 4 ET AL h(EART $ISEASE AND 3TROKE 3TATISTICS n 5PDATE v !MERICAN (EART !SSOCIATION $ALLAS #IRCULATION PP E E HTTPCIRCAHAJOURNALSORGCGICONTENTSHORTE )BID P -C'LYNN % ET AL h4HE 1UALITY OF (EALTH #ARE $ELIVERED TO !DULTS IN THE 5NITED 3TATES v *UNE 4HE .EW %NGLAND *OURNAL OF -EDICINE HTTPCONTENTNEJMORGCGICONTENTABSTRACT +OMAJDA - ET AL h!DHERENCE TO GUIDELINES IS A PREDICTOR OF OUTCOME IN CHRONIC HEART FAILURE THE -!(,%2 SURVEY v %UR (EART * PP )BID 3OLUCIENT 4OP (OSPITALS¸ .ATIONAL "ENCHMARKS FOR 3UCCESS %VANSTON 3OLUCIENT P h !NNUAL 2EPORT OF THE "OARDS OF 4RUSTEES OF THE &EDERAL (OSPITAL )NSURANCE AND &EDERAL 3UPPLEMENTARY -EDICAL )NSURANCE 4RUST &UNDS v 7ASHINGTON $# P 2EWARDING 3UPERIOR 1UALITY #ARE 4HE 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION #ENTERS FOR -EDICARE -EDICAID 3ERVICES &ACT 3HEET 7ASHINGTON $# HTTPWWWCMSHHSGOV(OSPITAL 1UALITY)NITSDOWNLOADS(OSPITAL0REMIER&3PDF
0OWERED BY /UTCOME #AMBRIDGE -ASS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
! 0ROVIDER ,ED !PPROACH TO 0AY FOR 0ERFORMANCE 4HE .ATIONAL #ARE 4RANSACTION #ONSORTIUM 7HILE MANY BELIEVE THAT @PAYING FOR PERFORMANCE WILL SOON BECOME THE NORM THE PLETHORA OF PROGRAMS AND REPORTING REQUIREMENTS IS CREATING CONFUSION AND ADMINISTRATIVE BURDENS FOR PROVIDERS 4HE SOLUTION REQUIRES BOTH COORDINATION AND INCREASED PARTICIPATION BY PROVIDERS "Y $AVID ,EVY 0RICEWATERHOUSE#OOPERS
0
AY FOR PERFORMANCE 00 PROGRAMS HAVE ENTERED THE HEALTHCARE MARKET AS A WAY TO INCENTIVIZE QUALITY CARE )N ROUGHLY ONE THIRD OF PAYERS HAD IMPLEMENTED SOME TYPE OF A 00 REIMBURSEMENT METHOD;= (OWEVER THE PROLIFERATION OF THESE PROGRAMS IS CHALLENGING TO PROVIDERS THAT ARE STRUGGLING TO KEEP UP WITH AN EVER EXPANDING LIST OF QUALITY METRICS TO REPORT 7HILE MANY PERFORMANCE MEASURES OVERLAP THE CURRENT STATE OF THESE PROGRAMS IS A COMBINATION OF MULTIPLE METRICS DElNITIONS AND STRUCTURES 4HE INDUSTRY IS ATTEMPTING TO IDENTIFY MEASURES THAT ARE CLINICALLY RELEVANT AND CORRELATED WITH QUALITY AND OUTCOMES 0ERFORMANCE MEASUREMENTS ARE EVOLVING AND HAVE MULTIPLE USES IN ADDITION TO PAYMENT INCENTIVES SUCH AS DATA COLLECTION PUBLIC REPORTING AND QUALITY IMPROVEMENT .OTED IN THE RECENT )NSTITUTE OF -EDICINE )/- REPORT h0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT v PUBLIC AND PRIVATE STAKEHOLDERS HAVE LAUNCHED MULTIPLE EFFORTS TO CREATE HEALTHCARE QUALITY IMPROVEMENT MEASURES FOR MEDICAL PROFESSIONALS;= 7HILE INDUSTRY LEADERS BELIEVE THAT hPAYING FOR PERFORMANCEv WILL BECOME THE NORM IN THE NEXT DECADE SOME BARRIERS TO UNIVERSAL ADOPTION EXIST -ULTIPLE QUALITY AND DATA STANDARDS &RAGMENTED AND DISORGANIZED REPORTING REQUIREMENTS ,ACK OF COORDINATION BETWEEN QUALITY ORGANIZATIONS PAYER GROUPS AND PROVIDERS ,ACK OF TRUST BETWEEN PROVIDERS AND PAYERS 3TATISTICALLY UNRELIABLE DATA #OST OF COLLECTION AND REPORTING OF QUALITY MEASURES AND 5RGENT NEED FOR ALIGNMENT OF DISPARATE PERFORMANCE MONITORING INITIATIVES 4HE PROLIFERATION OF 00 PROGRAMS LACKS CONTEXTUAL NETWORKS AND CONNECTIONS RESULTING IN PROVIDERS FEELING OVERBURDENED BY ADMINISTRATIVE RESPONSIBILITIES 0HYSICIANS AND HOSPITALS HAVE VOICED MULTIPLE BARRIERS TO THEIR ACCEPTANCE OF 00 INITIATIVES
AND THEIR ATTITUDES TOWARD 00 VARY WIDELY 3HORTCOMINGS RAISED BY THE MEDICAL COMMUNITY INCLUDE ,ACK OF MEASURES ON DISPARITIES IN CARE n IN GENERAL PERFORMANCE MEASURES DO NOT INCLUDE MEASURES OF PATIENT ACCESS AND EQUITY OF CARE ,ACK OF ATTENTION TO PATIENT VARIATIONS n SUCH AS PATIENT TREATMENT PATTERNS AND CASE MIX /VEREMPHASIS OF CERTAIN MEDICAL SPECIALTIES n SUCH AS CARDIOLOGY WHILE OTHER MEDICAL SPECIALTIES ARE NOT INCLUDED IN ANY MEASURES ,IMITATION BY THE PAYERS MARKET SHARE n PHYSICIANS HAVE GREATER INCENTIVES TO PARTICIPATE IN A 00 PROGRAM SPONSORED BY A HEALTH PLAN THAT COVERS A LARGE PORTION OF THEIR PATIENT MIX $IFlCULTY IN IMPLEMENTATION BY SMALL PHYSICIAN PRACTICES n THAT LACK THE RESOURCES AND INFRASTRUCTURE NEEDED TO SYSTEMATICALLY REPORT PERFORMANCE DATA AND &RAGMENTED OR NONEXISTENT INFRASTRUCTURE n FOR COLLECTING AND REPORTING QUALITY MEASURES IS FRAGMENTED OR NOT ESTABLISHED !DDRESSING THESE ISSUES WILL REQUIRE GREATER PARTICIPATION FROM PHYSICIANS TO ENSURE THAT MEASURES ARE MEANINGFUL TO A LARGER GROUP OF PHYSICIANS NOT JUST PHYSICIAN SUBGROUPS 4HE )/- REPORT ADDRESSED MANY OF THESE BARRIERS AND ISSUES OF CURRENT PERFORMANCE MEASUREMENT 4HE )/- MADE THE OBSERVATION hTHE NATION DOES NOT YET HAVE A COHERENT INTEGRATED SYSTEM FOR ESTABLISHING MEASURING AND TRACKING THE PERFORMANCE OF THE HEALTHCARE SYSTEM )N FACT THERE IS GROWING CONCERN IN SOME QUARTERS THAT THE CURRENT FRAGMENTED APPROACH COULD CREATE A CONFUSING DUPLICATIVE YET STILL INCORPORATED SET OF ACTIVITIES THAT WOULD ABSORB TOO MANY RESOURCESxv )T ALSO STATED h)F QUALITY IMPROVEMENTS INITIATIVES ARE TO ACHIEVE THEIR FULL POTENTIAL A CONCERTED NATIONAL EFFORT TO CONSOLIDATE HEALTHCARE PERFORMANCE MEASUREMENT AND REPORTING ACTIVITIES WILL BE ESSENTIALv;= /NE
$AVID ,EVY -$ IS A MANAGING DIRECTOR LEADING 0RICEWATERHOUSE#OOPERS $IGITAL (EALTH PRACTICE (E ALSO LED THE ,OUISIANA 2ECOVERY !UTHORITY PROJECT FOR THE RECOVERY OF THE POST +ATRINA HEALTHCARE SYSTEM (E WAS THE FOUNDER CHAIRMAN AND #%/ OF &RANKLIN (EALTH )NC A LEADING DISEASE MANAGEMENT COMPANY IN THE AREA OF COMPLEX ILLNESS (E IS TRAINED AS A FAMILY PHYSICIAN AND EPIDEMIOLOGIST AND FOUNDED AND MANAGED A HIGHLY SUCCESSFUL GROUP PRIMARY CARE PRACTICE IN "ERGEN #OUNTY .EW *ERSEY (E CAN BE REACHED AT DAVIDLLEVY USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
@ãO QN UHCDQ K DCã @OOQN@BGãSNãO@XãE NQãOD QE NQL @MBD OF THE MAJOR RECOMMENDATIONS OF THE REPORT WAS THE FORMATION THE .ATIONAL 1UALITY #OORDINATION "OARD .1#" AS AN INDEPENDENT FEDERAL ENTITY WITHIN THE 53 $EPARTMENT FOR (EALTH AND (UMAN 3ERVICES 4HE .1#" WOULD WORK WITH PUBLIC AND PRIVATE STAKEHOLDERS TO CREATE A NATIONAL SYSTEM FOR PERFORMANCE MEASUREMENT AND REPORTING 3IMILAR TO THE )/- NATIONAL HEALTHCARE LEADERS SUPPORT THE EXISTENCE OF SUCH AN ORGANIZATION
@4HE WORK OF THE )/- IS PREDICATED ON THE IDENTIFICATION AND ANALYSIS OF AN EVIDENCE BASE THAT IS AS ROBUST COMPREHENSIVE AND OBJECTIVE AS POSSIBLE 7E BELIEVE THAT THAT SHOULD BE THE BASIS FOR DISCUSSION AND ACTION BY ALL STAKEHOLDER GROUPS n *OHN # 2ING -$ DIRECTOR OF THE BOARD ON HEALTHCARE SERVICES OF THE )NSTITUTE OF -EDICINE 2ECENTLY 0RICEWATERHOUSE#OOPERS INITIATED AN EFFORT TO ADDRESS THE STRUCTURAL ISSUES IDENTIlED BY THE )/- 4HE lRM APPROACHED SOME OF THE NATIONS LEADING PROVIDER ORGANIZATIONS TO JOIN IN A FEASIBILITY STUDY TO ELUCIDATE HOW TO CREATE AN ENTITY WITH ATTRIBUTES OF THE )/-S .ATIONAL 1UALITY #OORDINATION "OARD 0RELIMINARILY NAMED THE .ATIONAL #ARE 4RANSACTION #ONSORTIUM THE GROUPS AIM IS TO RECOMMEND SCOPE GOVERNANCE SOURCE AND USES OF DATA TECHNOLOGY INFRASTRUCTURE CAPITAL REQUIREMENTS AND A SUSTAINABLE BUSINESS MODEL )F SUCCESSFUL THIS CONSORTIUM COULD LAY A PRIVATE SECTOR FOUNDATION FOR THE VISION ENCAPSULATED BY THE )/-S .1#" WHILE INCLUDING ALL OF THE RELEVANT STAKEHOLDERS SUCH AS PROVIDERS PAYERS CONSUMERS AND GOVERNMENT )N ADDITION IT COULD NONCOMPETITIVELY WORK WITH REGULATORS SUCH AS THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE PROFESSIONAL SOCIETIES AND OTHER INITIATIVES UNDER A SINGLE FRAMEWORK 4HE NEED FOR QUALITY AND SAFETY STANDARDS EMERGED AS A KEY FEATURE OF SUSTAINABLE HEALTH SYSTEMS ACCORDING TO A RECENT STUDY (EALTH#AST PUBLISHED BY 0RICEWATERHOUSE#OOPERS 4HE RESEARCH DERIVED FROM DISCUSSIONS AROUND THE COUNTRY WITH LARGE PROVIDER GROUPS HOSPITAL SYSTEMS PAYERS REGULATORS PROFESSIONAL SOCIETIES AND PATIENT ADVOCACY GROUPS WAS A GLOBAL SURVEY OF OVER HEALTHCARE LEADERS IN COUNTRIES &URTHER OBSERVATIONS EMANATING FROM DISCUSSIONS WITH INDUSTRY LEADERS SUPPLEMENT THIS RESEARCH AND SUGGEST THAT A PRIVATE SECTOR INITIATIVE SUCH AS A CARE TRANSACTION CONSORTIUM COULD BE REALIZED ,EADING PROVIDERS IN THE 53 ARE WILLING TO TAKE THE LEAD IN THE DEVELOPMENT OF THIS IDEA
%NLIGHTENED PAYERS ARE PREPARED TO SUPPORT IT 2EGULATORS GOVERNMENTAL AGENCIES AND PATIENT ADVOCACY GROUPS WOULD BE INTERESTED IN PARTICIPATING AND 0RICEWATERHOUSE#OOPERS COULD SERVE AS A TRUSTED THIRD PARTY BETWEEN ALL STAKEHOLDERS 4HE .ATIONAL #ARE 4RANSACTION #ONSORTIUM COULD REPRESENT A SIGNIlCANT STEP IN ORGANIZING INmUENTIAL PARTIES TO COLLABORATE IN NATIONAL HEALTHCARE QUALITY IMPROVEMENT 4HE MAJORITY OF 00 PROGRAMS TO DATE HAVE BEEN DESIGNED AND ADMINISTERED BY EMPLOYER COALITIONS AND INSURANCE COMPANIES /FTEN PROVIDERS HAVE BEEN ON THE RECEIVING END OF THE PERFORMANCE MEASURES $ESPITE SOME PROVIDER LED EFFORTS HOSPITALS OVERALL INVOLVEMENT IN THE DEVELOPMENT OF PERFORMANCE MEASURES AND 00 STRUCTURES HAS BEEN LIMITED 4HE .ATIONAL #ARE 4RANSACTION #ONSORTIUM THEREFORE OFFERS AN OPPORTUNITY FOR PROVIDERS TO ESTABLISH AN OPEN TRANSPARENT AND LEARNING MODEL OF QUALITY IMPROVEMENT MUCH LIKE THAT SEEN IN OTHER INDUSTRIES SUCH AS COMMERCIAL AVIATION ! PROVIDER LED CONSORTIUM COULD ALSO OFFER A VEHICLE FOR PROVIDING AN INCLUSIVE OPPORTUNITY FOR ALL PHYSICIANS FOR CARE IMPROVEMENT CONTINUING MEDICAL EDUCATION PROFESSIONAL RECREDENTIALING AND GREATER INCOME )T COULD ALSO REPRESENT A PROVIDER LED INDUSTRY VOICE FOR A CONSISTENT PERFORMANCE REWARD STRUCTURE )N ACHIEVING THIS GOAL IT WOULD $RIVE INDUSTRY STANDARDIZATION AROUND MEANINGFUL USABLE AND REWARDABLE QUALITY MEASURES 2EDUCE THE ADMINISTRATIVE BURDEN ON PROVIDERS AND PAYERS 2EPRESENT A hVOICEv FOR ALL LICENSED PHYSICIANS AND 0ROVIDE ONGOING MONITORING AND VALIDATION OF MEASURES 0RIVATE SECTOR LED CONSORTIA HAVE PROVEN TO BE A USEFUL WAY FOR OTHER INDUSTRIES TO COOPERATE WITH ONE ANOTHER TO BRING VALUE TO ALL OF THEIR STAKEHOLDERS 0RICEWATERHOUSE#OOPERS HAS PARTICIPATED IN MANY SUCH CONSORTIA PARTICULARLY IN THE lNANCIAL SERVICES INDUSTRY THAT HAVE ENABLED MANY OF THE DAILY lNANCIAL TRANSACTIONS THAT MOST TAKE FOR GRANTED 4HESE INCLUDE THE GLOBAL TRANSFER OF MONEY ELECTRONIC SETTLEMENT OF SECURITIES TRADING GLOBAL SECURITY AND AUTHENTICATION OF IDENTITY AND OTHERS )N ALL CASES 0RICEWATERHOUSE#OOPERS ACTED AS A TRUSTED THIRD PARTY INTERMEDIARY GARNERING THE TRUST FROM ALL PARTIES AND HELPING EXECUTE WITH INTEGRITY AND INDEPENDENCE !S THE HEALTHCARE INDUSTRY REALIGNS AROUND THE QUALITY AND VALUE OF SERVICES TO PATIENTS AN INTEGRAL PIECE OF THE PUZZLE WILL NECESSARILY MEAN TRANSPARENT AND VALID QUALITY MEASURES THAT ALL STAKEHOLDERS CAN USE WITH CONlDENCE )T IS HOPED THAT THE .ATIONAL #ARE 4RANSACTION #ONSORTIUM WILL PLAY A USEFUL ROLE IN THIS EFFORT %NDNOTES h0AY FOR 0ERFORMANCES 3MALL 3TEPS OF 0ROGRESS v 0RICEWATERHOUSE#OOPERS h0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT v )NSTITUTE OF -EDICINE )BID
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
0AY FOR 0ERFORMANCE AND "EYOND ! 2ECIPE FOR )MPROVING (EALTHCARE ! FUNDAMENTAL REFORM TO PROVIDER PAYMENT IS NEEDED THAT WILL DRIVE PAY FOR PERFORMANCE METHODS FORWARD AND LEAD THE WAY TO A MYRIAD OF IMPROVEMENTS IN DELIVERING TODAYS HEALTHCARE
"Y &RAN¥OIS DE "RANTES "RIDGES 4O %XCELLENCE
)
N $R ,ALUDE;= RECEIVED A LETTER OFFERING HIM A lNANCIAL BONUS FROM EMPLOYERS IN HIS COMMUNITY FOR THE QUALITY OF CARE HE WAS DELIVERING TO HIS DIABETIC PATIENTS 4O QUALIFY FOR THE BONUS $R ,ALUDE HAD TO RANDOMLY SELECT MEDICAL RECORDS FOR OF THOSE PATIENTS /NCE THE SELECTION WAS COMPLETE HE WOULD THEN NEED TO RECORD KEY MEASURES OF THEIR HEALTH STATUS AS WELL AS THE CARE THEY HAD RECEIVED AND REPORT IT TO THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1! &OR $R ,ALUDE THE QUALIFYING PROCESS SEEMED SIMPLE AND REQUIRED FEW HOURS OF WORK )N RETURN HE WOULD BE GETTING SEVERAL THOUSAND DOLLARS BECAUSE HE WAS CONlDENT IN THE QUALITY OF CARE HE WAS DELIVERING TO HIS PATIENTS (OWEVER AFTER GOING THROUGH THE RECORDS HE REALIZED HE WOULD NOT QUALIFY FOR THE REWARD 4HE AVERAGE BLOOD PRESSURE CHOLESTEROL LEVEL AND BLOOD SUGAR LEVEL OF HIS PATIENTS WERE NOT AS GOOD AS HE HAD INITIALLY THOUGHT AND NOT GOOD ENOUGH FOR HIM TO RECEIVE THE BONUS )N FACT HIS AVERAGE SCORE OF PERCENT WAS ALMOST IDENTICAL TO THE AVERAGE SCORE OF PHYSICIANS THAT HAD BEEN STUDIED BY "ETH -C'LYNN;= $R ,ALUDE REALIZED HE NEEDED TO IMPROVE INTERNAL PROCESSES AND SYSTEMS SO THAT HIS OFlCE COULD SYSTEMATICALLY mAG DIABETICS KEEP A LOG OF THEIR HEALTH STATUS AND ALLOW HIM TO FOCUS ON THE SUBSET OF PATIENTS WHO WERE NOT MONITORING THEIR DIABETES APPROPRIATELY /NCE THESE CHANGES WERE IMPLEMENTED $R ,ALUDE AND HIS STAFF NO LONGER WAITED FOR PATIENTS TO SHOW UP AT THE OFlCE BUT TOOK A PROACTIVE APPROACH AND REACHED OUT TO INDIVIDUAL PATIENTS TO GATHER FEEDBACK ON THEIR VITAL SIGNS AND ENCOURAGE REGULAR OFlCE VISITS "Y $R ,ALUDES AVERAGE PATIENT SCORES HAD DRAMATICALLY IMPROVED AND HE WAS ABLE TO QUALIFY FOR RECOGNITION AND THE BONUS $R ,ALUDE TRANSFORMED HIS PRACTICE BECAUSE HE KNEW THAT IT WAS THE RIGHT THING TO DO FOR HIS PATIENTS AND THE QUALITY OF CARE HE WAS DELIVERING TO THEM (E DID NOT DO IT SIMPLY FOR THE MONETARY REWARDS THOUGH THE INCENTIVES GAVE HIM THAT MUCH MORE OF A REASON TO RE EVALUATE THE QUALITY OF HIS CARE 5P UNTIL THAT POINT $R ,ALUDE REALLY DID NOT HAVE A REASON TO QUESTION HIS PERFORMANCE AS A PHYSICIAN .OW HE HAS
A SYSTEM IN PLACE THAT TELLS HIM HOW HE IS DOING AND HELPS HIM TARGET HIS EFFORTS $R ,ALUDES STORY HAS BEEN REPEATED THROUGHOUT THE COUNTRY BY SEVERAL THOUSANDS OF PHYSICIANS WHO HAVE BEEN PARTICIPATING IN PROGRAMS THAT ENCOURAGE THEM TO DELIVER BETTER CARE 4HESE PROGRAMS HAVE BEEN CALLED PAY FOR PERFORMANCE TO DISTINGUISH THEM FROM THE MORE COMMON WAY OF PAYING FOR CARE TODAY PAY FOR VOLUME FEE FOR SERVICE 4HE BETTER KNOWN PAY FOR PERFORMANCE EFFORTS INCLUDE THE )NTEGRATED (EALTHCARE !SSOCIATIONS )(!S 00;= EFFORT IN #ALIFORNIA AND "RIDGES 4O %XCELLENCE ;= WHICH IS ACTIVE IN SEVERAL STATES ON THE %AST #OAST AND IN THE CENTRAL REGION OF THE COUNTRY "RIDGES 4O %XCELLENCE "4% IS A NOT FOR PROlT ORGANIZATION THAT DESIGNS AND CREATES PROGRAMS THAT ENCOURAGE PHYSICIANS AND PHYSICIAN PRACTICES TO DELIVER SAFER MORE EFFECTIVE AND EFlCIENT CARE BY GIVING THEM lNANCIAL AND OTHER INCENTIVES TO DO SO
,ESSONS ,EARNED IN 00 "4%S MOST IMPORTANT LESSONS LEARNED DURING ITS INITIAL PILOTS WHICH LASTED THREE YEARS ALL OF WHICH HAVE BEEN PRESENTED TO MEMBERS OF THE )NSTITUTE OF -EDICINES 3UBCOMMITTEE ON 0AY FOR 0ERFORMANCE PRESENTED TO MEMBERS OF #ONGRESS THROUGH HEARINGS AND PUBLISHED IN A NUMBER OF JOURNALS AND ARTICLES ARE THAT )NCENTIVES MATTER AND THE SIZE OF THE INCENTIVE HAS A RELATIONSHIP TO A PHYSICIANS DECISION TO PARTICIPATE IN CARE PROCESS IMPROVEMENT )N GENERAL INCENTIVES MUST BE GREATER THAN OR EQUAL TO THE COST OF CHANGE OR AT THE VERY LEAST SUFlCIENT TO SIGNIlCANTLY CONTRIBUTE TO THE COST OF CHANGE &OR EXAMPLE A MULTI SPECIALTY GROUP PRACTICE IN !LBANY .9 WAS ABLE TO DEFRAY ABOUT A QUARTER OF THE MILLION INVESTMENT IN A NEW CLINICAL INFORMATION SYSTEM DUE TO THE lNANCIAL INCENTIVES RECEIVED THROUGH "4% 4HE PRACTICES WHOSE CARE PROCESSES WERE RE ENGINEERED ACHIEVED SIGNIlCANT IMPROVEMENTS IN THE MANAGEMENT OF PATIENTS WITH CHRONIC CONDITIONS %XHIBIT ILLUSTRATES BOTH POINTS OVERALL THERE IS A STATISTICALLY SIGNIlCANT DIFFERENCE BETWEEN THE MEAN REWARDS AVAILABLE FOR
&RAN¥OIS DE "RANTES IS THE NATIONAL COORDINATOR FOR "RIDGES 4O %XCELLENCE "4% AN ORGANIZATION FOCUSED ON REWARDING PHYSICIANS FOR BETTER QUALITY CARE )N THAT CAPACITY HE IS RESPONSIBLE FOR CREATING AND DEVELOPING NEW PROGRAMS FOR "4% AND FOR SUPERVISING THE IMPLEMENTATION OF "4% PROGRAMS IN DIFFERENT REGIONS IN THE COUNTRY -R DE "RANTES CAN BE REACHED AT &RANCOISDE"RANTES BRIDGES TOEXCELLENCEORG
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
O@XãEN QãO DQEN QL@MB Dã@MCãAD XNMCã@ãQD BHOD ãE NQãHL OQNU HMFãGD @KSGB@QD %XHIBIT -EAN 0ATIENT #OUNTS FOR 2ECOGNIZED AND .ONRECOGNIZED 0HYSICIANS -ARKET 0ROGRAM #INCINNATI $IABETES ,OUISVILLE $IABETES "OSTON $IABETES "OSTON ()4 3YSTEMS .9 #AP 2EG ()4 3YSTEMS
T VALUE
P LEVEL SIGN
.ONRECOGNIZED 0HYSICIAN -EAN 0ATIENT #OUNT
2ECOGNIZED 0HYSICIAN -EAN 0ATIENT #OUNT
RECOGNIZED PHYSICIANS AND NONRECOGNIZED PHYSICIANS IN EACH PILOT REGION SIZE PATIENT COUNT IS A PROXY FOR SIZE OF BONUS THERE IS A SIGNIlCANT DIFFERENCE BETWEEN THE MEAN PATIENT COUNT FOR PHYSICIANS RECOGNIZED FOR ADOPTING NEW SYSTEMS OF CARE AND THE PATIENT COUNT FOR PHYSICIANS BEING RECOGNIZED FOR DIABETES EXCELLENCE ONLY 7ITH RESPECT TO THIS SECOND POINT THE AVERAGE INVESTMENT FOR A PRACTICE OF THREE PHYSICIANS TO ADOPT NEW CLINICAL INFORMATION AND PATIENT MANAGEMENT SYSTEMS IS 4HE COSTS AND BENElTS OF PARTICIPATING IN AN INCENTIVE PROGRAM MUST BE KNOWN UP FRONT 0RACTICES n OR INDIVIDUAL PHYSICIANS WHO ARE ASKED TO INVEST BOTH TIME AND MONEY IN THAT PRACTICE TO IMPROVE THEIR PERFORMANCE n MUST HAVE A GOOD ESTIMATE OF THE BENElTS THEY WILL DERIVE FROM THAT EFFORT;= &OR EXAMPLE A GROUP OF PHYSICIANS IN $ELAWARE DECIDED NOT TO PARTICIPATE IN A "4% IMPLEMENTATION BECAUSE THEY ESTIMATED THAT THE BENElTS OF MEETING THE THRESHOLD FOR THE REQUIRED PERFORMANCE MEASURES EXCEEDED THE INITIAL INVESTMENT THEY WOULD HAVE TO MAKE TO ALLOW THEM TO MEET THE PERFORMANCE MEASURES 3ELF ASSESSMENT OF PERFORMANCE AND ITS VALIDATION BY AN INDEPENDENT THIRD PARTY IS A VERY POWERFUL AGENT OF CHANGE 0HYSICIANS AND PHYSICIAN PRACTICES THAT ARE ASKED TO PARTICIPATE IN A "4% IMPLEMENTATION MUST PERFORM A SELF AUDIT OF THEIR CURRENT PERFORMANCE 4HIS EFFORT WHILE TIME CONSUMING CREATES THE ROAD MAP FOR CHANGE &OR EXAMPLE $R ,ALUDE DISCOVERED THROUGH HIS SELF ASSESSMENT THAT HIS COMPLIANCE WITH GOOD STANDARDS OF CARE FOR HIS PATIENTS WITH DIABETES WAS PERCENT FAR BELOW THE PERCENT THRESHOLD REQUIRED FOR INCENTIVES 4HIS DISCOVERY MOTIVATED HIM EVEN MORE THAN THE lNANCIAL REWARDS TO RE ENGINEER HIS PRACTICE OF CARE FOR THOSE PATIENTS AND THE IMPROVEMENTS ACHIEVED IN UNDER A YEAR WERE SIGNIlCANT BOTH IN TERMS OF QUALITY OF CARE FOR THE PATIENTS AND THE COST OF CARE !DDITIONALLY INSTEAD OF HAVING HIS PERFORMANCE ASSESSED BY A PAYER WHO WOULD ONLY LOOK AT A PORTION OF HIS PATIENT PANEL $R ,ALUDES PERFORMANCE WAS ASSESSED BY THE .#1! VIA A REPRESENTATIVE SAMPLE OF HIS ENTIRE PANEL
(IGH QUALITY CARE CAN BE COST EFFECTIVE CARE 7HILE THERE IS CLEARLY NO CORRELATION TODAY BETWEEN QUALITY AND COST OF CARE "4%S ANALYSES OF CLAIMS DATA COMPARING PATIENTS THAT ARE SEEN BY "4% RECOGNIZED PHYSICIANS AND THOSE THAT GO TO NONRECOGNIZED PHYSICIANS SHOW CONCLUSIVELY THAT THEIR AVERAGE SEVERITY ADJUSTED COST OF CARE IS LOWER BY ABOUT TO PERCENT &OR EXAMPLE PATIENTS WITH DIABETES HAVE AVERAGE YEARLY COSTS OF ABOUT SEE %XHIBIT 0ATIENTS GOING TO RECOGNIZED PHYSICIANS HAVE COSTS OF ABOUT ;= 4HE DIFFERENCE COMES FROM LOWER RATES OF AVOIDABLE HOSPITALIZATIONS OR VISITS TO THE EMERGENCY ROOM WHICH IS A RESULT OF MORE FREQUENT PHYSICIAN OFlCE VISITS 4HIS IS A CLEAR SIGN THAT THE CARE THE PHYSICIAN IS DELIVERING IS MORE PROACTIVE AND IMPROVES THE CONSISTENCY OF CARE BEING DELIVERED TO PATIENTS 4HESE lNDINGS ARE IN LINE WITH A NUMBER OF STUDIES THAT EVALUATED THE ACTUARIAL IMPACT OF MEETING CERTAIN PERFORMANCE THRESHOLDS;= )N THESE STUDIES THE ABILITY FOR THE PHYSICIAN TO DEMONSTRATE GOOD CONTROL OF INTERMEDIATE OUTCOMES SUCH AS BLOOD PRESSURE AND CHOLESTEROL RESULTED IN SIGNIlCANT SAVINGS %XHIBIT INDICATES THE ACTUARIAL VALUE OF CONTROLLING INTERMEDIATE OUTCOMES FOR PATIENTS WITH DIABETES;= 4HE AVERAGE SAVINGS ESTIMATES ARE NOT FULLY ADDITIVE
"EST 0RACTICES IN 00 "OTH "4% AND THE )(! HAVE COMMON ELEMENTS THAT ARE RESPONSIBLE FOR THEIR SUCCESS THEY USE STANDARD PERFORMANCE MEASURES THEY REPRESENT MULTISTAKEHOLDER EFFORTS THAT BRING TOGETHER A LARGE GROUP OF PAYERS AND PURCHASERS TO MAKE REWARDS MEANINGFUL TO PHYSICIANS THEY USE INDEPENDENT THIRD PARTY ORGANIZATIONS TO MEASURE THE PERFORMANCE OF THE PHYSICIANS THEY PROVIDE PHYSICIANS WITH CLEARLY DElNED BENElTS WHICH HELPS THE PHYSICIANS DETERMINE THE VALUE OF PARTICIPATING AND THEY ENCOURAGE PHYSICIANS TO ADOPT BETTER SYSTEMS OF CARE INCLUDING HEALTH INFORMATION TECHNOLOGY TO SYSTEMATICALLY IMPROVE THE DELIVERY OF CARE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
O@XãEN QãO DQEN QL@MB Dã@MCãAD XNMCã@ãQD BHOD ãE NQãHL OQNU HMFãGD @KSGB@QD %XHIBIT !VERAGE %PISODE #OST FOR 0ATIENTS 3EEN BY 0HYSICIANS 2ECOGNIZED FOR %XCELLENCE IN $IABETES #ARE #OMPARED 7ITH 0ATIENTS 3EEN BY .ONRECOGNIZED 0HYSICIANS
BETTER BUT WE CAN AND SHOULD GO A GIANT STEP FURTHER ALL THE WAY TO COMPREHENSIVE PAYMENT REFORM )T IS UPON THIS CONCEPT THAT 02/-%4(%53 WAS DEVELOPED
02/-%4(%53 "EYOND 00
$IABETES #OSTS /NLY .ONRECOGNIZED 0HYSICIANS 2ECOGNIZED 0HYSICIANS
)N EVERY INDUSTRY SECTOR ORGANIZATIONS ARE REWARDED WHEN THEY IMPROVE THE VALUE OF THE SERVICES THEY DELIVER OR PRODUCTS THEY MAKE 4HIS IS NOT THE CASE IN HEALTHCARE )N HEALTHCARE FOR THE MOST PART ONLY THE VOLUME OF TRANSACTIONS IS REWARDED IRRESPECTIVE OF THE QUALITY OF THE CARE DELIVERED )N FACT IN MANY INSTANCES GENERATING A HIGHER VOLUME OF EXPENSIVE SERVICES CAN IMPLICITLY REWARD POOR QUALITY;= 0AY FOR PERFORMANCE IS AN ATTEMPT TO CHANGE THAT DYNAMIC BY INTRODUCING A COUNTERING INCENTIVE )TS IMPACT DEPENDS ON THE FACTORS LISTED ABOVE MAINLY THE SIZE OF THE INCENTIVE RELATIVE TO A PHYSICIANS OR HOSPITALS TOTAL REVENUES 4HE SMALLER THE INCENTIVE IN PERCENTAGE TERMS THE LOWER THE IMPACT 7HILE NO FORMAL STUDIES HAVE YET CLEARLY ANSWERED THIS ISSUE THERE IS A LOT OF EMPIRICAL DATA THAT SUGGEST THAT PHYSICIANS WILL STRONGLY RESPOND TO INCENTIVES THAT REPRESENT PERCENT OR MORE OF THEIR TOTAL REVENUES;= 4HIS IS BECAUSE CHANGE IS DIFlCULT AND MAINTAINING THE STATUS QUO IS FOR THE MOST PART EASY #HANGE CAN ONLY OCCUR IF THE BENElT OF THAT CHANGE IS GREATER THAN THE BENElT OF THE STATUS QUO OR IF THE STATUS QUO IS SO UNCOMFORTABLE THAT IT MAKES THE PROSPECT OF CHANGE MORE APPEALING 4ODAY THE STATUS QUO IS UNCOMFORTABLE FOR EMPLOYERS WHICH MAKES THE PROSPECT OF EXPERIMENTING WITH CHANGES IN PAYMENT APPEALING 9ET FOR MANY PHYSICIANS THE STATUS QUO WHILE NOT IDEAL IS NOT SO UNCOMFORTABLE AS TO OVERCOME THE PERCEIVED RISK OF CHANGE 7E CAN ALL CONTINUE TO PAY FOR VOLUME AND BECOME EVER MORE UNCOMFORTABLE OR WE CAN START RECOGNIZING THAT PHYSICIANS AND HOSPITALS ARE LIKE ANY OTHER ECONOMIC ENTITY IN THE ECONOMY 4HEY RESPOND TO INCENTIVES AND THE ONES WE HAVE NOW ARE QUITE POOR "4%S AND THE )(!S 00 PROGRAMS HAVE SHOWN US WE CAN DO
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
2ATHER THAN REPLACING THE TWO MAIN PAYMENT MODELS PREVALENT IN THE 5NITED 3TATES n FEE FOR SERVICE AND CAPITATION n 02/-%4(%53 0AYMENT;= ADDRESSES THEIR SHORTCOMINGS 4HE MODEL ATTEMPTS TO CREATE A PAYMENT ENVIRONMENT WHERE DOING THE RIGHT THINGS FOR THE PATIENT HELPS PROVIDERS AND INSURERS ALSO DO WELL FOR THEMSELVES 4HIS IS ACCOMPLISHED BY PAYING PROVIDERS FOR THE QUANTITY OF CARE THAT IS RECOMMENDED BY WELL ESTABLISHED GUIDELINES AND EVIDENCE /VERALL 02/-%4(%53 IS NOT AN ENTIRELY NEW CONCEPT #ASE RATES AND GLOBAL FEES WHICH ARE ITS CENTRAL ELEMENTS HAVE BEEN AROUND FOR DECADES "UT THERE ARE THREE IMPORTANT INNOVATIONS INCLUDED IN 02/-%4(%53 THAT CLEARLY DIFFERENTIATE IT FROM PRIOR MODELS 4HE BASIS FOR THE CASE RATES IS EVIDENCE BASED GUIDELINES AND INCLUDES ADJUSTMENTS FOR PATIENT SEVERITY OF DISEASE %XEMPLARY PERFORMERS CAN GET MORE THAN PERCENT OF THE CASE RATE #LINICAL INTEGRATION AROUND THE CARE OF THE WHOLE PATIENT n NOT JUST PARTS n IS EXPLICITLY ENCOURAGED AND REWARDED THROUGH A COMPREHENSIVE SCORECARD THAT INCLUDES MEASURES OF CLINICAL PROCESS AND OUTCOMES OF CARE PATIENT EXPERIENCE WITH CARE RECEIVED AND IN MANY INSTANCES COST EFlCIENCY )T IS DESIGNED TO ACCOMMODATE A WIDE RANGE OF PHYSICIAN SPECIALTIES HOSPITALS OTHER HEALTHCARE PROVIDERS AND THE MANY WAYS THEY ARE ORGANIZED TO DELIVER CARE n FROM LARGE INTEGRATED DELIVERY NETWORKS TO INDIVIDUAL PRACTITIONERS ! TEAM OF EXPERTS IN HEALTHCARE ECONOMICS LAW POLICY PLAN OPERATIONS AND PERFORMANCE MEASUREMENT CAREFULLY DESIGNED THESE INNOVATIONS IN AN EFFORT TO HELP PLANS AND PURCHASERS RESPOND TO ONE OF THE MAIN CHALLENGES SET FORTH BY THE )NSTITUTE OF -EDICINES SERIES OF REPORTS ON THE QUALITY OF CARE IN !MERICA;= TO REFORM A TOXIC PAYMENT SYSTEM /NE PURPOSE OF 02/-%4(%53 IS TO CREATE A SETTING THAT IMPROVES THE WORK ENVIRONMENT FOR PROVIDERS AND IMPROVES QUALITY OF CARE FOR PATIENTS 4HAT REFORM CAN ONLY OCCUR BY UNDERSTANDING THE ROOT CAUSES FOR THE FAILURE OF THE CURRENT PAYMENT MODELS AND DESIGNING PROCESSES THAT WILL MITIGATE THEIR EFFECTS WHILE ENCOURAGING THE RIGHT BEHAVIORS &OR EXAMPLE BROAD BASED CAPITATION SHIFTS INSURANCE RISK FROM INSURERS TO PROVIDERS 02/-%4(%53 SPECIlCALLY AVOIDS HOLDING PROVIDERS ACCOUNTABLE FOR INSURANCE RISK )T DOES HOLD THEM ACCOUNTABLE FOR THEIR ABILITY TO PROVIDE EXCELLENT CARE 3IMILARLY FEE FOR SERVICE SHIFTS THE RESPONSIBILITY FOR PRUDENT AND WISE USE OF RESOURCES FROM PROVIDERS TO INSURERS 02/-%4(%53 HOLDS PROVIDERS ACCOUNTABLE FOR THE EFlCIENT USE OF RESOURCES BUT IT FREES THEM TO MANAGE THOSE RESOURCES IN ANY WAY THEY SEE lT AND REMOVES CURRENT ARTIlCIAL BARRIERS TO INNOVATE
O@XãEN QãO DQEN QL@MB Dã@MCãAD XNMCã@ãQD BHOD ãE NQãHL OQNU HMFãGD @KSGB@QD %XHIBIT !CTUARIAL 6ALUE OF #ONTROLLING )NTERMEDIATE /UTCOMES FOR $IABETES 0ATIENTS
#LINICAL -EASURE
!NNUAL 3AVINGS 0ER $IABETIC 0ATIENT
-AX
0OOR #ONTROL 'OOD #ONTROL
MM (G MM (G
MGDL MGDL
(B!C CONTROL
"LOOD PRESSURE CONTROL
,$, CONTROL
.EPHROPATHY ASSESSMENT
%YE EXAMINATION
.OTATION OF SMOKING STATUS AND CESSATION ADVICE OR TREATMENT
#OMPLETION OF LIPID PROlLE
&OOT EXAMINATION
3ELF ASSESSMENT OF PERFORMANCE AND ITS VALIDATION BY AN INDEPENDENT THIRD PARTY IS A VERY POWERFUL AGENT OF CHANGE )MPLEMENTING 02/-%4(%53 0AYMENT WILL REQUIRE CREATING AN OPERATIONAL INFRASTRUCTURE AN hENGINEv THAT CAN BOLT ON TO EXISTING PLAN CLAIMS PAYMENT SYSTEMS TO PERFORM THE FOLLOWING lVE TASKS %STABLISH SEVERITY ADJUSTED EVIDENCE BASED CASE RATES %#2S $ETERMINE THE APPROPRIATE ALLOCATION OF THOSE CASE RATES ACROSS DIFFERENT TYPES OF PROVIDERS TREATING THE SAME PATIENT 4RACK THE PERFORMANCE OF ALL PROVIDERS CARING FOR THE PATIENT COVERED BY THE %#2 2ECONCILE ALL PAYMENTS TO REWARD GOOD PERFORMANCE AND #REATE A SCORECARD TO REPORT AND PAY FOR QUALITY AND EFlCIENCY 4HERE ARE SIGNIlCANT COMPLEXITIES CONTAINED WITHIN EACH OF THESE lVE TASKS AND IT WILL TAKE A SUBSTANTIAL AMOUNT OF EFFORT TO MAKE EACH OPERATIONAL AND THIS EFFORT IS WELL UNDER WAY 3EVERAL ORGANIZATIONS HAVE COMMITTED TO CREATING THE CRITICAL COMPONENTS OF THE ENGINE )N ADDITION MEMBERS OF MEDICAL PROFESSIONAL SOCIETIES ARE CONTRIBUTING TO BUILDING OUT %#2S AND SEVERAL REGIONS ARE DESIGNING IMPLEMENTATION PROGRAMS TO TEST 02/-%4(%53 !LTHOUGH THERE ARE CLEAR LIMITATIONS TO WHAT CAN BE COVERED UNDER THE SCOPE OF %#2S TODAY SPECIALTY SOCIETIES AND OTHER MEDICAL PROFESSIONAL ORGANIZATIONS WILL LIKELY RISE TO A NEW
CHALLENGE IF THE VALIDITY OF THE MODEL IS PROVEN TO DEVELOP ADDITIONAL CLINICAL PRACTICE GUIDELINES THAT TAKE INTO ACCOUNT THIS APPLICATION AND CAN FORM THE BASIS FOR CASE RATES COVERING THE MAJORITY OF CONDITIONS AND PROCEDURES
0OWERING 5P #ONSUMER $IRECTED (EALTHCARE (EALTH BENElTS REFORM WITHOUT PAYMENT REFORM OR PAYMENT REFORM WITHOUT HEALTH BENElTS REFORM IS ONLY HALF OF THE SOLUTION 7E NEED BOTH TO BE IN PLACE 4ODAY WE ARE IN A SITUATION WHERE BENElTS REFORM HAS MOVED MUCH FASTER THAN PAYMENT REFORM AND SO PAYMENT REFORM NEEDS TO CATCH UP (EALTH BENEFITS REFORM HAS CHANGED THE LEVEL OF SENSITIVITY CONSUMERS HAVE TOWARD THE COST OF CARE BY INCREASING CONSUMERS RESPONSIBILITY FOR MEETING DEDUCTIBLES AND MAKING HIGH CO INSURANCE PAYMENTS ! HEALTHCARE COST SURVEY SHOWS THAT MORE THAN PERCENT OF ALL HEALTH PLAN ENROLLEES OF LARGE COMPANIES ARE IN A HIGH DEDUCTIBLE PLAN AND A &ORRESTER 2ESEARCH SURVEY ESTIMATED THAT CLOSE TO MILLION !MERICANS WOULD BE IN A CONSUMER DIRECTED HEALTH PLAN #$(0 IN ;= !S A RESULT CONSUMERS ARE EAGERLY SEARCHING FOR COMPARATIVE INFORMATION ON THE COST AND QUALITY OF CARE THEY ARE INCREASINGLY PAYING FOR BUT CAN ONLY SOMETIMES FIND RELEVANT INFORMATION ON QUALITY AND VERY SELDOM ON COST;= )N RESPONSE TO THIS SITUATION POLICY MAKERS FROM THE PRESIDENT TO MEMBERS OF #ONGRESS HAVE ASKED THAT PRICES OF UNITS OF CARE SERVICES BE MADE PUBLIC AND THERE ARE A NUMBER OF EFFORTS TO PUBLISH RATES FOR RADIOLOGY SERVICES OR OFlCE VISITS;= (OWEVER BECAUSE CARE IS MOSTLY PAID FOR AFTER THE SERVICES HAVE BEEN
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
O@XãEN QãO DQEN QL@MB Dã@MCãAD XNMCã@ãQD BHOD ãE NQãHL OQNU HMFãGD @KSGB@QD DELIVERED AND THERE IS A VERY HIGH DEGREE OF VARIATION IN THE QUANTITY OF SERVICES DELIVERED TO A PATIENT CONSUMERS CAN ONLY ESTIMATE THEIR TOTAL ANTICIPATED COSTS OF CARE .OT ONLY IS IT AN ESTIMATED COST BUT TO GATHER THE NECESSARY INFORMATION IS VERY DIFlCULT &OR ALL INTENTS AND PURPOSES THERE IS NO RELEVANT hPRICEv FOR CONSUMERS TO LOOK AT AND FROM WHICH TO ESTIMATE THEIR EXPECTED COSTS OF CARE
7E CAN AND SHOULD GO A GIANT STEP FURTHER ALL THE WAY TO COMPREHENSIVE PAYMENT REFORM 4AKE 3ALLY *ONES WHO HAS RECENTLY BEEN DIAGNOSED WITH 3TAGE BREAST CANCER 7HAT ARE THE ESTIMATED COSTS OF HER CARE (ER ONCOLOGIST MAY PUBLISH OFlCE VISIT COSTS BUT THAT WILL NOT INCLUDE THE COST OF ANY ADJUVANT THERAPY 4HE REALITY IS THAT THE CURRENT MODE OF PAYING FOR PHYSICIAN SERVICES HOSPITAL STAYS PRESCRIPTION DRUGS DIAGNOSTIC STUDIES AND ANY OTHER HEALTHCARE SERVICE IS NOT DESIGNED FOR PRICING TRANSPARENCY )T WAS DESIGNED TO WORK IN THE CURRENT FEE FOR SERVICE AND CAPITATION PAYMENT SYSTEM WHICH ITSELF IS A REmECTION OF CURRENT PREVAILING FORMS OF HEALTHCARE INSURANCE PLANS %#2S SHOULD PROVIDE CONSUMERS WITH THE PRICE TRANSPARENCY THAT THEY REALLY NEED "Y HAVING ACCESS TO CASE RATES THAT ENCOMPASS ALL THE CARE REQUIRED TO TREAT THEIR CONDITION A CONSUMER CAN TRULY COMPARE THE COST OF CARE FROM ONE PROVIDER TO ANOTHER !RMED WITH ROBUST DATA ON BOTH THE FINANCIAL AND QUALITY PERFORMANCES OF PHYSICIANS AND HOSPITALS CONSUMERS CAN BECOME THE ARBITERS OF THEIR CARE IN MUCH THE SAME WAY THEY HAVE BECOME THE ARBITERS FOR ALL OTHER PURCHASING DECISIONS ,ETS TAKE 3ALLY *ONES AGAIN !S SOON AS THE DIAGNOSIS OF 3TAGE BREAST CANCER HAS BEEN CONlRMED 3ALLY IS ADVISED OF THE %#2 FOR HER CONDITION AND SHE CAN LOOK UP THE CASE RATES THAT ARE PUBLISHED BY HER PLAN FOR EACH OF THE PROVIDERS IN THE PLANS NETWORK 3HE CAN DETERMINE UP FRONT WHAT HER TOTAL EXPENSES WILL BE AND BUDGET ACCORDINGLY 4IED TO QUALITY INFORMATION ON EACH PROVIDER 3ALLY CAN NOW MAKE A DECISION AS A REAL CONSUMER AS SHE DOES IN ALL OTHER ASPECTS OF HER LIFE #REATING A MARKET IN HEALTHCARE THAT WILL DELIVER CONSISTENT VALUE TO ALL ITS PARTICIPANTS CANNOT BE DONE IN THE CURRENT PAYMENT AND BENElTS ENVIRONMENT -OVEMENT TOWARD HEALTH BENElTS THAT
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
ENCOURAGE PATIENTS TO ACT MORE LIKE CONSUMERS AND MOVEMENT TOWARD A PAYMENT SYSTEM THAT ENCOURAGES THE CONTINUOUS PURSUIT OF QUALITY AND COST EFFECTIVENESS MUST BE THE TWIN GOALS OF ALL EMPLOYERS AND HEALTH PLAN ADMINISTRATORS -ANY HAVE ALREADY EMBRACED THESE GOALS MANY MORE SHOULD
%NDNOTES ,ALUDE !PRIL PERSONAL COMMUNICATION WITH AUTHOR -C'LYNN ET AL h4HE 1UALITY OF (EALTH #ARE $ELIVERED TO !DULTS IN THE 5NITED 3TATES v .%*- P WWWIHAORG WWWBRIDGESTOEXCELLENCEORG 2OSENTHAL ET AL h%ARLY %XPERIENCE 7ITH 0AY FOR 0ERFORMANCE v /CT *!-! P "RIDGES 4O %XCELLENCE h%VALUATION OF THE $IABETES #ARE ,INK v &EBRUARY-ARCH HTTPWWWBRDGESTOEXCELLENCORGBTEPDF $020?%VAL?PDF AND PRESS RELEASE *ULY h#ALIFORNIA 0AY FOR 0ERFORMANCE 2ESULTS 3HOW )MPROVEMENTS IN (EALTH #ARE 1UALITY v )NTEGRATED (EALTH #ARE !SSOCIATION HTTPWWWIHAORGHTM h$IABETES #ARE !NALYSIS n 3AVINGS %STIMATE "RIDGES 4O %XCELLENCE $ECEMBER HTTPWWWBRIDGESTOEXCELLENCEORGBTEPDF$#,? ANALYSISPDF *AMES " PRESENTATION AT THE .ATIONAL 00 3UMMIT &EBRUARY DE "RANTES & h0ROVIDER )NCENTIVE -ODELS FOR )MPROVING THE 1UALITY OF #ARE v REPORT TO THE )/- 3UBCOMMITTEE ON 0AY FOR 0ERFORMANCE -AY HTTPWWWIOMEDU#-3 ASPX AND "AILIT ET AL -ARCH .ATIONAL (EALTH #ARE 0URCHASING )NSTITUTE HTTPWWWBRIDGESTOEXCELLENCEORGBTEWP?PROMETHEUSHTM h#ROSSING THE 1UALITY #HASM ! .EW (EALTH 3YSTEM FOR THE ST #ENTURY v )NSTITUTE OF -EDICINE -ARCH HTTPWWWIOMEDU #-3ASPX 4OWERS 0ERRIN 3EPTEMBER SEE THE FOLLOWING 52, TO REQUEST A COPY OF THE REPORT HTTPWWWTOWERSPERRINCOMHRSERVICES PUBLICATIONSTEMPLATESREQUEST?HCCSASP 0UBLICATION (EALTH #ARE #OST 3URVEY .OVEMBER &ORRESTER 2ESEARCH h!N %ARLY ,OOK AT #$(0 -EMBERS v HTTPWWWFORRESTERCOM2ESEARCH$OCUMENT %XCERPT HTML (ENRIKSEN ET AL h4HE 3TATE OF THE -ARKET FOR /NLINE (EALTHCARE #OST )NFORMATION 4OOLSv -ARCH REPORT TO THE #ALIFORNIA (EALTH #ARE &OUNDATION AND h(EALTH #ARE 0OLL v (ARRIS )NTERACTIVE !PRIL HTTPWWWHARRISINTERACTIVECOMNEWSNEWSLETTERSWSJHEALTHNEWS 73*/NLINE?()?(EALTH #ARE0OLLVOL?ISSPDF 7HITE (OUSE ANNOUNCEMENT ON 3TRENGTHENING (EALTH #ARE -AY HTTPWWWWHITEHOUSEGOVINFOCUSHEALTHCARE !ETNA 0RESS 2ELEASE !UGUST HTTPWWWAETNACOMNEWSPR? HTM /UTPATIENT 3ERVICES COST REPORT FOR ,OUISIANA (OSPITALS HTTPWWWLAHEALTHINFORMORGINDEXHTML
1! 0HYSICIANS 0ERSPECTIVES ON 1UALITY ! $ISCUSSION 7ITH 'ORDON -OORE $AVID #HIN AND 4IM 7ILSON 0HYSICIANS HAVE AN OBVIOUS AND DIRECT ROLE IN INmUENCING THE QUALITY OF CARE DELIVERY 0RICEWATERHOUSE#OOPERS RECENT (EALTH#AST SURVEY FOUND THAT A LARGE PROPORTION OF HEALTH LEADERS VIEW THE PHYSICIAN PATIENT RELATIONSHIP AS HAVING A MAJOR ROLE IN ENHANCING QUALITY SEE %XHIBIT 4O DISCUSS HOW PHYSICIANS CAN INmUENCE HEALTHCARE PERFORMANCE TODAY AND IN THE FUTURE 0RICEWATERHOUSE#OOPERS INTERVIEWED THREE PHYSICIAN THOUGHT LEADERS ON THIS TOPIC 4HIS PAPER REPRESENTS PHYSICIAN PERSPECTIVES AND PERSONAL OPINIONS ON QUALITY AND DOES NOT PORTRAY THE POSITIONS OR RECOMMENDATIONS OF 0RICEWATERHOUSE#OOPERS 'ORDON -OORE -$ -0( IS PROFESSOR OF !MBULATORY #ARE AND 0REVENTION AT (ARVARD -EDICAL 3CHOOL (IS RESEARCH AND WRITINGS ARE IN THE AREAS OF MANAGEMENT OF HEALTHCARE ORGANIZATIONS DESIGN OF INTERNATIONAL HEALTHCARE SYSTEMS DELIVERY OF AMBULATORY HEALTH SERVICES HEALTH POLICY EFFECTIVENESS OF PRIMARY CARE AND EDUCATIONAL STRATEGIES IN HEALTHCARE (E HAS PUBLISHED MORE THAN ARTICLES AND CHAPTERS $R -OORE WAS THE MEDICAL DIRECTOR AND CHIEF OPERATING OFlCER OF (ARVARD #OMMUNITY (EALTH 0LAN AND THE DIRECTOR OF TEACHING PROGRAMS AT (ARVARD 0ILGRIM (EALTHCARE (E DIRECTED THE .EW 0ATHWAY 0ROJECT AT (ARVARD -EDICAL 3CHOOL AND WAS RESPONSIBLE FOR THE DESIGN IMPLEMENTATION AND ADMINISTRATIVE DIRECTION OF (ARVARDS INNOVATIVE NEW CURRICULUM (E HAS ALSO SERVED ON THE -ASSACHUSETTS 0UBLIC (EALTH #OUNCIL AND TWO STUDY SECTIONS IN THE .ATIONAL #ENTER FOR (EALTH 3ERVICES 2ESEARCH $R -OORE HAS BEEN THE OUTSIDE NATIONAL EVALUATOR OF THE (EALTH OF THE 0UBLIC 0ROGRAM OF THE 2OCKEFELLER &OUNDATION AND 4HE 0EW #HARITABLE 4RUSTS AND DIRECTED THE EVALUATION OF THE 2OBERT 7OOD *OHNSON &OUNDATIONS NATIONAL INITIATIVE 0REPARING 0HYSICIANS FOR THE &UTURE $R -OORE HAS STARTED HIS OWN COMPANY 2X#EL WHOSE PRODUCTS ARE DESIGNED TO IMPROVE THE COST EFFECTIVENESS OF HEALTHCARE BY IMPROVING THE WORK OF DOCTORS AND HOSPITALS (E IS A GRADUATE OF (ARVARD -EDICAL #OLLEGE AND (ARVARD -EDICAL 3CHOOL (E CAN BE REACHED AT GORDON?MOORE HMSHARVARDEDU $AVID #HIN -$ IS A NATIONAL PARTNER WHO LEADS MAJOR STRATEGIC PLANNING AND OPERATIONS IMPROVEMENT ENGAGEMENTS FOR INSURERS ACADEMIC MEDICAL CENTERS AND LARGE EMPLOYERS IN THE (EALTHCARE !DVISORY 0RACTICE OF 0RICEWATERHOUSE#OOPERS ,,0 $R #HIN IS A PHYSICIAN EXECUTIVE WITH MORE THAN YEARS OF EXPERIENCE IN MANAGED CARE OPERATIONS HOSPITALPHYSICIAN NETWORK DEVELOPMENT AND THE MANAGEMENT OF LARGE MEDICAL GROUP PRACTICES "EFORE JOINING 0RICEWATERHOUSE#OOPERS $R #HIN WAS THE PRESIDENT OF .OVALIS #ORP A PRIVATELY HELD COMPANY THAT FRANCHISED (-/S ON A TURNKEY BASIS AND SERVED ON THE BOARD OF "AXTER )NTERNATIONAL )NC 0RIOR TO THOSE POSITIONS $R #HIN WAS THE PRESIDENT AND MEDICAL DIRECTOR OF THE (EALTH #ENTERS $IVISION OF THE (ARVARD #OMMUNITY (EALTH 0LAN A STAFF MODEL (-/ PROVIDING HEALTHCARE TO RESIDENTS IN EASTERN -ASSACHUSETTS (E CAN BE REACHED AT DAVIDCHIN USPWCCOM 4IM 7ILSON -$ HAS PRACTICED FOR YEARS AS A FAMILY DOCTOR IN THE 5+ AND WAS RECOGNIZED IN AS THE YOUNGEST &ELLOW BY ASSESSMENT OF THE 2OYAL #OLLEGE OF 'ENERAL 0RACTITIONERS '0 )N THE SAME YEAR HIS PRACTICE WAS ONE OF THE lRST TO RECEIVE A #HARTER -ARK FROM THE #ABINET /FlCE $R 7ILSON ESTABLISHED UNITS TO SUPPORT '0 COMMISSIONING AND THE 2OYAL #OLLEGE OF '0S 1UALITY 5NIT !S A SENIOR POLICY ANALYST FOR THE 5+ DEPARTMENT OF HEALTH STRATEGY UNIT HE HELPED DEVELOP THE .ATIONAL (EALTH 3ERVICE .(3 IMPROVEMENT PLAN AND CREATED POLICIES INCLUDING THE LONG TERM CONDITIONS STRATEGY PRACTICE BASED COMMISSIONING AND THE FUTURE OF PRIMARY CARE $R 7ILSON WAS A (ARKNESS &ELLOW WITH THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT AND AT (ARVARD -EDICAL 3CHOOL !S A SENIOR ADVISOR FOR CLINICAL PERFORMANCE WITH 0W# HE CONTINUES TO ADVISE THE 5+ DEPARTMENT OF HEALTH ON A RANGE OF PROJECTS INCLUDING PERFORMANCE IMPROVEMENT AND CLINICAL SERVICE RECONlGURATION FOR THE .(3 (E CAN BE REACHD AT TIMWILSON UKPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
1! 0RICEWATERHOUSE#OOPERS (OW DO PHYSICIANS PERCEIVE QUALITY 7HAT ARE THEIR MAJOR ISSUES WITH RESPECT TO QUALITY 'ORDON -OORE 4HERE IS A MAJOR DISJUNCTION BETWEEN ESPOUSED ATTITUDES TOWARDS QUALITY AND REAL ATTITUDES 0HYSICIANS CANT DENY THAT THERE ARE QUALITY PROBLEMS LACED THROUGHOUT THE SYSTEM TODAY (OWEVER THE ESPOUSED POSITION ENDS UP BEING VERY DIFFERENT -OST DOCTORS VIEW THEMSELVES AS BEING IN THE UPPER PERCENTILE OF QUALITY AND TO ADMIT THERE IS A PROBLEM COULD EXPOSE THEM TO MALPRACTICE AND LESSEN THEIR AUTONOMY )T WOULD TAKE A HIGH TOLERANCE OF COGNITIVE DISSONANCE FOR THEM TO ACCEPT A PROBLEM WITHIN THEIR OWN PRACTICE BECAUSE WHY IN THE WORLD WOULD ANYBODY STAY IN A PRACTICE THAT THEY DID NOT CONSIDER hTHE BEST v 3O THERE ARE A LOT OF REASONS WHY EVEN IF THEY DEEPLY FELT THAT THERE WERE QUALITY PROBLEMS THEY WOULDNT EXPRESS IT IN A PUBLIC FASHION
5NTIL WE GET IN THE CENTER OF THE FLOW OF CLINICAL INFORMATION OUR ABILITY TO EVEN BEGIN TO ASK WHAT IS QUALITY AND WHAT ARE ITS CORRELATES IS GOING TO BE ONLY HALF ANSWERED
4IM 7ILSON 4HATS BACKED UP BY PATIENT DATA )F YOU ASK PATIENTS WHETHER THEY THINK THERE ARE PROBLEMS WITH PHYSICIANS THEY ALL SAY hNOv 4HEY THINK THEIR PHYSICIAN IS A WONDERFUL PERSON AND VERY GOOD BUT IF YOU ASK THEM IN GENERAL IF THERE IS A PROBLEM WITH PHYSICIANS AND INDIVIDUAL DOCTORS WELL YES THERE ARE PROBLEMS BUT ITS NOT THEIR PHYSICIAN )T IS INTERESTING THAT THIS WORKS AT A PERSONAL LEVEL FOR THE PATIENT JUST AS IT DOES FOR PHYSICIANS 2ESEARCH IN !USTRALIA AND THE 5+ HAS SHOWN THAT NURSES VALUE STANDARDIZATION AS A DRIVER OF POLICY WHEREAS DOCTORS VALUE AUTONOMY AND INDIVIDUALIZATION 4HE VIEW THAT hQUALITY IS THE CARE THAT ) PROVIDEv IS NOT FAR OFF THE MARK FROM THE WAY THAT MANY PHYSICIANS THINK $AVID #HIN 4HE OTHER WAY THAT PHYSICIANS DElNE QUALITY IS IN THE SOMEWHAT TONGUE IN CHEEK WAY n hHIGH QUALITY IS THE WAY ) PRACTICEv n WHICH IS A BARRIER IN TERMS OF QUALITY IMPROVEMENT 0W# )S THERE A LACK OF ACCOUNTABILITY OR INFORMATION OR BOTH '- 4HERE CERTAINLY IS A LACK OF REAL DATA $OCTORS IN GENERAL HAVE BEEN IMMUNE TO THE IDEA THAT THERE WOULD BE DATA THAT GOT CLOSE TO WHAT THEY DO %VEN WITH STATISTICAL EPIDEMIOLOGIC CLAIMS BASED DATA DOCTORS TEND TO SAY THEY ARE NO GOOD AND THEREFORE SHOULDNT BE USED 4HATS A LITTLE DIFFERENT HOWEVER THAN AN ATTITUDE OF FEELING NOT ACCOUNTABLE $OCTORS FEEL SUPER ACCOUNTABLE MAYBE EVEN TOO ACCOUNTABLE FOR RESULTS IN A TERRAIN
WHERE OUTCOMES OFTENTIMES HAVE MORE TO DO WITH THE PATIENT AND THE SYSTEM THAN THEY DO WITH THE DOCTORS PROFESSIONAL QUALITIES -OST DOCTORS FEEL QUITE ACCOUNTABLE FOR THE RESULTS THAT THEY GET BUT THEY DONT WANT SOMEBODY ELSE MEASURING IT 47 4HE SITUATION IN FAMILY PRACTICE IN THE 5+ IS THAT THE QUALITY FRAMEWORK IS ESSENTIALLY A LARGE PAY FOR PERFORMANCE CONTRACT FOR FAMILY DOCTORS 4HEY HAVE TO BE MEASURED TO BE PAID &AMILY DOCTORS EARN POINTS THAT ARE VERY CLOSELY LINKED TO VERY SPECIlC OUTCOME AND PROXY OUTCOME MEASURES 3O FOR EXAMPLE CLINICAL RECORDS ARE EXAMINED FOR HOW FAMILY DOCTORS ARE CONTROLLING BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION 4HEY GET A FEW POINTS AND A SMALL PAYMENT FOR MEASURING PATIENTS BLOOD PRESSURE BUT A MUCH LARGER PAYMENT IF THEY BOTH MEASURE BLOOD PRESSURE AND KEEP IT UNDER CONTROL 4HEN THEY RECEIVE EVEN HIGHER PAYMENT LEVELS IF A CERTAIN PROPORTION OF THEIR HYPERTENSIVE PATIENT POPULATION HITS THE TARGET FOR BLOOD PRESSURE CONTROL )NTERESTINGLY SOME DOCTORS ARE VERY HAPPY BECAUSE THEY ARE GETTING PAID FOR THE WORK THEY WANT TO DO AND THEREFORE SEEM CONTENT WITH THE EXTERNAL MEASUREMENT THIS INVOLVES 4HE RESULT IS THAT 5+ FAMILY DOCTORS ARE THE HIGHEST PAID IN THE WORLD NOW 4HERE IS ALSO A DEGREE OF COMPETITION DOCTORS ARE STARTING TO COMPARE HOW MANY POINTS THEYVE GOT 4HERES A SENSE OF PRIDE AT BEING BEST EVEN THOUGH THIS DATA IS COLLECTED REMOTELY $# )N TERMS OF THE DATA COLLECTION PROCESS EXCEPT FOR MAYBE THE 5+ WHERE YOU HAVE SOME WIDESPREAD ADOPTION OF ELECTRONIC MEDICAL RECORDS %-2S AMONG PRIMARY CARE THERE REALLY IS NOT AN INFRASTRUCTURE TO COLLECT THE INFORMATION )TS VERY CUMBERSOME AND IT TAKES TWO TO HAVE SUCCESSFUL COMPLIANCE WITH GUIDELINES 4HE DOCTOR HAS TO USE THE GUIDELINE AND THE PATIENT ALSO HAS TO ADHERE TO IT 4HE LITERATURE WOULD INDICATE THAT FOR MOST THINGS THAT WE AS DOCTORS PRESCRIBE THERES ABOUT A PERCENT ADHERENCE RATE 3O WE HAVE A SITUATION WHERE AN INDIVIDUAL DOCTOR SAYS h7AIT YOU WANT ME TO BE ACCOUNTABLE FOR QUALITY BUT NOT ONLY DO ) NOT HAVE AN INCENTIVE TO DO SO BUT NEITHER DOES THE PATIENTv 0W# 7HERE DO YOU THINK THE SOLUTION RESIDES 7HAT DO YOU THINK NEEDS TO BE DONE TO HAVE THE PHYSICIANS EMBRACE AND ENHANCE QUALITY '- 7E WILL ONLY EMBRACE QUALITY IN A SERIOUS WAY WHEN WERE ABLE TO MEASURE WHAT MIGHT BE VIEWED AS REAL QUALITY AS DOCTORS PERCEIVE IT AND THEN LINK PAY FOR PERFORMANCE TO THAT )N THAT SENSE ) THINK THAT %NGLAND AND PROBABLY THE 53 TO A LESSER DEGREE ARE MOVING IN THE RIGHT DIRECTION 5NTIL WE GET IN THE CENTER OF THE mOW OF CLINICAL INFORMATION OUR ABILITY TO EVEN BEGIN TO ASK WHAT IS QUALITY AND WHAT ARE ITS CORRELATES IS GOING TO BE ONLY HALF ANSWERED 7HILE ITS A VERY INTERESTING EXPERIMENT FOR EXAMPLE IN %NGLAND TO HAVE THE INDICATORS IF YOU ASKED ME WHAT PERCENT OF GENERAL PRACTICE QUALITY THOSE INDICATORS REPRESENT ) WOULD HAVE TO GUESS THAT IT WOULD BE A VERY SIGNIlCANT MINORITY ) DONT BELIEVE WERE GOING TO MAKE A LOT OF PROGRESS UNTIL WE ARE ACTUALLY COLLECTING REAL DOCTOR DATA AND MOVING AWAY FROM CLAIMS BASED OR OTHER FORMS OF SECONDARY INFORMATION "UT ON
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
1! INITIATIVES THAT MAY BE A LITTLE DIFFERENT /NE IS THAT PHARMACY BENElT MANAGERS ARE INCORPORATING A LOT OF INFORMATION ABOUT PHYSICIAN PRESCRIBING HABITS AND THOSE mOWS ARE NOW BECOMING MORE AUTOMATED 4HEYRE PROBABLY AMONG THE MOST AUTOMATED TRANSACTIONS IN THE HEALTHCARE INDUSTRY AND WE CAN QUICKLY ASSEMBLE SOMEONES MEDICAL PROlLE BY JUST TAKING A LOOK AT THE MEDICINES THAT HE OR SHE IS TAKING ,ABORATORY DATA IS GOING THE SAME WAY AND PEOPLE ARE LEVERAGING THOSE DEVELOPMENTS INTO DISEASE MANAGEMENT COMPANIES THAT SOME OF THE LARGE INSURANCE COMPANIES HAVE ACQUIRED 4HE FEATURES OF THESE CARE MANAGEMENT COMPANIES IS THAT THEY MINE THESE DATABASES ON A NIGHTLY BASIS ALMOST IN REAL TIME TO PICK UP PATTERNS OF CARE n EITHER OMISSIONS OF CARE OR COMMISSIONS OF PROBLEMS n TO REACH OUT TO PATIENTS PROACTIVELY 3OME MODELS REACH OUT TO THE DOCTOR lRST WHILE OTHER MODELS REACH OUT TO THE PATIENT DIRECTLY )TS KIND 0W# 9OU TALK ABOUT THE mOW OF CLINICAL INFORMATION OF A SUPERSTRUCTURE IMPOSED ON THE CURRENT SYSTEM THAT MIGHT $O YOU MEAN SPECIlCALLY ELECTRONIC MEDICAL RECORDS IMPROVE QUALITY 4HERE ARE SIGNIlCANT EXPERIMENTS TO WIRE UP '- 4HE KIND OF INFORMATION THAT WERE INTERESTED IN IS LEVERAGED REGIONAL DELIVERY SYSTEMS IN A WAY THAT THEY CAN TALK TO EACH OTHER OFF ORDER ENTRY NOT OFF THE HISTORICAL OR PHYSICAL EXAMINATION &INALLY MANY HOSPITALS ARE MOVING TO THE ARCHIVAL KIND OF %-2 WHICH IS THE WAY THE ARCHIVAL RECORD GENERALLY WORKS 3O WHAT ) THAT PROVIDES THE INFRASTRUCTURE TO ASSEMBLE QUALITY INFORMATION MEAN IS AN ELECTRONIC PROCESS mOW INFRASTRUCTURE n THE ELECTRONIC IN A FAIRLY EFlCIENT WAY 7HEN IT BECOMES REINFORCED BY PAY FOR MEDICAL RECORD IS KIND OF A MISNOMER AND IT GETS US OFF IN THE PERFORMANCE YOU MIGHT HAVE SOMETHING WRONG DIRECTION )T MOVES US TOWARDS THE HIGH EFFORTLOW YIELD 47 $ATA IS CLEARLY IMPORTANT BUT ITS ALWAYS GOING TO BE ONLY PART OF )4 INFRASTRUCTURE RATHER THAN THE LOW EFFORTHIGH YIELD OR ONE COMPONENT OF IMPROVING QUALITY 4HE IMPORTANT AREAS THAT HIGH EFFORTHIGH YIELD SECTOR WHERE WE NEED TO BE ARE YET UNTAPPED ARE ADDRESSING HOW PHYSICIANS ARE GOING TO $# )M SEEING SOME DEVELOPMENTS THAT ARE ENCOURAGING IN BE FULLY ENGAGED AND HOW THE PHYSICIANPATIENT RELATIONSHIP TERMS OF lNALLY GETTING OFF THE DIME ON QUALITY INFORMATION AND IS GOING TO BE USED TO IMPROVE QUALITY 4HE DATA THAT WE CAN COLLECT IS ALWAYS GOING TO BE A SMALL PART OF THE %XHIBIT 4HE PHYSICIAN PATIENT RELATIONSHIP IS A MAJOR KEY BIGGER QUALITY PICTURE 9OU CAN MEASURE MORE TO IMPROVING QUALITY OF CARE BUT YOU CANNOT ALWAYS ANALYZE MORE 9OU GET TO THE POINT WHERE YOU CAN ONLY FOCUS YOUR 0OTENTIAL OF 3TAKEHOLDERS TO %LIMINATE 7ASTEFUL ATTENTION ON A CERTAIN NUMBER OF AREAS )M A VERY 3PENDING IN (EALTHCARE 'LOBAL 2ESULTS STRONG ADVOCATE OF ACTUALLY EMPOWERING PATIENTS MORE GIVING THEM A GREATER ROLE IN DETERMINING AND DRIVING THEIR HEALTHCARE ) THINK THAT WILL GET PHYSICIANS ATTENTION IN A DIFFERENT KIND OF WAY '- 4HERES THE OLD SAYING h4HE MEASURABLE DRIVES OUT THE IMPORTANT v AND THERE IS AN ELEMENT OF THAT 4HERE ARE SO MANY DIFFERENT ASPECTS )N THE 53 OF WHAT MIGHT BE VIEWED AS QUALITY n ACCESS 0HYSICIANS PSYCHOSOCIAL RELATIONSHIPS THE DIAGNOSIS OF WERE ILL FORMED PROBLEMS n THAT ARE REALLY ULTIMATELY 0ATIENTS GOING TO BE VERY DIFlCULT TO MEASURE 4HERES A VERY STRONG ARGUMENT TO BE MADE THAT IF IN FACT YOU PUT IN TOO MANY SPECIlC MEASUREMENTS AND CALL THAT QUALITY THEN WHAT WILL HAPPEN IS THAT DOCTORS WILL MEET THOSE TARGETS 4HEYRE VERY SMART PEOPLE AND VERY CLEVER AND OVER TIME THE OTHER ATTRIBUTES THAT YOU WANT IN QUALITY MIGHT VERY WELL DEGRADE 4HAT WOULD BE A TREMENDOUS LOSS 4HERE MAY BE SOME UNINTENDED CONSEQUENCES 3OURCE 0RICEWATERHOUSE#OOPERS (EALTH#AST 3URVEY AND ITS IMPORTANT TO LOOK FOR THOSE 4HE ATTITUDES THE POSITIVE SIDE ONCE DOCTORS BELIEVE THAT COLLECTING THAT DATA IS A EASY TO DO B HEAVILY LINKED TO THEIR ABILITY TO DO GOOD WORK AND THEN C VERY STRONGLY CORRELATED WITH THEIR INCOME WE WILL CREATE WHAT MIGHT BE VIEWED AS A VIRTUAL CYCLE 7E WILL COLLECT MORE AND BETTER DATA AND WILL BE BETTER ABLE TO CORRELATE THAT WITH IMPORTANT CLINICAL PROCESSES AND OUTCOMES PATIENT SATISFACTION INCLUDED AND START TRULY GETTING A BETTER HANDLE ON MEASURING QUALITY 4HE lRST STEP IS TO lND A WAY EASILY TO GET INSIDE THE mOW OF REAL CLINICAL DATA AND INFORMATION AND THEN TO REWARD THOSE DOCTORS WHO ARE ABLE TO ACHIEVE POSITIVE RESULTS "ETTER DOCTORS WILL MOVE IN THAT DIRECTION AND THEY WILL DRAG ALONG THE DOCTORS THAT ARE PERHAPS NOT QUITE SO HIGH ON THE QUALITY SCORES BUT WHO WILL NEED TO GET IN THE BUSINESS OF MEASURING AND IMPROVING IF THEY WANT TO KEEP UP WITH THEIR COLLEAGUES
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
1! AND THE VALUES OF DOCTORS n THEIR SENSE OF WHAT WE WOULD CALL PROFESSIONALISM AND PROFESSIONAL RESPONSIBILITY n ARE SUCH AN IMPORTANT PART OF THE OVERALL MIX OF QUALITY THAT WEVE GOT TO BE VERY CAREFUL TO KEEP OUR EYE ON THE FULL PICTURE AS MUCH AS WE CAN AND NOT RELY OVERLY ON SOME OF THE SPECIlC MEASURES
)F YOU LOOK AT THE UNDERLYING CONDITIONS THAT MAKE FOR AN EFFECTIVE MARKET IN OTHER DOMAINS LIKE BUYING A CAR OR A HOUSE THESE ARE REALLY SORELY MISSING IN MEDICAL CARE
0W# 7HAT CAN BE DONE TO HELP EMPOWER THE PATIENT 47 4HE KEY IS THAT AND THIS IS OFTEN UNDERESTIMATED YOU CAN COACH PATIENTS 9OU CAN COACH THEM TO ASK VERY PARTICULAR QUESTIONS THAT HELP THEM TO MAKE BETTER USE OF THEIR TIME WITH A PHYSICIAN 9OU CAN ALSO GIVE THEM DECISION SUPPORT TOOLS TO AID THEM TO MAKE CHOICES THAT SUIT THEM BEST '- ) DONT THINK WE HAVE ENOUGH MARKET FORCES TO EMPOWER PATIENTS -EDICINE IS AN ASYMMETRIC MARKETPLACE )F YOU LOOK AT THE UNDERLYING CONDITIONS THAT MAKE FOR AN EFFECTIVE MARKET IN OTHER DOMAINS LIKE BUYING A CAR OR A HOUSE THESE ARE REALLY SORELY MISSING IN MEDICAL CARE )F YOU DEVELOP A TYPE OF GUIDE OR FEEDBACK ABOUT DOCTORS YOU CAN BEGIN TO CREATE TRANSPARENCY THAT WOULD MAKE PATIENTS FAR BETTER CONSUMERS AND WHICH WOULD INCLUDE ASPECTS OF TECHNICAL QUALITY AS WELL AS SERVICE AND RELATIONSHIP QUALITY )N SYSTEMS IN WHICH THE PATIENT IS NOT AT COST RISK IT WILL BE VERY HARD TO ACTIVATE CONSUMER DRIVEN MARKET FORCES TO MAKE THE SYSTEM BETTER "UT THERE IS QUITE GOOD EVIDENCE THAT AS YOU BEGIN TO GET AT LEAST A LITTLE BIT OF lNANCIAL SKIN IN THE GAME THAT PATIENTS WILL DECIDE ABOUT WHERE TO GO BASED ON VALUE NOT JUST ON PERCEIVED QUALITY 7E DO NOT KNOW YET HOW BEST TO USE MARKET FORCES IN DRIVING QUALITY BUT THATS GOING TO BE THE MAJOR TRANSFORMATION THAT OCCURS IN THE NEXT YEARS AND PAY FOR PERFORMANCE IS ONLY OPENING THE DOOR JUST A CRACK 7E HAVE A LONG WAY TO GO ON THIS BUT THE THING THAT INTERESTS ME MOST IS NOT JUST GETTING CONSUMERS IN THE GAME BUT EMPOWERING THEM TO IMPROVE THE SYSTEM RATHER THAN WORKING OFF SECONDARY OR MARGINAL DATA WITHOUT ANY BENElTS TO BEING GOOD SHOPPERS 0W# 7HAT DO YOU THINK THE QUALITY LANDSCAPE WILL LOOK LIKE IN THREE TO lVE YEARS $# !T A MACRO LEVEL IN THE 5NITED 3TATES ANYWAY ) DONT THINK THREE TO lVE YEARS IS GOING TO BE MUCH TIME FOR A CHANGE )N SOME AREAS WELL SEE A CONmUENCE OF LOCAL %-2 INITIATIVES THAT TIE TOGETHER ENLIGHTENED EMPLOYERS OR INSURANCE COMPANIES THAT ARE WILLING TO GO WITH PAY FOR PERFORMANCE ON THE PROVIDER SIDE
AND HIGH DEDUCTIBLE HEALTH PLANS THAT PUT MORE SKIN IN THE GAME FOR THE PATIENTS ON THE OTHER SIDE 4HEN YOU MIGHT SEE SOME INTERESTING OUTCOMES IN THAT THREE TO lVE YEAR TIME FRAME 47 7E TEND TO OVERESTIMATE WHATS GOING TO HAPPEN IN THE NEXT FEW YEARS AND UNDERESTIMATE WHATS GOING TO HAPPEN IN YEARS 4HERE IS SOMETHING THATS GOING TO HAPPEN AROUND THE AVAILABILITY OF INFORMATION BOTH QUALITY DATA THAT WEVE TALKED ABOUT BUT ALSO AROUND INFORMATION ABOUT DIFFERENT MEDICAL CONDITIONS AND THE BEST FORM OF MANAGEMENT THAT IS GOING TO DRIVE THE QUALITY AGENDA IN WAYS WE CANNOT CURRENTLY CONCEIVE 4HE FACT THAT YOURE GOING TO BE ABLE TO SEE THE QUALITY OF YOUR PHYSICIAN IS PRETTY IMPORTANT ADDED TO WHICH YOULL BE ABLE TO COMMUNICATE WITH YOUR PHYSICIAN DIFFERENTLY 4HINGS ARE GOING TO BE VERY DIFFERENT IN YEARS BECAUSE OF THE )NTERNET BECAUSE OF MOBILE INFORMATION 4HE WHOLE THING WILL BE TRANSFORMED IN TERMS OF COMMUNICATION RELATIONSHIPS AND THE INFORMATION AVAILABLE '- 4O TALK ABOUT QUALITY AS A SINGLE MEASURE WEAKENS THE THINKING THAT NEEDS TO GO ON 7E SHOULD BE THINKING ABOUT VALUE THAT IS THE OUTPUTS AND BY THAT ) MEAN PATIENT SATISFACTION AND TECHNICAL QUALITY AND ACTUAL OUTCOMES FROM THE WORK THAT WE DO "UT IT SHOULD BE RELATED TO COST 7HETHER THE INDIVIDUAL PAYS n IN WHICH CASE YOU HAVE AN INDIVIDUAL DRIVEN MARKETPLACE n OR WHETHER THE NATION STATE OR A COMPANY PAYS TO TAKE COST OUT OF THE EQUATION AND ONLY TALK ABOUT QUALITY IS REALLY ONLY HALF THE DISCUSSION 3O ) WOULD NUMBER ONE MAKE A PLEA ABOUT THAT .UMBER TWO ) THINK WHAT WELL SEE IN THE NEXT THREE TO lVE YEARS ARE POCKETS OF THINGS THAT ARE INTERESTING BUT WHAT WILL HAPPEN MORE BROADLY IS THAT DATA WILL BECOME MORE AVAILABLE )N EVERY lELD WHETHER IT WAS THE TELEPHONE OR COMPUTERS WHEN THEY WERE lRST INVENTED n WHAT WE DO WHEN WE HAVE SOMETHING NEW AVAILABLE IS TO DUPLICATE WHAT WEVE DONE BEFORE !ND THEN AFTER ABOUT TO YEARS YOU BEGIN TO SEE OUT OF THE BOX THINGS THAT TRANSFORM THE NATURE OF AN INDUSTRY 'OOGLE OR E"AY WOULD BE GOOD EXAMPLES OF USES OF DATA OR INFORMATION CREATING EXCHANGES THAT NOBODY REALLY HAD PREDICTED AT THE BEGINNING OF THE DIGITAL )NTERNET 7EB AGE 7E DONT KNOW WHAT THE WILD CARDS OR THE TRANSFORMATIVE OR DISRUPTIVE USES OF DATA WILL BE 7E CAN SAY THAT THERE WILL BE MORE DATA )T WILL BE UBIQUITOUS )T WILL ATTEMPT TO TRY TO DESCRIBE PERFORMANCE ) HOPE IT DESCRIBES VALUE NOT JUST QUALITY "UT WHAT WE DONT KNOW ARE THE UBIQUITOUS WAYS THAT THE CAPITALISTS OR SMART POLICY PLANNERS WILL USE THAT TO DO THINGS THAT YOU CANT EVEN CONCEIVE OF RIGHT NOW )TS IMPORTANT FOR US TO KEEP OUR EYES OPEN AND BEGIN TO LOOK FOR THOSE SORTS OF DISRUPTIVE USES BECAUSE THOSE ARE THE THINGS THAT WILL TRANSFORM THIS CONVERSATION INTO SOMETHING THATS MUCH MORE INTERESTING 3OMEBODY WILL COME UP WITH REALLY A TRANSFORMATIVE BRILLIANT IDEA THAT WILL DIFFUSE VERY RAPIDLY IN THE GLOBAL MARKET OF HEALTHCARE THAT WE LIVE IN 4HATS GOING TO BE THE EXCITING STUFF TO LOOK AT n 4HIS PAPER REPRESENTS PHYSICIAN PERSPECTIVES AND PERSONAL OPINIONS ON QUALITY AND DOES NOT PORTRAY THE POSITIONS OR RECOMMENDATIONS OF 0RICEWATERHOUSE#OOPERS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
7ORKING 4OGETHER 0HYSICIANS AND (OSPITALS 0ARTNERING FOR 1UALITY )MPROVEMENT 4HE AMBULATORY CARE ENVIRONMENT IS PRODUCING MEANINGFUL EXAMPLES OF DOCTOR HOSPITAL COLLABORATIONS DESIGNED TO ADVANCE PARTICIPANTS GOALS FOR INTEGRATED HEALTHCARE DELIVERY REGULATORY COMPLIANCE AND lNANCIAL PERFORMANCE "Y *EFF "OOTH "RETT - (ICKMAN AND "RIAN -ATSON 0RICEWATERHOUSE#OOPERS
#REATING 2ESULTS 4HROUGH #OLLABORATION !S KEY INDUSTRY AND GOVERNMENTAL BODIES PROGRESSIVELY EMBRACE QUALITY AS A MEASURE OF HEALTHCARE DELIVERY PERFORMANCE AN INCREASED FOCUS ON ACCOUNTABILITY HIGH PERFORMANCE AND QUALITY LEADERSHIP HAS LED TO SUCCESSFUL COLLABORATIONS BETWEEN HOSPITALS AND PHYSICIANS IN THE AMBULATORY SETTING 7HILE SUCH VENTURES OFTEN HINGE ON lNANCIAL CONSIDERATIONS A FOCUS ON QUALITY IMPROVEMENT LEADS TO MORE THAN COST REDUCTION )T CREATES A DYNAMIC NEW PARADIGM FOR DRIVING CULTURAL CHANGES ALIGNING lNANCIAL INCENTIVES AND FULlLLING EXPECTATIONS FOR HEALTHCARE DELIVERY 0ROVIDER VARIABILITY AND A COMPLEX REGULATORY SETTING HAVE LED TO A SOMEWHAT CAUTIOUS ENVIRONMENT WITH RESPECT TO COLLABORATION #OLLABORATION ALSO FACES ENORMOUS CULTURAL OBSTACLES CREATED BY A TRADITIONAL CONmICT 0HYSICIANS SEEK MORE CONTROL AND HOSPITALS FEAR LOSING IT )N THIS ENVIRONMENT MANY HOSPITALS MOVE SLOWLY IF AT ALL PRIMARILY BECAUSE THEY LACK A CLEAR UNDERSTANDING OF AND COMFORT WITH COMPLICATED REGULATORY CONSIDERATIONS 0HYSICIANS CONSEQUENTLY GROW FRUSTRATED BY AN INABILITY TO AFFECT ADMINISTRATIVE OR OPERATING INEFlCIENCIES PARTICULARLY WHEN THOSE INEFlCIENCIES DECREASE THEIR PRODUCTIVITY IN A WORLD OF DECLINING REIMBURSEMENT RATES $ESPITE SUCH ECONOMIC PRESSURES PHYSICIANS OFTEN RESIST lNANCIAL ARRANGEMENTS THAT LACK ALIGNMENT AROUND GOVERNANCE CLINICAL MANAGEMENT AND OPERATIONS 3UCH ARRANGEMENTS ARE NOT SUSTAINABLE BECAUSE WITHOUT TRUE ALIGNMENT PHYSICIANS AND HOSPITALS MAY WORK WITH CONmICTING OR DISJOINTED PURPOSES POTENTIALLY CREATING NEGATIVE IMPACTS FROM CLINICAL AND SERVICE STANDPOINTS &OR EXAMPLE PHYSICIANS MAY HAVE LITTLE MOTIVATION TO ADHERE TO BENCHMARKS SUCH AS ON TIME STARTS FOR SURGERY OR FULL
UTILIZATION OF BLOCK TIME RESERVATION OF TIME IN ADVANCE ON THE SURGERY SCHEDULE AT HEALTHCARE FACILITIES IN WHICH THEY HAVE NO PARTICIPATION IN GOVERNANCE OR OWNERSHIP 7HEN PHYSICIANS HOLD A VESTED INTEREST IN OVERALL PERFORMANCE THEY BECOME MORE COMPLIANT WITH PROCESS MEASURES SUCH AS lRST CASE STARTS SUPPLY USAGE PROTOCOLS AND OTHER STANDARDIZATIONS )N ANOTHER EXAMPLE PHYSICIANS AND HOSPITALS ACTIVELY COLLABORATING THROUGH A CARDIOLOGY SERVICE LINE MANAGEMENT COMPANY OFTEN ARE ABLE TO WORK TOGETHER TO MEET OR EXCEED NATIONAL hDOOR TO BALLOONv MEASURES AND GOALS OF ABOUT MINUTES $OOR TO BALLOON TIME STARTS WITH A PATIENTS ARRIVAL BY AMBULANCE AT THE HOSPITAL EMERGENCY ROOM AND ENDS WHEN THE HEART ARTERY IS OPENED WITH BALLOON ANGIOPLASTY IN A CARDIAC CATHETERIZATION LAB h$OOR TO BALLOONv IN A STANDARD HOSPITAL MANAGED SETTING CAN BE AS HIGH AS THREE TO FOUR HOURS A TIME DURING WHICH PRECIOUS HEART MUSCLE MAY BE IRREPARABLY DAMAGED /THER EXAMPLES OF MECHANISMS FOR ALIGNING PERFORMANCE AND INCENTIVES INCLUDE THE USE OF UNDER ARRANGEMENT JOINT VENTURES FOR AREAS SUCH AS GASTROINTESTINAL AND IMAGING SERVICES !PPRECIATING THE BENElTS FOR ALL STAKEHOLDERS PROGRESSIVE HOSPITALS AND PHYSICIANS IN SOME MARKETS HAVE MOVED ASSERTIVELY INTO THE COLLABORATIVE ARENA 4HOSE SEEKING TO JOIN THE TREND SHOULD EXAMINE THEIR OWN BUSINESS CASES AND CREATE A UNIQUE APPROACH FOR THEIR MARKETS %VERY MARKET HAS DIFFERENT QUALITIES AND CHARACTERISTICS EACH COLLABORATIVE RELATIONSHIP MUST ACCOMMODATE AND LEVERAGE THEM 2EGARDLESS OF THE APPROACH PHYSICIAN PARTICIPANTS NEED TO PROVIDE ACTIVE MANAGEMENT WITH A DIRECT IMPACT ON QUALITY TO MEET REGULATORY SCRUTINY &UNDAMENTALLY SUCCESS DEPENDS NOT ON REGULATIONS
*EFF "OOTH IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE (E HAS OVER YEARS EXPERIENCE WITH THE HEALTHCARE PROVIDER MARKET PRINCIPALLY IN THE AREAS OF STRATEGY lNANCE PERFORMANCE IMPROVEMENT PHYSICIAN PARTNERING PAY FOR PERFORMANCE AND TRANSACTIONS (E CAN BE REACHED AT JEFFQBOOTH USPWCCOM "RETT - (ICKMAN -"! #0! IS A PARTNER IN 0RICEWATERHOUSE#OOPERS !DVISORY 3ERVICES AND NATIONAL LEADER OF THE (EALTH )NDUSTRIES 3TRATEGY AND 0LANNING PRACTICE (E HAS MORE THAN YEARS OF EXPERIENCE IN THE HEALTHCARE INDUSTRY INCLUDING ALIGNING INCENTIVES PARTNERSHIPS AND JOINT VENTURES BETWEEN HOSPITALS AND PHYSICIANS (E IS ALSO A #ERTIlED 0UBLIC !CCOUNTANT LICENSED IN )LLINOIS AND )NDIANA (E CAN BE REACHED AT BRETTMHICKMAN USPWCCOM "RIAN -ATSON -(! IS A DIRECTOR IN 0RICEWATERHOUSE#OOPERS (EALTHCARE 'ROWTH PRACTICE (E HAS OVER YEARS EXPERIENCE PARTICULARLY OPERATIONAL IN THE HEALTHCARE INDUSTRY WITH FOCUS ON THE PLANNING DEVELOPMENT AND OPERATION OF FREESTANDING OUTPATIENT AND INPATIENT MEDICAL SERVICES )N ADDITION HE HAS SIGNIlCANT EXPERIENCE IN THE DESIGN AND CONSTRUCTION OF FACILITIES OFFERING SPECIALTY HOSPITAL AMBULATORY SERVICES AND PHYSICIAN MEDICAL OFlCE PROGRAMS (E CAN BE REACHED AT BRIANDMATSON USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
VNQJHMFãSNFDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S BUT ON ALL PARTIES REACHING A CLEAR UNDERSTANDING OF THEIR OPTIONS AND DEVELOPING CONSENSUS ON THE APPROACH THAT BEST FULlLLS THE BUSINESS CASE FOR BOTH
"ASIC -ODELS FOR )NTEGRATION 4HE FULL MENU OF FUNDAMENTAL MODELS FOR HOSPITAL AND PHYSICIAN COLLABORATION OFFERS A WIDE RANGE OF OPPORTUNITIES -OST DO NOT DIRECTLY ALIGN QUALITY INITIATIVES WITH INCENTIVES AND OTHERS OFFER ONLY A lNITE MECHANISM FOR PARTNERING !S SHOWN IN %XHIBIT THERE ARE A NUMBER OF OPTIONS FOR PARTNERSHIP DEPENDING ON THE DESIRED LEVEL OF INTEGRATION &OR EXAMPLE THE LOWEST LEVEL OF INTEGRATION INCLUDES MEDICAL DIRECTORSHIPS AND OTHER CONTRACTUAL ARRANGEMENTS WITH PHYSICIANS /THER MODELS INCLUDE -EDICAL DIRECTORSHIPS STIPENDS AND MANAGEMENT CONTRACTS FOR PHYSICIANS 'AIN SHARING FOR SHORT TERM IMPROVEMENTS TO ACHIEVE SAVINGS OR OPERATING EFlCIENCIES 0ERFORMANCE OR TAXABLE BONDS THAT ALLOW PHYSICIANS TO PARTICIPATE IN CAPITAL INVESTMENTS UNDER CERTAIN CIRCUMSTANCES ,EASING OF SPACE TIME OR TECHNOLOGY BY PHYSICIANS FROM HOSPITALS -ANAGEMENT COMPANIES SUCH AS THOSE THROUGH WHICH HOSPITALS AND PHYSICIANS ACTIVELY MANAGE AN ENTIRE SERVICE LINE OR A DElNED OR SPECIlC PORTION OF THE SERVICE
5NDER ARRANGEMENT JOINT VENTURES THROUGH WHICH PHYSICIANS AND HOSPITALS INVEST IN A NEW COMPANY THAT OPERATES CERTAIN SERVICES ON BEHALF OF THE HOSPITAL %QUITY JOINT VENTURES SUCH AS OUTPATIENT SURGERY CENTERS IN WHICH PHYSICIANS AND HOSPITALS HAVE FULLY INVESTED AND &ULLY INTEGRATED DELIVERY SYSTEMS THROUGH WHICH HOSPITALS DIRECTLY EMPLOY PHYSICIANS /F THE MODELS SERVICE LINE MANAGEMENT AND UNDER ARRANGEMENT JOINT VENTURES ARE INCREASINGLY POPULAR AMONG HOSPITALS AND PHYSICIANS 4HESE MODELS CAN ALSO SERVE AS STEPPING STONES TO HIGHER LEVELS OF INTEGRATION -AJOR DRIVERS ARE THE PROLIFERATION OF PAY FOR PERFORMANCE PROGRAMS AND THE EVER INCREASING NEED FOR HOSPITALS AND PHYSICIANS TO ALIGN AROUND A COMPREHENSIVE SET OF SERVICES 4HESE MODELS ULTIMATELY COULD BE THE FOUNDATION FOR SUCCEEDING IN A PAY FOR PERFORMANCE REIMBURSEMENT ENVIRONMENT )N ORDER FOR THESE MODELS TO BE SUCCESSFUL IT IS IMPERATIVE THAT lNANCE AND LEGAL COUNSEL BE INVOLVED IN THE KEY DECISION MAKING PROCESS TO ASSESS EXPECTED RESULTS AND POTENTIAL PITFALLS ! STRONG LINE OF COMMUNICATION MUST EXIST AMONG ALL PARTIES 3ERVICE LINE MANAGEMENT COMPANIES SUCH AS CARDIOVASCULAR hCENTERS OF EXCELLENCE v ENABLE PHYSICIANS TO HOLD LEADERSHIP POSITIONS TO INmUENCE AND IMPROVE DAY TO DAY CLINICAL MANAGEMENT AND OPERATIONS &OCUSING ON ALIGNING INCENTIVES THROUGH A STRONG RELATIONSHIP WITH QUALITY AND OUTCOMES THE
%XHIBIT /PTIONS FOR (OSPITAL 0HYSICIAN )NTEGRATION 3COPE OF (OSPITAL 0HYSICIAN )NTEGRATION @!LIGNED )NCENTIVE 3YSTEMS
%XAMPLES
%XAMPLES
%XAMPLES
%XAMPLES
%XAMPLES
%XAMPLES
%XAMPLES
EDICAL $ 2' ULTIPLE 2 EAL %STATE # 6 $ IGESTIVE ) 0/0 $IRECTORS 3PECIlC (EALTH $IAGNOSTIC $ISEASE 3ERVICE 3YSTEMS #ENTER #ENTER OF ,INES 3 ERVICE # ATH ,AB THROUGHOUT %XCELLENCE ( !GREEMENTS ) 0/0 EART 3TENTS THE #OUNTRY # ARDIO )MAGING (OSPITAL % 2 / RTHOPEDIC VASCULAR #ENTER WITHIN A #ONTRACTS )MPLANTS #ENTER OF (OSPITAL % XCLUSIVE 3 ERVICE ,INE %XCELLENCE USCULO !GREEMENTS 3PECIlC $ EPARTMENT SKELETAL s #ARDIOLOGY OF 3URGERY #ENTERS s /RTHOPEDICS s 'YNECOLOGY s 0ULMONOLOGY s 3URGERY s /NCOLOGY
%XAMPLES
%XAMPLES
) MAGING ! 3#S
# LEVELAND #LINIC
0 (/S
+ AISER
3 PECIALTY (OSPITALS
3 ISTERS OF 3T &RANCIS
' ENERAL (OSPITALS
. EUROSCIENCES # ANCER #ENTER OF #ENTERS %XCELLENCE . EUROSCIENCE / RTHOPEDICS 3ERVICE ,INE
#ENTERS OF %XCELLENCE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
VNQJHM FãSN FDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S %XHIBIT 3ERVICE ,INE -ANAGEMENT #OMPANY 4YPICAL -ANAGEMENT #ONTRACT #OMPENSATION #OMPONENTS
"ASE -ANAGEMENT &EE &INANCE #OMMITTEE 0ARTICIPATION "OARD 0ARTICIPATION
-EDICAL $IRECTOR &EES /PERATING #OMMITTEE 0ARTICIPATION
$AY TO $AY /PERATIONS /VERSIGHT
)NCENTIVE #OMPENSATION
/PERATIONAL %FlCIENCY )NCENTIVES "UDGETARY /BJECTIVES
.EW 0ROGRAM $EVELOPMENT 1UALITY OF 3ERVICE )NCENTIVES
3UBJECT TO LEGAL AND REGULATORY LIMITATIONS
MODEL CREATES SHARED MANAGEMENT RESPONSIBILITY FROM TOP TO BOTTOM FOR POLICIES PROCEDURES AND PROTOCOLS 0HYSICIANS AND HOSPITALS ACTIVELY MANAGE STAFF TOGETHER 4HEY CREATE MEASURE AND ADDRESS CLINICAL EXCELLENCE AND PATIENT SATISFACTION ISSUES #OMPENSATION FOR PHYSICIANS TYPICALLY INVOLVES A lXED COMPONENT WITH INCENTIVES ALIGNED AROUND OPERATIONAL EFlCIENCY SERVICE EXCELLENCE BUDGETARY OBJECTIVES AND NEW PROGRAM DEVELOPMENT )N THIS SETTING COLLABORATORS CAN CHOOSE FROM A WIDE RANGE OF METRICS TO MEASURE HOW WELL THEY MANAGE SERVICES TOGETHER 4HEY CAN ORGANIZE THOSE METRICS AROUND STANDARD MECHANISMS SUCH AS SURVEYS OR CREATE NEW MECHANISMS FOR DEMONSTRATING IMPROVEMENTS OVER TIME AGAINST BENCHMARKS OR INITIAL INTERNAL PERFORMANCE BASELINES %XHIBIT PRESENTS THE TYPICAL COMPONENTS FOR A SERVICE LINE MANAGEMENT COMPANY !N EXAMPLE OF AN UNDER ARRANGEMENT JOINT VENTURE WOULD BE A CANCER CENTER OPERATED BY PHYSICIANS THROUGH AN ARRANGEMENT WITH THE HOSPITAL 0HYSICIANS UNDERTAKE GREATER RISK AND THEREFORE
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
ENJOY GREATER OPPORTUNITY FOR HIGHER RETURNS 4HIS APPROACH HAS BECOME POPULAR IN THE AMBULATORY ARENA PRIMARILY AROUND SURGERY AND MEDICAL IMAGING AS HOSPITALS PUSH SUCH SERVICES PHYSICALLY CLOSER TO PHYSICIANS TO MAKE THEM MORE EFlCIENT 4HROUGH THIS MODEL PHYSICIANS ASSUME GREATER RESPONSIBILITY FOR MANAGING EVERY ASPECT OF THE SERVICE AND OWN THE COMPANY FROM A REVENUE AND EXPENSE STANDPOINT 4HE UNDER ARRANGEMENT JOINT VENTURE HOLDS RESPONSIBILITY FOR MANAGING THE FACILITY STAFF SUPPLIES EQUIPMENT AND OTHER ASPECTS OF THE BUSINESS 4YPICALLY COMPENSATION INVOLVES A FEE SCHEDULE FOR SERVICES BASED ON FAIR MARKET VALUE CONSIDERATIONS AND ACCOUNTING FOR INCREASED EXPOSURE TO RISK !DDITIONAL INCENTIVES IN THIS MODEL GENERALLY DO NOT FEATURE AS PROMINENTLY AS THEY DO IN SERVICE LINE MANAGEMENT COMPANY SETTINGS %XHIBIT ILLUSTRATES THE ORGANIZATIONAL STRUCTURE FOR AN UNDER ARRANGEMENT VENTURE 7HICHEVER MODEL OR COMBINATION OF MODELS IS CHOSEN COLLABORATION WORKS BEST WHEN FOCUSED UPON ACCOUNTABILITY AND
VNQJHM FãSNFDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S QUALITY n THE MOST RELEVANT STRUCTURE FOR MUTUAL BENElT n RATHER THAN ON CREATING A MECHANISM FOR MANAGING REGULATORY CONCERNS 3OME PARTNERS MAY CHOOSE HIGHLY INTEGRATED APPROACHES /THERS MAY DETERMINE THAT LOWER LEVELS OF INTEGRATION WORK BEST 0OTENTIAL PARTNERS SHOULD EXERCISE CARE AND SELECTIVITY WHEN CHOOSING WHERE TO COLLABORATE SO THEY CAN CREATE LONG TERM VALUE 0ARTNERS SHOULD NOT ATTEMPT TO ENLIST IN EVERYTHING BUT FOCUS ON HOW TO AGGREGATE AND EFFECTIVELY LEVERAGE SELECT SERVICES 4HEY SHOULD BALANCE TRADE OFFS CREATE A TRANSPARENT PROCESS AND SET CLEAR AND REALISTIC TIMELINES EXPECTATIONS PRINCIPLES AND POLICIES TO GENERATE BENElTS FOR ALL CONSTITUENCIES 0ARTNERS MUST ALSO MANAGE MANY NUANCES FROM STATE REGULATIONS
TO CUSTOMER PREFERENCES )N THIS RESPECT EXTERNAL EXPERTS CAN PROVIDE SUBSTANTIAL VALUE TO THE PROCESS 0HYSICIANS AND HOSPITALS CAN LEVERAGE EXPERTS EXPERIENCE AND USE THEM AS SOUNDING BOARDS TO REMAIN TRUE TO THEIR STRATEGY AND EXERCISE THE mEXIBILITY REQUIRED TO RECOGNIZE AND CORRECT ERRORS ALONG THE WAY )N ADDITION EXTERNAL RESOURCES CAN SERVE AS EFFECTIVE INFORMED INTERMEDIARIES TO RESOLVE CULTURAL DIFFERENCES "Y APPROACHING THE CHALLENGE FROM A SYSTEMS AND CULTURE PERSPECTIVE PHYSICIANS AND HOSPITALS CAN BECOME KEY PLAYERS IN EACH OTHERS SUCCESS 0HYSICIANS CAN PROMOTE AND ASSIST IN RECRUITMENT FOR HOSPITALS )NCREASED TRUST CAN BREAK DOWN BARRIERS AND FOSTER ACTIVE PARTICIPATION BY PHYSICIANS 7ORKING
%XHIBIT /RGANIZATIONAL 3TRUCTURE FOR AN 5NDER !RRANGEMENT 6ENTURE
-EMBERS (OSPITAL 8 /WNERSHIP
9 /WNERSHIP
)NVESTOR 0HYSICIANS AND 'ROUPS
!MBULATORY 3URGERY #ENTER
"OARD OF -ANAGERS (OSPITAL 0HYSICIANS
-EDICAL !DVISORY #OMMITTEE -!#
1UALITY !SSURANCE 1! #OMMITTEE 5TILIZATION 2EVIEW 52 #OMMITTEE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
VNQJHMFãSN FDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S TOGETHER PHYSICIANS AND HOSPITALS CAN CREATE NEW BUSINESS IN EXISTING AND NEW MARKETS AND GENERATE VOLUME AND REVENUE GROWTH #APITAL RESOURCES CAN BE POOLED AND NEW IDEAS FOR DELIVERING CARE REALIZED %ACH CAN SPUR NEW WAYS TO REMAIN COMPETITIVE 4HE hWIN WINv INCENTIVE MOTIVATES BOTH PARTIES TO SUCCEED
@#AREGIVERS NEED TO UNDERSTAND hTHE BETTER MY OUTCOME THE BETTER ) GET PAIDv )T SHOULD BE SOMEWHAT LIKE OTHER SERVICES ONE BUYS 0EOPLE PAY FOR BETTER QUALITY 4HOSE CONCEPTS NEED TO TIE TO HEALTHCARE REIMBURSEMENT )T SHOULD NOT JUST BE DRIVEN BY THE NUMBER OF UNITS PERFORMED n "RAD "UXTON DIVISIONAL SENIOR VICE PRESIDENT (EALTH #ARE -ANAGEMENT (EALTH #ARE 3ERVICE #ORPORATION
)NTEGRATING THE 1UALITY &OCUS #ONSUMERISM INCREASINGLY INmUENCES THE HEALTHCARE MARKET AS BETTER EDUCATED PATIENTS GAIN GREATER ACCESS TO DATA ABOUT PHYSICIANS AND HOSPITALS SPECIlCALLY QUALITY AND OUTCOME DATA #OMPANIES THAT OBTAIN AND SELL DATA FOR EXAMPLE WILL CONTINUE TO ASSESS PROVIDERS QUALITY PERFORMANCE AND INmUENCE PATIENT DECISIONS (OSPITALS AND PHYSICIANS CANNOT STOP THE USE OF DATA BUT THEY CAN IMPROVE THE NATURE OF INFORMATION USED BY CONSUMERS BY WORKING TOGETHER TO GATHER REPORT AND COMMUNICATE RELEVANT STANDARDIZED DATA THAT DEMONSTRATE A QUALITY FOCUS AND QUALITY IMPROVEMENT -EANINGFUL QUALITY DATA WILL THEN BECOME PART OF THE CULTURE AND LEAD TO THE MOST SUCCESSFUL KIND OF lNANCIAL INCENTIVE WHEN PROVIDERS RECEIVE MORE FOR IMPROVING QUALITY FOR PATIENTS #ONSUMERS WILL ALWAYS SEEK THE BEST IN QUALITY
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
4O DATE MOST INITIATIVES IN HOSPITAL PHYSICIAN PARTNERING HAVE FOCUSED ON CLINICAL PROGRAM DEVELOPMENT SUCH AS BUILDING SURGERY CENTERS AND CLINICS RATHER THAN ON QUALITY IMPROVEMENT #LINICAL ADVANCEMENTS PROMOTE THIS APPROACH TO IMPROVING PATIENT CARE AND SATISFACTION BY AFFORDING INPATIENT OUTCOMES IN AN OUTPATIENT SETTING )N THIS RESPECT CLINICAL CONSIDERATIONS HAVE DRIVEN NONCLINICAL MEASURES CUSTOMER SATISFACTION FROM THE PERSPECTIVES OF PATIENT PHYSICIAN AND EMPLOYEE OPERATIONAL EFFECTIVENESS AND EFlCIENCY AND PRODUCTIVITY 4HEY ALSO CONTINUE TO DRIVE BUDGETARY PERFORMANCE AND NEW PROGRAM DEVELOPMENT 4HROUGH SUCH INITIATIVES KEY PLAYERS WILL CREATE A CORE SET OF ANSWERS TO THE hWHAT IS QUALITY v QUESTION AND DEVELOP A STANDARD APPROACH TO MEASURING QUALITY AS PHYSICIANS HOSPITALS PATIENTS AND PAYERS BUY IN TO THE SAME OUTCOME METRICS %ITHER BY CONSUMER CHOICE OR PAYER INCENTIVE QUALITY BASED lNANCIAL REWARDS WILL ARRIVE ONE WAY OR THE OTHER 4HIS IS THE BEST ARGUMENT FOR HOSPITAL PHYSICIAN COLLABORATION
$OS AND $ONTS 3UCCESSFUL COLLABORATION BETWEEN PHYSICIANS AND HOSPITALS STARTS WITH A SIMPLE LIST OF DOS AND DONTS $O "E PROACTIVE )NVOLVE EXTERNAL COUNSEL AND THE PAYER &OCUS ON THE PATIENT AND )NITIATE DIALOGUE $ONT !CT IN ISOLATION 3ACRIlCE LONG TERM GAINS FOR SHORT TERM EXPEDIENCY 5SE REGULATIONS AS AN EXCUSE FOR NOT MOVING FORWARD !LLOW BAD DATA TO CREATE FALSE CONCLUSIONS AND IMPROPER ACTIONS AND 4HINK THE WHOLE THING WILL SIMPLY GO AWAY %NDNOTE HTTPWWWADVOCATEHEALTHCOMCORPHEALTHABOUTVALUE2EPORT
VNQJHM FãSN FDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S !DVOCATE (EALTH 0ARTNERS ! CASE STUDY IN ALIGNING PHYSICIANS AND HOSPITALS FOR QUALITY;=
!DVOCATE (EALTH #ARE IS A MULTIHOSPITAL SYSTEM THAT IS THE LARGEST PROVIDER OF HEALTHCARE SERVICES IN #HICAGO AND THE SECOND LARGEST PRIVATE SECTOR EMPLOYER IN )LLINOIS 3YSTEM LEADERS FORMED !DVOCATE (EALTH 0ARTNERS !(0 A CARE MANAGEMENT AND MANAGED CARE CONTRACTING JOINT VENTURE BETWEEN THE HOSPITALS AND SELECT PHYSICIANS FROM THE MEDICAL STAFF )T IS COMPRISED OF A NETWORK OF PHYSICIANS IN UNIQUE PRACTICE SITES SERVING EIGHT HOSPITAL CAMPUSES CAPITATED LIVES AND 00/ PATIENTS !(0 ESTABLISHED A CLINICAL INTEGRATION PROGRAM THAT COMBINES EVIDENCE BASED MEDICINE INFORMATION SYSTEMS AND QUALITY IMPROVEMENT TECHNIQUES UNDER PAY FOR PERFORMANCE INCENTIVES WITH A GOAL OF IMPROVING CARE FOR PATIENTS AND DEMONSTRATING VALUE TO EMPLOYERS INSURANCE COMPANIES AND GOVERNMENT REGULATORS 4HE PROGRAM IS COMPRISED OF SEPARATE INITIATIVES SEE %XHIBIT LEVERAGING THE RECOMMENDATIONS OF SEVERAL NATIONAL QUALITY ORGANIZATIONS INTO DISEASE SPECIlC CARE MANAGEMENT PROGRAMS AND TARGETED DEPLOYMENT OF HEALTHCARE TECHNOLOGIES %XHIBIT #LINICAL )NTEGRATION 0ROGRAM )NITIATIVES !STHMA /UTCOMES
$EPRESSION 3CREENING OF THE #HRONICALLY )LL
'ENERIC 0RESCRIBING
%FFECTIVE 5SE OF (OSPITAL 2ESOURCES
3MOKING #ESSATION %DUCATION 0ROGRAM
$IABETIC #ARE /UTCOMES
0HARMACEUTICAL &ORMULARY 5SAGE
/RTHOPEDIC )MPLANT )NITIATIVE
#ONGESTIVE (EART &AILURE /UTCOMES
$EEP 6EIN 4HROMBOPHLEBITIS 0REVENTION
E)#5¸ 0ARTICIPATION
(OSPITAL 1UALITY )NDICATORS
#ORONARY !RTERY $ISEASE /UTCOMES
#OMMUNITY !CQUIRED 0NEUMONIA -ANAGEMENT
(OSPITALIST 0ROGRAM 0ARTICIPATION
1UALITY )MPROVEMENT !CTIVITY
#ARDIOVASCULAR $ISEASE !MBULATORY /UTCOMES
/BSTETRICS 2ISK 2EDUCTION
#OMPUTERIZED 0HYSICIAN /RDER %NTRY
0HYSICIAN %DUCATION 2OUNDTABLES
4HE PROGRAM HAS REALIZED MEASURABLE IMPROVEMENTS IN QUALITY )N !(0 PAID OUT OVER MILLION IN PERFORMANCE BASED BONUSES TO PHYSICIANS THROUGH INITIATIVES WITH MAJOR BENElTS INCLUDING PERCENT INCREASE IN GENERIC USAGE OVER TWO YEARS PERCENT IMPROVEMENT IN BETA BLOCKER PERCENT IMPROVEMENT IN !#% INHIBITORS USAGE FROM TO PERCENT MORE CHRONICALLY ILL PATIENTS SCREENED FOR DEPRESSION THAN THE PUBLISHED COMMUNITY STANDARD PERCENT OF !(0 PATIENTS WHO WERE CURRENT OR RECENT SMOKERS PROVIDED SMOKING CESSATION EDUCATION PERCENT BETTER RATE OF CONTROL THAN NATIONAL PERFORMANCE LEVELS FOR DIABETIC CARE AND PERCENT OF ASTHMA DISEASE REGISTRY PATIENTS RECEIVING A CUSTOMIZED TREATMENT PLAN IN !(0 REQUIRES THAT AFlLIATED PHYSICIANS BE CONNECTED BY LEADING EDGE INFORMATION TECHNOLOGIES )N PERCENT OF !(0S PHYSICIANS HAD HIGH SPEED )NTERNET ACCESS 4HE
!(0 BOARD MANDATED CONNECTIVITY AS A REQUIREMENT FOR CONTINUED MEMBERSHIP IN AND BY YEARS END PERCENT OF !(0 PHYSICIANS HAD HIGH SPEED )NTERNET ACCESS IN THEIR OFlCES 4HIS INCREASE IN CONNECTIVITY IS ILLUSTRATED IN %XHIBIT 0HYSICIANS HAVE ONLINE ACCESS TO CLINICAL PATHWAYS CONSULTATIONS WITH COLLEAGUES AND UP TO DATE HEALTH PLAN INFORMATION 4HEY CAN ALSO ACCESS !DVOCATE HOSPITALS CLINICAL DATA REPOSITORY ELECTRONIC MEDICAL RECORDS COMPUTERIZED PHYSICIAN ORDER ENTRY SYSTEM ELECTRONIC DATA INTERCHANGE %$) LIBRARY RESOURCES AND ELECTRONIC REFERRALS 4HIS CONNECTIVITY PROVIDED TANGIBLE COST SAVINGS EG BY CONNECTING ALL OF ITS PHYSICIANS AND OFFERING %$) SERVICES !(0 WAS ABLE TO REDUCE ITS CLAIMS ADMINISTRATIVE STAFF COSTS BY PERCENT IN ONE YEAR 4HIS HELPED TO OFFSET INVESTMENTS IN THE CLINICAL INFORMATION PROGRAM IT CURRENTLY HAS A DEDICATED STAFF OF &4%S AND MAKE IT SELF SUPPORTING 7HILE OTHER HEALTH ORGANIZATIONS HAVE TRIED UNSUCCESSFULLY TO SUPPLY PHYSICIANS WITH INFORMATION TECHNOLOGY !(0 #ONTINUED ON THE NEXT PAGE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
VNQJHMFãSNFDSGDQãOGXRHBH@MRã@MCãGNROHS@KRãO@QSMDQHMFãENQãPT@KH SXãHLOQNUDLDMS !DVOCATE (EALTH 0ARTNERS ! CASE STUDY IN ALIGNING PHYSICIANS AND HOSPITALS FOR QUALITY;= CONTINUED %XHIBIT #ONNECTIVITY OF !DVOCATES -EDICAL 3TAFF
0ERCENT OF 0HYSICIANS 7ITH (IGH 3PEED )NTERNET
"ETHANY
#HRIST
'OOD 'OOD 3AMARITAN 3HEPHERD
)LLINOIS -ASONIC
3OURCE !DVOCATE (EALTH 0ARTNERS
TOOK THE INITIATIVE TO ACTUALLY MAKE IT HAPPEN h7E WENT OUT AND INVENTORIED EACH OF THE OFlCES TO IDENTIFY WHAT THEIR OPTIONS WERE FOR CONNECTIVITY OFFERED THEM THE CHOICES AND THEN LITERALLY MADE THE ARRANGEMENTS WITH THE TELECOMMUNICATIONS COMPANIES TO BRING IT IN TO INSTALL IT AND THEN TRAIN THE PHYSICIANS STAFF TO USE IT v SAYS ,EE " 3ACKS -$ PRESIDENT OF !DVOCATE (EALTH 0ARTNERS h/NCE THE PHYSICIANS STARTED USING IT THEY SAW HOW IT CAN POSITIVELY IMPACT THEIR EFlCIENCY AND PRACTICE 7E HAVENT HAD ANY COMPLAINTS ABOUT THE COSTv !(0 SUPPORTS ITS MEMBER PHYSICIANS IN OTHER WAYS AS WELL )N !(0 STARTED USING THE !DVOCATE CALL CENTER FOR OUTBOUND CALLS AND DOING DIRECT MAILINGS TO NONCOMPLIANT PATIENTS !(0 SENDS QUARTERLY REPORT CARDS TO PHYSICIANS AND DETAILED DElNITIONS OF THE QUALITY MEASURES TO IMPROVE PERFORMANCE h9OU HAVE TO BE CREDIBLE AND QUICKLY EARN THE TRUST OF THE PHYSICIANS AND THEIR OFlCE STAFF THAT THE DATA YOU ARE DISPLAYING IS AN ACCURATE REmECTION OF WHAT YOU ARE DOING )TS THE COMBINATION OF DOING IT CORRECTLY AND EDUCATING THEM BECAUSE EVERYBODY THINKS THEY ARE DOING A MUCH BETTER JOB THAN THEY ARE REALLY DOING v SAYS 3ACKS (E CONTINUES h4HE INDEPENDENT PHYSICIANS ESPECIALLY LIKE THE SUPPORT THAT THEY ARE GETTING THE DEMONSTRATION OF IMPROVEMENTS IN CARE -Y HOPE IS THAT WITH THE DATA WE ARE GIVING BACK TO OUR PHYSICIANS AND THE INFRASTRUCTURE
1 5!,)49 # / . 5 . $ 2 5 - # (!04% 2
,UTHERAN
3OUTH 3UBURBAN
4RINITY
/VERALL 0(/
!(#
$REYER
9% #) 0ROGRESS 2EPORT ST #) 0ROGRESS 2EPORT ND #) 0ROGRESS 2EPORT
SUPPORT THEY WILL OVERCOME CHALLENGES AND CONTINUE TO IMPROVE PERFORMANCEv 3ACKS HOPES TO SHOW THAT QUALITY CAN BE A COMPETITIVE DIFFERENTIATOR FOR !(0 4ODAY MOST OF THE COMMERCIAL MANAGED CARE PLANS IN THE #HICAGO AREA PROVIDE PAY FOR PERFORMANCE FUNDING TO !(0 UNDER THE CLINICAL INTEGRATION PROGRAM h/UR HOPE IS THAT ITS EASIER TO DO YOUR MANAGED CARE WORK THROUGH !DVOCATE (EALTH 0ARTNERS AND AS A RESULT YOUD WANT TO DO IT THROUGH US ) HAVE ALWAYS SAID TO OUR BOARD AND LEADERSHIP TEAM THAT WE NEED TO EARN THE BUSINESS AND KEEP RE EARNING IT v SAYS 3ACKS !DDITIONALLY !(0S 3ACKS CONSIDERS THAT IT WILL JUST BE A MATTER OF TIME UNTIL -EDICARE REQUIRES PAY FOR PERFORMANCE ON A WIDE SCALE BASIS AND WANTS TO BE PREPARED TO HELP AFlLIATED PHYSICIANS SUCCEED ON THOSE QUALITY METRICS !(0 FORMALLY ASSESSES THE CLINICAL INTEGRATION PROGRAM EACH YEAR AND MAKES CHANGES BASED ON ACHIEVEMENT OF GOALS AND FEEDBACK FROM PATIENTS PHYSICIANS EMPLOYERS AND INSURERS !(0S GOAL IS TO EVOLVE THE PROGRAM IN MANAGEABLE AND MEASURABLE INCREMENTS EACH YEAR h$ONT TRY TO DO EVERYTHING AT ONCE OR ON DAY ONE v 3ACKS ADVISES h7E STARTED WITH A FAIRLY SIMPLE PROGRAM THAT YOU COULD SHOOT SOME HOLES IN AS OPPOSED TO TRYING TO DESIGN THE PERFECT PROGRAM BECAUSE THAT PROBABLY WOULD HAVE SUNK US "UT OUR GOAL WAS TO MAKE IT WORK SHOW THAT WE CAN IMPROVE CARE LEARN FROM IT AND ADD THINGS IN AN INCREMENTAL FASHIONv
)MPROVING (EALTHCARE 1UALITY IN THE 0EDIATRIC !MBULATORY %NVIRONMENT 5SING A SYSTEMS APPROACH AND TOOLS SUCH AS COMPUTER SIMULATION CAN IMPROVE QUALITY OF CARE IN A PEDIATRIC AMBULATORY ENVIRONMENT
"Y 3HAMITA #HAKRABORTY AND !NTHONY $ 3LONIM #HILDRENS .ATIONAL -EDICAL #ENTER
(
EALTHCARE QUALITY HAS INCREASED IN IMPORTANCE FOR HEALTHCARE CLINICIANS AND ADMINISTRATORS ALIKE 7HILE EFFORTS AIMED AT IMPROVING THE DELIVERED SERVICES FOR INDIVIDUALS AND POPULATIONS HAVE MATURED THEY ARE STILL PRIMARILY FOCUSED ON THE INPATIENT ARENA WHERE HIGH RISK CARE IS DELIVERED TO VULNERABLE PATIENTS !S HEALTHCARE QUALITY EXPANDS ITS ROLE BEYOND THE WALLS OF THE ACUTE CARE HOSPITAL THERE IS A NEED TO TRANSITION THE TECHNIQUES THAT HAVE RELEVANCE FOR AN OUTPATIENT PRACTICE AND TO CAPITALIZE ON NEW AND INNOVATIVE STRATEGIES THAT WILL BE USEFUL ACROSS OUTPATIENT SERVICE LINES 4HIS MANUSCRIPT DESCRIBES OUR USE OF ONE SUCH TOOL COMPUTER SIMULATION FOR IMPROVING THE QUALITY OF CARE THAT WE DELIVER TO OUR PEDIATRIC OUTPATIENTS
3ETTING #HILDRENS .ATIONAL -EDICAL #ENTER IS A HEALTHCARE SYSTEM THAT IS NATIONALLY AND INTERNATIONALLY KNOWN FOR DELIVERING PEDIATRIC PRIMARY AND SPECIALTY CARE #HILDRENS (OSPITAL IS THE MAIN FACILITY SITED IN 7ASHINGTON $# )T HOUSES INPATIENT BEDS AND PRIMARY CARE AND SPECIALTY OUTPATIENT CLINICS #HILDRENS THROUGH THE #HILDRENS 2ESEARCH )NSTITUTE DEVELOPS AND USES INNOVATIVE STRATEGIES FOR TREATING PEDIATRIC ILLNESS AND INJURY INCLUDING THE METHODS APPLIED HERE USING COMPUTER SIMULATION TO IMPROVE HEALTHCARE DELIVERY #HILDRENS 2EGIONAL /UTPATIENT #ENTERS 2/#S ARE A KEY COMPONENT OF #HILDRENS .ATIONAL -EDICAL #ENTER #.-# -ORE THAN PEDIATRIC SPECIALTY SERVICES ARE PROVIDED AT SIX CENTERS SURROUNDING THE 7ASHINGTON $# METROPOLITAN REGION 4HESE CENTERS PROVIDE CARE TO AN ANNUAL VOLUME OF NEARLY AMBULATORY PATIENTS AND HELP TO ENSURE THAT CHILDREN HAVE ACCESS TO #HILDRENS PROVIDERS WITH PEDIATRIC EXPERTISE IN THE COMMUNITIES IN WHICH THEY LIVE
2ESEARCH &OUNDATIONS 4WO COMPLEMENTARY BODIES OF RESEARCH HAVE RELEVANCE TO HEALTHCARE QUALITY GENERALLY AND THE USE OF SIMULATION MODELS SPECIlCALLY 4HE lRST IS THE HEALTH SERVICES RESEARCH FRAMEWORK OF STRUCTURE PROCESS AND OUTCOME PROMULGATED lRST BY $ONABEDIAN 4HE SECOND IS SYSTEMS THEORY AND ITS RELEVANCE TO DRIVING IMPROVEMENTS THROUGHOUT COMPLEX ORGANIZATIONS
3TRUCTURE 0ROCESS AND /UTCOME 3TRUCTURE IS COMMONLY THOUGHT OF AS THE hBRICKS AND MORTARv OF A HEALTHCARE ORGANIZATION BUT IT REALLY EXTENDS WELL BEYOND THE PHYSICAL COMPOSITION TO INCLUDE THE AVAILABILITY ORGANIZATION AND lNANCING OF HEALTHCARE PROGRAMS INCLUDING HUMAN CAPITAL 3TRUCTURE MUST ALSO ACCOUNT FOR THE CHARACTERISTICS OF THE POPULATIONS AND ENVIRONMENTS THAT ARE SERVED 0ROCESS REFERS TO THE INTERACTIONS BETWEEN PATIENTS AND THE MEMBERS OF THEIR HEALTHCARE TEAM )T IS IMPORTANT TO REMEMBER THAT PATIENTS ARE ALSO INCREASINGLY INTERACTING WITH TECHNOLOGY IN A SERIES OF PROCESSES THAT MUST BE ACCOUNTED FOR WHEN CONSIDERING OPPORTUNITIES TO IMPROVE HEALTHCARE DELIVERY AND AMELIORATE RISK /UTCOMES ARE THE RESULTANT EFFECTS OF THE HEALTHCARE EXPERIENCE 7HEN CONSIDERING OUTCOMES IN SIMULATION IT IS IMPORTANT TO DElNE THE MODELING PERSPECTIVE 4HE IMPORTANCE OF PERSPECTIVE BECOMES CLEARER AS THE SECOND RESEARCH FOUNDATION SYSTEMS THEORY IS CONSIDERED
3YSTEMS 4HEORY !DMINISTRATORS CLINICIANS PAYERS AND PATIENTS EACH VIEW THE DELIVERY OF HEALTHCARE THROUGH THEIR OWN INDIVIDUAL hLENS v WHICH DEPENDS IN PART ON THEIR BACKGROUND AND THE GOALS ESTABLISHED FOR A PARTICULAR HEALTHCARE INTERACTION &OR EXAMPLE WHEN A
3HAMITA #HAKRABORTY IS A PHARMACIST BY BACKGROUND AND HAS A -ASTER OF 3CIENCE IN HEALTH ADMINISTRATION 3HE IS THE ADMINISTRATOR IN THE #ENTER FOR #LINIC %FFECTIVENESS AT #HILDRENS .ATIONAL -EDICAL #ENTER AND WORKS CLOSELY WITH $R 3LONIM IN AREAS SUCH AS CLINIC OPERATIONS IMPROVEMENT AND HEALTHCARE QUALITY INITIATIVES 3HE IS A MEMBER OF THE !MERICAN #OLLEGE OF (EALTHCARE %XECUTIVES 3HE CAN BE REACHED AT SCHAKRAB CNMCORG !NTHONY $ 3LONIM -$ $R0( IS AN INTENSIVE CARE PHYSICIAN AND THE EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS AT #HILDRENS .ATIONAL -EDICAL #ENTER AND VICE CHAIRMAN OF 0EDIATRICS OF THE 'EORGE 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE IN 7ASHINGTON $# )N ADDITION TO HIS MEDICAL EDUCATION AND TRAINING HE HAS A DOCTORATE IN HEALTHCARE ADMINISTRATION AND PERFORMS RESEARCH IN HEALTHCARE QUALITY AND PATIENT SAFETY (E IS GRANT FUNDED FROM !(21 FOR THIS WORK $R 3LONIM IS A &ELLOW IN THE !MERICAN #OLLEGE OF 0HYSICIAN %XECUTIVES AND THE !MERICAN #OLLEGE OF #RITICAL #ARE -EDICINE (E CAN BE REACHED AT ASLONIM CNMCORG
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
HLOQNUHMFãGD@KSGB@QDãP T@K H S Xã H M ã S G D ã OD C H @S Q H B ã @ LA T K @SN Q Xã D M U H Q N M LD M S SERVICE LINE ADMINISTRATOR IS CONSIDERING OPTIMAL OUTCOMES FROM THE SERVICE LINE THERE ARE LIKELY TO BE CLINICAL lNANCIAL AND OPERATING METRICS ASSOCIATED WITH THEIR WORK THAT ASSIST IN DECISION MAKING (OWEVER IF THE SAME SERVICE LINE ADMINISTRATOR HAS A CHILD THAT BECOMES A PATIENT WITH A DISEASE REQUIRING CARE FROM THAT SERVICE LINE THE PERSPECTIVE CHANGES #LINICAL OUTCOMES AT THE LEVEL OF THE INDIVIDUAL RATHER THAN AT THE LEVEL OF THE SERVICE LINE TAKE PRECEDENCE AND ARE SUPERIOR TO THE lNANCIAL OUTCOMES OF THE SERVICE LINE 7HEN PERFORMING SIMULATION THE MODELING TEAM NEEDS TO MAINTAIN THEIR LENS FOCUSED ON THE FUNCTIONING OF THE ENTIRE SYSTEM
/PPORTUNITIES TO CAPITALIZE ON THE TOOLS PROVIDED BY OTHER INDUSTRIES SHOULD BE CONSIDERED AND STUDIED 4HE HEALTHCARE SYSTEM IS ORGANIZED HIERARCHICALLY INTO MULTIPLE LEVELS 3YSTEMS THEORY POSES TWO DISCRETE hLEVELSv FOR THAT ORGANIZATION n THE MACROSYSTEM AND THE MICROSYSTEM 4HE MACROSYSTEM PROVIDES THE STRUCTURAL COMPONENTS PROCESSES AND OUTCOMES THAT ARE HELD IN ASCENDANCY OVER THE MICROSYSTEM -ICROSYSTEMS REPRESENT FUNCTIONALLY DISCRETE YET INTEGRATED UNITS WITHIN THE MACROSYSTEM AND HAVE A STRUCTURE PROCESSES AND OUTCOMES OF THEIR OWN BUT ALSO RELY HEAVILY ON THE ABILITY OF
THE MACROSYSTEM TO FUNCTION SO THAT THE MICROSYSTEM OUTCOMES CAN BE ACHIEVED WWWCLINICALSYSTEMSORG 7HILE AT lRST GLANCE THIS SEEMS LIKE AN INTUITIVE APPROACH IT IS A CRITICAL lRST STEP THAT ESTABLISHES THE FOUNDATION FOR MODEL BUILDING )MPROVEMENTS IN SIMULATION NEED TO BE ACCOMPLISHED WITH A PERSPECTIVE THAT FOCUSES ON THE SYSTEM TO AVOID WHAT IS COMMONLY REFERRED TO AS THE hPROCESS PARADOX v WHERE SEEMINGLY GOOD PROCESS IMPROVEMENT WORK AT THE MICROSYSTEM LEVEL WHICH IS OFTEN EASILY PERFORMED AND MEASURED FAILS TO ACHIEVE SUSTAINABLE RESULTS 7ORK THAT IS FOCUSED TOO SPECIlCALLY ON INDIVIDUAL MICROSYSTEMS WITHOUT ACCOUNTING FOR THE BROADER FRAME OF REFERENCE OF THE MACROSYSTEM ARE LIKELY TO CAUSE PERTURBATIONS IN OTHER MICROSYSTEMS THAT WILL ONLY BE DISCOVERED AND WORKED ON AT SOME FUTURE DATE )N OUR WORK THE MACROSYSTEM WAS DElNED AS THE FUNCTIONING OF ONE OF THE 2/#S AND THE MICROSYSTEMS WERE THE INDIVIDUAL PHYSICIAN PRACTICES AND THE AMBULATORY SURGERY CENTER WITHIN THE 2/# SEE %XHIBIT 4HESE PRACTICES ARE INTERDEPENDENT IN ACHIEVING THE OUTCOMES AT THE MACROSYSTEM BECAUSE EACH RELIES ON SHARED SPACE AND RESOURCES &OR EXAMPLE IF ONE SPECIALTY NEEDS TO EXPAND ITS PRESENCE IN A PARTICULAR LOCATION THERE NEEDS TO BE EITHER AN EXPANSION OR A REORGANIZATION OF THE OTHER PRACTICES TO ACCOMMODATE THIS PRESENCE 4HE STRUCTURE PROCESS AND OUTCOME RELATIONSHIPS DISCUSSED ABOVE ARE OPERATIVE NOT ONLY AT THE LEVEL OF THE MACROSYSTEM BUT ALSO WITHIN AND BETWEEN THE MICROSYSTEMS
%XHIBIT -ODEL $EPICTING THE 2EGIONAL /UTPATIENT #ENTER MACROSYSTEM AND THE !MBULATORY 3URGERY #ENTER MICROSYSTEM 5NDER %VALUATION
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
HLOQNUHMFãGD@KSGB@QDãP T@K H S Xã H M ã S G D ã OD C H @S Q H B ã @ LA T K @SN Q Xã D M U H Q N M LD M S %XHIBIT -ODEL $EPICTING 0ATIENT &LOW IN THE !MBULATORY 3URGERY #ENTER 3UPERIMPOSED ON THE !CTUAL &LOOR 0LAN 7ITH 3PECIlED ,OCATIONS 2OUTES AND 2ESOURCES
3IMULATION ! 4OOL FOR 0ERFORMANCE )MPROVEMENT
THAN EXPERIMENTING ON THE ACTUAL SYSTEM PARTICULARLY WHERE PATIENTS MAY BE AT RISK
7HAT )S 3IMULATION
3TEPS FOR 0ERFORMING A 3UCCESSFUL 3IMULATION 0ROJECT
3IMULATION IS A POWERFUL TOOL THAT USES COMPUTERIZED MODELS OF HEALTHCARE SYSTEMS TO MAKE DESIGN DECISIONS AND PERFORMANCE ENHANCEMENTS )T HAS AS ITS OUTPUT CLINICAL BUSINESS AND SERVICE PERFORMANCE TARGETS LINKED THROUGH PROCESSES USING A SHARED INFORMATION PLATFORM
7HY 5SE 3IMULATION 3IMULATION PROVIDES AN EFFECTIVE METHOD OF ANALYSIS THAT IS FORMAL AND PREDICTIVE )T IS A METHOD OF ANALYZING THE IMPACT OF POTENTIAL PROCESS CHANGES PRIOR TO THEIR IMPLEMENTATION 4HE BENElTS INCLUDE AN ABILITY TO ACCURATELY PREDICT SYSTEM PERFORMANCE IDENTIFY RESOURCE NEEDS AND CONSTRAINTS IDENTIFY NEW OR UNPERCEIVED RISK POINTS CREATED BY THE REDESIGN AND TO EXAMINE ALTERNATIVE COURSES OF ACTION BY RUNNING THE MODEL THROUGH YEARS OF OPERATIONS IN A MATTER OF MINUTES 4HIS ALLOWS A MANAGER TO ACCURATELY PREDICT OUTCOMES AND MAKE INFORMED AND EFFECTIVE MANAGEMENT AND OPERATIONAL DECISIONS "Y USING A SYSTEMS APPROACH THAT FOCUSES ON DESIGN DETAILS SIMULATION CAN CAPTURE SYSTEM INTERDEPENDENCIES ACCOUNT FOR VARIABILITY IN THE SYSTEM AND PROVIDE DATA ON MULTIPLE PERFORMANCE MEASURES WITH RESULTS THAT ARE QUANTITATIVE AND EASY TO UNDERSTAND 4HE MODELS ARE VISUALLY APPEALING AND ENGAGE THE INTEREST OF THE FRONT LINE STAFF IN hREAL LIFE SCENARIOSv 4HESE MODELS ARE LESS COSTLY LESS TIME CONSUMING AND LESS DISRUPTIVE
! SIMULATION PROJECT IS SIMILAR TO OTHER PROJECTS THAT NEED TO BE MANAGED IN THE ORGANIZATION ! TEAM NEEDS TO BE CHARTERED WITH CLEAR OBJECTIVES SCOPE OUTCOMES AND TIME LINES 4HE TEAM SHOULD BE MULTIDISCIPLINARY TO PROVIDE APPROPRIATE EXPERTISE IN HOW EACH OF THE MICROSYSTEMS WORK 4HIS WILL SUPPORT A BETTER UNDERSTANDING OF THE MACROSYSTEMS FUNCTIONING AND ALLOW SPECIlCATION OF THE SIMULATION WORK 4HE NEXT MAJOR STEP IS TO BEGIN MODELING THE SYSTEM 4HERE ARE TWO COMPONENTS TO THIS STEP &IRST A hWALK THROUGHv OF THE PROCESS WITH THE MAJOR STAKEHOLDERS AND A MAPPING OF MICROSYSTEM LEVEL PROCESSES AND THEIR RELATIONSHIP TO THE MACROSYSTEM MUST OCCUR .EXT THE TEAM NEEDS TO CONSIDER THE DATA REQUIREMENTS FOR THE EXERCISE 2EAL LIFE OR HISTORICAL DATA WHENEVER POSSIBLE NEED TO BE INCLUDED IN THE MODELING TO PROVIDE REALISTIC PROJECTIONS 4HE DATA MAY BE OBTAINED FROM TIME STUDIES ELECTRONIC BUSINESS OR CLINICAL SYSTEMS 4HE DATA DISTRIBUTIONS EG 7EIBULL OR 'AUSSIAN WITH THEIR DESCRIPTIVE STATISTICAL ELEMENTS EG MEAN AND STANDARD DEVIATIONS NEED TO BE COLLECTED 4HESE QUANTITATIVE ELEMENTS ARE TAUGHT AS A PART OF QUANTITATIVE IMPROVEMENT METHODS LIKE 3IX 3IGMA AND ALLOW THE MODEL TO REALISTICALLY REPRESENT THE SYSTEM UNDER STUDY BASED UPON DATA FROM PAST PERFORMANCE AND THE CURRENT PROCESS MAPS 4HE LITERATURE CAN ALSO PROVIDE IMPORTANT DATA FOR PROJECTS THAT HAVE BEEN PERFORMED AT OTHER ORGANIZATIONS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
HLOQNUHMFãGD@KSGB@QDãP T@K H S Xã H M ã S G D ã OD C H @S Q H B ã @ LA T K @SN Q Xã D M U H Q N M LD M S ! MODELING PROGRAM SUCH AS -EDMODEL WWWPROMODELCOM CAN ASSIST WITH THESE STEPS AND PROVIDES THE OPPORTUNITY TO UPLOAD mOOR PLANS AND SYSTEM DESIGNS THAT REPLICATE THE ACTUAL LOCATION AND PROCESS SEE %XHIBIT /NCE THE MODEL IS BUILT AN IMPORTANT STEP IS VALIDATION 4HIS REQUIRES THAT THE COMPOSITE DATA AND PROCESS PIECES BE VERIlED BY THE TEAM INCLUDING THE FRONT LINE STAFF 4HE MODEL CAN THEN BE RUN THROUGH SEVERAL ITERATIONS TO DETERMINE THAT IT REPRESENTS THE REAL LIFE OR hBASEv STATE OF THE SYSTEM -ULTIPLE hWHAT IFv SCENARIOS CAN NOW BE RUN BY MAKING CHANGES TO THE EXISTING MODEL &OR EXAMPLE IF THE NUMBER OF STAFF IN THE CLINIC IS DOUBLED HOW WILL THAT AFFECT CAPACITY COST PER PATIENT VISIT AND THROUGHPUT 4HESE SCENARIOS CAN BE mOWED THROUGH YEARS OF OPERATIONS TO PROVIDE DATA ON THE KEY ELEMENTS OF INTEREST #OMPARISONS OF THESE SCENARIOS AND THE DATA GENERATED BY THEM TO THE BASE STATE ALLOW APPROPRIATE MANAGEMENT DECISIONS TO BE MADE /NCE CONVINCED THAT THE CHANGES IDENTIlED THROUGH MODELING CAN LEAD TO OPERATIONAL IMPROVEMENTS THE IMPLEMENTATION OF THOSE CHANGES NEEDS TO OCCUR 7HILE CULTURE CHANGE AND REORGANIZATION CAN BE A DIFlCULT PROCESS THE MODEL HELPS TO PROVIDE A PICTORIAL REPRESENTATION OF CURRENT VERSUS FUTURE PRACTICE AND PROVIDES THE DATA THAT DEMONSTRATE THE LIKELIHOOD OF IMPROVEMENTS 4HIS IS A VERY POWERFUL TOOL FOR PERSUADING STAFF OF THE BENElTS OF CHANGE
/VERVIEW OF #.-#S /UTPATIENT #LINIC 3IMULATION 0ROJECT 4HE #ENTER FOR #LINICAL %FFECTIVENESS AT #HILDRENS .ATIONAL -EDICAL #ENTER HAS BECOME FAMILIAR WITH THE USE OF SIMULATION
SOFTWARE AS A MEANS OF BOTH IMPROVING CLINICAL OPERATIONS AND PERFORMING CLINICAL RESEARCH 4HE #ENTER CHARTERED AND FACILITATED THE PROJECT TEAM ESTABLISHED THE PROJECT SCOPE COLLECTED THE REPRESENTATIVE DATA PERFORMED THE SYSTEMS ANALYSIS AND IMPLEMENTED THE CHANGES $ElNING THE 0ROJECT 3COPE 4HE KEY COMPONENT OF THIS SIMULATION PROJECT WAS TO UNDERSTAND THE VALUE OF EXPANDING OUR EXISTING AMBULATORY SURGERY CENTER WITHIN ONE OF OUR 2/#S 4HE PROJECT TEAM WAS INTERESTED IN PATIENT mOW CAPACITY THROUGHPUT STAFlNG AND THE INCREMENTAL SURGERIES WITH A VARIETY OF DIFFERENT APPROACHES RECOGNIZING THAT AN AMBULATORY SURGERY CENTER DIFFERS IN MANY WAYS FROM A HOSPITAL BASED OPERATING ROOM IN TERMS OF CASE MIX AND RESOURCES 4HE PERSPECTIVE OF THIS PROJECT USED THE 2/# AS THE MACROSYSTEM AND THE AMBULATORY SURGERY CENTER AS THE MICROSYSTEM SEE %XHIBITS AND )T IS IMPORTANT TO REMEMBER THAT AN ANALYSIS OF THE STRUCTURE PROCESS AND OUTCOMES OF BOTH THE MICRO AND MACROSYSTEMS NEEDS TO OCCUR TO EFFECTIVELY IMPROVE THE SYSTEM !NALYSIS OF INDIVIDUAL MICROSYSTEMS ALLOWS THE PROJECT WITH A LARGE SCOPE TO BE BROKEN DOWN INTO MANAGEABLE COMPONENTS "UILDING THE -ODEL 4HE lRST STEP TO IMPROVING THE AMBULATORY SURGERY CENTER EXPERIENCE WAS TO UNDERSTAND THE PROCESS IN DETAIL FROM THE PEOPLE THAT WORK AND ARE TREATED IN THE AMBULATORY SURGERY CENTER AND TO IDENTIFY OPPORTUNITIES FOR CHANGE AS THE PROCESS IS SPECIlED !N OVERVIEW OF THE PROCESS WAS CREATED 4HEN DETAILED
%XHIBIT 2ESULTS 3UMMARY #OMPARING THE "ASE -ODEL 7ITH 3CENARIOS AND
+EY )NDICATORS
%XITS
"ASE -ODEL
3CENARIO )NCREASE CLINIC HOURS BY HR
)MPACT ON +EY )NDICATORS 3CENARIO
3CENARIO !DD PREP ROOM !DD /2 !DD TECH .URSES 3URGEON AND !NESTHESIOLOGIST #LINIC HRS AM PM
)MPACT ON +EY )NDICATORS 3CENARIO
5TILIZATION /2 MINUTES
!VERAGE TIME IN SYSTEM MINUTES
!VERAGE TIME WAITING IN SYSTEM MINUTES
!VERAGE TIME BLOCKED IN SYSTEM MINUTES
!VERAGE TIME IN WAITING ROOM MINUTES
1 5!, ) 49 # / . 5 . $ 2 5 - # # ( ! 0 4 % 2
HLOQNUHMFãGD@KSGB@QDãP T@K H S Xã H M ã S G D ã OD C H @S Q H B ã @ LA T K @SN Q Xã D M U H Q N M LD M S PROCESS mOWS WERE MAPPED TO EACH OTHER 3OME DATA COLLECTION NEEDED TO OCCUR BY WATCHING THE PROCESS THROUGH RANDOM TIME STUDIES BUT FOR THE MOST PART WE RELIED ON DATA ELEMENTS THAT WERE CAPTURED AS A PART OF ROUTINE OPERATIONS USING ELECTRONIC SYSTEMS TO SUPPLY THE DATA WHENEVER POSSIBLE 4HE FOLLOWING DATA ELEMENTS REPRESENT A SAMPLE OF THE DATA USED TO DEVELOP THE MODEL 0ATIENT $ATA VOLUME CANCELLED APPOINTMENTS NO SHOW RATES AND ARRIVAL PATTERNS &ACILITIES )NFORMATION LAYOUT ROOM USE DATA n PREOPERATIVE OPERATING ROOM AND POSTOPERATIVE CAPACITY AND UTILIZATION 2ESOURCE $ATA STAFlNG INFORMATION REGARDING THE NUMBER OF PHYSICIANS NURSES /2 TECHNICIANS APPOINTMENT SLOTS PER SESSION VACANCIES PER SESSION AND 0ROCESSING )NFORMATION CHECK IN AND REGISTRATION TIMES PATIENT INTAKE TIME PROCEDURE TIMES RECOVERY TIMES TIME SEEN BY THE PHYSICIAN WAIT TIMES BETWEEN STEPS DOWNTIMES FOR CLEANUP AND STAFF BREAKS 4HE DATA FROM THE ABOVE PARAMETERS WERE USED TO DEVELOP A SIMULATION MODEL USING 0ROMODELS -EDMODEL SOFTWARE HTTP WWWPROMODELCOMPRODUCTSMEDMODEL SEE %XHIBIT "ASED UPON THE CURRENT CONlGURATION OF THE SYSTEM THROUGH BOTH PROCESS AND DATA THE VARIABLES WERE ORGANIZED INTO MODEL INPUTS INCLUDING THE DIFFERENT PATIENT LOCATIONS PATIENT TYPES PROCESSES AND RESOURCES WITH THEIR APPROPRIATE STATISTICAL DISTRIBUTIONS AND SPECIlCATIONS AND OUTPUT VARIABLES RESULTING FROM THE EXECUTION OF THE PROGRAM AND CORRESPONDING TO THE TARGETED OUTCOMES OF INTEREST 4HE MODEL WAS THEN VALIDATED WITH STAFF AND MODIlED TO REPRESENT THE BASE CASE BEFORE DIFFERENT SCENARIOS WERE RUN 3IMULATIONS WERE RUN WITH THE EXISTING CONDITIONS AND BY CHANGING VARIABLES SUCH AS STAFlNG BED SPACE AND PATIENT ARRIVAL PATTERNS 4HE OUTPUTS FOR THE SCENARIOS WERE COMPARED USING PERFORMANCE METRICS SUCH AS TOTAL PATIENT THROUGHPUT TIME WAIT TIMES AND lNANCIAL GAIN FROM THE CHANGE TO THE PROCESS !N EXAMPLE OF THE DIFFERENT OUTPUT ELEMENTS FROM THE SCENARIOS AS COMPARED WITH THE hBASE CASEv IS SHOWN IN %XHIBIT 3EVERAL REPLICATIONS OF THE MODEL WERE RUN TO SIMULATE PATIENT mOW IN AN hAS IS STATE v AND THE KEY INDICATORS FROM THE SIMULATION INCLUDED ,OCATION UTILIZATION WAITING ROOM OPERATING ROOM POST OP RECOVERY ROOMS ETC 2ESOURCE UTILIZATION !VERAGE TIME THE PATIENT IS IN THE SYSTEM AND !VERAGE PATIENT WAITING TIME 4HE lRST SCENARIO SOUGHT TO UNDERSTAND THE INCREMENTAL PATIENT VISITS IF WE INCREASED OUR SURGERY CENTERS DAILY HOURS BY ONE HOUR 7E NOTED THAT PATIENT VOLUME INCREASED BY PERCENT AND AVERAGE WAITING TIME IN THE SYSTEM AND AVERAGE TIME IN THE WAITING ROOM DECREASED ! SECOND SIMULATION WAS RUN TO UNDERSTAND THE NEED FOR A SECOND OPERATING ROOM 7E ADDED AN ADDITIONAL OPERATING ROOM WITH THE EXISTING RESOURCES AND NOTED THAT IT DID NOT SIGNIlCANTLY AFFECT THE KEY INDICATORS .EXT IN ORDER TO TRULY UNDERSTAND THE IMPACT OF AN ADDITIONAL /2 WE ADDED A PRE OPERATIVE AREA AND
ADDITIONAL RESOURCES TO MEET THE DEMAND !LTHOUGH OPERATING ROOM UTILIZATION WAS REDUCED BY PERCENT THE PATIENT THROUGHPUT AND WAIT TIMES IMPROVED DRAMATICALLY BY PERCENT AND PERCENT RESPECTIVELY THEREBY INCREASING THE NUMBER OF PATIENTS SEEN IN THE AMBULATORY SURGERY CENTER IN A GIVEN DAY BY PERCENT AND PROVIDING SOME OPPORTUNITIES TO IMPROVE PATIENT SATISFACTION /F IMPORTANCE THE MARGINAL EXPENSES FROM THIS STAFlNG MODEL NEEDED TO BE JUSTIlED BY THE INCREMENTAL PATIENT REVENUE 4HESE COST PROJECTIONS ARE INCLUDED AS THE MODEL CONTINUES TO EVOLVE
#ONCLUSION )F SUCCESS IN THE IMPROVEMENT OF QUALITY FOR PATIENTS IS TO BE ACHIEVED OPPORTUNITIES TO CAPITALIZE ON THE TOOLS PROVIDED BY OTHER INDUSTRIES SHOULD BE CONSIDERED AND STUDIED 3IMULATION IS ONE SUCH TOOL THAT HAS THE ABILITY TO ASSIST CLINICIANS AND ADMINISTRATORS IN MAKING DECISIONS ABOUT THEIR OPERATIONS FOR COMPLEX SYSTEMS )T IS BEST USED IF THERE IS A CLEAR OPERATIONAL DECISION THAT NEEDS TO BE MADE AND THERE ARE NUMEROUS INTERDEPENDENT PROCESSES THAT CAN BE WELL DElNED AT THE LEVEL OF THE SYSTEM $R 3LONIM IS SUPPORTED IN PART BY !(21 +/ (3 2ECOMMENDED 2EADING #ARSON *3 )) h)NTRODUCTION TO -ODELING AND 3IMULATION v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE #ENTENO - AND - #ARILLO h#HALLENGES OF )NTRODUCING 3IMULATION AS A $ECISION -AKING 4OOL v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE #LINICAL -ICROSYSTEMS WWWCLINICALMICROSYSTEMSORG $ONABEDIAN ! h%VALUATING THE 1UALITY OF -EDICAL #ARE v -ILBANK -EMORIAL &UND 1UARTERLY PP $RONZEK 2 h#ONDUCTING A 3UCCESSFUL (EALTHCARE 3IMULATION 0ROJECT v 3(3 -% &ORUM %LDABI 4 AND 2 0AUL h! 0ROPOSED !PPROACH FOR -ODELING (EALTHCARE 3YSTEMS FOR 5NDERSTANDING v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE h&UTURE OF THE /PERATING 2OOM 4HE #HANGING &ACE OF THE /2 v 4HE !DVISORY "OARD #OMPANY (ARRELL # " 'HOSH 2 "OWDER h3IMULATION 5SING 0ROMODEL v ND %D -C'RAW (ILL )NGALLS 2 h)NTRODUCTION TO 3IMULATION v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE WWWPROMODELCOMPRODUCTSMEDMODEL -ERKLE * h#OMPUTER 3IMULATION ! -ETHODOLOGY TO )MPROVE THE %FlCIENCY IN THE "ROOKE !RMY -EDICAL #ENTER &AMILY #ARE #LINIC v !MERICAN #OLLEGE OF (EALTHCARE %XECUTIVES AVAILABLE AT HTTPWWW ACHEORGMBERSHIPADVTOFELLOWCASERPTSMERKLECFM !CCESSED -AY 0ALL ' h4HE 0ROCESS #ENTERED %NTERPRISE n 4HE 0OWER OF #OMMITMENTS v #2# 0RESS ,,# 2USSELL 2 " 4AYLOR /PERATIONS -ANAGEMENT n 1UALITY AND #OMPETITI VENESS IN A 'LOBAL %NVIRONMENT TH %D *OHN 7ILEY 3ONS )NC 3ADOWSKI $ h4IPS FOR 3UCCESSFUL 0RACTICE OF 3IMULATION v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE 3ANCHEZ 3 h!"#S OF /UTPUT !NALYSIS v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE 3ARGENT 2 h6ERIlCATION AND 6ALIDATION OF 3IMULATION -ODELS v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE # ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
!CHIEVING 1UALITY 4HROUGH #USTOMER 3ERVICE !S DECISION MAKING RESPONSIBILITY SHIFTS FROM PAYER TO PATIENT HOSPITALS PHYSICIAN GROUPS AND OTHER HEALTHCARE ORGANIZATIONS NEED TO BECOME MORE SERVICE ORIENTED AND EXPAND THEIR UNDERSTANDING OF @QUALITY TO ENCOMPASS THE ENTIRE PATIENT CARE EXPERIENCE "Y -ARGARET 3TOVER 0RICEWATERHOUSE#OOPERS
#
ONSUMER PERCEPTIONS OF THE HEALTHCARE INDUSTRY HAVE DETERIORATED OVER THE LAST NINE YEARS )N THIS YEARS (ARRIS 0OLL¸ CONSUMERS WHO WERE ASKED WHETHER INDUSTRIES WERE GENERALLY DOING A GOOD JOB OR A BAD JOB OF SERVING THEIR PATIENTS GAVE HOSPITALS A PERCENT POSITIVE RATING AN PERCENT DROP FROM LAST YEAR;= 4HAT PUTS HOSPITALS FAR BELOW SUPERMARKETS AND SLIGHTLY BELOW ONLINE RETAILERS IN PERCEIVED CUSTOMER SATISFACTION;= )N HEALTHCARE PATIENTS ARE THE CUSTOMERS OR AT LEAST ONE SEGMENT OF CUSTOMERS 4HEIR SATISFACTION IS AN IMPORTANT DETERMINANT OF THE LEVEL OF QUALITY CARE DELIVERED 4HIS PAPER EXPLORES MANY OF THE VITAL REASONS HEALTH ORGANIZATIONS NEED TO IMPROVE CUSTOMER SERVICE /NE SIGNIlCANT DRIVER THOUGH NOT THE MAIN ONE IS TO MITIGATE RISK FROM MALPRACTICE LAWSUITS (OSPITALS AND PHYSICIANS THAT DEAL WITH PATIENTS RESPECTFULLY HANDLE COMPLAINTS EARNESTLY AND QUICKLY AND PROVIDE A GENERALLY SATISFACTORY PATIENT EXPERIENCE CAN PREVENT OR MITIGATE MANY MALPRACTICE CLAIMS -ALPRACTICE RISK IS NOT NECESSARILY PREDICTED BY PATIENT CHARACTERISTICS COMPLEXITY OF ILLNESS COMORBIDITIES OR PHYSICIANS TECHNICAL SKILLS )NSTEAD RISK APPEARS TO BE RELATED TO PATIENTS DISSATISFACTION WITH THEIR PHYSICIANS ABILITY TO COMMUNICATE EFFECTIVELY ESTABLISH RAPPORT PROVIDE ACCESS TO SERVICES AND ADMINISTER CARE CONSISTENT WITH THE PATIENTS EXPECTATIONS;= (OSPITALS NEED TO PARTNER WITH PHYSICIANS TO ENHANCE PATIENT INTERACTIONS AND RELATIONSHIPS 0ATIENT SATISFACTION HAS MANY BENElTS FOR CLINICIANS AND PATIENTS ALIKE 0ATIENTS WHO ARE MORE SATISlED WITH THEIR HEALTHCARE EXPERIENCES MAY BE MORE LIKELY TO COMPLY WITH TREATMENT AND MEDICATION INSTRUCTIONS AND HAVE BETTER LONG TERM OUTCOMES
,ISTENING TO 0ATIENTS 4O INCREASE PATIENT SATISFACTION IT IS IMPORTANT TO LISTEN TO WHAT PATIENTS SAY %NGAGING PATIENTS AND CLINICIANS IN CANDID DISCUSSIONS IS A GOOD PLACE TO START &OR EXAMPLE PATIENTS ARE LESS INTERESTED IN HOTEL LIKE AMENITIES FROM PROVIDERS THAN IN COMPREHENSIVE QUALITY HEALTHCARE THAT IS ACCESSIBLE
ACCOUNTABLE COORDINATED AND PROVIDES CONTINUITY OF CARE;= %XHIBIT ILLUSTRATES THESE PATIENTS EXPECTATIONS
%NHANCING #USTOMER 3ERVICE (IGH PERFORMING PROVIDERS HAVE ADOPTED KEY ATTITUDES AND ATTRIBUTES NECESSARY TO CREATE SATISlED PATIENTS EDUCATING PATIENTS ABOUT THEIR MEDICAL CONDITIONS ROLES AND RESPONSIBILITIES AS HEALTHCARE CONSUMERS AND GIVING ALL STAKEHOLDERS n PATIENTS PHYSICIANS NURSES CLINICIANS AND OTHER HEALTHCARE STAFF n THE SERVICES AND RESOURCES THAT ARE MOST IMPORTANT TO THEM
%MPLOYEES &IRST AND &OREMOST 3ATISlED PATIENTS BEGIN WITH SATISlED EMPLOYEES %MPLOYEES WHO FEEL VALUED n WHO lND THEIR JOBS ENJOYABLE LESS BURDENSOME AND WITH FEWER IMPEDIMENTS TO DOING THE WORK THEY WERE TRAINED TO DO n CAN TREAT PATIENTS WELL AND DELIVER SUPERIOR CARE RESULTING IN PATIENTS WHO ARE BOTH HAPPIER AND HEALTHIER 4HIS INCLUDES NOT JUST NURSES AND CLINICIANS BUT ALL EMPLOYEES %VEN A TELEPHONE SCHEDULER CREATES A LASTING lRST IMPRESSION THAT CAN DRAMATICALLY AFFECT THE PATIENTS PERCEPTION OF THE OVERALL EXPERIENCE 3TUDIES SUGGEST THAT PATIENT SATISFACTION WITH THE HOSPITAL EXPERIENCE IMPROVES WHEN NURSES SPEND AN EXTRA MOMENT COMFORTING A PATIENT AND HIS OR HER FAMILY AS THEY DEAL WITH A DIFlCULT HEALTHCARE ISSUE AND WHEN BUSINESS OFlCE WORKERS POST PAYMENT CORRECTLY %MPLOYEES WHO FEEL VALUED AND ARE RECOGNIZED AS INTEGRAL MEMBERS OF THE HEALTHCARE TEAM ARE BETTER ABLE TO GIVE PATIENTS QUALITY CARE AND A CARING ATTITUDE;=
2EWARDING %XCELLENCE (EALTHCARE ORGANIZATIONS NEED TO PROVIDE INCENTIVES FOR EMPLOYEES TO DO THEIR BEST WORK 2ELEVANT PERFORMANCE METRICS AND REWARDS FOR ACHIEVING BENCHMARKS HELP EMPLOYEES SEE THAT THEIR JOBS ARE IMPORTANT 3UPERVISORS SHOULD CONTINUALLY MONITOR PERFORMANCE IN CLINICAL AND BUSINESS RELATED AREAS AND REWARD EMPLOYEES AND BUSINESS UNITS WHEN THEY PERFORM WELL 2ECOGNITION SHOULD BE VISIBLE IN SOME WAY AND WHEN PRACTICAL INVOLVE EMPLOYEE FAMILIES (OSPITALS BENElTING FROM THE
-ARGARET 3TOVER IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE FOCUSES ON ACADEMIC MEDICAL CENTERS AND FACULTY PRACTICES AND HAS OVER YEARS EXPERIENCE LEADING AND ADVISING PHYSICIAN PRACTICES IN MEDICAL SCHOOLS AND HEALTH SYSTEM SETTINGS 3HE CAN BE REACHED AT MARGARETSTOVER USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
@BGHDUHMFãP T@ KH S Xã S G Q N T FG ã B T RSN LD Q ã RD Q U H B D %XHIBIT #USTOMER %XPECTATIONS &ROM THE (EALTHCARE %XPERIENCE
!##%33
!##/5.4!"),)49
0ATIENTS WANT PROVIDERS WHO DELIVER
0ATIENTS WANT PROVIDERS WHO ARE
1UALITY CARE FOR INSURED UNINSURED AND SELF PAY PATIENTS
#OMPETENT
#ONVENIENCE IN CARE DELIVERY
'OOD COMMUNICATORS
0ATIENT PORTALS PROVIDING ACCESS TO EMAIL TEST RESULTS ELECTRONIC HEALTH RECORDS %(2S SCHEDULING ETC
)NVESTED IN THE RELATIONSHIP WITH PATIENTS
2ESPECTFUL TREATMENT
%FlCIENT AND EFFECTIVE
0ATIENT ADVOCATES
!BLE TO INTEGRATE PATIENT VALUES IN THE PLANS FOR CARE
'EOGRAPHIC PROXIMITY
#//2$).!4)/. /& #!2%
#/.4).5)49 /& #!2%
0ATIENTS WANT PROVIDERS WHO ARE
0ATIENTS WANT PROVIDERS WHO ARE
)NVOLVED IN ORCHESTRATING THEIR SERVICES
#APABLE OF PROVIDING A LONGER TERM RELATIONSHIP WITH PATIENTS
#OMMITTED TO KEEPING THEIR DOORS OPEN TO ALL PATIENTS WHO NEED CARE
2ESPONSIVE AND TECHNICALLY COMPETENT
2ESPECTFUL OF PATIENTS VALUES AND DECISION MAKING POTENTIAL WHEN MANAGING THEIR CARE
!BLE TO CREATE ANDOR MANAGE AND USE AN ONLINE ELECTRONIC HEALTH RECORD +NOWLEDGEABLE ABOUT EACH PATIENTS HISTORY AND UNIQUE RESPONSES TO MEDICAL AND HEALTHCARE DELIVERY
5P FRONT DETERMINATION OF COSTS AND lNANCIAL RESPONSIBILITY #OMMUNICATION PROlCIENCY IN OTHER LANGUAGES CULTURES 4OLERANCE FOR VISITS WITHOUT APPOINTMENTS %ASILY UNDERSTANDABLE INFORMATION !CCESS DURING VULNERABLE PERIODS OF TRANSITIONS #ONlDENTIALITY
EXPERIENCES OF WORLD CLASS BUSINESSES IN OTHER INDUSTRIES HAVE FOUND THE FOLLOWING REWARDS AND INCENTIVES TO BE EFFECTIVE;=
SUSTAINABLE WEAVING SERVICE AND SATISFACTION PRINCIPLES INTO THE CULTURE OF THE ORGANIZATION AND ITS PROCESSES
%MPLOYEE OF THE MONTH PROGRAMS BASED ON MEASURABLE CRITERIA NOT POPULARITY %MPLOYEE NEWSLETTERS THAT HIGHLIGHT EMPLOYEES WHO HAVE DONE SOMETHING EXCEPTIONAL TO IMPROVE A PATIENTS OUTCOME OR EXPERIENCE OR HAD A SIGNIlCANT IMPACT ON THEIR COMMUNITY 3TAFF AND FAMILY PICNICS !NNUAL AWARDS DINNERS AND 4ICKETS TO MOVIESSPORTSENTERTAINMENT )F A PATIENT TAKES THE TIME TO THANK AN EMPLOYEE IN A LETTER THAT SHOULD BE CELEBRATED IN A VISIBLE FASHION )F A DEPARTMENT ACHIEVES AN INDUSTRY BENCHMARK FOR OUTSTANDING PERFORMANCE SEIZE THAT OPPORTUNITY FOR A CELEBRATION 3URVEYING EMPLOYEES TO lND OUT WHAT KINDS OF REWARDS AND RECOGNITION PROGRAMS WILL HAVE MEANING FOR THEM WILL ENHANCE THE POSITIVE IMPACT OF THOSE PROGRAMS 2ECOGNITION OF EXCELLENCE ALIGNS THE PRINCIPLES OF CUSTOMER SERVICE WITH PERCEIVED JOB RESPONSIBILITIES 2EWARDING EXCELLENCE IN A FASHION THAT INVOLVES THE ORGANIZATIONS LEADERSHIP SAVES CUSTOMER SERVICE INITIATIVES FROM BEING DISMISSED AS THE hmAVOR OF THE MONTHv AND DESTINED FOR OBLIVION AND MAKES THEM
4RAINING 4HOSE 7HO 7ILL 5SE THE 4RAINING 3ERVICE TRAINING SHOULD START BY DIRECTLY INVOLVING THE EMPLOYEES YOU SEEK TO EDUCATE %MPLOYEES ON THE FRONT LINES OFTEN HAVE STRONG OPINIONS ABOUT WHEN AND HOW THE TRAINING SHOULD BE DELIVERED )NVOLVING THEM IN THE PROCESS OF DESIGNING AND PLANNING TRAINING WILL HELP THEM FEEL VALUED AND PASSIONATE ABOUT IMPLEMENTING AN EFFECTIVE TRAINING PROGRAM AND DESIGNING THE RIGHT KIND OF CUSTOMER SERVICE APPROACH FOR THE ORGANIZATION 4RAINING SHOULD INCLUDE SKILL DEVELOPMENT IN AREAS SUCH AS PHONE ETIQUETTE BUT ALSO TARGET THE DEVELOPMENT OF SOME OF THE SOFTER SKILLS SUCH AS UNDERSTANDING HOW THEY COME ACROSS ON THE PHONE 4OO MANY TRAINING PROGRAMS TELL THE EMPLOYEES WHAT THEY SHOULD DO BUT DO NOT HELP THE EMPLOYEES RECOGNIZE WHAT THEY ARE DOING AND PRACTICE NEW WAYS TO DO IT !S AN EXAMPLE MANY FRONT DESK EMPLOYEES FEEL VERY UNCOMFORTABLE ASKING FOR COPAYS PARTICULARLY IF IT IS NEW TO THEM !N EFFECTIVE TRAINING PROGRAM INVOLVES SCRIPTING AND ROLE PLAYING THIS RESPONSIBILITY 2EMEMBER THAT EMPLOYEES DISDAIN AFTER HOURS TRAINING 4RAINING THAT THE EMPLOYER VALUES WILL BE VALUED MORE BY EMPLOYEES IF
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
@BGHDUHMFãP T@ KH S Xã S G Q N T FG ã B T RSN LD Q ã RD Q U H B D !PPRECIATING THE )NHERENT 6ARIABILITY OF THE /UTPATIENT %XPERIENCE 4HE INPATIENT ENVIRONMENT INVOLVES A RELATIVELY SIMILAR GROUP OF ACTIVITIES PROVIDED TO RELATIVELY SIMILAR GROUPS OF PATIENTS IN RELATIVELY SIMILAR SURROUNDINGS /N AVERAGE hINPATIENTv MEANS AN OLDER ADULT ENGAGED IN A MULTIDAY STAY IN THE HOSPITAL FOR A COMPLEX PROCEDURE OR SET OF PROCEDURES WHICH MAY BE EVALUATIVE THERAPEUTIC OR INTERVENTIONAL )N THIS CONTEXT PATIENTS SHARE SIMILAR EXPERIENCES AND EXPECTATIONS AND PROVIDERS CAN INCORPORATE FAIRLY STANDARD QUALITY MEASUREMENTS FOR ONGOING IMPROVEMENT #ONVERSELY THE OUTPATIENT POPULATION REPRESENTS A LARGE HIGHLY VARIED GROUP OF INDIVIDUALS WITH EQUALLY VARIED EXPECTATIONS %VEN WHEN OUTPATIENTS SHARE CHARACTERISTICS SUCH AS AGE AND INCOME OTHER FACTORS COME INTO PLAY SUCH AS CULTURAL BACKGROUND &OR EXAMPLE THE POPULATION OF SOUTHERN &LORIDA REGARDLESS OF AGE AND INCOME LEVEL DEMONSTRATES A VERY HIGH NO SHOW RATE WHILE PATIENTS IN THE HEARTLAND VIRTUALLY NEVER SKIP APPOINTMENTS /UTPATIENT EXPERIENCES FURTHER DIVERGE ALONG A BROAD CONTINUUM n FROM AN ANNUAL PHYSICAL WITH A PRIMARY CARE PHYSICIAN OR FOLLOW UP MAMMOGRAPHY AT A RADIOLOGY PRACTICE TO A HOUR HOSPITALIZATION IN A DISTANT ACADEMIC MEDICAL INSTITUTION FOR A CARDIOVASCULAR PROCEDURE OR AN UNANTICIPATED VISIT TO THE LOCAL EMERGENCY DEPARTMENT %$ FOLLOWING AN AUTOMOBILE ACCIDENT /UTPATIENT SERVICES ARE DELIVERED IN A WIDE RANGE OF ENVIRONMENTS MOST RECENTLY INCLUDING THE LOCAL DRUGSTORE 0ROVIDERS INCLUDE A BROAD ARRAY OF PHYSICIANS NURSES TECHNICIANS CLINICS AND HOSPITALS (OSPITAL SETTINGS THEMSELVES VARY FROM LARGE ACADEMIC MEDICAL INSTITUTIONS WITH MULTIPLE FACILITIES TO SMALL CRITICAL ACCESS FACILITIES %VEN THE )NTERNET HAS BECOME AN OUTPATIENT SETTING AS COMMUNICATION TECHNOLOGY CREATES NEW WAYS FOR PROVIDERS TO INTERACT WITH PATIENTS 0HYSICIANS MAY USE EMAIL TO COMMUNICATE TEST RESULTS WITH PATIENTS FOR EXAMPLE IN LIEU OF REQUIRING AN OFlCE VISIT (OSPITALS MAY COMMUNICATE PRE VISIT DATA VIA WEBSITES INSTEAD OF MAILING PAPER TO PATIENTS HOMES 0ATIENT PERCEPTIONS OF QUALITY TIE CLOSELY TO THEIR LEVELS OF ANXIETY AND THE OUTPATIENT EXPERIENCE REmECTS WIDE RANGES OF PATIENT ANXIETY 4HE FUNDAMENTAL TENDENCY OF AN INPATIENT PERSPECTIVE TO CHARACTERIZE ANY OUTPATIENT EXPERIENCE AS hNOT THAT SERIOUSv BECAUSE IT MAY NOT BE LIFE THREATENING GROSSLY MISCONSTRUES HOW PATIENTS VIEW THEIR EXPERIENCES AND CONSEQUENTLY WHAT THEY EXPECT IN TERMS OF PROVIDER PERFORMANCE ,EVELS OF ANXIETY AND CONSEQUENT PERCEPTIONS OF QUALITY VARY AS GREATLY AS OUTPATIENTS VARY FROM EACH OTHER 7E ASSUME THAT A YEAR OLD WOMAN IS LESS ANXIOUS DURING AN HOUR LONG ROUTINE PHYSICAL THAN A YEAR OLD MAN UNDERGOING A DAY LONG CARDIOVASCULAR PROCEDURE IN THE HOSPITAL n UNTIL WE UNDERSTAND THAT THE WOMAN SUFFERS FROM GENERALIZED ANXIETY DISORDER !LTHOUGH THE OUTPATIENT ENVIRONMENT BY ITS VERY NATURE PRESENTS MORE CHALLENGES THAN THE INPATIENT SETTING FOR IDENTIFYING MEASURING AND MANAGING QUALITY ISSUES ALL PATIENTS hDElNEv QUALITY n OFTEN THROUGH VERY BASIC QUESTIONS &OR EXAMPLE h7AS THE FACILITY CLEAN 7ERE THE PEOPLE NICE #OULD ) lND MY WAY AROUND EASILY $ID ) HAVE TO ANSWER THE SAME QUESTIONS OVER AND OVER AGAIN 7AS ) TREATED WELL v -OST PATIENTS JUDGE EACH EXPERIENCE BY THE ANSWERS TO SUCH QUESTIONS NOT BY THE AGE OF THE #4 EQUIPMENT THE DOCTORS PUBLISHING CREDENTIALS OR ERUDITE STATISTICS /NE OF THE KEYS IS APPRECIATING THAT THERE ARE INCONSISTENT DElNITIONS FOR hCLEAN v hNICE v ETC )N MANY CASES A PATIENTS MEASURE OF QUALITY MAY NOT EVEN RELATE TO RESULTS &OR EXAMPLE A PATIENT MAY PERCEIVE HER MAMMOGRAPHY APPOINTMENT AS REmECTING THE HIGHEST QUALITY INDEPENDENT OF WHETHER SHE HAS TO RETURN FOR MORE IMAGING )NSIDE THE %$ ONE PATIENT MAY FEEL ENORMOUSLY GRATEFUL TO SEE A PHYSICIAN WITHIN FOUR HOURS WHILE ANOTHER WILL BEGIN COMPLAINING WITHIN MINUTES 7HATEVER THE CASE THOSE INSIDE THE EXPERIENCE DO THE BEST JOB OF DElNING IT FOR THE PURPOSE OF IMPROVING ITS QUALITY 4HE ABILITY TO GAUGE THE OUTPATIENT EXPERIENCE FURTHER RELATES TO THE NATURE OF THE LOCAL HEALTHCARE MARKET )N SOPHISTICATED MARKETS FOR EXAMPLE PATIENTS EXPECT PHYSICIANS TO PLAY INTO THE EQUATION )F THE HEALTHCARE MARKETS CONSTITUENCY CARES ABOUT TIME SPENT AS A WHOLE IT MIGHT NOT MATTER TO MOST PATIENTS IF IT TAKES SECONDS TO GET FROM THE PARKING LOT TO PRE OP CARE WHEN THEY MUST WAIT FOR AN HOUR TO SEE A PHYSICIAN )N CONTRAST IF A HOSPITAL CANNOT CONTROL THE TIME IT TAKES FOR PHYSICIANS TO SEE PATIENTS BECAUSE OF MARKET FRAGMENTATION THEN THAT HOSPITAL MIGHT CHOOSE TO CREATE FEATURES THAT MAKE WAITING MORE ACCEPTABLE INCLUDING THE COMFORT OF THE FURNITURE THE EASE OF ACCESS TO BEVERAGES AND THE AVAILABILITY OF POPULAR READING MATERIALS "ECAUSE OF THE SIGNIlCANT DIFFERENCES BETWEEN OUTPATIENT AND INPATIENT SETTINGS AND BETWEEN OUTPATIENTS AND INPATIENTS ASSESSING AND IMPROVING THE QUALITY OF OUTPATIENT SERVICES CANNOT BE ACCOMPLISHED FROM AN INPATIENT PERSPECTIVE 0ROVIDERS NEED TO CHALLENGE THE ASSUMPTIONS OF A TRADITIONAL HOSPITAL MIND SET IN ORDER TO EFFECTIVELY ADDRESS QUALITY IN THE OUTPATIENT SETTING
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
@BGHDUHMFãP T@ KH S Xã S G Q N T FG ã B T RSN LD Q ã RD Q U H B D IT IS CONDUCTED DURING BUSINESS HOURS 4HE PEOPLE WHO DO THE WORK hIN THE TRENCHESv WILL TAKE RESPONSIBILITY FOR DOING IT WELL AND FOR SUGGESTING IMPROVEMENTS IF THAT EXPECTATION AND LEVEL OF RESPECT IS AFFORDED TO THEM
@#ONSUMERS HAVENT HAD ENOUGH INFLU ENCE IN THE NATIONAL QUALITY AGENDA FOR A VARIETY OF REASONS $ISCUSSIONS ABOUT MEASURES ARE VERY TECHNICAL AND CONSUMERS ARE TYPICALLY UNDERREPRE SENTED IN DIALOGUES WHERE THE AGENDA IS SET n "ARBARA ! 2UDOLPH 0H$ DIRECTOR OF LEAPS AND MEASURES FOR THE ,EAPFROG 'ROUP
3IMULATING THE .EW %NVIRONMENT 0HYSICIAN OFlCES ADMITTING AND THE EMERGENCY DEPARTMENT REPRESENT THE FRONT DOOR OF THE ORGANIZATION (OW EMPLOYEES IN THESE VENUES MAKE INITIAL CONTACT WITH PATIENTS WILL GREATLY INmUENCE OVERALL PATIENT SATISFACTION WITH THE ORGANIZATION 4RAINING WORKS BEST WHEN IT IS DESIGNED TO ENABLE LEARNERS TO BECOME PROlCIENT IN CLEARLY DElNED SKILLS %FFECTIVE TRAINING WILL DEMONSTRATE HOW A SKILL IS PROPERLY PERFORMED THEN ALLOW LEARNERS TO PRACTICE ESPECIALLY IN AN ENVIRONMENT THAT SIMULATES THE SITUATION IN WHICH THE NEW SKILL WILL BE USED 4O TRAIN FRONT DESK PERSONNEL TO HANDLE PATIENTS AND THEIR lNANCIAL MATTERS MORE EFFECTIVELY SOME ORGANIZATIONS HAVE SET UP SIMULATION CENTERS WITH REALISTIC FRONT DESK ENVIRONMENTS 3MALL GROUPS OF EMPLOYEES COME TO THE SIMULATION CENTER AND REHEARSE THEIR NEW FRONT DESK PROCESSES WITH THEIR COLLEAGUES )N THIS WAY THEY LEARN NOT ONLY THE TECHNICAL SKILLS REQUIRED OF THEIR POSITION BUT ALSO MASTER SOFTER SKILLS SUCH AS EYE CONTACT TONE BODY LANGUAGE AND EXPRESSIONS OF CARING AND CONCERN n CREATING POSITIVE lRST IMPRESSIONS IN THEIR NEW ROLES AS PATIENT ADVOCATES IN A SERVICE INDUSTRY 4RAINING SHOULD ALSO PROVIDE JOB SATISFACTION AND CAREER MOBILITY FOR EMPLOYEES %MPLOYEES IN ENTRY LEVEL POSITIONS NEED A CAREER LADDER THAT CAN BE CONSTRUCTED BY BUILDING TIERS WITHIN POSITIONS BASED ON EDUCATION QUALIlCATIONS AND JOB PERFORMANCE )F A JOB POSITION REQUIRES THE INDIVIDUAL TO INTERFACE WITH INSURANCE COMPANIES AND HANDLE MEDICAL CORRESPONDENCE COMPLETING A CERTIlCATE COURSE IN MEDICAL TERMINOLOGY SHOULD EARN AN EMPLOYEE A CHANGE IN TITLE AND A MODEST RAISE IN PAY IF IT IS NOT A REQUIRED JOB SKILL "UILDING OPPORTUNITIES FOR CAREER ADVANCEMENT MAKES
EMPLOYEES FEEL MORE VALUED WHICH INCREASES THE LIKELIHOOD THEY WILL STAY LONGER AND CONTRIBUTE SIGNIlCANTLY TO THE ORGANIZATION
5SING @-YSTERY 3HOPPERS /NE TECHNIQUE THAT HOSPITALS HAVE BORROWED FROM OTHER SERVICE INDUSTRIES IS THE hMYSTERY SHOPPERv SURVEY 0ATIENT IMPERSONATORS MYSTERY SHOPPERS ARE HIRED TO INTERACT WITH THE HOSPITAL IN A NUMBER OF WAYS AND REPORT THE HOSPITALS PERFORMANCE )F PATIENTS HAVE TROUBLE SCHEDULING APPOINTMENTS OVER THE PHONE INTERACT WITH EMPLOYEES WHO SEEM DISTRACTED OR UNHELPFUL WAIT TOO LONG TO BE SEEN OR CONSISTENTLY SUFFER FROM OTHER PROBLEMS OR IRRITATIONS THAT DETRACT FROM THE CARE EXPERIENCE MYSTERY SHOPPERS CAN HELP UNCOVER THESE WEAKNESSES -YSTERY SHOPPERS CAN REVEAL THE UNEXPECTED ,AST YEAR THE #ALIFORNIA (EALTH #ARE &OUNDATION COMMISSIONED A STUDY OF HOSPITAL PRICING IN #ALIFORNIA IN WHICH MYSTERY SHOPPERS POSED AS UNINSURED PATIENTS NEEDING A TEST OR PROCEDURE 4HE STUDY REVEALED HUGE COMMUNICATION GAPS BETWEEN HOSPITALS AND PATIENTS;=
#ONCLUSION (EALTHCARE PROVIDERS ARE LEARNING FROM OTHER SERVICE INDUSTRIES HOW TO FOCUS ON PATIENT SATISFACTION 0ROVIDING QUALITY SERVICE MEANS PROVIDING BOTH QUALITY CLINICAL CARE AND AN EXCELLENT PATIENT CARE EXPERIENCE (EALTHCARE ORGANIZATIONS THAT CONSISTENTLY DELIVER HIGH QUALITY PLEASANT MEDICAL CARE TO PATIENTS THEREBY EARN RESPECT AND LOYALTY FROM BOTH PATIENTS AND THEIR PHYSICIANS DELIVERING BOTH MARKET GROWTH AND RISK MITIGATION IN AN INCREASINGLY COMPETITIVE AND LITIGIOUS INDUSTRY %NDNOTES h3UPERMARKETS "ANKS #OMPUTER 3OFTWARE #OMPANIES AND 0ACKAGED 'OODS 4OP THE ,IST OF )NDUSTRIES $OING A 'OOD *OB FOR 4HEIR #ONSUMERS v !PRIL BY (ARRIS 0OLL 2OCHESTER .9 HTTPSEVPRNEWSWIRECOMPUBLISHING INFORMATION SERVICES .945 HTML )BID (ICKSON ' AND # &EDERSPIEL * 0ICHERT # -ILLER * 'AULD *AEGER 0 "OST h0ATIENT #OMPLAINTS AND -ALPRACTICE 2ISK v *UNE *!-! P !DAPTED FROM h0RIMARY #ARE !DVOCACY 4OOLKIT v BY 0RIMARY #ARE 3OCIETY h#ONSUMERS AND 0RIMARY #ARE v #ARY ! AND " 'OLDBERG 3 -C$ANIEL ((. RESEARCH 3ENGIN + + h4HE 2ELATIONSHIP "ETWEEN *OB 3ATISFACTION OF 2EGISTERED .URSES AND 0ATIENT 3ATISFACTION IN !CUTE #ARE (OSPITALS v DISSERTATION SUBMITTED TO THE 5NIVERSITY OF 0ENNSYLVANIA HTTP REPOSITORYUPENNEDUDISSERTATIONS!!) !DAPTED FROM 7AYS TO 2EWARD %MPLOYEES .ELSON " 7ORKMAN 0UBLISHING #OMPANY .EW 9ORK h0RICE #HECK 4HE -YSTERY OF (OSPITAL 0RICING v $ECEMBER #ALIFORNIA (EALTH #ARE &OUNDATION
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
4HE +EY TO )MPROVING 1UALITY 3AVING ,IVES AND 2EDUCING ,AWSUITS 'ALLUP RESEARCH SHOWS THAT HIRING AND DEVELOPING TALENTED NURSES AND ENGAGING CURRENT HEALTHCARE EMPLOYEES CORRELATES WITH IMPROVED QUALITY AND SAFER HEALTHCARE
"Y $EBORAH ! 4OTO 4HE 'ALLUP /RGANIZATION
(
EALTHCARE LEADERS SPEND MILLIONS OF DOLLARS AND DEDICATE VAST AMOUNTS OF TIME AND RESOURCES TO PROVIDE THEIR PATIENTS WITH THE HIGHEST QUALITY CARE POSSIBLE 4HIS QUEST FOR QUALITY IS CONSTANT (EALTHCARE LEADERS SEARCH INCESSANTLY FOR NEW DEVELOPMENTS AND IMPROVEMENTS IN TECHNOLOGY IN AN ATTEMPT TO OFFER THEIR PATIENTS THE MOST THOROUGH AND RElNED CARE POSSIBLE 4HESE LEADERS ARE DRIVEN BY THEIR ORGANIZATIONS MISSIONS TO DELIVER EXCELLENT HEALTHCARE BUT IT IS ALSO TRUE THAT SAFER HIGHER QUALITY CARE POSITIVELY INmUENCES lNANCIAL RESULTS 'ALLUP HAS ANALYZED DATA FROM MORE THAN YEARS OF INTERVIEWS WITH PATIENTS PHYSICIANS AND EMPLOYEES 4HESE DATA CONlRM THAT HIGH QUALITY CARE PREDICTS BETTER lNANCIAL PERFORMANCE FOR HEALTHCARE PROVIDERS BOTTOM LINES 0ATIENTS WHO RECEIVE CARE THAT IS FREE OF AVOIDABLE COMPLICATIONS ARE MORE LIKELY TO SPEAK POSITIVELY ABOUT THEIR HEALTHCARE EXPERIENCE n AND THEY ARE MORE LIKELY TO RETURN FOR FUTURE SERVICES n THUS INCREASING A HOSPITALS REVENUES #ONVERSELY COSTS RISE WHEN A PATIENTS CARE GOES AWRY AS ILLUSTRATED BY THE FOLLOWING lNDINGS !CCORDING TO A STUDY BY THE 5NIVERSITY OF -ISSOURI LOW QUALITY NURSING HOMES DIRECT CARE COSTS ARE PERCENT HIGHER THAN THOSE OF HIGH QUALITY ORGANIZATIONS ! RECENT -EDSTAT STUDY REPORTS THAT ON AVERAGE A GENERAL SURGERY WITHOUT COMPLICATIONS COSTS A HOSPITAL ABOUT n BUT COSTS RISE TO MORE THAN WHEN MULTIPLE COMPLICATIONS OCCUR 4HE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21 REPORTS THAT MEDICAL ERRORS ARE RESPONSIBLE FOR INJURY IN AS MANY AS ONE OUT OF EVERY HOSPITAL PATIENTS AN ESTIMATED TO PATIENTS DIE FROM MEDICAL ERRORS EACH YEAR )N A LARGE TEACHING HOSPITAL ERRORS IN HEALTHCARE HAVE BEEN CONSERVATIVELY ESTIMATED TO COST MORE THAN MILLION PER YEAR AND PREVENTABLE HEALTHCARE RELATED ERRORS COST THE 53 ECONOMY UP TO BILLION EACH YEAR
4HESE AND OTHER NEGATIVE REPERCUSSIONS OF POOR CARE ON HEALTHCARE PROVIDERS BUSINESS OUTCOMES ARE ENOUGH TO LEAD HEALTHCARE LEADERS FROM ALL FACETS OF THE INDUSTRY TO ASK THE SAME QUESTION )S THERE A FAIL PROOF SOLUTION FOR DELIVERING NEAR PERFECT QUALITY TO PATIENTS 4HE ANSWER IS NO (OWEVER DECADES OF 'ALLUP RESEARCH AND STATISTICAL ANALYSIS HAVE UNCOVERED TWO FACTORS THAT POSITIVELY AFFECT SAFE QUALITY HEALTHCARE HIRING AND DEVELOPING TALENTED NURSES AND ENGAGING NURSES AND OTHER HEALTHCARE EMPLOYEES IN THEIR WORK
3ELECTING THE 2IGHT 0EOPLE -OST HEALTHCARE LEADERS RECOGNIZE THAT POOR HIRING PRACTICES CAN PROVE DISRUPTIVE EVEN IN THE BEST RUN HEALTHCARE FACILITIES (OWEVER 'ALLUPS EXPERIENCE SHOWS THAT MOST ORGANIZATIONS TYPICALLY UNDERESTIMATE THE ADVERSE EFFECT OF HIRING NURSES WHO ARE NOT THE RIGHT lT LEADING TO lNANCIAL AND QUALITY COSTS SUCH AS LOWER PERSONAL PRODUCTIVITY AMONG NURSES INCREASED TURNOVER OF NURSING STAFF AND INCREASED MEDICAL ERRORS AND PROBLEMS WITH PATIENT CARE 'ALLUP HAS STUDIED THE RELATIONSHIP BETWEEN PEOPLES NATURAL TALENTS AND PERFORMANCE IN VARIOUS JOBS FOR MORE THAN YEARS 'ALLUPS METHODS FOR ASSESSING AND DEVELOPING EMPLOYEES HAVE BEEN RElNED THROUGH WORK WITH HUNDREDS OF THOUSANDS OF EMPLOYEES IN A WIDE VARIETY OF ORGANIZATIONS AND INDUSTRIES 4HIS WEALTH OF EXPERIENCE HAS LED TO A SCIENTIlC METHODOLOGY FOR THE DEVELOPMENT OF TALENT ASSESSMENTS THAT ARE PREDICTIVE OF JOB SUCCESS 4HIS WORK IS FOUNDED ON THE BELIEF THAT A PERSONS NATURAL TALENTS ARE STRONGLY PREDICTIVE OF FUTURE PERFORMANCE 'ALLUPS RESEARCH DEMONSTRATES THAT TOP PERFORMERS IN ALL JOBS THINK SPEAK AND ACT DIFFERENTLY FROM THEIR COUNTERPARTS n AVERAGE AND POOR PERFORMERS 4HE 'ALLUP .URSE)NSIGHT» A STANDARDIZED 7EB BASED SELECTION INSTRUMENT BASED ON THIS RESEARCH IS DESIGNED TO
$EBORAH ! 4OTO IS GLOBAL PRACTICE LEADER HEALTHCARE FOR 4HE 'ALLUP /RGANIZATION 3HE IS RESPONSIBLE FOR LEADING 'ALLUPS HEALTHCARE CONSULTING PRACTICE INCLUDING RESEARCH AND DEVELOPMENT TECHNOLOGY INNOVATION MARKETING AND CLIENT RELATIONSHIP MANAGEMENT 3HE SPECIALIZES IN THE AREAS OF CUSTOMER AND EMPLOYEE ENGAGEMENT TALENT BASED SELECTION STRENGTHS BASED DEVELOPMENT AND COMPREHENSIVE ORGANIZATIONAL IMPROVEMENT 3HE CAN BE REACHED AT $EBORAH?4OTO 'ALLUPCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
SGDãJDX ãSN ãHLOQ N UHMFãPT @ KH S X ã R@U H M Fã K H U D Rã @ M C ã Q D C T B H M Fã K@V RT H S R HELP HOSPITALS lND AND SELECT HIGHLY TALENTED NURSES 4OP NURSES EXHIBIT CERTAIN RECURRING PATTERNS OF TALENTS n INNATE THOUGHTS FEELINGS AND BEHAVIORS n AND .URSE)NSIGHT OFFERS HOSPITAL OR NURSE MANAGERS A CLEAR IDEA ABOUT THE TALENTS OF NURSING CANDIDATES SUCH AS ATTENTION TO DETAIL EMPATHY AND SELF CONlDENCE AND WHETHER THOSE CANDIDATES ARE THE RIGHT lT FOR THE JOB /NE 'ALLUP CASE STUDY OF A HEALTHCARE PROVIDER FOUND THAT USING .URSE)NSIGHT AND OTHER 'ALLUP CONSULTING SERVICES
PRODUCED NUMEROUS POSITIVE CHANGES TO SOME OF THE MOST VITAL BUSINESS ORIENTED ASPECTS OF NURSE SELECTION 5SING THESE TOOLS SAVED THE PROVIDER TIME DURING THE APPLICATION PROCESS WHICH WAS REDUCED FROM THREE WEEKS TO HOURS AND PRODUCED A POOL OF hTALENT CERTIlEDv APPLICANTS WHO HAD ALREADY lNISHED THEIR ASSESSMENTS AND COULD BE CONTACTED FOR INTERVIEWS WHEN NURSING POSITIONS BECAME AVAILABLE 4HE HEALTHCARE PROVIDER SAW THE NUMBER OF APPLICANTS AND THE NUMBER OF HIRES INCREASE WHILE BOTH VACANCY AND TURNOVER AMONG REGISTERED NURSES DECREASED
%XHIBIT %MPLOYEE %NGAGEMENT !VOIDABLE $EATHS
-ORTALITY )NDEX ,EAST %NGAGED RD 1UARTILE
ND 1UARTILE -OST %NGAGED
#ORRELATION REGRESSION ANALYSIS OF %NGAGEMENT 'RAND-EAN AND -ORTALITY )NDEX STATISTICALLY SIGNIlCANT AT N ¹ 4HE 'ALLUP /RGANIZATION 0RINCETON .* !LL RIGHTS RESERVED
%XHIBIT %MPLOYEE %NGAGEMENT !VOIDABLE #OMPLICATIONS
#OMPLICATION )NDEX ,EAST %NGAGED RD 1UARTILE
ND 1UARTILE -OST %NGAGED
#ORRELATION REGRESSION ANALYSIS OF %NGAGEMENT 'RAND-EAN AND #OMPLICATION )NDEX STATISTICALLY SIGNIlCANT AT N ¹ 4HE 'ALLUP /RGANIZATION 0RINCETON .* !LL RIGHTS RESERVED
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
SGDãJDX ãSN ãHLOQ N UHMFãPT @ KH S X ã R@U H M Fã K H U D Rã @ M C ã Q D C T B H M Fã K@V RT H S R %XHIBIT %MPLOYEE %NGAGEMENT -ALPRACTICE ,OSS ,EAST %NGAGED ND 1UARTILE
RD 1UARTILE -OST %NGAGED
¹ 4HE 'ALLUP /RGANIZATION 0RINCETON .* !LL RIGHTS RESERVED
'ALLUPS RESEARCH DEMONSTRATES THAT TOP PERFORMERS IN ALL JOBS THINK SPEAK AND ACT DIFFERENTLY FROM THEIR COUNTERPARTS )N FACT TURNOVER DECREASED FROM TO PERCENT IN JUST THE lRST YEAR THAT THIS PROVIDER WORKED WITH .URSE)NSIGHT AND 'ALLUP 7HEN HEALTHCARE PROVIDERS IDENTIFY THE OPTIMAL SET OF EMPLOYEE TALENTS THAT CONTRIBUTES TO OUTSTANDING PERFORMANCE AND USE THESE TALENTS TO GUIDE HIRING DECISIONS THEY ARE EQUIPPED TO ENHANCE INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE LEADING TO BETTER BUSINESS AND CLINICAL OUTCOMES
%NGAGING THE 2IGHT 0EOPLE )DENTIFYING AND HIRING THE RIGHT EMPLOYEES IS JUST THE lRST STEP HEALTHCARE LEADERS CAN TAKE IN THE SEARCH FOR CONSISTENT QUALITY CARE 'ALLUPS RESEARCH lNDS THAT WHILE THERE ARE MANY FACTORS THAT INmUENCE QUALITY OUTCOMES THE ENGAGEMENT LEVEL OF NURSING PROFESSIONALS AND PHYSICIANS HAS AN ACUTE IMPACT %MPLOYEE ENGAGEMENT AS MEASURED BY 'ALLUPS 1¹ SURVEY ;= IS THE LEVEL AT WHICH EMPLOYEES IN ANY INDUSTRY OR JOB ARE PSYCHOLOGICALLY COMMITTED TO THEIR ROLES AND WORKPLACES +EEP IN MIND THAT hENGAGEMENTv IS MORE THAN WHETHER EMPLOYEES LIKE THEIR JOBS OR ARE SATISlED WITH THEIR MANAGER OR BENElTS %NGAGEMENT IS A MEASURE OF THE DEGREE TO WHICH EMPLOYEES HAVE AN EMOTIONAL BOND TO THEIR JOBS AND THEIR EMPLOYERS 'ALLUP HAS PRODUCED RESEARCH SHOWING THAT ENGAGED EMPLOYEES IN NUMEROUS INDUSTRIES AND POSITIONS ARE MORE PRODUCTIVE THAN THEIR COUNTERPARTS INCLUDING
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
BEING MORE PROlTABLE MORE CUSTOMER FOCUSED SAFER AND LESS LIKELY TO LEAVE THEIR ORGANIZATIONS &OR HEALTHCARE PROVIDERS THESE FACTORS AFFECT NOT ONLY lNANCIAL SUCCESS BUT THEY CAN BE THE DIFFERENCE BETWEEN EXCELLENT CARE AND GRAVE CONSEQUENCES ! RECENT 'ALLUP STUDY EXAMINED THE KEY FACTORS THAT INmUENCE AVOIDABLE DEATHS AND COMPLICATIONS AS WELL AS THE HUMAN INmUENCE ON PATIENT SAFETY AND HEALTHCARE QUALITY 4HE STUDY FOUND THAT HOSPITALS WITH HIGHER NURSE ENGAGEMENT HAVE A STATISTICALLY LOWER MORTALITY INDEX SEE %XHIBIT AND COMPLICATION INDEX SEE %XHIBIT %ACH INDEX IS THE CALCULATED DIFFERENCE BETWEEN WHAT ACTUALLY OCCURS IN A HOSPITAL AND THE OUTCOMES THAT ARE EXPECTED BASED ON THE TYPE OF PATIENTS WHO ARE ADMITTED TO THAT PROVIDER )N FACT A REGRESSION ANALYSIS OF THE RELATIONSHIPS IN THE DATA OF MORE THAN HOSPITALS IDENTIlED NURSE ENGAGEMENT AS THE TOP PREDICTOR OF BOTH MORTALITY AND COMPLICATION RATES ACROSS HOSPITALS 3O WHILE MORTALITY OR COMPLICATIONS ARE SOMETIMES INEVITABLE DUE TO A PATIENTS CONDITION ENGAGED NURSES REDUCE THE NUMBER OF UNEXPECTED DEATHS AND ADVERSE OUTCOMES RELATED TO CARE %NGAGEMENT ALSO HAS A SIGNIlCANT EFFECT ON OTHER SPECIlC QUALITY INDICATORS &OR EXAMPLE A 'ALLUP STUDY COMPARING NOSOCOMIAL INFECTION RATES AT AN INTERNATIONALLY ACCLAIMED MEDICAL INSTITUTION FOUND THAT BLOODSTREAM INFECTIONS WERE TIMES HIGHER AMONG PATIENTS TREATED BY LESS ENGAGED UNITS 4HE SAME STUDY FOUND THAT PATIENTS OF LESS ENGAGED UNITS WERE TIMES MORE LIKELY TO GET SURGICAL SITE INFECTIONS THAN THOSE TREATED BY ENGAGED UNITS %MPLOYEE ENGAGEMENT NOT ONLY AFFECTS THE QUALITY OF PATIENT CARE ENGAGEMENT ALSO HAS A MARKED lNANCIAL IMPACT ON HEALTHCARE PROVIDERS 6OLUNTARY TURNOVER IS LOWER AMONG ENGAGED NURSES THAN AMONG DISENGAGED NURSES 'ALLUP DATA ALSO SHOW
SGDãJDX ãSN ãHLOQ N UHMFãPT @ KH S X ã R@U H M Fã K H U D Rã @ M C ã Q D C T B H M Fã K@V RT H S R
%MPLOYEE ENGAGEMENT NOT ONLY AFFECTS THE QUALITY OF PATIENT CARE IT ALSO HAS A MARKED FINANCIAL IMPACT ON HEALTHCARE PROVIDERS THAT THE LESS ENGAGED NURSES ARE THE MORE HOSPITALS STAND TO LOSE IN MALPRACTICE CLAIMS IN FACT HOSPITALS WITH THE LEAST ENGAGED NURSES PAY APPROXIMATELY MILLION MORE ANNUALLY IN MALPRACTICE CLAIMS THAN HOSPITALS WITH THE MOST ENGAGED NURSES SEE %XHIBIT !GAIN RECOGNIZING THAT THERE ARE MULTIPLE FACTORS IN THESE CLAIMS DATA SHOW THAT WHEN HOSPITAL LEADERS FOCUS ON CREATING A MORE ENGAGING WORKPLACE FOR NURSES THE HOSPITAL PAYS OUT LESS IN LEGAL SUITS FOR MALPRACTICE CLAIMS
3ELECTION AND %NGAGEMENT IN !CTION 4HESE AND OTHER lNDINGS FROM 'ALLUP ANALYSIS POINT TO EMPLOYEE ENGAGEMENT AS A CRITICAL FACTOR IN ENSURING SAFE HIGH QUALITY HEALTHCARE FOR A PROVIDERS PATIENTS 'ALLUP CONSULTS WITH HEALTH CARE PROVIDERS ACROSS THE COUNTRY TO HELP THEM UNDERSTAND THE LINKS BETWEEN SELECTION AND ENGAGEMENT 4HE GOAL OF THIS PARTNERSHIP IS FOR HEALTHCARE LEADERS TO REALIZE CONSISTENT QUALITY CARE ALONG WITH INCREASINGLY POSITIVE BUSINESS RESULTS -EDICAL #ENTER OF 0LANO 4EXAS IS ONE EXAMPLE OF SELECTION AND ENGAGEMENT IN ACTION MAKING THESE KINDS OF POSITIVE DIFFERENCES -EDICAL #ENTER OF 0LANO A (OSPITAL #ORPORATION OF !MERICA (#! FACILITY OFFERS MORE THAN PATIENT BEDS IN THE $ALLAS &ORT 7ORTH AREA ! *ANUARY 'ALLUP -ANAGEMENT *OURNAL ARTICLE REPORTED ON THE lVE YEAR TREK DURING WHICH THE -EDICAL #ENTER OF 0LANO OVERCAME HIGH STAFF TURNOVER AND COMPETITION FROM DOZENS OF OTHER HEALTHCARE PROVIDERS IN ITS AREA TO BECOME AN INDUSTRY LEADER )N THE YEAR BEFORE LEADERS AT THE FACILITY BEGAN WORKING WITH 'ALLUP STAFF TURNOVER WAS AT PERCENT OVERALL AND ABOUT PERCENT AMONG lRST YEAR EMPLOYEES n A LOSS OF ABOUT PEOPLE 4HIS CONSTANT mUX OF NURSES AND OTHER EMPLOYEES WAS COSTING THE FACILITY MONEY AND IT LED OFlCIALS TO BEGIN WORKING WITH 'ALLUP TO IMPLEMENT NURSE SELECTION AND EMPLOYEE ENGAGEMENT PRACTICES 4HE -EDICAL #ENTER OF 0LANO DECIDED lRST TO FOCUS ON EMPLOYEE ENGAGEMENT WHICH MEANT THE FACILITY WOULD USE 'ALLUPS 1 SURVEY TO MEASURE ITS EMPLOYEES CURRENT STATE OF ENGAGEMENT 7HEN THE HOSPITAL TOOK ITS INITIAL READING OF ENGAGEMENT IN JUST PERCENT OF EMPLOYEES WERE ENGAGED PERCENT WERE NOT ENGAGED AND PERCENT WERE ACTIVELY DISENGAGED ,EADERS AT THE -EDICAL #ENTER OF 0LANO WORKED WITH 'ALLUP CONSULTANTS TO FOCUS ON EACH OF THE 1 SURVEY ITEMS TO HELP IDENTIFY AND CHANGE NEGATIVE PRACTICES AT THE HOSPITAL 4HIS INCLUDED USING 'ALLUPS TALENT SELECTION TOOLS BEGINNING IN THE SPRING OF WHICH PAID IMMEDIATE DIVIDENDS TO THE FACILITY
h7ITHIN DAYS AFTER WE IMPLEMENTED THE SELECTION TOOLS WE STARTED SEEING TURNOVER NUMBERS GO DOWN ESPECIALLY THE NUMBERS ASSOCIATED WITH lRST YEAR EMPLOYEES 4HESE WERE THE EMPLOYEES WE WANTED TO KEEP BECAUSE WE HAD IDENTIlED THAT THEY POSSESSED THE TALENTS WE NEEDED v SAID *ERRY -C-ORROUGH VICE PRESIDENT OF HUMAN RESOURCES AT THE -EDICAL #ENTER OF 0LANO -C-ORROUGH ADDED THAT USING SUCH A TOOL HELPS BECAUSE IT IS SO DIFlCULT TO lND NURSES WHO CAN FACE THE CHALLENGES OF A TOUGH lELD LIKE HEALTHCARE AND STILL PROVIDE GREAT PATIENT CARE 4HROUGH THE END OF THE -EDICAL #ENTER OF 0LANO HAD SUCCEEDED IN IMPROVING ENGAGEMENT AMONG ITS EMPLOYEES WITH PERCENT OF ITS EMPLOYEES ENGAGED PERCENT NOT ENGAGED AND JUST PERCENT ACTIVELY DISENGAGED n A STARK CONTRAST TO ITS lRST RESULTS lVE YEARS EARLIER 4HE IMPORTANCE OF THIS INCREASE IS OBVIOUS ACCORDING TO LEADERS AT THE FACILITY h4HERE IS A DElNITE TIE BETWEEN OUR IMPROVEMENT IN NURSE ENGAGEMENT AND QUALITY OUTCOMES v SAID #ATHY $YKE VICE PRESIDENT OF NURSING OPERATIONS FOR THE -EDICAL #ENTER OF 0LANO h!N ENGAGED NURSE GOES THE EXTRA MILE TO ENSURE THE PROVISION OF SAFE COMPETENT AND COMPASSIONATE CAREv 3ANDY (AIRE CHIEF NURSING OFlCER AT THE FACILITY AGREED SAYING h4HERE IS NO QUESTION THAT NURSE ENGAGEMENT AFFECTS QUALITY 7EVE INITIATED SHARED GOVERNANCE COUNCILS ON EVERY NURSING UNIT TO IMPROVE CARE BASED ON THE INPUT AND THE DECISIONS OF THE BEDSIDE NURSE n NOT TOP DOWN DIRECTIVES !LLOWING NURSES A VOICE IN THEIR PRACTICE NOT ONLY FOSTERS ENGAGEMENT BUT ALSO QUALITY OUTCOMESv 4HESE RESULTS ARE POSITIVE AND INSPIRING BUT ULTIMATELY THERE NEEDS TO BE AN IMPACT ON HOSPITALS BUSINESS OUTCOMES !S THE ENGAGEMENT LEVELS AND THE SELECTION PROCESSES AT THE -EDICAL #ENTER OF 0LANO INCREASED IN QUALITY SO TOO DID THE HOSPITALS PROlTS )N THE FACILITY REACHED MILLION IN GROSS REVENUE
"OTTOM ,INE 0OSITIVE lNANCIAL OUTCOMES ALONG WITH STATISTICS SHOWING LOWER MORTALITY AND COMPLICATION INDEXES AND LOWER TURNOVER RATES ARE JUST A FEW REASONS WHY HEALTHCARE INSTITUTIONS MUST SERIOUSLY FOCUS ON SELECTING AND ENGAGING THE RIGHT PEOPLE (EALTHCARE COMPANIES WILL CONTINUE TO DEVELOP NEW TECHNOLOGIES AND RElNE STRATEGIES FOR INCREASING QUALITY n AND THESE INNOVATIONS DO INmUENCE QUALITY (OWEVER SELECTING AND ENGAGING THE RIGHT PEOPLE MUST BE KEY STRATEGIC INITIATIVES FOR HEALTHCARE LEADERS IF THEY TRULY WANT TO TRANSFORM THE QUALITY OF THEIR ORGANIZATIONS %NDNOTE 'ALLUPS 1¸ SURVEY MEASURES KEY AREAS THAT CONSISTENTLY RELATE TO EMPLOYEE RETENTION PRODUCTIVITY PROlTABILITY CUSTOMER LOYALTY AND SAFETY "ASED ON MORE THAN YEARS OF IN DEPTH RESEARCH AND APPLICATION THESE AREAS HAVE BEEN DISTILLED INTO STATEMENTS THAT n ON THE BASIS OF EMPLOYEE AGREEMENT OR DISAGREEMENT n PROVIDE INSIGHTS INTO THE HEALTH OF A COMPANY
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
1UALITY AND THE 2EVENUE #YCLE (EALTHCARE PROVIDERS ARE REALIZING THAT TO BE REGARDED AS QUALITY INSTITUTIONS THEY MUST BE MORE PATIENT FRIENDLY IN THE WAY PATIENTS MUST ACCESS MEDICAL SERVICES AND THE MEANS THROUGH WHICH SERVICES ARE PAID "Y *OSEPH - !LBIAN *IM (ORNE AND "ELLINDA # -INKNER 0RICEWATERHOUSE#OOPERS
(
OSPITALS EXPEND GREAT EFFORT TO MONITOR EVALUATE AND IMPROVE THE SAFETY AND QUALITY OF THE CARE THEY DELIVER MEASURED BY POSITIVE CLINICAL TREATMENT AND OUTCOME INDICATORS (OWEVER A CUSTOMER CENTRIC DElNITION OF QUALITY MUST ENCOMPASS THE OVERALL PATIENT EXPERIENCE 0ROVIDERS NEED TO BROADEN THEIR DElNITION OF QUALITY TO INCLUDE THE ADMINISTRATIVE AND lNANCIAL ACTIVITIES ASSOCIATED WITH THE PATIENT CARE ENCOUNTER 4RANSPARENCY IN PRICING ADMINISTRATIVE ACTIVITIES AND OTHER FACTORS ALSO AFFECT A PATIENTS BROADER EVALUATION OF QUALITY 4HE INCREASING PREVALENCE OF HIGH DEDUCTIBLE HEALTH PLANS ($(0S AND CONSUMER DIRECTED HEALTH PLANS #$(0S OFTEN INCORPORATING HEALTHCARE SAVINGS ACCOUNTS (3!S OR HEALTH REIMBURSEMENT ARRANGEMENTS (2!S MEAN JUST ONE THING 0ATIENTS ARE PAYING FOR MORE OF THEIR HEALTHCARE EXPENSES OUT OF POCKET 'IVEN THESE TRENDS PROACTIVE PROVIDERS NEED TO BE ABLE TO DEMONSTRATE HIGH QUALITY AND REASONABLE COST AND HAVE THE ABILITY TO DETERMINE THE PATIENTS lNANCIAL RESPONSIBILITY AND COLLECT IT OR AGREE UPON lNANCIAL ARRANGEMENTS BEFORE OR AT THE TIME OF SERVICE 0ATIENTS DO NOT CURRENTLY AND PERHAPS NEVER WILL CHOOSE HEALTHCARE PROVIDERS IN THE SAME WAY THEY SHOP FOR OTHER PRODUCTS AND SERVICES .EVERTHELESS PATIENTS AND REGULATORS ARE INCREASINGLY DEMANDING THAT PROVIDERS MAKE AVAILABLE PRICING AND QUALITY DATA 0ATIENT CENTRIC ACCESS AND SERVICE DELIVERY PRACTICES OR THE LACK THEREOF HAVE NOT YET APPRECIABLY AFFECTED PATIENT VOLUME AT HOSPITALS SURVEYED BY 0RICEWATERHOUSE#OOPERS IN CONJUNCTION WITH THE (EALTHCARE &INANCIAL -ANAGEMENT !SSOCIATION (&-!
SEE SIDEBAR ;= BUT IMPROVING THE PATIENTS HOSPITAL EXPERIENCE IS INCREASINGLY SEEN AS A MARKET DIFFERENTIATOR
#HALLENGES AND "URDENS FOR 0ROVIDERS &EW INSURED PATIENTS UNDERSTAND THEIR HEALTH BENElTS OR THE ACTUAL TOTAL COST OF THE MEDICAL SERVICES THEY RECEIVE -ANY DO NOT KNOW OR UNDERSTAND THEIR COVERAGE RULES LIMITATIONS AND EXCLUSIONS OUT OF POCKET RESPONSIBILITIES OR EXPECTED COSTS FOR EITHER INPATIENT OR OUTPATIENT SERVICES !S AN EXAMPLE IN A STUDY RELEASED BY 'REAT 7EST (EALTHCARE IN !UGUST PARTICIPANTS AVERAGE PREDICTION PRICE OF A (ONDA !CCORD WAS WITHIN OF ACTUAL COST HOWEVER THEIR PREDICTION OF A FOUR DAY HOSPITAL STAY WAS OFF BY ;= 2IGHT NOW TRADITIONAL BILLING AND PRICING PRACTICES REVOLVE AROUND -EDICARE -EDICAID AND MANAGED CARE PLANS !S OF THE ROUGHLY MILLION !MERICANS INSURED BY ($(0S WERE STILL A RELATIVELY SMALL MINORITY PERCENT OF PRIVATELY INSURED ADULTS UNDER AGE HAD DEDUCTIBLES OF OR MORE ;= 4HIS PICTURE HOWEVER IS CHANGING RAPIDLY $EDUCTIBLES COPAYS AND COINSURANCE COSTS ARE INCREASING SIGNIlCANTLY EVEN IN TRADITIONAL HEALTH PLANS 4HE ANNUAL AMOUNT OF PER PERSON SPENDING FOR HEALTHCARE HAS INCREASED FROM IN TO A PROJECTED FOR ;= 0ROVIDERS INTERESTED IN PROTECTING OR GAINING MARKET SHARE MUST PREPARE FOR THE FAST APPROACHING TIME WHEN PATIENTS WILL SCRUTINIZE AND BASE THEIR HEALTHCARE DECISIONS AND THEIR SPENDING ON PERFORMANCE METRICS
*OSEPH - !LBIAN -"! IS A PARTNER IN 0RICEWATERHOUSE#OOPERS (EALTHCARE #ONSULTING PRACTICE AND HAS YEARS OF EXPERIENCE WITH HEALTHCARE AND ENTREPRENEURIAL COMPANIES (E SPECIALIZES IN OPERATIONS IMPROVEMENT AND lNANCIAL MANAGEMENT DRAWING FROM HIS ADMINISTRATIVE AND CONSULTING EXPERIENCE WITHIN THE HEALTHCARE INDUSTRY (E ALSO HAS EXTENSIVE EXPERIENCE IN OPERATIONAL AND lNANCIAL PLANNING ENGAGEMENTS AND LEADS 0W#S PROVIDER CONSUMERISM EFFORTS (E CAN BE REACHED AT JOEALBIAN USPWCCOM *IM (ORNE IS A MANAGING DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E HAS OVER YEARS OF HEALTHCARE INDUSTRY EXPERIENCE IN PERFORMANCE IMPROVEMENT IN HOSPITAL REVENUE CYCLE CLINICAL DOCUMENTATION AND QUALITY AND lNANCIAL MANAGEMENT (E CAN BE REACHED AT JIMHORNE USPWCCOM "ELLINDA # -INKNER IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE 3HE HAS YEARS OF EXPERIENCE IN THE HEALTHCARE INDUSTRY FOCUSING ON TRAINING AND DEVELOPMENT IN THE AREAS OF THE HOSPITAL AND PROVIDER REVENUE CYCLE AS WELL AS PAYER OPERATIONS 3HE CAN BE REACHED AT BELLINDACMINKNER USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
PT@KHS Xã @ M C ã S G D ã Q D U D M T D ã BXB KD -ANY HEALTHCARE PROVIDERS HAVE ALREADY BEEN WORKING TO STREAMLINE AND INTEGRATE THEIR ADMITTING SCHEDULING AND REVENUE CYCLE PROCESSES TO INCREASE PATIENT SATISFACTION -OTIVATED BY QUALITY CONSIDERATIONS AS WELL AS THE DESIRE TO REDUCE POTENTIAL BAD DEBT THEY ARE ADDING HUMAN AND TECHNOLOGICAL RESOURCES TO MOVE hBACK OFlCEv FUNCTIONS TO THE PRE SERVICE PHASE OF A PATIENTS HOSPITAL EXPERIENCE 7HEN A PHYSICIAN OR PATIENT CALLS TO REGISTER FOR OR SCHEDULE SERVICES HOSPITAL EMPLOYEES ARE BEGINNING TO ASK THE RIGHT QUESTIONS ABOUT A PATIENTS COVERAGE lNANCIAL RESPONSIBILITY AND ABILITY TO PAY ,EGISLATORS ARE CALLING FOR HOSPITALS TO CHANGE THEIR PRACTICES IN ORDER TO FAIRLY AND COMPLETELY REPORT THEIR COMMUNITY BENElT AND CLARIFY THEIR POLICIES TO CLEARLY DISTINGUISH CHARITY CARE FROM BAD DEBT
@0ATIENTS LOOK AT HOW THEY ARE TREATED AND THEY NOTICE TECHNICAL QUALITY MORE THAN PEOPLE REALIZE PARTICULARLY WHEN THEY SEE A LACK OF COORDINATION BETWEEN THEIR DOCTORS n -ARGARET % /+ANE PRESIDENT OF THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1! (IGH PERFORMING HOSPITALS ARE FOCUSED ON ENHANCING SYSTEMS AND PROCEDURES TO BE ABLE TO ROUTINELY PROVIDE REALISTIC ESTIMATES OF WHAT A PATIENTS MEDICAL SERVICES WILL COST HOW MUCH WILL BE COVERED BY INSURANCE AND HOW MUCH THE PATIENT WILL HAVE TO PAY OUT OF POCKET FOR NONEMERGENCY NONCOMPLICATED HOSPITAL SERVICES 4HESE PRICES ARE OFTEN QUITE DIFFERENT FROM HOSPITAL hLISTv CHARGES DUE TO NEGOTIATED MANAGED CARE CONTRACTUAL DISCOUNTS MAKING AVERAGE CHARGES FOR SIMILAR CASES SOMEWHAT IRRELEVANT $ISCUSSIONS REGARDING PATIENT lNANCIAL RESPONSIBILITY CAN BE STRESSFUL SO IT MAKES SENSE TO HANDLE lNANCIAL MATTERS IN ADVANCE 4HEN WHEN PATIENTS ARRIVE AT THE HOSPITAL THEY CAN FOCUS ON THE CLINICAL ENCOUNTERS WITH CAREGIVERS RATHER THAN ADMINISTRATIVE TRANSACTIONS WITH lNANCIAL MANAGERS %VENTUALLY FOR MANY STANDARD PROCEDURES PATIENTS WILL BE ABLE TO GO TO A PROVIDERS WEBSITE INPUT A PHYSICIAN PROVIDED DIAGNOSIS PROCEDURE DESCRIPTION AND INSURANCE DETAILS AND RECEIVE A REPORT SUMMARIZING ANTICIPATED COSTS AND A BREAKDOWN OF THEIR COSTS AND WHAT THEIR INSURER WILL PAY 4HEY WILL THEN BE ABLE TO REGISTER FOR AND SCHEDULE SERVICES FROM A HOME COMPUTER PAY THEIR RESPONSIBLE PORTIONS IN ADVANCE OR ON THE DAY OF SERVICE CHECK IN BY USING A POINT OF SERVICE KIOSK AND GO DIRECTLY TO THE CLINICAL SERVICE AREA KEEPING WAIT TIMES TO A MINIMUM
)N A FEW YEARS SUCH A SCENARIO MAY BE COMMONPLACE BUT IT IS NOT TODAY -ANY IMPEDIMENTS HAMPER SUCH A COMPREHENSIVE PATIENT CENTRIC SERVICE MODEL THOUGH IN SOME ISOLATED LOCATIONS AROUND THE COUNTRY THESE CAPABILITIES ARE IN PLACE /NE CHALLENGE IS THAT PAYERS LACK THE PROCESSES AND TECHNOLOGY TO PROVIDE REAL TIME INFORMATION ABOUT A PATIENTS ELIGIBILITY AND DEDUCTIBLE STATUS 0ROVIDERS ARE TRYING TO SERVE AS FACILITATORS OBTAINING DATA FROM THE PAYER ADDING IN THEIR COST ESTIMATES AND HELPING PATIENTS UNDERSTAND HOW MUCH IS COVERED AND HOW MUCH THEY WILL BE HELD RESPONSIBLE FOR PAYING 0ROVIDERS HAVE MADE CONSIDERABLE PROGRESS IN IMPROVING PRE REGISTRATION AND PRE SERVICE ACTIVITIES 4HEY HAVE BEGUN TO ASSESS THE NEED TO CHANGE JOB DESCRIPTIONS COMPETENCIES AND THE ORGANIZATIONAL STRUCTURE OF THEIR REVENUE CYCLE TEAMS 2EGISTRATION PROFESSIONALS WILL NEED TO UNDERSTAND AND GUIDE PATIENTS THROUGH THE INTRICACIES OF THEIR INSURANCE PLANS IN PARTICULAR HIGH DEDUCTIBLE CONSUMER DIRECTED HEALTH PLANS 4HEY WILL NEED TO LEARN HOW TO HANDLE PATIENTS UNACCUSTOMED TO PAYING FOR SERVICES BEFORE THE INSURANCE HAS PAID 3OME PROVIDERS ARE CONSIDERING EXPANDING THE ROLE OF THE lNANCIAL COUNSELOR SO THEY CAN COUNSEL PATIENTS ON NEW OPTIONS FOR PAYING THEIR MEDICAL BILLS 0ROVIDING PATIENT FRIENDLY lNANCIAL PRACTICES AT THE BEGINNING OF A PATIENT RELATIONSHIP IS VITAL TO CREATING A LOYAL POPULATION OF SATISlED CUSTOMERS AND A DISCREET AND COMPASSIONATE CLINICAL EXPERIENCE
!TTRIBUTES OF A 0ATIENT #ENTRIC 3ERVICE -ODEL 0ATIENT !CCESS AND 3CHEDULING -ANY HEALTHCARE ORGANIZATIONS ARE WORKING TO REORGANIZE RESTRUCTURE AND RE ENGINEER SCHEDULING PROCESSES FOR ALL INPATIENT AND OUTPATIENT SERVICES $EMOGRAPHIC MEDICAL AND INSURANCE DATA NEED TO BE SHARED ACROSS THE ENTIRE DELIVERY NETWORK SO THAT FOR EXAMPLE A PATIENT WHO IS SENT BY HER PHYSICIAN TO A DIAGNOSTIC LAB FOR BLOOD WORK THEN TO A RADIOLOGY FACILITY FOR AN 8 RAY OR TO THREE DIFFERENT DEPARTMENTS WITHIN THE SAME HOSPITAL WILL NOT HAVE TO REPEAT THE INFORMATION SHE HAS ALREADY PROVIDED AT ANOTHER LOCATION 0RE lNANCIAL CLEARANCE AND CONVENIENCE ARE ALSO IMPORTANT AND SOME ORGANIZATIONS ARE ADDRESSING THIS ANGLE OF PATIENT SATISFACTION BY BUILDING 7EB BASED PORTALS THAT ALLOW PATIENTS TO BOOK APPOINTMENTS IN REAL TIME VIA SELF SERVICE TECHNOLOGIES /THER PROVIDERS ARE COORDINATING THEIR RESOURCES THROUGHOUT THEIR SYSTEMS SO THAT THEY ARE CAPABLE OF PROVIDING SERVICES AT THE PATIENTS CONVENIENCE
"ILLING 0RICING TRANSPARENCY OR LETTING PATIENTS KNOW THE TOTAL COST OF SERVICES COMPONENTS OF THE TOTAL COST AND THEIR UP FRONT lNANCIAL RESPONSIBILITY IS BECOMING INCREASINGLY IMPORTANT TO CONSUMERS 4HE OBJECTIVE IS TO GIVE PATIENTS EASY ACCESS TO UNDERSTANDABLE INSURANCE SPECIlC INFORMATION THAT ENABLES
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
PT@KHS Xã @ M C ã S G D ã Q D U D M T D ã BXB KD 7HAT 0ATIENTS 7ANT 0RICEWATERHOUSE#OOPERS RECENTLY CONDUCTED A SURVEY ON BEHALF OF THE (&-! IN SUPPORT OF (&-!S 0ATIENT &RIENDLY "ILLING 0ROJECT )NITIATIVE FOCUSING ON CONSUMERISM IN HEALTHCARE WHICH INCLUDED SPONSOR ORGANIZATIONS n HOSPITALS HEALTH SYSTEMS INTEGRATED DELIVERY NETWORKS AND PHYSICIAN PRACTICES n CONSIDERED TO BE PROGRESSIVE IN ADDRESSING CONSUMER ISSUES FROM THE PROVIDER PERSPECTIVE 4HE REPORT SUGGESTS STRATEGIES THAT PROVIDERS OUGHT TO CONSIDER IN ORDER TO FACILITATE PATIENT ACCESS AND SCHEDULING BECAUSE 0ATIENTS LIKE THE EXPERIENCE OF CONVENIENT SCHEDULING ACROSS THE HEALTH SYSTEMPHYSICIAN NETWORK 0ATIENTS DO NOT LIKE MULTIPLE LENGTHY PHONE CALLS OR CONVERSATIONS WITH POORLY TRAINED STAFF WHO CANNOT RELIABLY ACCESS THE INFORMATION NEEDED TO SCHEDULE APPOINTMENTS COMPLETE NECESSARY FORMS AND PROVIDE INFORMATION ON THE COVERAGE AND COST OF THEIR SPECIlC SERVICE REQUIREMENTS -ANY CONSUMERISM FOCUSED RETAIL ORIENTED PATIENTS WANT TO BE ABLE TO SCHEDULE SERVICES AT TIMES THAT ARE CONVENIENT FOR THEM -ANY PATIENTS FAVOR HAVING MORE mEXIBILITY IN THE SCHEDULING PROCESS 0ATIENTS DO NOT WANT TO PROVIDE lNANCIAL AND DEMOGRAPHIC INFORMATION MULTIPLE TIMES DURING THEIR ENCOUNTER WITH THE HEALTHCARE SYSTEM 0ATIENTS DO NOT APPRECIATE FREQUENT AND UNNECESSARY REPEATED REQUESTS FOR INFORMATION THAT SHOULD BE SHARED THROUGHOUT THE SYSTEM AND ACCESSIBLE TO MEDICAL PERSONNEL AT EVERY POINT OF CONTACT 4HE REPORT ALSO SUGGESTS STRATEGIES FOR ACHIEVING SIMPLIlED CHARGE AND PAYMENT STRUCTURES AGREEMENT ON PAYMENT EXPECTATIONS AND PAYMENT TERMS AND APPROPRIATE STAFF SUPPORTS BECAUSE 0ATIENTS WANT TO RECEIVE BILLS THAT ARE EASY TO UNDERSTAND !DDITIONALLY PATIENTS DESIRE ACCURATE COMMUNICATION IN REGARD TO THE AMOUNT THEY OWE AND THAT IT BE BASED ON A RATIONAL AND UNDERSTANDABLE CHARGE AND REIMBURSEMENT SYSTEM 0ATIENTS PREFER SUMMARY COST INFORMATION RATHER THAN OVERLY DETAILED BILLS THAT CORRESPOND TO INCOMPREHENSIBLE ITEMS IN THE CHARGE DESCRIPTION MASTER #$- 0ATIENTS WANT TO UNDERSTAND THEIR INSURANCE COVERAGE AND ESTIMATED lNANCIAL RESPONSIBILITY AS EARLY IN THE PROCESS AS POSSIBLE 0ATIENTS APPRECIATE FRIENDLINESS HELPFULNESS AND PROFESSIONALISM !T THE POINT OF REGISTRATION AND DURING THE MEDICAL ENCOUNTER PATIENTS DESIRE FOCUSED PROVIDERS 0ATIENTS WANT PROACTIVE COMMUNICATION WITH THEIR PHYSICIANS AND PROVIDERS #OMMUNICATION PERTAINING TO BOTH CLINICAL AND lNANCIAL DETAILS OUGHT TO BE OF A CONSTRUCTIVE AND BALANCED NATURE
THEM TO DETERMINE THE COSTS OF THEIR OWN HEALTHCARE IN ADVANCE OF RECEIVING NONEMERGENCY AND NONCOMPLICATED SERVICES %MERGENCY ADMISSIONS SHOULD RECEIVE HOUR TURNAROUND OF COVERAGE INFORMATION AND PAYMENT EXPECTATIONS 4RADITIONALLY PATIENTS HAVE HAD LITTLE CONTROL OVER WHAT GETS CHARGED TO THEIR ACCOUNTS AND BECAUSE THEY HAVE NOT BEEN INVOLVED IN THE lNANCIAL ASPECT OF THEIR CARE THERE HAS BEEN LITTLE INCENTIVE TO TAKE RESPONSIBILITY TO PARTICIPATE 4ODAY MANY PATIENTS ARE WILLING TO TAKE THE RESPONSIBILITY TO PARTICIPATE IN THEIR OWN HEALTHCARE DECISIONS AND TO HELP CONTROL THE COSTS OF THEIR CARE 0ATIENTS OFTEN RECEIVE BILLS THAT ARE DIFlCULT TO UNDERSTAND AND RARELY CORRESPOND TO THE HOSPITALS EXPECTED PAYMENT FOR SERVICES SUPPLIES AND RESOURCES &OR MOST PATIENTS SUCH ITEMIZED BILLS ARE MEANINGLESS AT BEST AND CAUSE FOR SOURED RELATIONS WITH PROVIDERS &ORWARD LOOKING PROVIDERS ARE WORKING TO RATIONALIZE AND SIMPLIFY THEIR PRICING STRUCTURES BY RE ESTABLISHING RATES BASED ON A RELATIONSHIP TO MARKET
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
RATES OR OFFERING SERVICE PACKAGES (OWEVER REDESIGNING A HOSPITALS ENTIRE CHARGE STRUCTURE IS DIFlCULT BECAUSE PROVIDERS HAVE HISTORICALLY COMPUTED CHARGES USING COMPLEX ALGORITHMS DESIGNED TO ASSURE THAT THE REIMBURSEMENT RECEIVED FROM PAYERS WITH NEGOTIATED CONTRACTS IS SUFlCIENT TO COVER THE OPERATING COSTS AND UNCOMPENSATED CARE (OSPITALS ALSO NEED TO ASSESS PRICE CONSIDERATIONS FOR INPATIENT VERSUS OUTPATIENT SERVICES 2ADIOLOGY FACILITIES IMAGING CENTERS URGENT CARE CLINICS AND OTHER AMBULATORY SERVICE CENTERS HAVE A VOLUME AND COST STRUCTURE THAT MAY ENABLE THEM TO PRICE THEIR SERVICES BELOW WHAT MOST HOSPITALS MUST CHARGE (OSPITALS MAY NEED TO CHALLENGE CURRENT OUTPATIENT PRICING POLICIES DEPENDING ON CURRENT CAPACITY AND DEMAND ANDOR CHALLENGE THE ABILITY TO hSTEERv PRICE SENSITIVE CONSUMERS TO OUTPATIENT FACILITIES TO REMAIN COMPETITIVE WITH THESE FREESTANDING FACILITIES 7ITH INCREASING SCRUTINY OF PRICING HOSPITAL EXECUTIVES ARE LOOKING FOR TECHNOLOGIES AND PRACTICES THAT WILL LET THEM GO BEYOND
PT@KHS Xã @ M C ã S G D ã Q D U D M T D ã BXB KD
@&OR SO MANY CONDITIONS PEOPLE DONT HAVE TIME TO COMPARISON SHOP 4HEY RELY ON REPUTATION AND WORD OF MOUTH (OWEVER PUBLIC REPORTING IS IMPORTANT TO GET PROVIDERS TO UNDERSTAND HOW THEY ARE PERFORMING AND HOW THEY COMPARE AGAINST PEERS AND LEAD THEM TO MAKE NEEDED IMPROVEMENTS -ARIBETH 3HANNON DIRECTOR OF THE HOSPITALS AND NURSING HOMES PROGRAM OF THE #ALIFORNIA (EALTH#ARE &OUNDATION MERELY POSTING THEIR #$-S AND LISTS OF APPROPRIATE SERVICES FOR EACH DIAGNOSIS RELATED GROUP ON A WEBSITE ACCESSIBLE TO PATIENTS 4HEY HOPE TO PROVIDE MORE ACCURATE INDIVIDUALIZED COST PROJECTIONS AND ESTIMATES OF A PATIENTS lNANCIAL RESPONSIBILITY BY TAKING INTO ACCOUNT THE SPECIlC PLAN DETAILS NECESSARY TO CALCULATE PAYER AND PATIENT lNANCIAL RESPONSIBILITIES VIA COMMUNICATION WITH THAT PATIENTS INSURANCE COMPANY /NE BARRIER IS THAT MEDICAL COMPLICATIONS AND COMORBIDITIES CAN SUBSTANTIALLY INCREASE THE COST OF A PATIENTS HOSPITALIZATION OR OTHER CARE 3IMILAR TO ESTIMATES FOR AUTOMOTIVE REPAIR WHERE THE MECHANIC CANT BE SURE HOW MUCH THE REPAIR WILL COST UNTIL HE hDIAGNOSES THE PROBLEM v ANTICIPATED BILLING FOR A PATIENTS HEALTHCARE WILL OFTEN NEED ADJUSTMENT OR SUPPLEMENTATION FOLLOWING THE PATIENTS DISCHARGE
)NFORMATION AND %DUCATION )N ADDITION TO UNDERSTANDABLE PRICING INFORMATION PATIENTS INCREASINGLY WANT TO COMPARE PROVIDERS QUALITY RATINGS ! NUMBER OF GOVERNMENT AND PRIVATE WEBSITES ARE STARTING TO PROVIDE SCORECARDS ON HOSPITALS 4HE INDUSTRY IS CURRENTLY ENGAGED IN MUCH DISCUSSION ABOUT WHO SHOULD TAKE THE LEAD IN PROVIDING PATIENTS THIS INFORMATION 3OME PROVIDERS THAT WERE INTERVIEWED FOR THE JOINT 0W#(&-! SURVEY INDICATED THAT PATIENTS hTRUSTv INFORMATION MORE WHEN IT COMES DIRECTLY FROM THE HOSPITAL
(OWEVER PROVIDERS CAN ONLY GIVE INFORMATION ABOUT THEIR OWN PERFORMANCE
4EAMWORK 0ATIENT FRIENDLY PRACTICES WILL REQUIRE IMPROVED TRANSMISSION OF INFORMATION BETWEEN PHYSICIANS AND HOSPITALS &OR A HOSPITAL TO ACCURATELY ESTIMATE A PATIENTS OUT OF POCKET EXPENSES PRIOR TO SERVICE IT MUST HAVE INFORMATION ON DIAGNOSIS AND APPROPRIATE CLINICAL PROCEDURES FROM THE PHYSICIAN ALONG WITH ANY INSURANCE INFORMATION THE PATIENT HAS ALREADY PROVIDED (OSPITALS ALSO DEPEND ON PHYSICIAN PERFORMANCE FOR THEIR QUALITY RANKINGS ! HOSPITAL IS EVALUATED IN PART ON ITS CLINICAL OUTCOMES AND THESE ARE AN AGGREGATE OF PHYSICIANS OUTCOMES AND HOW EFlCIENTLY THEY PRACTICE (OSPITALS AND PHYSICIANS NEED TO COLLABORATE AND EDUCATE EACH OTHER TO DELIVER GOOD OUTCOMES AND EFlCIENT CARE
)TS THE 0ATIENT &IRST ,AST !LWAYS 0RICING AND QUALITY TRANSPARENCY ARE GOING TO BE CRITICALLY IMPORTANT IN THE EMERGING HEALTHCARE SYSTEM (OWEVER ALL QUALITATIVE ASPECTS OF THE SERVICE ENCOUNTER INCLUDING PATIENT SATISFACTION ARE CRITICAL COMPONENTS TO THE VALUE EQUATION 0ATIENTS AND THEIR PHYSICIANS BOTH WANT QUALITY SERVICE AND VALUE FOR MONEY SPENT $ELIVERING PATIENT FRIENDLY QUALITY OF CARE AND THE RESPECTFUL HELPFUL DISPOSITION OF lNANCIAL MATTERS ARE VITAL IN CREATING SATISlED PATIENTS %NDNOTES h#ONSUMERISM IN (EALTH #ARE !N )NITIATIVE OF THE 0ATIENT &RIENDLY "ILLING 0ROJECT v 3UMMER (EALTHCARE &INANCIAL -ANAGEMENT !SSOCIATION h#ONSUMER !TTITUDES 4OWARD (EALTH #ARE v 'REAT 7EST (EALTHCARE !UGUST HTTPWWWGREATWESTHEALTHCARECOM#3TUDIES AND3URVEYS$OCUMENT,IBRARY'REAT 7EST(EALTHCARE#ONSUMER !TTITUDES3URVEY?PDF 4HE #OMMONWEALTH &UND "IENNIAL (EALTH )NSURANCE 3URVEY HTTPWWWCMWFORGPUBLICATIONSPUBLICATIONS?SHOWHTM DOC? ID h3NAPSHOT (EALTHCARE #OSTS v %DITION #ALIFORNIA (EALTH#ARE &OUNDATION -ARCH $ATA 3OURCE #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3 /FlCE OF THE !CTUARY ACCESSED AT HTTP WWWCHCFORGDOCUMENTSINSURANCE(EALTH#ARE#OSTSPDF
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
1! 5SING 3IX 3IGMA TO )MPROVE 1UALITY IN (EALTHCARE ! 2OUNDTABLE $ISCUSSION @4O IMPROVE IS TO CHANGE TO BE PERFECT IS TO CHANGE OFTEN n 3IR 7INSTON #HURCHILL FORMER PRIME MINISTER 5+
3USAN -C'ANN "EN -ILES !DRIENNE -ASTER "LACK "ELT -ASTER "LACK %LBERFELD -ASTER "LACK "ELT AT 6IRTUA (EALTH "ELT AT 3T *OHN (EALTH $ETROIT AND DIRECTOR AT 6IRTUA (EALTH !LSO PROJECT OF STRATEGIC TEAM DIRECTOR FOR PARTNERSHIP BUILDING A NEW HOSPITAL IN .OVA -ICHIGAN
%D 0OPOVICH VICE PRESIDENT OF ENTERPRISE EXCELLENCE AT "OCA 2ATON &LORIDA #OMMUNITY (OSPITAL
3
IX 3IGMA A DATA DRIVEN QUALITY IMPROVEMENT METHODOLOGY ORIENTED TOWARD STRIVING FOR PERFECTION HAS BEEN ADAPTED BY MANY INDUSTRIES INCLUDING HEALTHCARE 3IX 3IGMA ALLOWS AN ORGANIZATION TO QUANTIFY HOW MANY hDEFECTSv ARE IN A PROCESS THE DEFECTS CAN BE SYSTEMATICALLY ELIMINATED TO ZERO 3IX 3IGMA %XHIBIT 3IGMA 0ERFORMANCE ,EVELS n /NE TO 3IX 3IGMA 3IGMA ,EVEL
$EFECTS 0ER -ILLION /PPORTUNITIES $0-/
4ABLE TAKEN FROM I3IX3IGMA ACCESSED *UNE AVAILABLE AT HTTPWWWISIXSIGMACOMLIBRARYCONTENTCAASP
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
*IM +ARAGIORGIS 'LENN #ROTTY MANAGING DIRECTOR -$ CHIEF OPERATING OFlCER FOR BUSINESS #HARLESTON !REA TRANSFORMATION ()0 (EALTH 0LAN -EDICAL #ENTER
$EBBIE 9OUNG VICE PRESIDENT OF QUALITY 'REEN "ELT #HARLESTON !REA -EDICAL #ENTER
IS ACHIEVED WHEN THERE ARE NO MORE THAN DEFECTS PER MILLION OPPORTUNITIES IN A PROCESS;= 4HE FUNDAMENTAL OBJECTIVE OF 3IX 3IGMA IS TO IMPLEMENT A MEASUREMENT BASED STRATEGY THAT FOCUSES ON PROCESS IMPROVEMENT AND VARIATION REDUCTION )N INDUSTRIES IT IS A VEHICLE FOR STRATEGIC CHANGE AND AN ORGANIZATIONAL APPROACH TO PERFORMANCE EXCELLENCE 4HE METHODOLOGY IS ADMINISTERED BY 3IX 3IGMA 'REEN "ELTS AND 3IX 3IGMA "LACK "ELTS BOTH ARE MONITORED BY 3IX 3IGMA -ASTER "LACK "ELTS )T IS ESTIMATED THAT 3IX 3IGMA "LACK "ELTS SAVE COMPANIES APPROXIMATELY PER PROJECT AND CAN COMPLETE FOUR TO SIX PROJECTS PER YEAR;= 4HE 3IX 3IGMA PROCESS IS COMPRISED OF SIX PERFORMANCE LEVELS NOTED IN %XHIBIT ;= #REATED BY -OTOROLA IN THE S 3IX 3IGMA HAS BEEN USED BY ORGANIZATIONS TO IMPLEMENT TACTICAL MEANS FOR QUALITY IMPROVEMENT !LTHOUGH -OTOROLA BENElTED SIGNIlCANTLY FROM USE OF 3IX 3IGMA ACHIEVING SAVINGS OF MORE THAN BILLION ;= IT WAS NOT UNTIL THAT *ACK 7ELCH #%/ OF 'ENERAL %LECTRIC '% MADE 3IX 3IGMA FAMOUS BY IMPLEMENTING IT THROUGHOUT '%;= "ECAUSE OF ITS HEAVY RELIANCE ON STATISTICAL TOOLS 3IX 3IGMA REQUIRES DETAILED AND OFTENTIMES CONSUMING ANALYTICS )T IS TYPICALLY USED FOR COMPLEX PROBLEMS OTHER APPROACHES ARE
1! AVAILABLE FOR SIMPLER PROBLEMS &OR EXAMPLE +AIZEN IS USED TO DEVELOP TACTICAL QUICK lXES THROUGH USE OF PROCESS MAPPING AND BASIC hBLOCKING AND TACKLINGv TOOLS ,EAN -ANUFACTURING ,EAN CAN BE USED WHEN THE SITUATION REQUIRES A FOCUS ON SPEED ELIMINATION OF WASTE STANDARDIZATION AND mEXIBILITYRESPONSIVENESS
+EY $EFINITIONS '%S COMPANYWIDE IMPLEMENTATION WHICH HELPED BRING RECOGNITION TO THE 3IX 3IGMA METHOD ALSO CONTRIBUTED TO THE COMMON USE OF TERMINOLOGY WITHIN THE PROGRAM 4HE FOLLOWING LIST DESCRIBES FREQUENTLY USED TERMS WITHIN THE METHODOLOGY;=
1UALITY !PPROACHES AND -ODELS $ESIGN FOR 3IX 3IGMA n ! SYSTEMATIC METHODOLOGY UTILIZING TOOLS TRAINING AND MEASUREMENTS FOR THE DESIGN OF PRODUCTS AND PROCESSES THAT MEETS CUSTOMER EXPECTATIONS AND CAN BE PRODUCED AT 3IX 3IGMA QUALITY LEVELS $ElNE -EASURE !NALYZE )MPROVE AND #ONTROL $-!)# n ! PROCESS FOR CONTINUED IMPROVEMENT 4HIS PROCESS IS UTILIZED WITH EXISTING PROCEDURES THAT FALL BELOW SPECIlCATION AND ARE IN NEED OF INCREMENTAL IMPROVEMENT )T IS SYSTEMATIC SCIENTIlC AND FACT BASED 4HIS CLOSED LOOP PROCESS ELIMINATES UNPRODUCTIVE STEPS OFTEN FOCUSES ON NEW MEASUREMENTS AND APPLIES TECHNOLOGY FOR IMPROVEMENT $ElNE -EASURE !NALYZE $ESIGN AND 6ERIFY n 4HIS PROCESS IS USED TO DEVELOP NEW PROCESSES OR PRODUCTS AT 3IX 3IGMA QUALITY LEVELS 7ORK /UT» n /NE TO THREE DAY SESSIONS DESIGNED TO GATHER ORGANIZATIONAL STAKEHOLDERS TOGETHER SO THAT MAJOR ISSUES CAN BE DISCUSSED AND ACTION TAKEN
+EY 1UALITY 4OOLS
3UPPLIERS )NPUTS 0ROCESS /UTPUTS AND #USTOMER n %NABLES A TEAM TO HAVE AN OVERALL VIEW OF A PROCESS 5SUALLY UTILIZED DURING THE MEASUREMENT POINT OF $-!)# ! TOOL THAT IS USED TO CLASSIFY ANY AND ALL ASPECTS OF ANY GIVEN PROCESS IN ORDER TO PERFECT THE PROCESS PRIOR TO BEGINNING WORK 3TATISTICAL 0ROCESS #ONTROL n 4HE APPLICATION OF STATISTICAL METHODS TO ANALYZE DATA AND STUDY AND MONITOR PROCESS CAPABILITY AND PERFORMANCE 4REE $IAGRAM n 'RAPHICALLY SHOWS ANY BROAD GOAL BROKEN DOWN INTO DIFFERENT LEVELS OF DETAILED ACTIONS )T ENCOURAGES TEAM MEMBERS TO EXPAND THEIR THINKING WHEN CREATING SOLUTIONS
1UALITY 4ERMS "LACK "ELT n ,EADER OF A TEAM RESPONSIBLE FOR MEASURING ANALYZING IMPROVING AND CONTROLLING KEY PROCESSES THAT INmUENCE CUSTOMER SATISFACTION ANDOR PRODUCTIVITY GROWTH "LACK "ELTS ARE FULL TIME POSITIONS #ONTROL n 4HE STATE OF STABILITY NORMAL VARIATION AND PREDICTABILITY 0ROCESS OF REGULATING AND GUIDING OPERATIONS AND PROCESSES USING QUANTITATIVE DATA #RITICAL TO 1UALITY #RITICAL h9v n %LEMENT OF A PROCESS OR PRACTICE WHICH HAS A DIRECT IMPACT ON ITS PERCEIVED QUALITY 4HESE ARE ALSO REFERRED TO AS CRITICAL CUSTOMER REQUIREMENTS $EFECTS n 3OURCES OF CUSTOMER IRRITATION $EFECTS ARE COSTLY BOTH TO CUSTOMERS AND TO MANUFACTURERS OR SERVICE PROVIDERS %LIMINATION OF DEFECTS CAN YIELD COST BENElTS 'REEN "ELT n 3IMILAR TO "LACK "ELT BUT NOT A FULL TIME POSITION -ASTER "LACK "ELT n )NDIVIDUALS RESPONSIBLE FOR THE REVIEW AND MENTORSHIP OF "LACK "ELTS 3ELECTION CRITERIA FOR -ASTER "LACK "ELTS INCLUDE QUANTITATIVE SKILLS AND THE ABILITY TO TEACH AND MENTOR -ASTER "LACK "ELTS ARE FULL TIME POSITIONS 6ARIANCE n ! CHANGE IN A PROCESS OR BUSINESS PRACTICE THAT MAY ALTER ITS EXPECTED OUTCOME
$EFECTS PER -ILLION
#ONTROL #HART n -ONITORS VARIANCE IN A PROCESS OVER TIME AND ALERTS THE BUSINESS TO UNEXPECTED VARIANCE WHICH MAY CAUSE DEFECTS $EFECT -EASUREMENT n !CCOUNTING FOR THE NUMBER OR FREQUENCY OF DEFECTS THAT CAUSE LAPSES %XHIBIT -ANUFACTURING ORIENTED QUALITY IMPROVEMENT APPROACHES IN PRODUCT OR SERVICE QUALITY LIKE 3IX 3IGMA ARE BEING ADAPTED FOR HEALTHCARE 0ARETO $IAGRAM n &OCUSES ON EFFORTS OR THE PROBLEMS THAT HAVE THE GREATEST POTENTIAL FOR "REAST CANCER SCREENING n IMPROVEMENT BY SHOWING RELATIVE FREQUENCY /UTPATIENT !"8 FOR COLDS ANDOR SIZE IN A DESCENDING BAR GRAPH "ASED ON .OSOCOMIAL INFECTIONS THE PROVEN 0ARETO PRINCIPLE PERCENT OF THE (OSPITALIZED PATIENTS INJURED THROUGH NEGLIGENCE SOURCES CAUSE PERCENT OF ANY PROBLEMS 0OST -)
BLOCKERS 0ROCESS -APPING n )LLUSTRATED DESCRIPTION OF !IRLINE BAGGAGE HANDLING HOW THINGS GET DONE WHICH ENABLES PARTICIPANTS $ETECTION !DVERSE DRUG !NESTHESIA RELATED TREATMENT OF TO VISUALIZE AN ENTIRE PROCESS AND IDENTIFY AREAS FATALITY RATE DEPRESSION EVENTS OF STRENGTH AND WEAKNESS )T HELPS REDUCE CYCLE 53 )NDUSTRY TIME AND DEFECTS WHILE RECOGNIZING THE VALUE OF "EST IN #LASS INDIVIDUAL CONTRIBUTIONS 2OOT #AUSE !NALYSIS n 3TUDY OF THE ORIGINAL REASON FOR NONCONFORMANCE WITH A PROCESS LEVEL DEFECTS 7HEN THE ROOT CAUSE IS REMOVED OR CORRECTED THE NONCONFORMANCE WILL BE ELIMINATED @#HANGE IS THE LAW OF LIFE !ND THOSE WHO LOOK ONLY TO THE PAST OR PRESENT ARE CERTAIN TO MISS THE FUTURE n *OHN & +ENNEDY TH PRESIDENT OF THE 5NITED 3TATES OF !MERICA
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
1! )N #OMMONWEALTH (EALTH #ORPORATION IN +ENTUCKY BECAME ONE OF THE lRST HEALTHCARE PROVIDERS TO ADOPT 3IX 3IGMA ON A SYSTEM WIDE BASIS;= !DOPTIONS BY OTHER HEALTHCARE ORGANIZATIONS HAVE SINCE GAINED MOMENTUM HOWEVER IMPACT ON QUALITY ACROSS THE CONTINUUM OF CARE IS STILL BEING DISCOVERED %XHIBIT ILLUSTRATES DEFECT LEVELS FOR MANY HEALTHCARE PROCESSES ! ROUNDTABLE DISCUSSION WAS HELD FOR A GROUP OF HEALTHCARE ORGANIZATIONS WHO HAVE REALIZED THE BENElTS OF 3IX 3IGMA AND CHAMPIONED IT 4HE ROUNDTABLE PARTICIPANTS WERE ASKED A SERIES OF QUESTIONS TO REmECT HOW 3IX 3IGMA HAS SHAPED THE FUTURE OF HEALTHCARE QUALITY WITHIN THEIR ORGANIZATIONS AND WHAT FACTORS ARE CRITICAL FOR SUCCESSFUL ADOPTION 4HE FOLLOWING TRANSCRIPT SUMMARIZES THEIR EXPERIENCES AND LESSONS LEARNED 0RICEWATERHOUSE#OOPERS (OW DOES YOUR ORGANIZATION APPLY THE 3IX 3IGMA METHODOLOGY 7HAT PROJECTS HAVE YOU IMPLEMENTED AND WHAT RESULTS HAVE YOU ACHIEVED 'LENN #ROTTY 7E STARTED 3IX 3IGMA SIX YEARS AGO TO TACKLE COMPLEX ISSUES AND THOSE CROSSING MULTIPLE AREAS AND DEPARTMENTS IN THE ORGANIZATION 7E USE IT FOR PROJECTS THAT HAVE A VALUE TO THE ORGANIZATION OF OR MORE 4HE PROJECTS USUALLY RANGE IN DURATION FROM THREE TO SIX MONTHS 7E HAVE A 3IX 3IGMA TEAM THAT DIFFERENT FOLKS IN THE ORGANIZATION HAVE USED ON A VARIETY OF PROJECTS RANGING FROM WORK ON OUR SUPPLY CHAIN TO MANY QUALITY ISSUES 7E PUT THE 3IX 3IGMA TEAM ON ALL OF THE #-3 QUALITY INDICATORS !-) ;ACUTE MYOCARDIAL INFARCTION= PNEUMONIA BYPASS HIP AND KNEE AND HEART FAILURE CARE AND HAVE ACHIEVED QUALITY IMPROVEMENTS 7E ALSO USE 3IX 3IGMA TO lND DOLLARS TO HELP MANAGE THE NEXT YEARS BUDGET 4HE PROJECTS RETURN APPROXIMATELY MILLION A YEAR !DRIENNE %LBERFELD /UR hCARDIAC MEDv PROJECT IS LOOKING AT ADMINISTRATION OF MEDICATIONS FOR PATIENTS WITH EITHER AN !-) OR CONGESTIVE HEART FAILURE DIAGNOSIS 7E CAME UP WITH A TASK FORCE AND APPOINTED A DIRECTOR OF hPROGRAMS OF EXCELLENCEv FOR CARDIOLOGY AND THEY STARTED WORKING TOGETHER AND LOOKING AT THE DATA "Y MIDYEAR THEY HAD DEPLOYED 3IX 3IGMA RESOURCES 7E HAD A PROJECT TEAM THAT WAS INTERDISCIPLINARY WITH PHYSICIAN CHAMPIONS CASE MANAGEMENT MEDICAL RECORDS NURSING AND PARAMEDICS ON THE TEAM -EANWHILE WE WORKED WITH THE PHYSICIAN CHAMPIONS TO lX THE PROCESSES UNDERNEATH 4HE PHYSICIANS ARE IMPORTANT BECAUSE A LOT OF IT HAD TO DO NOT WITH THE CARE WE WERE DELIVERING BUT WITH DOCUMENTATION ISSUES 7HEN WE WENT IN TO THE PROJECT THE PHYSICIANS QUESTIONED THE DATA THAT WE WERE REPORTING TO #-3 KNOWING THAT THIS DATA WAS GOING TO BECOME AVAILABLE TO THE PUBLIC 7E WENT THROUGH A FORMAL PROCESS OF LOOKING AT THE INTEGRITY AND ACCURACY OF THE DATA /UR DATA WAS BEING COLLECTED BY OUTCOMES ANALYSTS SOME OF WHOM HAVE BEEN DOING THE JOB FOR YEARS WHO ARE TRAINED NURSES AND DO CHART REVIEW POST DISCHARGE BASED ON THE CRITERIA 3O THEY FELT VERY CONlDENT THAT THEY KNEW WHAT THEY WERE DOING WHEN THEY WERE REVIEWING CHARTS 7E LOOKED AT CHARTS AND HAD THE SAME FOUR PEOPLE REVIEW EACH OF THEM 4HEY AGREED WITH EACH OTHER ONLY PERCENT OF THE TIME AND THEY WERE ONLY PERCENT ACCURATE FOR #-3 GUIDELINES 4HIS WAS THE BIG hUH OHv
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 04 % 2
NOBODY WAS REVIEWING THE CHARTS IN THE SAME MANNER 4HEY WERE LOOKING AT THE SAME DATA BUT INTERPRETING IT DIFFERENTLY /N ANOTHER PROJECT WE BROUGHT IN ,EAN FOR #4 SCAN PRODUCTIVITY 7E LOOKED AT ONE OF OUR FACILITIES TO SEE HOW LONG IT TOOK FOR US TO DO A HEAD OR ABDOMINAL #4 SCAN 7E HAD SOME BENCHMARK NUMBERS AND WANTED TO SEE HOW WE WERE DOING WITH THAT 7E DID OUR PROCESS MAP )T CAME OUT TO BE STEPS FROM THE STRETCHER CROSSING THE THRESHOLD INTO THE ROOM TO THE STRETCHER LEAVING THE ROOM 7E HAD A LOT OF VARIATION 7E GOT IT DOWN TO STEPS AND WE WERE ABLE TO MEET THE BENCHMARKS .ONE OF THAT DATA COULD BE COLLECTED ELECTRONICALLY 7E ACTUALLY HAD TO HAVE DATA COLLECTORS ON SITE COLLECTING THE DATA %D 0OPOVICH 7EVE HAD ONE PROJECT IN WHICH WE SIGNIlCANTLY REDUCED THE DIAGNOSTIC JOURNEY TIME IN OUR CENTER FOR BREAST CARE FROM ABOUT EIGHT WEEKS DOWN TO TWO AND A HALF HOURS DRASTICALLY SHORTENING THE TIME TO BEGIN TREATMENT FOR SUSPECTED CANCERS 7E HAVE AN ALL DIGITAL FACILITY AND ARE ABLE TO DO SOME UNIQUE THINGS 7EVE TAKEN ON AN EFFORT TO STREAMLINE THE mOW IN OUR LABORATORY 7E HAD ANOTHER PROJECT IN THE EMERGENCY DEPARTMENT IN WHICH WE CUT OUR CYCLE TIME BY ABOUT PERCENT OR MORE &OR EXAMPLE OUR DOOR TO REGISTRATION TIME WAS REDUCED FROM TO MINUTES 3OME OF OUR OTHER PROJECTS INCLUDE STREAMLINING THE BENElT PROCESS IN (2 ELECTRONIC LEARNING IN OUR LIFELONG LEARNING CENTER RESPONDING TO CALL BELL REQUESTS IN OUR PATIENT ROOMS REGISTRATION ERROR REDUCTION BILLING ERROR REDUCTION AND IMPROVEMENT IN OUR GUEST RELATIONS DEPARTMENT IN TERMS OF COMPLAINT RESOLUTION -OREOVER WE HAVE APPLIED $ESIGN FOR 3IX 3IGMA APPROACHES TO NEW FACILITY DESIGN INCLUDING CHANGING THE LAYOUTS AND SCHEMATICS FOR OUR NEW CANCER CENTER !PPLICATION TO OUR NEW COMMUNITY AFlLIATED TEACHING HOSPITAL WILL SERVE AS A CATALYST FOR CREATING A SAFE HOSPITAL BY DESIGN "EN -ILES 7ERE JUST ABOUT TO COMPLETE OUR THIRD YEAR WITH 3IX 3IGMA HERE AT 3T *OHN (EALTH )NITIALLY WE ROLLED IT OUT AT TWO PRIMARY SITES AND AFTER OUR lRST PROJECTS WERE SUCCESSFUL WE DECIDED TO TAKE THIS INITIATIVE SYSTEMWIDE !SIDE FROM CHOOSING THE RIGHT METRIC FOR EACH PROJECT WEVE HAD QUITE AN EDUCATION OVER THE PAST FEW YEARS WITH REGARD TO MATCHING THE RIGHT METHODOLOGY AGAINST THE ISSUE THAT WE ARE FACING )NITIALLY WE WERE TRYING TO TACKLE EVERY PROBLEM WE ENCOUNTERED EXCLUSIVELY THROUGH THE USE OF 7ORK /UT OR THE $-!)# PROCESS 7E FOUND ,EAN TO BE AN ABSOLUTELY PHENOMENAL COMPLEMENT TO THE STATISTICAL RIGOR OF THE 3IX 3IGMA METHODOLOGY ITSELF AND WE HAVE WITNESSED A GREATER ABILITY TO ADDRESS KEY BUSINESS METRICS THROUGH THE USE OF VALUE STREAM ANALYSIS 4HE MAPS THAT WE CREATE ALLOW US TO STUDY AND BETTER UNDERSTAND THE mOW ASSOCIATED WITH THESE KEY METRICS FROM START TO lNISH )N TURN WE ARE ABLE TO CORRECTLY MATCH THE CORRECT APPROACH FOR EACH SEGMENT OF THE VALUE STREAM BE IT THROUGH ,EAN $-!)# OR 7ORK /UT /UR SINGLE GREATEST IMPACT HAS BEEN IN THE EMERGENCY DEPARTMENT ;%$= 2ATHER THAN ATTACKING THIS ISSUE FROM AN INTUITIVE STANDPOINT WE CREATED A VALUE STREAM MAP AT EACH SITE AND MAPPED BOTH THE INPATIENT AND OUTPATIENT %$ mOWS 7E FOUND A STRONG CORRELATION BETWEEN INPATIENT BED AVAILABILITY AND THROUGHPUT TIMES IN THE %MERGENCY $EPARTMENT !S A
1! RESULT WEVE SEEN A TREMENDOUS REDUCTION IN BOTH THE AVERAGE AND THE VARIATION OF OUR THROUGHPUT TIMES )N SOME CASES THESE IMPROVEMENTS HAVE EXCEEDED PERCENT 7HILE THESE IMPROVEMENTS ARE READILY SEEN IN OUR MONTHLY DASHBOARD REPORTS WE ARE ENCOURAGED TO SEE THIS EFFECT ALSO REmECTED IN OUR PATIENT SATISFACTION SCORES 0W# (OW HAVE YOU USED 3IX 3IGMA TO FOSTER COLLABORATION WITHIN YOUR OWN ORGANIZATION '# )N A NUMBER OF 3IX 3IGMA PROJECTS WE HAD TO DO A LOT OF EXPLAINING WITH THE SURGEONS ANESTHESIA AND CERTIlED REGISTERED NURSE ANESTHETISTS TO EDUCATE AND DEMONSTRATE THE VALUE OF THE PROCESSES 7E FOUND YOU NEED TO DEMONSTRATE THE VALUE BECAUSE WE HAD SO MANY SKEPTICS AND PEOPLE SAYING h/H HERE IS ANOTHER mAVOR OF THE DAY v AND h4HIS WILL GO AWAY IF ) JUST IGNORE IT LONG ENOUGHv 3O ) MADE IT A REQUIREMENT TO GET THIS TRAINING 4HEN AS MORE AND MORE PEOPLE WERE TRAINED THEY SAID h4HIS IS REALLY VALUABLE ) CAN USE THIS METHODOLOGY AND ) SEE RESULTS FROM ITv $EBBIE 9OUNG ) THINK ONE OF THE BIG THINGS FOR US IS THAT IT IS DATA DRIVEN !NYTIME WE START A PROJECT WE GET BASELINE DATA 3O WE KNOW EXACTLY WHERE OUR ISSUES ARE *IM +ARAGIORGIS 'IVEN THAT 3IX 3IGMA REPRESENTS CHANGE AND A BREAK FROM PAST PRACTICES )M NOT SO CONCERNED ABOUT THOSE STAKEHOLDERS WHO OPENLY RESIST COLLABORATION BECAUSE IT GIVES US THE OPPORTUNITY TO LISTEN TO THEIR CONCERNS )N CONTRAST THOSE STAKEHOLDERS WHO QUIETLY RESIST BECAUSE THEY FEEL THREATENED CAN TRULY UNDERMINE CHANGE INITIATIVES AND THEIR EXISTENCE NEEDS TO BE ACKNOWLEDGED 4O ACHIEVE COLLABORATION DURING OUR DEPLOYMENT WEVE HAD TO COMMUNICATE OVER AND OVER AGAIN THAT A 3IX 3IGMA PROJECT IS INTENDED TO EXAMINE A PROCESS PROBLEM IMPLEMENT A SOLUTION AND THEN CONCLUDE ONCE THE PROCESS OWNER IS CAPABLE OF SUSTAINING THE IMPROVEMENT 4HIS WAS MADE EASIER BY lRST BUILDING RELATIONSHIPS WITH SEVERAL PROGRESSIVE PROCESS OWNERS WHO WERE ACTIVELY ENGAGED IN IMPROVING THEIR OPERATIONS /NCE PERCENT OF THE STAKEHOLDERS BOUGHT IN TO 3IX 3IGMA AND ITS INHERENT NEED FOR COLLABORATION TO ACHIEVE SUCCESS MOST OF THE OTHERS FOLLOWED 3USAN -C'ANN 7E HELD A 7ORK /UT WITH TWO OF OUR MAJOR PAYERS AND IN THIS PARTICULAR PROCESS WE RECOGNIZED THAT NOT ONLY DO WE HAVE OUR INTERNAL ISSUES BUT WE ALSO HAD AN EXTERNAL CUSTOMER 7E NEEDED TO MAKE SURE THAT ANY CHANGES WE WERE GOING TO MAKE IN OUR BILLING PROCESS WERE NOT GOING TO AFFECT OUR ABILITY TO GET PAID IN THE LONG RUN 3UBSEQUENTLY WE MADE SURE THAT WHEN WE LOOKED AT OUR BILLING PROCESS INTERNALLY IT WOULD NOT IMPACT THE WAY THINGS WERE RECEIVED ON THE OTHER END BY THE PAYERS !S A RESULT WE CONDUCTED A HALF DAY 7ORK /UT WITH EACH OF THEM )T WAS REALLY PHENOMENAL BECAUSE THEY ;THE PAYERS= WERE TAKEN ABACK BY WHAT WE WERE DOING INTERNALLY 7HAT ALSO EXCITED THEM WAS THAT WE ARE WORKING SO HARD TO IMPROVE THIS PROCESS AND THAT THEY ULTIMATELY WOULD BENElT FROM THE WORK WE WERE DOING TO STREAMLINE OUR PROCESSES
7HAT ARE THE CRITICAL SUCCESS FACTORS FOR IMPLEMENTING A 3IX 3IGMA PROJECT '# %ACH PROJECT HAS TO RETURN TO THE ORGANIZATION AT LEAST OF IMPROVEMENT TO THE BOTTOM LINE AND WE HAVE THIS VERIlED BY lNANCE )T HAS TO IMPROVE THE QUALITY AND SAFETY OF PROCESSES OR PROCEDURES IF ITS RELATED TO A CLINICAL ISSUE AND IT HAS TO SOLVE COMPLEX ISSUES ACROSS THE ORGANIZATION "- /NE OF THE SINGLE GREATEST FACTORS IS IDENTIFYING AND SUPPORTING THE ROLE OF THE PROCESS OWNER )T IS ESSENTIAL TO HAVE THIS PERSON INVOLVED ON A TEAM AS WELL AS ENSURE THAT EVERYONE UNDERSTANDS THEIR PERSONAL ACCOUNTABILITY TO SUSTAIN THESE IMPROVEMENTS OVER TIME ! SECOND KEY FACTOR IS HAVING THE lNANCE FUNCTION ENGAGED )TS MORE THAN JUST HAVING THEM DETERMINE WHETHER THE DOLLARS ARE HARD OR SOFT 9OU NEED TO TRULY PARTNER WITH THEM AND HAVE THEM HELP IDENTIFY WHERE THE KEY AREAS OF OPPORTUNITY ARE '# 3IX 3IGMA PROVIDES AN INDUSTRIAL STRENGTH QUALITY IMPROVEMENT METHODOLOGY 4HE VOICE OF THE CUSTOMER WILL HELP HEALTHCARE PROVIDERS FULlLL THE )/-S SIX AIMS FOR PATIENT CARE )T PROVIDES A WAY TO STANDARDIZE AND A METHODOLOGY FOR RELIABLE CARE n THE PURPOSE OF THE SIX QUALITY AIMS OF THE )NSTITUTE OF -EDICINE n %NDNOTES HTTPWWWGECOMENCOMPANYCOMPANYINFOQUALITYWHATISHTM HTTPWWWISIXSIGMACOMSIXSIGMASIX?SIGMAASP HTTPWWWISIXSIGMACOMLIBRARYCONTENTCAASP HTTPWWWISIXSIGMACOMLIBRARYCONTENTCAASP )BID !DAPTED FROM HTTPWWWGECOMENCOMPANYCOMPANYINFOQUALITY GLOSSARYHTM HTTPWWWGEHEALTHCARECOMTWZHPROD?SOLHCAREPDFGEPDF
!CHIEVING 1UALITY 4HROUGH 3IX 3IGMA ,ESSONS ,EARNED 5TILIZING 3IX 3IGMA IT IS ESTIMATED A COMPANY CAN SAVE APPROXIMATELY TO MILLION PER PROJECT DEPENDING ON THE TYPE OF PROJECT AND CAN SAVE A COMPANY ON AVERAGE MILLION TO MILLION PER YEAR BASED ON THE NUMBER OF PROJECTS UNDERTAKEN AND THE SIZE OF THE ORGANIZATION )MPLEMENTING 3IX 3IGMA REQUIRES A SIGNIlCANT lNANCIAL AND ADMINISTRATIVE INFRASTRUCTURE $ElNING AND TRACKING A PROBLEM IS KEY TO SUCCESSFUL IMPLEMENTATION %NSURING THAT PROBLEMS ARE ANALYZED WITH CORRECT DATA IS CRITICAL 2ESULTING PROJECTS ELIMINATE NONVALUE ADDED STEPS 3IX 3IGMA CAN HELP DECREASE THE TOTAL NUMBER OF STEPS IN A PROCESS BY AS MUCH AS PERCENT 3IX 3IGMA IS LEADERSHIP DEVELOPMENT )T CAN USE PEOPLE FROM VARIOUS BACKGROUNDS AND CHANGE THEIR METHOD OF THINKING
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
4HE 2OLE OF !CCREDITATION IN 1UALITY "Y SETTING OBJECTIVE AND MEASURABLE STANDARDS ACCREDITATION PROVIDES MORE THAN A mOOR FOR QUALITY 4HE ACCREDITATION PROCESS ITSELF PROVIDES AN OPPORTUNITY FOR HEALTH ORGANIZATIONS TO CRITICALLY EXAMINE THEIR QUALITY AND IMPLEMENT CHANGES TO IMPROVE THEIR PERFORMANCE "Y 2ICHARD ' "ATTAGLIA 0RICEWATERHOUSE#OOPERS
0
HYSICIANS AND HEALTHCARE ORGANIZATIONS OFTEN ASSUME THAT THEY ARE PROVIDING HIGH QUALITY CARE AND DO NOT RECOGNIZE AREAS OF DElCIENCY UNTIL THEY START TO MEASURE THEMSELVES 4HE ACCREDITATION PROCESS BY REQUIRING THAT THEY HOLD THEMSELVES ACCOUNTABLE TO AN OBJECTIVE SET OF QUALITY MEASURES PROVIDES AN OPPORTUNITY FOR SELF EXAMINATION AND QUALITY IMPROVEMENT "Y RECOGNIZING ACCREDITATION AS A PROCESS RATHER THAN AN EVENT PHYSICIANS AND HOSPITALS CAN INCORPORATE QUALITY IMPROVEMENT INTO THEIR ROUTINE CLINICAL AND ADMINISTRATIVE ACTIVITIES
!CCREDITATION n 4HE "ASICS %VERY DAY IN !MERICA MILLIONS OF PEOPLE SEE A DOCTOR VISIT A HOSPITAL OR CHOOSE A NEW INSURANCE PLAN -OST RECEIVE EXCELLENT CARE WITH GOOD RESULTS "UT OCCASIONALLY SOMETHING GOES WRONG -EDICAL ERRORS OCCUR THAT SHOULD HAVE BEEN PREVENTED 0ATIENTS ARE DIAGNOSED OR TREATED INCORRECTLY 4HE mAWS OF THE 53 HEALTHCARE SYSTEM AND THE FACT THAT IT DEPENDS ON PRIVATELY OWNED INSTITUTIONS AND ORGANIZATIONS HAVE GIVEN RISE TO ACCREDITATION !CCREDITATION IS ACCOMPLISHED THROUGH PRIVATE AGENCIES THAT MONITOR PROVIDERS AND PAYERS TO ENSURE QUALITY HEALTHCARE 7HILE A GROWING NUMBER OF ORGANIZATIONS ARE INVOLVED IN HEALTHCARE ACCREDITATION THE TWO LARGEST ARE THE *OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS *#!(/ AND THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1! *#!(/ ACCREDITS HOSPITALS AND OTHER HEALTHCARE ORGANIZATIONS INCLUDING HOME CARE AGENCIES LONG TERM CARE FACILITIES AND AMBULATORY CARE PROVIDERS;= .#1! EVALUATES HEALTH PLANS BASED ON THEIR EFFECTIVENESS OF QUALITY IMPROVEMENT ASSESSMENT OF CREDENTIALS AND QUALIlCATIONS OF HEALTH PROFESSIONALS APPLICATION OF UTILIZATION MANAGEMENT PROGRAMS
PROMOTION AND PROTECTION OF MEMBERS RIGHTS AND OUTCOMES OF STANDARDIZED PERFORMANCE MEASURES -ORE THAN THREE QUARTERS OF (-/ ENROLLEES IN THE 53 ARE IN .#1! ACCREDITED PLANS;= ! COMPELLING REASON PROVIDERS AND PAYERS SEEK ACCREDITATION IS lNANCIAL *#!(/ HAS hDEEMED STATUS v WHICH MEANS THAT BY PASSING *#!(/ SURVEYS HOSPITALS ARE ELIGIBLE FOR -EDICARE REIMBURSEMENT WHICH ON AVERAGE MAKES UP ABOUT PERCENT OF A HOSPITALS REVENUES -ANY STATES ALSO RELY ON *#!(/ ACCREDITATION AS A SUBSTITUTE FOR HAVING THEIR OWN REGULATORY SURVEY PROGRAMS "ECAUSE ACCREDITATION IS OFTEN LINKED TO -EDICARE CERTIlCATION HOSPITALS THAT DO NOT PASS THEIR SURVEYS OFTEN SPEND HUNDREDS OF THOUSANDS OF DOLLARS IN PRODUCTIVITY AND CONSULTING FEES TO ACHIEVE COMPLIANCE *#!(/ ALLOWS HOSPITALS DENIED ACCREDITATION TO APPEAL WHICH TAKES SEVERAL WEEKS )F A HOSPITALS APPEAL IS DENIED IT MAY REAPPLY AFTER NINE MONTHS /N THE HEALTH PLAN ACCREDITATION SIDE MANY EMPLOYERS REQUIRE THEIR HEALTH PLAN VENDORS TO RECEIVE .#1! ACCREDITATION !FTER RECEIVING ACCREDITATION MOST PAYERS AND PROVIDERS PUBLICIZE THIS FACT SUPPORTING THE BELIEF THAT PUBLIC RECOGNITION IS ALSO A SIGNIlCANT DRIVER OF ACCREDITATION ! SEAL OF APPROVAL FROM A WELL KNOWN ACCREDITING BODY PROVIDES BOTH PAYERS AND PROVIDERS WITH A COMPETITIVE ADVANTAGE IN THE MARKETPLACE
)NCREASED 3CRUTINY )MPROVED 1UALITY !S ACCREDITATION HAS BECOME THE ACCEPTED NORM A GREATER EMPHASIS ON PATIENT OUTCOMES HAS REPLACED THE PREVIOUS PREOCCUPATION WITH STRUCTURE AND PROCESS /VER THE LAST DECADE THE ACCREDITING ORGANIZATIONS WORKED ON COORDINATING CONSISTENT MEASUREMENTS BETWEEN INSTITUTIONS AND AMONG HEALTH PLANS
2ICHARD ' "ATTAGLIA -$ &!#0 IS A MANAGER IN 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E FOCUSES ON QUALITY IMPROVEMENT IN HEALTHCARE WITH A SPECIAL INTEREST IN THE ROLE OF ACCREDITATION AS A TOOL TO IMPROVE QUALITY 7ITH YEARS OF HEALTHCARE INDUSTRY EXPERIENCE HE HAS HELD LEADERSHIP POSITIONS IN BOTH PAYER AND PROVIDER ORGANIZATIONS (E CAN BE REACHED AT RICHARDGBATTAGLIA USPWCCOM (INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
SGDãQ N KDã N E ã @ B B Q D C H S@S H N M ã H M ã P T @ K H S X )N THIS WAY *#!(/ AND .#1! ARE COMPARING APPLES TO APPLES WHEN THEY LOOK AT PERFORMANCE OUTCOMES 4HE RESULT IS COMPARABLE POPULATIONS BEING MEASURED WITH OUTCOMES THAT ARE NOW A MORE RELIABLE INDICATOR OF TRUE QUALITY )N THE EARLY S .#1! TOOK OVER RESPONSIBILITY FOR ENHANCING THE (EALTH 0LAN %MPLOYER $ATA AND )NFORMATION 3ET (%$)3 A STANDARDIZED TOOL THAT MEASURES THE PERFORMANCE OF IMPORTANT ASPECTS OF CARE AND SERVICE AMONG HEALTH PLANS %MPLOYERS CONSULTANTS AND EVEN CONSUMERS NOW USE (%$)3 DATA TO CHOOSE HEALTH PLANS (%$)3 RESULTS ARE REVIEWED BY OUTSIDE AUDITORS TO ENSURE VALIDITY 3OME STATES HAVE EVEN STARTED TO MANDATE THAT (%$)3 MEASURES FOR THE -EDICAID POPULATION BE REPORTED TO THE STATES AND TO THE PUBLIC !S MEASUREMENT AND REPORTING BECAME MORE SOPHISTICATED THE ACCREDITATION PROCESS HAS GROWN MORE TRANSPARENT 0RIOR TO THE S SCORING MECHANISMS AND MEASUREMENT DETAILS WERE SEEN AS AN IMPENETRABLE BLACK BOX n WITH NO PLAYERS OTHER THAN THE ACCREDITING ORGANIZATIONS ABLE TO SEE INSIDE TO TRULY UNDERSTAND HOW PROGRAMS WERE MEASURED 2ESPONDING TO PRESSURE FROM #ONGRESS AND THE PUBLIC IN *#!(/ BEGAN REPORTING MORE DATA ABOUT PATIENT SAFETY .#1! ALSO MADE SCORING GUIDELINES AVAILABLE THAT WERE USED TO ASSIST ACCREDITATION DECISION MAKING )N ADDITION CRITERIA HAVE BECOME MORE STRINGENT OVER THE LAST YEARS SO ACHIEVING ACCREDITATION IS NO LONGER SEEN AS SIMPLY A RUBBER STAMP !LTHOUGH IT RARELY REVOKES A HOSPITALS ACCREDITATION *#!(/ HAS RAISED THE BAR BY CONTINUALLY INTRODUCING NEW STANDARDS TO HELP HOSPITALS BECOME SAFER AND MORE EFFECTIVE .#1! HAS SIMILARLY RAISED THE hINDUSTRY BARv 4HE NATURAL AND DESIRED OUTCOME OF AN INCREASED EMPHASIS ON MEASUREMENT IS IMPROVED PATIENT SAFETY 7HEN HOSPITALS FAIL TO PROTECT PATIENTS THE RESULT CAN BE A PUBLIC RELATIONS DISASTER AND INCREASED CONSUMER AWARENESS AND WARINESS )N THE LAST DECADE REPORTS OF HOSPITALS AMPUTATING THE WRONG LIMBS OR PATIENT DEATHS FROM MISADMINISTRATION OF MEDICINE HAS INCREASED PUBLIC SCRUTINY OF INSTITUTIONS PAVING THE WAY FOR ACCREDITING BODIES LIKE *#!(/ TO PROMOTE CHANGES TO INCREASE QUALITY AND SAFETY ! RELATIVELY RECENT CHANGE THAT HAS HELPED HOSPITALS IMPROVE QUALITY IS THAT *#!(/ VISITS ARE NOW UNSCHEDULED AND OFTEN UNEXPECTED 9EARS AGO A HOSPITAL WOULD HAVE MONTHS TO TWEAK OPERATIONS BEFORE A SURVEY 4ODAY SURVEYORS ARRIVE UNANNOUNCED REQUIRING HEALTHCARE INSTITUTIONS TO INCORPORATE QUALITY PRINCIPLES INTO THE WAY THEY DELIVER SERVICES ON A DAILY BASIS (OSPITALS THAT OPERATE IN A STATE OF hREADINESSv ARE MORE LIKELY TO CORRECTLY IMPLEMENT POLICIES AND PROCEDURES THAT DIRECTLY CORRELATE TO INCREASED CLINICAL QUALITY AND PATIENT SAFETY !NOTHER TREND IS THAT HOSPITALS ARE NOW PRACTICING MORE SELF REPORTING THAN EVER BEFORE )NSTEAD OF FOCUSING ON A SURVEY EVENT EVERY THREE YEARS INSTITUTIONS HAVE DEVELOPED AN ONGOING RELATIONSHIP WITH *#!(/ BY REGULARLY DELIVERING OPERATIONAL DATA 3ELF REPORTING CAUSES HOSPITALS TO REGULARLY CONSIDER HOW THEY DO BUSINESS AND CONDUCT PATIENT CARE SUPPORTING A CONTINUOUS FOCUS ON IMPROVING QUALITY
! 0ROACTIVE !PPROACH TO 1UALITY /NE OF THE MOST SIGNIlCANT BENElTS OF ACCREDITATION HAS BEEN THE GROWTH OF EVIDENCE BASED MEDICINE %MPHASIZING TREATMENT GUIDELINES BASED ON OBJECTIVE TESTS OF EFlCACY AND SAFETY PUBLISHED IN PEER REVIEWED SCIENTIlC LITERATURE EVIDENCE BASED MEDICINE SUPPORTS THE CONCEPT OF ACCREDITATION SINCE ACCREDITING BODIES CAN OBJECTIVELY DETERMINE WHETHER ACCEPTED GUIDELINES ARE BEING FOLLOWED "Y USING PERFORMANCE DATA WITH REGARD TO GUIDELINES AND BEST PRACTICES TO GUIDE QUALITY IMPROVEMENT EFFORTS BOTH PAYERS AND PROVIDERS BENElT KEEPING THEIR ACCREDITATIONS CURRENT AND MOST IMPORTANTLY ENHANCING PATIENT OUTCOMES )NCREASED PATIENT SAFETY IS A NATURAL OUTGROWTH OF PROACTIVE MEDICAL MANAGEMENT "Y ENSURING THAT PROCESSES ARE CONSISTENT AND SAFE FROM THE OUTSET PROVIDERS CAN BUILD SAFETY INTO PROGRAMS UP FRONT TO MINIMIZE HEALTH RISKS TO BOTH PATIENTS AND PATIENTS FAMILIES &OR EXAMPLE A HOSPITAL WITHOUT A lRE SAFETY PROGRAM MIGHT ENDANGER BOTH PATIENTS AND VISITORS IF A lRE WERE TO OCCUR ! CLINIC WITHOUT AN INFECTIOUS DISEASE POLICY DRAMATICALLY INCREASES THE RISK OF SPREADING INFECTIONS AMONG PATIENTS AND EMPLOYEES !N ONGOING QUALITY PROGRAM ENSURES PATIENT SAFETY AND MINIMIZES RISK FOR HOSPITALS )N ADDITION TO IMPROVING QUALITY AND SAFETY ACCREDITATION HAS RAISED AWARENESS OF PATIENTS RIGHTS #OMPETITIVE PRESSURES ON PAYERS AND PROVIDERS TO INCREASE QUALITY OF SERVICE HAS BEEN A WAKE UP CALL FOR ORGANIZATIONS TO REMEMBER WHO THEY ARE SERVING n CONSUMERS n AND THAT THESE CONSUMERS CHOOSE WHICH FACILITIES AND WHICH HEALTH PLANS GET THEIR BUSINESS &OR EXAMPLE IF A HEALTH PLAN INAPPROPRIATELY DENIES COVERAGE TO AN INDIVIDUAL AND DOES NOT HAVE APPROPRIATE MECHANISMS TO ENSURE MEMBER APPEAL RIGHTS ACCREDITATION SURVEYORS DEEM THIS AS UNACCEPTABLE AND NONCOMPLIANT WITH .#1! STANDARDS 3TANDARDIZED QUALITY MEASURES HAVE ALSO HELPED CONSUMERS COMPARE PROVIDERS AND PAYERS FOR EASIER DECISION MAKING 4HE FACT THAT MUCH OF THIS INFORMATION IS NOW PUBLICLY REPORTED INCREASES CONSUMER ACCESS AND EXERTS PRESSURE ON ALL HEALTHCARE PLAYERS TO PERFORM 0ATIENTS ALSO HAVE THE OPPORTUNITY TO REGISTER COMPLAINTS WITH *#!(/ AND #-3 0ATIENTS CAN FEEL CONlDENT THEIR ISSUES WILL BE INVESTIGATED AND ADDRESSED AS WELL
+EY 3UCCESS &ACTORS IN 0URSUING !CCREDITATION 4O PERFORM APPROPRIATELY AND RECEIVE ACCREDITATION ORGANIZATIONS SHOULD KEEP THESE KEY FACTORS IN MIND )NCORPORATE THE INTENT AND PRINCIPLES OF THE ACCREDITATION PROGRAM INTO EVERYDAY WORK !CCREDITATION CANNOT BE VIEWED AS A STAND ALONE FOCUS OR AN ADD ON TO A NINE TO lVE WORKDAY )T IS ALSO NOT THE SOLE RESPONSIBILITY OF COMPLIANCE OFlCERS 4RUE QUALITY EFFORTS MUST TOUCH EVERY DEPARTMENT AND INCORPORATE ONGOING IMPROVEMENT PROCESSES AND PROGRAMS INTO EVERY CORNER OF THE ORGANIZATION
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
SGDãQ N KDã N E ã @ B B Q D C H S@S H N M ã H M ã P T @ K H S X !DOPT A MULTIDISCIPLINARY APPROACH TO IMPROVEMENT RATHER THAN FOCUS ON INDIVIDUAL DEPARTMENTS 7HEN *#!(/ VISITS A HOSPITAL SURVEYORS TRACE A PATIENTS PATH THROUGHOUT A HOSPITAL STAY TO DETERMINE WHERE ERRORS MAY HAVE OCCURRED ! COMMUNICATION BREAKDOWN ALONG THAT PATH FOR EXAMPLE BETWEEN THE PHARMACY AND THE CARDIAC CARE UNIT INDICATES A WEAK LINK IN THE PATIENT CARE CHAIN THAT NEEDS TO BE RESOLVED )NTEGRATE DATA SYSTEMS TO PROMOTE EASY INFORMATION ACCESS 4HIS ALLOWS EVALUATION OF COMPLEX SYSTEMS AND PROGRAMS AND ENABLES GROUPS WITHIN AN ORGANIZATION TO USE MORE THAN ONE SET OF DATA TO SOLVE A PROBLEM !PPOINT ONE PERSON OR A GROUP OF PEOPLE TO KEEP UP WITH CHANGING STANDARDS AND NEW LITERATURE TO ENSURE THAT A MODIlCATION OR PATIENT SAFETY GOAL IS NOT MISSED 'ET THE #%/ AND GOVERNING BOARD INVOLVED SO THAT CHANGE MANAGEMENT CAN OCCUR FROM THE TOP DOWN ,EADERSHIP DISCONNECTED FROM THE MANAGEMENT OF ACCREDITATION WILL NOT BE PREPARED TO DEAL WITH THESE SURVEYORS #ONSIDER IDENTIFYING A WELL VERSED ORGANIZATIONAL LEADER OR CONSULTANT TO INTEGRATE THE INTENT OF THE STANDARDS INTO PRACTICAL BUSINESS PROCESSES 4HIS INDIVIDUAL SHOULD BE ABLE TO CLEARLY COMMUNICATE IMPROVEMENTS AND POSITIVE CULTURE CHANGES AS THEY OCCUR
/N THE (ORIZON $ESPITE THE MANY POSITIVE ASPECTS OF ACCREDITATION IT IS NOT A TOPIC WITHOUT CONTROVERSY /PPONENTS QUESTION THE VALUE OF ACCREDITATION GIVEN THE CONSIDERABLE FEES PAID TO ACCREDITING BODIES AS WELL AS THE AMOUNT OF STAFF TIME AND OTHER RESOURCES SPENT TO COMPLY 0ROPONENTS OF ACCREDITATION ARGUE THAT IMPROVEMENTS HAVE TAKEN PLACE AND THAT PATIENTS ARE NOW SAFER BECAUSE OF IT &OR EXAMPLE *#!(/S CHANGE TO UNANNOUNCED VISITS WAS DRIVEN IN LARGE PART BY INCREASED ATTENTION TO PATIENT SAFETY ISSUES )MPROVING PATIENT SAFETY WAS ALSO THE IMPETUS FOR THE INCREASE IN SELF REPORTING BY HOSPITALS
/RGANIZATIONS THAT RECOGNIZE ACCREDITATION AS A PROCESS NOT AN EVENT WILL APPLY ACCREDITATION PRINCIPLES AS AN INGRAINED PART OF DOING BUSINESS )N ADDITION TO MAKING THE WORK OF ACCREDITATION EASIER INTEGRATING A CULTURE OF QUALITY WILL INEVITABLY IMPROVE PATIENT OUTCOMES !S ACCREDITING BODIES CONTINUE TO ENHANCE MEASUREMENTS AND STANDARDS HOSPITALS AND INSURERS WILL BECOME MORE EFlCIENT KEEPING COSTS DOWN AND INCREASING CONSUMER SATISFACTION 4HE MOST IMPORTANT BENElTS OF ACCREDITATION IMPROVED CLINICAL QUALITY AND PATIENT SAFETY WILL CONTINUE TO KEEP PATIENTS IN THE FOREFRONT AND HOLD PAYERS AND PROVIDERS ACCOUNTABLE FOR DELIVERING QUALITY HEALTHCARE;= %NDNOTES 0ERSONAL COMMUNICATION *UNE *#!(/ !CCREDITATION #ERTIlCATES OFlCE HTTPWWWNCQAORG#OMMUNICATIONS0UBLICATIONSOVERVIEWNCQAPDF .EURATH 0 h3TUDY -EDICARE -EDICAID PAYMENTS DRIVE UP EMPLOYEE INSURANCE COSTS v 0UGET 3OUND "USINESS *OURNAL ACCESSED AT HTTPSEATTLE IZJOURNALSCOMSEATTLESTORIESDAILYHTML PAGE h+EY &INDINGS OF 'ALLUP 3URVEY !WARENESS OF AND !TTITUDES TOWARD "OARD #ERTIlCATIONS OF 0HYSICIANS v !MERICAN "OARD OF )NTERNAL -EDICINE EMBARGOED ON !UGUST HTTPWWWABMSORGDOWNLOADS NEWSGALLUPPOLLKEYlNDINGSPDF ACCESSED !PRIL 'REINER !# AND % +NEBEL EDS h(EALTH 0ROFESSIONS %DUCATION ! "RIDGE TO 1UALITY v )NSTITUTE OF -EDICINE 3ECTISH 4 # AND % , :ALNERAITIS # #ARRACCIO AND 2 % "EHRMAN h4HE STATE OF PEDIATRICS RESIDENCY TRAINING ! PERIOD OF TRANSFORMATION OF GRADUATE MEDICAL EDUCATION v 0EDIATRICS VOL PP h7HAT IS -AINTENANCE OF #ERTIlCATION -/# v !MERICAN "OARD OF -EDICAL 3PECIALTIES ACCESSED ON -AY HTTPWWWABMSORG $OWNLOADS0UBLICATIONS 7HAT PERCENTIS PERCENT-/#PDF 3TEINBOOK 2 h2ENEWING "OARD #ERTIlCATION v .%*- VOL PP h!WARENESS OF AND !TTITUDES TOWARD "OARD #ERTIlCATION OF 0HYSICIANS v !UGUST 4HE 'ALLUP /RGANIZATION FOR 4HE !MERICAN "OARD OF )NTERNAL -EDICINE HTTPWWWABIMORGRESOURCESPRESSGALLUP?REPORT PDF ACCESSED -AY HTTPWWWABIMORGRESOURCESPRESSGALLUP? REPORTPDF ACCESSED -AY
0HYSICIAN #ERTIlCATION 0HYSICIAN CERTIlCATION ALTHOUGH VOLUNTARY IS INCREASINGLY BECOMING THE GOLD STANDARD THAT STAKEHOLDERS USE TO JUDGE CLINICAL COMPETENCE AND QUALITY OF PHYSICIAN CARE 7HILE THEY MAY NOT UNDERSTAND THE RIGORS OF BOARD CERTIlCATION CONSUMERS DO RECOGNIZE ITS IMPORTANCE ! 'ALLUP SURVEY REVEALED THAT PERCENT OF CONSUMERS WOULD SELECT A BOARD CERTIlED PHYSICIAN RATHER THAN A PHYSICIAN WHO WAS NOT BOARD CERTIlED BUT WAS RECOMMENDED BY FRIENDS ANDOR FAMILY;= $ESPITE THE APPREHENSION OF ADDITIONAL ADMINISTRATIVE WORK PHYSICIAN LEADERS RECOGNIZE THE MOVEMENT TOWARD QUALITY REPORTING AND ARE TAKING THE LEAD IN IDENTIFYING NEW QUALITY IMPROVEMENT CERTIlCATION REQUIREMENTS BEFORE THEY ARE SET BY OTHER ORGANIZATIONS 4HE )NSTITUTE OF -EDICINES )/- REPORT h(EALTH 0ROFESSIONS %DUCATION ! "RIDGE TO 1UALITY v OUTLINED lVE COMPETENCIES THAT CERTIlCATION ORGANIZATIONS SHOULD OFFER TO
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
ENSURE PHYSICIANS DEVELOP AND MAINTAIN PROlCIENCY 4HE lVE AREAS IDENTIlED INCLUDE;= $ELIVERING PATIENT CENTERED CARE 7ORKING AS PART OF INTERDISCIPLINARY TEAMS 0RACTICING EVIDENCE BASED MEDICINE &OCUSING ON QUALITY IMPROVEMENT AND 5TILIZING INFORMATION TECHNOLOGY TO IMPROVE QUALITY )N RESPONSE THE !CCREDITATION #OUNCIL OF 'RADUATE -EDICAL %DUCATION AND THE !MERICAN "OARD OF -EDICAL 3PECIALTIES !"-3 DEVELOPED COMPETENCY STANDARDS THAT ARE ALIGNED WITH THOSE OF THE )/-S RECOMMENDATIONS;= -ORE THAN PERCENT OF PHYSICIANS IN SPECIALTIES ARE BOARD CERTIlED;= !"-3 AND OTHER PHYSICIAN SPECIALTY BOARDS HAVE RECENTLY MADE VAST EFFORTS TO DEVELOP GUIDELINES AND SET CREDENTIALING REQUIREMENTS CENTERED ON IMPROVING THE QUALITY OF PATIENT CARE #ONTINUED ON THE NEXT PAGE
SGDãQ N KDã N E ã @ B B Q D C H S@S H N M ã H M ã P T @ K H S X 0HYSICIAN #ERTIlCATION CONTINUED
1UALITY 2EQUIREMENTS FOR #ERTIlCATION )N *ANUARY 4HE !MERICAN "OARD OF )NTERNAL -EDICINE !")- AND !"-3 PHASED IN A QUALITY IMPROVEMENT REQUIREMENT AS A CONDITION FOR CERTIlCATION AND RECERTIlCATION )NTERNISTS ARE NOW REQUIRED TO COMPLETE PRACTICE PERFORMANCE EVALUATIONS TO BE RECERTIlED h4HE "OARDS INCLUDING !")- ARE AMONG THE FEW EXISTING ORGANIZATIONS THAT BOTH PHYSICIANS AND THE PUBLIC VALUE HIGHLY 4HE PROFESSION IS SETTING STANDARDS FOR ITSELF 7E ARE TRANSFORMING WHAT IT MEANS TO BE A BOARD CERTIlED SPECIALIST v SAYS #HRISTINE + #ASSEL -$ PRESIDENT AND #%/ OF !")- !")- PROVIDES ONLINE MODULES AND TOOLS FOR PHYSICIANS TO COLLECT AND REPORT SELF EVALUATIONS AND MEASURE PRACTICE PERFORMANCE 4HE NEW CERTIlCATION STANDARDS EXHIBIT HOW THE ORGANIZATION IS TRANSFORMING hWHAT IT MEANS TO BE A BOARD CERTIlED SPECIALIST THAT THE PHYSICIAN IS CURRENT WITH KNOWLEDGE AND COMMUNICATING THIS TO PATIENTS DURING TREATMENT v ACCORDING TO #ASSEL 4HE INCREASING USE OF SIMULATED PATIENTS AND CLINICAL SITUATIONS PARTICULARLY IN ANESTHESIA IN THE TRAINING OF MEDICAL STUDENTS AND RESIDENTS IS ALSO A GROWING TREND 4HIS IS NOT DISSIMILAR TO mIGHT SIMULATORS FOR PILOTS 4HIS SIMULATION TECHNOLOGY MAY BE LEVERAGED FOR PRACTICE PERFORMANCE EVALUATIONS IN THE FUTURE 5SE OF SIMULATION IN QUALITY IMPROVEMENT IS DISCUSSED FURTHER IN THE PAPER IN THIS BOOK h)MPROVING (EALTHCARE 1UALITY IN THE 0EDIATRIC !MBULATORY %NVIRONMENTv )N ADDITION TO BROADENING CREDENTIAL REQUIREMENTS !")- IS WORKING WITH CONSUMER GROUPS TO IMPROVE COMMUNICATION EFFORTS BETWEEN THE BOARD AND CONSUMERS !S EXPLAINED BY #ASSEL h)NFORMATION IS AVAILABLE FOR FREE FOR CONSUMERS )T ;BOARD CERTIlCATION= IS OFTEN TAKEN FOR GRANTED AND IS BELOW THE RADAR SCREENv /NE OF !")-S IMMEDIATE ACTION STEPS IS TO MAKE BOARD CERTIlCATION AND RECERTIlCATION RESULTS MORE ACCESSIBLE AND hUSER FRIENDLYv FOR CONSUMERS )N ANOTHER INITIATIVE !")- IS BECOMING ACTIVELY INVOLVED WITH QUALITY ORGANIZATION LEADERS IN PAY FOR PERFORMANCE INITIATIVES 4HE ORGANIZATION IS COLLABORATING WITH "RIDGES 4O %XCELLENCE COMMERCIAL INSURERS AND #-3 TO PROVIDE MEMBERS WITH CREDIT TOWARD THEIR RECERTIlCATION FOR PARTICIPATION IN PAY FOR PERFORMANCE PROGRAMS
4IME ,IMITED #ERTIlCATION "ECAUSE EVIDENCE SUGGESTS THAT THE KNOWLEDGE AND SKILLS OF PRACTICING PHYSICIANS DIMINISH OVER TIME SPECIALTY BOARDS ARE MOVING TOWARD TIME LIMITED RECERTIlCATION PROGRAMS;= 7HILE SOME SPECIALTY GROUPS LIKE THE !MERICAN "OARD OF 3URGERY HAVE REQUIRED TIME LIMITATION ON CERTIlCATION AND RE EXAMINATION SINCE THE S OTHERS HAVE ONLY RECENTLY MOVED TO THAT PRACTICE )N MEDICAL SPECIALTY BOARDS COLLECTIVELY AGREED TO ISSUE TIME LIMITED PHYSICIAN CERTIlCATION WITH RECERTIlCATION REQUIREMENTS IN INTERVALS OF YEARS OR LESS
&UTURE $IRECTIONS OF -EDICAL #ERTIlCATION "OARDS IN THE 1UALITY -OVEMENT #-3 INTENT TO EMBED PAY FOR PERFORMANCE INTO -EDICARE REIMBURSEMENT HAS LED PHYSICIANS TO INCREASE THEIR INPUT IN THE DEVELOPMENT OF QUALITY MEASURES &OR EXAMPLE MULTIPLE BOARDS ARE INVOLVED IN DEVELOPING PERFORMANCE MEASURES THROUGH THE !MERICAN -EDICAL !SSOCIATIONS 0HYSICIAN #ONSORTIUM FOR 0ERFORMANCE )MPROVEMENT 4HE RECENT ATTENTION TO PAY FOR PERFORMANCE HAS LED PHYSICIANS TO INCREASE THEIR INPUT IN THE DEVELOPMENT OF QUALITY MEASURES !S NOTED BY !")-S #ASSEL h4HE FOCUS NEEDS TO BE ON THE WHOLE RANGE OF ;MEDICAL= CONDITIONS AND NOT JUST SELECTED OUTCOMESv -EDICAL CERTIlCATION BOARDS ARE BEST SUITED TO UNDERSTAND THE CLINICAL ISSUES THAT RELATE TO COLLECTION OF CLINICAL DATA DESIGN OF PERFORMANCE MEASURES AND ESTABLISHMENT OF CARE GUIDELINES -EDICAL CERTIlCATION BOARDS ARE ALSO BEGINNING TO RESPOND TO THE NEEDS OF CONSUMERS #URRENTLY THERE ARE LIMITED PUBLIC RESOURCES THAT DESCRIBE PHYSICIANS BOARD CERTIlCATION STATUS THEIR SPECIALTY CERTIlCATION AND RECERTIlCATION STATUS !"-3 MAINTAINS A DIRECTORY OF BOARD CERTIlED MEDICAL SPECIALTIES THAT CAN BE ACCESSED ON ITS WEBSITE OR VIA A TOLL FREE NUMBER 4HE WEBSITE LISTS THE BOARD IN WHICH THE PHYSICIAN OBTAINED GENERAL AND SUBSPECIALTY CERTIlCATION (OWEVER THE WEBSITE DOES NOT LIST THE YEAR IN WHICH THE PHYSICIAN OBTAINED CERTIlCATION )N A 'ALLUP POLL SURVEY ONLY ONE THIRD OF CONSUMERS ACTIVELY RESEARCH OR INQUIRE ABOUT PHYSICIANS CERTIlCATION;= 9ET AS SOPHISTICATED CONSUMERS INCREASE THEIR USE OF THE )NTERNET TO OBTAIN MEDICAL INFORMATION THE DEMAND FOR ACCESS TO LICENSED AND CREDENTIALED PHYSICIANS MAY INCREASE n "Y (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
2ESHAPING (OSPITAL 4HROUGHPUT !CCELERATING A PATIENTS JOURNEY THROUGH THE HOSPITAL MEANS HAVING SENIOR LEADERSHIP CLINICIANS AND SUPPORT STAFF TALKING WITH EACH OTHER SWEATING THE DETAILS AND CASTING A WIDE NET WHEN SEARCHING FOR BOTTLENECKS TO UNCLOG AND SOLVE "Y *OAN $EMING -URPHY 0RICEWATERHOUSE#OOPERS
-
OST HOSPITALS URGENTLY NEED TO IMPROVE PATIENT mOW %XCESSIVE WAIT TIMES FOR EMERGENCY TREATMENT OR AN INPATIENT BED ARE A COMMON ISSUE IN HOSPITALS ACROSS THE COUNTRY "ACKUPS IN PATIENT mOW POTENTIALLY DIMINISH QUALITY OF CARE COMPROMISE PATIENT SAFETY UNNECESSARILY EXTEND PATIENTS LENGTHS OF STAY AND RESULT IN DISCHARGED PATIENTS WHO MAY BE DISSATISlED WITH THEIR HOSPITAL EXPERIENCES )MPROVING A PATIENTS WHOLE HOSPITAL EXPERIENCE INVOLVES ELIMINATING DELAYS AND STREAMLINING PATIENT mOW BETWEEN CLINICAL DEPARTMENTS AS WELL AS UTILIZING TECHNOLOGY SOLUTIONS TO ENABLE THE SHARING OF INFORMATION ABOUT THE PATIENTS STATUS THROUGHOUT THE ENTIRE ORGANIZATION
4HE 0ROBLEM )SNT 7HERE 9OU 4HINK ! HOSPITAL HAS MANY GATEWAYS WHERE BACKUPS CAN BE MOST VISIBLE AND MOST DETRIMENTAL TO THE HOSPITALS ABILITY TO PROVIDE PROMPT QUALITY CARE 4HE EMERGENCY DEPARTMENT %$ ADMITTING SURGERY AND DIAGNOSTIC DEPARTMENTS USUALLY REQUEST BEDS INDEPENDENTLY 4O COMPLICATE MATTERS FURTHER PATIENTS ARE OFTEN ADMITTED DIRECTLY FROM PHYSICIANS OFlCES OR TRANSFERRED FROM OTHER HOSPITALS OR OTHER INPATIENT mOORS 4HOUGH IT MAY SEEM REASONABLE TO SEEK THE REMEDY FOR THROUGHPUT PROBLEMS IN THE DEPARTMENTS WHERE THE BACKUPS OCCUR THE hBROKENv PROCESS CAN TYPICALLY BE FOUND FURTHER DOWN THE SERVICE CHAIN 4HIS GENERALLY INVOLVES AVAILABILITY OF DIAGNOSTIC TESTING TRANSPORTATION OF PATIENTS CLEANING AND PREPARING ROOMS NOTIlCATION OF DEPARTMENTS UPSTREAM WHEN BEDS ARE AVAILABLE OR ANY OF NUMEROUS KEY INTERRELATED PROCESSES THAT CAN BACK UP PATIENTS AT THEIR POINTS OF ENTRY 0ATIENT mOW BACKS UP BECAUSE OF SYSTEMWIDE PROBLEMS THAT CANNOT BE
SOLVED SIMPLY BY WORKING HARDER OR BY ADDING BEDS AND STAFF;= 0ROCESSES THROUGHOUT THE HOSPITAL AND BEYOND NEED TO BE EXAMINED AND REDESIGNED TO USE THE HOSPITALS AVAILABLE BEDS AND OTHER RESOURCES AS EFlCIENTLY AS POSSIBLE 0ATIENT CAPACITY IN RESOURCE INTENSIVE UNITS SUCH AS THE %$ SURGERY AND )#5 DEPENDS GREATLY ON THE LENGTHS OF STAY IN THE UNIT &OR EXAMPLE THE EFFECT OF AN EIGHT TO HOUR DECREASE IN AVERAGE LENGTH OF STAY FOR A GIVEN )#5 EQUATES TO THE ADDITION OF THREE )#5 BEDS;= &INDING AND lXING THROUGHPUT PROBLEMS REQUIRES COMMU NICATION AND BUY IN FROM DEPARTMENTS AND INDIVIDUALS THROUGHOUT THE ORGANIZATION (OSPITALS THAT HAVE EXPERIENCED THE EXPLORATIONS AND CHANGES NECESSARY TO IMPROVE PATIENT mOW STATE THEY NEVER REALIZED HOW MUCH HARD WORK WOULD BE INVOLVED OR HOW FAR REACHING THESE CHANGES COULD BE;=
-ANY 4RADE OFFS 4HROUGHPUT 3HOULDNT "E /NE OF 4HEM 0ATIENT CARE INVOLVES MANY PEOPLE PROCESSES AND A GREAT NUMBER OF HANDOFFS OF PATIENTS AND PATIENT INFORMATION FROM ONE DEPARTMENT OR CLINICIAN TO ANOTHER )NFORMATION mOWING ACROSS DEPARTMENTS INSTRUCTIONS BEING ACTED UPON AND NOTIlCATIONS BEING RETURNED ALL INVITE DELAYS "ROKEN PROCESSES ANYWHERE THAT IMPERFECTLY SUPPORT A HOSPITALS VAST ARRAY OF lNANCIAL CLINICAL AND LOGISTICAL FUNCTIONS CAN CAUSE BACKUPS AND DELAYS IN EXPEDITIOUSLY TREATING PATIENTS HAVING THEM DISCHARGED IN A TIMELY MANNER AND ENABLING THE HOSPITAL TO lLL EACH BED WITH ANOTHER PATIENT !N INTEGRATED HOSPITAL SYSTEM THAT SCHEDULES DIAGNOSTIC AND THERAPEUTIC PROCEDURES FOR PATIENTS IN THE MOST
*OAN $EMING -URPHY 2. -3 -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE WITH OVER YEARS EXPERIENCE IN THE INDUSTRY 3HE HAS SIGNIlCANT EXPERIENCE IN LEADING CLIENTS IN DESIGNING AND IMPLEMENTING OVERALL OPERATIONAL CHANGES IN HOSPITALS PARTICULARLY FOCUSING ON PATIENT THROUGHPUT AND HOSPITALWIDE PROCESS REDESIGN 3HE CAN BE REACHED AT JOAN EDEMING MURPHY USPWCCOM 6ICKI 0RINCE 7RIGHT -"! IS A CONSULTANT WITH 0RICEWATERHOUSE#OOPERS ,,0 IN #ANADA 3HE SPECIALIZES IN THE AREA OF HEALTHCARE BUSINESS DEVELOPMENT INCLUDING THE INTEGRATION OF PUBLIC AND PRIVATE CARE DELIVERY SYSTEMS AND LIFE SCIENCE PRODUCT SERVICE PROVIDERS 3HE HAS OVER YEARS EXPERIENCE IN WORKING WITH ORGANIZATIONS TO IMPROVE ORGANIZATIONAL EFlCIENCY THROUGH STRATEGY STRUCTURE PROCESS AND PEOPLE DEVELOPMENT 3HE CAN BE REACHED AT VICKIPRINCE WRIGHT CAPWCCOM 4OM 7ONG IS A PARTNER WITH 0RICEWATERHOUSE#OOPERS AND LEADS THE !DVISORY PRACTICES FOR (EALTHCARE AND )4 !DVISORY IN "RITISH #OLUMBIA 4OM IS A CHARTERED ACCOUNTANT WITH OVER YEARS OF EXPERIENCE IN PROVIDING HEALTHCARE )4 AND BUSINESS ADVISORY SERVICES TO CLIENTS IN #ANADA (E COMBINES HIS BUSINESS EXPERIENCE WITH HIS UNDERSTANDING OF TECHNOLOGIES TO WORK WITH EXECUTIVES AT A STRATEGIC LEVEL TO IDENTIFY OPPORTUNITIES TO IMPROVE PERFORMANCE AND THE RESULTING OUTCOMES (E CAN BE REACHED AT TOMWONG CAPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
Q DRG@OH M Fã G N ROH S@ K ã S G Q N T FG OT S LOGICAL SEQUENCE CAN SIGNIlCANTLY REDUCE DELAYS;= !LL PATIENT CARE PROCESSES NO MATTER WHAT DEPARTMENT IS INVOLVED SHOULD FOCUS ON THE COMMON GOAL OF FACILITATING PATIENT mOW THROUGHOUT THE ORGANIZATION "EYOND BEING A SOURCE OF AGGRAVATION THROUGHPUT ISSUES CAN AFFECT QUALITY OF CARE (OSPITALS JUDGED TO BE HIGH PERFORMING IN BOTH lNANCIAL AND QUALITY MEASURES DIAGNOSE PATIENTS ACCURATELY TREAT THEM RAPIDLY AND APPROPRIATELY AND DISCHARGE THEM TO THEIR HOMES OR CARE SETTINGS WHEN IMMEDIATELY PRACTICAL ,ONG LENGTHS OF STAY POTENTIALLY PUT QUALITY AND PATIENT SAFETY AT RISK AND OFTEN IMPACT THE BOTTOM LINE SINCE PAYER REIMBURSEMENTS WILL NOT ALWAYS COVER PATIENT STAYS BEYOND ESTABLISHED BENCHMARKS
!TTACKING THE 4HROUGHPUT #HALLENGE #URING THROUGHPUT ISSUES REQUIRES HOSPITAL LEADERSHIP AT THE MOST SENIOR LEVEL INCLUDING THE #%/ PHYSICIAN LEADERSHIP AND THE CHIEF NURSING OFlCER 4HESE EXECUTIVES MUST BE DEEPLY INVOLVED IN THE PROCESS OF MOTIVATING AND MANAGING CHANGE THROUGHOUT THE ORGANIZATION %XPLICIT AND ONGOING EXECUTIVE LEADERSHIP CREATES A SENSE OF URGENCY FOR ACCELERATING PATIENT mOW AND MOVES EMPLOYEES BEYOND RATIONALES FOR INACTION SUCH AS h4HIS IS NOT GOING TO WORK v OR h)M DOING MY PART DEPARTMENT 8 IS THE SOURCE OF DELAYSv ! SUCCESSFUL INITIATIVE REQUIRES STRONG LEADERSHIP TO KEEP PEOPLE ENGAGED AND CONTINUALLY LOOKING AT WAYS TO IMPROVE PERFORMANCE METRICS "ROKEN PRACTICES THAT SLOW DOWN PATIENT mOW CAN OCCUR EVEN BEFORE A PATIENT ENTERS THE HOSPITAL 0HYSICIANS CAN HAVE A GREAT IMPACT ON THROUGHPUT BUT USUALLY EXHIBIT MORE INTEREST IN BEING EFlCIENT WITH THEIR OWN TIME THAN UNDERSTANDING HOW THEY CAN EXPEDITE A PATIENTS TRAVEL FROM ADMITTANCE TO DISCHARGE &OR EXAMPLE ALTHOUGH SOME PHYSICIANS LIKE TO ADMIT PATIENTS TO THE HOSPITAL FOR PARTICULAR DIAGNOSTIC TESTS MANY OF THESE TESTS COULD BE PERFORMED ON AN OUTPATIENT BASIS )N OTHER INSTANCES %XHIBIT %FFECTIVE 0ATIENT 4HROUGHPUT
THE HOSPITAL MAY NOT BE THE BEST SETTING FOR PROVIDING A PATIENT THE APPROPRIATE LEVEL OF CARE )N HOSPITALS WITH AGGRESSIVE CASE MANAGEMENT PROGRAMS CASE MANAGERS CONFER WITH PHYSICIANS IN MAKING ADMITTING AND DISCHARGE DECISIONS 'ETTING THE RIGHT PATIENTS INTO THE HOSPITAL IMPROVES THE SPEED AND QUALITY OF TREATMENT FOR THOSE WHO REALLY NEED TO BE THERE /NCE THE RIGHT PATIENTS ARE ADMITTED PHYSICIANS CAN FURTHER HELP BY ISSUING DISCHARGE ORDERS EARLY IN THE DAY SO THAT PATIENTS DO NOT HAVE TO SPEND AN EXTRA DAY IN THE HOSPITAL WHILE ORDERS ARE PROCESSED AND DISCHARGE INSTRUCTIONS PREPARED 'ETTING PHYSICIANS TO UNDERSTAND THAT THEIR BEHAVIORS CAN SLOW PATIENT mOW IS A DIFlCULT BUT VITAL TASK 0HYSICIANS RESPOND WELL TO DATA (OSPITALS CAN ENCOURAGE THESE NEW PRACTICES BY MAKING PHYSICIANS AWARE OF PATIENT BENElTS COLLECTING RELEVANT METRICS ABOUT PHYSICIAN BEHAVIOR AND POSTING A PERFORMANCE hDASHBOARDv FOR ALL TO SEE 3TRATEGIES SUCH AS THESE MAY HELP MOTIVATE PHYSICIANS TO MEET OR EVEN EXCEED hBEST PRACTICEv PERFORMANCE STANDARDS
7ORKING /UT THE $ETAILS )N A HOSPITAL ONE PERSON OR ONE MISSED COMMUNICATION CAN CAUSE SIGNIlCANT DELAYS ! BUSY NURSE FAILS TO NOTIFY HOUSEKEEPING TO CLEAN A DIRTY BED !N ACCEPTING mOOR NURSE IS UNAVAILABLE TO TAKE A REPORT FROM ADMITTING OR THE %$ ! TRANSPORTER TAKES TOO MUCH TIME GETTING A PATIENT FROM ONE PLACE TO ANOTHER 2ESULTS FROM ANCILLARY TESTS TAKE TOO LONG TO APPEAR ON THE PATIENTS CHART 4HESE ALL CONTRIBUTE TO LONG WAIT TIMES FOR ADMITTANCE AND EXCESSIVE LENGTHS OF STAY 4HE KEY IS TO GET ALL THE STAKEHOLDERS TALKING TOGETHER CONNECTING THE DOTS TO SEE WHERE OPPORTUNITIES EXIST TO STREAMLINE HANDOFFS AND OVERLAPS BETWEEN AREAS ! THROUGHPUT INITIATIVE CALLS ON NURSES PHYSICIANS CLINICIANS ORDERLIES HOUSEKEEPING AND CLERICAL STAFF AND HOSPITAL ADMINISTRATORS TO BE ORGANIZED THINK ABOUT THE PATIENTS EXPERIENCE AND ANTICIPATE WHERE BOTTLENECKS ARE LIKELY TO OCCUR !LL NEED TO BROADEN THEIR VISION TO SEE hTHE BIG PICTUREv FROM THE PATIENTS PERSPECTIVE 2ESOLVING THROUGHPUT PROBLEMS NECESSITATES GOING THROUGH THE DETAIL OF PROCESSES IMPACTING PATIENT mOW 4HESE PROCESSES START PRIOR TO HOSPITAL ADMISSION AND EXTEND THROUGH DISCHARGE AS SHOWN IN %XHIBIT &OR EXAMPLE IF %$ NURSES HAVE TO WAIT TOO LONG FOR BUSY mOOR NURSES TO TAKE A PATIENT REPORT PERHAPS A FAX MACHINE OR VOICE MAIL CAN ALLEVIATE THE PROBLEM 0ART OF THE PROCESS REDESIGN SHOULD INCLUDE SUCH DETAIL AS LOCATION OF THE FAX MACHINE AND DIRECTIONS FOR USE (OW WILL WE MONITOR THE NEW PROCESS TO MAKE SURE IT WORKS (OW DO WE TRAIN THE PEOPLE WHO WILL USE IT /NLY PENETRATING TO THIS LEVEL OF INTRICATE AND PERHAPS EXCRUCIATING DETAIL WILL RESULT IN CHANGES THAT ARE EFFECTIVE AND SUSTAINABLE
4HROUGHPUT 0RACTICES 4HE FOLLOWING PRACTICES HAVE PROVEN SUCCESSFUL IN IMPROVING PATIENT mOW THROUGH LEADING HOSPITALS 2EVIEW ALL PATIENTS FOR APPROPRIATENESS OF ADMISSION PRIOR TO INPATIENT ADMISSIONS AT ALL POINTS OF ENTRY # ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
Q DRG@OH M Fã G N ROH S@ K ã S G Q N T FG OT S +EY 3TEPS TO A 3UCCESSFUL 0ATIENT 4HROUGHPUT )NITIATIVE (OSPITALS WORKING TO REMEDY THROUGHPUT PROBLEMS AND PATIENT mOW BACKUPS NEED TO ( AVE A CLEAR VISION OF THE CHALLENGES THAT NEED TO BE ADDRESSED ' ET STAKEHOLDERS TO BUY IN TO THE EFFORT AS EARLY AS POSSIBLE ) NVOLVE STAFF THROUGHOUT THE HOSPITAL IN REDESIGNING PROCESSES AND PRACTICES $ EVELOP BENCHMARKS AND METRICS TO EVALUATE PERFORMANCE ( OLD PEOPLE ACCOUNTABLE FOR ACHIEVING MEASURABLE RESULTS $ EVELOP A THOROUGH TRAINING PROGRAM 3OURCE "RICKMAN * -IKOS + 0ENNELL & $UGAN * $EMING -URPHY * AND ,OPEZ & h3TRAIGHT 4ALK .EW !PPROACHES IN (EALTHCARE v -ODERN (EALTHCARE 3EPT SPECIAL ADVERTISING SECTION AND EDUCATIONAL SUPPLEMENT PROVIDED BY 0RICEWATERHOUSE#OOPERS
)DENTIFY POST ACUTE RESOURCES EARLY IN THE HOSPITAL STAY AND WITHIN ESTABLISHED GUIDELINES %STABLISH A WELL DElNED DISCHARGE PLAN FOR EACH PATIENT BEGINNING WITH ADMISSION !CTIVELY MANAGE LENGTH OF STAY 2EDESIGN %$ OPERATIONS TO FACILITATE PATIENT mOW FROM ENTRY POINT TO DISPOSITION INCLUDING ADMISSION TO THE HOSPITAL /PTIMIZE SURGICAL SERVICES TO ENSURE EASY ACCESS FOR SURGEONS AND PATIENTS )NSTITUTE AN INTEGRATED SOLUTION TO IDENTIFY EMPTY BEDS GET THEM CLEANED AND MAKE THEM AVAILABLE TO PATIENTS AND %NHANCE COORDINATION AND COLLABORATION BETWEEN NURSING AND CASE MANAGEMENT FROM ADMISSION TO DISCHARGE
4HIS INFORMATION CAN BE CAPTURED ELECTRONICALLY SUMMARIZED ON A hDASHBOARDv AND PUT ON A lLE THAT CAN BE VIEWED BY ALL AREAS 4O BE MEANINGFUL THE DATA MUST BE COMPARED TO INDUSTRY BENCHMARKS AND THESE COMPARISONS OFTEN CALCULATED AS PERCENTILE SCORES SHOULD ALSO BE PART OF A FREQUENTLY UPDATED ELECTRONIC DASHBOARD %NCOURAGING PEOPLE TO COMPARE THEIR DEPARTMENTAL AND PERSONAL PERFORMANCES TO NATIONAL STANDARDS HELPS TO KEEP PATIENT mOW A CONSTANT PRIORITY AND GIVES THE HOSPITAL AN ONGOING REPORT ON THE SUCCESS OF THEIR EFFORTS TO BOOST THROUGHPUT
#ONCLUSION (ASTENING A PATIENTS JOURNEY THROUGH THE HOSPITAL INVOLVES GETTING THE RIGHT PATIENTS INTO THE RIGHT BEDS THEN HAVING THE RIGHT PEOPLE DO THE RIGHT THINGS AT THE RIGHT TIMES %FFECTIVE COLLABORATION AND COMMUNICATION AMONG ALL HOSPITAL DEPARTMENTS WITH A COMMON FOCUS ON THE PATIENT INITIATES THE CHANGES THAT WILL BROADEN EVERY STAFFS PERSPECTIVE 7ORKING OUT THE DETAILS OF THROUGHPUT ISSUES THEN CAPTURING AND PUBLICIZING RELEVANT PERFORMANCE METRICS WILL CREATE AND SUSTAIN IMPROVED PATIENT THROUGHPUT AND MAXIMIZE UTILIZATION OF THE HOSPITALS RESOURCES %NDNOTES (ARADEN # AND 2 2ESAR h0ATIENT &LOW IN (OSPITALS 5NDERSTANDING AND #ONTROLLING IT "ETTER v 3UMMER &RONTIERS OF (EALTH 3ERVICES -ANAGEMENT P )BID P "RICKMAN * AND + -IKOS & 0ENNELL * $UGAN * $EMING -URPHY & ,OPEZ h3TRAIGHT 4ALK .EW !PPROACHES IN (EALTHCARE v 3EPT -ODERN (EALTHCARE SPECIAL ADVERTISING SECTION AND EDUCATIONAL SUPPLEMENT PROVIDED BY 0RICEWATERHOUSE#OOPERS ,AMBERT - h)MPROVEMENTS AND )NNOVATION IN (OSPITAL /PERATIONS ! +EY TO /RGANIZATIONAL (EALTH v 3UMMER &RONTIERS OF (EALTH 3CIENCES P
4HE 2OLE OF 4ECHNOLOGY 4ECHNOLOGY ENABLES OPTIMUM THROUGHPUT 2ADIO FREQUENCY IDENTIlCATION 2&)$ TAGS ON PATIENTS THAT TRACK THEIR WHEREABOUTS IN THE HOSPITAL GLOBAL POSITIONING SYSTEM LOCATORS TO TRACK MEDICAL EQUIPMENT %$ TRACKING TOOLS SPECIAL CELL PHONES AND VOICE MAIL SYSTEMS TO ENHANCE COMMUNICATIONS ELECTRONIC BED BOARDS AND AUTOMATED NOTIlCATION SYSTEMS ALL HELP HOSPITALS TO BOOST THROUGHPUT /NCE A PROCESS HAS BEEN IDENTIlED AS NEEDING TO BE lXED THE NEXT STEP IS TO LINK THE REVISED PROCESS WITH A TECHNOLOGY THAT WILL SUPPORT IT 4ECHNOLOGY PROVIDES ENORMOUS POSSIBILITIES FOR ENABLING FASTER BETTER AND MORE RELIABLE PATIENT mOW PROCESSES
3USTAINING 3UCCESS 0EOPLE WILL CONTINUE DOING THE RIGHT THINGS BEYOND THE EXCITEMENT OF AN INITIATIVE FOR CHANGE ONLY IF THEY ARE CONTINUALLY MOTIVATED TO SEEK IMPROVEMENT IN PATIENT THROUGHPUT 4O KEEP CHANGE AT THE FOREFRONT HOSPITALS NEED TO CONTINUOUSLY MONITOR RELEVANT PERFORMANCE METRICS SUCH AS LENGTHS OF STAY DISCHARGE TIMES WAIT TIMES IN %$ AND ADMITTING TRANSPORT TIMES TURNAROUND TIME FOR ANCILLARY TESTING AND EVEN THE TIME SPENT CLEANING A BED
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
3YMPTOMS OF !ILING 0ATIENT &LOW 0ROCESSES (OSPITALS KNOW WHEN THROUGHPUT PROBLEMS ARE IMPACTING THEIR CLINICAL AND lNANCIAL PERFORMANCE 4HE DIAGNOSIS IS AS OBVIOUS AS THE CURE IS ELUSIVE 3YMPTOMS PRESENT THEMSELVES MOST VISIBLY AT GATEWAYS OR ACCESS POINTS TO MEDICAL SERVICES 3YMPTOMS OF THROUGHPUT PROBLEMS OR BACKUPS INCLUDE , ONG WAIT TIMES IN EMERGENCY DEPARTMENT %$ OR INPATIENT ADMITTING (IGH PERCENTAGE OF %$ PATIENTS LEAVING WITHOUT BEING SEEN ,7"3 ,OW PATIENT SATISFACTION ,OW PHYSICIAN SATISFACTION $IFlCULTY TRANSFERRING PATIENTS OUT OF THE )#5 ANDOR THE 0!#5 ,ONG LENGTHS OF STAY ,/3 $ISCHARGES LATE IN THE AFTERNOON OR EARLY EVENING ,ENGTHY TURNAROUND TIMES FOR ANCILLARY TESTING
Q DRG@OH M Fã G N ROH S@ K ã S G Q N T FG OT S 2ICHMOND (EALTH 3ERVICES !RTHROPLASTY 2EDESIGN 2ICHMOND (OSPITAL IS A COMMUNITY HOSPITAL LOCATED NEAR 6ANCOUVER #ANADA !S A SITE FOR ARTHROPLASTY SURGERY WITHIN A REGIONAL NETWORK 2ICHMOND WAS EXPERIENCING A CONVERGENCE OF INCREASING DEMAND LIMITED RESOURCES AND INCREASING COSTS 7AITING TIMES FOR HIP AND KNEE REPLACEMENTS RANGED FROM NEARLY NINE TO ALMOST MONTHS AND DEMAND WAS PROJECTED TO INCREASE BY PERCENT OVER THE NEXT YEARS &ROM A PATIENT CARE PERSPECTIVE RESEARCH INDICATES THAT PATIENTS WHO RECEIVE SURGERY WITHIN SIX MONTHS FARE BETTER MEANING THE CURRENT RANGE OF WAITING TIMES WAS SIMPLY NOT ACCEPTABLE 4HE WAITING TIME WAS CONTRIBUTING TO INCREASED DOWNSTREAM CARE COSTS BOTH IN TERMS OF PATIENT OUTCOMES AND OPERATING EXPENSES !DDITIONAL FUNDING TO REDUCE THE WAIT LISTS HAD BEEN MADE AVAILABLE HOWEVER THE TEAM AT 2ICHMOND (OSPITAL UNDERSTOOD THAT SIMPLY APPLYING ONE TIME FUNDING TO THE SITUATION WOULD NOT PRODUCE A SUSTAINABLE IMPROVEMENT (OSPITAL LEADERS ESTABLISHED A PROJECT TO HANDLE THESE CASES MORE EFlCIENTLY OVER THE LONG TERM 4HE OVERRIDING OBJECTIVE WAS TO PROVIDE BETTER OUTCOMES AND IMPROVED ACCESS FOR PATIENTS AS WELL AS OVERALL REDUCTIONS IN COSTS PER CASE %ARLY BENCHMARKING IDENTIlED AN h 4OTAL *OINT /2 $AYv IN TWO /2S AS A BEST PRACTICE WITHIN WORLD CLASS FACILITIES WHICH WERE GENERALLY LARGE TEACHING HOSPITALS ANDOR DEDICATED ARTHROPLASTY CENTERS h7E ASKED OURSELVES WHAT WE COULD DO TO BE AS GOOD AS THE BEST IN THE WORLD n WITHIN THE CONSTRAINTS OF A COMMUNITY HOSPITAL 4HE PILOT ;PROJECT= PROVED THAT WE COULD DO IT n THAT WE COULD PROVIDE THE RIGHT TREATMENT TO THE RIGHT PATIENTS WITH GOOD OUTCOMES WITHIN A COST CERTAIN ENVIRONMENT v SAID +EN (UGHES -$ ONE OF THE PROJECT LEADERS )N A COMMUNITY SETTING FEWER RESOURCES AND THE LACK OF A hDEDICATED ARTHROPLASTY TEAMv MEANT THAT THE ENTIRE CONTINUUM OF CARE WOULD NEED TO BE ENGAGED IN ENABLING THE INCREASE IN PATIENT mOW FROM AN AVERAGE OF THREE JOINT REPLACEMENTS IN ONE /2 TO EIGHT JOINT REPLACEMENTS IN TWO /2S IN A SINGLE DAY ! MULTIDISCIPLINARY TEAM WAS ASSEMBLED TO ADDRESS THE ENTIRE CONTINUUM OF CARE FOR ARTHROPLASTY PATIENTS FROM THE PREOPERATIVE THROUGH ACUTE AND TO THE POST OPERATIVE PHASES )T WAS TASKED WITH CREATING A COMMON UNDERSTANDING OF THE CURRENT SITUATION IMPLEMENTING A NUMBER OF EVALUATIVE MECHANISMS TO UNDERSTAND THE BASELINE AND THE BENCHMARKS AND REDESIGNING AN INTEGRATED PROCESS THAT PUT PATIENT NEEDS AT THE CENTER !CCORDING TO #INDY 2OBERTS ANOTHER PROJECT LEADER h#OORDINATING A MULTIDISCIPLINARY APPROACH TO PROCESS IMPROVEMENT IS KEY %VERY AREA THAT HAS POTENTIAL IMPACT ON THE PATIENTS JOURNEY THROUGHOUT THE ARTHROPLASTY ENCOUNTER FROM THE DECISION TO HAVE SURGERY TO COMPLETION OF POST OP REHABILITATION WAS INVOLVED AT SOME POINT IN REDESIGNING THE MODEL 4HIS INCLUDED SUPPORT STAFF THAT NEVER ACTUALLY CAME IN CONTACT WITH THE PATIENT TO CLINICIANS WITH HANDS ON INVOLVEMENTv 0ATIENTS WERE ENGAGED IN FOCUS GROUPS AND INPUT FROM PROVIDERS AND SUPPORT SERVICES WAS SOUGHT IN ORDER TO ENSURE A PROCESS THAT ADDRESSED BOTH PATIENT AND PROVIDER NEEDS 4HE CONTINUUM OF CARE WAS INTEGRATED FROM PREOPERATIVE IDENTIlCATION OF NEEDS TO SURGICAL BOOKING AND BED MAPPING THROUGH SURGERY POST OPERATIVE AND COMMUNITY CARE AND REHABILITATIVE CARE 3TANDARD SYSTEMS INCLUDING SURGICAL ASSESSMENTS PRIORITIZATION TOOLS AND INSTRUMENTATION SETS ALLOWED STAFF TO STREAMLINE INTERNAL PROCESSES 3UPPORTING THE WORK WAS THE DEVELOPMENT OF A RAPID RECOVERY PLAN THAT INTEGRATED CLINICAL PATHWAYS FROM VARIOUS DISCIPLINES AND IDENTIlED APPROPRIATE SURGICAL PATIENTS FOR FAST TRACKING )N THE FOCUS GROUPS PATIENTS HAD IDENTIlED THE NEED TO BE BETTER PREPARED FOR SURGERY 3UBSEQUENTLY A SERIES OF EDUCATIONAL PROGRAMS AND PRE OPERATIVE ASSESSMENTS WERE ESTABLISHED !T THE CENTER OF THE REDESIGNED PROCESS IS A COORDINATED STAGGERED SCHEDULING APPROACH WHEREBY TWO /2S WORKING CONCURRENTLY ENABLE TWO SURGEONS TO WALK BETWEEN ROOMS TO HELP EACH OTHER AT CRUCIAL TIMES DURING SURGERY 4HE PROJECT HAS DEMONSTRATED RESULTS A PERCENT INCREASE IN ARTHROPLASTY CASES FROM TO CASESYEAR A PERCENT OVERALL WAITLIST REDUCTION AND A PERCENT DECREASE IN WAIT TIME FOR SURGERY !T THE BEGINNING OF THE PROJECT PATIENTS WERE WAITING A MEDIAN TIME OF WEEKS 0RESENTLY THEY ARE WAITING A MEDIAN TIME OF WEEKS AND EFlCIENCY ON SURGICAL UNITS HAS IMPROVED BY PERCENT LENGTH OF STAY WAS REDUCED TO FOUR DAYS FOR HIP RECONSTRUCTION AND THREE DAYS FOR KNEE RECONSTRUCTION 3URGERY TIMES HAVE BEEN REDUCED FROM HOURS TO 4HE TEAM DEVELOPED AN hARTHROPLASTY PLAN v A TOOL KIT THAT LAYS OUT BOTH THE CLINICAL AND ADMINISTRATIVE PROCESSES PROVIDES A COSTING FRAMEWORK THAT COVERS CAPITAL AND RESOURCE REQUIREMENTS AND PROVIDES EXAMPLES OF THE CORRESPONDING TOOLS REQUIRED TO ENABLE THE PROCESSES 4HE TOOL KIT HAS ENABLED THE ARTHROPLASTY PLAN TO TAKE ON A REGIONAL PERSPECTIVE AND IMPLEMENTATION IN OTHER SITES IS NOW UNDER WAY !DDITIONALLY OTHER FACILITIES OUTSIDE OF THE REGION HAVE REQUESTED THE KIT AND ARE LOOKING FOR WAYS TO ADAPT THE MODEL TO THEIR OWN UNIQUE ENVIRONMENTS h7E NEEDED TO BROADEN OUR APPROACH TO CARE DELIVERY n WITH INCREASED ATTENTION TO THE PREOPERATIVE PERIOPERATIVE ASSESSMENT EDUCATION AND FOLLOW UP CARE PROCESSES WE HAVE ACHIEVED BOTH A MORE EFlCIENT AS WELL AS A MORE PRODUCTIVE CARE DELIVERY MODEL THAT IS SUSTAINABLE v SAYS *EFF #OLEMAN -$ AND CHIEF OPERATING OFlCER "Y 6ICKI 0RINCE 7RIGHT AND 4OM 7ONG 0RICEWATERHOUSE#OOPERS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
)MPROVING THE %MERGENCY $EPARTMENT %XPERIENCE %MERGENCY ROOMS n OFTEN OVERCROWDED AS HOSPITALS INCREASINGLY BECOME !MERICAS HEALTHCARE SAFETY NET n CAN ADOPT PATIENT FOCUSED STRATEGIES TO IMPROVE EVERY PATIENTS EXPERIENCE WITH EMERGENCY CARE AND DELIVER CARE OF EXTRAORDINARY QUALITY
"Y 0ATRICIA -ICHAELS AND *UDITH ! 2UNK 0RICEWATERHOUSE#OOPERS
$
ESPITE THE CHALLENGES FACED BY EMERGENCY DEPARTMENTS %$ PATIENTS CONTINUE TO EXPRESS SATISFACTION WITH THE CARE RECEIVED;= 0ATIENTS GENERALLY BELIEVE %$S PROVIDE QUALITY CARE THE STAFF IS CONCERNED FOR THEIR WELFARE AND THE WAIT TIME TO RECEIVE TREATMENT IS REASONABLE;= (OWEVER THAT IS ONLY THE GOOD NEWS -OST PEOPLE ALSO BELIEVE THAT %$S ARE APPROACHING A CRISIS SITUATION BECAUSE OF OVERCROWDING 4HIS IS A CRISIS THAT MOST EMERGENCY PHYSICIANS BELIEVE IS ALREADY MANIFEST;= (OSPITALS NATIONWIDE WHICH ARE INCREASINGLY BECOMING !MERICAS HEALTHCARE SAFETY NET ARE BEING CHALLENGED TO DO MORE WITH LESS &ORTUNATELY THERE IS A GREAT DEAL HOSPITALS CAN DO TO DECOMPRESS %$S AND IMPROVE EVERY PATIENTS EXPERIENCE WITH EMERGENCY CARE WHILE CONTINUING TO DELIVER CARE OF EXTRAORDINARY QUALITY -ORE !MERICANS DEPEND ON %$S THAN EVER BEFORE $URING THE PAST DECADE HOSPITAL %$ VISITS INCREASED PERCENT TO MILLION VISITS IN .EARLY PERCENT OF THE POPULATION REPORTED AT LEAST ONE %$ VISIT UP FROM PERCENT A DECADE EARLIER 5NFORTUNATELY DURING THIS SAME PERIOD THE NUMBER OF HOSPITAL %$S IN THE 53 DECREASED BY ABOUT PERCENT )T IS NO WONDER MANY %$ ADMINISTRATORS FEEL THAT THEIR DEPARTMENTS ARE BURSTING AT THE SEAMS ! RECENT REPORT BY THE 'OVERNMENT !CCOUNTABILITY /FlCE FOUND KEY PERFORMANCE INDICATORS THAT TELL AN %$ WHEN CROWDING IS OCCURRING;= .UMBER OF HOURS THAT AN %$ DIVERTS AMBULANCES TO OTHER FACILITIES 0ROPORTION OF PATIENTS AND LENGTH OF TIME THAT PATIENTS BOARD IN THE %$ AWAITING AN INPATIENT BED AND 0ROPORTION OF PATIENTS WHO LEAVE THE %$ BEFORE RECEIVING A MEDICAL EVALUATION USUALLY BECAUSE THEY ARE TIRED OF WAITING
%XCESSIVE VOLUME SLOW PATIENT mOW AND INEFlCIENT BED MANAGEMENT THROUGHOUT THE HOSPITAL AFFECT THE PERFORMANCE OF THE %$ 4HIS IS LIKELY THE CASE BECAUSE BACKUPS AND DELAYS ARE TYPICALLY EXPERIENCED IN THE %$ BEFORE ANY OTHER DEPARTMENT WHEN THE HOSPITAL IS OPERATING AT FULL CAPACITY;= 0ATIENTS DISSATISlED WITH LONG WAITS MAY LEAVE THE %$ BEFORE BEING EXAMINED BY A PHYSICIAN OR CHOOSE TO GO TO A DIFFERENT PROVIDER IN THE FUTURE .EARLY PERCENT OF %$ VISITS END WITH THE PROSPECTIVE PATIENT WALKING AWAY;= 3OME %$S EXPERIENCE RATES AS HIGH AS PERCENT OF THEIR %$ VISITS ENDING IN THE PATIENT LEAVING WITHOUT TREATMENT ,7/4 4HE ,7/4 RATE IS A KEY METRIC FOR HOSPITALS AS THEY MEASURE THE EFFECTIVENESS AND EFlCIENCY OF THEIR %$S (OSPITALS WITH PROGRAMS TO EXPEDITE PATIENT mOW THROUGH THE %$ CAN IMPROVE THAT STATISTIC TO LESS THAN PERCENT $IVERSIONS CAN ALSO TAKE THEIR TOLL IN ADMISSIONS 4HE %$ IS TYPICALLY THE SOURCE OF MORE THAN PERCENT OF HOSPITAL ADMISSIONS;=
4HE %$ &ROM THE 0ATIENTS 0OINT OF 6IEW 0ATIENTS EXPECT TO WAIT IN THE %$ (OW LONG THEY EXPECT TO WAIT IS THE SUBJECT OF MANY STUDIES BUT PATIENTS DElNITELY BECOME DISTRESSED WHEN WAIT TIMES IN THE %$ STRETCH BEYOND TWO HOURS 4HIS CAN BE MITIGATED IF PATIENTS FEEL THEY ARE BEING ATTENDED TO OR IF THEY ARE WAITING FOR TEST RESULTS OR FOR SOME MEDICAL REASON %NHANCEMENTS TO CUSTOMER SATISFACTION WITH THE %$ EXPERIENCE START WELL OUTSIDE THE %$ ITSELF -OST %$ PATIENTS DRIVE THEMSELVES TO THE HOSPITAL OR ARE BROUGHT IN BY FAMILY OR FRIENDS #OPING WITH PARKING COMPLEXITIES OR DISTANT LOTS CAN MAKE AN INHERENTLY STRESSFUL EXPERIENCE MUCH WORSE !MPLE PARKING NEAR THE %$
0ATRICIA -ICHAELS 2. -3. IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE FOCUSES ON HOSPITAL OPERATIONS AND PROCESS IMPROVEMENT AND HAS OVER YEARS EXPERIENCE IN THE ADMINISTRATION AND DELIVERY OF PATIENT CARE SERVICES 3HE HAS DIRECTED PERFORMANCE IMPROVEMENT CARE MANAGEMENT AND PATIENT CARE ENGAGEMENTS IN MULTIHOSPITAL SYSTEMS ACADEMIC MEDICAL CENTERS AND COMMUNITY HOSPITALS 3HE CAN BE REACHED AT PATRICIACMICHAELS USPWCCOM *UDITH ! 2UNK 2. -%D IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE HAS EXTENSIVE EXPERIENCE IN HEALTHCARE IN A VARIETY OF SETTINGS 3HE CURRENTLY FOCUSES ON PATIENT THROUGHPUT AND QUALITY WITH EXPERTISE IN CASE MANAGEMENT PATIENT mOW AND EMERGENCY DEPARTMENT SERVICES 3HE CAN BE REACHED AT JUDITHARUNK USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
HLOQNUHMFãSGDãD LD Q FD M BXã C D O@ Q S LD M S ã D W OD Q H D M B D ENTRANCE SHOULD BE AVAILABLE FOR PATIENTS AND THEIR FAMILIES &REE VALET PARKING AT THE %$ ENTRANCE MINIMIZES CONCERNS ABOUT PARKING AND LOSING TRACK OF A LOVED ONE %ASY TO UNDERSTAND SIGNS AND OTHER DIRECTIONAL MARKERS SUCH AS BOLD STRIPES ON WALLS AND mOORS SHOULD HELP PEOPLE NAVIGATE EASILY TO THE %$ /NCE PATIENTS ARRIVE IN THE %$ HUMAN INTERACTION IS OFTEN SOUGHT ! CONCIERGE OR GREETER OFTEN A TRAINED VOLUNTEER MAY HELP TO BEGIN THE HOSPITAL EXPERIENCE ON A CARING SENSITIVE NOTE OFFERING PERSONAL ASSISTANCE AND INFORMATION ABOUT WHAT THE PATIENT CAN EXPECT BASED ON KNOWLEDGE OF %$ OPERATIONS AND WHAT IS GOING ON THAT DAY 4HIS lRST FACE IS OFTEN THE CONSTANT FOR THE FAMILY SOMEONE WHO IS WILLING AND ABLE TO RESPOND TO THE SMALLEST OF DETAILS
@/UR ORGANIZATION HAS DEFINED QUALITY AS THE DEGREE TO WHICH YOU ACHIEVE YOUR MISSION COMPATIBLE OUTCOMES 4HIS DEFINITION ENCOMPASSES ANY BODYS WORK EG CASHIER CAFETERIA WORKERS PARKING STAFF AS WELL AS THE CLINICAL STAFF ETC n !NTHONY $ 3LONIM -$ $R0( EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS AT THE #HILDRENS .ATIONAL -EDICAL #ENTER IN 7ASHING TON $# AND ASSOCIATE PROFESSOR AND VICE CHAIRMAN DEPARTMENT OF PEDIAT RICS 4HE 'EORGE 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE .OT ONLY IS HUMAN INTERACTION IMPORTANT BUT ALSO THE HEALTHCARE SETTING ITSELF 4HE WAITING AREA SHOULD OFFER A COMFORTABLE ENVIRONMENT WITH PRIVATE AREAS SAFE PLAY NOOKS FOR CHILDREN CLEAN CONTEMPORARY FURNITURE CURRENT MAGAZINES AND VENDING MACHINES 4HE WAITING ROOM SHOULD NOT HOWEVER SUBTLY IMPRESS PATIENTS AS A PLACE TO SPEND A GREAT DEAL OF TIME n NO PLUSH FURNISHINGS COUCHES LONG ENOUGH FOR SLEEPING MICROWAVES OR HOME LIKE CONVENIENCES #ONCERNS FOR PRIVACY SHOULD ALSO BE CONSIDERED %$S AND WAITING ROOMS SHOULD BE DESIGNED WITH PRIVATE AREAS WHERE THE STAFF CAN INTERACT WITH PATIENTS AND THEIR FAMILIES SEPARATELY FROM OTHER WAITING PATIENTS 4REATMENT NEEDS SHOULD ALSO TAKE PLACE IN ROOMS THAT AFFORD PATIENTS PRIVACY %$ NURSES ADDITIONALLY OFTEN TRY TO EXHIBIT DISCRETION BY CALLING PATIENTS TO BE REGISTERED OR
ADMITTED BY ONLY THEIR lRST NAMES 4HE ETHNIC RELIGIOUS AND CULTURAL DIVERSITY OF PATIENTS MUST BE KEPT IN MIND %$ STAFF MEMBERS NEED TRAINING TO FAMILIARIZE THEMSELVES WITH VARIOUS BELIEFS FOOD RULES TABOOS FOLK REMEDIES ATTITUDES TOWARD GENDER AND OTHER FACTORS THAT AFFECT PATIENT INTERACTIONS 5NINTENTIONAL BUT UNINFORMED ACTS SUCH AS A MALE PHYSICIAN EXAMINING A -USLIM WOMAN OR FAILING TO RECOGNIZE THE DIETARY PRACTICES OF ORTHODOX *EWS CAN BE DEEPLY OFFENSIVE TO THESE PATIENTS AND AFFECT ALL EXPERIENCES FROM THAT POINT FORWARD %$ STAFF MUST ENGAGE ALL PATIENTS IN A HELPFUL NONJUDGMENTAL WAY AND IN CONVERSATIONAL FASHION GATHER THE MEDICAL AND REGISTRATION INFORMATION NEEDED SO THAT CLINICIANS CAN BEGIN CARING FOR THEM 2EGISTRATION IN THE %$ SHOULD NOT BE VIEWED AS AN UNPLEASANT TASK EITHER BY THE STAFF OR THE PATIENTS )NFORMATION CAN BE GATHERED IN STEPS AT A REGISTRATION DESK IN THE WAITING ROOM AND AT THE PATIENTS BEDSIDE IN THE TREATMENT ROOM 3EVERAL HOSPITALS AROUND THE COUNTRY ADVERTISE A WAITING TIME GUARANTEE IN THEIR %$S OFFERING PASSES TO RESTAURANTS OR ENTERTAINMENT IF PATIENTS WAIT MORE THAN MINUTES TO SEE A PERSON WITH CLINICAL DECISION MAKING AUTHORITY 4HIS WAITING TIME MAY REPRESENT AN UPPER LIMIT AFTER WHICH PATIENTS ARE LIKELY TO BECOME ANXIOUS OR IRRITATED IF NO ONE SEEMS TO BE ADDRESSING THEIR MEDICAL PROBLEMS 7HETHER HOSPITALS TRY TO ACHIEVE SOME SORT OF ARBITRARY TIME LIMIT THEY CAN RELIEVE SOME OF THE DISSATISFACTION OF WAITING BY ADOPTING THE h$ISNEY APPROACH v WHICH ACTS ON THE PROPOSITION THAT WAITING IS MORE AGREEABLE IF THE %$ STAFF MEMBERS VERBALLY COMMUNICATE SOME REALISTIC EXPECTATION OF HOW LONG THE WAIT WILL BE AND PATIENTS HAVE SOME PRODUCTIVE OR INTERESTING WAYS TO SPEND THE TIME %$ STAFF CAN OBTAIN REGISTRATION AND MEDICAL INFORMATION PREPARE THE PATIENT FOR TESTING THAT THE PHYSICIAN WILL NEED FOR DIAGNOSIS AND ANSWER THE PATIENTS QUESTIONS AND CONCERNS n ALL WHILE THE PATIENT AWAITS TRIAGE AND TREATMENT IN THE %$ WAITING ROOM 0ATIENTS ARE NOT INTERESTED IN HEARING ABOUT HOW BUSY THE %$ IS EACH PATIENT WANTS TO BE TREATED AS THE ONLY PATIENT NEEDING CARE %$ STAFF MEMBERS NEED TO BE TRAINED TO INTERACT WITH PATIENTS ON A ONE TO ONE BASIS KEEPING THE INTERACTION FOCUSED ON EACH PATIENTS INDIVIDUAL CLINICAL NEEDS 4RIAGING PATIENTS ALSO RELIEVES %$ CROWDING AND ENSURES AN EFlCIENT USE OF RESOURCES 3OME TRIAGE PRACTICES INCLUDE 3ENDING LESS ILL PATIENTS TO OTHER DEPARTMENTS 0ATIENTS WHO PRESENT WITH SUB ACUTE SYMPTOMS CAN OFTEN BE TREATED AT A MORE CONVENIENT TIME IN A BETTER EQUIPPED PLACE )F FOR EXAMPLE A PHYSICIAN DETERMINES THAT A PATIENT NEEDS A STRESS TEST TO DETECT A POTENTIAL CARDIAC PROBLEM THE %$ NURSE CAN QUICKLY SCHEDULE THE PROCEDURE AT THE NEARBY URGENT CARE DEPARTMENT FREEING THE RESOURCES OF THE %$ %LECTRONIC BEDBOARD AND TRACKING SYSTEMS % $ CLINICIANS CAN KEEP TRACK OF INPATIENT BEDS AND THE LOCATION OF EVERY %$ PATIENT IN THE HOSPITAL %LECTRONIC MONITORING AND TRACKING LETS %$ NURSES QUICKLY lND BEDS FOR PATIENTS WHO ARE SERIOUSLY ILL
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
HLOQNUHMFãSGDãD LD Q FD M BXã C D O@ Q S LD M S ã D W OD Q H D M B D &AST 4RACK AND %XPRESS #ARE PROGRAMS 0ROGRAMS SUCH AS &AST 4RACK ACKNOWLEDGE THAT SOME PATIENTS WILL USE THE %$ FOR PRIMARY CARE AND OTHERS WILL HAVE RELATIVELY MINOR INJURIES THAT STILL REQUIRE IMMEDIATE ATTENTION 4HESE PROGRAMS ASSIGN SUCH PATIENTS TO RECEIVE PROMPT ATTENTION FROM PRIMARY CARE PHYSICIANS PHYSICIAN ASSISTANTS OR NURSE PRACTITIONERS WHO USE STANDARD PROTOCOLS AND WHO CAN TREAT THEM QUICKLY AT FAR LESS COST THAN TYING UP %$ BEDS AND RESOURCES
4HROUGHPUT AND 0ATIENT #ARE %$ PATIENTS PROGRESS THROUGH FOUR BASIC STAGES INTERVIEW EXAMINATION DIAGNOSIS AND DISPOSITION 4HE MORE QUICKLY THESE PROCESSES HAPPEN THE BETTER THE OUTCOMES AND PATIENT SATISFACTION 7HEN THE %$ MUST COLLABORATE WITH OTHER DEPARTMENTS FOR ANCILLARY TESTING THESE INTERACTIONS NEED TO TAKE PLACE SWIFTLY AND RELIABLY -ETRICS WORTH MONITORING INCLUDE THE TIME NEEDED TO ADMINISTER TESTS AND TO DELIVER TEST RESULTS 7HERE NECESSARY THE HOSPITAL MUST RE ENGINEER PRACTICES TO ACHIEVE BEST PRACTICE BENCHMARKS )N AN EFFORT TO SHORTEN THE TIME REQUIRED FOR ANCILLARY TESTING SOME HOSPITALS ESPECIALLY THOSE WITH LARGE PATIENT VOLUMES LOCATE TESTING RESOURCES EITHER WITHIN OR IMMEDIATELY NEXT TO THE %$ 2ADIOLOGICAL TESTING DIAGNOSTIC IMAGING AND ROUTINE LABORATORY TESTS CAN BE CONDUCTED WITHIN THE %$ .EW MEDICAL TECHNOLOGY ENABLES %$ NURSES TO ADMINISTER AND ANALYZE BLOOD TESTS AT THE PATIENTS BEDSIDE $ELAYS IN GETTING AN %$ PATIENT ADMITTED CAN OFTEN BE SHORTENED SUBSTANTIALLY BY AN hADMISSIONS TEAMv THAT INCLUDES A PHYSICIAN STATIONED IN THE %$ TO CONDUCT AN ADMISSION WORKUP WRITE ADMISSION ORDERS AND TAKE THE PATIENT TO THE APPROPRIATE INPATIENT mOOR !NOTHER APPROACH IS FOR THE %$ STAFF TO ALERT THE hADMISSION TEAMv WHO WILL MEET THE PATIENT ON THE INPATIENT UNIT TO PERFORM THE ADMISSION WORKUP 4HE CLINICAL INTERACTION BETWEEN PHYSICIANS AND NURSES SIGNIlCANTLY AFFECTS THROUGHPUT 7HEN NURSES AND PHYSICIANS TRUST EACH OTHERS CLINICAL JUDGMENT NURSES WILL ANTICIPATE WHAT CLINICAL INFORMATION AND TESTING A PHYSICIAN WILL NEED %XPERIENCED %$ NURSES ARE ABLE TO ORDER TESTS FROM SPECIlC PROTOCOLS;=
%$ 0RACTICES n 4HE 'OOD THE "AD AND THE 5GLY 0RACTICES THAT PATIENTS DONT LIKE INCLUDE @"OARDING 0ATIENTS DO NOT LIKE BEING hBOARDED v OR TEMPORARILY STORED ON A BED WITHIN THE %$ WAITING FOR AN INPATIENT BED;= 0ATIENTS FEEL NEGLECTED WHEN THEY ARE BOARDED IN THE %$ %VIDENCE SUGGESTS THAT CARE IS SAFER IF THE PATIENT IS PLACED IN A HALLWAY BED ON THE DESIGNATED INPATIENT UNIT;= -OVING PATIENTS BACK AND FORTH ) N SOME BUSY %$S PATIENTS MAY BE BROUGHT IN TO TREATMENT ROOMS FOR EXAMINATION AND DIAGNOSTIC TESTS AND SENT BACK TO THE WAITING ROOM TO AWAIT TEST RESULTS OR THE AVAILABILITY OF A
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
PHYSICIAN TO EVALUATE THEM 4HIS MAY HELP TO FREE UP %$ BEDS BUT IS A MAJOR SOURCE OF DISSATISFACTION TO PATIENTS
#ONCLUSION .O HOSPITAL DEPARTMENT EARNS AS MUCH ADMIRATION WHEN THINGS GO RIGHT OR HARMS THE HOSPITALS REPUTATION AS MUCH WHEN THINGS GO WRONG AS THE %$ 7HEN PATIENTS MUST WAIT IN THE %$ FOR LONG PERIODS BEFORE RECEIVING MEDICAL TREATMENT OR RESPOND TO THE SAME QUESTIONS FOUR DIFFERENT TIMES FROM FOUR DIFFERENT PEOPLE WHEN THEY ARE hBOARDEDv IN %$ STORAGE ROOMS AND HALLWAYS WAITING FOR INPATIENT BEDS OR WHEN %$ STAFF FAIL TO CONVEY USEFUL INFORMATION AND A SYMPATHETIC ATTITUDE PATIENTS LOSE FAITH THAT THEY ARE RECEIVING ADEQUATE MEDICAL CARE !LTHOUGH SOME PROBLEMS THAT MANIFEST 0RACTICES THAT ENHANCE THE PATIENT EXPERIENCE INCLUDE !SKING QUESTIONS ONCE 2EPEATEDLY ASKING THE SAME QUESTIONS IRRITATES PATIENTS 4HEY FEEL THAT NO ONE IN THE LONG CHAIN OF CAREGIVERS SHARES PATIENT MEDICAL INFORMATION WITH ANYONE ELSE 2EGISTRATION ADMISSION DEMOGRAPHIC AND MEDICAL INFORMATION ABOUT EACH PATIENT NEEDS TO BE INTEGRATED INTO A COMPREHENSIVE INFORMATION SYSTEM ACCESSIBLE TO ALL WHO COME INTO CONTACT WITH THAT PATIENT 3OME CIRCUMSTANCES MAY REQUIRE THAT THE SAME QUESTION BE ASKED MULTIPLE TIMES SUCH AS AN -2) PATIENT QUERIED ABOUT A PACEMAKER OR A PATIENT ABOUT TO GO UNDER ANESTHESIA ASKED ABOUT THE TIME OF HIS LAST MEAL )N THESE CIRCUMSTANCES QUESTIONERS SHOULD EXPLAIN WHY THE ANSWER IS SO IMPORTANT THAT IT MUST BE VERIlED MORE THAN ONCE 3ENSITIVITY TOWARD COLLECTING COPAYS -OST HOSPITALS DO NOT COLLECT COPAYS IN THE %$ BEFORE SERVICES ARE RENDERED BUT BEFORE PATIENTS LEAVE (OWEVER PATIENTS DO NEED TO BE GUIDED BACK TO REGISTRATION SO THEIR COPAYS CAN BE COLLECTED AND lNANCIAL RESPONSIBILITY DETERMINED #LINICIANS SHOULD NOT BE ASKED TO TAKE ON THE RESPONSIBILITY OF ASKING PATIENTS FOR MONEY (ELP FOR THE UNINSURED AND UNDERINSURED 3OCIAL WORKERS AND CASE MANAGERS SHOULD BE AVAILABLE IN THE %$ TO WORK WITH THE GROWING POPULATION OF WORKING POOR PATIENTS WHO LACK HEALTH INSURANCE 4HESE %$ PERSONNEL CAN CONNECT INDIGENT PATIENTS TO COMMUNITY RESOURCES PROVIDE lNANCIAL COUNSELING AND OFFER OTHER IMPORTANT SERVICES;= &OLLOWING UP 4HE %$ NURSE SHOULD GIVE CLEAR DISCHARGE INSTRUCTIONS TO PATIENTS #OMPLIANCE WITH THESE INSTRUCTIONS IS OFTEN IMPORTANT TO A GOOD OUTCOME SO THE NURSE SHOULD TAKE THE TIME TO ASK QUESTIONS THAT VALIDATE THAT THE PATIENT UNDERSTANDS THE INSTRUCTIONS
HLOQNUHMFãSGDãD LD Q FD M BXã C D O@ Q S LD M S ã D W OD Q H D M B D THEMSELVES IN THE %$ RESULT FROM BROKEN PROCESSES ELSEWHERE IN THE HOSPITAL AND lNANCIAL CONSTRAINTS GENERALLY PRECLUDE EXPANDING THE %$ OR ADDING INPATIENT BEDS PATIENT FOCUSED STRATEGIES IMPLEMENTED BY A PROFESSIONAL CARING AND WELL TRAINED %$ STAFF CAN MAKE STAYS SHORTER SIGNIlCANTLY INCREASE PATIENT SATISFACTION ENHANCE THE QUALITY OF CARE THE HOSPITAL PROVIDES AND CAPTURE LOST REVENUE AS THE ,7/4 PERCENT DECREASES %NDNOTES -C)NTURFF " AND . -C#LESKEY h0UBLIC /PINION 3TRATEGIES +EY &INDINGS FROM 4WO .ATIONAL 3URVEYS ON BEHALF OF THE !MERICAN #OLLEGE OF %MERGENCY 0HYSICIANS v *ULY P )BID )BID P -C#AIG , AND # "URT .ATIONAL (OSPITAL !MBULATORY -EDICAL #ARE 3URVEY %MERGENCY $EPARTMENT 3UMMARY #$# !DVANCE $ATA FROM 6ITAL AND (EALTH 3TATISTICS -AY .O P HTTP WWWCDCGOVNCHSDATAADADPDF h4ACKLING THE #APACITY #RISIS 3UCCESSFUL "ED -ANAGEMENT 3TRATEGIES v (&- -ARCH P HTTPMPTMCKESSONCOMARTICLESHFMA?BED MGMTPDF -C#AIG , AND # "URT .ATIONAL (OSPITAL !MBULATORY -EDICAL #ARE 3URVEY %MERGENCY $EPARTMENT 3UMMARY #$# !DVANCE $ATA FROM 6ITAL AND (EALTH 3TATISTICS -AY .O P HTTP WWWCDCGOVNCHSDATAADADPDF )BID ,ARABEE * ET AL h0REDICTORS OF 0ATIENT 3ATISFACTION WITH )NPATIENT .URSING #ARE v 2ESEARCH IN .URSING (EALTH VOL P -C)NTURFF " AND . -C#LESKEY h0UBLIC /PINION 3TRATEGIES +EY &INDINGS FROM 4WO .ATIONAL 3URVEYS ON BEHALF OF THE !MERICAN #OLLEGE OF %MERGENCY 0HYSICIANS v *ULY P h4ACKLING THE #APACITY #RISIS 3UCCESSFUL "ED -ANAGEMENT 3TRATEGIES v (&- -ARCH P HTTPMPTMCKESSONCOMARTICLES HFMA?BEDMGMTPDF h!CTS OF #HARITY #HARITY CARE STRATEGIES FOR HOSPITALS IN A CHANGING LANDSCAPE v 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE
-INUTE #LINIC !S HEALTHCARE COSTS CONTINUE TO RISE CONSUMERS AND PAYERS SEARCH FOR ALTERNATIVES FOR AFFORDABLE QUALITY CARE 4HE GROWING RETAIL SEGMENT OF HEALTHCARE MAY AID IN THIS CAUSE 4HIS SEGMENT CONTINUES TO GROW WITH ONE STOP CLINICS THAT ARE GENERALLY OPEN SEVEN DAYS A WEEK DIAGNOSING AND TREATING A LIMITED SCOPE OF COMMON ILLNESSES 4HE LARGEST SUCH CHAIN -INUTE#LINIC FOCUSES ON MEDICAL CONDITIONS SUCH AS STREP THROAT MONO mU BLADDER INFECTIONS AND VACCINATIONS 4HE NURSE PRACTITIONERS WHO STAFF THE CLINICS LEVERAGE THEIR KNOWLEDGE THROUGH REPETITIVE DIAGNOSES OF SIMILAR CASES WITHIN A LIMITED SCOPE OF PRACTICE h1UALITY OF CARE IS OUR .O CONCERN v SAYS -ICHAEL (OWE #%/ OF -INUTE#LINIC WHICH HAS OPENED NEARLY SUCH CLINICS IN DRUGSTORES AND OTHER RETAIL OUTLETS SEE %XHIBIT FOR A DECISION TREE THAT SHOWS HOW -INUTE#LINIC MAINTAINS QUALITY "Y SEGMENTING ROUTINE CARE TO NURSE PRACTITIONERS DOCTORS CAN CONCENTRATE ON ATYPICAL CONDITIONS THEREBY PROVIDING A BETTER FOCUS OF CARE THROUGHOUT THE HEALTHCARE LANDSCAPE h0HYSICIANS NOW MORE THAN EVER ARE GOING TO BECOME AWARE OF CONSUMERS AND WILL NEED TO DEVELOP A PATIENT CENTRIC MENTALITY v SAYS -INUTE#LINICS (OWE A FORMER #%/ OF THE !RBYS FAST FOOD CHAIN
%XHIBIT 1UALITY $ECISION 4REE AND #HECKLIST FOR -INUTE#LINIC $O WE TREAT THIS
9ES .O
,IMITED SCOPE OF CONDITIONS VACCINATIONS 2EFERRED TO LOCAL PHYSICIANS HOSPITALS
(OW DO WE TREAT THIS
0ROTOCOLS FROM !MERICAN !CADEMY OF &AMILY 0HYSICIANS !MERICAN !CADEMY OF 0EDIATRICS )NSTITUTE FOR #LINICAL 3YSTEM )MPROVEMENT
!RE NURSE PRACTITIONERS FOLLOWING PROTOCOLS
$IAGNOSIS AND TREATMENT ARE TRACKED THROUGH COMPANYWIDE ELECTRONIC MEDICAL RECORD SYSTEM CHARTS RANDOMLY REVIEWED BY LOCAL MEDICAL DIRECTOR
7ILL TREATMENT BE SAFE
0RESCRIPTIONS ARE CHECKED WITH ELECTRONIC DRUG INTERACTION DATABASE
(OW CAN PATIENTS BE INCLUDED IN THE QUALITY CONTINUUM
%DUCATIONAL INFORMATION IS PRINTED FOR ALL PATIENTS UPON DISCHARGE FROM THE CLINIC
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
-AGNET .URSING 3TATUS 4IME AND MONEY SPENT ACHIEVING -AGNET NURSING STATUS IS PAYING QUALITY DIVIDENDS TO HOSPITALS CAREGIVERS AND PATIENTS ALIKE THROUGH RECRUITMENT AND RETENTION OF MORE PROFESSIONAL NURSES AND BETTER HEALTHCARE OUTCOMES
"Y $EBORAH !LLBACH 0RICEWATERHOUSE#OOPERS 3HERRY $ANELLO AND 3USAN (OWELL 3T *OSEPHS#ANDLER (EALTH 3YSTEM
4
HE -AGNET 2ECOGNITION 0ROGRAM¸ DEVELOPED AND ADMINIS TERED BY THE !MERICAN .URSES !SSOCIATION !.! PROMOTES AND HONORS EXCELLENCE IN HOSPITAL NURSING SERVICE !CHIEVING -AGNET STATUS REQUIRES A HEALTHCARE ENVIRONMENT THAT ENCOURAGES AND EXPECTS NURSES TO WORK IN PARTNERSHIP WITH PHYSICIANS AND OTHER STAFF IN DELIVERING QUALITY HEALTHCARE TO PATIENTS -AGNET NURSING STATUS IS RESPECTED AS THE ONLY QUALITY MEASURE AND RECOGNITION SYSTEM RELATED SPECIlCALLY TO HOSPITAL NURSING )T CONlRMS NURSES ABILITY TO COLLABORATE CONlDENTLY WITH PHYSICIANS AND OTHER CAREGIVERS AND THEIR PARTICIPATION IN MAKING THE DECISIONS THAT GOVERN THEIR OWN RESPONSIBILITIES PRACTICES AND PROFESSIONAL DEVELOPMENT $ECADES OF RESEARCH SHOW THAT THE ORGANIZATIONAL AND MANAGEMENT CHARACTERISTICS OF -AGNET HOSPITALS ARE ASSOCIATED WITH MORE PROFESSIONAL NURSE PRACTICE ENVIRONMENTS AND BETTER PATIENT AND STAFF OUTCOMES; = .URSES SEEK -AGNET ORGANIZATIONS BECAUSE THEY lND WORK MORE SATISFYING WHERE THEIR TALENTS ARE RESPECTED AND MAKE A DIFFERENCE TO PATIENT OUTCOMES 0ATIENTS ARE BEGINNING TO RECOGNIZE THAT SUCH ORGANIZATIONS ALSO DELIVER MORE SATISFYING PATIENT EXPERIENCES
4HE /RIGIN OF -AGNETISM 4HE EARLY S SAW A NATIONWIDE SHORTAGE OF NURSES (OSPITALS AND OTHER PROVIDERS SOUGHT TO RECRUIT AND RETAIN NURSES BY A VARIETY OF METHODS 3OME FELT OFFERING LARGER SALARIES WOULD SOLVE
THE NURSING SHORTAGE 4HE 2OBERT 7OOD *OHNSON &OUNDATION DECIDED TO TAKE A LOOK AT MANY hATTRACTORSv 7HAT ATTRACTED NURSES TO THE PROFESSION 7HAT KIND OF ENVIRONMENTS ATTRACTED THEM TO PARTICULAR HEALTH SYSTEMS 7HAT MADE THEM WANT TO STAY 4HIS AND MANY SUBSEQUENT STUDIES FOUND A HIGH CORRELATION BETWEEN HOSPITALS THAT DELIVER QUALITY CARE AND THOSE THAT ATTRACT AND RETAIN NURSES (OSPITALS THAT PROMOTE AND SUPPORT THE ROLE OF PROFESSIONAL NURSING AND GIVE NURSES AUTHORITY AND AUTONOMY TO ACT IN THEIR AREAS OF EXPERTISE ALSO CREATE INTERDISCIPLINARY CARE CULTURES PATIENT CENTRIC CARE ENVIRONMENTS AND BETTER PATIENT OUTCOMES;= .URSES PREFER TO WORK IN HEALTH SYSTEMS WHERE PATIENTS RECEIVE EXCELLENT CARE AND WHERE NURSES CAN FOCUS THEIR TIME AND TALENTS ON CONTRIBUTING TO PATIENT CARE SAFETY AND SATISFACTION .URSES WANT TO PARTICIPATE IN DECISIONS REGARDING PATIENT CARE AND THEIR ROLES RESPONSIBILITIES AND PRACTICES IN DELIVERING IT 4HEY WANT TO BE RESPECTED AS ESSENTIAL TO QUALITY CARE AND GOOD PATIENT OUTCOMES 4HEY WANT TO WORK IN A PLACE WHERE THEY CAN GROW AND DEVELOP THEIR EXPERIENCE AND EXPERTISE 2ESEARCH SUGGESTS THAT PROVIDING SUCH AN ENVIRONMENT DIFFERENTIATES HOSPITALS WITH SIGNIlCANTLY LESS TURNOVER AND FEWER NURSING VACANCIES FROM LESS hMAGNETICv COMPETITORS 4HIS WAS THE GENESIS OF THE -AGNET 2ECOGNITION 0ROGRAM¸ TODAY ADMINISTERED BY THE !MERICAN .URSES #REDENTIALING #ENTER AN ARM OF THE !.! 4HE PROGRAM AIMS TO HELP HOSPITALS PROVIDE MORE REWARDING LONG TERM CAREER SATISFACTION AND OPPORTUNITIES FOR
$EBORAH !LLBACH 2. -3. #.! IS A SUBJECT MATTER EXPERT WITH 0RICEWATERHOUSE#OOPERS (EALTHCARE #ONSULTING PRACTICE AND HAS MORE THAN YEARS EXPERIENCE AS A HEALTHCARE OPERATIONS LEADER 3HE SPECIALIZES IN CARE DELIVERY DESIGN PROCESS IMPROVEMENT COST CONTAINMENT REVENUE ENHANCEMENT AND QUALITY IMPROVEMENT 3HE CAN BE REACHED AT DEBORAHPALLBACH USPWCCOM 3HERRY $ANELLO -3. 2. #.!! IS VICE PRESIDENT OF PATIENT CARE SERVICES AND THE CHIEF NURSING OFlCER AT 3T *OSEPHS #ANDLER IN 3AVANNAH 'A 3HE HOLDS MASTERS DEGREES IN BOTH NURSING AND BUSINESS 3HE HAS MORE THAN YEARS EXPERIENCE IN HEALTHCARE AND HAS HELD JOBS IN CRITICAL CARE NURSING EDUCATION ADMINISTRATION AND OPERATIONS 3HE HAS ALSO LED A NUMBER OF INITIATIVES EVALUATING THE ENVIRONMENT OF NURSING PRACTICE AND HOW IT AFFECTS EFlCIENCY AND QUALITY 3HE CAN BE REACHED AT DANELLOS SJCHSORG 3USAN (OWELL %D$ 2. !/#. IS THE DIRECTOR OF PROFESSIONAL PRACTICE AT 3T *OSEPHS#ANDLER 3HE HAS FACILITATED THE PROCESS FOR OBTAINING -AGNET DESIGNATION AND REDESIGNATION FOR THE ORGANIZATION FOR THE PAST SIX YEARS $R (OWELL HAS OVER YEARS EXPERIENCE IN NURSING PRIMARILY IN THE lELDS OF ONCOLOGY AND EDUCATION 3HE CAN BE REACHED AT HOWELLS SJCHSORG
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
L@FM D S ã M T Q RH M Fã RS@S T R
&ORCES OF -AGNETISM ;=
&ORCE 1UALITY OF .URSING ,EADERSHIP +NOWLEDGEABLE STRONG RISK TAKING NURSE LEADERS FOLLOW A WELL ARTICU LATED STRATEGIC AND VISIONARY PHILOSOPHY IN THE DAY TO DAY OPERATIONS OF THE NURSING SERVICES .URSING LEADERS AT ALL LEVELS OF THE ORGANIZATION CONVEY A STRONG SENSE OF ADVOCACY AND SUPPORT FOR THE STAFF AND FOR THE PATIENT 4HE RESULTS OF QUALITY LEADERSHIP ARE EVIDENT IN NURSING PRACTICE AT THE PATIENTS SIDE
&ORCE /RGANIZATIONAL 3TRUCTURE /RGANIZATIONAL STRUCTURES ARE GENERALLY mAT RATHER THAN VERTICAL OR HIERARCHI CAL AND DECENTRALIZED DECISION MAKING PREVAILS 4HE ORGANIZATIONAL STRUCTURE IS DYNAMIC AND RESPONSIVE TO CHANGE 3TRONG NURS ING REPRESENTATION IS EVIDENT IN THE STRUCTURE OF THE ORGANIZATIONAL COMMITTEE .URSING LEADERS SERVE AT THE EXECUTIVE LEVELS OF THE ORGANIZATION 4HE CHIEF NURSING OFlCER TYPICALLY REPORTS DIRECTLY TO THE CHIEF EXECUTIVE OFlCER 4HE ORGANIZATION HAS A FUNCTIONING AND PRODUCTIVE SYSTEM OF SHARED DECISION MAKING
&ORCE -ANAGEMENT 3TYLE (EALTHCARE ORGANIZATION AND NURSING LEADERS CREATE AN ENVIRONMENT ENCOURAGING PARTICIPATION FROM STAFF AT ALL LEVELS IN OPERATIONAL DECISIONS &EEDBACK IS VALUED AND INCORPORATED INTO FUTURE DECISIONS AND PRAC TICES .URSES SERVING IN LEADERSHIP POSITIONS ARE VISIBLE ACCESSIBLE AND COMMITTED TO COMMUNICATING EFFECTIVELY WITH STAFF
&ORCE 0ERSONNEL 0OLICIES AND 0ROGRAMS 3ALARIES AND BENElTS ARE COMPETITIVE #REATIVE AND mEXIBLE STAFlNG MODELS THAT SUPPORT A SAFE AND HEALTHY WORK ENVIRONMENT ARE USED 0ERSONNEL POLICIES ARE CREATED WITH DIRECT CARE NURSE INVOLVEMENT 3IGNIlCANT OPPORTUNITIES FOR PROFESSIONAL GROWTH EXIST IN ADMINISTRATIVE AND CLINICAL TRACKS 0ERSONNEL POLICIES AND PROGRAMS SUPPORT PROFESSIONAL NURSING PRACTICE WORKLIFE BALANCE AND THE DELIVERY OF QUALITY CARE
&ORCE 0ROFESSIONAL -ODELS OF #ARE 4HERE ARE MODELS OF CARE IE PRIMARY NURSING CASE MANAGEMENT FAM ILY CENTERED DISTRICT AND HOLISTIC THAT GIVE NURSES THE RESPONSIBILITY AND AUTHORITY FOR DIRECT PATIENT CARE AND FOR CONTINUITY OF CARE ACROSS THE CONTINUUM .URSES ARE ACCOUNTABLE FOR THEIR OWN PRACTICE AS WELL AS THE COORDINATION OF CARE 4HE MODELS TAKE INTO CONSIDERATION PATIENTS UNIQUE NEEDS AND PROVIDE SKILLED NURSES AND ADEQUATE RESOURCES TO ACCOMPLISH DESIRED OUTCOMES
&ORCE 1UALITY OF #ARE 1UALITY IS THE SYSTEMATIC DRIVING FORCE FOR NURSING AND THE ORGANIZATION .URSES SERVING IN LEADERSHIP POSITIONS ARE RESPONSIBLE FOR PROVIDING AN ENVIRONMENT THAT POSITIVELY INmUENCES PATIENT OUTCOMES 4HERE IS A PERVA SIVE PERCEPTION AMONG NURSES THAT THEY PROVIDE HIGH QUALITY CARE TO PATIENTS
&ORCE 1UALITY )MPROVEMENT 4HE ORGANIZATION HAS STRUCTURES AND PROCESSES FOR THE MEASUREMENT OF QUALITY AND PROGRAMS FOR IMPROVING THE QUALITY OF CARE AND SERVICES DELIVERED TO PATIENTS THROUGHOUT THE ORGANIZATION
&ORCE #ONSULTATION AND 2ESOURCES 4HE HEALTHCARE ORGANIZATION PROVIDES ADEQUATE RESOURCES SUPPORT AND OPPORTUNITIES FOR THE UTILIZATION OF EXPERTS PARTICULARLY ADVANCED PRACTICE NURSES 4HE ORGANIZATION ALSO PROMOTES INVOLVEMENT OF NURSES IN PROFESSIONAL ORGANIZATIONS AND AMONG PEERS IN THE COMMUNITY
&ORCE !UTONOMY .URSES ARE ENCOURAGED AND EXPECTED TO PRACTICE AUTONOMOUSLY TO ASSESS AND PROVIDE APPRO PRIATE PATIENT CARE BASED ON COMPETENCE PROFESSIONAL EXPERTISE AND KNOWLEDGE AND CONSISTENT WITH PROFESSIONAL STANDARDS )NDEPENDENT JUDGMENT IS EXPECTED TO BE EXERCISED WITHIN THE CONTEXT OF INTERDISCIPLINARY AND MULTIDISCIPLINARY APPROACHES TO PATIENT CARE
&ORCE #OMMUNITY AND THE (EALTHCARE /RGANIZATION /RGANIZATIONS THAT ARE BEST ABLE TO RECRUIT AND RETAIN NURSES INVARIABLY MAINTAIN A STRONG COMMUNITY PRESENCE #OLLABORATION IS APPARENT WITH ALL TYPES OF HEALTHCARE PROVID ERS AND OTHER COMMUNITY ORGANIZATIONS TO DEVELOP STRONG PARTNERSHIPS THAT SUPPORT IMPROVED PATIENTCLIENT OUTCOMES AND THE HEALTH OF THE COMMUNITIES THEY SERVE #ONTINUED ON THE NEXT PAGE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
L@ FM D S ã M T Q RH M Fã RS@S T R &ORCES OF -AGNETISM CONTINUED ;=
&ORCE .URSES AS 4EACHERS 0ROFESSIONAL NURSES ARE INVOLVED IN EDUCATIONAL ACTIVITIES WITHIN THE ORGANIZATION AND COMMUNITY A ROLE THAT REPORTEDLY GIVES NURSES A GREAT DEAL OF PROFESSIONAL SATISFACTION 3TAFF IN ALL POSITIONS SERVE AS FACULTY AND PRECEPTORSMENTORS FOR STUDENTS FROM A VARIETY OF ACADEMIC PROGRAMS WHO ARE WELCOMED AND SUPPORTED IN THE ORGANIZATION 4HERE IS A PATIENT EDUCATION PROGRAM THAT MEETS THE DIVERSE NEEDS OF PATIENTS IN ALL OF THE CARE SETTINGS OF THE ORGANIZATION
&ORCE )MAGE OF .URSING 4HE SERVICES PROVIDED BY NURSES ARE CHARACTERIZED AS ESSENTIAL BY OTHER MEMBERS OF THE HEALTHCARE TEAM .URSES ARE VIEWED AS INTEGRAL TO THE HEALTHCARE ORGANIZATIONS ABILITY AND MISSION TO PROVIDE PATIENT CARE .URSES EFFECTIVELY INmUENCE SYSTEMWIDE PROCESSES
&ORCE )NTERDISCIPLINARY 2ELATIONSHIPS #OLLABORATIVE WORKING RELATIONSHIPS WITHIN AND AMONG THE DISCI PLINES ARE VALUED -UTUAL RESPECT IS BASED ON THE PREMISE THAT ALL MEMBERS OF THE HEALTHCARE TEAM MAKE ESSENTIAL CONTRIBUTIONS IN THE ACHIEVEMENT OF GOOD CLINICAL OUTCOMES #ONmICT MANAGEMENT STRATEGIES ARE IN PLACE AND ARE USED EFFECTIVELY WHEN NEEDED
&ORCE 0ROFESSIONAL $EVELOPMENT 4HE HEALTHCARE ORGANIZATION VALUES AND SUPPORTS WITH ADEQUATE HUMAN AND lSCAL RESOURCES THE PROFESSIONAL GROWTH AND DEVELOPMENT OF THE STAFF 0ROGRAMS THAT PROMOTE STAFF ORIENTATION IN SERVICE EDUCATION CONTINUING AND FORMAL EDUCATION CAREER DEVELOPMENT COMPETENCY BASED CLINICAL AND LEADERSHIPMANAGEMENT DE VELOPMENT AND PROFESSIONAL CERTIlCATION ARE EVIDENT 3OURCE !MERICAN .URSES !SSOCIATION
"ETTER PATIENT OUTCOMES AND MORE SATISlED PATIENTS ARE NATURAL CONSE QUENCES OF HAVING NURSES WHO ARE MORE INVESTED IN MAKING CHANGES AND BEING ASSERTIVE ABOUT THEIR PRACTICE ENVIRON MENT !CHIEVING -AGNET STATUS IS A CONTINUOUS JOURNEY )T IS THE JOURNEY
(OSPITALS APPLY FOR -AGNET STATUS ON A VOLUNTARY BASIS AND RETAIN THEIR -AGNET STATUS FOR FOUR YEARS 3TATUS CAN BE PULLED IF QUALITY DIPS OR IF THERE ARE SERIOUS EVENTS THAT AFFECT THE ORGANIZATIONS ABILITY TO CONTINUE COMPLIANCE WITH THE &ORCES OF -AGNETISM %ACH SUBSEQUENT APPLICATION IS TREATED THE SAME AS A NEW APPLICATION WITH THE SAME RIGOROUS REQUIREMENTS FOR ON SITE VISITATIONS AND EVIDENCE OF COMPLIANCE /NLY ABOUT LESS THAN PERCENT OF ALL HOSPITALS HAVE ACHIEVED -AGNET STATUS (OWEVER THE NUMBER OF THOSE APPLYING HAS INCREASED STEADILY IN RECENT YEARS;=
THAT MAKES A STRONGER NURSING SERVICE
4HE 0ATH TO -AGNETISM NURSES AND CONSEQUENTLY BETTER FULlLL THEIR MISSIONS AS COMMUNITY HEALERS !CHIEVING -AGNET HOSPITAL RECOGNITION IS BUILT AROUND COMPLIANCE WITH A SET OF PRINCIPLES THE h &ORCES OF -AGNETISMv "Y WORKING TO COMPLY WITH THESE PRINCIPLES AND GIVING EVIDENCE THAT THE REQUIRED LEVELS OF EXCELLENCE ARE ATTAINED HOSPITALS LEARN TO MEASURE KEY PERFORMANCE INDICATORS AND KEEP ALL STAKEHOLDERS APPRISED OF THE ORGANIZATIONS PROGRESS IN MEETING THEM 4HESE KEY PERFORMANCE INDICATORS SUCH AS INCIDENCE OF PRESSURE SORES PER PATIENT DAYS AND OTHER INDUSTRY BENCHMARKS HELP TO EVALUATE THE HOSPITALS SUCCESS AT CREATING SATISFYING EXPERIENCES FOR PATIENTS AND SATISFYING CAREERS FOR NURSES PHYSICIANS AND STAFF -OREOVER THE FORCES OF MAGNETISM CAN ALSO APPLY TO NON NURSING DEPARTMENTS 3HAPING THE PHILOSOPHY OF HOW A HOSPITAL DOES BUSINESS CAN BE EQUALLY OR EVEN MORE IMPORTANT TO THE ORGANIZATION THAN A NURSING ONLY FOCUS
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
4HE HOSPITALS OF 3T *OSEPHS#ANDLER (EALTH 3YSTEM 3*#(3 TWO OF THE OLDEST COMMUNITY HOSPITALS IN THE 53 HAVE ALWAYS HAD A TRADITION OF lRST RATE NURSING SERVICE AND QUALITY PATIENT CARE 4HE NURSES WITHIN THE SYSTEM HAVE CONTINUOUSLY BEEN ACKNOWLEDGED BY THE PHYSICIANS WITH WHOM THEY WORK AS HAVING A PIVOTAL ROLE IN PROVIDING QUALITY CARE AND GOOD CLINICAL OUTCOMES 4HE NURSES AND EXECUTIVES AT 3T *OSEPHS#ANDLER MOVED RAPIDLY TO INCORPORATE THE PRINCIPLES OF NURSING EXCELLENCE THE h &ORCES OF -AGNETISM v INTO THEIR PROFESSIONAL LIVES 4HE ORGANIZATIONS APPLICATION WAS EVALUATED FOR COMPLIANCE WITH THE PRINCIPLES OF -AGNETISM AND KEY PERFORMANCE INDICATORS THAT SUPPORTED THE APPLICATION 4WO YEARS AND SEVERAL CHALLENGES LATER IN THE !.! CONFERRED -AGNET NURSING STATUS ON 3T *OSEPHS#ANDLER (EALTH 3YSTEM 4HE SYSTEM WAS RECERTIlED FOUR YEARS LATER WITH AN ON SITE VISIT AND INTERVIEWS WITH NO LESS THAN PERCENT OF THE NURSING STAFF TO VERIFY THAT
L@ FM D S ã M T Q RH M Fã RS@S T R THE ORGANIZATION hLIVEDv THE PRINCIPLES OF NURSING EXCELLENCE AND MADE THEM PART OF THE HOSPITALS ONGOING OPERATING PRACTICES (OSPITAL LEADERSHIP AND NURSES AGREE THAT ACHIEVING -AGNET STATUS WAS WORTH THE EFFORT INVOLVED IN MAKING AND SUPPORTING THE APPLICATION 2ECRUITING AND RETAINING NURSES HAS NOT BEEN A PROBLEM FOR 3*#(3 IN SPITE OF SLIGHTLY HIGHER SALARIES OFFERED BY A COMPETITOR -OST IMPORTANTLY COMPLYING WITH THE &ORCES OF -AGNETISM HAS STEERED 3*#(3 TOWARD CONTINUOUS IMPROVEMENT IN THE QUALITY OF PATIENT CARE AND THE QUALITY OF THE PROFESSIONAL LIVES OF NURSES IN THE ORGANIZATION
%XECUTIVE NURSES WHO HAVE PARTICIPATED IN THE PROCESS OF ACHIEVING -AGNET STATUS FOR THEIR HOSPITALS OFFER THIS ADVICE FOR THOSE WHO ARE CONSIDERING THE JOURNEY 5SE THE APPLICATION PROCESS AS AN OPPORTUNITY AND THE INSPIRATION FOR CHANGE 'ET BUY IN FROM KEY STAKEHOLDERS FROM ACROSS THE ORGANIZATION NOT JUST EXECUTIVE LEADERSHIP AND NURSES 6ISIT OTHER -AGNET HOSPITALS FOR ADVICE AND INSPIRATION 3HOW PHYSICIANS THE DATA n THEY VALUE EVIDENCE AND 6ALUE THE PROCESS AS IMPORTANT IT IS A CONTINUOUS JOURNEY THAT CAN STRENGTHEN THE NURSING SERVICE
%XTENDING THE 2EACH OF .URSING
4HE #HARACTER OF .URSING
!PPLYING FOR -AGNET NURSING STATUS PLACES STRINGENT DEMANDS ON A HOSPITAL WITH RIGOROUS DOCUMENTATION REQUIRED TO DEMONSTRATE THAT THOSE DEMANDS HAVE BEEN MET )NTERVIEWS WITH CHIEF NURSING EXECUTIVES ABOUT ACHIEVING -AGNET STATUS EMPHASIZE THAT IT IS A COSTLY ENDEAVOR THAT INCLUDES TIME AND RESOURCES (OWEVER THEY ALSO STATE THAT THE TIME AND EFFORT ARE VALIDATED BY THE RESULT h#OMPARE THE MONEY YOU BUDGET FOR THIS ;-AGNET= TO WHAT YOU SPEND ON RECRUITMENT EVERY PERCENTAGE POINT THAT YOU DROP YOUR TURNOVER OR RETAIN YOUR STAFF IT MORE THAN PAYS FOR WHAT WE PUT INTO -AGNETv;= )T IS LIKELY THAT NO HOSPITAL WILL BE FULLY COMPLIANT WITH THE PRINCIPLES THAT MERIT -AGNET STATUS RECOGNITION WHEN IT APPLIES 0ART OF THE PURPOSE OF THE RECOGNITION PROGRAM IS TO PUSH ORGANIZATIONS BEYOND IMPROVEMENTS IN THEIR CLINICAL AND lNANCIAL PERFORMANCE TO CONTINUOUS EFFORTS AIMED AT DEVELOPING THE TALENTS EFFECTIVENESS AND SATISFACTION OF THEIR NURSES (OSPITALS ARE ALSO ENCOURAGED TO CONDUCT RESEARCH THAT MAY HELP TO DEVELOP BETTER NURSING PRACTICES &OR MANY YEARS HOSPITALS HAVE BEEN ORGANIZED AROUND WHAT WORKED BEST FOR THE STAFF .URSING RESEARCH PROJECTS ARE NOW LOOKING AT WHAT HAPPENS WHEN THE TIMING AND ORGANIZATION OF CARE DELIVERY IS BETTER ORIENTED TO PATIENT COMFORT AND SATISFACTION &OR EXAMPLE 3T *OSEPHS#ANDLER (OSPITAL IS MEASURING PATIENT AND STAFF SATISFACTION AS A RESULT OF MORE LENIENT VISITING POLICIES IN THEIR CRITICAL CARE UNIT AND THE HOSPITAL IS LOOKING AT IMPROVEMENTS IN PATIENTS VITAL SIGNS AS A RESULT OF INSTITUTING A PERIOD OF hQUIET TIMEv EACH DAY IN THEIR PROGRESSIVE CARE UNIT 4ECHNOLOGY PLAYS A ROLE AS WELL 4OOLS SUCH AS SAFETY SYSTEMS FOR )6 MEDICATION #/ MONITORING AND BEDS DESIGNED TO REDUCE PRESSURE SORES AND FALLS HELP NURSES CONCENTRATE ON BEING CAREGIVERS RATHER THAN WATCHDOGS
4HE -AGNET 2ECOGNITION 0ROGRAM¸ CONFERS -AGNET NURSING STATUS ON HOSPITALS WHOSE PRACTICES AND PEOPLE EXEMPLIFY THE ESSENCE OF NURSING TO BE A CARING KNOWING PRESENCE AND TO HELP RESTORE PATIENTS TO THE BEST LEVEL OF FUNCTION THEY CAN ATTAIN OR TO CONTRIBUTE TO A PEACEFUL DEATH 3UCH RECOGNITION CANNOT BE ACHIEVED IN ISOLATION COLLABORATION WITH THE REST OF THE PATIENT CARE TEAM IS ESSENTIAL 7HEN COMPETENT CONlDENT NURSES ARE ABLE TO COLLABORATE AS PARTNERS WITH PHYSICIANS AND OTHER MEMBERS OF THE HEALTHCARE TEAM AND ISSUES GET ADDRESSED AT A MUCH MORE MANAGEABLE LEVEL AND IN A MUCH MORE COLLEGIAL ATMOSPHERE "ETTER PATIENT OUTCOMES AND MORE SATISlED PATIENTS ARE NATURAL CONSEQUENCES OF HAVING NURSES WHO ARE MORE INVESTED IN MAKING CHANGES AND BEING ASSERTIVE ABOUT THEIR PRACTICE ENVIRONMENT !CHIEVING -AGNET STATUS IS A CONTINUOUS JOURNEY )T IS THE JOURNEY THAT MAKES A STRONGER NURSING SERVICE %NDNOTES (AVENS $3 h#OMPARISON OF NURSING DEPARTMENTAL INFRASTRUCTURE AND OUTCOMES !.## -AGNET AND NON-AGNET #.%S REPORT v .URS %CON PP !IKEN ,( $3 (AVENS AND $- 3LOANE h4HE -AGNET NURSING SERVICES RECOGNITION PROGRAM A COMPARISON OF TWO GROUPS OF -AGNET HOSPITALS v !M * .URS P !IKEN ,( h)MPROVING 1UALITY 4HROUGH .URSING v -AY 0OLICY #HALLENGES IN -ODERN (EALTH #ARE PP h4HE -AGNET 2ECOGNITION 0ROGRAM 2ECOGNIZING %XCELLENCE IN .URSING v !PPLICATION -ANUAL PUBLISHED BY !MERICAN .URSES #REDENTIALING #ENTER 'EORGIA !VENUE 3ILVER 3PRING -$ COPYRIGHT EDITION PP WWWANAORGANCC-AGNETINDEXHTML (AVENS $3 AND -! *OHNSTON h!CHIEVING -AGNET (OSPITAL 2ECOGNITION #HIEF .URSE %XECUTIVES AND -AGNET #OORDINATORS 4ELL 4HEIR 3TORIES v $ECEMBER *OURNAL OF .URSING !DMINISTRATION PP
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
%VIDENCE "ASED $ECISION 3UPPORT &ROM 0APER TO %LECTRONIC ! GROWING BODY OF RESEARCH DEMONSTRATES THAT BOTH PAPER AND ELECTRONIC FORMS OF EVIDENCE BASED DECISION SUPPORT CAN REDUCE ERRORS OF OVERUSE UNDERUSE OR MISUSE OF CLINICAL INTERVENTIONS
"Y 'REGORY ( $ORN :YNX (EALTH
4HE #HALLENGE 4HE SCIENTIlC ADVANCEMENTS OF THE MEDICAL INDUSTRY SPANNING THE LAST YEARS RANGE FROM THE WIDESPREAD USE OF ANTIBIOTICS AFTER 7ORLD 7AR )) TO THE S LANDMARK TRIALS ON BETA BLOCKERS FOLLOWED BY POWERFUL ENZYME INHIBITORS IN THE S EG (-' #O! REDUCTASE INHIBITORS TO RECENT RECOMBINANT MYELOPROLIFERATIVE AGENTS %ACH STEP ALONG THIS STAGGERING PATH OF INNOVATION HAS SOUGHT TO IMPROVE THE HEALTH OF A PARTICULARLY VULNERABLE POPULATION WITH THE HOPE OF ACHIEVING WIDESPREAD POPULATION HEALTH GAINS 4O SOME EXTENT THE BIOLOGICAL INNOVATION FOCUSED APPROACH HAS ACHIEVED ITS GOAL A CHILD BORN IN WILL LIKELY LIVE BEYOND WHEREAS IN THE CHANCES OF EXCEEDING WERE SLIGHTLY LESS THAN PERCENT;= 4HE INNOVATION APPROACH HAS COME AT A SIGNIlCANT COST TO THE 5NITED 3TATES MEASURED BY GROWING HEALTH EXPENDITURES;= WITH MARGINAL GAINS IN LONGEVITY;= *UXTAPOSING THE BRILLIANT HALF CENTURY OF THERAPEUTIC INNOVATIONS ARE DATA DEMONSTRATING THE MARGINAL SPECIlCITY OF THE HEALTHCARE SYSTEM AT DELIVERING THESE INTERVENTIONS TO ELIGIBLE PATIENTS n WELL DEMONSTRATED BY THE PREVALENT UNDERUSE OF HIGHLY COST EFFECTIVE THERAPIES;= &URTHER AGGRAVATING THE EFFECTIVENESS OF THE HEALTHCARE DELIVERY SYSTEM ARE THE lNDINGS OF ERRORS OF MISUSE AND OVERUSE OCCURRING CONJOINTLY WITH ERRORS OF UNDERUSE 4HE FOREGOING POSES A CENTRAL QUESTION 7ILL AN APPROACH FOCUSED PURELY ON INNOVATION CONTINUE TO SERVE THE HEALTH OF THE 53 POPULACE DEEP INTO THIS CENTURY OR SHOULD IT BE SUPPLEMENTED WITH AN APPROACH FOCUSED ON ELIMINATING THE OVERUSE UNDERUSE AND MISUSE OF CLINICAL INTERVENTIONS 4O OPTIMIZE THE DELIVERY OF THERAPIES SUCH THAT OVERUSE UNDERUSE AND MISUSE ERRORS ARE SIGNIlCANTLY REDUCED TWO
PROBLEMS MUST BE SOLVED &IRST WE DONT KNOW WHICH CLINICAL INTERVENTIONS ARE EFFECTIVE AND SECOND CLINICIANS MAY NOT KNOW OF EFFECTIVE INTERVENTIONS RELEVANT TO THEIR PATIENT AT THE POINT OF CARE %VIDENCE BASED MEDICINE CAN BE THE FRAMEWORK THAT SOLVES THESE TWO PROBLEMS &ROM THE SEMINAL WORK PUBLISHED NEARLY A DECADE AGO;= TO RECENT ADOPTION INTO MEDICAL EDUCATION CURRICULA EVIDENCE BASED MEDICINE IS NOW THE ACCEPTED METHODOLOGY USED TO ELUCIDATE EFFECTIVE CLINICAL INTERVENTIONS FROM THE MULTITUDE OF INDIVIDUAL PEER REVIEWED CLINICAL TRIALS lNDINGS 7HEN COUPLED WITH EFFECTIVE POINT OF CARE DELIVERY STRATEGIES THE SCIENCE OF EVIDENCE BASED MEDICINE UNDERPINS THE APPROACH KNOWN AS EVIDENCE BASED DECISION SUPPORT %"$3
4HE %VIDENCE "ASED $ECISION 3UPPORT 3OLUTION %VIDENCE BASED DECISION SUPPORT CAN TAKE TWO FORMATS PAPER OR ELECTRONIC )N THE PEER REVIEWED LITERATURE THE MOST COMMONLY STUDIED FORMS OF PAPER BASED %"$3 ARE ON THE CHART REMINDERS ORDER SETS AND CLINICAL PATHWAYS 4HE DOCUMENTED EFFECT OF PAPER BASED %"$3 IS A REDUCTION IN ERRORS OF UNDERUSE 3PECIlCALLY ON THE CHART REMINDERS IMPROVE BOTH IMMUNIZATION RATES IN THE AMBULATORY SETTING;= AND COMMUNITY ACQUIRED PNEUMONIA PROCESS OF CARE MEASURES SUCH AS TIME TO ANTIBIOTICS AND INTRAVENOUS TO BY MOUTH ANTIBIOTIC SWITCH RATES;= !LSO EFFECTIVE ARE CLINICAL PATHWAYS WHICH ARE ASSOCIATED WITH IMPROVEMENTS ACROSS A BROAD RANGE OF CLINICAL CONDITIONS AND VENUES %XAMPLES OF THE ASSOCIATION BETWEEN CLINICAL PATHWAYS AND QUALITY INCLUDE IMPROVED QUALITY OF CARE MEASURES IN COMMUNITY ACQUIRED PNEUMONIA; = AND REDUCED MALPRACTICE RISK IN OBSTETRICAL CARE;=
'REGORY ( $ORN -$ -0( IS THE EXECUTIVE VICE PRESIDENT AND GENERAL MANAGER OF :YNX (EALTH A (EARST "USINESS -EDIA #OMPANY WHERE HE HAS HELPED GUIDE THE ORGANIZATION THROUGH CHANGES OF OWNERSHIP AND EXPANDED THE REACH OF :YNX SOLUTIONS FROM LESS THAN HOSPITALS TO MORE THAN (E IS ALSO A LECTURER ON QUALITY IMPROVEMENT FOR THE 5#,! #ENTER FOR (EALTH 3ERVICES -ANAGEMENT AND A FACULTY PRESENTER FOR THE (EALTHCARE )NFORMATION -ANAGEMENT 3YSTEMS 3OCIETY MEETING (E CAN BE REACHED AT GDORN ZYNXCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
DUHCDMB D A@RDCãCDB HR H N M ã RT OON Q S ã E Q N Lã O@ OD Q ã SN ã D K D B S Q N M H B 4HE EFFECTIVENESS OF CLINICAL PATHWAYS LED TO THE EVALUATION OF ORDER SETS AS THEY CAN BE CONSIDERED COMPONENTS OF CLINICAL PATHWAYS 4HE CENTRAL RESEARCH QUESTION WAS #OULD A MORE FOCUSED APPROACH BE EQUALLY EFFECTIVE AS THE PATHWAY APPROACH ON QUALITY OF CARE MEASURES )N ADDITION TO ORDER SETS TARGETED DESIGN
4HE LITERATURE EVALUATING %"$3 IN #0/% AND %-2S IS GROWING RAPIDLY AND FOCUSES PREDOMINANTLY ON REMIND ERS AS THE IMPLEMENTATION STRATEGY OTHER REASONS THAT CONTRIBUTE TO THEIR EFFECTIVENESS AS A FORM OF %"$3 ARE THEY ARE FAMILIAR TO CLINICIANS THEY ARE INTEGRATED INTO THE WORK mOW THEY ARE CONDITION AND VENUE SPECIlC AND THEY SPEED ORDER WRITING 3UPPORTING THESE OBSERVATIONS ARE RESULTS DEMONSTRATING ORDER SETS EFFECTIVENESS AT IMPROVING CLINICAL PROCESSES AND OUTCOMES WITH RECENT lNDINGS IN COMMUNITY ACQUIRED PNEUMONIA AND ACUTE CORONARY SYNDROME; =
%LECTRONIC #ONVERGENCE 4HE SUCCESS OF PAPER BASED %"$3 AT REDUCING ERRORS OF UNDERUSE HAS CREATED ENTHUSIASM FOR THE ELECTRONIC IMPLEMENTATIONS OF ORDER SETS REMINDERS AND CLINICAL PATHWAYS ! GOAL OF IMPLEMENTING ORDER SETS REMINDER AND CLINICAL PATHWAYS IN AN ELECTRONIC ENVIRONMENT SUCH AS COMPUTERIZED PHYSICIAN ORDER ENTRY #0/% OR AN ELECTRONIC MEDICAL RECORD %-2 IS TO EXPAND THE SCALE AND EFFECTIVENESS SUCH THAT %"$3 REDUCES ERRORS OF UNDERUSE IN CONJUNCTION WITH ERRORS OF MISUSE AND OVERUSE 4HE LITERATURE EVALUATING %"$3 IN #0/% AND %-2S IS GROWING RAPIDLY AND FOCUSES PREDOMINANTLY ON REMINDERS AS THE IMPLEMENTATION STRATEGY 2EMINDERS CAN BE DElNED AS A RULES GENERATED POP UP WINDOW THAT PROVIDES A SPECIlC RECOMMENDATION TO THE CLINICIAN 7HEN REVIEWING THE LITERATURE THERE ARE NUMEROUS STUDIES EVALUATING ALERTS AND REMINDERS FOCUSED ON DRUG INTERACTIONS CRITICAL LABORATORY VALUES AND PREVENTIVE HEALTH MEASURES EG MAMMOGRAPHY VACCINATIONS AND CANCER SCREENING 4HE EVIDENCE SHOWS THAT ALERTS ARE EFFECTIVE AT REDUCING DRUG TO DRUG AND DRUG TO ALLERGY INTERACTIONS n ESSENTIALLY ERRORS OF MISUSE;= 3PECIlCALLY THE EFFECTIVENESS OF ALERTS ON REDUCING ERRORS OF MIS USE HAS BEEN MEASURED AT A PERCENT RELATIVE REDUCTION;= 4HIS INITIAL WORK HAS LED TO THE WIDER IMPLEMENTATION OF ALERTS FOCUSED ON DRUG TO DRUG INTERACTIONS EG WARFARIN AND mUCONAZOLE AND DRUG TO PHYSIOLOGICAL ABNORMALITIES AS MEASURED BY A LABORATORY TEST EG DIGOXIN AND HYPOKALEMIA 7HEN TARGETED TOWARD ABNORMAL LABORATORY lNDINGS COMPUTER IZED ALERTS HAVE INCREASED INPATIENT RATES OF NORMOKALEMIA AND INCREASED SERUM POTASSIUM LEVELS AT DISCHARGE FOR PATIENTS AT RISK FOR HYPOKALEMIA;= 4HESE EARLY lNDINGS HAVE PUSHED THE lELD
OF %"$3 TO EVALUATE MORE COMPLEX ALERTS FOCUSED ON VELOCITIES OF PHYSIOLOGICAL VALUES %XAMPLES INCLUDE RISING CREATININE OR FALLING POTASSIUM LEVELS OVER A lXED PERIOD OF HOURS ! CENTRAL lNDING OF RESEARCH IN REMINDERS HAS BEEN THEIR EFFECTIVENESS ACROSS A BROAD RANGE OF IMPLEMENTATION SCENARIOS /NE LARGE SCALE META ANALYSIS COMPARED ELECTRONIC AND PAPER BASED REMINDERS AND FOUND SIMILAR EFFECT SIZES FOR EACH #OMPUTER GENERATED REMINDERS HAD AN EFFECT SIZE OF PERCENT WHEREAS THE PAPER BASED REMINDERS EFFECT SIZE WAS PERCENT %LECTRONIC REMINDERS WERE DElNED AS POP UP MESSAGES IN A COMPUTER SYSTEM AND PAPER BASED REMINDERS WERE DElNED AS PROMPTS ATTACHED TO THE FRONT OF THE CHART;= 4HIS INTERESTING lNDING IMPLIES THAT %"$3 IN THE FORM OF REMINDERS CAN BE EQUALLY EFFECTIVE WHETHER IMPLEMENTED ON PAPER OR IN SOPHISTICATED SOFTWARE APPLICATIONS
)NCREASING %LECTRONIC 2IGOR AND #OMPLEXITY 4HERE ARE NUMEROUS STUDIES EVALUATING THE EFFECT OF REMINDERS AS DElNED ABOVE ON POPULATION BASED HEALTH MEASURES ! BROAD BASED STUDY AT 6ETERANS !DMINISTRATION MEDICAL CENTERS ENROLLING MEDICAL RESIDENTS AND PHYSICIANS DEMONSTRATED STATISTICALLY SIGNIlCANT IMPROVEMENTS IN A RANGE OF QUALITY OF CARE MEASURES;= 4HIS WAS FOLLOWED BY A RANDOMIZED CONTROLLED TRIAL EVALUATING REMINDERS EFFECT ON PNEUMOCOCCAL AND INmUENZA VACCINATION RATES PROPHYLACTIC SUBCUTANEOUS HEPARIN AND ASPIRIN AT DISCHARGE;= 4HIS EARLY RANDOMIZED CONTROLLED TRIAL RAISED THE METHODOLOGICAL RIGOR BY WHICH REMINDER EFFECTIVENESS IS NOW MEASURED 4HESE lNDINGS ALSO ESTABLISHED THE REQUIREMENT THAT REMINDERS BE A COMPONENT OF ELECTRONIC MEDICAL RECORD AND COMPUTERIZED PHYSICIAN ORDER ENTRY IMPLEMENTATIONS 0USHING THE SCIENCE OF REMINDERS FURTHER REQUIRES THAT COMPLEX REMINDER SYSTEMS BE IMPLEMENTED AND EVALUATED !N EXAMPLE OF A COMPLEX REMINDER IS A DEEP VENOUS THROMBOSIS $64 PROPHYLAXIS REGIMEN THAT INCLUDES A RANGE OF INTERVENTIONS GROUPED INTO A PROTOCOL OF CARE THAT IS MESSAGED TO THE CLINICIAN IN AN ALERT WINDOW BASED ON THE PATIENTS CLINICAL PARAMETERS ! GROUNDBREAKING STUDY IN EVALUATED A $64 PROPHYLAXIS REGIMEN BY RANDOMIZING ELIGIBLE PATIENTS TO ONE OF TWO GROUPS CLINICIANS MANAGING $64 PROTOCOL ELIGIBLE PATIENTS IN ONE GROUP RECEIVED AN ALERT RECOMMENDING THE $64 PROTOCOL AND CLINICIANS MANAGING $64 PROTOCOL ELIGIBLE PATIENTS IN THE OTHER GROUP DID NOT 4HE RESULTS SHOWED REDUCTIONS IN THE RATES OF $64 AMONG PATIENTS RANDOMIZED TO DOCTORS RECEIVING THE ALERT 4HIS RESULT HAS MOVED THE lELD OF %"$3 TOWARD THE IMPLEMENTATION OF INCREASINGLY COMPLEX PROTOCOLS 4HE USE OF ORDER SETS AS AN ELECTRONIC FORM OF %"$3 IS INCREASING WITH %-2 AND #0/% SYSTEM IMPLEMENTATIONS )N THE ELECTRONIC ENVIRONMENT ORDER SETS HAVE TWO PRIMARY FOCI ACCELERATING PHYSICIAN WORK mOW AND IMPROVING QUALITY THROUGH THE REDUCTION OF ERRORS OF UNDERUSE )T IS FEASIBLE THAT
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
DUHCDMB D A@RDCãCDB HR H N M ã RT OON Q S ã E Q N Lã O@ OD Q ã SN ã D K D B S Q N M H B ORDER SETS COULD IMPACT ERRORS OF OVERUSE AND MISUSE HOWEVER THE RESULTS IN THE LITERATURE SHOW ONLY IMPROVEMENTS IN UNDERUSE ERRORS ! STUDY FOCUSED ON VACCINE ADMINISTRATION RATES SHOWED THAT ORDER SETS WERE MORE EFFECTIVE THAN REMINDERS;= &URTHER SUPPORTING ORDER SET EFFECTIVENESS A LIMITED CASE CONTROL STUDY DOCUMENTED THE IMPACT OF ORDER SETS ON QUALITY OF CARE FOR ACUTE MYOCARDIAL INFARCTION PATIENTS;= )N LIGHT OF THESE lNDINGS IT IS CLEAR THAT MORE RESEARCH SHOULD FOCUS ON THE EFFECTIVENESS OF ORDER SETS IN ADDITION TO COMPLEX REMINDERS
0USHING THE SCIENCE OF REMINDERS FURTHER REQUIRES THAT COMPLEX REMINDER SYSTEMS BE IMPLEMENTED AND EVALUATED
#ONCLUSION )N SUMMARY %"$3 CAN TAKE ON A MYRIAD OF FORMS WHICH VARY IN THEIR EFFECTIVENESS /RGANIZATIONS SEEKING TO REAP THE BENElTS OF %"$3 SHOULD lRST ASK IN WHAT ENVIRONMENT THEY INTEND TO IMPLEMENT THE DECISION SUPPORT IN PAPER OR ELECTRONIC &ROM THAT BRANCHING DECISION ORDER SETS REMINDERS OR CLINICAL PATHWAYS COULD BE IMPLEMENTED DEPENDING ON WHETHER THE GOAL IS TO REDUCE ERRORS OF UNDERUSE MISUSE OR OVERUSE -OST ENCOURAGING ARE THE NUMEROUS STUDIES UNDER WAY EVALUATING THE EFFECTIVENESS OF COMPLEX REMINDER AND ORDER SETS ON THE THREE CATEGORIES OF MEDICAL ERRORS 5LTIMATELY IT IS THIS EMERGING DATA AND THE SUMMARIZED STUDIES HEREIN THAT WILL DRIVE BROAD BASED ACCEPTANCE OF %"$3 WITHIN THE HEALTHCARE DELIVERY SYSTEM %NDNOTES HTTPWWWCDCGOVNCHSDATANVSRNVSRNVSR?PDF P HTTPWWWCMSHHSGOV.ATIONAL(EALTH%XPEND$ATADOWNLOADS HIGHLIGHTSPDF HTTPWWWCDCGOVNCHSDATANVSRNVSRNVSR?PDF P -C'LYNN % ! ET AL h4HE QUALITY OF HEALTH CARE DELIVERED TO ADULTS IN THE 5NITED 3TATES v . %NGL * -ED *UNE PP %LLRODT ' ET AL h%VIDENCE "ASED $ISEASE -ANAGEMENT v *!-! PP 3TONE %' AND 3# -ORTON - % (ULSCHER - ! -AGLIONE % ! 2OTH * - 'RIMSHAW "3 -ITTMAN , 6 2UBENSTEIN , : 2UBENSTEIN 0 ' 3HEKELLE h)NTERVENTIONS THAT )NCREASE 5SE OF !DULT )MMUNIZATION
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
AND #ANCER 3CREENING 3ERVICES ! -ETA ANALYSIS v !NN )NTERN -ED PP 'OUNDER 00 AND $ # 2HEW , ,ANDRY 4 3KLAR ' ( $ORN * 9 7ONG 3 2 7EINGARTEN h! -ULTICENTER )NTERVENTION TO )MPROVE THE #ARE OF (OSPITALIZED 0ATIENTS WITH #OMMUNITY !CQUIRED 0NEUMONIA v *#/- VOL PP -EEHAN 40 ET AL h! STATE WIDE INTERVENTION TO IMPROVE THE CARE OF HOSPITALIZED PNEUMONIA PATIENTS 4HE #ONNECTICUT 0NEUMONIA 0ATHWAY 0ROJECT v !M * -ED VOL PP 4U '3 AND 4 0 -EEHAN * - &INE 9 7ANG % 3 (OLMBOE : -OHSENIFAR 3 2 7EINGARTEN h7HICH 3TRATEGIES &ACILITATE )MPROVEMENT IN 1UALITY OF #ARE FOR %LDERLY (OSPITALIZED 0NEUMONIA 0ATIENTS v *T #OMM * 1UAL 3AF VOL PP 2ANSOM 3" AND $ - 3TUDDERT - 0 $OMBROWSKI - - -ELLO 4 ! "RENNAN h2EDUCED -EDICOLEGAL 2ISK BY #OMPLIANCE 7ITH /BSTETRIC #LINICAL 0ATHWAYS ! #ASE #ONTROL 3TUDY v /BSTET 'YNECOL VOL PP (AUCK ,$ AND , - !DLER : $ -ULLA h#LINICAL 0ATHWAY #ARE )MPROVES /UTCOMES AMONG 0ATIENTS (OSPITALIZED FOR #OMMUNITY ACQUIRED 0NEUMONIA v !NN %PIDEMIOL VOL PP /ZDAS ! ET AL h)NTEGRATING @"EST OF #ARE 0ROTOCOLS INTO #LINICIANS 7ORKmOW VIA #ARE 0ROVIDER /RDER %NTRY )MPACT ON 1UALITY OF #ARE )NDICATORS FOR !CUTE -YOCARDIAL )NFARCTION v *!-)! VOL PP "ATES $7 AND * - 4EICH * ,EE $ 3EGER ' * +UPERMAN . -A,UF $ "OYLE , ,EAPE h4HE )MPACT OF #OMPUTERIZED 0HYSICIAN /RDER %NTRY ON -EDICATION %RROR 0REVENTION v *!-)! VOL PP &ELDSTEIN !# AND $ ( 3MITH . 0ERRIN 8 9ANG 3 2 3IMON - +RALL $ & 3ITTIG $ $ITMER 2 0LATT 3 " 3OUMERAI h2EDUCING 7ARFARIN -EDICATION )NTERACTIONS !N )NTERRUPTED 4IME 3ERIES %VALUATION v !RCH )NTERN -ED VOL PP 0ALTIEL / AND , 'ORDON $ "ERG ! )SRAELI h%FFECT OF A #OMPUTERIZED !LERT ON THE -ANAGEMENT OF (YPOKALEMIA IN (OSPITALIZED 0ATIENTS v !RCH )NTERN -ED VOL PP "ALAS %! AND 3 7EINGARTEN # 4 'ARB $ "LUMENTHAL 3 ! "OREN ' $ "ROWN h)MPROVING 0REVENTIVE #ARE BY 0ROMPTING 0HYSICIANSv !RCH )NTERN -ED VOL PP $EMAKIS *' AND # "EAUCHAMP 7 , #ULL 2 $ENWOOD 3 ! %ISEN 2 ,OFGREN + .ICHOL * 7OLLISCROFT 7 ' (ENDERSON h)MPROVING 2ESIDENTS #OMPLIANCE 7ITH 3TANDARDS OF !MBULATORY #ARE 2ESULTS FROM THE 6! #OOPERATIVE 3TUDY ON #OMPUTERIZED 2EMINDERS v *!-! PP $EXTER 02 AND 3 0ERKINS * - /VERHAGE + -AHARRY 2 " +OHLER # * -C$ONALD h! #OMPUTERIZED 2EMINDER 3YSTEM TO )NCREASE THE 5SE OF 0REVENTIVE #ARE FOR (OSPITALIZED 0ATIENTS v . %NGL * -ED VOL PP $EXTER 02 AND 3 0ERKINS + -AHARRY *ONES + # * -C$ONALD h)NPATIENT #OMPUTER "ASED 3TANDING /RDERS VS 0HYSICIAN 2EMINDERS TO )NCREASE )NmUENZA AND 0NEUMOCOCCAL 6ACCINATION 2ATES v *!-! VOL PP
1UALITY AND (EALTHCARE )NFORMATION 4ECHNOLOGY 4HE EXTENT TO WHICH A HOSPITAL ADOPTS )4 WILL NOT NECESSARILY PARALLEL THE EXTENT OF CLINICAL AND OPERATIONAL IMPROVEMENT 4HE KEY IS WHETHER THE TECHNOLOGIES BEING DEPLOYED ARE REALIZING MEASURABLE RETURNS IN PERFORMANCE AND QUALITY "Y .ICK "EARD 0RICEWATERHOUSE#OOPERS
)NTRODUCING THE $IGITAL (OSPITAL (OSPITALS ARE WIDELY CRITICIZED FOR FAILING TO ADOPT INFORMATION TECHNOLOGY MORE QUICKLY AND FOR TAKING A REACTIVE POSTURE DEFERRING THE COST OF INVESTING IN TECHNOLOGIES THAT CAN IMPROVE PATIENT CARE AND EFlCIENCY #RITICS WARN THAT SOME HOSPITALS RUN THE RISK OF FALLING BEHIND MISSING OUT ON IMPORTANT STRATEGIC BENElTS 4HIS CONCEPT IS THOROUGHLY DISCUSSED IN A 0RICEWATERHOUSE#OOPERS THOUGHT LEADERSHIP PAPER h2EACTIVE TO !DAPTIVE 4RANSFORMING (OSPITALS WITH $IGITAL 4ECHNOLOGYv;= $IGITAL HOSPITALS RELY ON TECHNOLOGY AS AN INTEGRAL PART OF THEIR BUSINESS STRATEGY TO PROMOTE HIGHER QUALITY CARE THROUGH EFlCIENT USE OF INFORMATION TECHNOLOGY AND PROCESS REDESIGN 4HESE )4 INITIATIVES SURPASS ADVANCED CLINICAL SYSTEMS TO INCLUDE ADDITIONAL INTEGRATION BETWEEN INFORMATION TECHNOLOGIES AND MEDICAL TECHNOLOGIES SUCH AS PATIENT BEDS SURGICAL EQUIPMENT NURSE CALL AND COMMUNICATION SYSTEMS PAGERS AND MEDICAL IMAGING TECHNOLOGIES
"ENElTS OF THE $IGITAL (OSPITAL 0ATIENT 3AFETY %XAMPLES OF AUTOMATION BENElTS ABOUND IN THE HEALTHCARE INDUSTRY 3OME ARE DERIVED FROM SIMPLE SINGLE INSTITUTIONAL CASE STUDIES SUCH AS A RADIOLOGY DEPARTMENT THAT REDUCES TRANSCRIPTIONIST FULL TIME EQUIVALENTS THROUGH THE USE OF SPEECH RECOGNITION SOFTWARE /THERS CAN BE SEEN IN MORE ACADEMICALLY ROBUST STUDIES OF BENElTS SUCH AS FEWER PRESCRIBING ERRORS AFTER IMPLEMENTATION OF COMPUTERIZED PHYSICIAN ORDER ENTRY #0/% SYSTEMS #0/% A KEY COMPONENT OF ANY DIGITAL HEALTH STRATEGY PLAYS A SIGNIlCANT ROLE IN PATIENT SAFETY 2ESULTS FROM SEVERAL STUDIES SUCH AS MANY CITED IN THE 0RESIDENTS )NFORMATION 4ECHNOLOGY !DVISORY #OMMITTEES REPORT h2EVOLUTIONIZING (EALTHCARE THROUGH )NFORMATION 4ECHNOLOGY v;= VALIDATE THIS CLAIM #0/% IMPROVES PATIENT SAFETY BY REDUCING ORDER TRANSCRIPTION ERRORS AND BY IMPROVING LEGIBILITY OF ORDERS 4HE INTEGRATION OF #0/%
WITH DECISION SUPPORT TECHNOLOGY FURTHER ENHANCES PATIENT SAFETY BECAUSE ALERTS AND REMINDERS CAN INTERCEPT POTENTIAL ERRORS SUCH AS DOSING MISTAKES MEDICATION CONmICTS AND ALLERGIES )MPROVING THE AVAILABILITY OF PATIENT INFORMATION BY ELIMINATING PAPER CHARTS AND REPLACING THEM WITH A WIDELY AND CONTINUOUSLY AVAILABLE %-2 ALSO CONTRIBUTES TO PATIENT SAFETY !CCORDING TO THE #ENTER FOR )NFORMATION 4ECHNOLOGY ,EADERSHIP #)4, APPROXIMATELY ONE lFTH OF MEDICAL ERRORS ARE DUE TO INADEQUATE AVAILABILITY OF PATIENT INFORMATION !NOTHER IMPORTANT ELEMENT OF A DIGITAL HOSPITAL STRATEGY IS CLINICAL KNOWLEDGE MANAGEMENT )N MOST HOSPITALS TECHNOLOGY RARELY PLAYS A SIGNIlCANT ROLE IN THE DIRECT SUPPORT OF CLINICAL BEST PRACTICES 4HE SELECTION OF IDEAL INVESTIGATION STRATEGIES OR PHARMACOLOGICAL REMEDIES TYPICALLY RELIES EXCLUSIVELY ON PROFESSIONAL JUDGMENT 4ECHNOLOGY CAN HELP PHYSICIANS MAKE THE RIGHT DECISIONS 2ECENT HEALTHCARE AUTOMATION HAS FOCUSED ON PATIENT SAFETY THROUGH THE AVOIDANCE OF ERRORS OF COMMISSION PRESCRIBING ERRORS BEING THE MOST SIGNIlCANT EXAMPLE (OWEVER EVIDENCE INDICATES THAT ERRORS OF OMISSION ARE MUCH MORE FREQUENT AND MORE DIFlCULT TO IDENTIFY %RRORS OF OMISSION MIGHT INCLUDE MISSING VACCINATION OPPORTUNITIES OR FAILING TO FOLLOW SPECIlC THERAPEUTIC RECOMMENDATIONS BASED ON CLINICAL PRACTICE GUIDELINES /NLY THROUGH THE USE OF ADVANCED CLINICAL DECISION SUPPORT WILL MANY ERRORS OF OMISSION BE ADDRESSED FOR THE lRST TIME )NFORMATION SYSTEMS ARE REQUIRED TO SUPPORT SUCH IMPROVEMENTS BUT DO NOT GUARANTEE THEM )NCREASED AUTOMATION MUST BE ACCOMPANIED BY ORGANIZATIONAL CHANGE SUCH AS THE FORMATION OF A MEDICAL INFORMATICS BOARD TO EVALUATE NEW PROPOSED CARE MANAGEMENT PROTOCOLS
/PERATIONAL %FlCIENCY (EALTHCARE AUTOMATION ENABLES ORGANIZATIONS TO REALIZE SIGNIlCANT OPERATIONAL EFlCIENCIES !CCORDING TO THE #)4, APPROXIMATELY PERCENT OF THE MORE THAN BILLION POINT TO POINT HEALTHCARE COMMUNICATIONS THAT OCCUR IN THE 5NITED 3TATES EACH YEAR ARE
.ICK "EARD -$ -3 IS A DIRECTOR IN THE 0RICEWATERHOUSE#OOPERS 'LOBAL 4ECHNOLOGY #ENTRE WHERE HE DIRECTS HEALTHCARE RESEARCH (E IS A PHYSICIAN WITH YEARS EXPERIENCE IN HEALTHCARE AND HEALTH )4 SPANNING SEVERAL COUNTRIES (E HAS SERVED AS A #)/ AND AS AN EXECUTIVE IN A LEADING HEALTHCARE SOFTWARE COMPANY AND IS A FREQUENT LECTURER AND SPEAKER AT VARIOUS UNIVERSITIES AND CONFERENCES (E CAN BE REACHED AT NICOLASBEARD USPWCCOM
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
P T@KHSX ã@MCãGD@ KS G B @ Q D ã H M E N Q L@S H N M ã S D B G M N KN FX CONDUCTED BY FAX PAPER MAIL OR PHONE ! DIGITAL HOSPITAL ADOPTS DIRECT INFORMATION INTERCHANGE THROUGH INTEROPERABLE INFORMATION TECHNOLOGY FOR MANY OF ITS TRANSACTIONS MAKING COMMUNICATION LESS EXPENSIVE FASTER AND MORE ACCURATE 3EVERAL STUDIES INCLUDING THE )NSTITUTE OF -EDICINES h4HE #OMPUTER "ASED 0ATIENT 2ECORD !N %SSENTIAL 4ECHNOLOGY FOR (EALTHCARE v;= HAVE DOCUMENTED THE AMOUNT OF STAFF TIME SPENT LOOKING FOR CLINICAL INFORMATION %FFECTIVE DEPLOYMENT OF %-2S DRAMATICALLY IMPROVES THIS SITUATION #ASE REVIEWS MAY BE UNDERTAKEN WITHOUT EXTENSIVE MANUAL SEARCHING .URSING HANDOVERS MAY BE SHORTENED SIGNIlCANTLY 3CHEDULING SYSTEMS ENABLE REDUCTIONS IN WAIT TIMES FOR PATIENTS AND STAFF ALIKE .EXT STEPS IN PROCESSES CAN BE SCHEDULED AUTOMATICALLY AND WHEN A TEST MUST BE CANCELED ASSOCIATED ORDERS CAN ALSO BE AUTOMATICALLY CANCELED
/THER "ENElTS 4ECHNOLOGY INVESTMENT CAN ALSO INCREASE PATIENT SATISFACTION )F PATIENT RECORDS ARE ELECTRONIC HEALTHCARE CAREGIVERS ARE LESS LIKELY TO ASK THE SAME QUESTIONS REPEATEDLY 0ATIENTS REPORT A REASSURING SENSE THAT PHYSICIANS AND NURSES KNOW MORE ABOUT THEIR CASES WHEN ALL THEIR INFORMATION CAN BE ACCESSED FROM ONE SOURCE /RGANIZATIONS CAN ALSO GAIN A COMPETITIVE ADVANTAGE THROUGH TECHNOLOGY 0HYSICIANS AND NURSES ARE INCREASINGLY ATTRACTED TO THE EFlCIENT OPERATIONAL ENVIRONMENT THAT AUTOMATION CAN OFFER $IGITAL HOSPITALS ALSO ENJOY MORE EFFECTIVE REIMBURSEMENT
MANAGEMENT THROUGH ONLINE ELIGIBILITY CHECKING PRIOR TO PROVIDING TREATMENT #LINICALLY DRIVEN REVENUE CYCLE MANAGEMENT REDUCES CHARGE ENTRY EFFORTS AND ENABLES BILLING TO BECOME MORE OF A BY PRODUCT OF THE CLINICAL PROCESS #HARGE CAPTURE BECOMES MORE RAPID AND ACCURATE WHICH CAN REDUCE THE AMOUNT OF REWORK THAT OFTEN PLAGUES BILLING FUNCTIONS
-EASURING THE "ENElTS OF THE $IGITAL (OSPITAL 4O FURTHER EXPLORE THE BENElTS OF DIGITAL HOSPITALS 0RICEWATERHOUSE#OOPERS TEAMED WITH ()-33 !NALYTICS A WHOLLY OWNED SUBSIDIARY OF THE (EALTHCARE )NFORMATION AND -ANAGEMENT 3YSTEMS 3OCIETY TO REVIEW OPERATIONAL lNANCIAL AND QUALITY METRICS OF A STUDY GROUP OF DIGITALLY ADVANCED HOSPITALS (OSPITALS IN THE GROUP WERE SELECTED ON THE BASIS OF THEIR REPUTATIONS IN THE INDUSTRY FOR IMPLEMENTING CLINICAL INFORMATION SYSTEMS 4HE RESULTS AND EVIDENCE OF THIS RESEARCH WERE EXPLORED AND DISCUSSED IN DETAIL IN THE PAPER h2EACTIVE TO !DAPTIVEv %XHIBIT PROVIDES AN OVERVIEW OF PERCEIVED DIGITAL HOSPITAL BENElTS DERIVED FROM THIS RESEARCH &OR THE RESEARCH PROJECT DIFFERENT APPLICATIONS IN THE ()-33 !NALYTICS $ATABASE3- WERE CATEGORIZED INTO THREE APPLICATION TYPES ADMINISTRATIVE BACK OFlCE AND CLINICAL 4HE CLINICAL CATEGORY WAS FURTHER BROKEN DOWN INTO CLINICAL AND ADVANCED CLINICAL 4HE SAMPLE GROUP WAS SIGNIlCANTLY MORE DIGITAL THAN THE FULL
%XHIBIT "ENElTS OF THE $IGITAL (OSPITAL #ONCEPT
0ATIENT SAFETY /PERATIONAL EFlCIENCY 2EIMBURSEMENT MANAGEMENT REVENUE CYCLE #ONSUMER IMPACT PATIENT SATISFACTION 0HYSICIAN RECRUITMENT AND RETENTION "EST USE OF CAPITAL RESOURCES #OMPETITIVE ADVANTAGE 2EGULATORY COMPLIANCE 2EVENUE GROWTH 3TAFF RECRUITMENT AND RETENTION
¹ 0RICEWATERHOUSE#OOPERS ,,0 !LL 2IGHTS 2ESERVED
7HEN ASKED TO RATE THE MOST COMPELLING BENElTS OF DIGITIZATION FOR A HEALTHCARE DELIVERY ORGANIZATION ON A SCALE OF TO WITH HAVING THE GREATEST IMPACT MORE THAN DOZEN HOSPITAL EXECUTIVES HEALTHCARE )4 VENDORS AND OTHER INDUSTRY EXPERTS CITED IMPROVEMENTS IN PATIENT SAFETY AS THE MOST LIKELY BENElT 2ESPONDENTS ALSO LOOK TO THE DIGITAL HOSPITAL TO PROVIDE GAINS IN OPERATIONAL EFlCIENCY
5!, 49 - # ( ! 0 4 % 2 1 5! ,)4 9 #/. 5 . $2 5
P T@KHSX ã@MCãGD@ KS G B @ Q D ã H M E N Q L@S H N M ã S D B G M N KN FX SET OF HOSPITALS IN THE ()-33 !NALYTICS %XHIBIT !VERAGE ,ENGTH OF 3TAY FOR $IGITALLY !DVANCED (OSPITALS $ATABASE 4HE DIGITALLY ADVANCED SAMPLE #OMPARED 7ITH !LL (OSPITALS GROUP SHOWED PERCENT IMPLEMENTATION !,/3 FOR OF GENERAL CLINICAL APPLICATIONS DIGITALLY !,/3 FOR ALL PERCENT IMPLEMENTATION OF ADVANCED 9EAR CHANGE CHANGE ADVANCED HOSPITALS
CLINICAL APPLICATIONS AND PERCENT HOSPITALS OVERALL !T THE SAME TIME THE AVERAGE IMPLEMENTATION LEVELS FOR ALL HOSPITALS IN THE DATABASE WERE PERCENT GENERAL
CLINICALS PERCENT ADVANCED CLINICALS
AND PERCENT OVERALL
4HE DATA ALSO SHOWED THAT THE DIGITALLY ADVANCED HOSPITALS TENDED TO
SHARE CHARACTERISTICS SUCH AS THE FACT 3OURCE !(! (OSPITAL 3TATISTICS
)NCLUDES ALL NONFEDERAL SHORT TERM GENERAL AND THAT MANY WERE ACADEMIC HOSPITALS %DITION 3OLUCIENT OTHER SPECIALTY HOSPITALS SURVEYED BY THE !(! 4HIS IS NOT SURPRISING SUCH HOSPITALS TEND TO BE LARGER THAN AVERAGE AND THE INDICATOR OF EFlCIENCY %XHIBIT USES DATA FROM 3OLUCIENT AND THE MOST MEDICALLY ADVANCED &URTHER LARGER HOSPITALS IN GENERAL !MERICAN (OSPITAL !SSOCIATION !(! TO COMPARE THE DIGITALLY AND HEALTHCARE SYSTEMS IN PARTICULAR ARE MORE LIKELY TO BE DIGITAL ADVANCED GROUP WITH ALL HOSPITALS .OT ONLY CAN SUCH ORGANIZATIONS REALIZE ECONOMIES OF SCALE BUT /VERALL THE DIGITALLY ADVANCED HOSPITALS ALSO REPORTED A HOSPITALS WITH MULTIPLE FACILITIES ARE ALSO GENERALLY ACCUSTOMED GREATER INCREASE IN REVENUES THAN ALL HOSPITALS SEE %XHIBIT TO ELECTRONIC COMMUNICATION AND COLLABORATION 4HE DATA ALSO )N ADDITION TO THE COST IMPACT OF DIGITAL TECHNOLOGY INVESTMENTS REVEALED THAT DIGITALLY ADVANCED HOSPITALS EXIST NATIONWIDE AND MOST ORGANIZATIONS SEEK QUALITY IMPROVEMENTS -EASURING CLINICAL ARE NOT LIMITED TO HIGH TECHNOLOGY REGIONS QUALITY USUALLY INVOLVES ASSESSMENT OF PROCESS MEASURES -OST 0RICEWATERHOUSE#OOPERS UNDERTOOK ADDITIONAL COMPARATIVE QUALITY METRICS REFER TO PROCESSES THAT ARE THOUGHT TO LEAD TO ANALYSES OF OPERATIONAL lNANCIAL AND QUALITY METRICS OF THE QUALITY &OR EXAMPLE THE #-3 HAS ASKED HOSPITALS TO REPORT ON STUDY GROUP OF HOSPITALS 4HE PERFORMANCE OF THE GROUP OF MEASURES THAT PERTAIN TO HOSPITAL CARE FOR THREE CONDITIONS DIGITALLY ADVANCED HOSPITALS WAS COMPARED TO NATIONAL AVERAGES HEART ATTACK HEART FAILURE AND PNEUMONIA 7HEN THE GROUP OF USING MEDICAL DATA FROM THE #ENTERS FOR -EDICARE -EDICAID DIGITALLY ADVANCED HOSPITALS WAS MEASURED AGAINST ALL HOSPITALS 3ERVICES #-3 (OSPITAL 1UALITY !LLIANCE h)MPROVING #ARE THAT HAD REPORTED ON THE INDICATORS THE DIGITALLY ADVANCED THROUGH )NFORMATIONv AND lNANCIAL DATA OBTAINED FROM 3OLUCIENT HOSPITALS RANKED HIGHER ON SEVEN OF THE INDICATORS FOR THE DIGITALLY ADVANCED HOSPITALS AND IN AGGREGATE 4HE DIGITALLY ADVANCED GROUP OF HOSPITALS SAW GREATER DROPS IN AVERAGE LENGTH OF STAY A MEASUREMENT GENERALLY REGARDED AS AN
-AKING THE "USINESS #ASE
%XHIBIT #HANGE IN /PERATING 2EVENUE FOR $IGITALLY !DVANCED (OSPITALS #OMPARED 7ITH !LL (OSPITALS 9EAR
$IGITALLY ADVANCED HOSPITALS
!LL HOSPITALS
#UMULATIVE INCREASE
)NCLUDES ALL NONFEDERAL SHORT TERM GENERAL AND OTHER SPECIALTY HOSPITALS SURVEYED BY THE !(!
3OURCE !(! (OSPITAL 3TATISTICS %DITION 3OLUCIENT
4HESE RESULTS SUGGEST A POTENTIALLY POSITIVE RELATIONSHIP BETWEEN INFORMATION TECHNOLOGY INVESTMENT AND THE BENElTS OF INTEGRATION HOWEVER THEY DO NOT NECESSARILY REACH STATISTICAL SIGNIlCANCE 4HE PERCEIVED WEAKNESS IN AVAILABLE EVIDENCE FOR STRONG CAUSAL LINKS BETWEEN )4 INVESTMENT AND SUBSEQUENT BENElTS IS ONE REASON IT CAN BE DIFlCULT FOR HEALTHCARE ORGANIZATIONS TO MAKE A PERSUASIVE CASE FOR INCREASED TECHNOLOGY SPENDING 4O JUSTIFY CAPITAL EXPENDITURES MOST HOSPITAL BOARDS FOR EXAMPLE SEEK PROOF OF A lNANCIAL RETURN ON INVESTMENT 4HE MAJORITY OF EMPIRICAL EVIDENCE TO DATE COMES FROM CASE STUDIES AND EXPERT OPINION RATHER THAN QUANTITATIVE CONTROLLED STATISTICALLY SIGNIlCANT RESEARCH !LTHOUGH THE RESULTS OF THE 0RICEWATERHOUSE#OOPERS RESEARCH CITED ABOVE WERE CULLED FROM YEARS OF DATA THE STATISTICAL TECHNIQUES USED WERE LARGELY BASED ON CROSS SECTIONAL STUDIES WHICH ALTHOUGH INTERESTING MADE IT IMPOSSIBLE TO CONCLUDE A CAUSAL RELATIONSHIP FROM THESE DATA $IFFERENT TECHNIQUES AND LARGER DATA SETS ARE REQUIRED TO ENABLE A MORE RIGOROUS ECONOMIC ANALYSIS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
P T@KHSX ã@MCãGD@ KS G B @ Q D ã H M E N Q L@S H N M ã S D B G M N KN FX
%MERGING %VIDENCE 0RICEWATERHOUSE#OOPERS HAS BEEN COLLABORATING WITH RESEARCHERS AT A LEADING BUSINESS SCHOOL;= TO EXPLORE THE RELATIONSHIP BETWEEN HEALTHCARE )4 INVESTMENT AND BUSINESS PERFORMANCE 4HE RESEARCH STUDY IS DESIGNED TO PROVIDE A STATISTICALLY RIGOROUS ANALYSIS OF BENElTS ASSOCIATED WITH HEALTHCARE INFORMATION TECHNOLOGY AND EVENTUALLY TO ENABLE COMPARISONS BETWEEN THE PERFORMANCE OF INDIVIDUAL INSTITUTIONS AND PEERS AT THE SAME LEVEL OF )4 ADOPTION
$ATA 3OURCES 4HE STUDY RELIED ON SEVERAL DATA SOURCES ( )-33 !NALYTICS $ATABASE DERIVED FROM $ORENFEST )($3 $ATABASE» WHICH MAINTAINS INFORMATION ON )4 APPLICATIONS IN MORE THAN HOSPITALS THROUGHOUT THE 53 !MERICAN (OSPITAL !SSOCIATIONS ANNUAL SURVEY DATABASE PROVIDING A WIDE RANGE OF HOSPITAL INFORMATION 3OLUCIENT 0ROVIDER6IEW WHICH PROVIDES A SOURCE OF -EDICARE DATA ON REVENUES COSTS AND PROlTS FROM OVER HOSPITALS FROM TO AND 3ELECT 1UALITY #ARE¸ FROM 7EB-$ WHICH PROVIDES HOSPITAL QUALITY DATA ON READMISSIONS COMPLICATIONS AND OTHER METRICS )N ADDITION TO LOOKING FOR EMPIRICAL EVIDENCE OF CAUSAL LINKS BETWEEN INFORMATION TECHNOLOGY ADOPTION AND BUSINESS PERFORMANCE THE RESEARCH ALSO SEEKS TO ENABLE INDIVIDUAL HOSPITALS TO GAIN FRESH INSIGHTS INTO THEIR OWN PERFORMANCE
3TATISTICAL -ETHODS !DVANCED STATISTICAL TECHNIQUES COMMONLY USED IN ECONOMIC RESEARCH ARE EMPLOYED TO HELP RESEARCHERS IDENTIFY THE RELATIVE CONTRIBUTIONS )4 HAS TO HOSPITAL EFlCIENCY AND OTHER PERFORMANCE MEASURES )NDIVIDUAL HOSPITALS ARE THEN COMPARED AGAINST NATIONAL AVERAGES FOR SIMILAR INSTITUTIONS WITH RESPECT TO THEIR LEVEL OF AUTOMATION
!NALYZING (OSPITAL 0ERFORMANCE 4HE RESEARCH EXPLORES RELATIONSHIPS BETWEEN AN ORGANIZATIONS POSITION ON THE )4 ADOPTION SCALE AND ITS CLINICAL AND BUSINESS PERFORMANCE !DVANCED STATISTICAL TECHNIQUES ARE EMPLOYED TO ANALYZE FOUR DIFFERENT AREAS OF HOSPITAL PERFORMANCE !S SUMMARIZED IN %XHIBIT THE STUDY EXAMINED MORTALITY RATES IN HOSPITALS WITH LOW VERSUS HIGH COSTS AND THOSE WITH LOW VERSUS HIGH )4 CAPITAL (OSPITALS WITH HIGHER COSTS TENDED TO HAVE LOWER MORTALITY RATES AND HOSPITALS IN THE hHIGH )4 USAGEv CATEGORY ALSO HAD LOWER MORTALITY RATES 4HE DIFFERENCES IN MORTALITY BETWEEN THE LOW )4 AND HIGH )4 GROUPS WITH ABOVE AVERAGE HOSPITAL COSTS IS STATISTICALLY SIGNIlCANT 4HIS RELATIONSHIP IS SUGGESTIVE OF A POSITIVE ASSOCIATION BETWEEN )4 INVESTMENT AND QUALITY OF CARE AND WARRANTS DEEPER INVESTIGATION
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
USING MORE PRECISE AND ACCEPTED DElNITIONS OF QUALITY 4HE FULL RESULTS OF THE STUDY WILL BE PUBLISHED UPON COMPLETION
7HAT 4HIS -EANS FOR (OSPITALS 4ODAY (OSPITALS THAT PROMOTE TECHNOLOGY AS AN INTEGRAL BUSINESS STRATEGY HAVE A COMPETITIVE ADVANTAGE 4HEY WILL ENJOY THE BENElTS OF AUTOMATION INCLUDING INCREASED PATIENT SAFETY AND OPERATIONAL EFlCIENCY %ARLY TECHNOLOGY ADOPTERS WILL ALSO REAP THE BENElTS OF INCREASED PATIENT SATISFACTION IMPROVED EMPLOYEE RETENTION AND MORE EFFECTIVE REIMBURSEMENT MANAGEMENT !LTHOUGH CASE STUDIES AND QUALITATIVE DATA HAVE BEEN IMPORTANT TO DATE NEW STATISTICAL TECHNIQUES ARE BEING EMPLOYED TO PROVIDE BETTER MORE DElNITIVE EVIDENCE OF THE RELATIONSHIP BETWEEN HEALTHCARE )4 INVESTMENT AND BUSINESS PERFORMANCE 4HIS WILL HELP HEALTHCARE ORGANIZATIONS BUILD A MUCH STRONGER BUSINESS CASE FOR THE )4 INVESTMENTS THEY NEED TO MAKE IN THE FUTURE 4HE RESEARCH WILL ALSO ENABLE THE USE OF A NOVEL BENCHMARKING TECHNIQUE ENABLING HOSPITALS TO IDENTIFY HOW WELL THEY ARE ACTUALLY USING THEIR TECHNOLOGY TO DRIVE MEASURABLE BUSINESS RESULTS %NDNOTES h2EACTIVE TO !DAPTIVE 4RANSFORMING (OSPITALS WITH $IGITAL 4ECHNOLOGY v -ARCH 'LOBAL 4ECHNOLOGY #ENTRE 0RICEWATERHOUSE#OOPERS ,,0 HTTPPWCCOMUSENGABOUTINDHEALTHCAREPUBDHHTML h2EVOLUTIONIZING (EALTHCARE 4HROUGH )NFORMATION 4ECHNOLOGY v *UNE 0RESIDENTS )NFORMATION 4ECHNOLOGY !DVISORY #OMMITTEE HTTP WWWNITRDGOVPITACREPORTS?HIT?REPORTPDF $ICK 2 3 AND % " 3TEEN % % $ETMER h4HE #OMPUTER "ASED 0ATIENT 2ECORD !N %SSENTIAL 4ECHNOLOGY FOR (EALTHCARE v *ANUARY )NSTITUTE OF -EDICINE 2ESEARCH COLLABORATION BETWEEN 0W# AND 0ROFESSOR ,ORIN (ITT AND -ICHAEL (OUSMAN OF THE $EPARTMENT OF /PERATIONS AND )NFORMATION -ANAGEMENT 4HE 7HARTON 3CHOOL 5NIVERSITY OF 0ENNSYLVANIA AND 0RICEWATERHOUSE#OOPERS
%XHIBIT (OSPITAL -ORTALITY 2ATES BY )4 )NVESTMENT AND /PERATING #OSTS ,OW )4 BOTTOM
(IGH )4 TOP
(IGH #OST TOP
,OW #OST BOTTOM
.ATIONAL !VERAGE 2ATE FOR 0OPULATION OF (OSPITALS IN OUR 3TUDY
3OURCE h4HE %FFECTS OF )4 )NVESTMENTS ON (OSPITAL #OST AND 1UALITY v 0W# WHITE PAPER
4HE 2OLE OF 2()/S AND /THER #OLLABORATIVES IN 1UALITY &RAGMENTED PATIENT DATA REPRESENTS A SIGNIlCANT CHALLENGE TO THE HEALTHCARE INDUSTRY 7ITHOUT A UNIFYING STRUCTURE CENTRAL GOVERNING BODY OR CONNECTED REPOSITORY THESE DISPARATE DATA MAY RESULT IN FRAGMENTED PATIENT CARE "Y "RUCE (ENDERSON 0RICEWATERHOUSE#OOPERS
-
ANY HOSPITALS AND PHYSICIAN OFlCES KEEP PATIENT INFOR MATION PRESCRIPTION RECORDS AND LAB RESULTS IN PAPER DOCUMENTS OR IN SEPARATE COMPUTER SYSTEMS "ECAUSE CLINICAL INFORMATION IS NOT INTEGRATED INTO ONE COMPREHENSIVE SOURCE IT CANNOT BE EASILY ACCESSED BY CAREGIVERS AT THE POINT OF CARE DELIVERY %LIMINATING PAPER RECORDS AND STORING ALL DATA IN INTEGRATED COMPUTER DATABASES WHERE IT CAN BE QUICKLY AND EASILY RETRIEVED WILL BE VITAL TO THE CONTINUING EVOLUTION AND IMPROVEMENT OF HEALTHCARE 2EGIONAL HEALTH INFORMATION ORGANIZATIONS 2()/S OFFER ONE VIABLE OPTION TO CREATE AND MANAGE SUCH DATABASES
(OW $O 2()/S 7ORK 2()/S FUNCTION AS REGIONAL CONDUITS TO COLLECT AND DISSEMINATE MEDICAL INFORMATION 4HEY ESTABLISH STRUCTURES POLICIES AND GOVERNANCE THAT DICTATE HOW HEALTHCARE DATA ARE USED AND SHARED WHICH PROVIDERS SHARE WHAT INFORMATION AND IN MANY CASES THE PRECISE BUSINESS MODEL THAT THE 2()/ FOLLOWS 4HE 2()/ hTOUCHESv PATIENT PRESCRIPTION AND LAB INFORMATION BENCHMARKS IT AND DISTRIBUTES IT TO IMPROVE NOT ONLY ACCESS TO HEALTHCARE DATA BUT THE PROCESS OF CARE ITSELF 2()/S OFFER SEVERAL KEY ADVANTAGES OVER THE CURRENT METHODS OF HEALTHCARE DATA COLLECTION STORAGE AND RETRIEVAL "ETTER QUALITY CARE n 7HEN CAREGIVERS CAN EASILY ACCESS ACCURATE INTEGRATED PATIENT MEDICATION AND LAB DATA THEY CAN MAKE CLINICAL DECISIONS BASED ON A COMPLETE PICTURE OF THE PATIENTS MEDICAL HISTORY 2EDUCED COSTS n !CCESS TO ACCURATE CURRENT RECORDS CAN DRASTICALLY REDUCE THE NUMBER OF REDUNDANT DIAGNOSTIC TESTS PERFORMED AND CLINICAL ERRORS MADE #ONSERVATIVE ESTIMATES PLACE SAVINGS FROM INTEGRATION OF DATA AT TO PERCENT;= SOME INDUSTRY EXPERTS CLAIM THOSE PERCENTAGES WILL BE MUCH HIGHER (EIGHTENED KNOWLEDGE TRANSFER n 7HEN CAREGIVERS
RECEIVE TIMELY COMPREHENSIVE INFORMATION THEY NOT ONLY USE IT THEY ADD TO IT AND IMPROVE UPON IT !S THE KNOWLEDGE IS TRANSFERRED IT GROWS EXPONENTIALLY 4HIS GROWTH OF KNOWLEDGE IMPROVES OUR UNDERSTANDING OF THE CAREGIVING PROCESS
(URRICANE +ATRINA 2EVEALS THE .EED FOR 4ECHNOLOGY "EFORE THE HURRICANE SEASON OF MOST HEALTHCARE PROVIDERS IN ,OUISIANA STORED PATIENT RECORDS ON PAPER /NLY ABOUT PERCENT OF PHYSICIANS IN THE STATE USED ELECTRONIC MEDICAL RECORDS OR SHARED DATA ELECTRONICALLY;= 7HEN +ATRINA DEVASTATED THE REGION DESTROYING COUNTLESS MEDICAL RECORDS IN THE PROCESS THE NEED FOR TECHNOLOGY IN THE REGIONS HEALTHCARE SYSTEM WAS PAINFULLY REVEALED ,OUISIANA RESPONDED /NE MONTH AFTER THE HURRICANE THE +ATRINA(EALTH3- PROGRAM A COLLABORATION AMONG PRIVATE BUSINESSES A NATIONAL FOUNDATION HEALTHCARE ORGANIZATIONS AND FEDERAL STATE AND LOCAL GOVERNMENTS MADE EVACUEES PRESCRIPTION HISTORIES AVAILABLE TO AUTHORIZED CAREGIVERS ONLINE VIA WWWKATRINAHEALTHORG (AVING THESE DATA HELPED CAREGIVERS GIVE THE RIGHT MEDICATIONS TO EVACUEES AVOIDING THE RISKS OF ADVERSE DRUG REACTIONS ,OUISIANA IS REBUILDING ITS HEALTHCARE SYSTEM WITH A COMPLETE TECHNOLOGY INFRASTRUCTURE THAT WILL SUPPORT DELIVERY OF CARE ! COLLABORATIVE WITH MULTIPLE STAKEHOLDERS HAS BEEN FORMED AND IS BASING ITS WORK ON THE SIX )NSTITUTE OF -EDICINE QUALITY PRINCIPLES )N ITS GUIDING PRINCIPLES THE COLLABORATIVE RECOGNIZED THAT )4 IS PART OF THE FOUNDATION FOR A QUALITY REDESIGNED HEALTHCARE SYSTEM AND IMPORTANT FOR VALUE BASED PERFORMANCE ,OUISIANA HAS A CONTRACT WITH THE $EPARTMENT OF (EALTH AND (UMAN 3ERVICES /FlCE OF THE .ATIONAL #OORDINATOR TO DEVELOP A HEALTH INFORMATION EXCHANGE THAT WILL BE THE HIGHWAY TO SHARE INFORMATION ACROSS
"RUCE (ENDERSON -(! -"! IS A SENIOR EXECUTIVE WITH YEARS EXPERIENCE IN LEADING GROWING AND ADVISING HEALTHCARE SYSTEMS ACADEMIC MEDICAL CENTERS MANAGED CARE ORGANIZATIONS LARGE MULTI SPECIALTY GROUP PRACTICES AND DIVERSIlED HEALTHCARE BUSINESSES (E IS SKILLED IN BUSINESS AND )4 STRATEGY AND TRANSFORMATION CUSTOMER MANAGEMENT AND TECHNOLOGY ENABLERS TO IMPROVE QUALITY BUILD COMPETITIVE ADVANTAGE AND ACHIEVE lNANCIAL SUCCESS (E IS KNOWLEDGEABLE ABOUT THE -EDICARE -ODERNIZATION !CT AND THE .ATIONAL (EALTH )NFORMATION )NFRASTRUCTURE (E IS AN EXECUTIVE LEADER OF 0RICEWATERHOUSE#OOPERS $IGITAL (EALTH #OMMUNITY PRACTICE (E CAN BE REACHED AT BRUCEAHENDERSON USPWCCOM
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
SGDãQNKDãN Eã1'(.Rã @ M C ã NS G D Q ã B N KK@ A N Q @S H U D Rã H M ã P T @ KH S X PROVIDERS /THER ONGOING PROGRAMS INCLUDE INSTALLING ELECTRONIC HEALTH RECORDS IN RURAL AREA EMERGENCY ROOMS )N ADDITION A 2OBERT 7OOD *OHNSON &OUNDATION GRANT IS PAYING FOR ELECTRONIC MEDICAL RECORDS IN DIFFERENT SAFETY NET SITES h4HIS NATURAL DISASTER HAS UNDERSCORED THE CRITICAL NEED FOR REAL TIME ACCESS TO THE MOST UP TO DATE MEDICATION HISTORY INFORMATION AT THE POINT OF CARE REGARDLESS OF WHERE INDIVIDUALS ARE BEING TREATED v SAID $AVID -C,EAN #%/ OF ONE OF THE SPONSORING COMPANIES OF +ATRINA(EALTH;=
@4HE SPIRIT OF COOPERATION AMONG HEALTHCARE STAKEHOLDERS IS MUCH HIGHER THAN ITS EVER BEEN IN OUR HIS TORY 7ERE SEEING PEOPLE WHO WERE HISTORICALLY COMPETITORS SIT DOWN AT THE TABLE TOGETHER TO FIGURE THINGS OUT 4HEY ARE ALL WORKING TOGETHER AND EXCITED ABOUT THE SAME PROJECT AND WANTING TO SHARE INFORMATION 7ITH THE HEALTH INFORMATION EXCHANGE n WE DID IN THREE MONTHS WHAT WOULD NORMALLY TAKE THREE TO FIVE YEARS IN ANY OTHER TIME IN OUR HISTORY )TS THE MOST AMAZ ING THING )VE EVER SEEN )VE TRULY SEEN SOME OF THE BEST OF HUMAN NATURE n 2OXANE 4OWNSEND -$ -EDICAID MEDICAL DIRECTOR FOR ,OUISIANA ,OUISIANA IS ATTEMPTING TO REBUILD ITS ENTIRE SYSTEM SO THAT ALL PAYERS ADOPT THE SAME PRINCIPLES PERFORMANCE MEASURES AND REIMBURSEMENT MECHANISMS !CCORDING TO ,OUISIANA -EDICAID MEDICAL DIRECTOR 2OXANE 4OWNSEND -$ h!S WE LOOK AT HOW WE WANT TO MOVE FORWARD IN ,OUISIANA WE REALIZE THAT UNLESS WE HAVE A SYSTEM OF CARE THAT GOES ACROSS THE BOARD WERE PROBABLY NOT GOING TO BE ABLE TO MAKE SIGNIlCANT CHANGES IN OUR QUALITY OR OUTCOMESv "ECAUSE OF THE URGENCY CREATED BY THE HURRICANE ,OUISIANA ESSENTIALLY HAS A BLANK SLATE TO FORM A COMPREHENSIVE SYSTEM WITH ALIGNED INCENTIVES 4OWNSEND ADDS h7ERE DOING THINGS NOW TO MAKE SURE THAT PATIENTS GET TAKEN CARE OF "UT WE DONT WANT THE SYSTEMS IN PLACE NOW TO BECOME THE @NEW NORMAL AND PERPETUATE 3OME OF THESE NEW SYSTEMS MAY GIVE EVEN WORSE OUTCOMES THAN WHAT WE HAD BEFORE 7ERE HOPING THAT COLLABORATIVE APPROACHES THAT WEVE DEVELOPED FOR THE SHORT TERM WILL lT INTO OUR LONG TERM PLANNING PRINCIPLESv
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
#URRENT %XAMPLES OF %FFECTIVE (EALTH )NFORMATION %XCHANGE 4HE FOLLOWING EXAMPLES ILLUSTRATE THE BENElTS OF EFFECTIVE TECHNOLOGY AND KNOWLEDGE TRANSFER IN THE DELIVERY OF HEALTHCARE 4HEY REPRESENT DIFFERENT APPROACHES ALL WITH THE SAME GOAL IMPLEMENTATION AND USE OF AN )4 INFRASTRUCTURE AND INTEGRATED DATA TO IMPROVE ACCESS TO MEDICAL DATA AND QUALITY OF CARE
5NITED +INGDOM 4HE LARGEST HEALTHCARE ORGANIZATION IN %UROPE THE 5NITED +INGDOMS .ATIONAL (EALTH 3ERVICE .(3 HAS STARTED ITS .ATIONAL 0ROGRAMME FOR )4 "Y CREATING AN )4 INFRASTRUCTURE THIS PROGRAM IS EXPECTED TO IMPROVE PATIENT CARE AND SERVICES /VER THE NEXT DECADE THE .ATIONAL 0ROGRAMME FOR )4 WILL TRANSFORM CARE BY CONNECTING MORE THAN GENERAL PRACTITIONERS AND NEARLY HOSPITALS )T WILL ALSO GIVE PATIENTS TOTAL ACCESS TO THEIR PERSONAL HEALTHCARE INFORMATION +EY ELEMENTS OF THE .ATIONAL 0ROGRAMME 4HE .(3 #ARE 2ECORDS 3ERVICE IMPROVES THE SHARING OF PATIENT RECORDS ACROSS THE ENTIRE ORGANIZATION 4HE )4 SYSTEM ELECTRONICALLY TRANSMITS PRESCRIPTION INFORMATION AND LETS PRIMARY CARE STAFF QUICKLY AND EASILY SCHEDULE PATIENT APPOINTMENTS AND !DAPTABILITY n THE SYSTEM CAN BE UPGRADED AND IMPROVED TO MEET THE FUTURE NEEDS OF THE .(3
!USTRALIA (EALTH#ONNECT AN ELECTRONIC NETWORK FOR HEALTHCARE DATA IMPROVES THE FLOW OF INFORMATION ACROSS THE !USTRALIAN HEALTHCARE SECTOR 4HE NETWORK ENABLES THE AUTOMATED COLLECTION STORAGE AND EXCHANGE OF CONSUMER HEALTH INFORMATION THROUGH A SECURE NETWORK THAT MEETS STRICT PRIVACY STANDARDS (EALTH#ONNECT GIVES DOCTORS AND OTHER HEALTH PROFESSIONALS QUICK AND SECURE ACCESS TO VITAL MEDICAL INFORMATION 7ORK ON A PHASED NATIONAL IMPLEMENTATION OF (EALTH#ONNECT HAS BEGUN IN CONCERT WITH STATES TERRITORIES AND HEALTHCARE PROVIDER GROUPS 4HE NETWORK WILL BE IMPLEMENTED ON A STATE BY STATE BASIS PARTICIPATION IS VOLUNTARY 5SING (EALTH#ONNECT PATIENT INFORMATION IS COLLECTED AT A POINT OF CARE THEN DOCUMENTED AND STORED IN THE NETWORK 7ITH THE PATIENTS CONSENT THE DATA MAY BE RETRIEVED BY OR EXCHANGED AMONG HEALTHCARE PROVIDERS (EALTH#ONNECT IS EXPECTED TO DELIVER THESE BENElTS 1UICK ACCESS TO COMPREHENSIVE ACCURATE PATIENT INFORMATION ,ESS DUPLICATION OF SERVICES -ORE TIME AVAILABLE FOR DIRECT PATIENT CARE 'REATER PORTABILITY OF HEALTH RECORDS FOR MOBILE HEALTHCARE PROVIDERS -ORE ACTIVE CONSUMER PARTICIPATION IN DECISIONS ABOUT THEIR HEALTHCARE AND )MPROVED DIAGNOSES AND HIGHER QUALITY CARE THROUGH BETTER QUALITY OF INFORMATION EXCHANGE AMONG HEALTHCARE PROVIDERS
SGDãQNKDãN Eã1'(.Rã @ M C ã NS G D Q ã B N KK@ A N Q @S H U D Rã H M ã P T @ KH S X
#ALIFORNIA
.EW 9ORK
#AL2()/ BEGAN IN *ANUARY AS A PROJECT OF THE (EALTH 4ECHNOLOGY #ENTER TO SUPPORT 2()/ EFFORTS THROUGHOUT THE STATES RURAL AND URBAN AREAS #AL2()/ HAS THREE MAIN GOALS #ATALOG EXISTING 2()/S IN #ALIFORNIA 3UPPORT NEW AND EXISTING 2()/S BY FUNCTIONING AS A CLEARINGHOUSE FOR BEST PRACTICES AND 0ROVIDE A NEUTRAL ENVIRONMENT FOR DISCUSSION AMONG STAKEHOLDERS AND THE DEVELOPMENT OF NEW 2()/ PROJECTS
4ACONIC (EALTH )NFORMATION .ETWORK AND #OMMUNITY IS A MULTI STAKEHOLDER COMMUNITYWIDE DATA EXCHANGE AMONG PHYSICIANS HOSPITALS REFERENCE LABORATORIES PHARMACIES PAYERS EMPLOYERS AND CONSUMERS IN THE (UDSON 6ALLEY REGION OF .EW 9ORK STATE )T PROVIDES CLINICAL INSURANCE AND DEMOGRAPHIC INFORMATION FOR MORE THAN PATIENTS VIA A SECURE )NTERNET INFRASTRUCTURE DESIGNED FOR DATA EXCHANGE
!PPALACHIA
3UMMARY
3OME INDUSTRY OBSERVERS HAVE SAID THAT INFORMATION TECHNOLOGY HOLDS THE PROMISE OF REDUCING HEALTHCARE DISPARITIES FOR THOSE LIVING IN RURAL COMMUNITIES "ASED IN RURAL CENTRAL !PPALACHIA #ARE3PARK IS BUILDING A SECURE )4 NETWORK THAT ENABLES A VARIETY OF HEALTHCARE PROVIDERS n PHARMACIES LABORATORIES IMAGING CENTERS AND PUBLIC HEALTH DEPARTMENTS n TO COMMUNICATE ELECTRONICALLY #ARE3PARK IS SUPPORTED BY MANY EMPLOYERS HEALTHCARE PROVIDERS HEALTHCARE PAYERS AND ACADEMIC CENTERS IN THE REGION
/HIO )NITIALLY FUNDED BY LOCAL HEALTH SYSTEMS AND INSURERS (EALTH"RIDGE STARTED IN AS A COMMUNITYWIDE COMPUTER PORTAL FOR PHYSICIANS IN THE GREATER #INCINNATI AREA 4HE SERVICE ALLOWS MEDICAL DATA TO BE EXCHANGED EVEN IF A PROVIDER DOES NOT HAVE AN ELECTRONIC MEDICAL RECORD SYSTEM (EALTH"RIDGE OFFERS CLINICAL MESSAGING FUNCTIONALITY AND PUBLIC HEALTH AND PHYSICIAN ALERTS AND IS IMPLEMENTING ELECTRONIC ORDER ENTRY IN AMBULATORY OFlCES 0ARTICIPANTS IN THIS 2()/ ATTEST TO IMPROVEMENTS IN EFlCIENCY AND PATIENT SAFETY AND A REDUCTION IN OPERATING EXPENSES /NE OF (EALTH"RIDGES DElNING CHARACTERISTICS IS ITS SUCCESS IN ACHIEVING COLLABORATION ACROSS STATE LINES
-ASSACHUSETTS -ASSACHUSETTS 3IMPLIFYING (EALTHCARE !MONG 2EGIONAL %NTITIES 3(!2% IS A COLLABORATIVE PROGRAM OF THE -ASSACHUSETTS (EALTH $ATA #ONSORTIUM -ASSACHUSETTS 3(!2% AIMS TO PROMOTE THE INTERORGANIZATIONAL EXCHANGE OF HEALTHCARE DATA VIA INFORMATION TECHNOLOGY STANDARDS AND SIMPLIlED ADMINISTRATION TO MAKE ACCURATE CLINICAL HEALTH INFORMATION AVAILABLE EFlCIENTLY COST EFFECTIVELY AND SAFELY -ASSACHUSETTS 3(!2% INTENDS TO IMPROVE COMMUNITY CONNECTIVITY THROUGH THE SHARING OF HEALTHCARE DATA AMONG PATIENTS DOCTORS HOSPITALS GOVERNMENT AGENCIES INSURERS (-/S AND OTHER PARTICIPANTS IN THE HEALTHCARE SYSTEM
0ACIlC .ORTHWEST 0EACE(EALTH IS AN INTEGRATED DELIVERY NETWORK THAT PROVIDES TECHNOLOGY SERVICES AND ACCESS TO ITS COMPREHENSIVE COMMUNITY HEALTH RECORD #(2 OF ABOUT MILLION PATIENTS 3MALLER RURAL CLINICS AND PHYSICIANS WITHOUT THE RESOURCES FOR EXPENSIVE )4 INVESTMENTS CAN SECURELY ACCESS THE NETWORK FOR A MODEST FEE 3INCE THE PROGRAM BEGAN INDEPENDENT PRACTICES USE ITS SERVICES AND MORE THAN AUTHORIZED CLINICIANS HAVE FULL ACCESS TO THE #(2 TO SUPPORT PATIENT CARE
3UCCESSFUL 2()/S WILL LIKELY BE BEST INITIATED AT THE GRASS ROOTS LEVEL BY HOSPITALS MEDICAL SOCIETIES OR INSURANCE PAYERS WHO SEE THEIR BENEFITS )N SOME CASES A STATE BECOMES THE CONVENING BODY FOR THE LOCAL ORGANIZATIONS ! CRITICAL SUCCESS FACTOR IS TO INCLUDE ALL KEY STAKEHOLDERS FROM THE START ,ONG TERM 2()/S MUST BE SELF SUSTAINING BUT THEY NEED INITIAL FUNDING TO START BUILDING THE )4 INFRASTRUCTURE 7HEN EDUCATED ABOUT THE VALUE OF THE 2()/ STATE AND FEDERAL GOVERNMENTS OFTEN PROVIDE FUNDING 0ROVIDERS CAN MOVE FORWARD WITH THEIR OWN h2()/ ACTIVATION PLANv BY FOLLOWING THESE GUIDELINES $ElNE THE GEOGRAPHICAL BOUNDARIES FOR THE 2()/ n THESE COULD BE A CITY A STATE OR SEVERAL REGIONS IN A STATE %DUCATE ALL POTENTIAL STAKEHOLDERS ABOUT THE IMPORTANCE OF THE 2()/ TO HEALTHCARE IN THE REGION 7ORK TO UNDERSTAND THE SPECIlC HEALTHCARE NEEDS AND PRIORITIES OF THE REGION (OW DOES IT NEED TO IMPROVE QUALITY 7HERE DOES IT NEED TO REDUCE COSTS 4O ESTABLISH A SENSE OF OWNERSHIP INVOLVE ALL STAKEHOLDERS AND MAKE SURE THEY ARE REPRESENTED WHEN POLICY DECISIONS ARE MADE #REATE IMPLEMENTATION AND lNANCIAL PLANS TO COVER OPERATING COSTS OF THE 2()/ 4O LEVERAGE EXISTING RESOURCES REVIEW THE EXISTING )4 INFRASTRUCTURE AND THE CURRENT STATE OF CONNECTIVITY 3ECURE AGREEMENT FROM ALL STAKEHOLDERS ON OBJECTIVES FOR THE 2()/ AND 4RY TO INVOLVE STATE AND FEDERAL AGENCIES IN ESTABLISHING STANDARDS AND CERTIlCATIONS AND PROVIDING INITIAL FUNDING 7ALK BEFORE RUNNING $O NOT TAKE ON TOO MUCH ACTIVITY OR EXPENSE IN THE BEGINNING &IRST LEARN HOW THE MECHANISM OF SHARING INFORMATION WORKS AND LATER TAKE ON ADDITIONAL ANALYTICAL AND PUBLIC HEALTH RESPONSIBILITIES %NDNOTES 0AN % ET AL h4HE 6ALUE OF (EALTHCARE )NFORMATION %XCHANGE AND )NTEROPERABILITY v #HICAGO (EALTH )NFORMATION -ANAGEMENT AND 3YSTEMS 3OCIETY h2EPORT ON ,OUISIANA (EALTHCARE $ELIVERY AND &INANCING 3YSTEM v REPORT TO THE ,OUISIANA 2ECOVERY !UTHORITY 3UPPORT &OUNDATION !PRIL 0RICEWATERHOUSE#OOPERS P HTTPWWWKATRINAHEALTHORGPRESSHTML
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
/VERVIEW OF 0HARMA AND ,IFE 3CIENCE 1UALITY )SSUES "Y BLENDING ITS TALENT FOR INNOVATION WITH A FOCUS ON @QUALITY BY DESIGN THE PHARMACEUTICAL INDUSTRY CAN DRIVE GROWTH AND REGAIN ITS ROLE AS A HEALTHCARE QUALITY LEADER
"Y !NTHONY , &ARINO 0RICEWATERHOUSE#OOPERS
&
OR MANY YEARS THE PHARMACEUTICAL INDUSTRY MAINTAINED A REPUTATION AS A LEADER IN THE IMPROVEMENT OF HEALTHCARE 4HE INDUSTRY CONSISTENTLY USED REMARKABLE INNOVATION TO CREATE NEW IMPROVED DRUGS THAT HELPED PATIENTS AND DROVE BUSINESS GROWTH AND PROlTS "UT TIMES HAVE CHANGED 4HE INDUSTRYS REPUTATION HAS SAGGED .UMEROUS ISSUES ARE AT THE HEART OF THIS DECLINE A STRING OF RECENT WELL PUBLICIZED PRODUCT WITHDRAWALS A SLOWDOWN IN THE INTRODUCTION OF NEW PRODUCTS RISING DRUG COSTS AND CONTROVERSY ABOUT DIRECT TO CONSUMER ADVERTISING -ANY CONSUMERS BELIEVE THAT DRUG COMPANIES HAVE STRAYED FROM THEIR ORIGINAL VISION OF HELPING PEOPLE BECOME HEALTHIER AND ARE MORE INTERESTED IN SATISFYING THEIR BUSINESS STAKEHOLDERS;= 4O REGAIN THE PUBLICS TRUST PHARMACEUTICAL COMPANIES MUST DEMONSTRATE THAT THEY HAVE REFOCUSED ON THE PATIENT 4O ACCOMPLISH THIS COMPANIES MUST USE A BUSINESS MODEL THAT COMBINES IMPROVEMENT IN OPERATIONS WITH A FOCUS ON INTEGRITY ETHICS AND VALUES AS ELEMENTS OF SUCCESS 4HE ISSUES OF GOVERNANCE RISK AND COMPLIANCE ALSO MUST PLAY IMPORTANT ROLES BEGINNING WITH RESEARCH AND DEVELOPMENT AND EXTENDING THROUGH MANUFACTURING AND SALES
%NSURE 1UALITY IN #LINICAL 4RIALS 0ROCESS )N TERMS OF DRUG DEVELOPMENT LIFE SCIENCES COMPANIES NEED TO ENSURE THAT CLINICAL TRIAL OUTCOMES ARE REPORTED ACCURATELY AND COMPLETELY BY COLLABORATING CLOSELY WITH HEALTHCARE WORKERS AND PATIENT GROUPS TO UNDERSTAND THE BEST MEANS OF CHANNELING CLINICAL TRIAL RESULTS 0OST MARKET PHARMACOVIGILANCE RISK MANAGEMENT PROTOCOLS NEED TO BE DESIGNED TO ACTIVELY INVESTIGATE AND ADDRESS ADVERSE DRUG EVENTS )N ADDITION THEY SHOULD FOCUS ON IMPROVING DEVELOPMENT PROCESSES THAT WILL HELP DRIVE GREATER PRODUCTIVITY AND HIGHER QUALITY DATA 4HIS SHOULD ENSURE THAT
DATA IS CONSISTENTLY PREPARED AND OF AN ACCEPTABLE MINIMUM QUALITY LEVEL REGARDLESS OF COUNTRY OF ORIGIN 0OST MARKET SAFETY PROCESSES AND TOOLS WERE DESIGNED IN AN EARLIER ERA AND IT IS DIFlCULT TO ADAPT THEM TO THE REQUIREMENTS OF THE CURRENT SAFETY ENVIRONMENT
)MPROVE THE -ANUFACTURING 0ROCESS )N GENERAL MANUFACTURING TECHNIQUES HAVE NOT KEPT UP WITH ADVANCES IN SCIENCE AND TECHNOLOGY 5NTIL RECENTLY THE ECONOMIC CLIMATE DID NOT DEMAND THAT THEY DO SO PRODUCT COMPLEXITY DID NOT REQUIRE IT AND THE REGULATORY FRAMEWORK ACTIVELY DISCOURAGED IT "UT THAT HAS ALL CHANGED )MPROVEMENTS TO THE DRUG MANUFACTURING PROCESS CAN RAISE THE LEVEL OF PRODUCT QUALITY )N 3EPTEMBER 4HE 7ALL 3TREET *OURNAL MADE A CONNECTION BETWEEN THE RISE IN PRODUCT RECALLS AND QUALITY PROBLEMS 4HE PUBLICATION NOTED THAT IN SPITE OF lNES OF MORE THAN MILLION FOR MANUFACTURING FAILURES PHARMA COMPANIES ARE NOT MAINTAINING ACCEPTABLE STANDARDS OF PRODUCT QUALITY;= 4HE lVE POINTS BELOW SUMMARIZE THE 53 &OOD AND $RUG !DMINISTRATIONS VISION FOR PHARMACEUTICAL DEVELOPMENT AND MANUFACTURING IN THE ST CENTURY 4HESE POINTS FOCUS ON hQUALITY BY DESIGN v SCIENTIlC MANUFACTURING AND RISK BASED REGULATORY OVERSIGHT $ESIGNING EFFECTIVE EFlCIENT MANUFACTURING PROCESSES TO ACHIEVE AND ENSURE PRODUCT QUALITY AND PERFORMANCE %STABLISHING PRODUCT SPECIlCATIONS BASED ON A MECHANISTIC UNDERSTANDING OF HOW FORMULATION AND PROCESS FACTORS IMPACT PRODUCT PERFORMANCE #ONTINUOUS hREAL TIMEv ASSURANCE OF QUALITY %STABLISHING REGULATORY POLICIES AND PROCEDURES THAT RECOGNIZE THE LEVEL OF SCIENTIlC KNOWLEDGE REQUIRED TO SUPPORT PRODUCT APPLICATIONS PROCESS VALIDATION AND PROCESS CAPABILITY AND
!NTHONY , &ARINO IS A PARTNER AND LEADER OF 0RICEWATERHOUSE#OOPERS 53 ,IFE 3CIENCES PRACTICE FOCUSED ON HELPING COMPANIES ADDRESS A BROAD RANGE OF STRATEGIC lNANCIAL AND OPERATIONAL ISSUES (E HAS OVER YEARS OF EXPERIENCE AND HAS AN IN DEPTH UNDERSTANDING OF PHARMACEUTICAL AND HEALTHCARE PRODUCTS DISTRIBUTION SALES AND MARKETING AND PRICING STRUCTURES (E CAN BE REACHED AT ANTHONYLFARINO USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
NUDQ UHDVãNEãOG@QL@ ã @ M C ã KH E D ã RB H D M B D ã P T @ KH S Xã H RRT D R 2EGULATORY SCRUTINY THAT IS RISK BASED AND RELATES TO THE SCIENTIlC UNDERSTANDING OF HOW FORMULATION AND MANUFACTURING PROCESSES AFFECT PRODUCT QUALITY AND PERFORMANCE IMPLEMENTING PROCESS CONTROL STRATEGIES TO PREVENT OR MITIGATE THE RISK OF PRODUCING A PRODUCT OF POOR QUALITY;= !CHIEVING THE &$!S VISION WILL PROBABLY REQUIRE SIGNIlCANT INVESTMENTS BY PHARMACEUTICAL COMPANIES BUT THE INVESTMENT COULD BE WELL WORTH IT 4HE &$! WANTS TO ACCELERATE THE RATE OF CHANGE BY PUBLISHING EXTENSIVE GUIDELINES AND FACILITATING THE ADOPTION OF CHANGE BY CREATING hSAFE HARBORSv FOR COMPANIES THAT MAKE THE CHANGES;=
@1UALITY IN THE 53 IS AT ITS BEST HIGHLY UNEVEN !T TIMES IT IS THE BEST IN THE WORLD SOMETIMES IT IS POOR AND SOMETIMES IT IS IN BETWEEN AND SHOULD BE BETTER ESPECIALLY GIVEN WHAT WE SPEND n (ELEN $ARLING PRESIDENT OF THE .ATIONAL "USINESS 'ROUP ON (EALTH
,EVERAGE #ONNECTIVITY FOR %XCHANGE OF 1UALITY $ATA (EALTHCARE EXPERTS POLICY MAKERS AND PAYERS CONSIDER HEALTH INFORMATION TECHNOLOGY ()4 SUCH AS ELECTRONIC HEALTH RECORDS AND COMPUTERIZED PROVIDER ORDER ENTRY TO BE CRITICAL FOR THE TRANSFORMATION OF THE HEALTHCARE INDUSTRY )NFORMATION MANAGEMENT IS FUNDAMENTAL TO HEALTHCARE DELIVERY "ECAUSE OF THE FRAGMENTED NATURE OF HEALTHCARE THE HIGH VOLUME OF TRANSACTIONS IN THE HEALTHCARE SYSTEM THE CONSTANT INTEGRATION OF NEW SCIENTIlC EVIDENCE INTO PRACTICE AND OTHER COMPLEX INFORMATION MANAGEMENT ACTIVITIES PAPER BASED INFORMATION MANAGEMENT CLEARLY CANNOT KEEP UP WITH THE DEMAND FOR ACCESS TO ACCURATE TIMELY COMPLETE PATIENT INFORMATION;= )F SYSTEMS ARE STANDARDIZED AND NETWORKED THEY CAN TRANSMIT VITAL HEALTH INFORMATION TO PROVIDERS PATIENTS AND INSURERS #REATING AND MAINTAINING THESE SYSTEMS REQUIRES SUBSTANTIAL EFFORT BUT THE BENElTS CAN INCLUDE DRAMATIC COST SAVINGS GREATLY INCREASED SAFETY AND IMPORTANT HEALTH BENElTS 3AVINGS FROM INCREASED EFlCIENCY n )F MOST HOSPITALS AND DOCTORS OFlCES ADOPTED ()4 THE POTENTIAL EFlCIENCY SAVINGS FOR BOTH INPATIENT AND OUTPATIENT CARE COULD AVERAGE MORE THAN BILLION PER YEAR;= 4HE LARGEST SAVINGS COME FROM REDUCED HOSPITAL STAYS REDUCED ADMINISTRATIVE TIME FOR NURSES AND MORE EFlCIENT USE OF DRUGS )NCREASED SAFETY n #OMPUTERIZED PHYSICIAN ORDER ENTRY SYSTEMS FOR MEDICATIONS GENERATE ALERTS AND REMINDERS THAT PROVIDE IMMEDIATE INFORMATION TO PHYSICIANS &OR EXAMPLE THIS TYPE OF SYSTEM WARNS PHYSICIANS ABOUT POTENTIAL ADVERSE
REACTIONS FROM A PATIENTS MEDICATIONS )F ALL HOSPITALS HAD AN ()4 SYSTEM THAT INCLUDED COMPUTERIZED PHYSICIAN ORDER ENTRY SOME HAVE ESTIMATED THAT ABOUT ADVERSE DRUG EVENTS COULD BE ELIMINATED EACH YEAR FOR ANNUAL SAVINGS OF ABOUT BILLION;= (EALTH BENElTS n ()4 CAN SCAN PATIENT RECORDS FOR RISK FACTORS AND RECOMMEND APPROPRIATE SERVICES SUCH AS VACCINATIONS AND SCREENINGS )F lVE PREVENTIVE SERVICES FOR PNEUMONIA n TWO TYPES OF VACCINATIONS AND THREE TYPES OF SCREENINGS n WERE INCREASED AT A TOTAL COST OF MILLION EACH YEAR SOME HAVE ESTIMATED THAT BETWEEN AND DEATHS FROM THE DISEASE COULD BE ELIMINATED ANNUALLY IN THE 53;= &OR AN ELECTRONIC HEALTH RECORD TO RAISE LEVELS OF PATIENT CARE AND SAFETY RECORDS MUST BE EASILY ACCESSED BY CAREGIVERS AND THEY MUST CONTAIN EXTENSIVE MEDICAL HISTORIES n INCLUDING PROGRESS NOTES TEST RESULTS 8 RAY IMAGES MEDICATIONS FUTURE APPOINTMENTS AND DEMOGRAPHIC DATA n THAT ENCOMPASS ALL MEDICAL ENCOUNTERS FOR EVERY PATIENT 4HE MOST COMPELLING REASON TO OFFER AN ELECTRONIC HEALTH RECORD IS THAT IT ALLOWS HEALTHCARE PROVIDERS TO OFFER SAFER AND MORE CONSISTENT CARE TO ALL PATIENTS
2ECONlGURE THE 3ALES 0ROCESS !ROUND %DUCATION /VER THE PAST TWO DECADES THE NATURE OF THE DOCTOR PATIENT RELATIONSHIP HAS CHANGED IRREVERSIBLY 4ODAYS PATIENTS WANT MORE MEDICAL INFORMATION AND THEY WANT TO ACTIVELY PARTICIPATE IN DECISIONS THAT AFFECT THEIR HEALTH $IRECT TO CONSUMER PROMOTION WHICH IN ITS EARLY STAGES DOESNT INVOLVE PRIMARY CARE DOCTORS AND OTHER PHYSICIANS ADDRESSES THIS TREND /PINIONS ARE MIXED ABOUT THIS TYPE OF PROMOTION ! SURVEY OF TELEVISION VIEWERS WHO WATCHED ADVERTISEMENTS FOR PHARMACEUTICALS FOUND THAT PERCENT LEARNED LITTLE OR NOTHING MORE ABOUT THE HEALTH CONDITION REQUIRING TREATMENT FROM THE AD )N ADDITION PERCENT SAID THAT THEY KNEW LITTLE OR NOTHING MORE ABOUT THE DRUG AFTER VIEWING THE ADVERTISEMENT;= 4HE EFFECT OF CONSUMER DRIVEN HEALTH PLANS COMBINED WITH CHANGES IN THE COMPLEXITY OF PRODUCTS AND THE DISEASE STATES THEY ARE DESIGNED TO TREAT WILL HAVE A TREMENDOUS IMPACT ON TODAYS PHARMACEUTICAL SALES AND MARKETING MODEL 4HE DEMAND FOR INFORMATION FROM PHYSICIANS PAYERS CONSUMERS AND OTHER STAKEHOLDERS WILL INCREASE DRAMATICALLY 4ECHNOLOGY WILL CONTINUE TO OFFER NEW WAYS TO REACH THESE STAKEHOLDERS !T THE SAME TIME THIS SHIFT HAS TREMENDOUS IMPLICATIONS FOR HOW TODAYS SALES ORGANIZATIONS ARE STRUCTURED AND THE METHODS THEY USE TO REACH THEIR TARGETED AUDIENCE !LSO CONSUMERS WILL BE PAYING MORE OUT OF POCKET FOR DRUGS IN THE FUTURE (EALTH PLANS GOVERNMENT AND EMPLOYERS NEED TO DEVELOP COST SHARING BENElT DESIGNS THAT ENCOURAGE PATIENTS TO TAKE THE DRUGS THEY NEED AND AVOID COSTLY HOSPITALIZATIONS )N ADDITION DEMAND FOR INFORMATION ON EFFECTIVENESS OF PRODUCTS WILL INCREASE AS PAYERS INCLUDING THE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
NUDQ UHDVãNEãOG@QL@ ã @ M C ã KH E D ã RB H D M B D ã P T @ KH S Xã H RRT D R GOVERNMENT CONSUMERS AND PHYSICIANS STRIVE TO UNDERSTAND THE MOST EFFECTIVE COURSE OF TREATMENT
@4HE ACKNOWLEDGMENT THAT WE NEED TO PUSH FORWARD ON MULTIPLE FRONTS TO REMOVE BARRIERS TO IMPROVING PATIENT SAFETY IS A FUNDAMENTAL MESSAGE $ENNIS 3 /,EARY -$ PRESIDENT OF THE *OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS
3ECURE THE 3UPPLY #HAIN &INALLY PHARMACEUTICAL COMPANIES MUST ENSURE THE QUALITY AND PURITY OF THE PRODUCTS THEY PRODUCE BY SECURING THE SUPPLY CHAIN )MPROVING A COMPANYS SUPPLY CHAIN PROCESSES TO PREVENT INAPPROPRIATE ACCESS THAT RESULTS IN COUNTERFEIT ADULTERATED OR DAMAGED PRODUCTS COMING TO MARKET WILL PROTECT THE COMPANYS REPUTATION AND MOST IMPORTANTLY PROTECT ITS CUSTOMERS FROM HARM ! PHARMACEUTICAL PRODUCT MOVING THROUGH THE COMPLEX PIPELINE FROM 2$ TO PRODUCTION TO MARKETING PASSES THROUGH MANY CHANNELS BEFORE IT REACHES THE PATIENT $RUG SHORTAGES AND SECONDARY DISTRIBUTION CHANNELS ALL PRESENT DIFlCULT CHALLENGES IN ENSURING THE SAFETY OF PRODUCTS 3HORTAGES OF CRITICAL MEDICATIONS FORCE PROVIDERS TO lND ALTERNATIVE PRODUCTS EXPEND MORE RESOURCES AND INCREASE THE COMPLEXITY OF PROVIDING PATIENT CARE;= 4HREE FACTORS HAVE INCREASED THE AMOUNT OF COUNTERFEIT DRUGS &IRST COMPUTER TECHNOLOGY FOR FORGING LABELS IS MORE SOPHISTICATED n IT IS NOW POSSIBLE TO REPRODUCE ANY LABEL ON ANY MEDICATION 3ECOND MANY SMALL WHOLESALERS ARE NOW BUYING AND SELLING MEDICATIONS 4HESE WHOLESALERS CREATE AN ACTIVE SECONDARY MARKET &INALLY THE HIGHER COST OF DRUG THERAPIES CREATES MORE POTENTIAL FOR HIGH PROlTS FOR FORGERS AND THOSE WHO SELL IMPURE OR ADULTERATED DRUGS;= 4HE 7ORLD (EALTH /RGANIZATION ESTIMATES THAT BETWEEN AND PERCENT OF THE WORLDWIDE TRADE IN PHARMACEUTICALS IS COUNTERFEIT -ANY INDUSTRY EXPERTS BELIEVE THIS IS A CONSERVATIVE ESTIMATE %VEN THOUGH THE OVERWHELMING MAJORITY OF DRUGS SOLD IN THE 53 ARE SAFE THE BILLION PER YEAR PHARMACEUTICAL MARKET IS AN ATTRACTIVE TARGET FOR COUNTERFEITERS;= ,AWS THAT DONT ASSIGN SUPPLY CHAINWIDE ACCOUNTABILITY TO ANY SINGLE AUTHORITY HINDER FEDERAL EFFORTS TO DEAL WITH COUNTERFEIT PRODUCTS 2EIMPORTATION OF DRUGS AND THE ADVENT OF )NTERNET PHARMACIES MAKE COUNTERFEITING DIFlCULT TO PREVENT
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
4HE KEYS TO INCREASING THE SECURITY OF PHARMACEUTICAL PRODUCTS ARE CONSISTENT AND EFFECTIVE REGULATORY STANDARDS CONSISTENT AND EFFECTIVE DILIGENCE BY PURCHASERS WHEN CHOOSING PRIMARY AND SECONDARY SUPPLIERS AND MORE ROBUST TRACKING OF PRODUCT ENABLED BY TECHNOLOGY 2EGULATIONS AND THE TECHNOLOGY USED TO ENFORCE THEM SHOULD SUPPORT AN ELECTRONIC PRODUCT hPEDIGREEv THAT WILL ADDRESS MANY CONCERNS ABOUT SECURITY BY VERIFYING THE AUTHENTICITY OF EVERY DRUG SOLD;=
#ONCLUSION #OMPANIES THAT QUANTIFY THEIR QUALITY AND COMPLIANCE RISKS AND PLAN STRATEGIC ACTIONS TO MITIGATE THOSE RISKS WHILE BUILDING A FOUNDATION FOR hQUALITY BY DESIGNv AND SCIENTIlC MANUFACTURING WILL LIKELY BE REWARDED WITH BUSINESS CERTAINTY OPERATIONAL EFlCIENCIES REDUCED REGULATORY BURDENS AND THE FREEDOM FOR REAL PROCESS AND PRODUCT INNOVATION;= "Y SECURING THE SUPPLY CHAIN IMPROVING THE MANUFACTURING PROCESS ENHANCING CONNECTIVITY THROUGH TECHNOLOGY AND FOCUSING SALES ORGANIZATIONS ON EDUCATING CONSUMERS THE PHARMACEUTICAL INDUSTRY CAN MAKE STRIDES TOWARD ITS FORMER STATUS AS AN INDUSTRY THAT USES IMPRESSIVE DOSES OF VISION COMPASSION AND EXPERTISE TO IMPROVE THE LIVES OF PATIENTS %NDNOTES h2ECAPTURING THE 6ISION v 0RICEWATERHOUSE#OOPERS P !BBOUD , AND 3 (ENSLEY h.EW 0RESCRIPTION FOR $RUG -AKERS 5PDATE THE 0LANTS v 3EPTEMBER 4HE 7ALL 3TREET *OURNAL h4HE -ETAMORPHOSIS OF -ANUFACTURING v )"- EXECUTIVE BRIEF P )BID (EALTH )NFORMATION 4ECHNOLOGY 2AND #ORPORATION P )BID )BID )BID h$IRECT TO #ONSUMER !DVERTISING n %DUCATION OR %MOTION 0ROMOTION v .EW %NGLAND *OURNAL OF -EDICINE P h)NTEGRITY OF THE 0HARMACEUTICAL 3UPPLY #HAIN 0RODUCT 3OURCING FOR 0ATIENT 3AFETY v (EALTH )NDUSTRY 'ROUP 0URCHASING !SSOCIATION P h3ECURING THE 0HARMACEUTICAL 3UPPLY #HAIN v !UTO )$ #ENTER P h)NTEGRITY OF THE 0HARMACEUTICAL 3UPPLY #HAIN 0RODUCT 3OURCING FOR 0ATIENT 3AFETY v (EALTH )NDUSTRY 'ROUP 0URCHASING !SSOCIATION P h%LECTRONIC $RUG 0EDIGREE h% 0EDIGREEv #ONSIDERATIONS IN #HOOSING A 0ARTNER FOR THE $RUG 0EDIGREE 2ACE v 6ERI3IGN )NC P h4HE -ETAMORPHOSIS OF -ANUFACTURING v )"- EXECUTIVE BRIEF P
&ROM 2ESEARCH TO 1UALITY 4RANSLATING #LINICAL ,AB 2ESULTS )NTO 0ATIENT #ARE 3EQUENCING OF THE HUMAN GENOME WILL ENABLE THE SHIFT FROM SYMPTOM BASED TREATMENT TO PERSONALIZED MEDICINE n A PRECURSOR TO REDUCED ADVERSE DRUG REACTIONS AND IMPROVED EFFECTIVENESS OF TREATMENT "Y 7ILLIAM - $RACOS -ICHAEL 2 'LICK 'ERRY -C$OUGALL AND "ARBARA 7ALSH 0RICEWATERHOUSE#OOPERS
3
INCE THE LATTER HALF OF THE TH CENTURY ADVANCES IN BIOMEDICAL RESEARCH HAVE LARGELY BEEN SUPPORTED THROUGH ALLOCATIONS OF SMALL TO MIDSIZE RESEARCH GRANTS TO ACADEMIC SCIENTISTS 2ESEARCH HAS BEEN CONDUCTED WITH A FOCUS ON DISCOVERY AND SCHOLARLY KNOWLEDGE &OR COMMERCIAL ENTITIES SUCH AS LARGE PHARMACEUTICAL COMPANIES DRUG DISCOVERY TECHNIQUES WERE BASED ON SYSTEMATIC SEARCHES FOR COMPOUNDS THAT COULD TREAT DISEASES "OTH OF THESE METHODS REPRESENTED LIMITED EFFORTS TO TRANSLATE BASIC DISCOVERY TO CLINICAL APPLICATION STEMMING BOTH FROM RELATIVE MYOPIA OF THEIR MISSIONS AND THE INABILITY TO UNDERSTAND DISEASE AT THE GENOMIC LEVEL 7HILE THESE APPROACHES HAVE LED TO MEDICAL ADVANCES OVER THE PAST DECADES THE STATUS QUO WILL PROVE TOO LIMITED TO DRIVE FUTURE DISCOVERY 4HE FUTURE OF MEDICINE LIES IN TRANSLATIONAL RESEARCH EFFORTS ENABLED BY THE APPLICATION OF TECHNOLOGIES TO UNDERSTAND THE GENOMIC BASIS OF DISEASE "ASED ON THE COMPLETED SEQUENCING OF THE HUMAN GENOME THE ST CENTURY HAS RESULTED IN THE DAWN OF TRANSLATIONAL RESEARCH AND A NEW ERA OF PROSPECTIVE AND PERSONALIZED MEDICINE 4RANSLATIONAL RESEARCH IS THE PROCESS OF TRANSLATING BASIC SCIENTIlC DISCOVERIES INTO CLINICAL APPLICATIONS SUCH AS NEW DIAGNOSTICS AND TREATMENTS #LINICAL PRACTICE IS SHIFTING FROM TREATMENT BASED ON SYMPTOMS TO TREATMENT BASED ON EACH PERSONS UNIQUE GENETIC MAKEUP n IN OTHER WORDS PERSONALIZED MEDICINE 4RANSLATIONAL RESEARCH HELPS TO SPEED DEVELOPMENTS OF NEW TREATMENTS FROM THE hBENCH TO BEDSIDEv )T ATTEMPTS TO REDUCE
THE TIME IT TAKES BETWEEN DISCOVERY OF A FAULTY GENE OR PROTEIN IMPLICATED IN A CANCER AND DEVELOPMENT OF A NEW DIAGNOSTIC TECHNIQUE OR DRUG THAT EITHER ARRESTS OR CORRECTS THE GENE OR PROTEINS MALFUNCTION IN THE PATIENT 4HIS RESEARCH MAKES POSSIBLE A PHARMACOGENIC COURSE OF TREATMENT THAT IS PERSONALIZED TO THE INDIVIDUAL PATIENT;= 4HERAPIES RESULTING FROM TRANSLATIONAL RESEARCH LEAP BEYOND TRADITIONAL DRUG THERAPIES WHICH CANNOT DIFFERENTIATE ONE TYPE OF PATIENT FROM ANOTHER &OR EXAMPLE IN PATIENTS CALLED HIGH RESPONDERS TRADITIONAL DRUG THERAPIES HAVE A HIGH EFlCACY )N POOR RESPONDERS DRUGS SHOW INCOMPLETE EFlCACY AND NONRESPONDERS DEMONSTRATE NO RESPONSE TO DRUGS AND MAY HAVE A HIGH RISK OF ADVERSE DRUG REACTIONS !$2S )NDIVIDUALS CALLED hPOOR METABOLIZERSv CANNOT CLEAR DRUGS FROM THEIR BODIES EFFECTIVELY AND FACE HIGH RISKS OF TOXICITY AND OTHER !$2S;= ! PHARMACOGENIC APPROACH MATCHES AN INDIVIDUAL PATIENT WITH DRUGS THAT ARE MORE LIKELY TO BE SAFE AND EFFECTIVE BASED ON THEIR GENETIC MAKEUP )MPROVING THE SAFETY AND EFlCACY OF TREATMENTS RAISES INCREASINGLY IMPORTANT QUALITY CONCERNS 4ODAY NEARLY MILLION OF THE APPROXIMATELY BILLION PRESCRIPTIONS WRITTEN ANNUALLY IN THE 53 ARE INAPPROPRIATE OR INEFFECTIVE -OST OF THESE PRESCRIBING ERRORS ARE MINOR BUT MANY STUDIES HAVE SHOWN AN INCREASE IN !$2S IN PATIENTS !CCORDING TO THE 53 &OOD AND $RUG !DMINISTRATION MORE THAN 53 PATIENTS DIE EACH YEAR FROM !$2S;=
7ILLIAM - $RACOS -"! IS A DIRECTOR WITHIN 0RICEWATERHOUSE#OOPERS ,IFE 3CIENCES !DVISORY PRACTICE MAINTAINING OVER YEARS OF HIGHER EDUCATION AND ACADEMIC MEDICINE EXPERIENCE (IS EXPERTISE INCLUDES STRATEGIC BUSINESS PLANNING OPERATIONAL IMPLEMENTATION AND IMPROVEMENT AND lNANCIAL ANALYSIS FOR RESEARCH HEALTHCARE AND HIGHER EDUCATION ORGANIZATIONS (E CAN BE REACHED AT BILLDRACOS USPWCCOM -ICHAEL 2 'LICK IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE (E FOCUSES ON HOSPITAL CLINICAL SERVICE LINE STRATEGY DEVELOPMENT WITH SIGNIlCANT FOCUS ON DEVELOPING ALIGNMENT MODELS AMONG HOSPITALS AND PHYSICIANS TO ENHANCE CLINICAL SERVICES (E CAN BE REACHED AT MICHAELRGLICK USPWCCOM 'ERRY -C$OUGALL IS THE PARTNER IN CHARGE OF 0RICEWATERHOUSE#OOPERS (EALTH 3CIENCES PRACTICE (E HAS BEEN ASSISTING RESEARCH ORGANIZATIONS WITH THEIR STRATEGIC AND OPERATIONAL ISSUES FOR MORE THAN YEARS AND FOCUSES ON THE DEVELOPMENT OF RESEARCH ORGANIZATIONS THROUGH PUBLIC PRIVATE PARTNERSHIPS (E CAN BE REACHED AT GERALDJMCDOUGALL USPWCCOM "ARBARA 7ALSH IS A MANAGING DIRECTOR IN 0RICEWATERHOUSE#OOPERS (EALTH 3CIENCES GROUP 3HE HAS MORE THAN YEARS OF EXPERIENCE IN ACADEMIC AND RESEARCH ORGANIZATIONS AND ISSUES 3HE CAN BE REACHED AT BARBARAEWALSH USPWCCOM
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
EQNLãQDRD@QBGãSN ãP T@KHSX ãSQ@M RK @S H M Fã B KH M H B @ Kã K @ A ã Q D RT K S Rã H M SN ã O@S H D M S ã B @ Q D
@4HE PRIMARY FOCUS OF 4'ENS RESEARCH CAN BE SUMMED UP IN FOUR WORDS EARLIER DIAGNOSIS SMARTER TREATMENTS /UR GOAL IS TO MAKE MEDICINE NOT ONLY MORE EFFECTIVE BUT ALSO MORE PERSONALIZED )TS A TRANSITION POINT BOTH FOR DRUG DEVELOPMENT AND CLINICAL IMPLEMEN TATION *EFF 4RENT 0H$ PRESIDENT AND SCIENTIFIC DIRECTOR OF 4'EN
4HE "EGINNINGS OF 'ENOMIC AND 4RANSLATIONAL -EDICINE 0RIOR TO THE TH CENTURY BIOMEDICAL SCIENCE COULD BE CHARACTERIZED AS hSYMPTOMATOLOGIC MEDICINE v AS ILLNESSES WERE IDENTIlED AND TREATED BASED UPON EXTERNAL SYMPTOMS AND DISEASE MANIFESTATION WITH LITTLE UNDERSTANDING OF THE UNDERLYING CAUSE OF THE DISEASE FOR EXAMPLE TREATMENTS FOCUSED ON ADDRESSING PHYSIOLOGICAL EFFECTS OF ILLNESS AND PHYSICIANS DIAGNOSED BASED ON SYMPTOMS SUCH AS hTHE PATIENT SUFFERED FROM A COUGHv $ISCOVERIES IN THE TH CENTURY ALLOWED FOR A BETTER UNDERS TANDING OF THE UNDERLYING CAUSES OF MANY DISEASES PARTICULARLY THOSE DRIVEN BY PATHOGENS SUCH AS VIRUSES AND BACTERIA 4REATMENTS FOR DISEASE BASED ON AN UNDERSTANDING OF HUMAN AND PATHOGENIC BIOLOGY COULD BE DESCRIBED AS hREACTIVE MEDICINE v WITH TREATMENTS APPLIED ONCE SYMPTOMS HAVE MANIFESTED 4HERAPIES SUCH AS PENICILLIN WERE OFTEN DEVELOPED BY HAPPENSTANCE OR THROUGH RANDOM APPLICATION OF COMPOUNDS SUCH AS HIGH THROUGHPUT CHEMISTRY AGAINST A DISEASE 4RANSLATIONAL MEDICINE IN WHICH CUTTING EDGE TECHNOLOGIES SUCH AS GENOMICS PROTEOMICS AND SYSTEMS BIOLOGY ARE APPLIED TO UNDERSTAND BIOLOGY AND DISEASE IS ANTICIPATED TO BE THE MEDICINE OF THE ST CENTURY 4RANSLATIONAL MEDICINE AIMS TO UNDERSTAND THE GENETIC ORIGINS OF DISEASE AND THEN TRANSLATE THAT KNOWLEDGE INTO THERAPEUTICS BASED ON AN INDIVIDUALS GENETIC PROlLE 'ENOMIC MEDICINE BEGAN IN WHEN AFTER A YEAR QUEST THE 53 (UMAN 'ENOME 0ROJECT REACHED ITS MIRACULOUS GOAL OF IDENTIFYING THE TO GENES AND BILLION CHEMICAL BASE PAIRS THAT MAKE UP HUMAN $.!;= 4HIS LANDMARK ACHIEVEMENT SIGNALED A PARADIGM SHIFT IN MEDICINE FOR THE ST CENTURY AND LED TO A NUMBER OF IMPORTANT MEDICAL ADVANCES &OR EXAMPLE WE NOW SEE WIDESPREAD GENETIC TESTING THAT IDENTIlES PEOPLE AT RISK FOR PREVENTABLE CHRONIC CONDITIONS OR DEVASTATING DISEASES /VER GENETIC TESTS ARE NOW AVAILABLE )N THE FUTURE THERE WILL BE SIX TIMES THE NUMBER OF GENE BASED DRUGS ON THE MARKET THAN THERE ARE NOW (OWEVER IT IS LIKELY THAT THESE DRUGS WILL NOT BE AVAILABLE TO PATIENTS UNTIL ;=
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
0HARMACOGENICS IN $RUG $EVELOPMENT /NE IMMEDIATE APPLICATION OF PHARMACOGENICS OCCURS DURING THE DRUG DEVELOPMENT PROCESS 5SING TRANSLATIONAL RESEARCH lNDINGS EARLY IN THE DRUG DEVELOPMENT PROCESS TO IMPROVE A DRUGS PERFORMANCE GREATLY REDUCES OR ELIMINATES PRODUCT FAILURES LATER IN THE PROCESS WHEN COSTS ARE MUCH HIGHER 4RIALS ARE EVALUATING THE EXPENSES RELATIVE TO THE INCREMENTAL SURVIVAL ADVANTAGE TO DETERMINE WHETHER THESE NEW THERAPIES RESULT IN A NET COST BENElT )N ADDITION PHARMACOGENICS BASED TRIALS STRATIFY CLINICAL TRIAL PARTICIPANTS TO INCLUDE THOSE WHO ARE MOST LIKELY TO BENElT FROM THE DRUG AND EXCLUDE THOSE WHO PROBABLY WILL NOT 3TRATIlCATION ENABLES THESE TRIALS TO ACHIEVE MORE SPECIlC RESULTS WITH SMALLER NUMBERS OF PATIENTS FURTHER REDUCING 2$ COSTS -ORE IMPORTANTLY FOR TRIAL PARTICIPANTS AND INTERNAL REVIEW BOARDS STRATIlCATION BASED ON CORRECT BIOMARKERS MAY REDUCE OR ELIMINATE ADVERSE EVENTS;=
#LINICAL )MPROVEMENTS )N A CLINICAL SETTING PHARMACOGENICS HELPS PHYSICIANS BETTER DElNE PATIENTS LONG TERM HEALTH RISKS MORE PRECISELY DIAGNOSE THE STAGE OF A PATIENTS ILLNESS AND MORE ACCURATELY PREDICT A PATIENTS RESPONSIVENESS TO SPECIlC DRUGS OR THE LIKELIHOOD OF ADVERSE EVENTS;= #ERTAIN PATIENT GROUPS SUCH AS END STAGE RELAPSED CANCER PATIENTS COULD ESPECIALLY BENElT FROM GENOMIC MEDICINE 4HESE PATIENTS HAVE RECEIVED MULTIPLE ROUNDS OF THERAPY AND WHILE THEY HAVE PROGRESSED ON ALL OF THE STANDARD AGENTS THEY HAVE FAILED ON SECOND AND THIRD ROUND TREATMENTS "ECAUSE EFlCACY AND SIDE EFFECTS OF THE NEW APPROACHES ARE UNKNOWN THEY ARE NOT APPROPRIATE FRONT LINE TREATMENT WITH EARLY STAGE CANCER PATIENTS FOR WHOM THERE ARE EXISTING EFFECTIVE TREATMENTS EVEN IF THOSE TREATMENTS ONLY HELP A SMALL SUBSET 4HEY MUST lRST BE RESEARCHED AND TESTED ON END STAGE PATIENTS 7HEN THESE PATIENTS ARE TREATED USING A PHARMACOGENIC APPROACH AND THEIR MOLECULAR TARGETS ARE FOUND AN EXISTING APPROVED AGENT IS MATCHED WITH THE PATIENTS CANCER -ATCHING THAT AGENT TO THE MOLECULAR CONSTRUCTION OF A PATIENTS TUMOR IMPROVES THE CHANCE OF INCREASING THAT PATIENTS LENGTH OF SURVIVAL AND WELLNESS 4HIS APPROACH HAS ALREADY ACHIEVED SOME REMARKABLE RESULTS;=
4HE 4RANSLATIONAL 'ENOMICS 2ESEARCH )NSTITUTE 4HE 4RANSLATIONAL 'ENOMICS 2ESEARCH )NSTITUTE 4'EN IS A NONPROlT C ORGANIZATION FOCUSED ON DEVELOPING EARLIER DIAGNOSTICS AND SMARTER TREATMENTS FOR CANCER NEUROLOGICAL DISORDERS DIABETES AND OTHER COMPLEX DISEASES 4'ENS RESEARCH IS BASED ON PERSONALIZED MEDICINE 7ITH AN ANNUAL BUDGET OF MORE THAN MILLION THE INSTITUTE IS NEARING
EQNLãQDRD@QBGãSN ãP T@KHSX ãSQ@M RK @S H M Fã B KH M H B @ Kã K @ A ã Q D RT K S Rã H M SN ã O@S H D M S ã B @ Q D !N %XAMPLE OF 4'ENS 2ESULTS 4'ENS STRATEGY OF APPLYING GENOMIC TECHNOLOGIES TO DEVELOP PERSONALIZED THERAPIES FOR PATIENTS HAS VERY REAL RESULTS 4'EN SCIENTIST $R -ICHAEL "ERENS PARTNERING WITH PHYSICIANS AT 0HOENIX #HILDRENS (OSPITAL HELPED A YEAR OLD GIRL WITH GLIOBLASTOMA BRAIN TUMOR WHO HAD FAILED RADIATION THERAPY AND lRST LINE CHEMOTHERAPY AND HAD BEEN GIVEN ONLY SIX MONTHS TO LIVE 4'EN SCIENTISTS TESTED THE GENOMIC PROlLE OF HER TUMOR AGAINST KNOWN EFFECTIVE CHEMOTHERAPIES lNDING A POTENTIAL MATCH 4HE TEEN WAS SUCCESSFULLY TREATED RESULTING IN REMISSION OF THE ORIGINAL TUMOR
EMPLOYEES THE MAJORITY OF WHOM ARE SCIENTISTS WORKING IN HIGHLY COLLABORATIVE TEAMS ,OCATED IN 0HOENIX 4'ENS LABS ARE STAFFED WITH CROSS FUNCTIONAL TEAMS OF ENGINEERS GENETICISTS CLINICIANS BIOLOGISTS AND COMPUTER EXPERTS 4HIS INFRASTRUCTURE IS COMBINED WITH SCIENTIlC TECHNOLOGIES AND PROGRAMS ACADEMIC AND CORPORATE PARTNERSHIPS AND ENTERPRISE EFFORTS 4HE ORGANIZATION GAINS LARGE SCALE ACCESS TO EXPERTISE AND TECHNOLOGY BY PARTNERING WITH ACADEMIA GOVERNMENT AGENCIES AND CLINICAL AND CORPORATE ENTITIES IN !RIZONA AND AROUND THE WORLD "Y COLLABORATING WITH ITS CLINICAL PARTNERS 4'EN ESTABLISHES LINKS TO PATIENTS AND HEALTHCARE PROVIDERS WHO CAN BENElT FROM THE ORGANIZATIONS RESEARCH 4'ENS GOAL IS TO EMPLOY WORLD CLASS SCIENTIlC EXPERTISE AND NOVEL RESEARCH PROGRAMS TO ACCELERATE THE TRANSLATIONAL PROCESS SO GENOMIC RESEARCH DISCOVERIES CAN QUICKLY BENElT PATIENTS 4HESE hACCELERATORSv ARE DESIGNED TO QUICKLY DEVELOP THERAPEUTICS PROGNOSTICS AND DIAGNOSTICS TO DELIVER THESE DISCOVERIES TO PATIENTS AS QUICKLY AS POSSIBLE 4'ENS RESEARCH DIVISIONS ARE DESIGNED TO FOSTER A WIDE RANGE OF GENETIC DISCOVERIES 4'EN IS PARTNERING WITH PAYERS AND COMMUNITY LEADERS TO SUPERSEDE TRADITIONAL TRIAL AND ERROR BASED MEDICINE 4HE INSTI TUTE IS FOCUSED ON ESTABLISHING GENOMIC BASED TESTING CENTERS LINKED TO COMMUNITY CENTERS THEN SENDING THE INFORMATION TO PHYSICIANS TO HELP THEM TREAT THEIR PATIENTS 4'EN VIEWS THE PARTICIPATION OF COMMUNITY CENTERS AS VITAL BECAUSE ONLY ABOUT PERCENT OF CANCER PATIENTS IN THE 5NITED 3TATES ARE SEEN AT THE MAJOR COMPREHENSIVE CANCER CENTERS %IGHT PERCENT RECEIVE THEIR CANCER CARE AT COMMUNITY BASED HOSPITALS;=
3IX 'UIDELINES FOR 3UCCESS 7HEN ESTABLISHING ITS RESEARCH PROGRAM IN 0HOENIX 4'EN FOCUSED ON THE FOLLOWING GUIDELINES 2ECOGNIZE AND LEVERAGE LOCAL ADVANTAGES %VERY LOCATION HAS ITS OWN ADVANTAGES SUCH AS QUALITY OF LIFE LOW COSTS AND OR ACCESS TO A POOL OF QUALIlED EMPLOYEES 4HESE ADVANTAGES NEED TO BE IDENTIlED MARKETED AND ACQUIRED
,EADERSHIP FROM THE TOP IS KEY )N !RIZONA HAVING THE STATE AND CITYS CHIEF EXECUTIVES PERSONALLY DRIVE THE PROJECT CUT RED TAPE AND ENSURED THAT POTENTIAL SUPPORTERS PAID ATTENTION %FFECTIVE LEADERSHIP ALSO HELPED TO FACILITATE RECRUITMENT OF SCIENTISTS AND EXECUTIVES "UILD PARTNERSHIPS 'OVERNMENT BUSINESS ACADEMIC AND NONPROlT GROUPS ALL MUST JOIN TOGETHER TO ENSURE A BROAD BASE OF SUPPORT THAT TRANSCENDS ANY SINGLE GROUPS NARROW INTERESTS 4HE 4'EN BOARD WAS STRUCTURED TO HELP FOSTER THESE PARTNERSHIPS GOING FORWARD 3ECURE SUPPORT AND FUNDING FROM MULTIPLE SOURCES $IVERSE FUNDING FROM THE PUBLIC AND PRIVATE SECTORS PROVIDES STABILITY AND BROAD STAKEHOLDER INVOLVEMENT !CCURATELY IDENTIFYING FUNDING REQUIREMENTS AS WELL AS REALISTICALLY IDENTIFYING WHERE AND WHEN FUNDS WILL BECOME AVAILABLE CAN HELP STABILIZE THE INITIATIVE QUICKLY %STABLISH AN ADMINISTRATIVE INFRASTRUCTURE QUICKLY %NSURING THAT THE ADMINISTRATIVE SUPPORT ELEMENTS ARE IN PLACE INCREASES EFlCIENCY AND ENABLES RESEARCHERS TO FOCUS ON WHAT THEY DO BEST DEVELOP DISCOVERIES AND SOLUTIONS 4RANSLATIONAL RESEARCH GENERATES TREMENDOUS BENElTS 4HE NEXUS BETWEEN BASIC RESEARCH AND ITS COMMERCIAL APPLICATIONS IS TOO OFTEN NEGLECTED YET IT CAN ATTRACT PLAYERS ON BOTH SIDES CREATING A TRUE HUB OF SCIENTIlC AND BUSINESS ACTIVITY;=
4HE &UTURE OF 0HARMACOGENICS $ESPITE THE ENORMOUS POTENTIAL OF PHARMACOGENICS MANY CHALLENGES REMAIN BEFORE THESE DRUGS CAN BE IMPORTANT TREATMENTS IN THE PHYSICIANS ARMAMENTARIUM )N ADDITION TO THE lNANCIAL TECHNOLOGICAL AND OPERATIONAL HURDLES PHARMACOGENICS POSES NUMEROUS DILEMMAS INCLUDING PRIVACY AND ETHICAL ISSUES AROUND THE COLLECTION OF $.! SAMPLES IMPENDING INTELLECTUAL PROPERTY BATTLES AND THE NEED FOR NEW REGULATORY AND REIMBURSEMENT POLICIES $ISCUSSIONS ON ALL OF THESE TOPICS HAVE BEGUN WITH THE ANTICIPATION THAT THESE PROBLEMS WILL BE RESOLVED AS PROVEN PRODUCTS ENTER THE MARKET;= %NDNOTES )NTERVIEW WITH *EFFREY - 4RENT 0H$ -AY PRESIDENT AND SCIENTIlC DIRECTOR 4RANSLATIONAL 'ENOMICS 2ESEARCH )NSTITUTE h0ERSONALIZED -EDICINE 4HE %MERGING 0HARMACOGENOMICS 2EVO LUTION v 0RICEWATERHOUSE#OOPERS P )BID 53 $EPARTMENT OF %NERGY (UMAN 'ENOME 0ROJECT HTTPWWWORNL GOVSCITECHRESOURCES(UMAN?'ENOMEPROJECTABOUTSHTML )BID h0ERSONALIZED -EDICINE 4HE %MERGING 0HARMACOGENOMICS 2EVOLUTION v 0RICEWATERHOUSE#OOPERS P )BID P h4'EN 4RANSLATIONAL 2ESEARCH )NSTITUTE ! #ASE 3TUDY v 0RICEWATERHOUSE#OOPERS P h0ERSONALIZED -EDICINE 4HE %MERGING 0HARMACOGENOMICS 2EVOLUTION v 0RICEWATERHOUSE#OOPERS P
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
$RUG 3AFETY AND 0HARMACOVIGILANCE )MPROVING DRUG SAFETY AND EFFECTIVENESS WILL INCLUDE INTEGRATION OF DATA ANALYSIS AND COMMUNICATION THROUGHOUT THE DRUG LIFE CYCLE AND REQUIRE COLLABORATION FROM ALL PARTICIPANTS IN THE HEALTHCARE DELIVERY PROCESS
"Y +ATE -ALONEY AND -ICHAEL -ENTESANA 0RICEWATERHOUSE#OOPERS
!
T A #LINICAL 2ESEARCH %DUCATIONAL #ONFERENCE 3COTT 'OTTLIEB -$ THE &$!S DEPUTY COMMISSIONER FOR MEDICAL AND SCIENTIlC AFFAIRS COMMENTED THAT h%VEN WHILE WE HAVE POURED BILLIONS INTO THE SCIENCE OF DISCOVERING NEW DRUGS WE HAVE INVESTED COMPARATIVELY LITTLE IN THE SCIENCE OF HOW WE GO ABOUT ACTUALLY TESTING AND EVALUATING THOSE DRUGS FOR SAFETY AND EFFECTIVENESSv;= 4HE &$! REPORTS AN ALARMING INCREASE IN THE NUMBER OF ADVERSE EVENTS FROM PRESCRIPTION DRUGS n AN AVERAGE OF PERCENT EVERY YEAR SINCE ;= 4HIS INCREASE AND A SERIES OF WELL PUBLICIZED DRUG WITHDRAWALS HAVE MADE DRUG SAFETY A TOP PRIORITY AT PHARMACEUTICAL AND BIOTECHNOLOGY COMPANIES #OMPANIES CAN NO LONGER JUST COMPLY WITH REGULATIONS THEY MUST TAKE A PROACTIVE APPROACH TO DRUG SAFETY TO PROTECT CONSUMERS AND PROTECT THEIR BOTTOM LINE !T THE HEART OF THIS NEW APPROACH IS A PHARMACOVIGILANCE PLAN THAT STARTS IN PREMARKET CLINICAL TRIALS AND CONTINUES THROUGHOUT THE DRUG LIFE CYCLE TO CONTINUALLY MONITOR FOR SIGNALS THAT MAY INDICATE A RISK
4RANSITION FOR )MPROVEMENT $ATABASES -ANY LARGE CLINICAL TRIALS STILL USE SLOW OUTDATED DATA COLLECTION AND MANAGEMENT TECHNIQUES INCLUDING HANDWRITTEN CASE REPORT FORMS AND MANUAL DATA ENTRY ! PAPER DRIVEN DATA MANAGEMENT SYSTEM CREATES A DELAY BETWEEN THE TIME A STUDY IS PERFORMED AND THE TIME RESEARCHERS RECEIVE THE DATA FOR REVIEW "ECAUSE
OF THIS DELAY AN OPPORTUNITY TO MAKE CLINICAL TRIALS SAFER AND MORE EFFECTIVE CAN BE MISSED )N RESPONSE SOME COMPANIES ARE ESTABLISHING DATABASES THAT INTEGRATE CLINICAL TRIAL AND POST MARKETING DATA TO IDENTIFY AND ADDRESS SAFETY PROBLEMS MORE QUICKLY (OWEVER FOR SOME COMPANIES THE COST OF SUCH DATABASES IS PROHIBITIVE )N /CTOBER THE &$! ANNOUNCED THAT ITS #ENTER FOR $RUG %VALUATION AND 2ESEARCH AWARDED FOUR CONTRACTS THAT GIVE THE &$! ACCESS TO DATABASES THAT HELP THE AGENCY EVALUATE THE SAFETY OF NEW DRUGS FASTER AND MORE EFFECTIVELY 4HE DATABASES CONTAIN MEDICAL CLAIMS FROM HEALTHCARE DELIVERY AND OUTPATIENT PRESCRIPTION DRUG USE THAT CAN BE USED TO STUDY MANY DRUGS AND THEIR ADVERSE EFFECTS 4HE DATABASES ALSO HELP THE &$! QUICKLY UNCOVER RARE SIDE EFFECTS THAT BECOME EVIDENT ONLY AFTER DRUGS ARE APPROVED AND GIVEN TO THOUSANDS OR EVEN MILLIONS OF PATIENTS
2ISK-!0 4HE 2ISK -INIMIZATION !CTION 0LAN 2ISK-!0 IS DElNED BY THE &$! AS A hSTRATEGIC SAFETY PROGRAM DESIGNED TO MEET SPECIlC GOALS AND OBJECTIVES IN MINIMIZING KNOWN RISKS OF A PRODUCT WHILE PRESERVING ITS BENElTSv;= ! 2ISK-!0 IS USED FOR DRUGS ASSOCIATED WITH AN UNUSUALLY HIGH LEVEL OF RISK THAT EMERGES BEFORE OR AFTER THE DRUG IS MARKETED 4HE 2ISK-!0 LISTS THE ACTIVITIES THAT A COMPANY WILL PERFORM SUCH AS EDUCATING PHYSICIANS ABOUT THE RISKS OF USING CERTAIN DRUGS AND CREATING MATERIALS FOR PHYSICIANS TO GIVE TO PATIENTS WHEN THEY PRESCRIBE DRUGS THAT ARE KNOWN TO BE HIGHER RISK
+ATE -ALONEY 2. -3 #0(1 IS A MANAGER IN 0RICEWATERHOUSE#OOPERS 'LOBAL 0HARMACEUTICAL AND (EALTH 3CIENCES PRACTICE 3HE HELPS TO LEAD THE lRMS EFFORTS TO PROVIDE PHARMACEUTICAL BIOTECH AND MEDICAL DEVICE CLIENTS WITH GUIDANCE AND DIRECTION ON &$! REGULATIONS )#( GUIDELINES AND THE %5 DIRECTIVE COMPLIANCE RELATING TO CLINICAL TRIALS BOTH NATIONALLY AND INTERNATIONALLY 3HE ALSO LEADS THE CLINICAL PORTION OF ENTERPRISE RISK MANAGEMENT PROJECTS 3HE IS A 3IX 3IGMA 'REEN "ELT WITH OVER YEARS OF NURSING #1) RISK MANAGEMENT BUSINESS DEVELOPMENT TRAINING AND CLINICAL TRIAL EXPERIENCE IN THE HOSPITAL PHARMACEUTICAL AND )4 SECTORS 3HE CAN BE REACHED AT KATENMALONEY USPWCCOM -ICHAEL -ENTESANA LEADS THE 53 0HARMACEUTICAL AND ,IFE 3CIENCE 2$ !DVISORY PRACTICE FOR 0RICEWATERHOUSE#OOPERS (E HAS OVER YEARS OF EXPERIENCE ASSISTING ORGANIZATIONS TO IMPROVE BUSINESS PERFORMANCE BY ACHIEVING TRANSFORMATIONAL CHANGE THROUGH OPERATIONS IMPROVEMENT (IS AREAS OF SPECIALIZATION INCLUDE SENIOR MANAGEMENT DECISION SUPPORT DEMAND MANAGEMENT PORTFOLIO VISUALIZATION OPERATIONAL PLANNING AND OPERATIONAL STRATEGY DEVELOPMENT ORGANIZATION DESIGN AND PROCESS IMPROVEMENT RE ENGINEERING (E CAN BE REACHED AT MICHAELMENTESANA USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
CQ TFãR@ED S Xã @ M C ã OG @ Q L@ B N U H FH K@ M B D
@7E WANT TO SEE QUALITY TREATED AS A CRISIS A .O PRIORITY A SAFETY CULTURE FOR ALL HEALTH ORGANIZATIONS AT THE HIGHEST LEVEL n (ELEN $ARLING PRESIDENT OF THE .ATIONAL "USINESS 'ROUP ON (EALTH 0ACKAGE )NSERTS 0HYSICIANS STRIVE TO STAY INFORMED ABOUT NEW DRUGS ON THE MARKET SO THEY CAN PRESCRIBE THE RIGHT ONES FOR THEIR PATIENTS "UT INDUSTRY CRITICS BELIEVE THAT ALL TOO OFTEN PHYSICIANS DONT HAVE TIME TO REVIEW THE MOUNTAINS OF INFORMATION THEY RECEIVE ABOUT A MULTITUDE OF DRUGS !S A RESULT THEY MAY PRESCRIBE A DRUG BASED ON PATIENT DEMAND REGARDLESS OF WHETHER THAT DRUG IS THE BEST THERAPY FOR A GIVEN PATIENT -ICHAEL ,EAVITT SECRETARY OF 53 (EALTH AND (UMAN 3ERVICES CLAIMS THAT IMPROVEMENTS TO PACKAGE INSERTS n THE PRINTED INFORMATION INSIDE PRESCRIPTION DRUG PACKAGING n CAN MAKE A BIG DIFFERENCE h0ROVIDING HEALTHCARE PROFESSIONALS AND PATIENTS WITH CLEAR AND CONCISE INFORMATION ABOUT PRESCRIPTIONS WILL HELP ENSURE SAFE AND OPTIMAL USE OF DRUGS WHICH TRANSLATES INTO BETTER HEALTH OUTCOMES FOR PATIENTS AND MORE EFlCIENT DELIVERY OF HEALTHCARE "Y IMPROVING THE PACKAGE INSERT TO MAKE IT MORE USEFUL FOR HEALTHCARE PROVIDERS IN THEIR DAY TO DAY CLINICAL PRACTICE WE ARE MAKING IT EASIER FOR THEM TO EXPLAIN THE BENElTS AND RISKS OF MEDICATIONS FOR THEIR PATIENTSv;= 4HE &$! AGREES 4O REDUCE THE RISKS OF MEDICATION ERRORS THE AGENCY RECENTLY MADE MAJOR REVISIONS TO THE FORMAT OF DRUG PACKAGE INSERTS 4HE REVISIONS TO THE INSERTS n THE lRST IN YEARS n ARE INTENDED TO GIVE HEALTHCARE PROVIDERS CLEARER MORE CONCISE PRESCRIBING INFORMATION 4HE NEWLY DESIGNED INSERT WILL BE PRINTED IN AN EASY TO READ FORMAT THAT DRAWS THE ATTENTION OF PHYSICIANS AND PATIENTS TO THE MOST IMPORTANT DRUG INFORMATION 4HE INSERTS ALSO INCLUDE A SECTION WITH INFORMATION ON PATIENT COUNSELING THAT EMPHASIZES THE IMPORTANCE OF COMMUNICATION BETWEEN HEALTHCARE PROFESSIONALS AND PATIENTS
0ROBLEMS 7ITH 0OST -ARKETING 3TUDIES )N PREMARKET CLINICAL TRIALS THE &$! CONDUCTS MORE EVALUATIONS FOR SAFETY THAN EVER BEFORE (OWEVER NO AMOUNT OF PREMARKET STUDY CAN PAINT THE TOTAL PICTURE OF THE EFFECTIVENESS OF AND RISKS ASSOCIATED WITH A DRUG #LINICAL TRIALS ARE CONDUCTED WITHIN CONTROLLED CONDITIONS !LL TRIAL SUBJECTS ARE GIVEN PRECISE DOSES ON A REGIMENTED SCHEDULE AND MONITORED CLOSELY FOR ANY SIGNS OF DRUG REACTION POSITIVE OR NEGATIVE "UT OVER TIME A DRUG THAT IS SAFE AND EFFECTIVE IN A CLINICAL TRIAL MAY POSE SAFETY RISKS IN A BROADER POPULATION IN UNCONTROLLED CONDITIONS
"ECAUSE THERE ARE NO SYSTEMATIC PLANS FOR POST MARKET RESEARCH SUFlCIENT INFORMATION IS OFTEN UNAVAILABLE ON A NUMBER OF TOPICS SUCH AS THE FREQUENCY OF ADVERSE EVENTS OF MARKETED DRUGS THE EFFECTS OF LONG TERM DRUG EXPOSURE AND THE EFFECTS OF A DRUG IN SPECIAL POPULATIONS;= )N THE POST MARKETING ENVIRONMENT PHARMACEUTICAL COMPANIES CANNOT CONTROL A NUMBER OF BEHAVIORS THAT CAN LEAD TO ADVERSE EVENTS 0HYSICIANS MAY PRESCRIBE A DOSAGE THAT IS NOT RECOMMENDED BECAUSE HE OR SHE IS UNAWARE OF THE RISKS OF DOING SO 0HYSICIANS MAY PRESCRIBE A DRUG FOR NONAPPROVED USES 0ATIENTS MAY NOT COMPLY WITH THE PRESCRIBED DOSING REGIMEN 0ATIENTS MAY BE USING OTHER PRESCRIPTION DRUGS OR OVER THE COUNTER PRODUCTS THAT WERE NEVER TESTED FOR INTERACTION WITH THE PRESCRIBED DRUG AND 0ATIENTS FROM VARIOUS ETHNIC ANDOR RACIAL GROUPS MAY NOT HAVE BEEN INCLUDED IN PREMARKET CLINICAL STUDIES AND THEREFORE MAY BE AT INCREASED RISK 4HESE ARE JUST A FEW REASONS WHY POST MARKET STUDIES ARE EXTREMELY IMPORTANT !DVERSE DRUG EFFECTS THAT ARE NOT DETECTED IN PREMARKETING TRIALS ARE OFTEN FOUND THROUGH POST MARKETING TRIALS SPONTANEOUS REPORTING OF ADVERSE EVENTS OR OBSERVATIONAL STUDIES OF WIDESPREAD USE OF THE PRODUCT /NE IMPORTANT QUESTION IS WHO IS GOING TO PAY FOR THESE STUDIES 4HE LACK OF INFORMATION AVAILABLE ABOUT THE PATIENTS USING A DRUG LIMITS THE EFFECTIVENESS OF POST MARKET STUDIES /NCE A DRUG IS MARKETED THERE IS NO RELIABLE SOURCE OF INFORMATION ON THE POPULATION THAT HAS BEEN PRESCRIBED THE DRUG AND HOW TO CONTACT THEM TO GET FOLLOW UP INFORMATION 4HE (EALTH )NSURANCE 0ORTABILITY AND !CCOUNTABILITY !CT PRIVACY REGULATIONS HAVE MADE IT EVEN MORE DIFlCULT FOR PHARMACEUTICAL COMPANIES TO GET ADVERSE EVENT INFORMATION ABOUT PATIENTS FROM PHYSICIANS OR HOSPITALS 3UCH INFORMATION IS CRITICAL FOR MEANINGFUL POST MARKETING STUDIES -ED7ATCH THE &$!S SAFETY INFORMATION AND ADVERSE EVENT REPORTING PROGRAM PROVIDES CLINICAL INFORMATION ABOUT SAFETY ISSUES WITH MEDICAL PRODUCTS INCLUDING PRESCRIPTION AND OVER THE COUNTER DRUGS -ED7ATCH ALLOWS HEALTHCARE PROFESSIONALS AND CONSUMERS TO REPORT SERIOUS PROBLEMS THAT THEY SUSPECT ARE ASSOCIATED WITH THE DRUGS AND MEDICAL DEVICES THEY PRESCRIBE DISPENSE OR USE 2EPORTING CAN BE DONE ONLINE BY PHONE OR BY SUBMITTING A -ED7ATCH FORM 7HILE IT OFFERS A VALUABLE SERVICE THE -ED7ATCH FORM FOR REPORTING ADVERSE DRUG EFFECTS IS A VOLUNTARY FORM AND MOST PHYSICIANS DONT lND THE TIME TO lLL OUT THE DETAILED REPORTS "ECAUSE CLINICAL TRIALS DO NOT IDENTIFY ALL OF THE SEVERE TOXICITY IN PATIENT POPULATIONS WHO ARE NOT INCLUDED IN STUDY GROUPS AND -ED7ATCH REPORTS LACK ADEQUATE DETAIL TO DETERMINE CAUSALITY SOME HAVE CALLED FOR A NEW POST MARKETING SAFETY SURVEILLANCE SYSTEM;= $ATA ON SAFETY AND EFFECTIVENESS WHICH ARE KEY ELEMENTS CAPTURED IN PREMARKET CLINICAL TRIAL PHASES ALSO NEED TO BE LINKED
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
CQ TFãR@ED S Xã @ M C ã OG @ Q L@ B N U H FH K@ M B D WITH POST MARKET DATA TO CREATE A hCONTINUUMv OF INFORMATION THAT MAY EXPOUND ON THE MORE ELUSIVE SAFETY SIGNALS THAT APPEAR RANDOMLY OVER TIME
@7E CANNOT SOLVE TODAYS PROBLEMS WITH A TH CENTURY SOLUTION 7E NEED A PATIENT CENTERED APPROACH THAT WILL DELIVER hINDUSTRIAL STRENGTHv RATHER THAN hCRAFTSMANv LEVEL QUALITY -ARGARET % /+ANE PRESIDENT .ATIONAL #OMMITTEE FOR 1UALITY
THAT EFFORT STANDARDIZING PHARMACOVIGILANCE OPERATIONAL AND DATA MANAGEMENT ACTIVITIES WITHIN THE SAFETY ORGANIZATION AND AROUND CROSS FUNCTIONAL SAFETY TOUCH POINTS TO IMPROVE MONITORING PRACTICES MAY BE BENElCIAL ! HOLISTIC FOUNDATION FOR PHARMACOVIGILANCE SHOULD ALSO BE SUPPORTED BY RISK MANAGEMENT AND INFORMATION TECHNOLOGY 2EGULATORS n 4HE FEDERAL GOVERNMENT SHOULD CONSIDER ALLOCATING FUNDING FOR hCUTTING EDGEv TECHNOLOGY TO COLLECT DATA EFlCIENTLY REVOLUTIONIZE DATA MINING MANAGE THE BURDEN OF DRUG SAFETY WARNING SIGNALS AND ENHANCE DATA ANALYSIS STRATEGIES TO PROMOTE POSITIVE INTERVENTION RATHER THAN REACTION TO DRUG SAFETY PROBLEMS 7ITH BETTER DETECTION SYSTEMS IN PLACE REGULATORS SHOULD BE ABLE TO MONITOR EVENTS WITH A SPECIlC NEW DRUG OR CLASS OF DRUGS THAT MAY INDICATE POTENTIAL SERIOUS ADVERSE EVENTS IF NOT ADDRESSED PROMPTLY
!SSURANCE .#1!
! 0RESCRIPTION FOR THE &UTURE !LTHOUGH THE PHARMACEUTICAL AND BIOTECHNOLOGY INDUSTRIES WILL LOGICALLY LEAD THE WAY ON PHARMACOVIGILANCE IT IS NOT THEIR SOLE RESPONSIBILITY !LL PARTICIPANTS IN THE HEALTHCARE DELIVERY PROCESS n PATIENTS PHYSICIANS HOSPITAL PERSONNEL INSURERS DRUG MANUFACTURERS PHARMACISTS GOVERNMENT REGULATORS n MUST PLAY A ROLE IN PHARMACOVIGILANCE 0HYSICIANS n 4HE MEDICAL COMMUNITYS GENERAL LACK OF FAMILIARITY WITH THE ADVERSE EVENT REPORTING PROCESS IS A SIGNIlCANT HURDLE TO PHARMACOVIGILANCE EFFORTS 0HYSICIANS NEED TO BE EDUCATED ON HOW TO REPORT ADVERSE DRUG EVENTS AND BE INCENTIVIZED TO DO SO 0HARMACISTS n 4HE AMOUNT OF TRUST THAT PATIENTS PUT IN THEIR PHARMACISTS IN ADVISING THEM ON DRUG ISSUES BECAME VERY CLEAR WITH THE INTRODUCTION OF THE -EDICARE DRUG BENElT 3URVEYS SHOWED THAT SENIORS HEAVILY RELIED ON PHARMACISTS FOR ADVICE IN SELECTING A DRUG PLAN 0HARMACISTS CAN PLAY A KEY ROLE IN EDUCATING PATIENTS ABOUT DRUG RISKS AND SYMPTOMS OF WHICH TO BE AWARE $RUG MANUFACTURERS n &OR MANY COMPANIES PHARMACO VIGILANCE PROGRAMS HAVE BEEN REACTIVE RATHER THAN PROACTIVE #OMPANIES MUST DEVELOP A FRAMEWORK TO COLLECT AND ANALYZE DATA CAPTURED THROUGHOUT THE LIFE CYCLE OF A DRUG INCLUDING CLINICAL TRIAL RESEARCH AND POST MARKET INFORMATION !S PART OF
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
3UMMARY 0ROACTIVE hSAFETY SIGNALv MONITORING THROUGH THE CONTINUUM FROM CLINICAL TRIALS TO POST MARKETING AND LONG TERM SAFETY SURVEILLANCE MAY HELP PHARMACEUTICAL COMPANIES AVOID CRISIS SITUATIONS MINIMIZE THE RISK OF COSTLY STUDY SETBACKS BUSINESS INTERRUPTIONS PRODUCT WITHDRAWALS LITIGATION EXPENSES AND TARNISHED COMPANY REPUTATIONS -ORE IMPORTANTLY IT WILL IMPROVE DRUG SAFETY FOR PATIENTS (OWEVER FOR THAT TYPE OF INCLUSIVE MONITORING TO HAPPEN ALL STAKEHOLDERS NEED TO BE PROACTIVELY INVOLVED IN DRUG SAFETY %NDNOTES 3PEECH BEFORE #LINICAL 2ESEARCH %DUCATIONAL #ONFERENCE .ORTHWESTERN 5NIVERSITY -EDICAL #ENTER #HICAGO -AY REMARKS BY 3COTT 'OTTLIEB -$ DEPUTY COMMISSIONER FOR MEDICAL AND SCIENTIlC AFFAIRS HTTPWWWFDAGOVOCSPEECHESNORTHWESTERNHTML h)MPROVING 0UBLIC (EALTH 4HROUGH (UMAN $RUGS v #$%2 2EPORT TO THE .ATION !UGUST #ENTER FOR $RUG %VALUATION AND 2ESEARCH ACCESSED AT HTTPWWWFDAGOVCDERREPORTSRTNRTN HTM !PRIL h0HARMACOVIGILANCE ! .EW %RA IN $RUG 3AFETY v WWWDATAMONITOR COM $!MORE . h.EW 0ACKAGE )NSERTS !RE #LEARER v -ARCH -ED !D .EWS P 2AY 7 ! AND # - 3TEIN h2EFORM OF $RUG 2EGULATION n "EYOND AN )NDEPENDENT $RUG 3AFETY "OARD v .EW %NGLAND *OURNAL OF -EDICINE PP h0HARMACOVIGILANCE ! .EW %RA IN $RUG 3AFETY v WWWDATAMONITOR COM
"RIDGING #ARE AND 2ESEARCH 4HROUGH (EALTH )NFORMATION 4ECHNOLOGY #ONVERGENCE OF CLINICAL CARE AND CLINICAL RESEARCH ELECTRONIC INFORMATION SYSTEMS COULD BETTER SUPPORT CLINICAL RESEARCH ENABLE MORE EFlCIENT DRUG DEVELOPMENT AND OFFER SIGNIlCANT lNANCIAL BENElTS TO RESEARCHERS AND SPONSORS "Y .ICK "EARD 0RICEWATERHOUSE#OOPERS
#
LINICAL RESEARCH IS CENTRAL TO THE MISSION OF PHARMACEUTICAL COMPANIES AND MEDICAL RESEARCH CENTERS &OR BOTH TYPES OF ORGANIZATIONS CLINICAL TRIALS ARE INFORMATION INTENSIVE AND THE ASSOCIATED PROCESSES CAN BE CUMBERSOME 0HARMACEUTICAL COMPANIES AND HEALTHCARE PROVIDERS HAVE DESIGNED DIFFERENT APPROACHES TO COLLECTING PATIENT DATA ELECTRONICALLY 4HESE SYSTEMS ADDRESS THE PRIMACY OF DIRECT PATIENT CARE IN THE MISSION OF THE MEDICAL CARE CENTER AND THE RESEARCH AND COMMERCIALIZATION GOALS OF PHARMACEUTICAL COMPANIES 9ET IF THE SECTORS DEVELOPED MUTUALLY EFFECTIVE ELECTRONIC DATA SYSTEMS THEY COULD WORK MORE SYNERGISTICALLY FOR ADDED EFlCIENCIES PROlTS AND SATISFACTORY OUTCOMES IN CLINICAL RESEARCH
#LINICAL 4RIALS 2EGARDLESS OF WHETHER PATIENTS ARE PARTICIPATING IN A CLINICAL TRIAL OR IN CLINICAL CARE INDIVIDUALS GENERALLY EXPERIENCE SIMILAR INTERCHANGES WITH CLINICIANS 4HEY ARE ASKED ABOUT THEIR PROBLEMS THEIR HEALTH AND ANY SYMPTOMS THEIR VITAL STATISTICS ARE TAKEN TESTS MAY BE UNDERTAKEN AND SOMETIMES THEY ARE GIVEN A COURSE OF THERAPY 4HERE IS A SIGNIlCANT OVERLAP IN THE DATA COLLECTED IN BOTH SITUATIONS IE GENDER AGE WEIGHT BLOOD PRESSURE ETC DEPENDING ON THE PATIENTS CONDITION )N A TRIAL SPECIlC DATA MAY BE REQUIRED BEYOND THAT NORMALLY GATHERED 4HE PARTICULARS MAY VARY WIDELY BECAUSE THE OBJECTIVES DO )N CLINICAL CARE THE PRIMARY GOAL IS THE TREATMENT OF THE PATIENTS UNDERLYING PROBLEM AND IDEALLY TO MAKE THE PATIENT FEEL BETTER 0HYSICIANS PRESCRIBE THE THERAPY OR MEDICATIONS THEY BELIEVE WILL DELIVER THE MOST OPTIMAL RESULTS 4HERAPIES ARE OFTEN ADMINISTERED BY THE PATIENTS OR THEIR CARETAKERS WHO MAY OR MAY NOT DISPENSE THE PRESCRIBED AMOUNT AT THE DESIGNATED INTERVALS )NFORMATION ENTERED INTO THE MEDICAL RECORD MAY INCLUDE PRECISE DATA POINTS SUCH AS BLOOD PRESSURES OR BLOOD TEST RESULTS ALONG WITH PHYSICIANS OBSERVATIONS AND PATIENTS DESCRIPTIONS OF THEIR SYMPTOMS REACTIONS OR RESULTS WHICH MAY BE MORE SUBJECTIVE
4HE GOAL OF CLINICAL RESEARCH IS TO GENERATE STATISTICALLY SIGNIlCANT EVIDENCE THAT A THERAPY YIELDS SUITABLE BENElTS 3UCH RESEARCH TAKES SEVERAL FORMS INCLUDING PHARMACEUTICAL COMPANY SPONSORED STUDIES WITH PROSPECTIVELY DElNED END POINTS THAT FORM THE BASIS FOR DRUG APPROVAL )NVESTIGATOR INSTIGATED STUDIES MAY COMPARE THERAPIES OR EXPLORE THE EFlCACY OF A PRODUCT IN AN OFF LABEL USE )NCLUSION AND EXCLUSION CRITERIA ENSURE THAT THE SUBJECTS ARE SIMILAR TO ONE ANOTHER IN KEY WAYS )N ALMOST ALL CASES PATIENTS ARE ASSIGNED RANDOMLY TO RECEIVE ONE THERAPY OR THE OTHER AND USUALLY NEITHER THE PATIENT NOR THE RESEARCHERS KNOW WHICH THEY ARE RECEIVING 4O GENERATE VALID SCIENTIlC EVIDENCE OF EFlCACY SUCH STUDIES MUST COMPARE SPECIlC DATA POINTS TAKEN FROM EVERY SUBJECT IN THE SAME WAY
4HE 6ISION )T WILL TAKE SIGNIlCANT INVESTMENTS OF TIME FUNDING AND COMMITMENT TO BUILD AN ELECTRONIC MEDICAL RECORD %-2 SYSTEM THAT ALSO SERVES ALL CLINICAL RESEARCH NEEDS !S A STEP TOWARD THAT LONG TERM VISION ONE MODEL FOR MAKING THE TWO DATA COLLECTION APPROACHES INTEROPERABLE IS EMERGING -ULTIPLE ORGANIZATIONS AND VENDORS ARE WORKING ON AN APPROACH TO ENABLE CLINICAL TRIAL DATA COLLECTION PROGRAMS TO BE hPLUGGED INv TO THE %-2 )N THIS SCENARIO DRUG SPONSORS CONTRACTING WITH A HEALTHCARE PROVIDER TO CONDUCT A CLINICAL TRIAL WOULD PROVIDE THE STUDY PROTOCOL AND INCLUSION CRITERIA IN A FORMAT THAT COULD BE PIGGYBACKED ONTO THE %-2 7HEN PATIENTS CHECKED IN AT THEIR HEALTHCARE PROVIDER THE %-2 SYSTEM WOULD SCAN THEIR lLES AND THOSE WHO MET THE STUDY CRITERIA WOULD BE mAGGED FOR POSSIBLE INCLUSION IN THE TRIAL 3PECIlC CONSENT FORMS AND OTHER PAPERWORK WOULD BE CUED TO PRINT /NCE ENROLLED THE PATIENTS lLES WOULD AUTOMATICALLY DISPLAY THE TREATMENT PROTOCOL TO BE FOLLOWED AND THE CASE REPORT FORM TO BE COMPLETED 4HE BENElTS OF ALIGNING CLINICAL CARE AND RESEARCH RECORD KEEPING ARE SIGNIlCANT &OR THE OVERALL HEALTHCARE SYSTEM COMPATIBLE %-2S
.ICK "EARD -$ -3 IS A DIRECTOR IN THE 0RICEWATERHOUSE#OOPERS 'LOBAL 4ECHNOLOGY #ENTRE WHERE HE DIRECTS HEALTHCARE RESEARCH (E IS A PHYSICIAN WITH YEARS EXPERIENCE IN HEALTHCARE AND HEALTH )4 SPANNING SEVERAL COUNTRIES (E HAS SERVED AS A #)/ AND AS AN EXECUTIVE IN A LEADING HEALTHCARE SOFTWARE COMPANY AND IS A FREQUENT LECTURER AND SPEAKER AT VARIOUS UNIVERSITIES AND CONFERENCES (E CAN BE REACHED AT NICOLASBEARD USPWCCOM
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
AQ HCFHMFãB @QDã@MCãQDRD@QB G ã S G Q N T FG ã G D @ KS G ã H M E N Q L@S H N M ã S D B G M N KN FX AND ELECTRONIC DATA CAPTURE %$# PROGRAMS WOULD GENERATE DATA THAT COULD BE CROSS REFERENCED AND MINED TO IDENTIFY AND SUPPORT A WIDE VARIETY OF RESEARCH SAFETY EPIDEMIOLOGIC AND OTHER MISSIONS FOR BOTH THE CLINICIAN AND THE RESEARCHER &OR ACADEMIC MEDICAL CENTERS !-#S AND OTHER HEALTHCARE PROVIDERS THE EFlCIENCIES INHERENT IN USING THEIR OWN %-2S AND EVERYDAY OPERATING PROCEDURES IN THE CONDUCT OF CLINICAL TRIALS AND OTHER CLINICAL RESEARCH PROJECTS WOULD SAVE STAFF TIME REDUCE THE TRAINING REQUIRED FOR EACH SEPARATE TRIAL AND MAKE THE INSTITUTIONS MORE EFFECTIVE AND MARKETABLE AS TRIAL INVESTIGATORS &OR HEALTHCARE PROVIDERS WHICH FACE COST AND REIMBURSEMENT PRESSURES SUCH ADDED EFlCIENCIES ARE VITAL #ONDUCTING CLINICAL TRIALS CAN GENERATE REVENUES AND HELP FULlLL THE RESEARCH ORGANIZATIONS MISSION WHILE RAISING ITS PROlLE WITHIN THE MEDICAL AND SCIENTIlC COMMUNITIES &URTHER STREAMLINED AND COMPATIBLE DATA COLLECTION SYSTEMS WOULD HELP ENSURE COMPLIANCE WITH THE (EALTH )NSURANCE 0ORTABILITY AND !CCOUNTABILITY !CT )NSTITUTIONAL 2EVIEW "OARD REQUIREMENTS INTERNAL OPERATING PROCEDURES AND OTHER GUIDANCE
@7E HAVE A CULTURE IN HEALTHCARE OF NOT LOOKING AT OURSELVES AS A DATA DRIVEN BUSINESS EXCEPT FOR lNANCIAL DATA 7E DONT HAVE A LOGISTICAL CLINICAL OR EPI DEMIOLOGICAL NATIONAL DATABASE n #HRISTINE + #ASSEL PRESIDENT AND #%/ !MERICAN "OARD OF )NTERNAL -EDICINE 0HARMACEUTICAL AND LIFE SCIENCES COMPANIES ALSO WOULD BENElT FROM COMPATIBLE %-2%$# PROGRAMS "Y CONNECTING CLINICAL DATA CAPTURE WITH THE INVESTIGATORS MEDICAL PRACTICE THE COMPANIES AND THEIR INVESTIGATORS COULD MORE EASILY IDENTIFY POTENTIAL TRIAL PARTICIPANTS *UST KNOWING WITH WHICH PATIENTS TO DISCUSS POSSIBLE TRIAL PARTICIPATION IS A SUBSTANTIAL STEP TOWARD COMPLETING ENROLLMENT ! STUDY OF NEARLY CANCER PATIENTS FOUND THAT EIGHT OUT OF EVERY PATIENTS WERE UNAWARE OF THE OPTION TO PARTICIPATE IN CLINICAL TRIALS /F THOSE PERCENT SAID THAT IF THEY HAD KNOWN ABOUT CLINICAL TRIALS THEY WOULD HAVE BEEN SOMEWHAT OR VERY RECEPTIVE TO PARTICIPATE;= 5SING THE %-2 TO COLLECT CLINICAL TRIAL DATA WOULD BE BENElCIAL IN MAKING POTENTIAL SUBJECT SCREENING MORE EFlCIENT AND COMPREHENSIVE &URTHER PARTICIPATION IN THE CLINICAL TRIAL WOULD MIRROR SUBJECTS REGULAR CARE MAKING IT MORE LIKELY THAT THEY WOULD COMPLETE THE STUDY 4HE DROPOUT RATE OF CLINICAL TRIAL PATIENTS IS ESTIMATED TO AVERAGE ABOUT PERCENT PER TRIAL;= !LTHOUGH REASONS FOR PATIENTS WITHDRAWING FROM STUDIES INCLUDE DEATH ADVERSE REACTIONS UNPLEASANT STUDY PROCEDURES LACK OF IMPROVEMENT EARLY RECOVERY AND OTHER FACTORS RELATED OR UNRELATED TO TRIAL PROCEDURE AND TREATMENTS ;= EFFORTS TO MAKE THE TESTING ROUTINE WOULD BE BENElCIAL "Y MAKING THE
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
CLINICAL TRIALS LESS DISRUPTIVE DRUG SPONSORS WOULD SEE HIGHER PARTICIPATION AND REPEAT RATES AMONG PATIENTS AND INVESTIGATORS -ANY INVESTIGATORS PARTICIPATE IN ONE CLINICAL TRIAL AND ELECT NOT TO REPEAT THE EXPERIENCE;= 4RIAL SPONSORS ALSO MAY REALIZE MONETARY SAVINGS OF NO LONGER PROVIDING COMPUTERS AND RELATED HARDWARE TO INVESTIGATIVE SITES FOR EACH TRIAL !DDING SOFTWARE CAPABILITIES THAT PROVIDE EXTENSIONS TO THE %-2 AND AVOIDING DUPLICATING SIGNIlCANT ELEMENTS OF INFORMATION CAPTURE WOULD NOT BE WITHOUT COST BUT THE OVERALL COSTS SHOULD BE LOWER 4HE EFlCIENCIES ALSO TRANSLATE INTO QUICKER ASSEMBLY AND EVALUATION OF DATA SUBMITTALS TO REGULATORS FOR MARKET APPROVAL OF NEW PHARMACEUTICALS OR NEW USES FOR EXISTING PRODUCTS %LECTRONIC CAPTURE OF CLINICAL RESEARCH DATA BUILDS IN QUALITY CONTROL MECHANISMS &OR EXAMPLE lELDS IN THE SYSTEM CAN BE SET UP TO EXPECT CERTAIN DATA RANGES WHEN OUTLYING DATA IS ENTERED THE COMPUTER QUERIES IMMEDIATELY 4HIS CONTRASTS THE NONAUTOMATED SYSTEMS IN WHICH TRIAL MONITORS ARE CHARGED WITH lNDING SUCH MISTAKES AND INITIATING QUERIES TO DETERMINE THE ACTUAL VALUES 3UCH FOLLOW UP IS TIME CONSUMING AND CAN BE COSTLY %STIMATES RANGE FROM TO PER QUERY;= !S IMPORTANT TO TRIAL SPONSORS WOULD BE THE REAL TIME TRACKING OF TRIAL ENROLLMENT AND THE EARLIER IDENTIlCATION OF UNEXPECTED SIDE EFFECTS OR FAILURES OF CANDIDATE PRODUCTS "EYOND DIVERTING FUNDS TO MORE PROMISING PROJECTS EARLY TERMINATION OF UNSUCCESSFUL TESTING ADDS A LAYER OF SAFETY TO THE CLINICAL TRIAL PROCESS WHILE ENHANCING THE AVAILABLE SCIENTIlC KNOWLEDGE FOR DRUG DEVELOPERS AND MEDICAL RESEARCHERS 4HE QUALITY ADVANTAGES FOR PATIENTS AND RESEARCH SUBJECTS WILL COME VIA LESS DISRUPTIVE AND SAFER CLINICAL TRIAL PARTICIPATION AND IN THE LONGER TERM WITH BETTER AND SAFER PRODUCTS MORE COMPREHENSIVE SAFETY MONITORING AND MORE RELIABLE OUTCOME COMPARISONS
4HE #HALLENGE (EALTHCARE PROVIDERS AND MEDICAL RESEARCHERS AND THE SEPARATE SOFTWARE INDUSTRIES SERVING THEM HAVE DEVELOPED QUITE DIFFERENT SYSTEMS TO MEET THEIR RESPECTIVE NEEDS 4HE MAJORITY OF HEALTHCARE PROVIDERS HAVE IMPLEMENTED SYSTEMS TO SUPPORT BASIC ADMINISTRATIVE AND BILLING PROCESSES 4HOSE THAT HAVE ELECTRONIC MEDICAL RECORDS ESTIMATED TO BE TO PERCENT ;= IMPLEMENTED THEM PRIMARILY TO FACILITATE CLINICAL CARE 4HE USER INTERFACES THEY OFFER AND THE STANDARDS AND CODING SYSTEMS THEY SUPPORT ARE RARELY SELECTED WITH CLINICAL RESEARCH IN MIND %VEN IN HEALTHCARE PROVIDERS AND !-#S WHERE RESEARCH IS A KEY MISSION THE ABILITY OF THE %-2 TO TRULY SUPPORT RESEARCH DATA COLLECTION IS NOT ALWAYS TAKEN INTO ACCOUNT AT ITS PURCHASE !MONG PHARMACEUTICAL COMPANIES THE LEVEL OF INTEREST IN IMPLEMENTING %$# SYSTEMS IS HIGH AND A NUMBER ARE REPORTEDLY REALIZING UP TO AN PERCENT COST REDUCTION IN CLINICAL TRIAL COSTS WHEN USING %$# INSTEAD OF PAPER REPORTING ! SAVINGS OF TO PERCENT IS REALIZED THROUGH CUTS TO THE TRADITIONAL MONITORING AND DOUBLE DATA ENTRY FUNCTIONS ALONE;=
AQ HCFHMFãB @QDã@MCãQDRD@QB G ã S G Q N T FG ã G D @ KS G ã H M E N Q L@S H N M ã S D B G M N KN FX -OST TRIAL SPONSORS WHO HAVE CREATED %$# SYSTEMS HAVE DESIGNED SYSTEMS PROPRIETARY TO THEIR ORGANIZATIONS %VERY TRIAL MAY HAVE AN %$# SYSTEM CUSTOMIZED FOR ITS PARTICULAR PROTOCOL AND DATA REQUIREMENTS 4HESE TAILORED SYSTEMS SERVE IN PART TO HELP PROTECT THE COMPANYS INTELLECTUAL PROPERTY AND ITS HIGHLY SENSITIVE AND VALUABLE CLINICAL TRIAL DATA 4HUS CONVERGED DATA APPROACHES WILL HAVE TO INCLUDE ROBUST SECURITY FOR CLINICAL TRIAL DATA WITHIN THE %-2 !NOTHER CHALLENGE FOR CLINICAL TRIAL SPONSORS IN THIS ARENA IS THAT THE RATE OF %-2 UPTAKE VARIES WIDELY AMONG DIFFERENT COUNTRIES #LINICAL TRIALS ARE FREQUENTLY INTERNATIONAL UNDERTAKINGS AND SLOW UPTAKE OF %-2S IN KEY MARKETS COULD SLOW THE PHARMACEUTICAL INDUSTRYS ADOPTION OF INTEROPERABLE SYSTEMS SINCE THE BENElTS ASSOCIATED WITH CONVERGENCE OF %-2 AND %$# SYSTEMS MAY BE DILUTED IF ONLY PART OF A MULTINATIONAL TRIAL CAN BE ACCELERATED
4HE $RIVERS $ESPITE THE CHALLENGES AND THE DISPARATE NEEDS AND DIFFERENT ADOPTION RATES FOR CONVERGENCE AMONG PHARMACEUTICAL COMPANIES AND HEALTHCARE PROVIDERS PROGRESS IS BEING MADE &IRST ALL OF THE PLAYERS HAVE lNANCIAL INCENTIVES TO STREAMLINE AND OPTIMIZE THEIR DATA COLLECTION SYSTEMS &OR INVESTIGATORS SPONSORED CLINICAL TRIALS PROVIDE ESSENTIAL REVENUE AND INDEPENDENT STUDIES YIELD AUTHORITY AND PRESTIGE THAT SUPPORTS THEIR RESEARCH MISSIONS 4HE PHARMACEUTICAL INDUSTRY IS UNDER PRESSURE FROM ITS INVESTORS REGULATORS AND CUSTOMERS TO DEVELOP MORE AND BETTER DRUGS AND TO ENSURE PRODUCT SAFETY !CCESSIBLE USABLE AND hMINE ABLEv DATA PLAY A KEY ROLE TOWARD THOSE GOALS #ONVERGENCE OF REQUIREMENTS AND TECHNOLOGY TO SUPPORT THEM COULD OCCUR AS PART OF THE CONTINUING CONSOLIDATION OF THE HEALTHCARE INFORMATION TECHNOLOGY INDUSTRY !LTERNATIVELY INTEROPERABLE DATA SYSTEMS MAY RESULT FROM EMERGING TECHNOLOGY DEVELOPMENTS SUCH AS SERVICES ORIENTED ARCHITECTURES WHICH FACILITATE SIGNIlCANT IMPROVEMENTS IN HOW INFORMATION SYSTEMS CAN FUNCTION IN CONCERT 3UCH DEVELOPMENTS COULD ALSO DELIVER NEW EFlCIENCIES AND OPEN NEW MARKETS FOR ANCILLARY PLAYERS IN THE MEDICAL RESEARCH ARENA 4HESE INCLUDE SOFTWARE DEVELOPERS CURRENTLY CATERING TO SPONSORS OF CLINICAL TRIALS OR TO HEALTHCARE PROVIDERS 7HILE PILOT STUDIES AND DEVELOPMENT PROGRAMS HAVE BEEN ANNOUNCED CURRENTLY NO COMPANY TRULY BRIDGES THE NEEDS OF RESEARCHERS AND CLINICIANS IN AN INTEGRATED SOLUTION !S HEALTHCARE PROVIDERS AND MEDICAL RESEARCHERS CONCENTRATE ON MEETING THEIR IMMEDIATE RESPONSIBILITIES A NUMBER OF ORGANIZATIONS ARE WORKING TOWARD MAKING THE SHARING OF ELECTRONIC MEDICAL DATA REGARDLESS OF SOURCE POSSIBLE !MONG THEM ARE TWO IMPORTANT STANDARDS BODIES (EALTH ,EVEL 3EVEN AN )NTERNATIONAL /RGANIZATION FOR 3TANDARDIZATION WHICH STUDIES STANDARDS FOR HEALTHCARE DATA MANAGEMENT AND THE #LINICAL $ATA )NTERCHANGE 3TANDARDS #ONSORTIUM A USER AND VENDOR GROUP;=
"OTH GROUPS ARE FOCUSED ON ESTABLISHING THE FOUNDATIONS ON WHICH INTEROPERABLE DATA SYSTEMS WILL RUN;=
.EAR 4ERM 3TEPS 4HE COMPONENTS OF INTEROPERABLE MEDICAL CARE AND RESEARCH DATA ARE IN PLACE AND SLOWLY GAINING MOMENTUM 4HE FULCRUM TO BE LEVERAGED IS THE POINT OF HEALTHCARE DELIVERY THE ACADEMIC MEDICAL CENTERS HOSPITALS AND LARGE PHYSICIAN PRACTICES THAT CONDUCT RESEARCH AS WELL AS TREAT PATIENTS !S THESE ORGANIZATIONS IMPLEMENT MORE ADVANCED CLINICAL SYSTEMS THEY SHOULD SEIZE THE OPPORTUNITY AND DEMAND RESEARCH SUPPORT FUNCTIONS IN THE PRODUCTS THEY DEPLOY 4HEY SHOULD INSIST THAT SOFTWARE VENDORS INCORPORATE RESEARCH COMPONENTS THAT WILL FOR EXAMPLE AUTOMATICALLY IDENTIFY TRIAL SUBJECTS AND MEET THE STRINGENT INFORMATION MANAGEMENT REQUIREMENTS OF CLINICAL TRIALS )NVESTIGATORS SHOULD BEGIN NEGOTIATING USE OF THEIR %-2S IN SPONSORED TRIALS "RIDGING THE TECHNICAL PROCEDURAL AND OPERATIONAL DIVISIONS BETWEEN CLINICAL RESEARCH AND CLINICAL CARE RECORD KEEPING COULD YIELD SIGNIlCANT EFlCIENCIES AND lNANCIAL BENElTS IN DRUG DEVELOPMENT AND OTHER CLINICAL RESEARCH !S !-#S AND OTHER HEALTHCARE PROVIDERS DEPLOY ELECTRONIC INFORMATION SYSTEMS THEY WOULD BENElT BY lNDING WAYS FOR THOSE SYSTEMS TO ACCOMMODATE BOTH CLINICAL CARE AND CLINICAL RESEARCH DATA %NDNOTES h$OCTORS 0ATIENTS &ACE $IFFERENT "ARRIERS TO #LINICAL 4RIALS v .ATIONAL #ANCER )NSTITUTE POSTED !PRIL REVIEWED BY .#) *ANUARY HTTP WWWCANCERGOVCLINICALTRIALSDEVELOPMENTSDOCTORS BARRIERS (YNES 4 h,ETS "RING THE 4RIAL TO THE 3UBJECTv !PPLIED #LINICAL 4RIALS *ULY ACCESSED AT HTTPWWWACTMAGAZINECOMAPPLIEDCLINICALTRIALSARTICLEARTICLE$ETAIL JSP ID 3HIH 7 * h0ROBLEMS IN $EALING WITH -ISSING $ATA AND )NFORMATIVE #ENSORING IN #LINICAL 4RIALS v #URR #ONTROL 4RIALS #ARDIOVASC -ED P 5EHLING - h(OVDE 2EPORT 7HEN )T 0AYS TO /UTSOURCE THE /UTSOURCERSv .OVEMBER ")/ )4 7ORLDE#LINIQUA ACCESSED AT HTTPWWWBIO ITWORLDCOMARCHIVEECLINICAHTML %LLIS , $ h!CHIEVING #OST 3AVINGS 5SING %$# %FFECTIVELY v 2ESEARCH $YNAMICS #ONSULTING 'ROUP ,TD .OVEMBER ACCESSED AT HTTPWWWCLICKlNDCOM2$#' PERCENT%$# PERCENTPAPER PERCENT#,)#+&).$ PERCENT PERCENT&).!,PDF AND 0HASE&ORWARD h0'0S 0ROGRESSIVE E#LINICAL )NTEGRATION v ADAPTED FROM 0ROCTER 'AMBLE 0HARMACEUTICALS "EST 0RACTICES ENTRY TO "IO )4 7ORLD -ARCH ACCESSED AT HTTPWWWPHASEFORWARDCOMNEWSMEDIA HTM &ONKYCH + AND 4AYLOR 2 h4HE 3TATE AND 0ATTERN OF (EALTH )NFORMATION 4ECHNOLOGY !DOPTION v 2!.$ (EALTH -ULLIN 2 h$RUG &IRMS 'OVERNMENT 3EEK )4 3TANDARDS FOR #LINICAL $ATA v #HEMICAL %NGINEERING .EWS &EBRUARY ACCESSED AT HTTPPUBSACSORGCENCOVERSTORYPHARMAHTML 3TAKEHOLDER COMPENDIUM FOR 5NIVERSITY OF 0ITTSBURGH #ANCER #ENTER CA")' #4-3 n $EVELOPER STATEMENT OF WORK 50#) #4-3 STAKEHOLDER COMPENDIUM $ECEMBER VOL ACCESSED AT CABIGCVSNCI NIHGOVVIEWCVSVIEWCVSCGISTRUCTUREDPROTOCAL
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
)MPORTANT .EXT 3TEPS FOR !CHIEVING THE 6ISION 4HE FUTURE OF 53 HEALTHCARE WILL BE DETERMINED BY OUR NATIONAL APPROACH TO INSURANCE COVERAGE QUALITY STANDARDS PRACTITIONER EDUCATION PATIENT ACTIVATION AND THE lNANCING OF QUALITY INFRASTRUCTURE "Y 3TEPHEN # 3CHOENBAUM +AREN $AVIS AND !NNE -ARIE * !UDET
(
EALTHCARE FOR !MERICANS CAN BE SIGNIlCANTLY BETTER IN THE FUTURE THAN IT HAS BEEN IN THE PAST ! NUMBER OF INDIVIDUALS AND ORGANIZATIONS ARE RESPONDING TO THE CHALLENGE OF ENVISIONING A HEALTH SYSTEM WORTHY OF THE TWENTY lRST CENTURY 7HILE THERE IS A MAJOR LEAP FROM IDEAS TO ACTION THERE ARE PROMISING SIGNS ON THE HORIZON )N 4HE #OMMONWEALTH &UND PUBLISHED h! 6ISION FOR !MERICAN (EALTH #AREv )TS COMPONENTS INCLUDED AUTOMATIC AND AFFORDABLE HEALTH INSURANCE COVERAGE FOR ALL ACCESS TO HEALTHCARE FOR ALL PATIENT RESPONSIVE HEALTHCARE INFORMATION DRIVEN HEALTHCARE INCLUDING CARE THAT IS BASED ON SCIENTIlC EVIDENCE AND SUPPORTED BY CLINICAL INFORMATION SYSTEMS AND A COMMITMENT BY EACH PROVIDER OF HEALTHCARE AND PROVIDER ORGANIZATION TO CONTINUOUS IMPROVEMENT OF CARE AND TO BETTERMENT OF HEALTH OUTCOMES;= 3INCE THEN TWO COMPONENTS OF THE VISION HAVE BEEN ADDED n HAVING A SATISlED HEALTHCARE WORKFORCE AND A WILLINGNESS TO LEARN FROM AND SHARE LESSONS WITH OTHER COUNTRIES SO THAT !MERICAN HEALTHCARE CAN CROSS THE QUALITY CHASM !LTHOUGH THE 5NITED 3TATES IS FAR FROM ACHIEVING THIS VISION WE BELIEVE IT IS POSSIBLE TO ACHIEVE &OR EACH COMPONENT WE HAVE NOT ONLY POINTED OUT THE CURRENT PROBLEMS BUT ALSO EXAMPLES OF POSITIVE WORK OR POSSIBILITIES FOR CHANGE 4HERE ARE A RELATIVE HANDFUL OF CHANGES THAT MUST OCCUR IF THE VISION IS TO BE ACHIEVED PARTICULARLY BY 4HESE INCLUDE A MORE PROACTIVE STANCE TO HEALTH INSURANCE COVERAGE BY THE FEDERAL GOVERNMENT OR FAILING THAT BY MORE STATE GOVERNMENTS A MORE PROACTIVE STANCE TO IMPROVEMENT OF QUALITY OF CARE BY THE FEDERAL GOVERNMENT SERIOUS CHANGES IN THE EDUCATION OF ALL HEALTH PROFESSIONALS ACTIVATION OF PATIENTS TO UNDERSTAND THAT THEY CAN RECEIVE AND MUST DEMAND CONSIDERABLY BETTER CARE n CARE THAT IS SAFER MORE EFFECTIVE MORE EFlCIENT MORE TIMELY MORE EQUITABLE AND BETTER DESIGNED AROUND THE NEEDS OF CONSUMERS NOT PROVIDERS AND ALL PAYER COALITIONS ARE NEEDED TO SUPPORT THE lNANCING OF QUALITY IMPROVEMENT ACTIVITIES AT LEAST IN THE SHORT RUN ! MORE PROACTIVE STANCE TO HEALTH INSURANCE COVERAGE BY THE FEDERAL GOVERNMENT OR FAILING THAT BY MORE STATE GOVERNMENTS IS THE ONLY WAY ALL !MERICANS WILL HAVE INSURANCE COVERAGE 4HERE ARE NOW SEVERAL STATES WITH RELATIVELY LOW RATES OF UNINSURANCE OWING TO VARIOUS TYPES OF STATE SPECIlC LEGISLATION 3TATES OFFER AN IMPORTANT OPPORTUNITY
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
TO EXPERIMENT WITH DIFFERENT APPROACHES TO COVERING THE ENTIRE POPULATION AND GATHER DATA ON THE PLUSES AND MINUSES OF THESE VARIOUS APPROACHES !S PREVIOUSLY INDICATED WE BELIEVE THERE IS ALREADY SUFlCIENT INFORMATION TO DESIGN FEDERAL LEGISLATION THAT WOULD EITHER GUARANTEE COVERAGE FOR ALL !MERICANS OR WOULD REQUIRE ALL STATES TO DEVELOP APPROPRIATE STATE SPECIlC APPROACHES -ISSING AT THIS WRITING IS A MANDATE FROM THE !MERICAN PEOPLE TO EMBOLDEN #ONGRESS TO ENACT AND THE PRESIDENT TO SIGN SUCH LEGISLATION ! MORE PROACTIVE STANCE TO IMPROVEMENT OF QUALITY OF CARE BY THE FEDERAL GOVERNMENT IS ESSENTIAL TO PUT SOME ORDER INTO THE CHAOS OF THE !MERICAN HEALTHCARE SYSTEM OR hNONSYSTEMv AS SOME CONSIDER IT TO BE 4HERE ARE MANY THINGS THAT THE FEDERAL GOVERNMENT COULD AND MUST DO n AND SOME ARE BEGINNING TO BE DONE 7E BELIEVE THESE INCLUDE DEVELOPING A DEDICATED FEDERAL AGENCY FOR SETTING OF NATIONAL PRIORITIES FOR IMPROVEMENT DEVELOPMENT OR RATIlCATION OF CLINICAL GUIDELINES PERFORMANCE MEASURES AND STANDARDS OF CARE LEADING INITIATIVES FOR PUBLIC REPORTING OF PERFORMANCE FURTHER SUPPORT FOR THE DEVELOPMENT AND ADOPTION OF CLINICAL INFORMATION TECHNOLOGY DEVELOPING THE CAPABILITY TO PROVIDE TECHNICAL ASSISTANCE IN QUALITY IMPROVEMENT TO ALL PARTS OF THE HEALTHCARE SYSTEM HEADING THE EFFORT TO ALIGN INCENTIVES SO THAT QUALITY IMPROVEMENT IS STIMULATED AND REWARDED AND FUNDING KEY DEMONSTRATION PROJECTS THAT EXPLORE NEW WAYS OF COORDINATING CARE AND PAYING FOR IMPROVED CARE;= 3ERIOUS CHANGES IN THE EDUCATION OF ALL HEALTH PROFESSIONALS ARE ESSENTIAL BUT THIS WILL REQUIRE A CHANGE IN ACADEMIAS APPROACH TO QUALITY IMPROVEMENT *UST AS IN THE LATE NINETEENTH CENTURY WITH THE OPENING OF *OHNS (OPKINS MEDICAL SCHOOL MEDICAL EDUCATION BEGAN TO BE MORE SCIENTIlC A PROCESS THAT ACCELERATED IN THE EARLY TWENTIETH CENTURY THANKS TO THE &LEXNER 2EPORT THAT HIGHLIGHTED THE POOR SCIENTIlC QUALITY OF MOST SCHOOLS NOW MEDICAL EDUCATION AND THE EDUCATION OF OTHER HEALTH PROFESSIONALS MUST BECOME ORIENTED TO PUTTING THE PATIENTPERSON AND HIS HER HEALTH AND NOT THE SCIENTIlC ASPECTS OF DISEASE AT THE CENTER OF THE UNIVERSE !CADEMIC HEALTH CENTERS MUST BECOME LEADERS IN PATIENT CENTERED CARE AND QUALITY IMPROVEMENT 4HE !#'-%S COMPETENCIES SEEM TO BE THE CATALYST FOR THIS
HLONQ S@MSãMDWS ã RS D ORã E N Q ã @ B G H D U H M Fã S G D ã U H RH N M CHANGE AND COULD SERVE AS THE TWENTY lRST CENTURY EQUIVALENT OF THE &LEXNER 2EPORT !CTIVATION OF PATIENTS TO UNDERSTAND THAT THEY CAN RECEIVE AND MUST DEMAND CONSIDERABLY BETTER CARE n CARE THAT IS SAFER MORE EFFECTIVE MORE EFlCIENT MORE TIMELY MORE EQUITABLE AND BETTER DESIGNED AROUND THE NEEDS OF CONSUMERS NOT PROVIDERS 4HIS IS EASIER SAID THAN DONE &OR THE MOST PART CONSUMERSPATIENTS ARE NOT ORGANIZED AS A LOBBY IN THE 5NITED 3TATES AND UNFORTUNATELY HAVE DEPENDED ON THE CHAOTIC HEALTHCARE SYSTEM TO GIVE THEM hTHE BEST CARE IN THE WORLDv 0UBLIC CONCERN ABOUT QUALITY OF CARE IN THE 5NITED +INGDOM HAS LED TO THE PUBLICS WILLINGNESS INDEED DEMAND TO EXPEND MORE NATIONAL RESOURCES ON HEALTH 4HIS IS ANOTHER LESSON FROM ABROAD THAT THE 5NITED 3TATES COULD PROlT FROM IMPORTING 0UBLIC ACTIVATION IS LIKELY TO COME IN RESPONSE TO PROBLEMS HIGHLIGHTED IN THE MEDIA OR BY POLITICIANS WHO ARE LEADERS NOT MERE REACTORS 4HE MORE INFORMATION THE PUBLIC RECEIVES THE MORE LIKELY CONSUMERS WILL BECOME ACTIVISTS !CCORDINGLY WE STRONGLY FAVOR PUBLIC REPORTING OF INFORMATION ABOUT QUALITY OF CARE !LL PAYER COALITIONS ARE NEEDED TO SUPPORT THE lNANCING OF QUALITY IMPROVEMENT ACTIVITIES AT LEAST IN THE SHORT RUN 5LTIMATELY ALL QUALITY IMPROVEMENT ACTIVITIES SHOULD EITHER BENElT PROVIDERS BY BEING MORE EFlCIENT OR YIELDING PERFORMANCE BASED PAYMENTS OR BENElT SOCIETY AS A WHOLE BY CREATING A HEALTHIER MORE PRODUCTIVE COUNTRY )NITIALLY ADOPTION
OF INFORMATION TECHNOLOGY AND TRAINING THE WORKFORCE IN QUALITY IMPROVEMENT METHODS ARE LIKELY TO BE SEEN AS NET EXPENDITURES BY THOSE WHO MUST INVEST IN AND IMPLEMENT THEM 4HE FEDERAL GOVERNMENT AS THE SINGLE LARGEST PAYER FOR HEALTHCARE IN THE 5NITED 3TATES CAN TAKE THE LEAD BUT IDEALLY WOULD BRING TOGETHER ALL PAYERS SO THAT THERE IS BROAD BASED lNANCIAL SUPPORT FOR CREATING RAPID CHANGE IN THE HEALTHCARE DELIVERY SYSTEM 4HE hPERFECT STORMv IS KNOWN TO HAPPEN AND CAUSE UNSPEAKABLE DISASTERS 7E BELIEVE THE TIME IS RIPE FOR THE hPERFECT OPPORTUNITYv )T IS APPROPRIATE TO BE HOPEFUL THAT WE ARE REACHING A TIPPING POINT -AJOR PROGRESS IN THE lVE AREAS OUTLINED WOULD ALLOW THE VISION TO BE ACHIEVED 4HIS WOULD PRODUCE A VASTLY IMPROVED HEALTHCARE SYSTEM FOR ALL !MERICANS AND A HEALTHIER AND MORE PRODUCTIVE COUNTRY 4HIS PAPER WAS EXCERPTED FROM 3TEPHEN # 3CHOENBAUM +AREN $AVIS !NNE -ARIE * !UDETS h6ISIONS OF THE &UTURE v IN $AVID " .ASH AND .EIL * 'OLDFARBS 4HE 1UALITY 3OLUTION *ONES AND "ARTLETT 0UBLISHERS 3UDBURY -ASS WWWJBPUBCOM 2EPRINTED WITH PERMISSION %NDNOTES $AVIS + AND # 3CHOEN 3# 3CHOENBAUM h! 6ISION FOR !MERICAN (EALTH #ARE v !RCHIVES OF )NTERNAL -EDICINE PP 3CHOENBAUM 3# AND ! - !UDET + $AVIS h/BTAINING 'REATER 6ALUE FROM (EALTHCARE 4HE 2OLES OF THE 53 'OVERNMENT (EALTH !FFAIRS PP
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
,OOKING "ACK -OVING &ORWARD 2EmECTIONS ON THE 1UALITY #ONUNDRUM BY 0ROFESSORS $ON "ERWICK )NSTITUTE FOR (EALTHCARE )MPROVEMENT 2ICHARD 'ROL 2ADBOUD 5NIVERSITY .IJMEGEN !CHIEVING LONG TERM IMPROVEMENTS IN QUALITY HEALTHCARE WILL REQUIRE COMMITMENT TO PRIMARY CARE CONSISTENT POLICY IMPLEMENTATION AND AN UNWAVERING FOCUS ON THE PATIENT
"Y 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
(
OSPITALS PHYSICIANS HEALTH PLANS PHARMACEUTICAL MANUFACTURERS EMPLOYERS GOVERNMENTS AND PATIENTS ALL WANT QUALITY 9ET AS ADDRESSED THROUGHOUT THIS BOOK ACHIEVING QUALITY REQUIRES CHANGES IN THE WAY HEALTH SERVICES AND TREATMENTS ARE DEVELOPED PROVIDED MEASURED AND lNANCED #HANGE IS DIFlCULT (OWEVER IT IS MADE EASIER WHEN LEADERS ARE WILLING TO PUSH THE ENVELOPE EXPOSE THE MYTHS AND OFFER PRACTICAL SOLUTIONS 4WO SUCH LEADERS ARE AN !MERICAN PHYSICIAN $ONALD "ERWICK -$ AND A $UTCH RESEARCHER 2ICHARD 'ROL 0H$ "OTH HAVE ACHIEVED INTERNATIONAL STATURE AS STATESMEN FOR QUALITY SEE SIDEBAR )N THE FACE OF DEPRESSING STATISTICS ABOUT MEDICAL ERRORS AND THE LACK OF APPROPRIATE CARE "ERWICK AND 'ROL HAVE BEEN LUMINARIES ADVOCATING A RESEARCH BASED APPROACH TO SOLUTIONS 4HEIR IDEAS ARE OFTEN REVOLUTIONARY &OR THIS lNAL CHAPTER WE TALKED WITH THEM EXAMINED THEIR WORK AND ANALYZED HOW THE INDUSTRY CAN LEARN FROM THEM TODAY 4HROUGHOUT THE CONVERSATIONS EACH HAD AN OVERARCHING COMMENT "ERWICK SPOKE OF THE NEED FOR THE INDUSTRY TO REMEMBER THAT BEHIND EVERY QUALITY PROBLEM IS A HUMAN TALE (EALTHCARE IS A PEOPLE BUSINESS INVOLVING AND AFFECTING THOSE WHO RECEIVE AND DELIVER CARE 'ROL ON THE OTHER HAND ADVOCATED A NEED FOR CONSISTENCY )MPROVEMENT IN HEALTHCARE CAN ONLY BE ACHIEVED THROUGH STEP BY STEP CONSISTENT APPROACHES AND POLICIES 0OLICY MAKERS NEED TO GUARANTEE CONSISTENCY IN POLICIES BUDGETS AND LEADERSHIP
)NVEST IN 0RIMARY #ARE "ERWICK HAS FREQUENTLY MENTIONED THAT THE lDELITY OF THE COST QUALITY LINK IS QUESTIONABLE 4HE GROUNDBREAKING WORK OF 3IR "RIAN
*ARMAN PROFESSOR EMERITUS OF PRIMARY HEALTHCARE AT )MPERIAL #OLLEGE 3CHOOL OF -EDICINE IN ,ONDON AND )() SENIOR FELLOW HAS SHOWN THAT LINKS BETWEEN COSTS AND STANDARDIZED MORTALITY RATES IN HOSPITALS IN THE 53 AND 5+ ARE VARIABLE;= (EALTH SYSTEMS AROUND THE WORLD ABSORB LARGER PROPORTIONS OF NATIONAL WEALTH AND WHILE THERE ARE IMPROVEMENTS THE GAPS IN QUALITY SEEM TO PERSIST -ORE MONEY THEREFORE DOES NOT APPEAR TO BE THE ANSWER 'ROL NOTES THAT RESEARCH HAS REPEATEDLY SHOWN THAT PRIMARY CARE ORIENTED SYSTEMS HAVE FAR BETTER HEALTH OUTCOMES LOWER MORTALITY RATES AND HIGHER SATISFACTION AMONG CONSUMERS n ALL FOR $ONALD "ERWICK -$ IS PRESIDENT AND CHIEF EXECUTIVE OFlCER OF THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT )() )() IS A NOT FOR PROlT ORGANIZATION LEADING THE IMPROVEMENT OF HEALTHCARE THROUGHOUT THE WORLD )N "ERWICK RANKED THIRD ON -ODERN (EALTHCARES LIST OF -OST 0OWERFUL 0EOPLE IN (EALTHCARE "ERWICK IS CLINICAL PROFESSOR OF PEDIATRICS AND HEALTHCARE POLICY AT THE (ARVARD -EDICAL 3CHOOL AND PROFESSOR OF (EALTH 0OLICY AND -ANAGEMENT AT THE (ARVARD 3CHOOL OF 0UBLIC (EALTH 2ICHARD 'ROL 0H$ CHAIRS THE DEPARTMENT OF 1UALITY OF #ARE AT THE 2ADBOUD 5NIVERSITY .IJMEGEN IN THE .ETHERLANDS AND HOLDS A PERSONAL CHAIR AT -AASTRICHT 5NIVERSITY (E IS DIRECTOR OF THE 7/+ #ENTRE FOR 1UALITY OF #ARE 2ESEARCH ONE OF THE LEADING RESEARCH AND DEVELOPMENT CENTERS ON QUALITY OF HEALTHCARE IN THE WORLD AND IS ACTING DIRECTOR OF THE .IJMEGEN #ENTRE FOR %VIDENCE "ASED 0RACTICE
4IM 7ILSON -$ IS A FAMILY DOCTOR IN THE 5+ !FTER WORKING AT THE HIGHEST LEVEL IN GOVERNMENT HE MOVED TO 0RICEWATERHOUSE#OOPERS WHERE HE IS SENIOR ADVISOR ON CLINICAL PERFORMANCE IMPROVEMENT (E HAS PUBLISHED EXTENSIVELY ON THE SUBJECTS OF QUALITY AND SAFETY (E CAN BE REACHED AT TIMWILSON UKPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
KNN JHMFãA@B J ãLNUHMFãENQ V@ Q C ã Q D E KD B S H N M Rã N M ã S G D ã P T @ K H S Xã B N M T M C Q T L LOWER COST 4HESE STUDIES CARRY AN IMPORTANT MESSAGE )NVESTING IN A WORKFORCE OF WELL TRAINED FAMILY MEDICINE SPECIALISTS AND NURSES SETTING UP INTEGRATED PRIMARY SECONDARY CARE PROGRAMS FOR CHRONIC CARE INCREASING THE NUMBERS OF NURSES TAKING RESPONSIBILITY FOR SURVEILLANCE AND EDUCATINGCOUNSELING PATIENTS WITH LONG TERM CONDITIONS MIGHT REAP DIVIDENDS 3UCH AN APPROACH IS BEING TAKEN IN THE REFORMS OF THE $UTCH SYSTEM WHICH HAS MOVED TOWARD INTEGRATED MULTIDISCIPLINARY PRIMARY CARE CENTERS )N ADDITION PRIMARY CARE COOPERATIVES HAVE BEEN FORMED TO PROVIDE AFTER HOURS AND EMERGENCY CARE;=
"EWARE OF 0OPULAR 4RENDS 4HAT -AY .OT )MPROVE 1UALITY "ERWICK IDENTIlES WHAT HE SEES AS lVE hCANONSv OF CURRENT HEALTH POLICY n POWERFUL TRENDS THAT ARE DRIVING HEALTH SYSTEM CHANGES TODAY h$ISAGREE WITH THEM AT YOUR PERIL v HE NOTES 4HEY ARE THE USE OF MARKETS AND COMPETITION INCREASING PATIENT CHOICE PUBLIC DISCLOSURE OF INFORMATION SHIFT OF AN INCREASING BURDEN OF lNANCIAL RESPONSIBILITY TO THE PATIENT AND USE OF PAY FOR PERFORMANCE CONTRACTS (OWEVER "ERWICK SUSPECTS THAT NONE OF THESE OFFER AN ANSWER "ECAUSE HUMAN INTERACTION LIES AT THE HEART OF HEALTHCARE MANY OF THESE POLICIES COULD CAUSE HARM BY DISTORTING PRIORITIES STRIPPING OUT SOME OF THE MOST HUMANE ASPECTS OF HEALTHCARE AND ENCOURAGING PERVERSE BEHAVIORS AMONGST CAREGIVERS (EALTHCARE PROVIDERS AND PAYERS SHOULD CONSIDER THE INTRINSIC MOTIVATION BEHIND THESE TRENDS PARTICULARLY IN AN UNREFORMED HEALTHCARE SYSTEM LIKE THAT OF THE 53 !T BEST THESE POLICIES MAY ACT AS A DISTRACTION TO THE URGENT NEED FOR REFORM AT WORST AS A BARRIER &OR EXAMPLE "ERWICK NOTED THAT THE .ATIONAL (EALTH 3ERVICES .(3 PAY FOR PERFORMANCE CONTRACT IN THE 5+ HAS COST MORE THAN ANTICIPATED AND CREATED A NUMBER OF PROBLEMS SUCH AS THE LOSS OF CONTINUITY OF CARE WITH DISRUPTIONS TO EMERGENCY SERVICES -ORE DETAILS ABOUT THIS CONTRACT ARE MENTIONED IN THE PAPER h4HE 0AY FOR 0ERFORMANCE ,ANDSCAPEv IN THIS BOOK (E ALSO POINTS OUT THAT MARKET DRIVEN SYSTEMS OFTEN LACK THE DISCIPLINE OF lXED BUDGETS 4HEREFORE THEY DO NOT HAVE THE SAME URGENCY TO ADOPT INNOVATIONS THAT lNANCIAL CONTROL BRINGS 3IMILAR CONCLUSIONS CAN BE DRAWN FROM OTHER CANONS IN HEALTHCARE IMPROVEMENT FROM PAST DECADES 4HOSE CANONS HAVE INCLUDED EVIDENCE BASED MEDICINE CHART AUDITS CLINICAL GOVERNANCE CAPITATED BUDGETS FOR GENERAL PRACTITIONERS CONTINUING PROFESSIONAL DEVELOPMENT TOTAL QUALITY MANAGEMENT AND BUSINESS PROCESS REDESIGN ORGANIZATIONAL LEARNING AND DEVELOPMENT PATIENT EMPOWERMENT AND hBREAKTHROUGHv COLLABORATIVES !LL HAVE RAISED HIGH EXPECTATIONS JUST AS PUBLIC REPORTING AND PAY FOR PERFORMANCE ARE CURRENTLY DOING AND THEIR DEFENDERS HAVE CLAIMED THAT THEY ARE ABLE TO BRING SUBSTANTIAL
IMPROVEMENTS IN CARE (OWEVER THERE IS VERY LITTLE EVIDENCE OF SUBSTANTIAL AND SUSTAINED IMPACT ON PATIENT CARE AND OUTCOMES 3OME VERY INTERESTING APPROACHES HAVE NOT BEEN EVALUATED PROPERLY OTHERS HAVE NOT DEMONSTRATED MUCH BENElT
,EARN &ROM %MERGING -ODELS "ERWICK AND 'ROL CITE FOUR MAJOR INITIATIVES TO ILLUSTRATE QUALITY IMPROVEMENT WORK . (3 IN THE 5+ HAS TAKEN A TOP DOWN APPROACH THROUGH A MIX OF PUSH IE INCENTIVES REGULATION INSPECTION AND TARGETS AND SUPPORT IE THE -ODERNIZATION !GENCY ;NOW THE .(3 )NSTITUTE FOR )MPROVEMENT AND )NNOVATION= THE .ATIONAL 0ATIENT 3AFETY !GENCY ;.03!= AND AN ENORMOUS INCREASE IN RESOURCES "ERWICK DESCRIBES .(3 EFFORTS AS hONE OF THE LARGEST SYSTEMATIC QUALITY IMPROVEMENT PROJECTS IN THE WORLDv &OR EXAMPLE THE NEW CONTRACT WITH GENERAL PRACTITIONERS PAYS BONUSES TO THOSE WHO MONITOR CHRONIC CONDITIONS (EALTHCARE PROFESSIONALS ARE BEING REWARDED FOR SYSTEMATICALLY APPLYING THE CARE THAT THEY BELIEVE IS RIGHT EXTRINSIC lNANCIAL REWARDS CAN MATCH THE INTERNAL MOTIVATIONS OF PROFESSIONALS #-30REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION IN THE 53 IS USING A SERIES OF ORGANIZATIONAL LEVEL lNANCIAL INCENTIVES TO IMPROVE CARE PROVIDED BY HOSPITALS BY REWARDING HOSPITALS IN THE TOP TWO DECILES FOR PERFORMANCE AS JUDGED BY A SERIES OF QUALITY METRICS WITH OR PERCENT EXTRA REVENUE DEPENDING ON WHETHER THEY FALL WITHIN THE TOP TH OR TH DECILE RESPECTIVELY )N THE THIRD YEAR HOSPITALS THAT CONTINUE TO PERFORM AT THE LOWEST DECILE BASED ON THE PERFORMANCE RATINGS MEASURED IN THE lRST YEAR OF THE PROJECT ARE PENALIZED 4HEREFORE HOSPITALS CAN AVOID PENALIZATION THROUGH MAKING IMPROVEMENTS 4HE )-0!#4 0ROGRAMME IS )()S MEMBERSHIP NETWORK COMPOSED OF OPTIMISTIC AND ENTERPRISING ORGANIZATIONS AND INDIVIDUALS COMMITTED TO BUILDING A BETTER FUTURE FOR HEALTHCARE )T WAS FOUNDED ON THE SIMPLE BELIEF THAT IT IS EXPONENTIALLY EASIER TO IMPROVE TOGETHER THAN IT IS ALONE 4HE COLLECTIVE KNOWLEDGE OF )-0!#4 MEMBERS COUPLED WITH )()S IMPROVEMENT EXPERTISE AND GUIDANCE GIVES )-0!#4 ORGANIZATIONS A POTENT FRAMEWORK FOR TAKING ACTION AND A POWERFUL LEVER FOR ACHIEVING SUSTAINING AND SPREADING BREAKTHROUGH IMPROVEMENTS 4HE )()S K ,IVES #AMPAIGN HAS USED A SOCIAL MOVEMENT TECHNIQUE TO SAVE LIVES THAT WOULD HAVE OTHERWISE BEEN LOST BY ENGAGING HOSPITALS ACROSS THE 53 4HE CAMPAIGN BUILDS ON THE VIRTUES OF COOPERATION AND SHARING ENCOURAGING THROUGH THE USE OF THE ACCELERATORS IDENTIlED BY )() AND ESPECIALLY APPEALS TO THE INTERNAL MOTIVATION OF CAREGIVERS TO IMPROVE THE CARE THEY PROVIDE 4HE AIM IS TO FOCUS ON KEY PROVEN INTERVENTIONS LIKE RAPID RESPONSE TEAMS IN HOSPITALS AND REDUCING VENTILATOR ACQUIRED PNEUMONIA IN THE PARTICIPATING HOSPITALS !LREADY SOME HOSPITALS HAVE COMPLETELY ELIMINATED VENTILATOR ACQUIRED PNEUMONIA 4HE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
KNN JHMFãA@B J ãLNUHMFãENQ V@ Q C ã Q D E KD B S H N M Rã N M ã S G D ã P T @ K H S Xã B N M T M C Q T L RESULTS ARE IMPRESSIVE !LTHOUGH THE TARGET MAY NOT BE REACHED PROJECTIONS SUGGEST OVER LIVES COULD BE SAVED BY THE END OF THE CAMPAIGN n A STADIUMFUL OF PEOPLE
)DENTIFY THE )NTEGRATORS 4HE NEED FOR INTEGRATION IS CRUCIAL FOR QUALITY IN PATIENT CARE BUT OFTEN NO ONE OR NO ORGANIZATION TAKES ON THE ROLE OF INTEGRATOR "ERWICK POINTS TO TWO INTEGRATORS THAT ARE WORKING WELL *ÚNKÚPING #OUNTY #OUNCIL IN 3WEDEN AND "URNLEY 0ENDLE 2OSSENDALE 0RIMARY #ARE 4RUST IN THE 5+ "OTH ARE RESPONSIBLE FOR A POPULATION IN A GEOGRAPHICAL AREA )N ADDITION BOTH HAVE DEMONSTRATED EXCELLENCE THROUGH A SERIES OF PERFORMANCE METRICS FOR THE 3WEDISH GROUP AND THROUGH WORKING ACROSS MANY AGENCIES TO DELIVER CARE TO A DEPRIVED POPULATION IN THE %NGLISH CASE 'ROL NOTED THAT THE *ÚNKÚPING PROGRAM WAS PARTICULARLY SUCCESSFUL BECAUSE OF ITS COMPREHENSIVENESS IN ADDRESSING MUTUALLY RELATED ACTIVITIES AND INITIATIVES AT ALL LEVELS 4HE PROGRAM ALSO HAS A LEVEL OF CONSISTENCY IT WAS CREATED OVER MANY YEARS TO GAIN CONSENSUS AND ACCEPTANCE )NTEGRATORS USE DIFFERENT APPROACHES TO QUALITY IMPROVEMENT IN HEALTHCARE AND BUILD BRIDGES AMONG THEM 4HE CHALLENGE OF CHANGE IN HEALTHCARE IS TOO LARGE AND TOO COMPLEX TO BE LEFT TO ONE APPROACH 'ROL HAS POINTED OUT THE IMPORTANCE OF SETTING UP CONSISTENT COMPREHENSIVE QUALITY IMPROVEMENT SYSTEMS IN WHICH DIFFERENT APPROACHES ARE UTILIZED 4HESE CAN INCLUDE EVIDENCE BASED GUIDELINES PERFORMANCE INDICATORS EDUCATION AND SUPPORT TO PROFESSIONALS FEEDBACK AND REPORTING IMPROVING TEAMWORK AND COLLABORATION REDESIGN OF PROCESSES COLLABORATIVE WORK AND LEARNING FROM OTHER TEAMS AND PRACTICES INTEGRATED CARE MODELS AND INCENTIVES !UTHORITIES POLICY MAKERS AND MANAGERS AT DIFFERENT LEVELS OF HEALTHCARE NEED TO TAKE THE LEAD IN DEMANDING FACILITATING AND SUPPORTING SUCH SYSTEMS BUT THEY ARE PREFERABLY CONDUCTED BY THOSE WHO ARE DIRECTLY RESPONSIBLE FOR CARE PROVISION )N TERMS OF SETTING UP AN INTEGRATED SYSTEM AROUND QUALITY "ERWICK AND )() HAVE POINTED TO THE APPROACHES DEVELOPED BY THE *APANESE QUALITY EXPERT .ORIAKI +ANO +ANO WHO IS KNOWN FOR THE STUDY OF PRIORITIZING CUSTOMER QUALITY ISSUES HAS SUGGESTED THAT HEALTHCARE ORGANIZATIONS VIEW QUALITY THROUGH THESE THREE LENSES;=
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
%LIMINATING QUALITY PROBLEMS THAT ARISE BECAUSE THE EXPECTATIONS OF CONSUMERS ARE NOT MET 2EDUCING COSTS SIGNIlCANTLY WHILE MAINTAINING OR IMPROVING QUALITY AND %XPANDING THE EXPECTATIONS OF CONSUMERS BY PROVIDING PRODUCTS AND SERVICES THAT THEY PERCEIVE AS UNUSUALLY HIGH IN VALUE +ANOS IDEAS PROVIDE THE BASIS FOR AN INTEGRATED SYSTEM OF IMPROVING THE VALUE OF HEALTHCARE AND UNDERSTANDING THE RELATIONSHIP BETWEEN THE QUALITY AND COST OF CARE
-OVE "EYOND 2ESEARCH TO &OCUS ON !CCELERATING #HANGE 4HE KEY TO QUALITY IMPROVEMENT IS IN HOW TO ENCOURAGE THOSE AREAS OF GOOD PRACTICE TO BE SUSTAINED AND SPREAD ACROSS WHOLE HEALTH SYSTEMS )() HAS IDENTIlED EIGHT KEY ACCELERATORS %STABLISH BOLD AIMS -EASURE THOSE AIMS 5SE THE APPROACH OF hALL TEACH ALL LEARNv $O IMPROVEMENT AT A LOCAL LEVEL BUILD THE SKILLS LOCALLY ,EVERAGE INTRINSIC MOTIVATION AS THE MOST POWERFUL INCENTIVE 5SE A SYSTEMATIC APPROACH TOWARD SPREAD !LWAYS LISTEN TO THE VOICE OF THE PATIENT AND ,EADERSHIP LEADERSHIP LEADERSHIP )N SUMMARY NO SYSTEM HAS IT PERFECTLY RIGHT 7HAT IS CLEAR IS THAT EXTRINSIC INCENTIVES AND INTRINSIC MOTIVATION DO NEED TO BE ALIGNED BOTH FROM THE PATIENTS AND CAREGIVERS PERSPECTIVES &URTHER IT IS THE SYSTEMATIC AND CONSISTENT APPLICATION OF POLICIES OVER A BROAD RANGE OF METHODS n AND AT ALL LEVELS IN HEALTHCARE SYSTEMS n THAT IS LIKELY TO HAVE AN IMPACT %NDNOTES h2EDUCING (OSPITAL -ORTALITY 2ATES v )NSTITUTE FOR (EALTHCARE )MPROVEMENT ACCESSED AT WWWIHIORG)()0ROGRAMS#OLLABORATIVE,EARNING2EDUCING (OSPITAL-ORTALITY2ATESHTM 'ROL 2 h1UALITY $EVELOPMENT IN (EALTHCARE IN THE .ETHERLANDS v -ARCH 4HE #OMMONWEALTH &UND #ENTRE FOR 1UALITY OF #ARE 2ESEARCH 2ADBOUD 5NIVERSITY .IJMEGEN -EDICAL #ENTRE ACCESSED AT WWWCMWF ORG0UBLICATIONSPUBLICATIONS?SHOWHTM DOC?ID .OLAN 4 AND -AUREEN "ISOGNANO h&INDING THE "ALANCE BETWEEN 1UALITY AND #OST v (&- *OURNAL !PRIL ACCESSED AT WWWIHOORG.2 RDONLYRES"#$"$ %! " "%!%$? PDF
4HE 1UALITY #ONUNDRUM ILLUMINATES BOTH THE ROADBLOCKS AND BETTER PATHS TO A MUCH BETTER PERFORMING HEALTHCARE SYSTEM
v
n !2.)% -),34%). -$ -0( -%$)#!, $)2%#4/2 0ACIlC "USINESS 'ROUP ON (EALTH #()%& 0(93)#)!. -ERCER (EALTH AND "ENElTS
h
h
)N HEALTHCARE QUALITY SHOULD NOT BE A CONUNDRUM )T SHOULD BE AN INEVITABLE OUTCOME 2AISING AWARENESS OF OUR QUALITY CHALLENGES AND HOW TO ADDRESS THEM WILL HELP US GET THERE
v
n -!2'!2%4 /+!.% 02%3)$%.4 .#1!
4HE 1UALITY #ONUNDRUM ADDRESSES A KEY CHALLENGE IN HEALTHCARE QUALITY )T CAPTURES REAL WORLD EXPERIENCES AND SHOULD SERVE AS A VALUABLE RESOURCE TO ANYONE DELIVERING HEALTHCARE
v
n ,/5)3% ,)!.' -$ 3%.)/2 6)#% 02%3)$%.4 1UALITY AND #LINICAL 3YSTEMS 3UPPORT +AISER 0ERMANENTE
h
4HIS EXTRAORDINARY COMPENDIUM OF THE LATEST THINKING RESEARCH AND REAL WORLD EXPERIENCES PROVIDES A COMPREHENSIVE SYSTEMATIC AND VIEW IN THE ONGOING EFFORTS TO IMPROVE THE QUALITY OF HEALTHCARE )TS ALL ENCOMPASSING VIEW OF QUALITY ILLUSTRATED BY A HYPOTHETICAL SCENARIO DESCRIBED FROM THE PERSPECTIVE OF A lCTITIOUS CHRONICALLY ILL PATIENT IS UNIQUE )T DISPELS THE MYTH THAT HIGH QUALITY AND HIGH COST ARE SYNONYMOUS AND HIGHLIGHTS THE ROLE THAT TECHNOLOGY WILL PLAY IN ACHIEVING HIGH QUALITY COST EFFECTIVE HEALTHCARE n -!2# (/,,!.$ 02/'2!- $)2%#4/2 (EALTH 0ROVIDER 2ESEARCH (EALTH )NDUSTRY )NSIGHTS
v
).42/$5#4)/.
#(!04%2
7HY )S 1UALITY A #ONUNDRUM (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
4HE 1UALITY ,ANDSCAPE 2HONDA !RRINGTON "ENJAMIN )SGUR AND (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
1UALITY IN THE 0OST -ANAGED #ARE %RA $ONALD &ETTEROLF -ATRIA (EALTHCARE !LL 1UALITY 2OADS ,EAD TO $ATA (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
4HE (ORIZON "EYOND ()0!! "ALANCING 0RIVACY AND 3ECURITY 7ITH 0ATIENT #ARE 2ICHARD "AICH *EFF &USILE *AMES +OENIG AND #INDY 3MITH 0RICEWATERHOUSE#OOPERS 'LOBAL 0ERSPECTIVES ON 1UALITY 2ACHEL !BBOTT #ARRIE 3CHULMAN AND 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
!CCESSING "ENElTS 4HROUGH THE 7ORKPLACE 1UALITY AND %MPLOYER "ENElT 0LAN $ESIGN "ARRY "ARNETT AND 7ILLIAM 2OSENBERG 0RICEWATERHOUSE#OOPERS
(OW #ORPORATE !MERICA #AN (ELP ,IFT #LINICAL 0ERFORMANCE ! $ISCUSSION 7ITH !RNIE -ILSTEIN AND "OB 'ALVIN
%MPLOYERS 5SE OF (EALTHCARE 1UALITY $ATA "ENJAMIN )SGUR AND #HRISTOPHER +USCHEL 0RICEWATERHOUSE#OOPERS
%MPLOYERS $IRECTIONS IN (EALTHCARE &INANCIAL -ANAGEMENT 3USAN -ARGOLIS AND -ICHAEL 4HOMPSON 0RICEWATERHOUSE#OOPERS
#(!04%2
#(!04%2
0AYING FOR 1UALITY #ARE
4HE 2OLE OF THE 0ATIENT 0ATIENT #HOICE AND !CTIVATION IN (EALTHCARE 2ACHEL !BBOTT 0RICEWATERHOUSE#OOPERS !NNA $IXON +INGS &UND *UDITH (IBBARD 5NIVERSITY OF /REGON
4HE 2OLE OF THE #ONSUMER IN 1UALITY ! $ISCUSSION 7ITH THE 3USAN ' +OMEN &OUNDATION
1UALITY IN )NTEGRATED 4OTAL (EALTH -ANAGEMENT -ARY !NN 3HEA *ACKIE -AZOWAY !NURAG 3HARMA AND $AVID 3ACHS 0RICEWATERHOUSE#OOPERS
)NTEGRATING -EDICAL AND 0RODUCTIVITY -ANAGEMENT *ACKIE -AZOWAY AND -ARY !NN 3HEA 0RICEWATERHOUSE#OOPERS 1UALITY IN -EDICAID 0ROGRAMS 3ANDRA (UNT 0RICEWATERHOUSE#OOPERS
"LOGS AND 3OCIAL -EDIA 4HE .EW #ITIZEN !RBITERS OF (EALTHCARE 1UALITY $MITRIY +RUGLYAK 4HE -EDICAL "LOG .ETWORK
!CHIEVING 0ATIENT #ENTRIC 1UALITY #ARE 4HROUGH 4ECHNOLOGY ! $ISCUSSION 7ITH +AISER 0ERMANENTE
! +EY 3TRATEGY FOR 3OLVING THE (EALTHCARE #RISIS )NTEGRATING 3ICK #ARE AND 7ELL #ARE 3TEPHEN % "ELLER .ATIONAL (EALTH $ATA 3YSTEMS 3ABATINI * -ONATESTI %3 %NTERPRISES
4HE 0AY FOR 0ERFORMANCE ,ANDSCAPE (INDY 3HAMAN AND 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
"LUE #ROSS AND "LUE 3HIELD OF -INNESOTA (EALTHCARE &ACTS¸ ! .EW -ODEL FOR (OSPITAL 2EPORTING "ASED ON #ONSUMER %NGAGEMENT -ARY!NN 3TUMP AND 4AMARA , 9OUNG "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA
1UALITY 0AY FOR 0ERFORMANCE AND THE 2OLE OF #-3 ! $ISCUSSION 7ITH 4RENT (AYWOOD
)MPROVING THE %MERGENCY $EPARTMENT %XPERIENCE 0ATRICIA -ICHAELS AND *UDITH ! 2UNK 0RICEWATERHOUSE#OOPERS
1UALITY AS A "USINESS -ODEL "RETT - (ICKMAN 0RICEWATERHOUSE#OOPERS
-AGNET .URSING 3TATUS $EBORAH !LLBACH 0RICEWATERHOUSE#OOPERS 3HERRY $ANELLO AND 3USAN (OWELL 3T *OSEPHS#ANDLER (EALTH 3YSTEM
! 0ROVIDER ,ED !PPROACH TO 0AY FOR 0ERFORMANCE 4HE .ATIONAL #ARE 4RANSACTION #ONSORTIUM $AVID ,EVY 0RICEWATERHOUSE#OOPERS 0AY FOR 0ERFORMANCE AND "EYOND ! 2ECIPE FOR )MPROVING (EALTHCARE &RAN¥OIS DE "RANTES "RIDGES 4O %XCELLENCE
%VIDENCE "ASED $ECISION 3UPPORT &ROM 0APER TO %LECTRONIC 'REGORY ( $ORN :YNX (EALTH
1UALITY AND (EALTHCARE )NFORMATION 4ECHNOLOGY .ICK "EARD 0RICEWATERHOUSE#OOPERS
)DENTIFYING 1UALITY 0HYSICIAN #ARE
4HE 2OLE OF 2()/S AND /THER #OLLABORATIVES IN 1UALITY "RUCE (ENDERSON 0RICEWATERHOUSE#OOPERS
0HYSICIANS 0ERSPECTIVES ON 1UALITY ! $ISCUSSION 7ITH 'ORDON -OORE $AVID #HIN AND 4IM 7ILSON
#(!04%2
#(!04%2
7ORKING 4OGETHER 0HYSICIANS AND (OSPITALS 0ARTNERING FOR 1UALITY )MPROVEMENT *EFF "OOTH "RETT - (ICKMAN AND "RIAN -ATSON 0RICEWATERHOUSE#OOPERS
)MPROVING (EALTHCARE 1UALITY IN THE 0EDIATRIC !MBULATORY %NVIRONMENT 3HAMITA #HAKRABORTY AND !NTHONY $ 3LONIM #HILDRENS .ATIONAL -EDICAL #ENTER
!CHIEVING 1UALITY 4HROUGH #USTOMER 3ERVICE -ARGARET 3TOVER 0RICEWATERHOUSE#OOPERS
4HE +EY TO )MPROVING 1UALITY 3AVING ,IVES AND 2EDUCING ,AWSUITS $EBORAH ! 4OTO 4HE 'ALLUP /RGANIZATION
%NSURING 6ALUE FROM 0HARMA CEUTICALS AND -EDICAL $EVICES /VERVIEW OF 0HARMA AND ,IFE 3CIENCE 1UALITY )SSUES !NTHONY , &ARINO 0RICEWATERHOUSE#OOPERS
&ROM 2ESEARCH TO 1UALITY 4RANSLATING #LINICAL ,AB 2ESULTS )NTO 0ATIENT #ARE 7ILLIAM - $RACOS -ICHAEL 2 'LICK 'ERRY -C$OUGALL AND "ARBARA 7ALSH 0RICEWATERHOUSE#OOPERS
#(!04%2
$RUG 3AFETY AND 0HARMACOVIGILANCE +ATE -ALONEY AND -ICHAEL -ENTESANA 0RICEWATERHOUSE#OOPERS
"RIDGING #ARE AND 2ESEARCH 4HROUGH (EALTH )NFORMATION 4ECHNOLOGY .ICK "EARD 0RICEWATERHOUSE#OOPERS
)MPROVING THE (OSPITAL %XPERIENCE
#(!04%2
1UALITY AND THE 2EVENUE #YCLE *OSEPH - !LBIAN *IM (ORNE AND "ELLINDA # -INKNER 0RICEWATERHOUSE#OOPERS
#ONCLUSION
5SING 3IX 3IGMA TO )MPROVE 1UALITY IN (EALTHCARE ! 2OUNDTABLE $ISCUSSION
4HE 2OLE OF !CCREDITATION IN 1UALITY 2ICHARD ' "ATTAGLIA AND (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
2ESHAPING (OSPITAL 4HROUGHPUT *OAN $EMING -URPHY 0RICEWATERHOUSE#OOPERS
)MPORTANT .EXT 3TEPS FOR !CHIEVING THE 6ISION 3TEPHEN # 3CHOENBAUM +AREN $AVIS AND !NNE -ARIE * !UDET 2EPRINTED WITH PERMISSION FROM $AVID " .ASH AND .EIL * 'OLDFARBS 4HE 1UALITY 3OLUTION *ONES AND "ARTLETT 0UBLISHERS 3UDBURY -ASS WWWJBPUBCOM
,OOKING "ACK -OVING &ORWARD 2EmECTIONS ON THE 1UALITY #ONUNDRUM BY 0ROFESSORS $ON "ERWICK )NSTITUTE FOR (EALTHCARE )MPROVEMENT 2ICHARD 'ROL 2ADBOUD 5NIVERSITY .IJMEGEN 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
B
COqNUNqDRUM K N N DR M N ! RIDDLE IN WHICH A FANCIFUL QUESTION IS ANSWERED BY A PUN ! PARADOXICAL INSOLUBLE OR DIFlCULT PROBLEM A DILEMMA
1
UALITY HEALTHCARE IS UNDENIABLY IMPORTANT -ANY HEALTH IN DUSTRY LEADERS WOULD GO SO FAR AS TO SAY THAT IT IS IN A STATE OF CRISIS "UT WHY IS IT A CONUNDRUM #ERTAINLY THE 1UALITY #ONUNDRUM HAS SOME OF THE NICE ALLITERATIVE PROPERTIES THAT ONE SEEKS IN A BOOK TITLE "UT THERE WAS MORE INTENT BEHIND OUR CHOICE OF WORDS 1UALITY AND SAFETY STANDARDS ARE CRITICAL TO SUSTAINABILITY 0RICEWATERHOUSE#OOPERS GLOBAL REPORT h(EALTH#AST #REATING A 3USTAINABLE &UTURE v IDENTIlED QUALITY AND SAFETY STANDARDS AS ONE OF SEVEN SUSTAINABILITY FEATURES 4HIS BOOK BUILDS ON THAT REPORT WHICH HIGHLIGHTED THE GROWING IMPORTANCE OF hDElNED AND ENFORCED CLINICAL STANDARDS THAT ESTABLISH MECHANISMS FOR ACCOUNTABILITY AND ENHANCED TRANSPARENCY THEREBY BUILDING CONSUMER TRUSTv;= (OWEVER EMBEDDING QUALITY INTO HEALTH SERVICES TREATMENTS AND PROCESSES PRESENTS A CHALLENGE AND DILEMMA AT MULTIPLE LEVELS !LTHOUGH THE 53 HAS ONE OF THE HIGHEST LIVING STANDARDS IN THE WORLD AND SPENDS MORE THAN ANY OTHER /%#$ NATION ON HEALTHCARE IT RANKS IN THE LOWEST QUARTILE OF COUNTRIES ON EVEN THE MOST BASIC MEASURES OF HEALTH STATUS SUCH AS LIFE EXPECTANCY AT BIRTH AND INFANT MORTALITY;= ! GROWING MILLION INDIVIDUALS n OVER PERCENT OF OUR POPULATION n LACK HEALTH INSURANCE AND HAVE LIMITED ACCESS TO BASIC PREVENTIVE AND PRIMARY CARE SERVICES;= $ESPITE THE PLETHORA OF MEDICAL TECHNOLOGY ADVANCES SOME MIGHT ARGUE EVEN BECAUSE OF THE COMPLEXITY THEY ENGENDER NEARLY HOSPITAL PATIENTS DIE UNNECESSARILY DUE TO
MEDICAL ERRORS AND PEOPLE GET THE RECOMMENDED CARE ONLY PERCENT OF THE TIME;= 2EGIONAL VARIATIONS IN CARE PERSIST WITH NO APPARENT RELATION TO EXPENDITURES 2ECENT SURVEYS INDICATE THAT AN INCREASING PERCENTAGE OF CONSUMERS ARE CONCERNED ABOUT HEALTHCARE SAFETY AND QUALITY !DOPTION OF INFORMATION SYSTEMS THAT COULD WARD AGAINST MISUSE OVERUSE AND UNDERUSE OF MEDICAL SERVICES REMAINS LOW n PERCENT FOR PHYSICIANS AND PERCENT FOR HOSPITALS;= #AROLYN - #LANCY -$ DIRECTOR OF THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY POINTS TO SEVERAL REASONS FOR THE GAPS IN QUALITY h4ODAYS HEALTH CARE SYSTEM IS HIGHLY FRAGMENTED 4HERE ARE MORE INSTANCES THAN WE WOULD LIKE WHEN INFORMATION GETS LOST AND WE ARE LAGGING BEHIND OTHER INDUSTRIES IN THE EFFECTIVE USE OF INFORMATION TECHNOLOGY AS A TOOL FOR QUALITY IMPROVEMENT 7ITHIN HEALTH CARE ORGANIZATIONS WE TOO OFTEN SEE FRAGMENTATION AMONG THE WORK OF DIFFERENT KINDS OF HEALTH CARE PROFESSIONALS !S A RESULT OUR ABILITY TO FUNCTION AS A TEAM IS MORE ASPIRATIONAL THAN REAL 7HAT WE NEED ARE LEADERS WHO CAN ARTICULATE A VISION FOR HOW HEALTH CARE SHOULD BE DELIVERED AND WHO CAN THEN HELP BRING TOGETHER CLINICIANS POLICY MAKERS AND OTHERS TO MAKE THAT VISION A REALITYv -OREOVER CURRENT lNANCIAL INCENTIVES DO NOT TYPICALLY REWARD QUALITY h7E HAVE AN ABSOLUTELY TOXIC lNANCING SYSTEM &INANCING AND ECONOMICS ARE POWERFUL EVERYTHING IS GOING UPHILL AGAINST NON OR MIS ALIGNED INCENTIVES v STATES #HRISTINE + #ASSEL -$ PRESIDENT AND #%/ OF THE !MERICAN "OARD OF )NTERNAL -EDICINE !LTHOUGH NEW PROGRAMS SUCH AS PAY FOR PERFORMANCE AND CONSUMER DIRECTED HEALTH BENElTS ARE BEING DEVELOPED TO INCENT THE PROVISION OF QUALITY CARE AND EMPOWER CONSUMERS TO SELECT HIGH QUALITY PROVIDERS THEIR PENETRATION IN THE MARKET REMAINS MODEST 4HE VAST MAJORITY OF CARE IS PAID THROUGH MECHANISMS THAT REWARD VOLUME RATHER THAN QUALITY h4HERE ISNT A CLEAR lNANCIAL INCENTIVE FOR QUALITY IMPROVEMENT 0EOPLE
(INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
VGXãHRãPT @KHSXã@ãBNMT MCQT L DONT SEE THE CONNECTION BETWEEN ENHANCING PATIENT SAFETY AND IMPROVING THE BOTTOM LINE !BSENT A CHANGE IN lNANCIAL INCENTIVES THROUGH PAY FOR PERFORMANCE AND -EDICARE WERE JUST TINKERING AT THE EDGES v SAYS $AVID " .ASH -$ -"! CHAIRMAN OF THE DEPARTMENT OF HEALTH POLICY *EFFERSON -EDICAL #OLLEGE OF 4HOMAS *EFFERSON 5NIVERSITY 3O ALTHOUGH HIGH QUALITY REMAINS AN AIM IT IS NOT YET A REALITY 0RICEWATERHOUSE#OOPERS CONDUCTED IN DEPTH INTERVIEWS WITH MORE THAN HEALTH EXECUTIVES AND INDUSTRY LEADERS 4HEY WERE UNANIMOUS IN THE VIEW THAT DESPITE DECADES OF WORK ON THE QUALITY ISSUE WE CONTINUE TO FALL SHORT OF OUR ASPIRATIONS AND GOALS !ND THERE WAS NEAR UNIVERSAL AGREEMENT ON THE VIEW THAT THE STATE OF HEALTHCARE QUALITY WILL LIKELY NOT CHANGE SIGNIlCANTLY WITHIN THE NEXT THREE TO lVE YEARS )N SHORT THE HEALTH EXECUTIVES AND LEADERS SAW THE SHORT TERM FUTURE AS hMUCH OF THE SAMEv WITH RESPECT TO QUALITY 1UALITY IS A CONUNDRUM ON ANOTHER LEVEL 7ITH RECENT STUDIES POINTING TO THE MAGNITUDE AND SCOPE OF MEDICAL ERRORS THE QUALITY ISSUE HAS BEEN A MAJOR FOCUS OF ATTENTION )N THE PAST YEARS DOZENS OF ORGANIZATIONS HAVE BEEN DESIGNATED OR
CREATED AT THE NATIONAL LEVEL TO ADDRESS QUALITY SEE %XHIBIT "UT WITH ALL OF THESE PLAYERS ONE MUST WONDER IF THE NOISE TO ACTION RATIO IS TOO HIGH h4HERES A CACOPHONY OF ORGANIZATIONS IN THE QUALITY SPACE 7E NOW KNOW WHAT TO DO 4HERES SO MUCH QUALITY RELATED ACTIVITY ITS BEGINNING TO BOG DOWN UNDER ITS OWN WEIGHT AND COULD BE BETTER ORGANIZED v SAYS $ONALD &ETTEROLF -$ -"! &!#0 VICE PRESIDENT OF THE !MERICAN #OLLEGE OF -EDICAL 1UALITY AND CORPORATE VICE PRESIDENT FOR HEALTHCARE INTELLIGENCE OF -ATRIA (EALTHCARE -ARGARET % /+ANE PRESIDENT OF THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1! A GROUP THAT ACCREDITS HEALTH PLANS BASED ON QUALITY METRICS AGREES h4HE QUALITY COMMUNITY HAS BECOME A QUALITY PROBLEM IN ITS OWN RIGHT #ONFUSION IS AN IMPEDIMENT TO PROGRESS !S THE ENVIRONMENT GETS MORE CONFUSING WERE IN DANGER OF PROVIDERS THROWING UP THEIR HANDS IN FRUSTRATIONv (ELEN $ARLING PRESIDENT OF THE .ATIONAL "USINESS 'ROUP ON (EALTH ."'( STATES h4HERE IS NOT NEARLY ENOUGH STRONG AGGRESSIVE IMPATIENT LEADERSHIP n WHICH IS ESSENTIAL IF WE ARE TO OVERCOME ALL OF THE FORCES WORKING AGAINST SIGNIlCANT CHANGE INERTIA COMPETING PRIORITIES AND SADLY A LACK OF URGENCYv
%XHIBIT /RGANIZATIONS )NVOLVED IN (EALTHCARE 1UALITY
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
VGXãHRãPT @KHSXã@ãBNMT MCQT L 7ITH THE LARGE NUMBER OF ORGANIZATIONS AND LACK OF A DESIGNATED LEADER PROVIDERS ARE FACED WITH MOUNTING REQUIREMENTS FOR PERFORMANCE REPORTING n WITH NO CONSISTENT STANDARDS OR DElNITIONS h7ITH ALL OF THE VARIOUS PAY FOR PERFORMANCE PROGRAMS THERES A MULTIPLICITY OF MANDATES v SAYS 0AUL $ #LEARY 0H$ PROFESSOR OF HEALTHCARE POLICY IN THE DEPARTMENTS OF HEALTHCARE POLICY AND SOCIAL MEDICINE AT (ARVARD -EDICAL 3CHOOL h#URRENTLY THERES CONFUSION ON WHATS THE RIGHT THING TO MEASURE AND WHAT THE FOCUS SHOULD BE (OSPITALS START WORKING ON ONE INITIATIVE AND THEN SWITCH GEARS TO ANOTHER WITHOUT COMPLETING EITHER 4YPICALLY HOSPITALS HAVE A FRAGMENTED REACTIVE APPROACH TO QUALITY 4HEY DONT HAVE A WELL THOUGHT OUT SET OF PRIORITIES AND QUALITY STRATEGIC GOALS TO MOVE THE ORGANIZATION FORWARD v SAYS ,AURA *ACQUIN 2. -"! PRESIDENT OF 0REMIER (EALTHCARE 3OLUTIONS A PROFESSIONAL SERVICES lRM PROVIDING PROJECT MANAGEMENT AND INTERIM STAFF SUPPORT TO HEALTHCARE ORGANIZATIONS IN AREAS INCLUDING DENIAL MANAGEMENT AND PATIENT ACCESS -ARY #OOPER -$ *$ VICE PRESIDENT AND CHIEF QUALITY OFlCER OF .EW9ORK 0RESBYTERIAN (OSPITAL A BED FACILITY WITH MOSTLY MASTERS TRAINED STAFF DEDICATED TO QUALITY AGREES h7ERE PASSIONATE ABOUT QUALITY )TS ENCOURAGED BY THE VERY TOP OF OUR ORGANIZATION AND HELD IN HIGH ESTEEM "UT ) WORRY THAT AS AN INDUSTRY OUR ATTENTION SPAN ON SOME OF THESE EFFORTS ISNT LONG 7HATS IMPORTANT TODAY ISNT NECESSARILY IMPORTANT TOMORROW )TS HARD TO SUSTAIN IMPROVEMENTSv %XHIBIT 2OLES /PPORTUNITIES FOR 1UALITY )MPROVEMENT
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
h4HERES A WILLINGNESS TO EMBRACE THE QUALITY ISSUE FROM MANY QUARTERS WHERE THERE WASNT BEFORE WHICH IS PROMISING "UT THERES A LACK OF CERTAINTY ABOUT WHAT TO DO lRST #ONFRONTING QUALITY IS COMPLEX AND PEOPLE NEED A CLEAR IDEA OF WHERE TO BEGIN 7ITH CLEAR PRIORITIES WE COULD MAKE A LOT MORE PROGRESS v SAYS .#1!S /+ANE !S A REmECTION OF THIS WIDESPREAD SENTIMENT THE )NSTITUTE OF -EDICINE )/- RECENTLY CALLED FOR THE ESTABLISHMENT OF A .ATIONAL 1UALITY #OORDINATION "OARD h)N OUR REPORT ENTITLED @0ERFORMANCE -EASURES !CCELERATING )MPROVEMENT WE RECOMMEND THE ESTABLISHMENT OF A .ATIONAL 1UALITY #OORDINATION "OARD TO PERFORM A VARIETY OF CRUCIAL FUNCTIONS IDENTIFY AND ARTICULATE CONSENSUS GOALS FOR HEALTHCARE CHOOSE EXISTING ANDOR DEVELOP NEW MEASURES OF PERFORMANCE THAT WILL PROMOTE HEALTHCARE QUALITY AND COORDINATE EFFORTS BY PUBLIC AND PRIVATE STAKEHOLDERS TO MAXIMIZE THE RATE AT WHICH PROGRESS IS MADE .O CURRENTLY EXISTING ENTITY CAN PERFORM ALL OF THESE TASKS v STATES *OHN # 2ING -$ DIRECTOR OF THE BOARD ON HEALTHCARE SERVICES OF THE )/- ,ASTLY QUALITY IS A CONUNDRUM BECAUSE WE ARE AT A TURNING POINT 7E HAVE RECOGNITION OF THE ISSUE AND A BASELINE OF ACTIVITIES ESTABLISHED FROM WHICH WE CAN BUILD MOMENTUM AND ACHIEVE SIGNIlCANT RESULTS (OWEVER WITH CONTINUED LACK OF COORDINATION AND STANDARDIZATION WE FACE THE RISK OF FRUSTRATION PARALYSIS AND DIVERSION OF RESOURCES h4HE ISSUE ISNT DOING MORE RESEARCH ABOUT PERFORMANCE MEASUREMENT ITS JUST DOING IT 0EOPLE HAVE TO GET MOVING EVERYBODY HAS WORK TO DO 4HIS IS WORSE THAN WATCHING
VGXãHRãPT @KHSXã@ãBNMT MCQT L 4HE 2OAD 4O (EALTHCARE 1UALITY ! #ONmUENCE OF 3EEMINGLY 5NRELATED #ONNECTIONS "UILDS THE &UTURE 0AST IS PROLOGUE OR SO SAID 3HAKESPEARE 3O IN TERMS OF QUALITY HOW DID WE GET TO THE STATE WERE IN TODAY 7HAT EVENTS HAVE LED US TO OUR CONUNDRUM AROUND QUALITY IN HEALTHCARE (OW WILL THESE EVENTS AFFECT OUR EFFORTS TO DElNE HEALTHCARE IN THE FUTURE )NNOVATION AND CHANGE OFTEN ARE CREATED BY DISPARATE FORCES INmUENCING AN OUTCOME OVER TIME /FTEN AN OBSERVER OF THESE INDIVIDUAL EVENTS WOULD NOT BE ABLE TO CONTEMPLATE THE lNAL OUTCOME 4HE FOLLOWING TIMELINE SHOWS HOW DISCOVERIES EVENTS AND TECHNOLOGIES ALL CONVERGED TO BRING US TO OUR MODERN DAY DEVELOPMENT AND USE OF HEALTHCARE QUALITY n 4HE "ROADSTREET PUMP OUTBREAK GIVES BIRTH TO DATA DRIVEN PUBLIC HEALTH INITIATIVES;= 3OME HAVE CALLED $R *OHN 3NOW THE GREATEST PHYSICIAN OF ALL TIME $URING ONE OF THE WORST OUTBREAKS OF CHOLERA IN ,ONDONS HISTORY 3NOW USED DATA TO MAP THE SOURCE OF THE EPIDEMIC TO A WATER PUMP ON "ROADSTREET 2EMOVING THE PUMP HANDLE SLOWED THE SPREAD OF CHOLERA IN THAT AREA -ODERN EPIDEMIOLOGY AND PUBLIC HEALTH WERE BORN AS WELL AS THE DOCUMENTED USE OF STATISTICAL MAPPING TO IMPROVE HEALTH OUTCOMES -ORE THAN YEARS AGO THE CONCEPT OF USING DATA TO IMPROVE HEALTH QUALITY WAS BORN n 4HE lRST AUTOMOBILE RELIABILITY INFORMATION IS INCLUDED IN #ONSUMER 2EPORTS MAGAZINE;= "ASED ON READERS SURVEYS ON THE FREQUENCY OF AUTOMOBILE REPAIRS THIS MAGAZINE LAUNCHED THE MODERN CONSUMER MOVEMENT 4HE CONSUMER PRODUCT MOVEMENT BASED QUALITY DECISIONS ON ACTUAL DATA AND RELIED ON PURCHASING POWER AND PUBLIC POLICY ACTIVISM TO PROTECT CONSUMERS 4HE MOST UBIQUITOUS SYMBOL OF CONSUMER QUALITY RATINGS ARE THE #ONSUMER 2EPORTS AUTOMOBILE hCOLORED BUBBLESv WHICH DEMOCRATIZED QUALITY RATINGS SO THAT EVERYONE COULD PARTICIPATE IN FACT BASED DECISION MAKING -ANY HEALTHCARE QUALITY ORGANIZATIONS EMULATE THIS CONCEPT OF QUALITY RATINGS BASED ON SURVEY DATA TODAY n 0ATENTS FOR THE INTEGRATED CIRCUIT OR @MICROCHIP ARE lLED;= #OMPUTERS MEDICAL EQUIPMENT AND EVEN SOME COFFEEMAKERS HAVE THEM 4HE MICROCHIP MAKES THE MODERN WORLD RUN n MEDICAL TECHNOLOGY INCLUDED *ACK +ILBY AND 2OBERT .OYCE ARE CREDITED WITH THE INVENTION THAT KICK STARTED THE COMPUTER AGE -ODERN HEALTHCARE IS INTERTWINED WITH TECHNOLOGY AND THE MICROCHIP IS THE BACKBONE OF THE HEALTHCARE TECHNOLOGY CHAIN FROM THE -2) MACHINE TO THE COMPUTER IN THE PHYSICIANS OFlCE 4ODAYS HEALTHCARE
QUALITY DATA IS PROCESSED ON A MICROCHIP INVENTED OVER YEARS AGO n 0RESIDENT ,YNDON "AINES *OHNSON SIGNS THE -EDICARE BILL INTO LAW;= !S PART OF THE 3OCIAL 3ECURITY !CT !MENDMENT -EDICARE CHANGED HEALTHCARE IN !MERICA OVERNIGHT BY CREATING THE LARGEST HEALTH INSURANCE PROGRAM THAT WOULD FUNNEL DOLLARS INTO HOSPITAL CARE (OSPITALS SPROUTED UP EVERYWHERE AND DATA FOLLOWED IN THE FORM OF -EDICARE COST REPORTS (EALTHCARE DATA IS ONE OF THE CORNERSTONES OF HEALTHCARE QUALITY AND THE -EDICARE PROGRAM IS ONE OF THE BIGGEST SOURCES OF DATA &ORTY YEARS AFTER ITS IMPLEMENTATION THE -EDICARE PROGRAM IS USED AS THE lRST NATIONAL PROGRAM FOR PROVIDER QUALITY REPORTING ON KEY METRICS n %DWARD $EMING IS NAMED AS AN HONORARY MEMBER OF THE !MERICAN 3OCIETY FOR 1UALITY;= (E IS CONSIDERED ONE OF THE FATHERS OF THE QUALITY MOVEMENT BECAUSE OF HIS CONTRIBUTION TO THE THEORIES OF PROCESS IMPROVEMENT (IS MOST FAMOUS WORK WAS HELPING TO REBUILD THE *APANESE INDUSTRIAL BASE AFTER 77)) USING STATISTICAL QUALITY CONTROL -ANY OF OUR MODERN DAY PROCESS IMPROVEMENT SYSTEMS INCLUDING 4OTAL 1UALITY -ANAGEMENT AND 3IX 3IGMA ARE BASED ON HIS RESEARCH AND TEACHINGS (EALTHCARE SYSTEMS ARE NOW ADOPTING QUALITY IMPROVEMENT INITIATIVES BASED ON STATISTICAL ANALYSIS n )NSTITUTE OF -EDICINE RELEASES 4O %RR IS (UMAN;= 0ATIENT SAFETY AND QUALITY MOVED TO THE FOREFRONT OF THE PUBLIC DEBATE AFTER THE )/- REPORTED THAT BETWEEN AND PATIENTS DIE EACH YEAR DUE TO MEDICAL ERRORS 4HESE STUNNING NUMBERS MOVED THE DEBATE FROM THE POSITION THAT HEALTHCARE QUALITY IS ABOUT IMPROVING QUALITY TO ONE OF GREATER URGENCY IN SAVING LIVES S n 7ITH MORE THAN YEARS OF CONNECTIONS BETWEEN PEOPLE PROCESS AND TECHNOLOGY HEALTHCARE QUALITY IS BECOMING A REALITY 4HE -EDICARE -ODERNIZATION !CT PAY FOR PERFORMANCE INITIATIVES THE ELECTRONIC MEDICAL RECORD 3IX 3IGMA PROCESS DESIGN REGIONAL HEALTH INFORMATION ORGANIZATIONS AND PROVIDER REPORT CARDS ALL BUILT ON PAST ADVANCES (EALTHCARE QUALITY AND THE DECISIONS THAT ARE MADE BASED ON THAT INFORMATION ARE QUICKLY BECOMING PART OF THE 53 HEALTHCARE SYSTEM 7HAT WILL IT LOOK LIKE IN AND WHAT CONNECTIONS WILL NEED TO BE MADE n "Y "ENJAMIN )SGUR 0RICEWATERHOUSE#OOPERS
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
VGXãHRãPT @KHSXã@ãBNMT MCQT L PAINT DRY v SAYS $ENNIS 3 /,EARY -$ PRESIDENT OF THE *OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS *AMES #ONWAY SENIOR FELLOW OF THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT AND SENIOR CONSULTANT OF THE $ANA &ARBER #ANCER )NSTITUTE SAYS h) WORRY ABOUT SUSTAINABILITY (EALTHCARE HAS A HISTORY OF A @PHILOSOPHY DU JOUR 4HERE ARE SO MANY WAYS FOR PEOPLE TO GET DISTRACTED 7E NEED TO LEARN HOW TO SUSTAIN FOCUSv (E ADDS h7E DONT SUFFER FROM AN ABSENCE OF IDEAS 7E SUFFER FROM AN ABSENCE OF WILL AND EXECUTIONv
4HE SUCCESS OR FAILURE OF ANY QUALITY INITIATIVE ULTIMATELY HINGES ON THE PATIENT CLINICIAN INTERACTION 3OME ARE MORE OPTIMISTIC -ATRIA (EALTHCARES &ETTEROLF SEES THE LARGE NUMBER OF QUALITY ORGANIZATIONS AND ACTIVITIES AS hxNOT NECESSARILY A BAD THING !LL OF THE PIECES n THE KNOWLEDGE TOOLS INFORMATION RESOURCES AND MEASURES n ARE THERE 3O WE CAN BE MORE HOPEFUL ABOUT THE FUTUREv 7HAT CAN HEALTH EXECUTIVES DO TO ENSURE THAT WE GAIN MOMENTUM RATHER THAN ENTER A STATE OF PARALYSIS 4HE GOOD NEWS IS THAT EVERYONE CAN MAKE A DIFFERENCE 1UALITY IS NOT SOMETHING THAT IS CONlNED IN THE IVORY TOWER OR RESTS SOLELY IN THE HANDS OF GURUS 2ATHER IT IS AN ISSUE FOR WHICH EVERY STAFF MEMBER AT EVERY LEVEL IN EVERY HEALTH ORGANIZATION CAN MAKE AN IMPACT (EALTH ORGANIZATIONS FROM EVERY SECTOR OF THE INDUSTRY HAVE A ROLE TO PLAY AS SHOWN IN %XHIBIT 7HEREVER WE LOOK THERE ARE IMPORTANT AND EFFECTIVE ACTIVITIES TO ENHANCE QUALITY WHETHER AT THE GOVERNANCE AND LEADERSHIP LEVEL OR THE FRONT LINE EMPLOYERS WHO PROVIDE THEIR STAFFS WITH INFORMATION ABOUT THE RISK OF MEDICAL ERRORS AND QUALITY OF PROVIDERS HEALTH PLANS THAT SHOW PROVIDERS HOW THEY COMPARE WITH PEERS AND CAN IMPROVE THEIR PERFORMANCE x HOSPITAL BOARD MEMBERS WHO SET POLICIES AND MONITOR PROGRESS AGAINST ANNUAL GOALS x HEALTH ORGANIZATION EXECUTIVES WHO GET A DAILY REPORT ON THE NUMBER OF MEDICAL ERRORS IN THE PAST HOURS AND INVESTIGATE ROOT CAUSES IMMEDIATELY x PHYSICIANS WHO WILLINGLY REPORT THEIR CLINICAL ACTIVITIES AND USE THIRD PARTY RATINGS TO IMPROVE THEIR PERFORMANCE x NURSES WHO LOOK PATIENTS IN THE EYE DURING A CONVERSATION RATHER THAN AT A CLIPBOARD x CASE MANAGERS WHO ACT AS CLINICIANS ARMS AND LEGS TO ASSIST WITH DOCUMENTATION THE REGISTRATION CLERK WHO EXPLAINS THE PATIENTS BILL IN CLEAR SIMPLE LANGUAGE EVEN THE PARKING ATTENDANT WHO LENDS AN ARM TO HELP A PATIENT GET OUT OF THE CAR /UR CHALLENGE IS TO MOBILIZE OUR EFFORTS SUSTAIN OUR FOCUS AND CATALYZE RESULTS 7HERE DO WE GO FROM HERE &ROM 0RICEWATERHOUSE#OOPERS INTERVIEWS THE FOLLOWING MAJOR THEMES EMERGED AS PRACTICAL STEPS THAT HEALTH EXECUTIVES NEED TO TAKE TO ACHIEVE PROGRESS ON QUALITY 3ET ANNUAL QUALITY GOALS AND ESTABLISH PRIORITIES (EALTH EXECUTIVES NEED TO REALIZE THAT THEY CANT DO EVERYTHING AT ONCE
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
BUT THEY NEED TO ESTABLISH TANGIBLE GOALS THAT CLEARLY RELATE TO THEIR ORGANIZATIONAL STRATEGY h7E NEED TO CREATE CULTURES OF SAFETY WITHIN ALL HEALTH ORGANIZATIONS 1UALITY AND SAFETY IMPROVEMENT HAVE TO BE PERSONAL PRIORITIES FOR ALL STAFF "UT WE NEED TO DElNE PRIORITIES FOR WHAT WE WANT THEM TO DO 4HE ANSWER CANT BE @EVERYTHING v SAYS THE *OINT #OMMISSIONS /,EARY $ANA &ARBERS #ONWAY ADDS h&ROM WHAT ) SEE LESS THAN HALF OF ORGANIZATIONS HAVE SPECIlC GOALS FOR QUALITY AND SAFETY -IDDLE MANAGERS ARE OVERWHELMED DEPRESSED AND FRUSTRATED 4HEY DONT KNOW HOW THEIR ACTIVITIES AT A PROCESS LEVEL lT WITH SYSTEM LEVEL TRANSFORMATIONv )NVOLVE BOARD MEMBERS AND SENIOR LEADERSHIP TEAMS IN CLINICAL ISSUES AND QUALITY *UST AS BOARD MEMBERS REGULARLY AND ROUTINELY GET REPORTS ON THE lNANCIAL STATUS OF THE HEALTH ORGANIZATIONS THEY GOVERN THEY ALSO NEED TO RECEIVE QUALITY REPORTS "OARD MEMBERS ARE ULTIMATELY ACCOUNTABLE FOR THE QUALITY OF SERVICES AND PRODUCTS PROVIDED $ANA &ARBERS #ONWAY SAYS h"OARD MEMBERS NEED TO UNDERSTAND THAT THEY ARE ACCOUNTABLE 4HEY HAVE THE PRIVILEGE OF SAYING @9OU WILL 4HEY NEED TO SET EXPECTATIONS AND ESTABLISH FOCUS ALIGNMENT AND RESOURCES n INCLUDING TAKING SOME THINGS OFF THE TABLEv (E GOES ON TO RECOMMEND THAT SENIOR LEADERS ASK THEMSELVES THE FOLLOWING QUESTIONS h7ERE PATIENT ANDOR STAFF SAFETY ISSUES ON THE AGENDA OF OUR LAST TEAM MEETING 7HERE WAS THE PLACEMENT OF THESE ISSUES ON THE AGENDA lRST MIDDLE LAST )S DATA FROM PATIENT AND STAFF SAFETY INDICATORS ROUTINELY REVIEWED AND DISCUSSED !RE SAFETY AGENDA ITEMS FOLLOWED BY ACTION PLANS WITH AN ASSIGNED SENIOR LEADER ACCOUNTABLE FOR FOLLOW UP 7HAT IS THE PERCENTAGE OF TIME THAT THE TEAM SPENDS ON DISCUSSION OF PATIENT CARE ISSUES INCLUDING SAFETY AND OTHER OPERATIONAL MATTERS v 2EALIGN ORGANIZATIONS AND STRUCTURES TO IMPROVE QUALITY 1UALITY INITIATIVES CUT ACROSS )4 ACCESS REGULATORY AND CLINICAL AREAS !NTHONY $ 3LONIM -$ $R0( EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS AT THE #HILDRENS .ATIONAL -EDICAL #ENTER IN 7ASHINGTON $# AND ASSOCIATE PROFESSOR AND VICE CHAIRMAN OF THE DEPARTMENT OF PEDIATRICS AT THE 'EORGE 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE BELIEVES THAT h#%/ SUCCESS IN THE FUTURE WILL NOT JUST BE DEPENDENT ON ACHIEVEMENT OF lNANCIAL METRICS BUT ALSO ON QUALITY AND SAFETY OUTCOMES 3TRATEGIC INITIATIVES WILL BE QUALITY RELATED "OARD MEMBERS WILL ASK QUALITY QUESTIONS !S AN INDUSTRY WE ARE ALREADY STARTING TO SEE THESE CHANGESv (E CONNOTES THE NEED FOR UPWARD AND DOWNWARD COMMUNICATION ACROSS LEADERSHIP AND FRONT LINE STAFF TO A hSPIDER WEBv h7E NEED TO START PAYING ATTENTION TO HOW WE ARE RUNNING INTERFERENCE IN THIS SPIDER WEB 4HE SPIDERS IN THE WEB ARE WHERE HEALTHCARE IS DRIVEN 4HE WORK WITHIN THE WEB IS CRITICAL IN ORDER TO BE SUCCESSFULv 2OBIN * 4HOMASHAUER EXECUTIVE DIRECTOR OF THE #OUNCIL FOR !FFORDABLE 1UALITY (EALTHCARE A NONPROlT ALLIANCE OF HEALTH PLANS NETWORKS AND TRADE ASSOCIATIONS THAT SEEKS TO CATALYZE INDUSTRY COLLABORATION TO SIMPLIFY HEALTHCARE
VGXãHRãPT @KHSXã@ãBNMT MCQT L ADMINISTRATION CONCURS WITH THE NEED TO BRIDGE TRADITIONAL SILOS WITH INFORMATION h7HATS NEEDED IS AN EFlCIENT WAY FOR PLANS TO QUICKLY SECURELY SHARE DATA WITH PROVIDERS ONE THAT BALANCES INTERNAL AND INDUSTRY PRIORITIESv !DOPT CLINICAL INFORMATION TECHNOLOGY 4HE ABILITY TO MEASURE MANAGE AND IMPROVE HEALTHCARE QUALITY REQUIRES CLINICAL INFORMATION 4HOMAS ( ,EE -$ NETWORK PRESIDENT FOR THE "OSTON BASED HOSPITAL SYSTEM 0ARTNERS (EALTH#ARE 3YSTEM STATES h)N MEDICAL SCHOOL ) WAS TAUGHT NOT TO OPEN A 0$2 IN FRONT OF A PATIENT n WE WANTED TO GIVE PATIENTS THE MESSAGE THAT WE KNEW EVERYTHING 4ODAY ITS CLEAR THAT NO ONE CAN KNOW IT ALL &OR SICK COMPLEX PATIENTS IT NEEDS TO BE A TEAM SPORT !S SOME OF MY FRIENDS SAY WE WERE TRAINED TO BE #HUCK 9EAGER BUT WE NEED TO BE *OHN 'LENN .OT IMPROVISE BUT FOLLOW THE RULES -EDICINE IS SO COMPLEX THAT YOU CANT GIVE GOOD CARE TO PATIENTS ALL BY YOURSELF 4HERES TOO MUCH TO DO TOO MUCH TO KNOWv 4ODAYS CLINICIAN NEEDS )4 SOLUTIONS SUCH AS ELECTRONIC MEDICAL RECORDS AND COMPUTERIZED PHYSICIAN ORDER ENTRY SYSTEMS WITH MEDICAL DECISION SUPPORT $EVELOP NEW STAFlNG SKILLS AND CATEGORIES 7E NEED TO BE ABLE TO MANIPULATE ANALYZE AND INTERPRET QUALITY DATA 7E DONT HAVE ENOUGH INDIVIDUALS TRAINED IN CLINICAL ANALYSIS NOW 0ARTICULARLY WITH INCREASED ADOPTION OF INFORMATION TECHNOLOGY WELL SEE MORE AND MORE INFORMATION GATHERING THAT WILL GO INTO A DATA WAREHOUSE THAT WELL NEED TO MINE h)N OUR PROFES SIONAL SCHOOLS WE DONT TEACH PEOPLE ABOUT SYSTEMS THINKING OR TEAMING IN HEALTHCARE YET PERCENT OF THE OPPORTUNITIES TO IMPROVE SAFETY LIE IN SYSTEMS REDESIGN &EW HOSPITALS n LESS THAN PERCENT n HAVE SYSTEM REDESIGN CAPABILITIES OR SYS TEMS ENGINEERS ON STAFF v SAYS THE *OINT #OMMISSIONS /,EARY %XISTING TRAINING PROGRAMS ARE NOT SUFlCIENT TO PREPARE HEALTH PROFESSIONALS FOR THE DEMANDS AHEAD !CCORDING TO *ANET - #ORRIGAN 0H$ -"! PRESIDENT AND CHIEF EXECUTIVE OFlCER OF THE .ATIONAL 1UALITY &ORUM A PRIVATE NOT FOR PROlT MEMBER %XHIBIT 3COPE OF THE 1UALITY #ONUNDRUM
SHIP ORGANIZATION CREATED TO DEVELOP AND IMPLEMENT A NATIONAL STRATEGY FOR HEALTHCARE QUALITY MEASUREMENT AND REPORTING h7E NEED TO DO MORE WITH EDUCATION AND TRAINING OF HEALTH PROFESSIONALS PHYSICIANS NURSES PHARMACISTS 7E WANT THEM TO PRACTICE IN AN INFORMATION RICH ENVIRONMENT USE DECISION SUPPORT TOOLS ENGAGE CONSUMERS AND PRACTICE IN A MULTIDISCI PLINARY MANNER "UT WE DONT TRAIN THEM ACCORDINGLY #URRENTLY WE DONT HAVE ENOUGH CUTTING EDGE PRACTICE SETTINGS FOR TRAIN ING )TS A CATCH v %NGAGE CLINICIANS 4HE SUCCESS OR FAILURE OF ANY QUALITY INITIATIVE ULTIMATELY HINGES ON THE PATIENT CLINICIAN INTERACTION 4HOUGH MANY IN THE MEDICAL COMMUNITY RESISTED ATTEMPTS TO MONITOR AND MEASURE QUALITY PERFORMANCE IN THE PAST THEY ARE GRADUALLY COMING AROUND TO THE INEVITABILITY OF THESE EFFORTS h0HYSICIANS KNOW THAT TRANSPARENCY AND PUBLIC REPORTING IS INEVITABLE )N THE BEST OF CIRCUMSTANCES SUCH DATA CAN PROMPT PERFORMANCE IMPROVEMENT PROGRAMS IN PROVIDER ORGANIZATIONS v STATES $AVID 7 0LOCHER -$ CHIEF MEDICAL OFlCER AND SENIOR VICE PRESIDENT FOR HEALTH MANAGEMENT AND INFORMATICS "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA 2ECRUIT CONSUMER AND PATIENT PARTICIPATION IN QUALITY EFFORTS #ONSUMERS NEED TO TAKE A MORE ACTIVE ROLE (ISTORICALLY THEY HAVE TAKEN QUALITY FOR GRANTED AND LITTLE CLEAR INFORMATION HAS BEEN AVAILABLE TO THEM "UT WITH INCREASED TRANSPARENCY AND REPORTING THEY WILL BECOME MORE ACTIVE ."'(S $ARLING STATES h!S CONSUMERS GET MORE INFORMATION THROUGH RESULTS OF STUDIES REGARDING HOW THEY COULD HAVE BEEN HARMED THEY WILL BECOME MORE CONSERVATIVE ABOUT MEDICAL CARE 4HEIR REACTION TO RECENT SAFETY STUDIES INDICATES THAT PEOPLE ARE PAYING MORE ATTENTION 7ITHIN WEEKS THOUSANDS OF WOMEN DROPPED (24 4HEYRE USING WORD OF MOUTH RATHER THAN DATA TO SELECT PROVIDERS RIGHT NOW BECAUSE THE DATA IS SIMPLY NOT AVAILABLEv %LIZABETH "RADLEY ASSOCIATE PROFESSOR AND DIRECTOR OF THE HEALTH MANAGEMENT PROGRAM WITHIN HEALTH POLICY AND ADMINISTRATION AT THE 9ALE 3CHOOL OF 0UBLIC (EALTH ADDS h4HERE IS A TRANSLATION PROBLEM 7E NEED TO MAKE THE INFORMATION MEANINGFUL FOR PATIENTS AND FAMILIES 4HERE IS A BALANCE ONE CANNOT OVERWHELM PATIENTS WITH DATA BUT ON THE OTHER HAND ONE HAS TO RETAIN ADEQUATE DETAIL TO MAKE THE DATA ACCURATE AND NOT OVERLY GENERALv 2EWARD QUALITY 7HETHER AT A SYSTEM ORGANIZATIONAL DEPARTMENTAL OR AN INDIVIDUAL LEVEL BEHAVIORS THAT PROMOTE QUALITY NEED TO BE REWARDED 1UALITY INCENTIVES CAN ENCOMPASS PAY FOR PERFORMANCE PROGRAMS BETWEEN PAYERS AND PROVIDERS STAFF COMPENSATION DESIGN AND EMPLOYEE RECOGNITION CAMPAIGNS h)T WILL BE THE INCENTIVES THAT DRIVE THE MARKET v ADDS 0AUL !LCALA VICE PRESIDENT AND CHIEF INFORMATION OFlCER OF .ORTHBAY (EALTHCARE 3YSTEMS IN #ALIFORNIA 4HE REMAINDER OF THIS BOOK EXPLORES THESE PRACTICAL APPROACHES IN FURTHER DETAIL ADDRESSING QUALITY AS A MULTIDIMENSIONAL ISSUE THAT IMPACTS PATIENTS AND HEALTH ORGANIZATIONS ACROSS
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
VGXãHRãPT @KHSXã@ãBNMT MCQT L THE INDUSTRY n EMPLOYERS INSURERS PHYSICIANS HOSPITALS AND PHARMACEUTICAL AND LIFE SCIENCE COMPANIES n WITH REPERCUSSIONS FOR lNANCIAL PERFORMANCE CLINICALCARE MANAGEMENT OPERATIONS AND TECHNOLOGY DEVELOPMENT AND INTEGRATION %XHIBIT DEPICTS THE SCOPE OF ISSUES ADDRESSED 4HE BOOK DESCRIBES SELECTED EXAMPLES OF INNOVATIVE QUALITY IMPROVEMENT PRACTICES NOT TO REPRESENT A COMPREHENSIVE SET OF LEADING PRACTICES BUT RATHER TO ILLUSTRATE THE RANGE OF PRACTICAL APPROACHES THAT ARE BEING EMPLOYED BY A VARIETY OF HEALTH ORGANIZATIONS ACROSS THE COUNTRY
%VERY ORGANIZATION AND EVERY INDIVIDUAL IN THE HEALTHCARE INDUSTRY HAS THE POWER TO MAKE A SUBSTANTIAL DIFFERENCE IN HOW PATIENTS ARE TREATED 4HE BOOK IS STRUCTURED AS FOLLOWS )NTRODUCTION ADDRESSES THE CURRENT LANDSCAPE OF HEALTHCARE QUALITY MAJOR PLAYERS CHANGING MODELS DElNITIONS OF QUALITY AND SOURCES OF PERFORMANCE DATA 4HE 2OLE OF THE 0ATIENT FOCUSES ON QUALITY AS VIEWED BY CONSUMERS THE ROLE OF PATIENT ADVOCACY PATIENT CHOICE AND ACTIVATION USE OF THE )NTERNET IN DECISION MAKING AND HOW INCENTIVES CAN MOTIVATE PATIENTS TO MAKE APPROPRIATE CHOICES REGARDING THEIR LIFESTYLE AND HEALTHCARE !CCESSING "ENElTS 4HROUGH THE 7ORKPLACE EXPLORES QUALITY RELATED ACTIVITIES THAT EMPLOYERS ARE BRINGING INTO PLAY SUCH AS CONSUMER ORIENTED BENElT PLAN DESIGN DECISION SUPPORT TOOLS AND VALUE BASED PURCHASING INITIATIVES 0AYING FOR 1UALITY #ARE EXPLORES INSURERS USE OF QUALITY INCENTIVES EMERGING MODELS OF DISEASE MANAGEMENT LEADING PRACTICES IN PROVIDER PROlLING AND PUBLIC REPORTING AND THE IMPACT OF PAY FOR PERFORMANCE )DENTIFYING 1UALITY 0HYSICIAN #ARE LOOKS AT THE CHANGING PHYSICIAN PATIENT RELATIONSHIP CURRENT MODELS FOR COLLABORATION WITH HOSPITALS NEW TRAINING METHODS AND CUSTOMER SERVICE APPROACHES )MPROVING THE (OSPITAL %XPERIENCE DISCUSSES PATIENT ACCESS SAFETY AND SERVICE IN THE HOSPITAL SETTING INCLUDING NEW DIRECTIONS IN ACCREDITATION LEADING QUALITY PRACTICES IN REVENUE CYCLE MANAGEMENT NURSING CARE MODELS USE OF 3IX 3IGMA EMERGENCY DEPARTMENT AND PATIENT CARE THROUGHPUT AND ADOPTION OF CLINICAL INFORMATION TECHNOLOGIES
%NSURING 6ALUE FROM 0HARMACEUTICALS AND -EDICAL $EVICES EXPLORES THE ROLE OF PERSONALIZED MEDICINE IN QUALITY DRUG AND MEDICAL DEVICE SAFETY PHARMACOVIGILANCE AND THE CONVERGENCE OF INFORMATION TECHNOLOGY FOR RESEARCH AND CLINICAL CARE #ONCLUSION SUMS UP WHAT IS ON THE HORIZON AND HOW HEALTH ORGANIZATIONS CAN PREPARE FOR THE FUTURE )N CONCLUSION QUALITY IS A CONUNDRUM BECAUSE IT IS A COMPLEX PROBLEM A SOLUTION WILL REQUIRE DIFFERENT APPROACHES THAN WHAT HAS BEEN TRIED IN THE PAST )F WE ARE TO STAY ON OUR CURRENT COURSE FAILURE TO MAKE PROGRESS BEYOND WHAT HAS ALREADY BEEN ACHIEVED IS LIKELY 7ITH THE HEALTHCARE ENVIRONMENT GROWING MORE COMPLICATED WITH EACH PASSING YEAR THE RISK OF LOSING GROUND IS ALSO POSSIBLE IN THE ABSENCE OF ACCELERATED EFFORTS 4HE GOOD NEWS IS THAT EVERY ORGANIZATION AND EVERY INDIVIDUAL IN THE HEALTHCARE INDUSTRY HAS THE POWER TO MAKE A SUBSTANTIAL DIFFERENCE IN HOW PATIENTS ARE TREATED 7E NOW FACE A TURNING POINT THAT REQUIRES A CONSCIOUS DECISION BETWEEN hBUSINESS AS USUALv AND A NEW MIND SET 4HE NEW PATH IS NOT NECESSARILY EXPENSIVE OR RUGGED "UT IT WILL TAKE A DEDICATED SPIRIT %NDNOTES h(EALTH#AST #REATING A 3USTAINABLE &UTURE v .OVEMBER 0RICEWATERHOUSE#OOPERS 2EINHARDT 5% AND 0 % (USSEY ' & !NDERSON h#ROSS NATIONAL #OMPARISONS OF (EALTH 3YSTEMS 5SING /%#$ $ATA v (EALTH !FFAIRS PP h)NCOME 3TABLE 0OVERTY 2ATE )NCREASES 0ERCENTAGE OF !MERICANS WITHOUT (EALTH )NSURANCE 5NCHANGED 0RESS RELEASE !UGUST 53 #ENSUS "UREAU RETRIEVED *UNE AT HTTPWWWCENSUSGOV 0RESS 2ELEASEWWWRELEASESARCHIVESINCOME?WEALTHHTML -C'LYNN ET AL h.ATIONAL 6ITAL 3TATISTICS 2EPORT v )NSTITUTE OF -EDICINE .EW %NGLAND *OURNAL OF -EDICINE #2- $AILY REPORT POSTED ON HTTPWWWCRM DAILYCOMSTORY XHTML STORY?ID AND ACCESSED !PRIL REPORT OF ()-33 CONFERENCE SURVEY AND &ORRESTER 2ESEARCH 5#,! $EPARTMENT OF %PIDEMIOLOGY HTTPWWWPHUCLAEDUEPI SNOWBROADSTREETPUMPHTML #ONSUMER 2EPORTS HTTPWWWCONSUMERREPORTSORGCROABOUTUS HISTORYINTERACTIVEINDEXHTM )NVENTORS OF THE -ODERN #OMPUTER HTTPINVENTORSABOUTCOMLIBRARY WEEKLYAAHTM #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES HTTPWWWCMSHHS GOV(ISTORY !MERICAN 3OCIETY FOR 1UALITY HTTPWWWASQORGABOUT ASQWHO WE AREBIO?DEMINGHTML )NSTITUTE OF -EDICINE HTTPWWWIOMEDU
@7HEN YOU COME TO A FORK IN THE ROAD TAKE IT n 9OGI "ERRA
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
4HE 1UALITY ,ANDSCAPE 7HILE A NATIONALLY RECOGNIZED DElNITION OF QUALITY HEALTHCARE HAS YET TO EMERGE INNOVATIVE HEALTHCARE ORGANIZATIONS ARE ADOPTING PRINCIPLES AND PRACTICES DESIGNED TO IMPROVE HEALTH OUTCOMES PROCESSES AND PATIENT PERCEPTIONS "Y 2HONDA !RRINGTON "ENJAMIN )SGUR AND (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
@3OCIAL IMPROVEMENT IS ATTAINED MORE READILY BY A CONCERN WITH THE QUALITY OF RESULTS THAN WITH THE PURITY OF MOTIVES n %RIC (OFFER 53 PHILOSOPHER @1UALITY IS *OB n &ORD -OTOR #OMPANY
)
N MEDIEVAL %UROPE CRAFTSMEN WERE ORGANIZED INTO GUILDS THAT WERE RESPONSIBLE FOR PRODUCT AND SERVICE QUALITY RULES /FTEN MASTER CRAFTSMEN MARKED THEIR GOODS WITH A SPECIAL SYMBOL TO PROVE THEIR QUALITY 4HESE MARKS REPRESENTED A GUARANTEE OF REPUTATION AND AN OBLIGATION TO QUALITY FOR MEDIEVAL %UROPEAN SOCIETIES;= &AST FORWARD YEARS AND OUR MASTER CRAFTSMEN ARE NOW PROFESSIONALS SUCH AS DOCTORS AND NURSES WHO FOLLOW PROTOCOLS AND PROCESS GUIDELINES WHILE OUR MARKS OF QUALITY ARE ACCREDITATIONS DATA SCORES AND REPORT CARDS "UT ARE WE SURE THESE MODERN DAY MARKINGS STAND FOR QUALITY HEALTHCARE $O OUR ST CENTURY MEDICAL AND HEALTH ASSOCIATIONS UPHOLD QUALITY STANDARDS TO THE SAME LEVEL AS A TH CENTURY STONE MASONS GUILD !ND DO OUR HEALTH PROFESSIONALS HAVE THE SAME RESPONSIBILITY TO QUALITY AS THE SILVERSMITH WHO ETCHED HIS NAME ON THE BACK OF EVERY ITEM SOLD
.ATIONALLY 2ECOGNIZED $ElNITIONS OF 1UALITY !NSWERS TO THESE QUESTIONS REQUIRE A FRAMEWORK AND DElNITION OF HEALTH QUALITY A DElNITION THAT HAS OFTEN BEEN ELUSIVE TO POLICY MAKERS AND HEALTH INDUSTRY EXECUTIVES 7HILE AN ANALYSIS OF QUALITY DElNITIONS FROM A VARIETY OF HEALTH LEADERS INDICATES
THAT A SINGULAR DElNITION OF QUALITY DOES NOT EXIST A FRAMEWORK OF COMPONENTS DOES EMERGE SEE %XHIBIT )N THE )NSTITUTE OF -EDICINE )/- DElNED QUALITY AS THE hDEGREE TO WHICH HEALTH SERVICES FOR INDIVIDUALS AND POPULATIONS INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES AND ARE CONSISTENT WITH CURRENT PROFESSIONAL KNOWLEDGEv;= )NHERENT IN THIS DElNITION IS THE DESIRE TO DO THE hRIGHTv THING NOT ONLY FOR INDIVIDUALS BUT ALSO FOR THE GREATER POPULATION )N THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21 DElNED HIGH QUALITY HEALTHCARE AT ITS MOST BASIC LEVEL AS hDOING THE RIGHT THING AT THE RIGHT TIME IN THE RIGHT WAY FOR THE RIGHT PERSON 4HE CHALLENGE THAT CLINICIANS AND HEALTH SYSTEM MANAGERS FACE EVERY DAY IS KNOWING WHAT THE RIGHT THING IS WHEN THE RIGHT TIME IS AND WHAT THE RIGHT WAY ISv;= 4HIS DElNITION IS QUITE APROPOS AS MANY HEALTHCARE SECTORS n PROVIDERS PAYERS LIFE SCIENCE AND PHARMACEUTICAL COMPANIES n STRIVE TO DO WHAT IS IN THE BEST INTEREST OF THE PATIENT !LSO IN 4HE .ATIONAL 2OUNDTABLE ON (EALTH #ARE 1UALITY CONVENED BY THE )/- CHARACTERIZED QUALITY PROBLEMS AS hUNDERUSE OVERUSE OR MISUSEv;= 4HEN IN THE )/- IN ITS GROUNDBREAKING PUBLICATION #ROSSING THE 1UALITY #HASM EXPANDED UPON ITS DElNITION TO ARTICULATE SPECIlC AIMS FOR IMPROVING THE HEALTHCARE DELIVERY SYSTEM WHICH IF APPLIED WOULD IMPROVE THE PATIENT EXPERIENCE
2HONDA !RRINGTON -0( IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE CONTRIBUTED TO THE CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS OF HEALTHCARE CONSULTING EXPERIENCE AND SPECIALIZES IN PROJECT MANAGEMENT PROCESS IMPROVEMENT AND PERFORMANCE MEASUREMENT 3HE CAN BE REACHED AT RHONDAARRINGTON USPWCCOM "ENJAMIN )SGUR -0!FF IS THE ASSISTANT DIRECTOR OF 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE (E FOCUSES ON THE DEVELOPMENT OF THOUGHT LEADERSHIP AND RESEARCH INITIATIVES FOR THE lRM AND CLIENTS (E CAN BE REACHED AT BENJAMINISGUR USPWCCOM (INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM ) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGD ãPT @KHSXãK@MCRB@OD %XHIBIT (EALTHCARE 1UALITY $ElNITION n &RAMEWORK AND #OMPONENTS #OMPONENTS 3UBCOMPONENTS 0RIMARY $RIVERS
/UTCOMES ;-AKING THE PATIENT BETTER= #LINICAL /UTCOMES ;)MPROVED (EALTH=
3ERVICE %XPERIENCE ;0ATIENT 3ATISFACTION=
(EALTH 0ROFESSIONALS (EALTH 0ROFESSIONALS +NOWLEDGE #ULTURE AND 4RAINING AND 2ESEARCH
THEREBY MAKING THE CARE RECEIVED SAFER TIMELY EFFECTIVE AND EFlCIENT 4HE )/-S AIMS WERE BUILT UPON SIX CORE PRINCIPLES SAFE EFFECTIVE PATIENT CENTERED EFlCIENT TIMELY AND EQUITABLE
6IEWS OF 1UALITY AT THE @'RASSROOTS ,EVEL 4HE !(21 AND )/- BENCHMARK DElNITIONS INmUENCE THE WAYS IN WHICH MANY HEALTHCARE ORGANIZATIONS OPERATIONALIZE QUALITY WITHIN THEIR INSTITUTIONS 4HE DElNITIONS ALSO PROVIDE IMPETUS FOR PLANNING DEVELOPMENT AND IMPLEMENTATION OF MANY QUALITY IMPROVEMENT EFFORTS 1UALITY EXPERTS BROADLY ACKNOWLEDGE )/- AS THEIR STANDARD DElNITION BY SIMPLY STATING h7HY REINVENT THE WHEEL v -ANY IN THE HEALTHCARE INDUSTRY LOOK TOWARD THESE QUALITY DElNITIONS AS THE MEANS TO PULL PROCESS AND OUTCOME TOGETHER 9ET THE TRANSLATION OF THESE DElNITIONS INTO PRACTICE AMONG HEALTHCARE CONSTITUENTS YIELDS SOMEWHAT DIFFERENT VIEWPOINTS ON QUALITY h(EALTHCARE QUALITY IS A NEVER ENDING PROCESS OF CONTINUOUS IMPROVEMENT n ITS A PROCESS NOT DElNED IN BLACK AND WHITE v SAYS ,EE " 3ACKS -$ PRESIDENT OF !DVOCATE (EALTH 0ARTNERS ONE OF THE LARGEST HEALTHCARE DELIVERY SYSTEMS IN #HICAGO h1UALITY IS THE PERCEPTION OF PERFORMANCE ITS A JUDGMENTAL DETERMINATION IN THE EYE OF THE BEHOLDER v SAYS $ENNIS 3 /,EARY -$ PRESIDENT OF THE *OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS 4HE CLARION CALL FOR PROCESS IMPROVEMENT IS ECHOED BY !NTHONY $ 3LONIM -$ $R0H EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS AT THE #HILDRENS .ATIONAL -EDICAL #ENTER IN 7ASHINGTON $# AND ASSOCIATE PROFESSOR AND VICE CHAIRMAN OF THE DEPARTMENT OF PEDIATRICS AT THE 'EORGE 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE h7E CANT KEEP DOING THINGS IN THE SAME WAY THAT WE ALWAYS HAVE WE MUST THINK CREATIVELY ABOUT THE METHODS THAT WILL DRIVE QUALITY IMPROVEMENT IN OUR ORGANIZATIONS #URRENTLY HOSPITALS ARE NOT INCENTIVIZED TO COLLABORATE AND SHARE INFORMATION BUT OUR PATIENTS AND THEIR FAMILIES ARE GOING TO START DEMANDING ITv (OW CAN WE IMPROVE WHAT WE CANT MEASURE AND HOW CAN WE MEASURE WHAT WE CANT DElNE /R IS QUALITY JUST ANOTHER ONE
0ROCESS ;-AKING THE SYSTEM BETTER=
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
-ETHODS ;'UIDELINES AND 0ROTOCOLS=
)MPROVEMENT ;!NALYSIS AND #HANGE=
$ATA
)NCENTIVES
OF THOSE ATTRIBUTES THAT YOU KNOW WHEN YOU SEE IT !CCORDING TO *OE #ARMICHAEL PRESIDENT OF .2# 0ICKER A MARKET RESEARCH lRM THAT CONDUCTS PATIENT SATISFACTION SURVEYS THERE IS NOT A SINGLE DElNITION h)TS ABOUT HOW THE PATIENT VIEWS THEIR HEALTHCARE EXPERIENCEv 1UALITY IS MORE THAN JUST CLINICAL OUTCOMES h4HE lNAL OUTCOME FOR EVERYONE IS ULTIMATELY DEATH BECAUSE THATS WHAT LIFE ENDS WITH 3O QUALITY HAS TO DO NOT JUST WITH OUTCOMES BUT WITH HOW SATISlED PATIENTS ARE AND THE DEGREE TO WHICH THEYRE ABLE TO CONTINUE WITH THEIR LIFESTYLE v SAYS 2OXANE 4OWNSEND -$ -EDICAID MEDICAL DIRECTOR OF ,OUISIANA $ON &ETTEROLF -$ -"! &!#0 VICE PRESIDENT OF THE !MERICAN #OLLEGE OF -EDICAL 1UALITY AND CORPORATE VICE PRESIDENT OF HEALTHCARE INTELLIGENCE AT -ATRIA (EALTHCARE AGREES THAT EVERYONE HAS THEIR OWN DElNITION h4HE DElNITION DEPENDS ON THE AUDIENCE &OR SOME ITS BETTER SERVICE FOR OTHERS ITS CONFORMANCE TO GUIDELINES AND OF COURSE THERE IS ALWAYS THE MEASURE OF LOWER MORTALITYv
#ONSUMER 6IEWS OF 1UALITY 3O IS QUALITY ABOUT PROCESS OR OUTCOME MEASURES OR PATIENT PERCEPTIONS $ID OUR MEDIEVAL HOMEOWNERS CARE ABOUT THE PROCESS OF BUILDING THE STONE WALL OR THAT THE STONE WALL KEPT THE ROOF SUPPORTED /R WAS THE MOST IMPORTANT ASPECT OF QUALITY THE PERCEPTION OF THE RECIPIENT OF THE STONEMASONS SERVICES )N A WORLD FOCUSED ON CUSTOMER SERVICE WHERE CONSUMERS ARE RECOGNIZING THEIR TRUE INmUENCE ON SUPPLY AND DEMAND TELEVISION PROGRAMMING AND CUSTOMIZATION THERE STILL IS DISCREPANCY IN HOW TO TRANSLATE THIS POWER INTO HEALTHCARE MATTERS 7HERE IS THE VOICE OF THE CONSUMER AND HOW IS IT BEING GALVANIZED TO AFFECT HEALTHCARE DELIVERY #AN CONSUMERS REALLY EFFECT CHANGE 7HAT ARE THEIR PERSPECTIVES ON QUALITY ! SURVEY OF ADULTS CONlRMED THAT NEARLY HALF OF 53 RESIDENTS SAY THEY ARE CONCERNED ABOUT THE SAFETY OF THE MEDICAL CARE THEY AND THEIR FAMILIES RECEIVE AND MORE THAN HALF PERCENT SAY THEY ARE DISSATISlED WITH THE QUALITY OF
SGD ãPT @KHSXãK@MCRB@OD
)T IS REMARKABLE HOW MUCH CONSUMERS CAN ACHIEVE WHO ARE WILLING TO TAKE AN ACTIVE ROLE IN THEIR CARE &URTHER PUBLIC REPORTING OF INFORMATION ON QUALITY AND COSTS WHAT WE OFTEN REFER TO AS TRANS
ACHIEVE PATIENT CENTEREDNESS THE RESULT WOULD BE EFlCIENCIES IN HEALTHCARE DELIVERY BETTER PATIENT PROVIDER RELATIONSHIPS IMPROVED PATIENT OUTCOMES AND HIGHER PATIENT SATISFACTION OVERALL .2# 0ICKER LEVERAGES THE VOICE OF THE CONSUMER THROUGH ITS HOSPITAL PATIENT EXPERIENCE SURVEYS IN WHICH THE FOCUS IS ON IMPROVEMENT RATHER THAN MEASUREMENT .2# 0ICKER HAS IDENTIlED EIGHT DIMENSIONS OF CARE THAT MATTER MOST TO PATIENTS
PARENCY IS MAKING A BIG IMPACT
%MOTIONAL 3UPPORT 0HYSICAL #OMFORT 0ATIENTS 0REFERENCES )NFORMATION AND %DUCATION #ONTINUITY AND 4RANSITION &AMILY AND &RIENDS #OORDINATION OF #ARE !CCESS TO #ARE
HEALTHCARE IN THIS COUNTRY;= !LTHOUGH MOST CONSUMERS STILL RELY ON WORD OF MOUTH FOR HEALTHCARE DECISIONS PERCENT OF ADULTS WHO USE THE )NTERNET LOOK FOR HEALTHCARE INFORMATION AT SOME TIME OR ANOTHER A PERCENT INCREASE FROM 4HE VAST MAJORITY OF CONSUMERS VIEW RESULTS OF THEIR ONLINE HEALTH INFORMATION SEARCHES AS SUCCESSFUL PERCENT AND RELIABLE PERCENT ;= !ND INCREASINGLY PERSONAL REFERRALS AND GENERAL HEALTH CONTENT ARE BEING SUPPLEMENTED WITH PUBLIC REPORTING OF PERFORMANCE METRICS FOR PHYSICIANS AND HOSPITALS IN THE FORM OF hREPORT CARDSv /R IN MANY CASES PATIENTS LOOK UP THEIR PRESCRIPTIONS ONLINE AFTER THEY GET HOME FROM THE PHYSICIANS OFlCE
4HE %RA OF 4RANSPARENCY 7ITH THE ADVENT OF CONSUMERISM AND PATIENT ACTIVATION COLLABORATIVE GROUPS ACROSS THE HEALTHCARE SPECTRUM ARE PUSHING FOR MORE TRANSPARENCY OF INFORMATION FROM HOSPITALS AND PHYSICIANS SO CONSUMERS CAN MAKE INFORMED DECISIONS AND DEMAND QUALITY AT EVERY DOOR n EMERGENCY ROOM PHYSICIANS OFlCE SURGERY CENTER AND PHARMACY !CCORDING TO A SURVEY CONDUCTED BY THE +AISER &AMILY &OUNDATION PERCENT OF THE POPULATION HAS SEEN COMPARATIVE INFORMATION REGARDING HEALTH PLANS HOSPITALS OR DOCTORS .INETEEN PERCENT REPORT ACTUALLY UTILIZING THE INFORMATION TO MAKE HEALTHCARE DECISIONS;= !LTHOUGH THESE NUMBERS MAY SEEM INSIGNIlCANT JUST FOUR YEARS EARLIER IN A SIMILAR STUDY CONDUCTED BY THE FOUNDATION ONLY PERCENT HAD UTILIZED SOME TYPE OF QUALITY INDICATOR ON WHICH TO BASE A HEALTH RELATED DECISION;= -ARIBETH 3HANNON DIRECTOR OF THE HOSPITALS AND NURSING HOMES PROGRAM AT THE #ALIFORNIA (EALTH#ARE &OUNDATION PREDICTS THAT hTHE THREAT OF CONSUMER ENGAGEMENT AND SHEDDING LIGHT ON PERFORMANCE WILL MOTIVATE THE HEALTH SYSTEM TO CHANGE ITSELF 0UBLIC REPORTING WILL BE A STICK FOR PROVIDERS THAT DONT DO WELL BUT A CARROT FOR THOSE THAT DOv #AROLYN - #LANCY -$ DIRECTOR OF THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21 AGREES THAT h)T IS REMARKABLE HOW MUCH CONSUMERS CAN ACHIEVE WHO ARE WILLING TO TAKE AN ACTIVE ROLE IN THEIR CARE &URTHER PUBLIC REPORTING OF INFORMATION ON QUALITY AND COSTS n WHAT WE OFTEN REFER TO AS TRANSPARENCY n IS MAKING A BIG IMPACTv !(21 IS WORKING TO ENGAGE CONSUMERS AND IS PROMOTING SPECIlC STEPS FOR HOSPITAL PATIENTS TO GET SAFER CARE SUCH AS BRINGING A FAMILY MEMBER AND A LIST OF MEDICATIONS 7HILE MORE HEALTHCARE CONTENT IS READILY AVAILABLE A CONSUMERS IDEA OF QUALITY VARIES WITH EACH HEALTHCARE EXPERIENCE 4O TRULY
!CHIEVING 1UALITY 7ITH ALL OF THE VARYING STAKEHOLDERS AND THE MANY PERSPECTIVES ON QUALITY IT IS CLEAR THAT THE DRIVERS OF IMPROVEMENT LIKELY DIFFER ACROSS SECTORS $ESPITE THE COMPLEXITIES THAT MAY EMERGE FROM SO MANY VIEWPOINTS SUCH DIVERSITY CAN BREED INNOVATION AND SPAWN DEMONSTRATION PROJECTS THAT HELP DEFINE LEADING PRACTICES )N THIS SPIRIT MANY ORGANIZATIONS ARE IMPLEMENTING INNOVATIVE IMPROVEMENT PROJECTS ON A NATIONAL OR REGIONAL LEVEL TO MEET THE VARIED GOALS OF QUALITY ! FEW EXAMPLES INCLUDE )NSTITUTE FOR (EALTHCARE )MPROVEMENT )() n )() HELPS ACCELERATE CHANGE BY CULTIVATING PROMISING CONCEPTS FOR IMPROVING PATIENT CARE )TS ,IVES #AMPAIGN;= HAS ENLISTED MORE THAN HOSPITALS IN MAKING SIX CHANGES TO AVOID DEATHS OVER AN MONTH PERIOD 4HE SIX CHANGES ARE DEPLOY RAPID RESPONSE TEAMS AT THE lRST SIGN OF PATIENT DECLINE DELIVER RELIABLE EVIDENCE BASED CARE FOR ACUTE MYOCARDIAL INFARCTION TO PREVENT DEATHS FROM HEART ATTACK PREVENT ADVERSE DRUG EVENTS !$%S BY IMPLEMENTING MEDICATION RECONCILIATION DECREASE THE INCIDENCE OF CATHETER BLOODSTREAM INFECTIONS PREVENT SURGICAL SITE INFECTIONS BY RELIABLY DELIVERING SUCH THINGS AS THE CORRECT PERIOPERATIVE ANTIBIOTICS AT THE PROPER TIME AND PREVENT VENTILATOR ASSISTED PNEUMONIA 4HE CAMPAIGN HAS ALREADY EARNED NOTABLE SUCCESSES &OR EXAMPLE HOSPITALS THAT DEPLOY RAPID RESPONSE TEAMS n EXPERTS WHO CAN BE CALLED TO A PATIENTS BEDSIDE BY A NURSE OR ANY STAFF MEMBER WHO FEELS UNEASY ABOUT A PATIENTS CONDITION n HAVE SHOWN A SIGNIlCANT REDUCTION IN THE NUMBER OF hCODESv CALLED ON PATIENTS 4EAMS ARE LINKED THROUGH BEEPERS AND PHONES THAT HAVE A CODED BUTTON DIRECTED TO THE RAPID RESPONSE TEAM /N THE ISSUE OF !$%S HOSPITALS HAVE BEGUN TO IMPLEMENT MEDICAL RECONCILIATION SYSTEMS THAT COMBINE THE MEDICATION LIST AND ORDER SHEET INTO A SINGLE FORM TO AVOID DUPLICATION AND POTENTIAL ERRORS /NE SUCH HOSPITAL IMPLEMENTED THE
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGD ãPT @KHSXãK@MCRB@OD PROGRAM AND WATCHED ITS !$% RATE DROP FROM TO PER PATIENTS SELECTED;= !NOTHER SUCCESS HAS BEEN IN PREVENTING SURGICAL SITE INFECTIONS )N A YEAR LONG .ATIONAL 3URGICAL )NFECTION 0REVENTION 3)0 0ROJECT SPONSORED BY #-3 AND QUALITY IMPROVEMENT ORGANIZATIONS NATIONWIDE ENABLED HOSPITALS TO REDUCE THEIR INFECTION RATE BY PERCENT -ORE RECENTLY AN )() INITIATIVE COLLABORATIVE PRODUCED ENCOURAGING RESULTS;= +AISER &OUNDATION (EALTH 0LAN n "Y INTEGRATING INFORMATION TECHNOLOGY THE +0 (EALTH#ONNECT INITIATIVE HOPES TO IMPROVE QUALITY ELIMINATE INEFlCIENCIES AND ERRORS PROVIDE COMPLETE ACCESS TO UP TO THE MINUTE MEDICAL RECORDS IMPROVE THE DOCTOR PATIENT RELATIONSHIP AND ENHANCE THE ABILITY TO CONDUCT CLINICAL RESEARCH 4HE +0 (EALTH#ONNECT SYSTEM IS IN PLACE OR CURRENTLY BEING IMPLEMENTED IN ALL OF +AISER 0ERMANENTES EIGHT REGIONS +AISER 0ERMANENTES TWO LARGEST REGIONS .ORTHERN AND 3OUTHERN #ALIFORNIA ARE IMPLEMENTING THE SYSTEM FACILITY BY FACILITY AND WILL COMPLETE IMPLEMENTATION IN ;= )NDIANA (EALTH )NFORMATION %XCHANGE )()% n 4HIS NONPROlT COMPANY WAS FOUNDED BY A UNIQUE COLLABORATION TO CREATE A COMMON SECURE ELECTRONIC INFRASTRUCTURE THAT EXPANDS COMMUNICATION AND INFORMATION SHARING AMONG PARTICIPATING PROVIDERS HOSPITALS PUBLIC HEALTH ORGANIZATIONS AND OTHER HEALTH CARE ENTITIES 4HE EXCHANGE HAS BEEN ROLLING OUT A CLINICAL MESSAGING SERVICE TO PROVIDE ITS MEMBERSHIP WHICH INCLUDES COMMUNITY PHYSICIANS AT HOSPITALS WITH ELECTRONIC ACCESS TO PATHOLOGY LABORATORY RADIOLOGY AND ELECTROCARDIOGRAM REPORTS 4O DATE MORE THAN PERCENT OF THE REGIONS DOCTORS ARE RECEIVING REPORTS FROM THE CLINICAL MESSAGING SERVICE 4HE SERVICE COSTS BETWEEN AND CENTS TO SEND A MESSAGE COMPARED WITH CENTS PER MESSAGE USING THE OLD SYSTEM 4HE INFORMATION IS ALSO MADE AVAILABLE TO DOCTORS VIA AN )()% PORTAL;= #OUNCIL FOR !FFORDABLE 1UALITY (EALTHCARE #!1( n 4HIS HEALTH PLAN COALITION HAS FOCUSED ON TWO QUALITY INITIATIVES OVERUSE OF ANTIBIOTICS AND BETA BLOCKER COMPLIANCE AFTER HEART ATTACK )N ADDITION TO ESTABLISHING A SYSTEM TO MEASURE COMPLIANCE EACH INITIATIVE WAS SUPPORTED BY PROGRAM TOOL KITS AND MATERIALS TO EDUCATE VARIOUS CONSTITUENTS SUCH AS CONSUMERS AND EMPLOYERS 4HE CARDIAC MEASUREMENT EFFORT LED TO ITS INCLUSION AS A (EALTH 0LAN %MPLOYER $ATA AND )NFORMATION 3ET (%$)3 MEASURE !S A RESULT THE GROUP REPORTS A DECREASE IN OVERALL ANTIBIOTIC RATES FROM TO OF PERCENT FOR CHILDREN AND PERCENT FOR ADULTS 4HE RATE OF STREP TESTING IMPROVED BY PERCENT FOR CHILDREN AND PERCENT FOR ADULTS 4HESE TRENDS ARE MEANINGFUL IN RESOLVING ANTIBIOTIC UTILIZATION AND RESISTANCE ISSUES;= #ALIFORNIA (EALTH#ARE &OUNDATION n 4HE #ALIFORNIA (OSPITAL !SSESSMENT AND 2EPORTING 4ASKFORCE #(!24 WHICH IS LED BY RESEARCHERS AT THE 5NIVERSITY OF #ALIFORNIA 3AN &RANCISCOS )NSTITUTE FOR (EALTH 0OLICY 3TUDIES AND SUPPORTED BY THE #ALIFORNIA (EALTH#ARE &OUNDATION PRODUCES
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
A STATEWIDE REPORT CARD ON HOSPITAL PERFORMANCE AND QUALITY &IFTY HOSPITAL PERFORMANCE INDICATORS WERE COLLECTED IN AND IN SPECIlC CLINICAL AREAS SUCH AS CARDIAC CARE MATERNITY PNEUMONIA TREATMENT AND INTENSIVE CARE 4HEY ALSO INCLUDE HOSPITALWIDE OUTCOMES SUCH AS INFECTION CONTROL AND PATIENT EXPERIENCE 4HUS FAR MORE THAN HOSPITALS HAVE AGREED TO PARTICIPATE AND PAY THE COSTS OF DATA COLLECTION 4HE #(!24 IMPLEMENTATION PHASE BEGAN IN !UGUST WITH THE lRST PUBLIC REPORT CARD EXPECTED *UNE ;= )NNOVATION AND LEADING PRACTICES ARE ALSO IN PLACE AT THE GRASSROOTS LEVEL WHERE PATIENT INTERACTION IS DIRECT AND QUALITY IS PUT INTO PRACTICE AT THE POINT OF SERVICE OR DELIVERY !S ILLUSTRATED IN %XHIBIT THERE ARE MANY EXAMPLES OF HOW EACH OF THE )/-S SIX QUALITY AIMS CAN BE ACHIEVED WITHIN INDIVIDUAL HEALTH ORGANIZATIONS
-OVING !HEAD 2EGARDING THE FUTURE WHAT IS BEING DONE ABOUT TEACHING QUALITY TO MEDICAL STUDENTS INTERNS AND RESIDENTS $AVID " .ASH -$ -"! CHAIRMAN OF THE DEPARTMENT OF HEALTH POLICY AT *EFFERSON -EDICAL #OLLEGE OF 4HOMAS *EFFERSON 5NIVERSITY REPORTS THAT THE COLLEGE IS INTEGRATING QUALITY INTO THE CURRICULUM h7E HAVE AN ALL DAY CONFERENCE ON QUALITY FOR THE THIRD YEAR CLASS HAVE INCORPORATED A HEALTH POLICY ELECTIVE AND HAVE TOOLS EG #$S A WEBSITE AND BOOKS ON QUALITY GEARED TOWARDS STUDENTS )TS GREAT WHEN WE GET CONVERTSv !T (ARVARD -EDICAL 3CHOOL IN AN EFFORT TO BETTER TRAIN DOCTORS TO UNDERSTAND ILLNESS FROM THE PATIENTS PERSPECTIVE AND APPRECIATE HOW PATIENTS LIVES AND THE DISJOINTED HEALTHCARE SYSTEM COMPLICATE THEIR CARE THIRD YEAR MEDICAL STUDENTS WILL STAY IN ONE HOSPITAL AND FOLLOW SOME PATIENTS THE ENTIRE YEAR 3TUDENTS ALSO WILL BE REQUIRED TO TAKE ONE SEMESTER CLASSES ON THE EFFECT OF SOCIAL AND ECONOMIC CONDITIONS ON DISEASE MEDICAL ETHICS AND PROFESSIONALISM AND HEALTH POLICY;= 7ITH SO MUCH INNOVATION IN QUALITY SOME COMMON TRENDS ARE CLEARLY STARTING TO EMERGE 0UBLIC ACCOUNTABILITY -ORE TRANSPARENCY OF INFORMATION TO THE CONSUMER AND OTHER HEALTHCARE PROVIDERS IN THE FORM OF hREPORT CARDSv THAT PROlLE AND COMPARE THE PERFORMANCE OF PHYSICIANS AND HOSPITALS WITH WIDE DISSEMINATION AND PUBLIC AVAILABILITY 2EPORTING STANDARDS (OMOGENIZING PROCESS AND OUTCOME MEASURES TO STREAMLINE REPORTING REQUIREMENTS FOR HOSPITALS AND PHYSICIANS WHILE PROVIDING MEANINGFUL INFORMATION TO CONSUMERS IN ORDER TO MAKE RELIABLE HEALTHCARE DECISIONS %VIDENCED BASED MEASURES )NTEGRATING CLINICAL PRACTICE AND RESEARCH TO DEVELOP STANDARDIZED MEASURES THAT CONSIDER THE hREALITY OF PATIENT CAREv AND WHICH ONCE IMPLEMENTED WILL OPTIMIZE PATIENT OUTCOMES AND IMPROVE QUALITY #OLLABORATION )NTEREST GROUPS WORKING TOGETHER TO ADVANCE THE QUALITY AGENDA AND INCORPORATING EXPERTISE FROM VARIOUS HEALTHCARE SECTORS SPECIALTIES AND DISCIPLINES IN BOTH CLINICAL AND NONCLINICAL AREAS
SGD ãPT @KHSXãK@MCRB@OD %XHIBIT %XAMPLES OF THE )/-S 3IX 1UALITY !IMS IN !CTION 3AFE
. EW9ORK 0RESBYTERIAN (OSPITAL HAS A LARGE CENTRAL QUALITY ORGANIZATION WITHIN ITS BED SYSTEM /NE OF ITS QUALITY PROGRAMS IS A PAY FOR PERFORMANCE PROGRAM WITH AN INSURER WHEREBY CARDIAC DIABETES AND VASCULAR DISEASE PATIENTS RECEIVE PHARMACEUTICAL COUNSELING PRIOR TO DISCHARGE WITH THE GOAL OF RECONCILING DIFFERENT PRESCRIPTION ORDERS REDUCING MEDICAL ERRORS ASSOCIATED WITH MULTIPLE PROVIDERS PRESCRIBING AND FACILITATING ONGOING USE OF MEDICATIONS -ARY #OOPER -$ *$ VICE PRESIDENT AND CHIEF QUALITY OFlCER STATES THAT h7E SET ANNUAL GOALS AND HAVE A LOT OF FOCUS ON 2/) SO WE CAN OFTEN DEMONSTRATE BENElTS "UT EVEN BEYOND THE MEASURABLE RESULTS THERES A PERCEPTION AROUND THE HOSPITAL THAT THIS INITIATIVE WOULD BE GOOD TO OFFER TO EVERYONEv
%FFECTIVE
" LUE #ROSS AND "LUE 3HIELD OF -INNESOTA HAS SET UP CENTERS OF EXCELLENCE FOR HIGH RISK PROCEDURES EG BONE MARROW AND ORGAN TRANSPLANTS BARIATRIC CARDIAC SURGERIES AND TIERED PROVIDER NETWORKS 0ROVIDERS ARE SELECTED BASED ON COMPLICATION RATES AND COMPLIANCE WITH SPECIALTY SPECIlC STANDARDS OF CARE h4HERE ARE SOME THAT THINK THAT THE FUTURE WILL BE TRANSPARENCY ALONE AND THAT CONSUMERS WILL USE THE DATA TO GO WHERE THEY WANT v SAYS $AVID 7 0LOCHER -$ CHIEF MEDICAL OFlCER AND SENIOR VICE PRESIDENT FOR HEALTH MANAGEMENT AND INFORMATICS h"UT IT IS MORE THAN LIKELY THAT NETWORKS AND TIERING WILL REMAIN #ONSUMERS LIKE HAVING SOME ASSISTANCE IN EVALUATING QUALITY DATAv
0ATIENT #ENTERED
3 OME PROVIDERS ARE LETTING PATIENTS SCHEDULE TESTS AND VISITS ONLINE WHILE OTHERS ALLOW THEM TO VIEW MOST OF THEIR MEDICAL RECORD 4HOMAS ( ,EE -$ NETWORK PRESIDENT 0ARTNERS (EALTHCARE 3YSTEMS COMMENTS THAT PRACTICES SUCH AS THESE CAN BE hA TREMENDOUS PATIENT SATISlER /NCE THEYVE EXPERIENCED THIS THEYD NEVER GO BACK n NEVER LEAVE THE SYSTEMv
%FlCIENCY
!DVOCATE (EALTH 0ARTNERS CLINICAL INTEGRATION PROGRAM ALIGNS ITS INDEPENDENT COMMUNITY BASED PHYSICIANS EMPLOYED PHYSICIANS AND EIGHT HOSPITALS IN LEADING EDGE TECHNOLOGIES TO COORDINATE CARE DELIVERY 7ITH STRONG COMMITMENT FROM ITS BOARD !DVOCATE GOT NEARLY PERCENT OF PHYSICIANS TO INSTALL HIGH SPEED )NTERNET CONNECTIONS IN THEIR OFlCES STARTING FROM PERCENT IN !CCORDING TO ,EE " 3ACKS -$ h#LINICIANS MOVED PAST COMPLAINING AND RESISTANCE BECAUSE WE TOOK EACH COMPLAINT SERIOUSLY AND ADDRESSED IT 3OMETIMES IT WAS AS SIMPLE AS A TRAINING ISSUEv )N ADDITION TO HOSPITAL BASED SYSTEMS LIKE COMPUTERIZED PHYSICIAN ORDER ENTRY #0/% PHYSICIANS HAVE ELECTRONIC ACCESS TO PATIENT RECORDS LAB AND RADIOLOGY DATA AND DISCHARGE SUMMARIES AS WELL AS ADMINISTRATIVE FUNCTIONS SUCH AS ELIGIBILITY CHECKS AND REFERRALS
4IMELY
.ORTHBAY (EALTHCARE 3YSTEM IS ALSO AGGRESSIVELY TRACKING QUALITY !CCOUNTABILITY FOR QUALITY IS ENFORCED THROUGH THE MANDATORY REPORTING OF PATIENT SATISFACTION AND CORE CLINICAL MEASURES DIRECTLY TO THE BOARD 4O ACHIEVE THIS TRANSPARENCY AND PROVIDE MANAGERS AND CLINICIANS WITH TIMELY INFORMATION .ORTHBAY IS AUTOMATING ITS HOSPITAL OPERATIONS AND MEDICAL RECORDS STARTING WITH #0/% h/UR ORGANIZATION HAS THE RIGHT PERSPECTIVE ABOUT AUTOMATION 7E BELIEVE THAT ITS THE TOOL THAT MUST BE PUT IN PLACE TO ACHIEVE THE DESIRED OUTCOMES "UT ITS NOT JUST THE TECHNOLOGY THAT WILL MAKE IT WORK THERE NEEDS TO BE A CULTURE AND BEHAVIOR CHANGE v STATES 0AUL !LCALA VICE PRESIDENT AND CHIEF INFORMATION OFlCER 4HIS PROCESS IS DRIVEN BY INTEGRATED TEAMS THAT INCLUDE )4 AND END USERS
%QUITABLE
4HE QUALITY IMPROVEMENT PROGRAM AT #HILDRENS .ATIONAL -EDICAL #ENTER #.-# INCLUDES A RESEARCH AND DEVELOPMENT COMPONENT THAT HAS LOOKED AT EQUITY IN THE TREATMENT OF ASTHMA INCLUDING RACIAL DIFFERENCES IN PRESCRIBING PRACTICES AND CONFORMANCE WITH GUIDELINES FOR PATIENTS OF DIFFERENT RACES !NTHONY $ 3LONIM -$ $R0( EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS REMARKS THAT THE HOSPITAL hBENElTS BY IDENTIFYING OPPORTUNITIES TO IMPROVE THE CARE DELIVERED TO OUR PATIENTS AND WE WERE ABLE TO CONTRIBUTE TO THE LITERATURE TO SHARE OUR LEARNING 4HIS PROGRAM LOOKS AT HOW PRACTICES AT #.-# RELATE TO AND CAN INFORM NATIONAL PRACTICEv !DDITIONALLY #.-#S CARE DELIVERY FORUMS PROVIDE AN OPPORTUNITY FOR UNIT BASED CARE DELIVERY TEAMS COMPOSED OF A NURSE MANAGER AND A MEDICAL UNIT DIRECTOR TO GET TOGETHER TO SHARE THE WORK THEY ARE DOING AROUND QUALITY AND TO LEARN FROM EACH OTHER 3LONIM DESCRIBES THESE FORUMS AS hTHE MOST ENERGIZING MEETINGS OF THE WEEK WHERE QUALITY MOVES FROM BOARDROOM TO THE PATIENTSv
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGD ãPT @KHSXãK@MCRB@OD %XHIBIT )NDUSTRY !CHIEVEMENTS IN 1UALITY )NDUSTRY
!CHIEVEMENT
!UTOMOTIVE
7 HEN #ONSUMER 2EPORTS BEGAN RATING *APANESE CARS IN THE S !MERICAN CARMAKERS CONTROLLED MORE THAN PERCENT OF THE MARKET 3LOWLY THE HIGH RANKINGS OF *APANESE CARS STARTED TO ERODE THE MARKET SHARE ENJOYED BY 53 MANUFACTURERS "Y *APANESE CARS WHICH LED THE RATINGS IN TERMS OF VALUE HAD A PERCENT MARKET SHARE;=
%NTERTAINMENT
ILM CAMERAS WERE ONCE THE STANDARD FOR RECORDING AND TRANSMITTING MOVIE IMAGES 4HE STANDARD HAS & EVOLVED TO DISTRIBUTING MOVIES ON COMPUTER DISCS THROUGH DIGITAL MEANS AS OPPOSED TO OUTDATED lLM CANISTERS 4HIS METHOD IMPROVES THE PROJECTION OF lLM QUALITY WHILE PRESERVING THE RECORDED MATERIAL 4HIS REVOLUTION WILL ALSO REDUCE SHIPPING COSTS FOR THE lLM INDUSTRY BY AS MUCH AS BILLION PER YEAR;=
%LECTRIC 5TILITIES
IR POLLUTION CONTINUES TO BE AN ISSUE IN THE ELECTRIC UTILITY INDUSTRY %LECTRIC UTILITIES HAVE SPENT BILLIONS ! OF DOLLARS OVER THE PAST THREE DECADES TO IMPROVE AIR QUALITY )N ADDITION TO AIR QUALITY THE INDUSTRY ALSO SPENDS BILLION TO BILLION PER YEAR ON ENVIRONMENTAL BEST PRACTICES !PPROXIMATELY DIFFERENT TECHNOLOGIES ARE UTILIZED TO REMOVE OR HANDLE POLLUTION;=
!IRLINE
#ONSIDERING THE EFFECTS OF THE 3EPTEMBER ATTACKS ON THE INDUSTRY AIRLINES NEEDED TO STREAMLINE OPERATIONS IN ORDER TO STAY COMPETITIVE /NE SUCH VEHICLE FOR THIS REVITALIZATION IS THE 'LOBAL !IRLINE 1UALITY -ONITOR !1- 4HE !1- PROVIDES QUALITY MEASURES FOR ALL ASPECTS OF SERVICE TO ENSURE THAT QUALITY IS QUANTIlED ON A hSTAND ALONEv BASIS AND hCOMPETITIVE PERFORMANCEv 4HIS IS CRITICAL TO OBTAIN THE DEEPEST UNDERSTANDING AS TO WHERE STANDARDS CAN OR NEED TO BE IMPROVED;=
(OSPITALITY
UALITY DRIVES CONSUMER SATISFACTION AND SECURES MARKET SHARE IN THIS HIGHLY COMPETITIVE SATURATED 1 INDUSTRY #USTOMIZED SERVICE AND EFFECTIVENESS SURVEYS ARE EMPLOYED TO IDENTIFY AREAS OF IMPROVEMENT AND SATISFACTION TO DELIVER VALUE TO THE CONSUMER -ANY HOSPITALITY COMPANIES LINK MANAGERS SALARIES AND INCENTIVES TO THE RESULTS ON GUEST SATISFACTION RATINGS;=
#ONSUMER COMMUNICATION VIGOROUSLY PROMOTING HEALTH CARE LITERACY TO CONSUMERS AND PATIENTS IN A MANNER THAT IS TIMELY EASY TO UNDERSTAND ACCESSIBLE AND MEANINGFUL TO HELP THEM MAKE hINFORMEDv DECISIONS REGARDING NOT ONLY THEIR TREATMENT BUT WITH REGARD TO THE PROVIDERS THAT TREAT THEM 0ROPER INCENTIVES CREATIVELY DEVELOPING INCENTIVES EITHER lNANCIAL OR NONlNANCIAL FOR PHYSICIANS PAYERS AND PATIENTS THAT hREWARDv THE ACHIEVEMENT OF MEASUREMENT GOALS ANDOR CHANGED BEHAVIORS IN ORDER TO ACHIEVE DESIRED OUTCOMES AND IMPROVE QUALITY 4ECHNOLOGY LEVERAGING INFORMATION TECHNOLOGY TO BE THE ENABLER OF TRANSPARENCY AND TO AFFECT THE PROCESS OF CARE THROUGH ENHANCED CONNECTIVITY AND CONCATENATION OF DATA FROM DISPARATE SYSTEMS ON BROADER MORE ENTERPRISE LIKE SCALES EG PERSONAL HEALTH RECORDS OR COMMUNITYREGIONAL HEALTH INFORMATION EXCHANGES WHILE ENSURING DATA QUALITY INTEGRITY AND SECURITY )NNOVATION GIVES RISE TO TRENDS AND THE BEST TRENDS EVOLVE INTO PRACTICE 4HE REAL TEST FOR QUALITY OVER THE NEXT lVE TO YEARS IS TO BUILD A SUSTAINABLE FUTURE IN WHICH CONSENSUS IS ACHIEVED
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
AMONG ALL SECTORS TO RECOGNIZE NOT JUST WHAT QUALITY IS BUT ALSO ITS RELATION TO COST AND ULTIMATELY THE VALUE OF CARE DELIVERED )S IT POSSIBLE FOR HEALTH EXECUTIVES TO MOVE THE QUALITY NEEDLE #AN THERE REALLY BE A SUCCESSFUL WAY TO INTEGRATE AND IMPLEMENT THESE PRINCIPLES 4HE SHORT ANSWER IS YES THERE IS HOPE 0RIVATE INDUSTRY INCLUDING EXAMPLES DESCRIBED IN %XHIBIT HAS DEMONSTRATED HOW THE APPLICATION OF THESE PRINCIPLES CAN EQUATE TO TRANSPARENCY ACCOUNTABILITY AND RELIABLE DECISION MAKING ON BEHALF OF THE CONSUMER AND IMPROVED QUALITY OF SERVICE %NDNOTES 4HE (ISTORY OF 1UALITY n 'UILDS OF -EDIEVAL %UROPE !MERICAN 3OCIETY FOR 1UALITY HTTPWWWASQORGLEARN ABOUT QUALITYHISTORY OF QUALITY OVERVIEWGUILDSHTML #ROSSING THE 1UALITY #HASM 4HE )/- (EALTH #ARE 1UALITY )NITIATIVE HTTPWWWIOMEDU#-3ASPX !(#02 3TRATEGIC 0LAN !GENCY FOR (EALTH #ARE 0OLICY AND 2ESEARCH $ECEMBER HTTPWWWAHRQGOVABOUTSTRATPLN HTMSTRENGTHEN 3TATEMENT ON 1UALITY #ARE 4HE .ATIONAL 2OUNDTABLE ON (EALTH #ARE 1UALITY *ANUARY CONVENED BY THE )NSTITUTE OF -EDICINE A COMPONENT OF THE .ATIONAL !CADEMY OF 3CIENCES
SGD ãPT @KHSXãK@MCRB@OD .ATIONAL 3URVEY OF #ONSUMERS %XPERIENCES WITH 0ATIENT 3AFETY AND 1UALITY )NFORMATION .OVEMBER 4HE +AISER &AMILY &OUNDATION THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY AND THE (ARVARD 3CHOOL OF 0UBLIC (EALTH HTTPWWWKFFORGKAISERPOLLSUPLOAD .ATIONAL 3URVEY ON #ONSUMERS %XPERIENCES 7ITH 0ATIENT 3AFETY AND 1UALITY )NFORMATION 3URVEY 3UMMARY AND #HARTPACKPDF #YBERCHRONDRIACS UPDATE !UGUST 4HE (ARRIS 0OLL h&IVE YEARS AFTER )/- REPORT ON MEDICAL ERRORS NEARLY HALF OF ALL CONSUMERS WORRY ABOUT THE SAFETY OF THEIR HEALTH CARE v .OVEMBER +AISER &AMILY &OUNDATION HTTPWWWKFFORGKAISERPOLLS POMRNRCFM h.ATIONAL SURVEY ON !MERICANS AS HEALTH CONSUMERS !N UPDATE ON THE ROLE OF QUALITY INFORMATION v $ECEMBER +AISER &AMILY &OUNDATION HTTPWWWAHRQGOVDOWNLOADSPUBKFFSUMMARYPDF )NSTITUTE FOR (EALTHCARE )MPROVEMENT ,IVES #AMPAIGN HTTPWWWIHIORG)()0ROGRAMS#AMPAIGN !CCURACY AT %VERY 3TEP 4HE #HALLENGE OF -EDICATION 2ECONCILIATION HTTPWWWIHIORG)()4OPICS0ATIENT3AFETY-EDICATION3YSTEMS )MPROVEMENT3TORIES!CCURACYAT%VERY3TEPHTM 4HE 3TEPS TO 3AFER 3URGERY HTTPWWWIHIORG)()4OPICS0ATIENT3AFETY 3URGICAL3ITE)NFECTIONS)MPROVEMENT3TORIES4HE3TEPSTO3AFER3URGERYHTM 0RICEWATERHOUSE#OOPERS INTERVIEW WITH ,OUISE ,IANG -$ AND 2UTH "RENTARI +AISER 0ERMANENTE -AY
)NDIANA (EALTH .ET "REAKS .EW 'ROUND ON % RECORDS HTTPWWW COMPUTERWORLDCOMPRINTTHIS HTML -EASUREMENT 3TUDY %XECUTIVE 3UMMARY HTTPWWWCAQHORGSAS? MEMBERHTML #ALIFORNIA (OSPITAL !SSESSMENT AND 2EPORTING 4ASKFORCE HTTP WWWCHCFORGTOPICSHOSPITALSINDEXCFM ITEM)$ h,EARNING THE 0ATIENTS 6IEW (ARVARD !LTERS $OCTORS 4RAINING v -ARCH 4HE "OSTON 'LOBE (OUSE #OMMITTEE ON 7AYS AND -EANS STATEMENT OF 2EGINA % (ERZLINGER 0H$ AND .ANCY 2 -C0HERSON 0ROFESSOR (ARVARD "USINESS 3CHOOL "OSTON -ASS *UNE 4ESTIMONY "EFORE THE 3UBCOMMITTEE ON /VERSIGHT OF THE (OUSE #OMMITTEE ON 7AYS AND -EANS AVAILABLE AT HTTPWAYSANDMEANSHOUSEGOVHEARINGSASP FORM MODE VIEWID h$IGITAL 2EVOLUTION 4RANSFORMING %NTERTAINMENT )NDUSTRY SAYS &ILMMAKER v HTTPWWWADVANCEUCONNEDUHTM !DVANCED 4ECHNOLOGY HTTPWWWCAREENERGYCOMTECHNOLOGY UTILITYASP !IRLINE 1UALITY -ONITOR HTTPWWWAIRLINEQUALITYCOMMAINAQM? HTM -EASURING 3ERVICE 1UALITY #USTOMER 3ATISFACTION AND #USTOMER 6ALUE IN THE (OSPITALITY )NDUSTRY HTTPOLDFCSIASTATEEDUHRIMRESEARCH CUSTOMERVALUEASP
@4HE THING IS TO BE ABLE TO OUTLAST THE TRENDS n 0AUL !NKA SINGER SONGWRITER
@)T SEEMS WERE ALWAYS IN TRANSITION AND THAT ITS MORE ABOUT TRENDS THAN IT IS ABOUT WHATS MEANINGFUL n -ARLEE -ATLIN ACTRESS ADVOCATE
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1UALITY IN THE 0OST -ANAGED #ARE %RA )T WILL BE THE CHALLENGE OF THE NEXT SEVERAL DECADES TO KNIT TOGETHER COMPETING SERVICES ORGANIZATIONS AND STRATEGIES INTO A COHERENT ALIGNED SET OF PRINCIPLES THAT WILL TRULY DELIVER QUALITY IN HEALTHCARE "Y $ONALD &ETTEROLF -ATRIA (EALTHCARE @)F YOU WANT QUALITY ACT AS IF YOU ALREADY HAD IT n 7ILLIAM *AMES PHILOSOPHER
1
UALITY HAS BEEN DElNED BY MANY DIFFERENT PEOPLE IN MANY DIFFERENT WAYS INCLUDING CONFORMANCE TO GUIDELINES PATIENT SAFETY CONSUMER IDEALS COST EFFECTIVENESS AND ACCREDITATION ACHIEVEMENT;= .OTIONS ABOUT QUALITY HAVE ALSO CHANGED OVER TIME EVOLVING FROM EARLY hQUALITY ASSURANCEv ACTIVITIES TARGETING POOR SURGICAL OUTCOMES TO MORE CONTEMPORARY SOPHISTICATED APPROACHES OF hCONTINUOUS QUALITY IMPROVEMENT v BORROWING HEAVILY FROM INDUSTRIAL PRINCIPLES AND DEVELOPED WITH INPUT FROM THE EVIDENCE BASED MEDICAL LITERATURE 7ITH A LARGE NUMBER OF QUALITY EXPERTS AND INITIATIVES CURRENTLY IN THE MARKETPLACE IN MANY WAYS WE HAVE EXCEEDED OUR EARLY DREAMS OF MOVING THE QUALITY AGENDA FROM SMALL GROUPS OF EXPERTS INTO THE ENTIRE HEALTHCARE ENVIRONMENT /N THE OTHER HAND THIS PLETHORA OF QUALITY EXPERTS AND ORGANIZATIONS HAS LEFT A NUMBER OF PEOPLE WITH THE FEELING THAT THERE IS IN FACT ORGANIZATIONAL CHAOS AND THAT REAL FORWARD MOVEMENT IN THE PROGRESSION OF MEDICAL QUALITY IS BEING DILUTED OR MISDIRECTED BY THE MANY ORGANIZATIONS COMMITTED TO THAT PATH 7E MIGHT START WITH 7EBSTERS .EW 7ORLD $ICTIONARY DElNITION OF QUALITY WHICH VAGUELY IDENTIlES IT AS hANY OF THE FEATURES THAT MAKE SOMETHING WHAT IT IS CHARACTERISTIC ELEMENT ATTRIBUTEv OR MORE DIRECTLY hTHE DEGREE OF EXCELLENCE WHICH A THING POSSESSESv;= $ElNITIONS OF MEDICAL QUALITY CAN BE EQUALLY VAGUE AND RANGE WIDELY DEPENDING ON THE PERSPECTIVE OF THE INDIVIDUAL OR ORGANIZATION DElNING IT
0AST 'ENERATIONS OF 1UALITY )T IS HELPFUL TO CONSIDER HOW CONCEPTS OF QUALITY IN MEDICINE HAVE EVOLVED OVER THE PAST OR YEARS SEE %XHIBIT )NITIALLY THE hlRST GENERATIONv OF QUALITY WAS LARGELY INSPECTION DRIVEN AND FOCUSED ON SENTINEL EVENT MONITORING ADVERSE OCCURRENCE MONITORING AND PHYSICIAN AND INSTITUTIONAL CREDENTIALING .OON
CONFERENCES WERE HELD AFTER A PATIENT HAD DIED AND FACULTY IN LARGE MEDICAL SCHOOLS QUIZZED THE INTERN AND RESIDENTS AS TO WHAT THEY THOUGHT HAD OCCURRED !T THE INSTITUTIONAL LEVEL ACCREDITATION IN ITS EARLY FORM FOCUSED ON THE ORGANIZATIONS PERFORMANCE OF INSPECTION TYPE ACTIVITIES AND DOCUMENTATION THAT PROCESS ADEQUACY WAS IN PLACE 4HROUGH THE EARLY S A hSECOND GENERATIONv OF QUALITY CAME TO THE FOREFRONT AS AN ERA OCCURRED WHICH EMPHASIZED STATISTICAL QUALITY CONTROL MEASURES BORROWED FROM SIMILAR DEVELOPMENTS IN THE MANUFACTURING ENVIRONMENT 1UALITY GURUS $EMING AND *URAN ;= AS THE EARLY GODS OF INDUSTRIAL QUALITY MANAGEMENT SYSTEMS BECAME HOUSEHOLD NAMES IN HOSPITAL AND QUALITY SYSTEMS 4HOUGHTS ON WHAT QUALITY MIGHT BE IN THE HEALTHCARE ARENA WERE DElNED BY !VEDIS $ONABEDIAN WHO DEVELOPED THE EARLY PHILOSOPHY FOR MEDICAL QUALITY EXPERTS AND 0HILLIP #ROSBY ;= WHO DElNED IT AS CONFORMANCE TO REQUIREMENTS )N THIS PERIOD DIAGNOSIS SPECIlC VARIATIONS IN CARE WERE NOTED AND STUDIED $ETAILED STATISTICS FOR ADMISSION RATES SURGICAL OUTCOMES AND PHARMACEUTICAL PROlLING WERE COMPILED AND ANALYZED FROM NEWLY DEVELOPED DATA INFORMATION WAREHOUSES 3TATISTICS WERE CALCULATED TRENDED AND NOTED WITH RESPECT TO THEIR AVERAGE STANDARD DEVIATION AND ABILITY TO DElNE A NORMAL hBELL CURVEv s)N THE LATE S AND EARLY S A hTHIRD GENERATIONv OF QUALITY BEGAN TO EMERGE AS INDIVIDUALS FACED WITH COMPLEX STATISTICAL PROCESS ANALYSIS WERE REPEATEDLY ASKED TO DElNE WHAT GIVEN THE VARIATION THE CORRECT OUTCOMES SHOULD BE $AVID %DDY DElNED MANY OF THE EARLY (%$)3 QUALITY INDICATORS ON THE BASIS OF THEIR ATTRIBUTES OF RELEVANCE REPRODUCIBILITY FACE VALIDITY AND OTHER SIMILAR CHARACTERISTICS $URING THIS TIME AND AS A RESULT OF THOSE QUESTIONS QUALITY WORKERS BEGAN TO CONSIDER A BROADER DElNITION OF QUALITY OUTSIDE STATISTICAL ANALYSIS OF MEDICAL CLAIMS DATA TO INCLUDE PATIENT SATISFACTION INSTRUMENTS LINKAGES
$ONALD &ETTEROLF -$ -"! IS A &ELLOW IN THE !MERICAN #OLLEGE OF 0HYSICIANS THE !MERICAN #OLLEGE OF 0HYSICIAN %XECUTIVES THE !MERICAN #OLLEGE OF -EDICAL 1UALITY AND THE !CADEMY OF (EALTHCARE -ANAGEMENT (E IS ON THE BOARD OF DIRECTORS OF THE $ISEASE -ANAGEMENT !SSOCIATION OF !MERICAN $-!! AND IS VICE PRESIDENT OF THE !MERICAN #OLLEGE OF -EDICAL 1UALITY $R &ETTEROLF IS CURRENTLY CORPORATE VICE PRESIDENT FOR (EALTH )NTELLIGENCE AT -ATRIA (EALTHCARE )NC A LARGE DISEASE MANAGEMENT ORGANIZATION BASED IN !TLANTA WITH OPERATIONS THROUGHOUT THE 5NITED 3TATES (E CAN BE REACHED AT DON?FETTEROLF MATRIACOM
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
P T@K HSXãHMãSGD ãONRS L @M@FD C B@QD ãD Q@
TO DISABILITY AND ABSENTEEISM RISK INTERVENTION ANALYSIS AND PREVENTIVE SERVICE SATISFACTION 7HILE ALL OF THESE ACTIVITIES HAD BEEN PRESENT BEFORE IT WAS ATTEMPTS TO QUANTIFY AND IMPROVE THEM IN AN ORGANIZED WAY THAT WERE AMONG THE THINGS THAT MANAGED CARE SOUGHT TO BRING TO THE TABLE TO IMPROVE THE QUALITY OF CARE FOR HEALTH PLAN PARTICIPANTS AS WELL AS REDUCE THEIR OVERALL COSTS /UTCOME MEASURES INCLUDED CONVENTIONAL MEDICAL OUTCOMES FUNCTIONAL STATUS AND WELL BEING HEALTH RISK APPRAISAL ANALYSIS SMALL AREA ANALYSIS AND ULTIMATELY THE LINKAGE WITH PREVIOUS WORK ON COSTS THROUGH VARIOUS ITERATIONS AND MODIlCATIONS OF COST EFFECTIVENESS ANALYSIS
)NTO THE 0RESENT $AY )N THE MID S THIS ATTEMPT TO INTEGRATE BROADER GOALS IMPROVE OUTCOMES AND BUILD ANALYTICS SLID IMPERCEPTIBLY TO THE hFOURTH GENERATIONv OF BIG MANAGEMENT SYSTEMS SEE %XHIBIT )F ANALYTICS ARE THE ANSWER TO HEALTHCARE THEN LARGER NUMBERS AND BIGGER SYSTEMS SEEM TO BE THE METHOD FOR DOING SO h)NTEGRATED DELIVERY SYSTEMSv WERE ALL THE RAGE AS CONSULTANTS IN THAT PERIOD DROVE TO CREATE LARGE MULTISPECIALTY GROUP PRACTICES hCOMMUNITY HEALTH INFORMATION NETWORKSv AND OTHER LARGE DATA DRIVEN MANAGEMENT
SYSTEMS TO BETTER INTEGRATE THE DELIVERY SYSTEM AND LINK PHYSICIANS HOSPITALS COMPANIES AND INDIVIDUALS &OR A VARIETY OF REASONS THIS ERA HAS NOT SEEMED TO FULlLL ITS PROMISED EVOLUTION OR WIDELY PREDICTED OUTCOMES BUT TRACES REMAIN !S THESE LARGE ORGANIZATIONS CONTINUED TO ATTEMPT TO EVOLVE AND ORGANIZE CONCERN ON THE PART OF BUSINESS AND PUBLIC ORGANIZATIONS ALSO LED TO THE EVOLUTION OF A LARGE NUMBER OF GOVERNMENTAL AND PSEUDO GOVERNMENTAL ORGANIZATIONS FOCUSED ON EVALUATING THE MANAGEMENT OF THESE PROGRAMS /RGANIZATIONS WERE ENCOURAGED TO OFFER OVERSIGHT PROTECTION FROM POTENTIAL OR FEARED MISDIRECTION OF MANAGEMENT OVER INDIVIDUAL AUTONOMY OR INFORMATION CONlDENTIALITY ,ARGE GOVERNMENT ORGANIZATIONS INCLUDING #-3 !(21 AND STATE DEPARTMENTS OF HEALTH AND INSURANCE EMERGED TO VOICE THEIR OPINIONS 1UASI GOVERNMENTAL PARTICIPATION BY THE )NSTITUTE OF -EDICINE THE .ATIONAL 1UALITY &ORUM AND 02/ AND 1)/ ORGANIZATIONS WERE NOTED AS WELL !CCREDITATION BUREAUCRACIES GREW DRAMATICALLY IN STRENGTH AND INmUENCE AND EXTENDED THEIR INTEREST FROM THEIR CORE FUNCTIONS TO INCLUDE ALL ASPECTS OF HEALTHCARE DELIVERY 4HE *#!(/ .#1! 52!# AND !!(# ORGANIZATIONS BRANCHED BROADLY AND DEVELOPED CONSIDERABLE PSEUDO GOVERNMENTAL STRENGTH IN THE MARKETPLACE AS PURVEYORS
%XHIBIT 4HE 'ENERATIONS OF 1UALITY n S TO %ARLY S 'ENERATION
&OCUS
!TTRIBUTES
&IRST 'ENERATION CIRCA S
)NSPECTION
s 0HYSICIAN INSTITUTIONAL CREDENTIALING s 0ROCEDURE SPECIlC CREDENTIALING s 3ENTINEL EVENT MONITORING s 5-1) TECHNOLOGY ASSESSMENT PROCESS ADEQUACY s !DVERSE OCCURRENCE MONITORING s %XTERNAL ACCREDITATION
3ECOND 'ENERATION CIRCA S
3TATISTICAL 1UALITY #ONTROL
s $IAGNOSIS SPECIlC ADMISSIONS VARIATIONS s 4ARGETED SURGICAL VARIATIONS s 4ARGETED AMBULATORY SURGERY VARIATIONS s 0HYSICIAN STATISTICAL COSTMORTALITY PROlLING s 0HARMACEUTICAL PROlLING
4HIRD 'ENERATION CIRCA LATE S EARLY S
/UTCOME -EASURES
s 3ELECTED CLAIMS BASED OUTCOMES s 0ATIENT SATISFACTION INSTRUMENTS s #LINICAL OUTCOMES MEASURES s 0REVENTIVE SERVICE STANDARD SATISFACTION s $ISEASE SPECIlC PATIENT PERCEPTIONS s ,INKAGE TO DISABILITYABSENTEEISM s ,IFE EVENT RISK INTERVENTION ANALYSIS
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXãHMãSGD ãONRS L @M@FD C B@QD ãD Q@ %XHIBIT 4HE 'ENERATIONS OF 1UALITY n ,ATE S TO 0RESENT 'ENERATION
&OCUS
!TTRIBUTES
&OURTH 'ENERATION CIRCA MID S
-ANAGEMENT 3YSTEMS
,ARGE HEALTHCARE SYSTEMS s )NTEGRATED CARE MANAGEMENT DELIVERY SYSTEMS s -ULTISPECIALTY GROUP PRACTICE s 0(/ 0(#/ )0! #(). AND OTHERS .EW METHODS TOOLS AND CONCEPTS s $ATA DRIVEN INFORMATION SYSTEMS s 3TATISTICAL QUALITY CONTROL SHIFTING THE BELL CURVE #OMPARING ACROSS PLANS HOSPITALS COMPANIES AND INDIVIDUALS s "EST PRACTICE ANALYSIS s $ECISION SUPPORT TOOLS
&IFTH 'ENERATION 0RESENT
0OST -ANAGED #ARE
'OVERNMENT AGENCY PARTICIPATION s #-3 !(21 0SEUDO GOVERNMENTAL PARTICIPATION s .1& )/- 02/S 1)/S !CCREDITATION BUREAUCRACIES s *#!(/ 52!# .#1! !!!(# )NTEGRATED CARE MANAGEMENT DELIVERY SYSTEMS s 0(/ 0(#/ )0! #(). AND OTHERS s (EALTH PLANS (-/S GROUP PRACTICE /THER PLAYERS
OF THE PROPER METHOD OF HEALTHCARE DELIVERY IN THIS hlFTH GENERATIONv OF QUALITY IMPROVEMENT EVOLUTION
! #LUTTERED ,ANDSCAPE @1UALITY IS NEVER AN ACCIDENT IT IS ALWAYS THE RESULT OF INTELLIGENT EFFORT n *OHN 2USKIN AUTHOR POET ARTIST )N THE POST MANAGED CARE ERA WE NOW lND OURSELVES IN A POSITION OF BOTH VICTORY AND UNCERTAINTY #LEARLY DUE TO THE EVOLUTION OF THESE LARGE ORGANIZATIONS THE SYSTEMATIC DELIVERY OF THE QUALITY MESSAGE IS FAR IN EXCESS OF WHAT WAS CONCEIVED BY INDIVIDUAL PROPONENTS OF THE QUALITY MOVEMENT OR YEARS AGO 4HE MESSAGE OF THE IMPORTANCE OF QUALITY HAS BEEN PERVASIVE THROUGHOUT THE HEALTHCARE SYSTEM YET IN MANY WAYS INDIVIDUALS AND ORGANIZATIONS FEEL FRUSTRATED THAT MORE PROGRESS HASNT BEEN MADE 4HERE ARE MANY SELF PROCLAIMED LEADERS OF THE MOVEMENT SOMETIMES WITH CONmICTING GOALS AND DIRECTIONS %XHIBIT ILLUSTRATES A LIST OF ORGANIZATIONS CLAIMING AUTHORITY IN QUALITY AND REPRESENTS A SERIES OF THREE AND FOUR LETTER ACRONYMS THAT COULD GO ON FOR PAGES
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
3PECIlC APPROACHES TO QUALITY HAVE BECOME SPECIALIZED EACH ACQUIRING THEIR OWN FOLLOWING AND TENETS WITH AN INTENSITY SOME HAVE LIKENED TO A CULT &OR EXAMPLE OFTEN WITHIN HEALTH PLANS THE DIRECTOR OF QUALITY BELIEVES HE IS THE ONLY INDIVIDUAL WHO CAN INTERPRET THE LARGE VOLUMES OF QUALITY DIRECTIVES ISSUED BY THE .#1! )T FOLLOWS THAT HEALTH PLANS FACE CLAIMS FROM BENElT MANAGEMENT CONSULTANTS THAT THEIR PROPOSALS DElNE TRUE QUALITY hBEYOND (%$)3v )N ADDITION 3IX 3IGMA PROGRAMS CAN ONLY BE SUPERVISED BY BLACK BELT SPECIALISTS WHO CARRY A UNIQUE SET OF KNOWLEDGE AND TOOLS TO HELP AN ORGANIZATION OPTIMIZE ITS POTENTIAL 3IMILARLY LEADERS CAN BE FOUND IN THE AUTOMOTIVE INDUSTRYS PRODUCTION PROGRAMS DRIVING )3/ CONFORMANCE AND (OSHIN PROCESS PLANNING A METHOD OF STRATEGIC AND OPERATIONAL PLANNING DEVELOPED AND RElNED IN *APAN %ACH OF THE LARGE MAJOR ORGANIZATIONS HAS A LISTING OF hPRIORITY CONDITIONSv 4HE .ATIONAL 1UALITY &ORUM n WITH MEMBER ORGANIZATIONS PLUS OR MINUS n HAS ITS OWN SERIES OF hPRIORITY CONDITIONSv AND OVER hPRIORITY SAFE PRACTICESv WHICH COMPLEMENT BUT DO NOT LINE UP DIRECTLY WITH THE !(21 LIST OF PRIORITY CONDITIONS PRIORITY INDICATORS ETC "USINESS ORGANIZATIONS INCLUDING 4HE ,EAPFROG 'ROUP SIMILARLY HAVE LISTS OF PRIORITY ISSUES TYPES OF MEASURES AND SO ON
P T@K HSXãHMãSGD ãONRS L @M@FD C B@QD ãD Q@ %XHIBIT ,IST OF /RGANIZATIONS &OCUSING ON (EALTHCARE 1UALITY &EDERAL
0UBLIC 0RIVATE
&OUNDATIONS
!GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21
!MBULATORY #ARE 1UALITY !LLIANCE !1!
+AISER &AMILY &OUNDATION
#ENTERS FOR $ISEASE #ONTROL #$#
!MERICAN #OLLEGE OF -EDICAL 1UALITY !#-1
+ELLOGG &OUNDATION
#ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3
!MERICAN (EALTH 1UALITY !SSOCIATION !(1!
2OBERT 7OOD *OHNSON &OUNDATION
.ATIONAL )NSTITUTES OF (EALTH .)(
!SSOCIATION OF (EALTH )NSURANCE 0LANS !()0
4HE #OMMONWEALTH &UND
53 $EPARTMENT OF (EALTH (UMAN 3ERVICES $((3
&OUNDATION FOR !CCOUNTABILITY &!!#4 SUNSET
/THER 'ROUPS
6ETERANS (EALTH !DMINISTRATION 6(!
)NSTITUTE FOR #LINICAL 3YSTEMS )MPROVEMENT )#3)
"USINESS COALITIONS
0HYSICIAN 3PECIALTY 'ROUPS #ONSORTIUMS
)NSTITUTE FOR (EALTHCARE )MPROVEMENT )()
(EALTHCARE CONSULTING lRMS BOUTIQUE AND LARGE
!MERICAN !CADEMY OF &AMILY 0HYSICIANS !!&0
*OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS *#!(/
%MPLOYERS AND LABOR UNIONS
!MERICAN "OARD OF 1UALITY !SSURANCE AND 5TILIZATION 2EVIEW 0HYSICIANS !"1!520
4HE ,EAPFROG 'ROUP
(EALTH INSURERS
!MERICAN #OLLEGE OF 0HYSICIANS !#0
.ATIONAL !SSOCIATION OF #HILDRENS (OSPITALS .!#(
(OSPITALS AND HEALTH SYSTEMS
!MERICAN "OARD OF -EDICAL 3PECIALTIES !"-
.ATIONAL !CADEMY OF 3CIENCES )NSTITUTE OF -EDICINE )/-
0ATIENT ADVOCACY GROUPS
!MERICAN -EDICAL !SSOCIATION n 0HYSICIAN #ONSORTIUM ON 0ERFORMANCE )MPROVEMENT !-!
.ATIONAL "USINESS 'ROUP ON (EALTH
0HARMACEUTICAL COMPANIES
.ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1!
/THER MEDICAL SPECIALTY ASSOCIATIONS !(! !##
.ATIONAL )NITIATIVE FOR #HILDRENS (EALTHCARE 1UALITY .)#(1
,IFE SCIENCES BIOTECHNOLOGY
.ATIONAL 1UALITY &ORUM .1& n .ATIONAL #OMMITTEE FOR 1UALITY (EALTH #ARE .#1(#
,OCALREGIONAL COLLABORATIVES AND COALITIONS
5TILIZATION 2EVIEW !CCREDITATION #OMMISSION 52!#
3URVEY RESEARCH ENTITIES .2# 0ICKER 0RESS 'ANEY
4ECHNOLOGY VENDORS
5NIVERSITIES MEDICAL SCHOOLS SCHOOLS OF PUBLIC HEALTH
4HE NEXT GENERATION IN THE EVOLUTION OF QUALITY WILL NEED TO ADDRESS MANY OF THESE ISSUES 4HERE IS A CACOPHONY OF PLAYERS WITH MANY GURUS IN MANY ORGANIZATIONS AND INTERORGANIZATIONAL POLITICAL STRESSES AROUND WHO WILL DOMINATE VARIOUS QUALITY hSPACESv /FTENTIMES IF YOU SCAN THE BOARDS OF DIRECTORS OF THESE ORGANIZATIONS YOULL SEE THE SAME CAST 7ITH SO MUCH DISSONANCE THERE IS WIDE REACHING CONCERN ABOUT THE REAL IMPACT OF ALL OF THE
EFFORTS OF QUALITY WHICH SEEM IN MANY QUARTERS TO FAIL DESPITE ALL OF THE EFFORT DIRECTED THAT WAY 4HE )/- REPORTS ARE THE BEACONS OF HOPE TO HELP OBJECTIFY THE NEED TO CREATE ORDER FROM THIS DISARRAY 4HE NEXT GENERATION OF QUALITY MUST DElNE AND PRIORITIZE AREAS THAT ARE WORTH PURSUING AND THOSE WHICH ARE NOT !S SCARCITY OF HEALTHCARE RESOURCES AND AN INCREASING POPULATION CONTINUOUSLY STRESS THE HEALTHCARE
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXãHMãSGD ãONRS L @M@FD C B@QD ãD Q@ DELIVERY SYSTEM COST EFFECTIVENESS ANALYSIS WILL EMERGE AS A DRIVING PRINCIPLE BEHIND MEDICAL CARE DELIVERY AND THE FOCUS ON QUALITY &INALLY THE DILUTIONAL EFFECTS OF MULTIPLE ONGOING ACTIVITIES n ALL CLAIMING PRIORITY AND IMPORTANCE n WILL NEED TO BE SORTED OUT BY INDIVIDUALS WORKING IN THE QUALITY lELD 0AY FOR PERFORMANCE ELECTRONIC MEDICAL RECORDS PATIENT SAFETY EMPLOYER COALITION DESIRES CONSUMERISM HIGH DEDUCTIBLE HEALTH PLANS AND THE SHIFT OF BENElT DESIGNS AND RISING MULTICULTURALISM WILL PROVE IMPORTANT VECTORS IN MOVEMENT OF THE QUALITY INITIATIVE IN THE EARLY ST CENTURY
1UALITY AS A MOVEMENT HAS IMPROVED IN MANY AREAS BUT CHANGE TAKES TIME AND PERFECTION TAKES AN ETERNITY 4HE 53 GOVERNMENT AS A VERY IMPORTANT CENTRALIZING AND UNIFYING FORCE HAS EMERGED AS A MAJOR PLAYER AND MAY BE THE ULTIMATE MODEL OF QUALITY WITH THE VARIOUS INITIATIVES THAT ARE EMANATING FROM #-3 'OVERNMENT WILL NEED TO CONTINUE TO BE INTERESTED AND INVESTED IN ORDER FOR STANDARDIZATION TO OCCUR -OST FUTURISTS PREDICT THAT #-3 SPECIlCALLY THE -EDICARE PROGRAM WILL DO MORE IN THE DIRECTION OF ORGANIZING THE QUALITY EFFORTS OF THE NATION AND IN PUBLIC REPORTING OF OUTCOMES AS TRANSPARENCY IS ON THE RISE (EALTH PLANS FACED WITH THE OVERWHELMING NEED FOR CONSUMERISM SEEMED TO BE MOVING TOWARD BECOMING lNANCIAL SERVICE COMPANIES WHILE AT THE SAME TIME FUNCTIONING AS DEVELOPERS AND SUPPORTERS OF QUALITY IN CONSUMERIST PROGRAMS &URTHER IMPROVEMENT IN HEALTHCARE QUALITY IS POSSIBLE /VER THE hNEXT GENERATION v QUALITY WILL NEED TO BE BETTER DElNED PERHAPS AS hVALUEv AND HOW IT IS MEASURED IN TERMS THAT ARE RELEVANT TO THE PATIENT 1UALITY WILL EMPHASIZE ACCESS AND AVAILABILITY OF SERVICES AS WELL AS MORE SOPHISTICATED CONCEPTS AS PURCHASERS OF HEALTHCARE SERVICES FURTHER UNDERSTAND THE IMPORTANCE OF CLINICAL OUTCOMES AND IMPROVED FUNCTIONING OF PATIENTS &URTHERMORE QUALITY INITIATIVES THAT DEMONSTRATE SUSTAINED CLINICAL IMPROVEMENTS WILL NARROW THE GAP BETWEEN RESEARCH AND APPLICATION AND CAN POTENTIALLY OPTIMIZE COSTS )MPROVED PATIENT FUNCTION AS MEASURED BY FUNCTIONAL STATUS AND HEALTH RISK SURVEYS CORRELATE WITH BETTER QUALITY OF LIFE AND IMPROVED WORKFORCE CAPABILITIES .EW MEASURES OF QUALITY ARE AND WILL ALMOST CERTAINLY CHANGE THE APPROACHES OF THE HEALTHCARE INDUSTRY IN CREATING THEM 7E ARE ALREADY SEEING SHIFTS IN THE COMPLEXITY AND SERVICES
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
OF DISEASE MANAGEMENT COMPANIES TO INCLUDE ADVANCED INFORMATICS CAPABILITIES (EALTH PLANS AND DISEASE MANAGEMENT COMPANIES ARE ALSO LOOKING TO DEVELOP A BROADER hWHOLE LIFEv HEALTH ENHANCEMENT APPROACH TO THEIR SERVICE OFFERINGS AS IT BECOMES CLEAR THAT THE TOTAL ECONOMIC COST OF HEALTHCARE IN THE POPULATION CAN BE MANAGED BETTER BY UNDERSTANDING THE HEALTHY AS WELL AS THE SICK SPECTRUM OF THE POPULATION -ORE EMPHASIS ON PREVENTIVE CARE ON A SELF DIRECTED CONSUMER APPROACH TO HEALTH RISK AND SIMILAR CURRENT TRENDS ARE CREATING SIGNIlCANT CORPORATE STRUCTURE AND PRODUCT DESIGN CHANGES
0REPARING FOR THE &UTURE 7HAT SHOULD WE DO )T IS DIFlCULT NOT TO LOSE THE FOREST FOR THE TREES 7E SHOULD NOT CONFUSE MARKET TRENDS OR BUZZ GENERATED BY THIS YEARS EXPERTS WITH WHAT IS CORRECT IN THE APPLICATION OF BASIC PRINCIPLES IN QUALITY MANAGEMENT WHERE THEY STILL WORK 1UALITY AS A MOVEMENT IS NOT DEAD )T HAS IMPROVED IN MANY AREAS BUT CHANGE TAKES TIME AND PERFECTION TAKES AN ETERNITY 4HE FUNDAMENTAL ISSUE IS THAT IT IS NOW DISTRIBUTED WIDELY ACROSS MANY DIFFERENT DIMENSIONS AND ENVIRONMENTS (ENCE THE STATE OF HEALTHCARE QUALITY IS SOMEWHERE BETWEEN CHANGE WITH MANY STAKEHOLDERS LEADING THE CHARGE FROM MANY ANGLES AND EXCELLENCE WHERE MEASUREMENT AND TRANSPARENCY COME FROM A FOCUSED EFFORT AND ONE VOICE REPRESENTS THE MULTIDISCIPLINARY TEAMS WHO WERE THE ARCHITECTS OF THE DESIGN )N A WAY WE HAVE WON MANY BATTLES TO CREATE AN EMPHASIS ON QUALITY BUT WHICH HAVE FORCED THE CHALLENGE FOR THE FUTURE TO TRULY LEAD AND NOT BE JOSTLED ABOUT BY THE "ROWNIAN MOTION OF DIFFUSE POLITICAL INTERESTS 7E OFTEN LIKE TO CHALLENGE OUR STUDENTS BY PROPOSING THE FOLLOWING QUESTION FOR YOUR DINNER DISCUSSION THIS EVENING h4HE PRESIDENT OF THE 5NITED 3TATES COMES TO YOUR HOUSE TO VISIT !S THE REAL LEGACY OF HIS PRESIDENCY HE WANTS TO IMPROVE THE QUALITY OF HEALTHCARE !S YOU lNISH DINNER AND TURN TO DESSERT HE ASKS @7HAT SHOULD ) DO v 7HAT WILL YOU TELL HIM %NDNOTES #OUCH * -$ *$ &!#0% h(EALTH #ARE 1UALITY -ANAGEMENT FOR THE ST #ENTURY v !MERICAN #OLLEGE OF 0HYSICIAN %XECUTIVES 7EBSTERS .EW 7ORLD $ICTIONARY OF !MERICAN %NGLISH 7EBSTERS .EW 7ORLD #LEVELAND AND .EW 9ORK 7ALTON - 4HE $EMING -ANAGEMENT -ETHOD 0ERIGEE "OOKS #ROSBY 0 1UALITY 7ITHOUT 4EARS 4HE !RT OF (ASSLE &REE -ANAGEMENT -C'RAW (ILL
!LL 1UALITY 2OADS ,EAD TO $ATA 3UCCESSFUL IMPLEMENTATION OF NEW TOOLS AND METHODS FOR MEASURING EVALUATING AND DISSEMINATING HEALTHCARE DATA WILL BE STRONGLY INmUENCED BY DATA UTILITY AND ITS RELATIONSHIP TO IMPROVED PATIENT CARE "Y (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
4
HE ADAGE h9OU CANT MANAGE WHAT YOU CANT MEASUREv IS OFTEN REPEATED BY QUALITY GURUS WHEN DISCUSSING HEALTHCARE QUALITY EFFORTS 4HE ONLY WAY TO KNOW WHETHER THE QUALITY OF CARE IS IMPROVING IS TO MEASURE PERFORMANCE 4HERE ARE THREE TYPES OF TOOLS THAT HEALTH ORGANIZATIONS HAVE AT THEIR DISPOSAL TO INmUENCE QUALITY PUBLIC DISCLOSURE OF PERFORMANCE DATA PAYMENT POLICIES AND PERFORMANCE IMPROVEMENT PROCESSES %ACH HINGES ON THE AVAILABILITY OF ACCURATE RELIABLE AND VALID PERFORMANCE MEASURES $ESPITE THE CRITICAL IMPORTANCE OF HAVING VALID INFORMATION DEVELOPMENT OF QUALITY MEASUREMENT STANDARDS REMAINS A WORK IN PROGRESS 4HIS PAPER PROVIDES A HIGH LEVEL SUMMARY OF THE TYPES OF MEASURES AVAILABLE AND THE INNOVATIVE EFFORTS UNDER WAY TO ENHANCE THE AVAILABILITY AND USE OF QUALITY DATA THE ARRAY OF ORGANIZATIONS INVOLVED IN IDENTIFYING DEVELOPING AND DISSEMINATING QUALITY MEASURES AND EXISTING GAPS IN QUALITY DATA AND DEVELOPMENT PRIORITIES FOR THE FUTURE
4YPES OF -EASURES ! LARGE NUMBER OF MEASURES TO ASSESS HEALTHCARE QUALITY ARE AVAILABLE OR UNDER DEVELOPMENT AND THEY ARE GENERALLY CATEGORIZED AS STRUCTURE PROCESS OR OUTCOME MEASURES $ETAILS AND SELECTED EXAMPLES OF EACH ARE DESCRIBED BELOW 'ENERAL FEATURES ARE SUMMARIZED IN %XHIBIT
3TRUCTURE -EASURES !DMINISTRATION/PERATIONS REmECT THE STRUCTURE SYSTEM OR SETTING OF CARE DELIVERY 3OME OF THE MOST COMMON MEASURES ARE THE NUMBER OF BEDS NUMBER OF NURSES PER PATIENT AND ACCREDITATION STATUS 5TILIZATION MEASURES THE FREQUENCY OF SELECTED PROCEDURES INPATIENT ADMISSIONS AND LENGTH OF STAY .UMEROUS RESEARCH STUDIES HAVE DEMONSTRATED THAT HIGHER VOLUMES CORRELATE WITH BETTER OUTCOMES FOR MANY PARTICULARLY HIGH RISK MEDICAL
PROCEDURES 4HE #LEVELAND #LINIC IS ONE PROVIDER THAT REPORTS MULTIPLE UTILIZATION MEASURES ON ITS PUBLIC WEBSITE INCLUDING ITS AVERAGE LENGTH OF STAY THE NUMBER OF HEART TRANSPLANTS ELECTROPHYSIOLOGY CATHETER ABLATION AND OTHER CARDIAC PROCEDURES PERFORMED ANNUALLY AS WELL AS OVER THE LAST FOUR YEARS;= &LORIDA -ASSACHUSETTS 4EXAS .EW *ERSEY 2HODE )SLAND AND /REGON ALL REPORT PROVIDER UTILIZATION ON THEIR PUBLIC WEBSITES &OR EXAMPLE THE 2HODE )SLAND $EPARTMENT OF (EALTH HAS PUBLICLY REPORTED HEALTHCARE QUALITY INFORMATION AND HOSPITAL PERFORMANCE DATA SUCH AS EMERGENCY ROOM UTILIZATION AND INPATIENT LENGTH OF STAY;= /VERALL STATES HAVE GOVERNMENT MANDATES TO REPORT QUALITY INFORMATION TO THE GENERAL PUBLIC;= !ND AS DESCRIBED LATER IN THIS PAPER SEVERAL NATIONAL ORGANIZATIONS SUCH AS #-3 AND *#!(/ PROVIDE INFORMATION TO THE PUBLIC AS WELL 0ATIENT SAFETY MEASURES SPECIlC ACTIONS TO REDUCE MEDICAL ERRORS SUCH AS IMPLEMENTATION OF COMPUTERIZED ORDER ENTRY SYSTEMS AND ESTABLISHMENT OF PROTOCOLS TO REDUCE WRONG SITE OR PROCEDURE ERRORS 4HE ,EAPFROG 'ROUP AN EMPLOYER PURCHASER COALITION GROUP ASSIGNS A h3AFE 0RACTICES 3COREv TO HOSPITALS BASED ON PATIENT SAFETY PRACTICES )TS WEBSITE RANKS HOSPITALS PROGRESS ON hLEAPSv INCLUDING HOSPITAL VOLUME FOR HIGH RISK SURGERY AND NEONATAL INTENSIVE CARE COMPUTERIZED PHYSICIAN ORDER ENTRY AND INTENSIVIST STAFlNG FOR CRITICAL CARE UNITS;=
0ROCESS -EASURES (OSPITAL ORIENTED MEASURES GAUGE THE DEGREE TO WHICH HOSPITALS OFFER CLINICAL INTERVENTIONS AND SERVICES TO PATIENTS #OMMON MEASURES INCLUDE PREVENTIVE SCREENINGS TREATMENT OF CARDIAC DISEASE AND HEART FAILURE DIABETES AND ASTHMA CARE AND MANAGEMENT OF UPPER RESPIRATORY TRACT INFECTIONS (OSPITAL#OMPARECOM A WEBSITE ADMINISTERED BY THE #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3 ALLOWS CONSUMERS TO COMPARE HOSPITALS PERFORMANCE IN PROVIDING RECOMMENDED CARE FOR HEART ATTACKS HEART FAILURE PNEUMONIA AND SURGERY &OR EXAMPLE QUALITY MEASURES FOR HEART ATTACKS INCLUDE THE
(INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@
@#LINICIANS ARE OPEN TO PROFILING IF AND ONLY IF THE DATA ARE PERCEIVED AS VALID 0HYSICIANS IN PARTICULAR LIKE DATA AND IF ONE CAN ASSURE THEM THE DATA ARE VALID THEY WILL RESPOND n %LIZABETH "RADLEY ASSOCIATE PROFESSOR AND DIRECTOR OF THE HEALTH MANAGEMENT PROGRAM WITHIN HEALTH POLICY AND ADMINISTRATION AT THE 9ALE 3CHOOL OF 0UBLIC (EALTH
PERCENTAGE OF PATIENTS PROVIDED BETA BLOCKERS AT ARRIVAL OR DISCHARGE (OSPITALS ALSO REPORT THE PERCENT OF SURGERY PATIENTS WHO RECEIVED ANTIBIOTICS ONE HOUR BEFORE SURGERY A PROCESS THAT REDUCES NOSOCOMIAL INFECTIONS 0HYSICIAN ORIENTED MEASURES REPORT THE DEGREE TO WHICH PHYSICIANS PROVIDE SERVICES TO PATIENTS AND COMPLY WITH SPECIALTY SPECIlC CLINICAL PRACTICE GUIDELINES "ECAUSE OF SAMPLE SIZE CONSTRAINTS AND SOME RESISTANCE FROM PHYSICIANS MOST REPORTING TO DATE HAS BEEN DONE AT THE GROUP LEVEL 0RIORITY (EALTH A HEALTH PLAN BASED IN 'RAND 2APIDS -ICH IS ONE OF THE FEW ORGANIZATIONS THAT PUBLICLY REPORTS PERFORMANCE DATA FOR INDIVIDUAL PRIMARY CARE PHYSICIANS 5SING MEDICAL CLAIMS DATA AUDITS OF MEDICAL REPORTS AND STATE INFORMATION 0RIORITY (EALTH LOOKS AT THE PERCENTAGE OF A PHYSICIANS PATIENTS WHO RECEIVE THE SERVICES IDENTIlED FOR MEASUREMENT EACH YEAR 4ARGETS FOR MOST MEASURES ARE BASED ON TH PERCENTILE PERFORMANCE AGAINST NATIONAL IE (%$)3 BENCHMARKS 0RIORITY (EALTH GIVES PHYSICIANS A SCORE OF FOUR APPLES FOR SUPERIOR PERFORMANCE AGAINST BENCHMARKS 0HYSICIANS WHO SCORE IN THE HIGHEST THIRD OF PERFORMANCE BELOW THE TARGET RATE EARN THREE APPLES ON A MEASURE THE MIDDLE THIRD SCORE TWO APPLES AND THE LOWEST THIRD EARN ONE APPLE (EALTH PLAN MEMBERS CAN USE A PHYSICIAN SEARCH TOOL ON THE WEBSITE TO SORT THE PHYSICIANS ACCORDING TO THEIR NUMBER OF APPLES 4HE SAME LEVEL OF PERFORMANCE THAT EARNS FOUR APPLES ALSO TRIGGERS PAYMENT FOR THE HEALTH PLANS QUALITY BASED PAY FOR PERFORMANCE PROGRAM 0RIORITY (EALTH BELIEVES THAT IT IS IMPORTANT TO TIGHTLY ALIGN TOOLS THAT DRIVE CLINICAL PERFORMANCE IMPROVEMENT;= 0OPULATION BASED MEASURES REmECT CARE FOR ALL PATIENTS WITH A CERTAIN CONDITION OR IN A CERTAIN GEOGRAPHIC LOCATION 4HIS IS TYPICALLY MEASURED BY PAYER &OR EXAMPLE (%$)3 MEASURES FOCUS ON HOW WELL HEALTH PLANS ARE SERVING THE NEEDS OF THEIR ENTIRE MEMBERSHIP /NE MEASURE MIGHT BE BREAST CANCER SCREENINGS 7HILE QUALITY MEASUREMENTS ON INDIVIDUAL PROVIDERS ARE IMPORTANT PAYERS PLAY AN IMPORTANT ROLE IN CREATING THE RIGHT INCENTIVES TO PROVIDE EFlCIENT AND EFFECTIVE CARE 4HEY ALSO CAN CREATE APPROPRIATE INCENTIVES FOR PATIENTS TO REFRAIN FROM EITHER OVER OR UNDERUTILIZING THE SYSTEM 0ATIENT ORIENTED MEASURES ARE AN EMERGING AREA OF QUALITY ASSESSMENT THAT USE hALL OR NONEv DIMENSIONS &OR EXAMPLE ALL OR NONE MEASURES REmECT THE PERCENT OF DIABETES PATIENTS RECEIVING ALL OF THE APPROPRIATE CARE FOR MANAGEMENT OF THEIR CONDITION EG (B!C TESTING LIPID PROlLING RETINAL EXAMINATION
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
FOOT EXAMINATION AND INmUENZA VACCINATION ANNUALLY )N CONTRAST TRADITIONAL POPULATION BASED MEASURES REmECT THE PERCENT OF PATIENTS RECEIVING EACH TEST IE THE PERCENT RECEIVING (B!C TESTING THE PERCENT RECEIVING LIPID PROlLING ETC ! PROVIDER COULD PROVIDE EACH OF THE VARIOUS DIABETES TESTS TO A HIGH PROPORTION OF THE ELIGIBLE PATIENTS BUT STILL MISS ONE OR MORE TESTS FOR THE MAJORITY 4HUS ALL OR NONE MEASUREMENT ENCOURAGES HEALTH PROVIDERS TO THINK AND ACT AS A SYSTEM CONCERNED WITH THE WHOLE SEQUENCE OF CARE AND HANDOFFS NOT ONLY ITS PARTS;=
/UTCOME -EASURES #LINICAL /UTCOMES INCLUDE DISEASE STAGE MORBIDITY AND MORTALITY MEASURES WHICH ARE TYPICALLY ADJUSTED FOR AGE SEVERITY OR OTHER CO DETERMINATES -UCH OF THIS INFORMATION IS AVAILABLE WITHIN INDIVIDUAL HEALTH SYSTEMS OR SELECTED STATES THAT COLLECT CLINICAL DATA &OR EXAMPLE #ALIFORNIAS /FlCE OF 3TATEWIDE (EALTH 0LANNING AND $EVELOPMENT /3(0$ HAS REPORTED CLINICAL OUTCOMES MEASURES FOR SELECT MEDICAL CONDITIONS SINCE )TS MEASURES INCLUDE RISK ADJUSTED DAY MORTALITY RATES AND CLINICAL OUTCOME FOR CORONARY ARTERY BYPASS GRAFT SURGERY AT BOTH THE HOSPITAL AND SURGEON LEVEL;= -OST CLINICAL OUTCOME MEASURES ARE BASED ON COMPLEX RESEARCH MODELS THAT ARE MOST USEFUL TO HEALTHCARE PROFESSIONALS AND PURCHASERS BUT MAY BE DIFlCULT FOR THE AVERAGE CONSUMER TO UNDERSTAND 3ATISFACTION MEASURES PATIENT EMPLOYEE AND PHYSICIAN PERSPECTIVES )N THE PROVIDER SETTING THE #ONSUMER !SSESSMENT OF (EALTHCARE 0ROVIDERS AND 3YSTEMS #!(03 FAMILY OF SURVEYS IS CONSIDERED THE GOLD STANDARD DATA INFORMATION PROGRAM FOR PATIENTS ASSESSMENT OF THE QUALITY OF HOSPITALS AND HEALTH PLANS &OR HOSPITAL SETTINGS MEASURES INCLUDE PATIENT EVALUATIONS OF THEIR COMMUNICATION WITH PHYSICIANS AND NURSES RESPONSIVENESS OF HOSPITAL STAFF CLEANLINESSNOISE LEVEL OF THE PHYSICAL ENVIRONMENT PAIN CONTROL COMMUNICATIONS ABOUT MEDICINE AND DISCHARGE INFORMATION #!(03 IS ALSO DEVELOPING AND TESTING A NEW SURVEY FOR MEASURING AND IMPROVING THE EXPERIENCES OF PATIENTS WITH THEIR PHYSICIANS AND MEDICAL GROUPS INCLUDING PATIENTS PERCEPTIONS REGARDING WHETHER THEY GOT CARE QUICKLY GOT NEEDED CARE HOW WELL PROVIDERS COMMUNICATE AND HOW WELL THE OFlCE STAFF COMMUNICATED -OST INDUSTRY LEADERS EXPECT PATIENT SATISFACTION MEASURES TO GROW IN IMPORTANCE h#ONSUMERS CURRENTLY PLAY A SMALL ROLE IN PERFORMANCE AND QUALITY MEASUREMENT 4HE PREMISE BEHIND #!(03 IS THAT CONSUMERS NEED MORE INFORMATION TO MAKE
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ DECISIONS 7HILE CONSUMERS WILL USE QUALITY INFORMATION MORE IN THE FUTURE THEY DONT USE IT A LOT NOW 9ET HEALTH ORGANIZATIONS BEHAVE AS IF CONSUMERS DO v REMARKS 0AUL $ #LEARY 0H$ PROFESSOR OF HEALTHCARE POLICY IN THE DEPARTMENTS OF HEALTHCARE POLICY AND SOCIAL MEDICINE AT (ARVARD -EDICAL 3CHOOL 4HE HOSPITAL SURVEY IS NOT MANDATORY BUT IS ALREADY VIEWED BY MANY HOSPITALS AS A hVOLUNTARY MANDATEv 5SERS OF #!(03 SURVEY RESULTS INCLUDE PATIENTS AND CONSUMERS QUALITY MONITORS AND REGULATORS PURCHASERS PROVIDER ORGANIZATIONS AND HEALTH PLANS 4HESE INDIVIDUALS AND ORGANIZATIONS USE THE DATA TO INFORM THEIR PURCHASING OR CONTRACTING DECISIONS AND TO IMPROVE THE QUALITY OF HEALTHCARE SERVICES;=
1UALITY $ATA /RGANIZATIONS ! LARGE AND GROWING NUMBER OF FEDERAL AND STATE AGENCIES PUBLIC PRIVATE ALLIANCES AND PRIVATE SECTOR ORGANIZATIONS ARE CURRENTLY INVOLVED IN IDENTIFYING DEVELOPING CERTIFYING IMPLEMENTING AND DISTRIBUTING QUALITY METRICS ! HANDFUL OF STATES ARE BEGINNING TO REPORT VARIOUS QUALITY METRICS 3OME ARE USING THE QUALITY INDICATORS COLLECTED BY -EDICARE SUCH AS ADMINISTRATION OF ANTIBIOTICS BEFORE SURGERY AND BETA BLOCKERS AFTER DISCHARGE /THERS ARE GOING A STEP FURTHER &OR EXAMPLE &LORIDA REPORTS CARDIAC DEATH RATES BY CONDITION
%XHIBIT 'ENERAL 4YPES OF 1UALITY -EASURES 4YPE OF -EASURE
%XAMPLES
3OURCES
!DVANTAGES
3TRUCTURE
6OLUME
!DMINISTRATIVE AND CLAIMS DATA
%ASY AND INEXPENSIVE TO COLLECT ,IMITED IN NUMBER
3TAFlNG LEVELS !CCREDITATION
0ROVIDER SURVEYS
%STABLISHMENT OF PATIENT SAFETY ACTIVITIES
/UTCOME
$O NOT EXIST FOR AMBULATORY CARE
-ORE PREDICTIVE OF SUBSEQUENT 2ARELY REmECT PERFORMANCE OF INDIVIDUAL HOSPITALS PERFORMANCE THAN OTHER MEASURES FOR SOME PROCEDURES OR PROVIDERS EG HIGH RISK SURGERIES 'ENERALLY NOT ACTIONABLE EG A SMALL HOSPITAL OR -OST USEFUL FOR SELECTIVE PHYSICIAN PRACTICE CANNOT REFERRALS AND NETWORK TIERING TURN ITSELF INTO A HIGH VOLUME CENTER
"OARD CERTIlCATION
0ROCESS
/NE MEASURE MAY RELATE TO SEVERAL OUTCOMES
$ISADVANTAGES
!GE APPROPRIATE MAMMOGRAPHY FOR WOMEN
!DMINISTRATIVE AND CLAIMS DATA
!SPIRIN USE FOR PATIENTS WITH CORONARY ARTERY DISEASE
0ROVIDER SURVEYS
2EmECT CARE THAT PATIENTS RECEIVE AND THAT CLINICIANS DELIVER 3UPPORTED BY PROVIDERS !CTIONABLE FOR QUALITY IMPROVEMENT ACTIVITIES
3AMPLE SIZE CONSTRAINTS FOR SOME CONDITIONS ,IMITED UTILITY FOR PROlLING INDIVIDUAL PHYSICIANS OR SMALL PRACTICES OR PAY FOR PERFORMANCE PROGRAMS
'ENERALLY DO NOT REQUIRE RISK ADJUSTMENTS
%XTENT TO WHICH PROCESS MEASURES CORRELATE WITH IMPORTANT OUTCOMES CAN VARY AND IS OFTEN UNKNOWN
2ISK ADJUSTED MORTALITY
-EDICAL CHART REVIEWS
)NTRINSICALLY VALID
3AMPLE SIZE CONSTRAINTS
#OMPLICATION RATES
0ATIENT SURVEYS
.EED FOR RISK ADJUSTMENT
0ATIENT SATISFACTION
!DMINISTRATIVE AND CLAIMS DATA
-EASUREMENT ALONE CAN IMPROVE OUTCOMES
(EALTH STATUS
0ROVIDER SURVEYS 3TATE OR NATIONAL LEVEL CLINICAL REGISTRIES
.OT PARTICULARLY USEFUL FOR MANY AMBULATORY SERVICES WHERE CLEAR OUTCOMES OCCUR INFREQUENTLY OR MUCH LATER THAN THE CARE IS DELIVERED
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ /RGANIZATIONS ACTIVE ON A NATIONAL SCALE INCLUDE THOSE FOUND IN %XHIBIT )N ADDITION TO THESE ORGANIZATIONS A NUMBER OF HEALTH DATA TECHNOLOGY VENDORS SPECIALIZE IN COLLECTION AND MANAGEMENT OF QUALITY DATA 4HEY PROVIDE TIMELY INFORMATION AND IN DEPTH ANALYSIS OF
BOTH PUBLICLY AND PRIVATELY AVAILABLE DATA TO CONSUMERS PROVIDERS HEALTH PLANS AND OTHER INDUSTRY STAKEHOLDERS (OWEVER BECAUSE THEIR DATA AGGREGATION AND REPORTING METHODOLOGIES DIFFER QUALITY RATINGS FOR AN INDIVIDUAL PROVIDER CAN VARY BY VENDOR 3OME OF THE MORE WELL KNOWN COMPANIES ARE PROlLED IN THE !PPENDIX
%XHIBIT .ATIONAL 1UALITY 2ELATED /RGANIZATIONS
/RGANIZATION
3TRUCTURE
$ESCRIPTION
!GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21
&EDERAL AGENCY
!S ONE OF AGENCIES WITHIN THE 53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES !(21 SUPPORTS HEALTH SERVICES RESEARCH THAT WILL IMPROVE THE QUALITY OF HEALTHCARE AND PROMOTE EVIDENCE BASED DECISION MAKING 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWAHRQGOV
!MBULATORY #ARE 1UALITY !LLIANCE !1!
0RIVATE COLLABORATIVE GROUP
)MPROVE HEALTHCARE QUALITY AND PATIENT SAFETY THROUGH A COLLABORATIVE PROCESS IN WHICH KEY STAKEHOLDERS AGREE ON A STRATEGY FOR MEASURING PERFORMANCE AT THE PHYSICIAN OR GROUP LEVEL COLLECTING AND AGGREGATING DATA IN THE LEAST BURDENSOME WAY AND REPORTING MEANINGFUL INFORMATION TO CONSUMERS PHYSICIANS AND OTHER STAKEHOLDERS TO INFORM CHOICES AND IMPROVE OUTCOMES 4HE WEBSITE CAN BE ACCESSED AT HTTPWWW AMBULATORYQUALITYALLIANCEORG
#ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3
&EDERAL AGENCY
!DMINISTERS -EDICARE AND -EDICAID !SSURES HEALTHCARE SECURITY FOR BENElCIARIES 2ECENTLY INITIATED THE QUALITY INITIATIVE IN WHICH HOSPITALS REPORT PERFORMANCE ON QUALITY INDICATORS TO RECEIVE HIGHER REIMBURSEMENT FROM -EDICARE 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWCMSHHSGOV
*OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS *#!(/
)NDEPENDENT NOT FOR PROlT
*#!(/ EVALUATES AND ACCREDITS MORE THAN HEALTHCARE ORGANIZATIONS AND PROGRAMS IN THE 5NITED 3TATES *#!(/ HAS DEEMED STATUS FROM -EDICARE )TS /298¸ INITIATIVE INTEGRATES OUTCOMES AND OTHER PERFORMANCE MEASUREMENT DATA INTO THE ACCREDITATION PROCESS 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWJOINTCOMMISSIONORG
.ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1!
0RIVATE NOT FOR PROlT
'ENERATES INFORMATION TO IMPROVE THE QUALITY OF HEALTHCARE TO HELP INFORM CONSUMER AND EMPLOYER CHOICE !CCREDITS HEALTH PLANS THAT MEET CERTAIN QUALITY METRICS 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWNCQAORG
.ATIONAL 1UALITY &ORUM .1&
0RIVATE NOT FOR PROlT
#REATED TO DEVELOP AND IMPLEMENT A NATIONAL STRATEGY FOR HEALTHCARE QUALITY MEASUREMENT AND REPORTING 4HE MISSION OF THE .1& IS TO IMPROVE !MERICAN HEALTHCARE THROUGH ENDORSEMENT OF CONSENSUS BASED NATIONAL STANDARDS FOR MEASUREMENT AND PUBLIC REPORTING OF HEALTHCARE PERFORMANCE DATA THAT PROVIDE MEANINGFUL INFORMATION ABOUT WHETHER CARE IS SAFE EFFECTIVE PATIENT CENTERED EFlCIENT TIMELY AND EQUITABLE 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWQUALITYFORUMORG
0HYSICIAN #ONSORTIUM FOR 0ERFORMANCE )MPROVEMENT
0ROFESSIONAL SOCIETY ASSOCIATION
! GROUP OF CLINICAL AND METHODOLOGICAL EXPERTS CONVENED BY THE !MERICAN -EDICAL !SSOCIATION TO PROVIDE EVIDENCE BASED CLINICAL PERFORMANCE MEASURES AND OUTCOMES REPORTING TOOLS FOR PHYSICIANS AND TO ENSURE THAT ALL COMPONENTS OF THE MEDICAL PROFESSION HAVE A VOICE IN NATIONAL FORUMS SEEKING TO EVALUATE THE QUALITY OF PATIENT CARE 4HE WEBSITE CAN BE ACCESSED AT HTTPWWWAMA ASSNORGAMAPUB CATEGORYHTML
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@
@$IFFERENT HEALTHCARE STAFF NEED DIFFERENT TOOLS 7E NEED A RANGE OF TOOLS AND RE SOURCES TO ADDRESS WHY MEASURES ARE IMPORTANT WHAT THE METRICS MEAN HOW TO UNDERSTAND VARIATION IN DATA BY MARKET SEGMENT AND ASSISTANCE TO INTERPRET OR SEE hCOLORv AROUND NUMBERS n *OE #ARMICHAEL PRESIDENT OF .2# 0ICKER
)NDUSTRY 'ETS THE &IRST 3WING AT 1UALITY 1UALITY ASSESSMENT RESTS WITH INDUSTRY HEALTH ORGANIZATIONS GET THE lRST SWING AT DEVELOPING QUALITY MEASURES )F THEY DO NOT CONNECT GOVERNMENT MAY STEP IN /NE HISTORICAL EXAMPLE OF HOW THE INDUSTRY HAS RESPONDED TO THE NEED FOR QUALITY MEASURES IS THE .#1! WHICH BEGAN ACCREDITING MANAGED CARE ORGANIZATIONS IN 4HE S WERE AN ERA IN WHICH !MERICANS WERE VOICING DOUBTS ABOUT MANAGED CARE AND THE .#1! WAS FORMED AROUND THE NEED FOR STANDARDIZED OBJECTIVE INFORMATION ABOUT THE QUALITY OF HEALTH PLANS 7HILE THE ACCREDITATION IS VOLUNTARY LARGE EMPLOYERS AND HEALTH PLANS EMBRACED THE OPPORTUNITY (%$)3 REPORTS EFFECTIVENESS CARE MEASURES FOR THE MILLION !MERICANS ENROLLED IN .#1! ACCREDITED HEALTH PLANS .#1! REPORTS THAT QUALITY HAS IMPROVED n A TESTAMENT TO MEASURING AND PUBLISHING QUALITY STANDARDS &OR EXAMPLE MEMBERS IN COMMERCIAL HEALTH PLANS ACCREDITED BY .#1! ARE NOW MORE LIKELY TO RECEIVE BETA BLOCKERS AFTER A HEART ATTACK AND CHOLESTEROL MANAGEMENT SEE %XHIBIT ;= 4ODAY A SIMILAR DYNAMIC EXISTS AROUND DRUG SAFETY $ESPITE THE ESTABLISHMENT OF A NEW DRUG SAFETY OVERSIGHT BOARD A -ARCH REPORT FROM THE 53 'OVERNMENT !CCOUNTABILITY /FlCE '!/ CRITICIZED THE &OOD AND $RUG !DMINISTRATION &$! FOR FAILURE TO TAKE STRONG ACTION AGAINST POST MARKET DRUGS THAT APPEAR UNSAFE;= )N PARTICULAR THE REPORT NOTED THE &$!S INABILITY TO ENSURE THAT LONG TERM POST MARKET FOLLOW UP STUDIES ARE CONDUCTED CITING THAT PERCENT OF STUDIES AGREED UPON WERE CARRIED OUT BETWEEN AND 'IVEN RECENT
%XHIBIT #OMMERCIAL 0AYER %FFECTIVENESS #ARE -EASURES
PATTERNS OF BEHAVIOR AND THE ATTENTION CURRENTLY DEVOTED TO THE ISSUE OF DRUG SAFETY THE '!/S lNDINGS COULD REASONABLY INDUCE #ONGRESS TO ENACT LEGISLATION TO ENHANCE THE OVERSIGHT AUTHORITY OF REGULATORY AGENCIES AROUND POST MARKET DRUG SAFETY 4HESE EFFORTS ARE PROMPTING PHARMACEUTICAL COMPANIES TO RETHINK THEIR PROCESSES AROUND DRUG SAFETY "Y VIEWING POST MARKET SAFETY AS A COMPONENT OF A CONTINUUM AND BY PERFORMING ADVANCED DATA MINING AND ANALYTICS ACROSS AN INTEGRATED DATA SET ORGANIZATIONS CAN IMPROVE THEIR SEARCH FOR SAFETY SIGNALS AND MEET THE RENEWED DRUG SAFETY EXPECTATIONS -ANY WOULD ARGUE THAT INDUSTRY KNOWS BEST HOW TO CREATE THE APPROPRIATE QUALITY STANDARDS YET LACKS THE DISCIPLINE TO ADMINISTER THEM "RAD "UXTON DIVISIONAL SENIOR VICE PRESIDENT HEALTHCARE MANAGEMENT FOR (EALTH #ARE 3ERVICE #ORP REMEMBERS WHEN THE "LUES PLANS WERE PUTTING TOGETHER A STATEWIDE HEART NETWORK BASED ON QUALITY AND EFlCIENCY BENCHMARKS /NLY OUT OF HOSPITALS MADE IT INTO THE NETWORK AND WHILE SOME HOSPITAL EXECUTIVES WERE OUTRAGED AT THEIR EXCLUSION OTHERS WERE GRATEFUL h0AYING THE HEALTHCARE DELIVERY SYSTEM ACCORDING TO RESULTS NOT ONLY WILL IMPROVE THE CARE PEOPLE RECEIVE BUT HAS PROVEN IT CAN CONTROL THE TREND v SAYS "UXTON
! #ALL FOR 3TANDARDIZATION AND #OORDINATION 4HE CURRENT ENVIRONMENT HAS RESULTED IN WIDELY DIVERSE QUALITY MEASURES AS WELL AS SIMILAR MEASURES WITH DIFFERENT METHODOLOGIES AND DElNITIONS AND CALLS FROM HEALTHCARE PROFESSIONALS TO CREATE REPORTING STANDARDS !S NOTED BY #HRISTINE + #ASSEL -$ PRESIDENT AND #%/ OF THE !MERICAN "OARD OF )NTERNAL -EDICINE h#URRENTLY WE HAVE A VIRTUAL SOUP OF DIFFERENT MEASUREMENT REQUIREMENTS /UR GOAL IS TO REDUCE THE REDUNDANCY OF THE MEASURING REQUIREMENTSv 2ECOGNIZING THIS NEED QUALITY DATA ORGANIZATIONS ARE ATTEMPTING TO ENSURE CONSENSUS AND ALIGNMENT BY PARTICIPATING IN EACH OTHERS STEERING COMMITTEES AND REVIEW PROCESSES AS DEPICTED IN %XHIBIT h7ERE MOVING BEYOND COMPETING MEASURES AND TOWARDS GETTING PEOPLE AND ORGANIZATIONS TOGETHER TO REACH A CONSENSUS ON WHAT THE STANDARD MEASURES ARE v SAYS (ARVARDS #LEARY "UT THIS CONSENSUS BUILDING REQUIRES EXTENSIVE RESOURCES AND TIME 3OME HAVE ALSO NOTED THAT AS LONG AS CONSENSUS IS UTILIZED TO ESTABLISH QUALITY MEASURES PROGRESS WILL BE IMPEDED
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ %XHIBIT ! #ACOPHONY OF 0LAYERS !CTIVITIES AND -EASURES
3OURCE 0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT )NSTITUTE OF -EDICINE !PPENDIX "
h4HE PROGRESS IS SLOW )T TAKES SIGNIlCANT TIME FOR A MEASURE TO BE DEVELOPED PILOTED TESTED REACH A NATIONAL LEVEL AND BE ENDORSED YET STANDARDIZATION IS IMPORTANT v STATES "ARBARA ! 2UDOLPH 0H$ DIRECTOR OF LEAPS AND MEASURES FOR 4HE ,EAPFROG 'ROUP AN EMPLOYER COALITION FOCUSED ON QUALITY 3EVERAL SOLUTIONS HAVE BEEN SUGGESTED TO ADDRESS THE NEED FOR STANDARDIZATION AND COORDINATION 4HE )/- IN ITS REPORT TITLED h0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT v HAS RECOMMENDED THE CREATION OF A FEDERAL .ATIONAL 1UALITY #OORDINATION "OARD TO DEVELOP STANDARD PERFORMANCE MEASURES AND MONITOR THE NATIONS PROGRESS TOWARD QUALITY GOALS 0RIVATE SECTOR EFFORTS HAVE ALSO BEEN PROPOSED *ANET - #ORRIGAN 0H$ -"! PRESIDENT AND CHIEF EXECUTIVE OFlCER OF THE .1& WOULD LIKE TO MAKE THE ENDORSEMENT PROCESS MORE EFlCIENT
&UTURE 0RIORITIES #LOSING THE 'APS IN 1UALITY )NFORMATION 7HILE THE INDUSTRY IS BEGINNING TO RECOGNIZE THE IMPORTANCE OF TRANSPARENCY IN QUALITY MEASURES MANY GAPS REMAIN 4HE MAJORITY OF QUALITY DATA REPORTED IS IN REGARD TO PATIENTS EXPERIENCES IN HOSPITALS OR WITH HEALTH PLANS 1UALITY DATA REMAINS RELATIVELY
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
LIMITED ON INDIVIDUAL PHYSICIANS NURSING CARE FACILITIES HOME HEALTH AGENCIES PSYCHIATRIC TREATMENT FACILITIES AND AMBULATORY CARE CENTERS -EASUREMENT ORGANIZATIONS CONTINUE TO STRUGGLE WITH HOW TO RISK ADJUST QUALITY PERFORMANCE FOR LOW VOLUME PROVIDERS -OST DATA ARE REPORTED IN AGGREGATE AT THE PHYSICIAN GROUP AND PATIENT POPULATION LEVEL BUT CARE IS PROVIDED BY INDIVIDUAL PHYSICIANS AND TO INDIVIDUAL PATIENTS h7E NEED A PROCESS THAT CUTS ACROSS ALL SPECIALTIES AND IS BASED ON SCIENCE %ACH SPECIALTY IS DEVELOPING ITS OWN MEASURES n AND ONCE YOU GET BEYOND DIABETES ASTHMA ETC THERE IS NO SCIENTIlC AGREEMENT ON WHAT SHOULD BE MEASURED 4HIS LACK OF CLARITY ON WHAT GOOD CARE IS PRESENTS A HUGE PROBLEM THAT MUST BE RESOLVED BASED ON SCIENTIlC EVIDENCE AND MEDICAL KNOWLEDGE v STATES -ARGARET % /+ANE PRESIDENT OF .#1! 0ART OF THE CHALLENGE LIES IN MULTIPLE PERHAPS EVEN COMPETING OBJECTIVES FOR QUALITY DATA 4ODAYS QUALITY METRICS HAVE MANY PURPOSES INCLUDING PUBLIC REPORTING DEVELOPMENT OF PROFESSIONAL STANDARDS lNANCIAL INCENTIVES GOVERNMENTAL OVERSIGHT PROFESSIONAL CERTIlCATION QUALITY IMPROVEMENT AND SELECTIVE REFERRAL NETWORK TIERING h4HERES BEEN SOME PUSHBACK BY PROVIDERS THAT IF THE MEASURE ISNT USEFUL FOR QUALITY IMPROVEMENT PURPOSES ITS NOT A USEFUL MEASURE !S MUCH PROGRESS AS WERE
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ MAKING IN PUBLIC REPORTING THERE IS EQUAL EFFORT TO ELIMINATE MEASURES WHICH ARE MEANINGFUL FOR CONSUMERS 7E NEED TO BE CLEAR THAT THERE ARE MEASURES WHICH MAY NOT BE GEARED TOWARD QUALITY IMPROVEMENT BUT ARE IMPORTANT FOR PUBLIC REPORTING v SAYS ,EAPFROGS 2UDOLPH )N ITS h0ERFORMANCE -EASUREMENTv REPORT THE )/- NOTED THAT MOST PERFORMANCE MEASUREMENT PROJECTS TO DATE HAVE RELIED ON A SMALL SET OF TECHNICAL QUALITY MEASURES DERIVED FROM ADMINISTRATIVE DATA AND FROM PATIENT SURVEYS 4HESE MEASURES DO NOT ANSWER KEY QUESTIONS SUCH AS WHETHER PATIENTS RECEIVED THE FULL SET OF SERVICES AND ONLY THOSE SERVICES FROM WHICH THEY WOULD LIKELY BENElT WHETHER SERVICES WERE PROVIDED IN A TIMELY AND EFlCIENT MANNER AND WHETHER PATIENTS ACHIEVED THE DESIRED SHORT AND LONG TERM OUTCOMES )T NOTED GAPS IN MEASURES OF
7HATS 6ALID )/-S #RITERIA FOR -EASURE 3ELECTION )/- HAS RECOMMENDED A hSTARTER SETv OF HOSPITAL MEASURES AMBULATORY CARE MEASURES AND HEALTH PLAN MEASURES THAT COULD BE USED TO ALIGN PERFORMANCE WITH PAYMENT UNDER THE -EDICARE PROGRAM #RITERIA FOR SELECTION WERE 3 CIENTIlCALLY 3OUND 4HE EVIDENCE BASE IS RELIABLE VALID AND EXPLICIT & EASIBLE 4HE DATA NEEDED FOR A MEASURE ARE IN CURRENT USE AVAILABLE AND EXAMINED FOR THE COST OR BURDEN OF MEASUREMENT ON PROVIDERS ) MPORTANT 4HE MEASURE ADDRESSES A LEADING CAUSE OF DEATH OR DISABILITY OR IS ASSOCIATED WITH HIGH RESOURCE USE AND MUST HAVE AN IMPACT ON HEALTH ! LIGNED -EASURES SHOULD BE DRAWN FROM EXISTING MEASURE SETS AND WITH THE SAME DElNITIONS TO REDUCE REDUNDANCY AND THE BURDEN OF REPORTING # OMPREHENSIVE -EASURES SHOULD BE PART OF A SET TO REmECT QUALITY IN A PARTICULAR AREA OF CARE OR BUNDLED SERVICES OF NECESSARY CARE FOR A GIVEN CONDITION 4HE MEASURE SET SHOULD ADDRESS THE WAY CARE IS DELIVERED AND THE NATURE OF THE QUALITY PROBLEM SOLVED n UNDERUSE MISUSE OR OVERUSE 3OURCE h0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT v #OMMITTEE ON REDESIGNING HEALTH INSURANCE PERFORMANCE MEASURES PAYMENT AND PERFORMANCE IMPROVEMENT PROGRAMS "OARD ON (EALTH #ARE 3ERVICES )NSTITUTE OF -EDICINE
PATIENT CENTERED CARE EQUITY AND EFlCIENCY AS WELL AS MEASURES FOR CHILDREN OR THOSE AT THE END OF LIFE -OST MEASURES FOCUS ON A SINGLE POINT IN TIME AND DO NOT ASSESS CARE ACROSS SETTINGS !ND MOST MEASURES FOCUS ON AN INDIVIDUAL PROVIDERS ACTIONS RATHER
THAN SHARED ACCOUNTABILITY h4HE BARRIERS TO REALIZING OUR VISION ARE NOT SO MUCH AT NATIONAL LEVEL BUT IN DELIVERY SYSTEMS )TS NOT TRIVIAL TO IMPLEMENT COMPOSITE MEASURES THAT CROSS THE DELIVERY SYSTEM 7E NEED NEW RELATIONSHIPS TO SHARE AND LINK DATA AND NEW LINKAGES TO COORDINATE CARE v SAYS .1&S #ORRIGAN !S QUALITY MEASURES BECOME MORE UBIQUITOUS AND POTENT IN THEIR USE AS AGENTS OF CHANGE BOTH INTENDED AND UNINTENDED OUTCOMES MUST BE CONSIDERED )NCREASED AVAILABILITY OF INTEGRATED INFORMATION SYSTEMS WILL BE CRITICAL IN THIS REGARD h4HE NEXT MOVE WILL BE TO DEVELOP INFORMATION SYSTEMS TO SUPPORT CLINICAL CARE FROM WHICH QUALITY INDICATORS CAN BE EXTRACTED IN REAL TIME AND AT MINIMAL COSTS v STATES (ARVARDS #LEARY h)NFORMATION TECHNOLOGY ISNT THE PANACEA BUT ITS THE RATE LIMITED STEP IN MUCH OF WHAT WERE DOING RIGHT NOWv #AROLYN - #LANCY -$ DIRECTOR OF THE !(21 AGREES THAT h4HE SYSTEMS SOLUTIONS ARENT SIMPLE 7E CANT YET REPORT ON QUALITY n EVEN WITHIN HEALTHCARE ORGANIZATIONS THAT HAVE ELECTRONIC HEALTH RECORDS n BY HITTING @& &OR EXAMPLE WE CANT IDENTIFY THE CORRECT DENOMINATOR WITHOUT SOME MANUAL ABSTRACTINGv 4HE BOTTOM LINE IS THAT MORE WORK NEEDS TO BE DONE TO INCREASE THE USEFULNESS OF QUALITY DATA h! CARDINAL PRINCIPLE OF HIGH QUALITY HEALTHCARE IS THAT IT BE PATIENT CENTERED 4HOUGH HEALTHCARE SERVICES INVOLVE MANY DIFFERENT STAKEHOLDERS INCLUDING PROVIDERS INSURERS AND PURCHASERS AND REGULATORS THE FOCUS ULTIMATELY HAS TO BE ON ONE PARTICULAR CONSUMER GROUP n THE PATIENTS v SAYS *OHN # 2ING -$ DIRECTOR OF THE BOARD ON HEALTHCARE SERVICES OF THE )/- *OE #ARMICHAEL PRESIDENT OF .2# 0ICKER A MARKET RESEARCH lRM THAT CONDUCTS PATIENT SATISFACTION SURVEYS AGREES ABOUT THE NEED TO FOCUS ON HOW THE DATA IS USED RATHER THAN MEASUREMENT FOR ITS OWN SAKE h)TS NOT ABOUT MEASUREMENT ITS ABOUT IMPROVEMENT )TS NOT ABOUT COLLECTING DATA ITS ABOUT TRYING TO IMPROVE THE QUALITY OF HEALTHCARE )TS NOT ABOUT A THREE RING BINDER THATS A LAUNDRY LIST OF IMPROVEMENT IDEAS )DEAS NEED TO BE IDENTIlED BY AREAS OF WEAKNESS AND TAILORED TO AN ORGANIZATIONS PERFORMANCEv 5LTIMATELY ITS NOT ABOUT MEASUREMENT FOR MEASUREMENTS SAKE n BUT FOR IMPROVED QUALITY OF CARE
!PPENDIX 3ELECTED $ATA 4ECHNOLOGY 6ENDORS 3UBIMO IS A PRIVATE FOR PROlT COMPANY THAT PROVIDES DECISION SUPPORT TOOLS TO HELP CONSUMERS OBTAIN HEALTHCARE INFORMATION 4HE COMPANY ALSO OFFERS SUPPORT TOOLS FOR HEALTH INSURANCE PURCHASERS 3UBSCRIBERS PAY AN ANNUAL FEE TO HAVE ACCESS TO HOSPITAL COMPARISON TOOLS AND GENERAL PHYSICIAN INFORMATION SUCH AS AGE OFlCE LOCATION AND THE PHYSICIANS MEDICAL SCHOOL 3UBIMO ALLOWS THE USER TO OBTAIN COMPARISON INFORMATION OF HOSPITALS BY INDIVIDUALLY RANKING THE IMPORTANCE OF SELECTED FACTORS AND CHOOSING ONE OF PROCEDURES OR CONDITIONS WITHIN SPECIlC AREAS 4HE WEBSITE CAN BE ACCESSED AT WWW SUBIMOCOM
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@K K ãP T@KHSXãQN@CRãKD @CãSNãC@S@ (EALTH'RADES IS A PRIVATE FOR PROlT COMPANY THAT RATES PERFORMANCE FOR ALMOST EVERY HOSPITAL IN THE NATION IN ADDITION TO NURSING HOMES AND HOME HEALTH AGENCIES 4HE WEBSITE ALSO PROVIDES RESEARCH ON PHYSICIANS INCLUDING BOARD CERTIlCATION MEDICAL EDUCATION AND PATIENT SATISFACTION RESULTS 4HE HOSPITAL AND PHYSICIAN REPORTS REQUIRE AN ACCESS FEE 4HE WEBSITE WWW HEALTHGRADESCOM ALSO PROVIDES FREE ACCESS TO HOSPITAL RATINGS ON IN HOSPITAL AND POST HOSPITAL STAY PATIENT MORTALITY FOR DIFFERENT PROCEDURESDIAGNOSES 3OLUCIENT UTILIZES PUBLIC DATA SUCH AS THE -EDICARE 0ROVIDER !NALYSIS AND 2EVIEW DATA SET THE #ENTERS FOR -EDICARE -EDICAID 3ERVICES 3TANDARD !NALYTICAL &ILE AND -EDICARE #OST 2EPORTS 3OLUCIENT PRODUCES A LIST OF THE TOP HOSPITALS IN THE NATION AND BENCHMARKS HOSPITALS BASED ON CLINICAL OUTCOMES CLINICAL PROCESS AND OPERATIONAL MEASURES 3OLUCIENT DATA CAN BE ACCESSED FROM WWWSOLUCIENTCOM 7EB-$ 1UALITY 3ERVICES FORMERLY KNOWN AS (EALTHSCORE 4ECHNOLOGY PROVIDES TWO TOOLS TO ASSIST HEALTH PLAN MEMBERS EMPLOYEES AND PURCHASERS COMPARE HOSPITAL QUALITY 3ELECT 1UALITY #ARE #ONSUMER IS A 7EB BASED TOOL THAT PROVIDES CONSUMERS WITH SEVERITY ADJUSTED CONDITION SPECIlC SIDE BY SIDE COMPARISONS OF ADMINISTRATIVE AND UTILIZATION MEASURES AND CLINICAL OUTCOMES 3ELECT 1UALITY #ARE 0ROFESSIONAL OFFERS MORE IN DEPTH ANALYSIS OF SEVERITY ADJUSTED USING 2$2'S OR !02 $2'S PUBLICLY AVAILABLE DATA TO COMPARE HOSPITAL PERFORMANCE BASED UPON BOTH COST AND QUALITY !(21 QUALITY INDICATORS ,EAPFROG AND #-3 MEASURES ARE ALSO INCORPORATED 4HE WEBSITE CAN BE ACCESSED AT WWWSELECTQUALITYCARECOM (EALTH "ENCHMARKS )NC OFFERS SEVERAL PRODUCTS THAT SUPPORT HEALTH PLANS IN EVALUATING PHYSICIAN AND HOSPITAL QUALITY 4O EVALUATE PHYSICIAN CARE QUALITY (") HAS DEVELOPED MORE THAN QUALITY INDICATORS ACROSS lVE SPECIALTY AREAS )TS &OCUS
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
#ARE (OSPITAL PRODUCT INCLUDES HOSPITAL PERFORMANCE INDICATORS THAT MEASURE HEALTH OUTCOMES PATIENT SATISFACTION AND RESOURCE USE (") UTILIZES A CLINICAL ADVISORY GROUP OF PHYSICIANS AND STATISTICIANS TO DEVELOP A FRAMEWORK THAT PROVIDES A COMPREHENSIVE EVALUATION OF HOSPITAL SYSTEMS AND SERVICES 4HE WEBSITE CAN BE ACCESSED AT WWWHEALTHBENCHMARKSCOM %NDNOTES 1UALITY -EASURES AT THE #LEVELAND #LINIC HTTPWWWCLEVELANDCLINIC ORGQUALITY 2HODE )SLAND $EPARTMENT OF (EALTH 0ERFORMANCE -EASUREMENT AND 2EPORTING ACCESSED -ARCH HTTPWWWHEALTHRIGOVCHIC PERFORMANCE h4HE 3TATE OF THE !RT OF /NLINE (OSPITAL 0UBLIC 2EPORTING ! 2EVIEW OF &IFTY /NE 7EBSITES v ND EDITION *ULY HTTPWWWDELMARVAFOUNDATIONORGNEWS!ND0UBLICATIONSPRESS 2ELEASES??PDF h4HE .ATIONAL 1UALITY &ORUM 3AFE 0RACTICES ,EAP v 4HE ,EAPFROG 'ROUP &ACT SHEET !PRIL HTTPWWWLEAPFROGGROUPORGMEDIA lLE,EAPFROG .ATIONAL?1UALITY?&ORUM?3AFE?0RACTICES?,EAPPDF )NFORMATION PRESENTED AT THE 7ORLD (EALTH #ARE #ONGRESS 7ASHINGTON $# !PRIL AND POSTED ON WWWPRIORITYHEALTHCOM ACCESSED !PRIL HTTPWWWPRIORITY HEALTHCOMSAFETYQUALITYAPPLES .OLAN 4 AND $ - "ERWICK h!LL OR .ONE -EASUREMENT 2AISES THE "AR ON 0ERFORMANCE -ARCH *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP /FlCE OF 3TATEWIDE (EALTH 0LANNING AND $EVELOPMENT (EALTHCARE 1UALITY !NALYSIS $IVISION (EALTH /UTCOMES #ENTER ACCESSED -ARCH HTTPWWWOSHPDCAHWNETGOVHQAD/UTCOMESINDEXHTM #!(03 /VERVIEW HTTPSWWWCAHPSAHRQGOVCONTENTCAHPS/VERVIEW /6%2?)NTROASP h4HE 3TATE OF (EALTH #ARE 1UALITY v .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE 7ASHINGTON $# ACCESSED -AY HTTPWWWNCQAORG$OCS3/(#1?PDF h$RUG 3AFETY )MPROVEMENT .EEDED IN &$!S 0OSTMARKET $ECISION MAKING AND /VERSIGHT 0ROCESS v REPORT TO #ONGRESSIONAL 2EQUESTERS '!/ -ARCH HTTPWWWGAOGOVNEWITEMSDPDF
4HE (ORIZON "EYOND ()0!! "ALANCING 0RIVACY AND 3ECURITY 7ITH 0ATIENT #ARE 0ROVIDERS CAN BALANCE THE NEED FOR PRIVACY WITH THE NEED TO PROVIDE THE BEST POSSIBLE CARE CREATING MEANINGFUL OPPORTUNITIES FOR ONGOING QUALITY IMPROVEMENT THAT ALSO BECOME COMPETITIVE ADVANTAGES "Y 2ICHARD "AICH *EFF &USILE *AMES +OENIG AND #INDY 3MITH 0RICEWATERHOUSE#OOPERS
! -ATTER OF 0ERSPECTIVE )NFORMATION TECHNOLOGY HAS ENHANCED THE PRACTICE OF MEDICINE DRAMATICALLY PARTICULARLY IN RECENT YEARS 0ROVIDERS TODAY HAVE ACCESS TO TREMENDOUS VOLUMES AND TYPES OF INFORMATION AND A REMARKABLE ABILITY TO COMMUNICATE WITH COLLEAGUES AND PATIENTS IN VIRTUAL REAL TIME /BTAINING AND RECORDING PATIENT INFORMATION PLANNING PATIENT CARE INTERPRETING RESULTS AND RESEARCHING NEW MODALITIES ALL BENElT FROM MAXIMIZED USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES BUT THESE TECHNOLOGIES ALSO INCREASE THE POSSIBILITY THAT UNWELCOME PARTIES MAY GAIN ACCESS TO PATIENT INFORMATION 4ECHNOLOGY HAS EMPOWERED MANY TO COLLECT COPIOUS AMOUNTS OF DATA MUCH OF WHICH CAN BE STORED ON AND ACCESSED FROM VARIOUS lXED AND MOBILE DEVICES 4HESE DEVICES CONTINUE TO GROW SMALLER WHILE THEIR STORAGE CAPABILITY INCREASES SUBSTANTIALLY n A GIGABYTE OF DATA CAN COMMONLY BE STORED ON A 53" mASH DRIVE THAT EASILY ATTACHES TO CAR KEYS !LTHOUGH THIS TECHNOLOGY ENABLES GREATER BUSINESS PROCESS mEXIBILITY AND EFFECTIVENESS IT INHERENTLY PRESENTS AN OPPORTUNITY FOR INFORMATION LOSS AND MISUSE 4HE POSSIBILITIES EXTEND WIDELY INCLUDING LAPTOPS STOLEN FROM
AUTOMOBILES MISPLACED BACKUP TAPES AND #$S ERRANT EMAILS HACKERS AND )$ THIEVES AND CARELESS DISHONEST OR DISGRUNTLED EMPLOYEES 4HE RESULTS COULD INCLUDE USE OF AN INDIVIDUALS NAME AND HEALTH INFORMATION TO OBTAIN MEDICAL CARE OR UNSCRUPULOUS PROVIDERS USING PATIENT INFORMATION TO RECEIVE REIMBURSEMENT FOR TESTS AND OTHER SERVICES THAT WERE NEVER PROVIDED !LTHOUGH THE CONmICT BETWEEN OPENNESS AND SECURITY ON THE HEALTH INFORMATION HIGHWAY PRESENTS CHALLENGES IT DOES NOT AND CANNOT CREATE A BARRIER TO QUALITY .EITHER THE (EALTH )NSURANCE 0ORTABILITY AND !CCOUNTABILITY !CT OF ()0!! NOR ANY OTHER REGULATIONS PRECLUDE PROVIDERS FROM IMPLEMENTING QUALITY IMPROVEMENTS THROUGH INFORMATION TECHNOLOGY ! RECENT RULING SUGGESTED THAT ()0!!S GOAL OF PRIVACY SHOULD NOT INTERFERE WITH THE PROVISION OF THE BEST POSSIBLE HEALTHCARE WHEN THE /HIO 3UPREME #OURT RULED THAT THE STATES OPEN RECORDS LAW SUPERSEDES ()0!! )N ITS UNANIMOUS -ARCH DECISION THE COURT FOUND THAT THE #INCINNATI (EALTH $EPARTMENT ERRED BY CITING PERSONAL HEALTH INFORMATION PRIVACY WHEN IT REFUSED TO RELEASE RECORDS ABOUT LANDLORDS AND HOMEOWNERS CITED FOR LEAD PAINT CONTAMINATION ;=
2ICHARD "AICH -"! -3- #)330 #)3- IS A MANAGING DIRECTOR WITH 0RICEWATERHOUSE#OOPERS 0ERFORMANCE )MPROVEMENT PRACTICE (E IS A FORMER #)3/ AND A PUBLISHED AUTHOR (E HAS OVER YEARS EXPERIENCE FOCUSING ON DELIVERING SOLUTIONS WHICH ENABLE ORGANIZATIONS TO EFFECTIVELY AND EFlCIENTLY BALANCE RISK TECHNOLOGY AND DATA MANAGEMENT DECISIONS WITH DATA PROTECTION RISKS REGULATORY COMPLIANCE ISSUES AND SECURITY CONTROLS (E CAN BE REACHED AT RICHBAICH USPWCCOM *EFF &USILE IS A PARTNER WITH 0RICEWATERHOUSE#OOPERS (E HAS NEARLY YEARS OF HEALTHCARE INDUSTRY EXPERIENCE AND IS A LEADER IN THE lRMS 2EGULATORY #OMPLIANCE AND 'OVERNANCE TEAM (E IS ALSO LEADER OF 0W#S ()0!! !DVISORY 3ERVICES PRACTICE AND IS AN ELECTED MEMBER OF THE BOARD OF DIRECTORS FOR THE 7ORKGROUP FOR %LECTRONIC $ATA )NTERCHANGE 7%$) (E CAN BE REACHED AT JEFFFUSILE US PWCCOM *AMES +OENIG #)00 IS A LEADER OF 0RICEWATERHOUSE#OOPERS 0RIVACY 3TRATEGY AND #OMPLIANCE PRACTICE (E HAS AN EXTENSIVE BUSINESS TECHNOLOGY AND LEGAL BACKGROUND AND IS A RECOGNIZED AUTHORITY ON PRIVACY ISSUES IMPACTING HEALTHCARE lNANCIAL SERVICES DIRECT MARKETING AND TECHNOLOGY *AMES PROVIDES GLOBAL PRIVACY AND SECURITY STRATEGY COMPLIANCE AND TRAINING SERVICES FOCUSED ON 2/) DRIVEN SOLUTIONS THAT BALANCE THE GOALS OF BUSINESS WITH RESPECT FOR CONSUMER PRIVACY (E CAN BE REACHED AT JAMESHKOENIG US PWCCOM #INDY 3MITH #)330 IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS 0ERFORMANCE )MPROVEMENT PRACTICE 3HE HAS OVER YEARS EXPERIENCE IN INFORMATION SECURITY INCLUDING STRATEGY DEVELOPMENT RISK ASSESSMENTS TOOL SELECTIONIMPLEMENTATION AND COMPLIANCE PROGRAM DEVELOPMENT 3HE HAS MANAGED REGULATORY COMPLIANCE AND TECHNICAL SECURITY ASSESSMENTS AT "#"3 ORGANIZATIONS HEALTH PLANS HOSPITALS PHARMACEUTICAL COMPANIES DRUGSTORE CHAINS GOVERNMENT AGENCIES BEHAVIORAL HEALTH PROVIDERS AND FOR EMPLOYERS 3HE CAN BE REACHED AT CYNTHIAESMITH USPWCCOM
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
S G Dã GN QHYN MãADXN MCã'( /
ãA@K@MBHMFãOQHU@BXã@MCãRD BT QHSXãVHSGãO @SHD MSãB@QD
@)N THE FUTURE THE DEBATE ABOUT TRANSPARENCY WILL BE OVER WE WILL JUST DO IT 4HERE WILL BE MORE SUCCESS STORIES 7E WILL LOOK BACK AND SAY THAT THE DECISION TO PUBLICLY REPORT PATIENT EXPERIENCE MADE A DIFFERENCE IN PERFORMANCE n *OE #ARMICHAEL PRESIDENT OF .2# 0ICKER 4O BE WELL BALANCED AND EFFECTIVE A PRIVACY AND SECURITY PROGRAM WILL DO AS MUCH TO MAKE INFORMATION AVAILABLE TO APPROPRIATE STAKEHOLDERS AS IT DOES TO MAKE IT UNAVAILABLE TO INAPPROPRIATE
PARTIES ! WELL BALANCED PROGRAM USES A BROAD STRATEGIC AND mEXIBLE FRAMEWORK THROUGH WHICH PROVIDERS CAN INVEST IN INFORMATION TECHNOLOGY TO PROTECT PRIVACY PROMOTE HEALTH AND SAVE LIVES 4HE 53 $EPARTMENT OF #OMMERCE 3AFE (ARBOR IS ONE EXAMPLE OF SUCH A BROAD FRAMEWORK WITH BALANCED ATTRIBUTES 4HESE INVESTMENTS ALSO RETURN lNANCIAL VALUE MANY TIMES OVER )N THE 53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES ESTIMATED INDUSTRYWIDE SAVINGS OF BILLION OVER YEARS FROM IMPLEMENTING TRANSACTION STANDARDS;= 2EGARDLESS OF WHETHER THIS ESTIMATE WAS ACCURATE THERE IS LITTLE DOUBT THAT THE HEALTHCARE INDUSTRY STANDS TO REAP SUBSTANTIAL SAVINGS AND IMPROVEMENTS FROM THE EFFECTIVE USE OF INFORMATION TECHNOLOGY 4HIS WILL PROVE TRUE NOT ONLY FROM AN ADMINISTRATIVE STANDPOINT BUT WILL BE DWARFED BY THE ENHANCEMENTS THAT )4 STANDS TO PROVIDE IN CLINICAL OPERATIONS !SIDE FROM THESE OBVIOUS lNANCIAL BENElTS INVESTMENTS IN PRIVACY AND SECURITY ALSO LEAD TO INCREASED FAITH IN THE COMMUNITY HEALTHCARE SYSTEM MAKING PATIENTS LESS LIKELY TO WITHHOLD CRITICAL INFORMATION OR AVOID CARE BECAUSE OF PRIVACY CONCERNS
!TTRIBUTES OF A "ALANCED &RAMEWORK 4HE h3EVEN 3AFE (ARBOR 0RINCIPLESv;= DEVELOPED BY THE 53 $EPARTMENT OF #OMMERCE INCORPORATE A NUMBER OF PRACTICAL ATTRIBUTES FOR PRIVACY AND SECURITY 7HILE THE AUTHORS ARE NOT ADVOCATING THIS MODEL SPECIlCALLY IT DOES PROVIDE A WIDELY ACCEPTED FRAMEWORK THAT PROVIDES A NICE ILLUSTRATION FOR THE READER .OTICE !N ORGANIZATION MUST NOTIFY INDIVIDUALS ABOUT THE PURPOSES FOR WHICH IT COLLECTS AND USES INFORMATION HOW THEY CAN PROCESS INQUIRIES AND COMPLAINTS THE TYPES OF THIRD PARTIES TO WHICH IT DISCLOSES ITS INFORMATION AND THE OPTIONS AND WAYS IT OFFERS TO LIMIT INFORMATION USE AND DISCLOSURE #HOICE !N ORGANIZATION MUST GIVE INDIVIDUALS THE OPPORTUNITY TO CHOOSE WHETHER THEIR PERSONAL INFORMATION WILL BE DISCLOSED TO A THIRD PARTY USED IN WAYS INCOMPATIBLE WITH ITS ORIGINAL PURPOSE OR USED FOR ANYTHING OTHER THAN THE SPECIlC PURPOSE FOR WHICH THEY AUTHORIZED ITS USE 4HIS IS COMMONLY CALLED hOPTING OUTv )N ADDITION FOR SENSITIVE INFORMATION INDIVIDUALS MUST GIVE THEIR AFlRMATIVE OR EXPLICIT CHOICE hOPTING INv FOR DISCLOSURE OF INFORMATION TO A THIRD PARTY FOR USE IN WAYS INCOMPATIBLE WITH ITS ORIGINAL PURPOSE OR USE FOR ANYTHING OTHER THAN THE SPECIlC PURPOSE FOR WHICH THEY AUTHORIZED ITS USE /NWARD 4RANSFER 4RANSFERS TO 4HIRD 0ARTIES !N ORGANIZATION MUST APPLY THE NOTICE AND CHOICE PRINCIPLES TO DISCLOSE INFORMATION TO A THIRD PARTY )T MAY TRANSFER INFORMATION TO A THIRD PARTY THAT IS ACTING AS ITS AGENT PROVIDED THE THIRD PARTY SUBSCRIBES TO THE 3AFE (ARBOR PRINCIPLES OR HAS ENTERED INTO A WRITTEN AGREEMENT THAT IT WILL PROVIDE AT LEAST THE SAME LEVEL OF PRIVACY PROTECTION AS IS REQUIRED BY THE RELEVANT PRINCIPLES !CCESS )NDIVIDUALS MUST HAVE ACCESS TO THEIR OWN PERSONAL INFORMATION AND BE ABLE TO CORRECT AMEND OR DELETE INACCURATE INFORMATION EXCEPT WHEN THE BURDEN OR EXPENSE OF PROVIDING ACCESS WOULD BE DISPROPORTIONATE TO THE RISKS TO THE INDIVIDUALS PRIVACY OR WHERE PROVIDING ACCESS WOULD VIOLATE THE RIGHTS OF PERSONS OTHER THAN THE INDIVIDUAL 3ECURITY !N ORGANIZATION MUST TAKE REASONABLE PRECAUTIONS TO PROTECT PERSONAL INFORMATION FROM LOSS MISUSE AND UNAUTHORIZED ACCESS DISCLOSURE ALTERATION AND DESTRUCTION $ATA INTEGRITY 0ERSONAL INFORMATION MUST BE RELEVANT FOR ITS INTENDED PURPOSES AN ORGANIZATION SHOULD TAKE REASONABLE STEPS TO ENSURE THAT THE DATA SUITS ITS INTENDED USE AND IS ACCURATE COMPLETE AND CURRENT %NFORCEMENT !N ORGANIZATION MUST PROVIDE READILY AVAILABLE AND AFFORDABLE INDEPENDENT RECOURSE FOR INVESTIGATING AND RESOLVING INDIVIDUAL COMPLAINTS AND DISPUTES AND FOR AWARDING DAMAGES WHERE PROVIDED BY THE APPLICABLE LAW OR PRIVATE SECTOR INITIATIVES )T ALSO MUST HAVE PROCEDURES FOR VERIFYING IMPLEMENTATION OF THE COMMITMENTS IT MAKES TO ADHERE TO THE 3AFE (ARBOR PRINCIPLES AND PROCEDURES FOR REMEDYING PROBLEMS ARISING FROM ITS FAILURE TO COMPLY )T MUST USE SANCTIONS SUFlCIENTLY RIGOROUS TO ENSURE COMPLIANCE
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
S G Dã GN QHYN MãADXN MCã'( /
ãA@K@MBHMFãOQHU@BXã@MCãRD BT QHSXãVHSGãO @SHD MSãB@QD
@7E NEED TO FOLLOW THROUGH ON TRANSPARENCY AND EMBRACE THE INFORMATION AVAILABLE TODAY )TS NOT PERFECT BUT RATHER THAN STRIVE FOR PERFECTION WE NEED TO EMBRACE WHAT WE HAVE AVAILABLE TO US n *OE #ARMICHAEL
4HE "ALANCING !CT 0ROVIDERS INSURERS LITIGATORS AND OTHERS HAVE BEGUN TO REALIZE THE FALLACY OF PRIORITIZING PRIVACY OVER HEALTH SERVICE DELIVERY IN AN INDUSTRY FUNDAMENTALLY FOCUSED ON MAKING PEOPLE HEALTHIER AND KEEPING THEM ALIVE 4HE BALANCE BETWEEN CONlDENTIALITY AND ACCESSIBILITY SHOULD HINGE ON BUSINESS REALITIES AND ON MAKING THE BUSINESS MORE EFlCIENT AND EFFECTIVE TO CREATE VALUE FOR PATIENTS n NOT SOLELY ON REGULATORY REQUIREMENTS 2ESPONSIBLE SHARING OF INFORMATION ENHANCES PRODUCTIVITY DRIVES QUALITY FORWARD AND POSITIONS PRIVACY AS A BENElT RATHER THAN AN IMPOSITION ! COMPLIANCE FOCUS MIGHT ALLEVIATE LEGAL RISKS BUT EFFECTIVE INFORMATION RISK MANAGEMENT INCLUDING A DOCUMENTED EXCEPTION PROCESS MIGHT ULTIMATELY RAISE CONSUMER CONlDENCE AND IMPROVE THE QUALITY OF HEALTHCARE PROVIDED !GGREGATING DATA THROUGH REGIONAL HEALTH INFORMATION ORGANIZATIONS OFFERS SIGNIlCANT OPPORTUNITIES TO IMPROVE QUALITY IN THE COMMUNITY 4HE )NDIANA (EALTH )NFORMATION %XCHANGE FOR
EXAMPLE SHARES ADMINISTRATIVE PATIENT DATA COLLECTED BY SEVERAL HOSPITALS IN THE )NDIANAPOLIS AREA )T INCORPORATES A STRAIGHTFORWARD CONSENT FORM FOR PATIENTS THAT INFORMS THEM ABOUT DATA USE AND ALLOWS THEM TO CHOOSE WHETHER TO HAVE THEIR INFORMATION SHARED WITH THE GROUP 4ECHNOLOGY SAFEGUARDS INFORMATION AS IF IT NEVER hLEFT THE BUILDINGv;= -ANY BUSINESS OPPORTUNITIES BASED ON THIS KIND OF COLLABORATION EXIST TODAY -ANY MORE WILL EMERGE WITHIN THE NEXT FEW YEARS )N ORDER TO ENGAGE AND REAP THE BENElTS HEALTHCARE ORGANIZATIONS NEED TO IMPLEMENT WELL MANAGED MECHANISMS FOR SHARING AND PROTECTING INFORMATION NOW 7HETHER THEIR UNDERLYING DATA INFRASTRUCTURE INVOLVES INTERNAL OUTSOURCED OR SHARED SYSTEMS THEY MUST PUT REASONABLE CONTROLS INTO PLACE TO AFFECT PATIENT CARE POSITIVELY AND CONSEQUENTLY REMAIN COMPETITIVE ,EADING THE WAY IN THE LOCAL MARKET ALSO CAN CREATE NEW BUSINESS OPPORTUNITIES SUCH AS SMALL SUBURBAN HOSPITALS SERVING PRIVACY CONSCIOUS PATIENTS BETTER THAN LARGE METROPOLITAN MEDICAL CENTERS COMBINING BETTER PROVEN OUTCOMES THAT ARE SIGNIlCANTLY LESS EXPENSIVE TO CONSUMERS INSURERS AND EMPLOYERS
! 0RACTICAL !PPROACH /THER INDUSTRIES HAVE IN LARGE PART MOVED BEYOND A FOCUS ON COMPLIANCE OBLIGATIONS IMPOSED BY LAWS AND REGULATIONS AND HAVE STARTED TO INVESTIGATE AND IMPLEMENT STRATEGIC PRIVACY FRAMEWORKS )N CONTRAST SOME PHYSICIANS HOSPITALS AND OTHER TYPES OF PROVIDERS REMAIN SQUARELY FOCUSED ON ()0!! AND ITS REQUIREMENTS AS THE UBIQUITOUS DEFINER OF PRIVACY !S A RESULT OF THIS NARROW FOCUS OPPORTUNITIES TO REALIZE THE
%XHIBIT $ATA ,IFE #YCLE
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
S G Dã GN QHYN MãADXN MCã'( /
ãA@K@MBHMFãOQHU@BXã@MCãRD BT QHSXãVHSGãO @SHD MSãB@QD
VALUE OF A PROVEN WELL BALANCED PRIVACY FRAMEWORK WITH SPECIFIC GUIDING PRINCIPLES MAY BE OVERLOOKED ()0!! IS SIMPLY ONE PART OF THE BROADER FRAMEWORK )N THIS INFORMATION AGE COMPANIES CANNOT AFFORD TO FIND THEMSELVES PERPETUALLY RESPONDING IN A KNEE JERK FASHION TO GOVERNMENT REGULATIONS )T MAKES FAR MORE SENSE TO CREATE A FLEXIBLE PROGRAM WITH A SOLID FRAMEWORK FOR ADDRESSING AND ACCOMMODATING EXISTING AND FUTURE BUSINESS ISSUES AND REGULATIONS 3HIFTING PERSPECTIVES ALLOWS PROVIDERS TO SET REALISTIC EXPECTATIONS BASED ON UNIVERSAL CONCEPTS AND BUSINESS CONSIDERATIONS AND FOLLOW THROUGH WITH BENCHMARKED APPROACHES h$OING THE RIGHT THINGv BY CREATING A SYSTEM THAT DEMONSTRATES GENUINE CONCERN FOR PATIENT SAFETY AND PRIVACY PRESENTS MANY CHALLENGES AND A NEED FOR HARD WORK SUCH AS DOCUMENTING AND MANAGING WHO HAS PROVIDED PERMISSION TO WHOM TO USE WHAT PART OF THEIR HEALTHCARE DATA 4HE LONG TERM BENElTS HOWEVER ARE WORTH THE SHORT TERM PAIN 0ROVIDERS CAN CREATE A COMPREHENSIVE PRIVACY AND INFORMATION RISK MANAGEMENT PROGRAM FROM THIS FOUNDATION THAT CONSIDERS APPLICABLE FEDERAL AND STATE LAWS ENFORCEMENT TRENDS RULES AND REGULATIONS AND GUIDING PRINCIPLES 4HE RESULTING FRAMEWORK ALIGNS PEOPLE PROCESSES AND TECHNOLOGY IN A WAY THAT OUTLASTS THE LATEST hREGULATION OF THE DAYv
6ERSATILITY AND &LEXIBILITY FOR .OW AND THE &UTURE #HANGES TO ()0!! AND THE EVOLUTION OF NEW FEDERAL AND STATE LEGISLATION WILL CONTINUE AS THE 53 GRAPPLES WITH VARYING STATE
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
AND FEDERAL REGULATIONS AND AS THE WORLD WRESTLES WITH GLOBAL INTERCONNECTION /RGANIZATIONS THAT DESIGN VERSATILE AND mEXIBLE INFORMATION RISK MANAGEMENT FRAMEWORKS WILL MOST EFFECTIVELY AND EFlCIENTLY EMBRACE FUTURE DEVELOPMENTS WITH MINIMAL INCREASED COSTS AND ENHANCED QUALITY 2EGARDLESS OF THE STRATEGY CHOSEN THOSE ORGANIZATIONS WILL HAVE DElNED DOCUMENTED AND IMPLEMENTED PROGRAMS AND POLICES TO ADDRESS THE DATA LIFE CYCLE FROM ITS CREATION TO ITS DESTRUCTION %ACH PIECE OF THAT LIFE CYCLE n CREATION MOTION STORAGE ACCESS AND DESTRUCTION SEE %XHIBIT n REQUIRES A DElNED PROGRAM THAT MANAGES PEOPLE AND TECHNOLOGY IN A REALISTIC OPERATIONAL AND APPROPRIATE WAY 4HE PROCESS ONCE STARTED IS ONGOING )NFORMATION RISK MANAGEMENT IS A JOURNEY AND ONE THAT REQUIRES CONTINUAL DILIGENCE 'ETTING THIS BALANCE RIGHT IS CRITICAL TO SUCCESSFULLY ENHANCING )4 INVESTMENTS TO IMPROVE CLINICAL OUTCOMES AND THE PATIENT EXPERIENCE OVER THE LONG TERM %NDNOTES &ERRIS . h()0!! $OESNT 0ROTECT !LL (EALTH )NFORMATION /HIO #OURT 2ULES v 'OVERNMENT (EALTH )4 -ARCH HTTPWWWGOVHEALTHIT COMARTICLE 7EB h0ROTECTING THE 0RIVACY OF 0ATIENTS (EALTH )NFORMATION 3UMMARY OF THE &INAL 2EGULATIONS v (EALTH AND (UMAN 3ERVICES &ACT 3HEET $ECEMBER 53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES HTTPASPEOSDHHSGOVADMNSIMPFINALPVC FACTHTM 3AFE (ARBOR 0RINCIPLES CAN BE ACCESSED AT HTTPWWWEXPORTGOV SAFEHARBORSH?OVERVIEWHTML 4HE )NDIANA (EALTH )NFORMATION %XCHANGE HTTPWWWIHIECOM SERVICESHTM
'LOBAL 0ERSPECTIVES ON 1UALITY 7HILE NATIONAL HEALTHCARE QUALITY IMPROVEMENTS MAY BE MOTIVATED BY COUNTRY SPECIlC POLITICAL OR ECONOMIC DRIVERS REGIONAL APPROACHES AND INNOVATIONS TO QUALITY DELIVERY ARE DEMONSTRATING CROSS BORDER APPLICATIONS
"Y 2ACHEL !BBOTT #ARRIE 3CHULMAN AND 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
0
ATIENTS PHYSICIANS AND POLICY MAKERS AROUND THE WORLD AGREE THAT THERE ARE QUALITY PROBLEMS IN HEALTHCARE AS ILLUSTRATED IN %XHIBIT (OWEVER UNIQUE CULTURAL POLITICAL ECONOMIC AND HISTORIC ENVIRONMENTS MEAN DIFFERENT IMPROVEMENT PRIORITIES IN DIFFERENT COUNTRIES #USTOMIZED SOLUTIONS THAT ACCOUNT FOR VARIOUS lNANCING AND DELIVERY SYSTEMS ARE BEGINNING TO TAKE SHAPE IN DIFFERENT TERRITORIES !S THEY APPROACH THESE SOLUTIONS QUALITY EXPERTS ARE lNDING THAT THE FOLLOWING ISSUES MUST BE ADDRESSED 2ESPONSIBILITIES AND ACCOUNTABILITY -EASUREMENT 0URCHASING AND #ROSS BORDER ASSESSMENT MODELS
2ESPONSIBILITIES AND !CCOUNTABILITY #OUNTRIES AND CULTURES TAKE A VARIETY OF APPROACHES TO ASSIGNING RESPONSIBILITY FOR QUALITY IN HEALTHCARE 4HESE DIFFERENCES OFTEN DEPEND ON THE DEGREE TO WHICH THEY REGARD THE PATIENT AS A CONSUMER #OUNTRIES SUCH AS THE 5NITED 3TATES WHERE MORE THAN HALF OF HEALTHCARE IS PAID FOR BY EMPLOYERS AND PRIVATE HEALTH PLANS TAKE A MARKET ORIENTED APPROACH TO QUALITY MONITORING AND IMPROVEMENT /N THE OTHER HAND IN %UROPES AND !USTRALIAS LARGELY PUBLICLY FUNDED HEALTH SYSTEMS THE QUESTION OF ACCOUNTABILITY IS MORE A POLITICAL ISSUE WITH A STRONG PUBLIC DRIVE AROUND QUALITY )N PARTICULAR FAILURE OF TAX FUNDED HOSPITALS PUTS PRESSURE ON GOVERNMENTS TO INTERVENE;= 2EGARDLESS OF THE lNANCING SOURCE GOVERNMENTS PROFESSIONALS AND PATIENTS ALL HAVE A ROLE IN QUALITY IMPROVEMENT 4HE CURRENT
DEBATE IS AROUND HOW THOSE ROLES ARE CHANGING AND HOW ACCOUNTABILITY IS DETERMINED 4HE S SAW A CULTURAL SHIFT TOWARD GOVERNMENT DRIVEN QUALITY AGENDAS AS OPPOSED TO PROFESSIONAL SELF MONITORING 4HIS WAS TRIGGERED IN PART BY HIGH PROlLE MEDIA SCANDALS IN !USTRALIA AND THE 5NITED +INGDOM THAT EXPOSED MEDICAL ERROR RATES AND UNETHICAL PRACTICES BY INDIVIDUALS ! NEED FOR PUBLIC REASSURANCE LED TO AN INCREASE IN CENTRALLY DRIVEN AGENDAS 4HE GOVERNMENT PRESSURED PROVIDERS TO REFORM THEIR PRACTICES AND VOTERS PRESSURED THE GOVERNMENT TO MONITOR QUALITY 4HE LANDMARK BOOK 4O %RR IS (UMAN ;= HIGHLIGHTED THE SIZE AND SCOPE OF MEDICAL ERRORS IN THE 53 4HE RESULT WAS INCREASED PRESSURE ON PROVIDERS AND AN IMPORTANT ROLE FOR INDEPENDENT ACCREDITATION ORGANIZATIONS RATHER THAN SOLE RELIANCE ON GOVERNMENT REGULATION;= $IFFERING OPINIONS ABOUT THE VARIOUS ROLES OF STAKEHOLDERS IN QUALITY CAME OUT IN 0RICEWATERHOUSE#OOPERS (EALTH#AST RESEARCH;= (EALTH EXECUTIVES IN COUNTRIES WERE ASKED WHICH STAKEHOLDER HAD BEEN MOST SUCCESSFUL IN IMPROVING QUALITY )N THE 53 PATIENT ADVOCACY GROUPS RATED lRST )N %UROPE AND #ANADA PHYSICIANS RANKED HIGHEST )N THE -IDDLE %AST !USTRALIA AND !SIA GOVERNMENT WAS VIEWED AS MAKING THE MOST PROGRESS "ROADLY SPEAKING GOVERNMENTS INmUENCE OVER HEALTHCARE PROVIDERS CAN BE VIEWED AS REGULATION LEGISLATION OR LICENSING ACTIVITIES THAT MANDATE BEHAVIOR DIRECT MANAGEMENT OF HEALTH SYSTEMS IN WHICH THE GOVERNMENT HAS A DIRECT ROLE IN RUNNING THE HEALTH SYSTEM OR INCENTIVES MARKET BASED APPROACHES TO ENCOURAGE CERTAIN BEHAVIOR 'OVERNMENTS IN %UROPE HAVE TAKEN A HYBRID APPROACH TO INmUENCING PROVIDERS BY ENACTING LEGISLATION THAT MANDATES ATTENTION TO QUALITY WHILE BEING NONPRESCRIPTIVE IN THE MECHANISMS &OR EXAMPLE 'ERMANY THE &IFTH 3OCIAL !CT
2ACHEL !BBOTT -3 IS AN EXECUTIVE WITH 0RICEWATERHOUSE#OOPERS 'OVERNMENT AND 0UBLIC 3ECTOR PRACTICE IN ,ONDON 3HE HAS SEVERAL YEARS EXPERIENCE IN THE HEALTHCARE INDUSTRY IN COMMUNICATIONS AND PUBLIC AFFAIRS AND STUDIED INTERNATIONAL HEALTH POLICY AT THE ,ONDON 3CHOOL OF %CONOMICS 3HE CAN BE REACHED AT RACHELEABBOTT UKPWCCOM #ARRIE 3CHULMAN -0! 04 IS A SENIOR MANAGER WITH 0RICEWATERHOUSE#OOPERS ON SECONDMENT IN THE 5+ FROM THE 53 (EALTH )NDUSTRIES PRACTICE 3HE COORDINATES HEALTH INITIATIVES FOR 0W#S 'LOBAL (EALTH SECTOR AND HAS OVER YEARS OF EXPERIENCE IN THE HEALTH INDUSTRY 3HE CAN BE REACHED AT CARRIESCHULMAN UKPWCCOM 4IM 7ILSON -$ IS A FAMILY DOCTOR IN THE 5+ !FTER WORKING AT THE HIGHEST LEVEL IN GOVERNMENT HE MOVED TO 0RICEWATERHOUSE#OOPERS WHERE HE IS SENIOR ADVISOR ON CLINICAL PERFORMANCE IMPROVEMENT (E HAS PUBLISHED EXTENSIVELY ON THE SUBJECTS OF QUALITY AND SAFETY (E CAN BE REACHED AT TIMWILSON UKPWCCOM ) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
F KN A@KãOD QROD BSHU D RãNMãPT @KHSX PUBLICIZING INNOVATIVE BEST PRACTICES SUCH AS IMPROVEMENT IN ARTIlCIAL RESPIRATION FOR INTENSIVE CARE PATIENTS )N TERMS OF PROFESSIONALS GOVERNMENTS ARE INmUENCING QUALITY BY FACILITATING OR MOTIVATING SELF REGULATION )N SEVERAL %UROPEAN COUNTRIES FOR EXAMPLE IN %ASTERN %UROPE AND 3PAIN GROUPS OF PROVIDERS HAVE INITIATED QUALITY ASSESSMENT AND ACCREDITATION SYSTEMS WHICH SUBSEQUENTLY FAILED DUE TO LACK OF GOVERNMENT SUPPORT AND UNIVERSAL APPLICATION (OWEVER INITIATIVES THAT HAVE BEEN TOO hTOP DOWNv HAVE BEEN MET WITH RESISTANCE FROM PROVIDERS WHO MAY VIEW THESE PROGRAMS AS AN ADDITIONAL ADMINISTRATIVE BURDEN )N THE .ETHERLANDS hQUALITY CIRCLESv OF ABOUT HEALTHCARE PROFESSIONALS REVIEW CLINICAL PRACTICE GUIDELINES IN MULTIDISCIPLINARY GROUPS h0EER VISITSv FROM OTHER HEALTHCARE PROFESSIONALS ARE ALSO IMPORTANT IN ENSURING THAT CLINICAL GUIDELINES ARE IMPLEMENTED AND IMPROVEMENTS IN QUALITY ARE ENCOURAGED )N GENERAL A CAREFUL BALANCE BETWEEN CENTRAL GOVERNMENT AUTHORITY AND PROFESSIONAL SELF REGULATION IS NEEDED 4HE .ORWEGIAN -EDICAL !SSOCIATION .-! THE PHYSICIANS PROFESSIONAL TRADE ASSOCIATION STARTED THE "REAKTHROUGH 0ROJECT IN 4HE IDEA FOR THIS PROJECT ORIGINATED FROM THE )NSTITUTE OF (EALTHCARE )MPROVEMENT IN "OSTON AND THE METHOD IS USED IN SEVERAL HOSPITALS ACROSS THE 53 AND %UROPE (EALTHCARE PROFESSIONALS FROM ACROSS .ORWAY ARE CHOSEN TO PARTICIPATE IN QUALITY PROJECTS LASTING SIX TO EIGHT MONTHS ALONG SPECIlC THEMES USING A STRICT FRAMEWORK 4HE .-! IS EAGER TO REPLICATE SUCCESS AND CREATE DISCUSSIONS ABOUT THE RESULTS 4HE EFFORT WILL CONTINUE UNTIL AT WHICH POINT THE LONG TERM RESULTS OF THE PROJECTS WILL BE CONSIDERED !LREADY RESULTS FROM PROJECTS FOCUSING ON INTENSIVE AND PERINATAL CARE HAVE MOTIVATED CHANGES IN PRACTICE 0ATIENTS HAVE AN IMPORTANT ROLE IN QUALITY BUT EXPERTS AGREE THEY NEED MORE INFORMATION TO MAKE DECISIONS %XPERTS SAY PATIENTS OFTEN LACK AN UNDERSTANDING OF MEDICAL INFORMATION AND THE RESULTING CONlDENCE TO MAKE INFORMED %XHIBIT 1UALITY IS A GLOBAL PROBLEM DECISIONS ABOUT THEIR OWN HEALTH AND HEALTHCARE !53 #!. '%2 .: 5+ 53 %VEN WITHOUT CHOOSING THEIR CARE BASED ON QUALITY PATIENTS IN MANY COUNTRIES PLAY AN /VERALL 2ANKING IMPORTANT ROLE IN MONITORING HEALTHCARE QUALITY THROUGH MANDATORY PATIENT SATISFACTION SURVEYS (IGHEST ,OWEST AND COMPLAINTS SYSTEMS !DDITIONALLY PATIENT 0ATIENT 3AFETY ADVOCACY GROUPS ARE IMPORTANT ADVOCATES FOR %FFECTIVENESS HEALTH SYSTEM CHANGE 4HESE GROUPS PRESSURE 0ATIENT #ENTEREDNESS PAYERS FOR NEW TECHNOLOGIES AND MEDICATIONS AND 4IMELINESS PRESSURE PROVIDERS TO IMPLEMENT BEST PRACTICES %FlCIENCY 0ATIENT RIGHTS AND DATA PROTECTION HAVE BEEN %QUITY IMPORTANT TOPICS ON THE QUALITY IMPROVEMENT AGENDA IN 'ERMANY FOR MORE THAN YEARS (EALTH %XPENDITURES PER #APITA 2ECENTLY A LARGE NUMBER OF HOSPITALS HAVE BEEN CERTIlED BASED ON )3/ %&1- ANDOR 3OURCE 4HE #OMMONWEALTH &UND h-IRROR -IRROR ON THE 7ALL !N 5PDATE ON THE +41 A 'ERMAN QUALITY ASSESSMENT SYSTEM 4HIS 1UALITY OF !MERICAN (EALTH #ARE 4HROUGH THE 0ATIENTS ,ENS v !PRIL TREND IN CERTIlCATION AIMS TO IMPROVE EFlCIENCY AND ESTABLISH A HIGH STANDARD OF CARE 'ERMANY
REQUIRES QUALITY ASSURANCE SYSTEMS IN HOSPITALS THAT APPLY TO BOTH ORGANIZATIONAL SYSTEMS AND OUTCOMES BUT IS LIMITED IN ITS DElNITION OF THESE SYSTEMS )N THIS WAY GOVERNMENT POLICY FORCES ATTENTION ON A QUALITY AGENDA BUT ALLOWS MANAGERS AND POLICY MAKERS TO CONSIDER LOCAL NEEDS AND INTERESTS IN DESIGNING THE MOST APPROPRIATE MEANS TO DO SO )N )TALY QUALITY INDICATORS ARE DEVELOPED AT A NATIONAL LEVEL AND IMPLEMENTED LOCALLY BASED UPON SPECIlC REGIONAL NEEDS %VERY HOSPITAL HAS A QUALITY OFlCE AND HEALTHCARE DIRECTOR RESPONSIBLE FOR QUALITY 3IMILARLY IN 3PAIN EACH OF AUTONOMOUS COMMUNITIES REGULATES QUALITY STANDARDS INDEPENDENTLY %ACH REGION DESIGNS INDEPENDENT MECHANISMS FOR HEALTHCARE QUALITY REGULATION WITH SOME PROVIDING lNANCIAL INCENTIVES LINKED TO QUALITY (OWEVER THIS REGIONAL APPROACH CREATES AN OBSTACLE TO DATA SHARING AS THERE ARE NO NATIONAL DElNITIONS OR AGGREGATED DATA SETS )N CONTRAST TO THE DEVOLVED CONTROL OF THE 3PANISH AND )TALIAN HEALTHCARE SYSTEMS CENTRAL REGULATION OF %NGLANDS .ATIONAL (EALTH 3ERVICE .(3 ENABLES THE $EPARTMENT OF (EALTH TO ISSUE QUALITY REPORTS ACROSS THE ENTIRE SERVICE )N THIS WAY NATIONAL STANDARDS CAN MEAN NATIONWIDE QUALITY BUT INEFFECTIVE POLICIES AND PROGRAMS MAY BE MAGNIlED )N THE .ETHERLANDS THE -INISTRY OF (EALTH IS DRIVING THE QUALITY AGENDA WITH INPUT FROM PROVIDERS 4HE 3NELLER "ETER "ETTER &ASTER PROGRAM WAS IMPLEMENTED TO HIGHLIGHT BEST PRACTICES WITH A SPECIlC FOCUS ON SAFETY AND hPATIENT LOGISTICSv OR COMMUNICATION AND TRANSFER PROCESSES BETWEEN DEPARTMENTS ,AUNCHED IN .OVEMBER THE PROGRAM HAS DRAWN ON EXPERTISE FROM OTHER INDUSTRIES AND AIMS TO HELP HEALTHCARE PROFESSIONALS IMPROVE THEIR PERFORMANCE STARTING WITH HOSPITAL AND PRIMARY HEALTHCARE 3NELLER "ETER IS COMPRISED OF THREE CORE ACTIVITIES BENCHMARKS FOR HOSPITALS AND PRIMARY HEALTHCARE INDICATORS FOR SAFER CARE AND A QUALITY INNOVATION AND EFlCIENCY PROGRAM 4HE PROGRAM HAS BEEN SUCCESSFUL IN IDENTIFYING AND
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
F KN A@KãOD QROD BSHU D RãNMãPT @KHSX ALSO HAS STRONG DATA SECURITY LAWS WHICH COMPLICATE EFFORTS TO STRENGTHEN MONITORING SYSTEMS AND INCREASE INFORMATION SHARING BETWEEN HOSPITALS AND PROVIDERS "Y 'ERMAN LAW ALL PUBLIC DATA MUST BE FULLY ANONYMOUS
-EASUREMENT )NTERNATIONAL DEBATE CONTINUES AROUND HOW TO MEASURE QUALITY ESPECIALLY THE USE OF PROCESS VERSUS OUTCOME DATA;= 4HESE CHALLENGES ARE DISCUSSED IN THE PAPER h!LL 1UALITY 2OADS ,EAD TO $ATAv IN THIS BOOK )N REALITY PERFORMANCE INDICATORS ARE GENERALLY DETERMINED BY PRACTICAL CONSIDERATIONS 7HILE HEALTHCARE OUTCOMES ARE A PART OF THE PATIENTS BASIC MEDICAL RECORD DISCRETE PROCESS INFORMATION HAS NOT HISTORICALLY BEEN COLLECTED IN MANY PUBLICLY FUNDED HEALTH SYSTEMS )N CONTRAST THE BILLING AND PAYMENT STRUCTURES IN THE 53 HAVE NECESSITATED EXTENSIVE PROCESS DATA COLLECTION 9ET EVEN IN THE 53 ACCESS AND USE OF PROCESS DATA IS COMPLICATED BY INCONSISTENCIES BETWEEN MEDICAL AND BILLING RECORDS OFTEN MAKING THIS INFORMATION UNUSABLE IN PRACTICAL TERMS )N BOTH INSTANCES IMPROVEMENTS IN ELECTRONIC INFORMATION SYSTEMS ARE NEEDED TO MAKE PROCESS AND CLINICAL OUTCOME DATA MORE ACCESSIBLE )N .ORWAY PHYSICIANS HAVE A LEADERSHIP ROLE IN QUALITY MONITORING 3ELECTED SYSTEM MEASURES LIKE WAITING TIMES INFECTION RATES ACCIDENTS AND NEAR ACCIDENTS AND PATIENT SATISFACTION ARE REPORTED BY ALL HOSPITALS BUT THERE ARE NO NATIONALLY AGREED UPON DElNITIONS FOR CLINICAL QUALITY #LINICAL QUALITY DATA ARE INSTEAD COLLECTED BY GROUPS OF PHYSICIANS WITHIN MEDICAL SPECIALTIES 7HILE PROFESSIONAL COLLABORATION ON CLINICAL QUALITY STUDIES HAS HELPED IDENTIFY BEST PRACTICES NATIONAL STANDARDS FOR COLLECTING CLINICAL DATA ARE NEEDED TO ENABLE BETTER COMPARISON ACROSS PROVIDERS )N THE -IDDLE %AST A RECENT SURVEY OF HEALTHCARE PROVIDERS ACROSS THE REGION IDENTIlED THE NEED FOR IMPROVEMENT IN THE ACCURACY OF MEDICAL RECORDS )T IS THOUGHT THAT THE MAJORITY OF MEDICAL RECORD DOCUMENTATION MAY BE MISCODED 4HIS ALARMING SITUATION WAS ATTRIBUTED TO THE VARIETY OF LANGUAGES USED BY THE WORKFORCE AND A LACK OF )4 INFRASTRUCTURE %XPERTS IN 3AUDI !RABIA SIMILARLY CITE LACKING BROADBAND CAPABILITIES AND PRIMARILY MANUAL RECORD KEEPING PROCESSES AS HINDERING DATA COLLECTION 0OOR AVAILABILITY AND INCONSISTENT DATA QUALITY MAKE MEANINGFUL ANALYSIS DIFlCULT !S $2' STYLE PAYMENT SYSTEMS REPLACE HOSPITAL BUDGETS IN %UROPE AND !USTRALIA THERE IS INCREASING EMPHASIS ON ACCURATE MEDICAL RECORD DOCUMENTATION AND CODING (OWEVER ADVANCED INFORMATION TECHNOLOGY IS NOT A PANACEA AND PROBLEMS WITH MEDICAL RECORD ACCURACY ARE ALSO COMMON IN COUNTRIES WITH MORE SOPHISTICATED )4 INFRASTRUCTURES )N %NGLAND AN AMBITIOUS NATIONAL HEALTH )4 PROJECT CURRENTLY UNDER WAY ACROSS THE .(3 HAS HIGHLIGHTED THE IMPORTANCE OF ACCURATE RECORD KEEPING 4HE 5+ CARDIAC SURGERY COMMUNITY WAS ONE OF THE lRST TO RIGOROUSLY COLLECT AND PUBLISH CLINICAL OUTCOME DATA (OWEVER THE NATIONAL OUTCOMES DATABASE WAS
FOUND TO BE INCOMPLETE AND UNRELIABLE DUE TO INCONSISTENCIES IN REPORTING AND FAILURE IN TRANSFERRING INFORMATION FROM PATIENTS RECORDS;= 4HIS IS ALSO A CONCERN IN THE 53 WHERE DETAILED CLINICAL INFORMATION IS OFTEN RECORDED BY HAND IN PATIENTS MEDICAL RECORDS AND NOT DUPLICATED IN ELECTRONIC BILLING RECORDS )N OTHER WORDS ELECTRONIC DATABASES ARE ONLY AS VALUABLE AS THE QUALITY AND CONSISTENCY OF THE INFORMATION INPUT )N 3PAIN EXPERTS FEEL THAT IMPROVING HEALTHCARE QUALITY IS IMPOSSIBLE WITHOUT A hDIGITAL TRANSFORMATIONv 4HE FOCUS IS ON IMPLEMENTATION OF ELECTRONIC PHARMACY PRESCRIPTIONS AND ELECTRONIC MEDICAL RECORDS !UTONOMOUS COMMUNITIES HAVE LOCAL EFFORTS UNDER WAY TO IMPLEMENT REGIONAL HEALTHCARE NETWORKS 4HE NEXT STEPS WILL BE TO CREATE A hNETWORK OF NETWORKSv COVERING THE ENTIRE NATIONAL TERRITORY AND ENABLING INFORMATION EXCHANGE "ETTER INFORMATION SHARING IS VITAL TO CONTINUITY OF CARE 4HE JUNCTURES BETWEEN PROVIDERS AND SERVICES ARE OFTEN POINTS OF BOTH QUALITY AND EFlCIENCY FAILURES )MPROVING CARE MANAGEMENT OF CHRONIC CONDITIONS IS THE FOCUS OF A PROCESS REDESIGN FOR DISTRICT MEDICAL SERVICES IN *APAN WHICH AIMS TO CLARIFY THE ROLE OF LOCAL GENERAL PRACTITIONERS AND SMALL HOSPITALS IN RELATION TO OTHER PROVIDERS #HRONIC CARE MANAGEMENT IS ALSO A PRIORITY IN )TALY WHERE A THREE YEAR IMPROVEMENT PLAN INCLUDES DEVELOPING A NATIONAL INFORMATION SYSTEM TO ALLOW IDENTIlCATION OF APPROPRIATE CLINICAL PATHWAYS ACCORDING TO PATIENT HISTORY ! QUALITY INITIATIVE BY THE GOVERNMENT OF !USTRALIA TARGETED CHRONIC DISEASE MANAGEMENT 4HE .ATIONAL !CTION 0LAN FOR /STEOARTHRITIS 2HEUMATOID !RTHRITIS AND /STEOPOROSIS LAYS OUT KEY OBJECTIVES FOR QUALITY IMPROVEMENT IN THESE SPECIALTIES -OST RECENTLY THE "ETTER !RTHRITIS #ARE BUDGET INITIATIVE FOR FUNDED QUALITY IMPROVEMENT PROJECTS FOCUSED ON IMPROVED PATIENT ACCESS TO CARE
0URCHASING 4HE 7(/ 7ORLD (EALTH 2EPORT IDENTIlED STRATEGIC PURCHASING AS A POWERFUL TOOL FOR HEALTH SYSTEM IMPROVEMENT )NCREASINGLY GOVERNMENTS IN COUNTRIES WITH LARGELY PUBLICLY FUNDED HEALTH SYSTEMS ARE RECOGNIZING THE POTENTIAL FOR BUILDING PERFORMANCE INDICATORS INTO PURCHASING AND REIMBURSEMENT ACTIVITIES 3WEDEN &INLAND AND 'ERMANY HAVE ADOPTED SOME DEGREE OF PUBLIC SECTOR PURCHASING DESIGNED TO MOTIVATE QUALITY AND QUALITY OF CARE IS A KEY ELEMENT IN PROVIDERS CONTRACTS IN &RANCE )TALY AND THE 5+ 3PECIlCALLY THE 'ERMAN ORGANIZATION h'EM"!v 'EMEINSAMER "UNDESAUSSCHUSS WAS CREATED TO MAKE PURCHASING AND REIMBURSEMENT DECISIONS IN COLLABORATION WITH GOVERNMENT AND PUBLIC INSURERS 3IMILARLY RECENT HEALTH SYSTEM REFORMS INTRODUCED IN THE .ETHERLANDS IN *ANUARY INCLUDE CHANGES TO INSURANCE REIMBURSEMENT PRACTICES WHICH WILL NOW INCLUDE CONSIDERATION OF PROVIDER QUALITY AND EFlCIENCY ! PAY FOR PERFORMANCE BREAST CANCER TREATMENT PROGRAM HAS BEEN SUCCESSFULLY PILOTED AT A 4AIWANESE SPECIALIST CANCER
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
F KN A@KãOD QROD BSHU D RãNMãPT @KHSX HOSPITAL THE +OO &OUNDATION 3UN9AT 3EN #ANCER #ENTER +&39## ! KEY SUCCESS FACTOR WAS DEVELOPING A HOSPITALWIDE DATABASE TO MONITOR AND IMPROVE PATIENT CARE 4HE BREAST CANCER PROGRAM WHICH hENCOURAGES QUALITY RATHER THAN QUANTITY OF CAREv HAS CONTRIBUTED TO ACHIEVING AN PERCENT SURVIVAL RATE AT ALL STAGES AT +&39## 4HE PROGRAM WILL BE EXPANDED NATIONALLY AND +&39## IS COLLABORATING WITH 5#,! AND 2!.$ IN THE 53 TO DEVELOP A #ENTRE FOR (EALTHCARE )MPROVEMENT;=
#ROSS "ORDER !SSESSMENT -ODELS )T IS INCREASINGLY COMMON FOR PATIENTS TO TRAVEL ABROAD FOR HEALTHCARE /FTEN REFERRED TO AS HEALTHCARE TOURISM CROSS BORDER CARE IS NO LONGER LIMITED TO A FEW WEALTHY INDIVIDUALS WITH SPECIALIZED NEEDS (OWEVER THE INCREASE IN CROSS BORDER CARE IS PROMPTING THE NEED FOR CROSS BORDER QUALITY ASSESSMENT MODELS THAT PROVIDE SOME DEGREE OF STANDARDIZATION COMPARABILITY AND RESULTS EVALUATION 4HE %UROPEAN &OUNDATION FOR 1UALITY -ANAGEMENT %&1- A NONPROlT MEMBERSHIP ORGANIZATION ESTABLISHED A GENERIC INDUSTRY MODEL FOR QUALITY ASSESSMENT THAT IS NOW WIDELY USED BY HEALTHCARE ORGANIZATIONS ACROSS %UROPE !S SHOWN IN %XHIBIT THE GENERAL %&1- FRAMEWORK IS COMPRISED OF lVE hENABLER v OR PROCESS RELATED CRITERIA AND FOUR hRESULTS v OR OUTCOME ORIENTED CRITERIA;= 3EVERAL AUTONOMOUS COMMUNITIES IN 3PAIN HAVE ADOPTED THE %&1- SYSTEM AND REVIEWS OF SPECIlC ORGANIZATIONS HAVE BEEN IMPORTANT IN UNDERSTANDING THE MOST APPROPRIATE APPLICATION OF THE MODEL IN THE HEALTH SECTOR 4HIRTY ONE ORGANIZATIONS OF THE "ASQUE (EALTH 3ERVICE WERE STUDIED FOLLOWING PARTICIPATION IN QUALITY ASSESSMENT PROGRAMS USING THE %&1- %XCELLENCE -ODEL 4HE ASSESSMENT FOUND IMPROVEMENT IN PROCESS MEASURES THE MOST DRAMATIC BEING IMPROVEMENTS IN PATIENT SATISFACTION;= 3TANDARDS DEVELOPED BY THE )NTERNATIONAL /RGANIZATION FOR 3TANDARDIZATION )3/ FOR MANAGEMENT SYSTEMS ARE ALSO USED AS THE BASIS OF HEALTH SYSTEM QUALITY ASSESSMENT IN MULTIPLE %UROPEAN COUNTRIES;=
%XHIBIT %&1- %XCELLENCE -ODEL #RITERIA
%NABLERS
,EADERSHIP 0OLICY AND STRATEGY 0EOPLE 0ARTNERSHIPS AND RESOURCES 0ROCESSES
2ESULTS
#USTOMER RESULTS 0EOPLE RESULTS 3OCIETY RESULTS +EY PERFORMANCE RESULTS
1 5!,)4 9 # / . 5 . $ 2 5 - ) .4 2 / $ 5 #4 ) / .
%STABLISHING QUALITY COMPARISON METHODS IS ESPECIALLY IMPOR TANT IN %UROPE WHERE CROSS BORDER TREATMENT IS BECOMING INCREASINGLY COMMON "ESIDES MEDICAL RECORD KEEPING INCONSISTENCIES IN FUNDING AND PAYMENT DATA ARE PROBLEMATIC AND MAKE MEANINGFUL INTERPRETATION OF %UROPE WIDE STATISTICS SOMEWHAT INCONCLUSIVE 4HE %UROPEAN #OMMISSION HAS RECOMMENDED BETTER METHODS FOR SHARING INFORMATION ABOUT PROVIDERS AND QUALITY ON AN INTERNATIONAL BASIS INCLUDING BETTER USE OF COUNTRY LEVEL DATA TO TRACK DISEASE PATTERNS IN %UROPE;= 4HE /%#$ AND 7(/ HAVE BEEN INVOLVED IN ALIGNING INTERNATIONAL QUALITY INDICATORS 1UALITY INDICATORS IDENTIlED BY AN INTERNATIONAL PANEL OF EXPERTS CONVENED BY THE /%#$ WERE BROKEN DOWN INTO THREE DIMENSIONS IMPACT ON HEALTH IMPORTANCE TO NATIONAL POLICY AND ABILITY OF THE HEALTHCARE SYSTEM TO INmUENCE THE MEASURE /NE OF THE PROBLEMS ENCOUNTERED BY THE /%#$ CARDIAC EXPERT PANEL WAS ISOLATING INDICATORS OF QUALITY IN PRIMARY PREVENTION BECAUSE MEASURES MUST EXTEND BEYOND MEDICAL CARE AND INTO COMMUNITY AND SOCIAL CARE &URTHERMORE MANY MEASURES OF PRIMARY AND SECONDARY CARE COULD NOT BE AGREED ON INTERNATIONALLY AND WHEN THEY WERE UNIVERSAL COULD NOT FEASIBLY BE COLLECTED INTERNATIONALLY;= 3UCH DISAGREEMENT IS A CHALLENGE FOR INTERNATIONAL COLLABORATION "OTH THE %&1- AND )3/ QUALITY ASSESSMENT MODELS ARE IMPORTANT TO HEALTHCARE QUALITY IN THE .ETHERLANDS 4HE $UTCH )NSTITUTE FOR (EALTHCARE )MPROVEMENT BEGAN DEVELOPING COMPREHENSIVE CLINICAL PRACTICE GUIDELINES IN THE EARLY S 'UIDELINES HAVE NOW BEEN DEVELOPED FOR BOTH HOSPITAL AND PRIMARY CARE AND A RANGE OF EDUCATIONAL MATERIALS ARE UPDATED AND DISTRIBUTED REGULARLY TO HEALTHCARE PROFESSIONALS 3PECIlC INDICATORS HAVE BEEN DEVELOPED TO ENABLE BETTER MONITORING OF ADHERENCE TO THESE NATIONAL PRACTICE GUIDELINES 4HE %&1- IS APPLIED AS GENERAL GUIDANCE FOR EXCELLENCE 3PECIlC CERTIlCATION INCLUDING A NATIONAL ACCREDITATION SYSTEM FOR LABORATORIES AND RECENTLY DEVELOPED LABORATORY QUALITY SYSTEMS ARE BASED ON )3/ STANDARDS 4HE 5NITED !RAB %MIRATES IS LEVERAGING BEST PRACTICES TO IMPROVE QUALITY FOR CROSS TERRITORY CARE 4HE GOVERNMENT OF $UBAI HAS CREATED THE $UBAI (EALTHCARE #ITY $(## A REGIONAL EDUCATION RESEARCH AND HEALTHCARE SERVICES CENTER OF EXCELLENCE ! PHYSICAL SITE WITHIN $UBAI IT WILL BE COMPRISED OF MEDICAL TREATMENT AND RESEARCH FACILITIES ESTABLISHED IN COLLABORATION WITH (ARVARD -EDICAL )NTERNATIONAL $(## HAS ESTABLISHED THE h#ENTRE FOR (EALTHCARE 0LANNING AND 1UALITYv WITH (ARVARD TO CREATE A QUALITY MANAGEMENT SYSTEM FOR THE $(## FACILITIES !S A FACILITY THAT EXISTS AND OPERATES OUTSIDE OF AN ESTABLISHED HEALTH SYSTEM $(## PLANNERS HAVE THE OPPORTUNITY TO SHARE INTERNATIONAL BEST PRACTICES AND DEVELOP QUALITY MONITORING AND IMPROVEMENT SYSTEMS DRAWING FROM WIDE INTERNATIONAL EXPERIENCE )N %UROPE SEVERAL COUNTRIES HAVE ENTERED INTO STRUCTURED AGREEMENTS WITH NEIGHBORS TO MEET THE CAPACITY NEEDS OF STRUGGLING PUBLIC SYSTEMS FOR EXAMPLE THE $EPARTMENT OF (EALTH IN %NGLAND HAS CONTRACTED WITH "ELGIUM FOR ORTHOPEDIC SURGERY
F KN A@KãOD QROD BSHU D RãNMãPT @KHSX 4HIS PROCESS HAS BEEN EASED BY RECENT CHANGES TO THE %UROPEAN 5NIONS LEGAL FRAMEWORK ALLOWING PATIENTS REQUIRING TREATMENT AWAY FROM HOME TO EXTEND THEIR NATIONAL HEALTH PLANS WITH THE USE OF %5 INSURANCE CARDS )NITIALLY TRIGGERED BY HIGH PROlLE LAWSUITS %5 INSURANCE ARRANGEMENTS MAKE CARE ABROAD A MORE COMMON EXPERIENCE FOR MANY %UROPEANS 0ATIENTS IN 'ERMANY CROSS INTO 0OLAND TO GET DENTAL CARE AND 5+ RETIREES MOVE TO 3PAIN AND SEND BILLS HOME FOR PAYMENT /PENING PATIENT CHOICE TO BOTH DOMESTIC AND FOREIGN PROVIDERS ALSO HAS THE THEORETICAL POTENTIAL TO DRIVE QUALITY IMPROVEMENT DUE TO COMPETITION )N ,UXEMBOURG PATIENTS CAN EASILY CROSS BORDERS TO RECEIVE CARE IN 'ERMANY "ELGIUM AND &RANCE AND ABOUT ONE QUARTER OF PATIENTS DO AND SERVICES ARE REIMBURSED BY ,UXEMBOURGS MANDATORY HEALTH INSURANCE !S A RESULT THE GOVERNMENT THE INSURANCE FUND AND THE PROVIDERS ARE ALL INTERESTED IN ALIGNING QUALITY INFORMATION SYSTEMS AND RISK MANAGEMENT PROCESSES WITHIN THE COUNTRY AND WITH ITS NEIGHBORS .ATIONAL PERFORMANCE INDICATORS ARE GUIDED BY WIDER %5 POLICY DEVELOPMENTS AND OVER THE NEXT TWO YEARS THE ELECTRONIC MEDICAL RECORD SYSTEM IN ,UXEMBOURG WILL BE ORIENTED TO %5 STANDARDS #ROSS BORDER CARE PRESENTS CHALLENGES FOR FOLLOW UP AND CONTINUITY OF CARE REQUIRING SOPHISTICATED AND COMPREHENSIVE INFORMATION SHARING BETWEEN PROVIDERS ACROSS BORDERS AND IS BASED FOREMOST ON AN INFORMED PATIENT "ELGIUMS SIZE AND HISTORICAL EXPERIENCE WITH LANGUAGES AND WORKFORCES CROSSING BORDERS HAS SIMILARLY MADE CROSS BORDER HEALTHCARE A NATURAL EXPERIENCE /VER THE PAST YEARS PROVIDERS AND INSURERS HAVE TAKEN THE INITIATIVE TO MAKE THIS PROCESS EASIER AND MORE EFlCIENT FOR PATIENTS "ELGIAN HOSPITALS BENElT FROM FOREIGN PATIENTS PAID FOR BY FOREIGN INSURERS AND DIFFERENTIATE THEMSELVES IN SPECIALTIES IN A COMPETITIVE MARKET 3HARED PROTOCOLS ARE IN PLACE BETWEEN THE .ETHERLANDS AND "ELGIUM TO REDUCE TRANSMISSION OF ANTIBIOTIC RESISTANT BACTERIA A CONCERN IN CROSS BORDER CARE 3UCH PATIENT MOBILITY PROMOTES QUALITY IMPROVEMENTS IN BOTH $UTCH AND "ELGIAN HOSPITALS;=
#ONCLUSION )T IS NOT SURPRISING THAT INTERNATIONAL VARIATION IN THE CULTURAL POLITICAL ECONOMIC AND HISTORIC ENVIRONMENTS SURROUNDING HEALTHCARE CREATE AN EQUALLY WIDE VARIETY OF NATIONAL CONCERNS
AND PRIORITIES FOR QUALITY IMPROVEMENT 4HE GLOBAL EXPERIENCES HIGHLIGHTED IN THIS PAPER DEMONSTRATE THESE DIFFERENCES (OWEVER AS VARIABLE AS THESE EXPERIENCES ARE INTERNATIONAL EXPERIENCE ALSO PROVIDES SOME UNIQUE AND INNOVATIVE SOLUTIONS TO QUALITY ISSUES THAT MAY NOT BE EXCLUSIVE TO A REGION OR COUNTRY !S CARE ACROSS BORDERS BECOMES INCREASINGLY COMMON HEALTH SYSTEMS PLANNERS HAVE THE OPPORTUNITY TO BENElT FROM THEIR NEIGHBORS NOT ONLY BY SHARING SERVICES AND PROVIDERS BUT ALSO BY SHARING APPROACHES TO QUALITY MONITORING AND IMPROVEMENT %NDNOTES 3CRIVENS % h!CCREDITATION AND THE REGULATION OF QUALITY IN HEALTH SERVICES REGULATING ENTREPRENEURIAL BEHAVIOR IN %UROPEAN HEALTH CARE SYSTEMS v %DS 3ALMAN "USSE -OSSIALOS %UROPEAN /BSERVATORY "UCKINGHAM 4O %RR IS (UMAN "UILDING A 3AFER (EALTH 3YSTEM )NSTITUTE OF -EDICINE .ATIONAL !CADEMY OF 3CIENCE .ATIONAL !CADEMY 0RESS ,EAPE , , AND $ - "ERWICK -AY h&IVE 9EARS !FTER 4O %RR )S (UMAN 7HAT (AVE 7E ,EARNED v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP h(EALTH#AST #REATING A 3USTAINABLE &UTURE v 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE REPORT .OVEMBER -ANT * h0ROCESS VERSUS OUTCOME INDICATORS IN THE ASSESSMENT OF QUALITY IN HEALTH CARE v )NTERNATIONAL *OURNAL FOR 1UALITY IN (EALTH #ARE PP &INE , ET AL h(OW TO EVALUATE AND IMPROVE THE QUALITY AND CREDIBILITY OF AN OUTCOMES DATABASE VALIDATION AND FEEDBACK STUDY ON THE 5+ #ARDIAC 3URGERY %XPERIENCE v "RITISH -EDICAL *OURNAL P 4AIWAN $EPARTMENT OF (EALTH 4AIWAN (EALTH /UTLOOK 4AIPEI 4AIWAN %UROPEAN &OUNDATION FOR 1UALITY -ANAGEMENT WWWEFQMORG ACCESSED !PRIL 3ANCHEZ % ET AL h! DESCRIPTIVE STUDY OF THE IMPLEMENTATION OF THE %&1- EXCELLENCE MODEL AND UNDERLYING TOOLS IN THE "ASQUE (EALTH 3ERVICE v *OURNAL FOR 1UALITY IN (EALTH #ARE PP *OINT #OMMISSION )NTERNATIONAL WWWJOINTCOMMISSIONORG ACCESSED -AY "ERTINATO , ET AL 0OLICY "RIEF #ROSS "ORDER (EALTH #ARE IN %UROPE %UROPEAN /BSERVATORY "UCKINGHAM -ARSHALL - AND 3 ,EATHERMAN 3 -ATTKE h3ELECTING )NDICATORS FOR THE 1UALITY OF (EALTH PROMOTION 0REVENTION AND 0RIMARY #ARE AT THE (EALTH 3YSTEM ,EVEL IN /%#$ #OUNTRIES v /%#$ (EALTH 4ECHNICAL 0APERS 0ARIS "AETEN 2 h#ROSS BORDER #ONTRACTING IN "ELGIAN (OSPITALS v PAPER PRESENTED FOR THE %00%$ 'ROUP HEARING /BSERVATOIRE SOCIAL EUROPEEN ASBL "RUSSELS
) . 4 2 / $ 5 #4 ) / . 1 5!, ) 4 9 # / . 5 . $ 2 5 -
0ATIENT #HOICE AND !CTIVATION IN (EALTHCARE 0ATIENTS CAN BECOME EFlCIENT HEALTHCARE CONSUMERS WHEN ARMED WITH THE TOOLS TO ACTIVELY ENGAGE IN THEIR TREATMENT OPTIONS n A CRITICAL STEP TOWARD QUALITY IMPROVEMENT AND COST CONTAINMENT "Y 2ACHEL !BBOTT 0RICEWATERHOUSE#OOPERS !NNA $IXON +INGS &UND *UDITH (IBBARD 5NIVERSITY OF /REGON
)NTRODUCTION 4HE OVERARCHING OBJECTIVE OF MANY HEALTH POLICY PLANNERS IS TO DESIGN SYSTEMS THAT IMPROVE HEALTHCARE QUALITY WHILE CONTAINING COSTS 4O DATE THE MAJORITY OF POLICIES AND PROGRAMS DESIGNED TO ACHIEVE THESE GOALS HAVE FOCUSED ON PROVIDING INCENTIVES TO OR REGULATING INSURERS AND PROVIDERS !N OPPORTUNITY EXISTS TO ENGAGE PATIENTS IN MEETING THESE OBJECTIVES )NCREASINGLY POLICY MAKERS ARE CONSIDERING THE ROLE OF THE PATIENT IN INFORMED DECISION MAKING AND SELF MANAGEMENT OF HIS OR HER OWN HEALTHCARE "UT TO DO SO PATIENTS REQUIRE SKILLS CONlDENCE KNOWLEDGE AND OPPORTUNITIES 4HEORETICALLY A COMPETITIVE PROVIDER MARKET COULD DRIVE IMPROVEMENTS IN QUALITY AND REDUCE COSTS 9ET THIS ASSUMES PATIENTS ACT AS RATIONAL CONSUMERS AND MAKE WELL INFORMED CHOICES )N GENERAL THREE BASIC ELEMENTS ARE NECESSARY FOR PATIENTS TO MAKE EFFECTIVE AND INFORMED CHOICES ABOUT THEIR HEALTHCARE 4HE PATIENT NEEDS OPTIONS FROM WHICH TO CHOSE TIMELY ACCESS TO APPROPRIATE INFORMATION ON WHICH TO BASE THESE CHOICES AND THE PERSONAL RESOURCES AND MOTIVATION TO ENGAGE IN AN ACTIVE DECISION MAKING PROCESS ! HEALTHCARE SYSTEM WITH ADEQUATE PATIENT CHOICE AND AVAILABILITY OF HIGH QUALITY COMPARATIVE INFORMATION ON PROVIDERS MAY STILL FAIL TO PROMOTE QUALITY AND EFlCIENCY THROUGH MARKET MECHANISMS IF PATIENTS ARE NOT ADEQUATELY MOTIVATED AND EQUIPPED TO RECEIVE PROCESS AND APPLY INFORMATION TO THEIR CHOICES 2ESEARCHERS SUGGEST THAT ACTIVATED PATIENTS WITH THE KNOWLEDGE SKILLS AND CONlDENCE TO MANAGE THEIR OWN HEALTH AND HEALTHCARE MAY ALSO BE MORE LIKELY TO ACT AS INFORMED CONSUMERS OF HEALTHCARE SERVICES BY SEEKING INFORMATION AND MAKING CHOICES
AROUND QUALITY AND COST EFFECTIVENESS 0OLICIES AND PRACTICES THAT SUPPORT PATIENT ACTIVATION MAY ENABLE THE POTENTIAL BENElTS OF A PATIENT DRIVEN SYSTEM TO BE REALIZED
/PPORTUNITIES FOR #HOICE 7HATEVER THE TYPE OF CHOICE ENHANCED PATIENT DECISION MAKING IS THOUGHT TO IMPROVE HEALTHCARE OUTCOMES AND PATIENT SATISFACTION 4HE &OUNDATION FOR )NFORMED -EDICAL $ECISION -AKING HAS PUBLISHED RESEARCH SHOWING THAT hWHEN PATIENTS ARE WELL INFORMED AND PLAY A SIGNIlCANT ROLE IN DECIDING HOW THEY ARE GOING TO TREAT OR MANAGE THEIR HEALTH CONDITIONS THINGS WORK OUT BETTERv;= -AKING DECISIONS BASED ON PERSONAL PREFERENCES AND VALUES AND ENGENDERING A COMMITMENT TO TREATMENT REGIMES THEY WERE INVOLVED IN DESIGNING LED BOTH TO GREATER PATIENT SATISFACTION AND IMPROVED TREATMENT OUTCOMES )N SECTORS OF THE HEALTH ECONOMY WHERE PROVIDERS COMPETE FOR PATIENTS PATIENT DECISION MAKING ALSO HAS THE POTENTIAL TO INmUENCE QUALITY AND EFlCIENCY OF HEALTHCARE SERVICES 4HIS REQUIRES THAT PATIENTS HAVE ADEQUATE CHOICE OF AND MOBILITY BETWEEN DOCTORS AND HOSPITALS (OWEVER REAL CHOICE MAY NOT BE POSSIBLE DUE TO LIMITED CAPACITY AND GEOGRAPHIC INEQUALITIES IN ACCESS TO CARE 0ATIENT CHOICE MAY ALSO BE LIMITED BY TRAVEL TIME AND EXPENSE PARTICULARLY FOR LOWER SOCIO ECONOMIC GROUPS AND BY THE CONDITION AND CIRCUMSTANCES OF THE PATIENT 3OME OF THE LIMITATIONS ON OPPORTUNITIES TO CHOOSE WERE HIGHLIGHTED BY EVALUATIONS OF THE PATIENT CHOICE PILOT PROGRAMS IN %NGLAND SEE SIDEBAR h4HE ,ONDON 0ATIENT #HOICE 0ROGRAMMEv
2ACHEL !BBOTT -3 IS AN EXECUTIVE WITH 0RICEWATERHOUSE#OOPERS 'OVERNMENT AND 0UBLIC 3ECTOR PRACTICE IN ,ONDON 3HE HAS SEVERAL YEARS EXPERIENCE IN THE HEALTHCARE INDUSTRY IN COMMUNICATIONS AND PUBLIC AFFAIRS AND STUDIED INTERNATIONAL HEALTH POLICY AT THE ,ONDON 3CHOOL OF %CONOMICS 3HE CAN BE REACHED AT RACHELEABBOTT UKPWCCOM !NNA $IXON IS DEPUTY DIRECTOR OF POLICY AT THE +INGS &UND 3HE HAS CONDUCTED RESEARCH ON INTERNATIONAL HEALTHCARE POLICY ISSUES INCLUDING lNANCING REGULATION AND PATIENT CHOICE AND WORKED AS AN ADVISER TO GOVERNMENTS AND INTERNATIONAL ORGANIZATIONS 3HE WAS AWARDED A (ARKNESS &ELLOWSHIP IN (EALTHCARE 0OLICY BY THE #OMMONWEALTH &UND 3HE CAN BE REACHED AT ADIXON KINGSFUNDORG UK *UDITH (IBBARD $R0H IS A PROFESSOR OF HEALTH POLICY IN THE $EPARTMENT OF 0LANNING 0UBLIC 0OLICY AND -ANAGEMENT AT THE 5NIVERSITY OF /REGON (ER PUBLICATIONS ON CONSUMER DECISION MAKING AND CONSUMER ROLES IN CARE ARE WIDELY READ AND HAVE BEEN INmUENTIAL IN INFORMING HEALTHCARE POLICY 3HE CAN BE REACHED AT JHIBBARD UOREGONEDU
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
O @SHDMSãB GN HBD ã@MCã@BSHU@SHNMãHMãGD @KSGB@QD 4HE ,ONDON 0ATIENT #HOICE 0ROGRAMME (EALTH SYSTEM REFORMS IN THE 5NITED +INGDOM OVER THE PAST YEARS HAVE FOCUSED ON IMPROVING QUALITY AND EFlCIENCY )N THE %NGLISH .ATIONAL (EALTH 3ERVICE .(3 POLICIES HAVE FOCUSED ON THE POTENTIAL FOR CHOICE TO IMPROVE QUALITY AND EFlCIENCY 4HIS REQUIRES THAT MOBILE PATIENTS COMPARE OPTIONS AND MAKE DECISIONS BASED ON QUALITY INFORMATION;= 4HE ,ONDON 0ATIENT #HOICE 0ROGRAMME ,0#0 GAVE PATIENTS ON LONG WAITING LISTS FOR TREATMENT AT ,ONDON HOSPITALS THE OPPORTUNITY TO CHOOSE FASTER TREATMENT AT AN ALTERNATIVE HOSPITAL PROVIDER !S PART OF THE EVALUATION PATIENT DECISION MAKING PROCESSES WERE ANALYZED TO UNDERSTAND HOW DIFFERENT GROUPS OF PATIENTS WEIGHED DIFFERENT FACTORS IN THEIR DECISION MAKING;= 4HE EVALUATION FOUND THAT MOST PATIENTS PERCENT EXERCISED THE OPTION TO CHANGE HOSPITALS WHEN CARE WAS AVAILABLE SOONER ELSEWHERE AND IN DECIDING TO DO SO CONSIDERED THE REPUTATION OF THE NEW HOSPITAL TRAVEL TIME EXPENSE INVOLVED AND THE NEED FOR FOLLOW UP CARE;= 0ATIENTS SURVEYED AFTER PARTICIPATION IN THE ,0#0 REPORTED THAT THE INFORMATION MOST IMPORTANT TO THEM IN DECISION MAKING WAS HOSPITAL LOCATION REPUTATION AND SUCCESS RATES PERTINENT TO THEIR CONDITION OR TREATMENT FOLLOWED BY AN INTEREST IN CLEANLINESS AND RISK OF HOSPITAL ACQUIRED INFECTION;= 4HE ,0#0 WAS AN IMPORTANT PRECURSOR TO THE INTRODUCTION OF PATIENT CHOICE FOR ELECTIVE SURGERY AT THE POINT OF REFERRAL ACROSS THE %NGLISH .(3 IN
)NFORMATION FOR #HOICE )N ORDER TO MAKE AN INFORMED CHOICE THAT lTS WITH PATIENT VALUES AND PREFERENCES PATIENTS NEED THE RIGHT INFORMATION AT THE RIGHT TIME;= $ECISION SUPPORT TOOLS ARE AVAILABLE TO ASSIST PATIENTS IN MAKING CHOICES ABOUT SCREENING TREATMENT OPTIONS AND SELF MANAGEMENT -ARKET BASED APPROACHES TO IMPROVING HEALTHCARE QUALITY AND EFlCIENCY ALSO REQUIRE THAT PATIENTS ACT AS INFORMED CONSUMERS (OWEVER THE COMPLEXITIES AND UNCERTAINTIES OF HEALTHCARE MEAN THAT PUBLIC REPORTING OF PERFORMANCE INDICATORS ALONE MAY NOT BE SUFlCIENT TO ALLOW INFORMED PATIENT CHOICE;= h-ARKET INCENTIVES WILL ONLY HELP TO DRIVE UP QUALITY STANDARDS IF PATIENTS ARE ABLE TO ACT AS DISCERNING CONSUMERSv;= 0ATIENTS MUST HAVE ACCESS TO A SUFlCIENT QUANTITY OF TIMELY AND APPROPRIATE INFORMATION ABOUT THEIR CHOICES &OR PATIENTS TO BE ABLE TO USE SUCH INFORMATION IN DECISION MAKING IT MUST BE BOTH ACCESSIBLE AND PRESENTED IN A WAY THAT SUPPORTS THEIR DECISION MAKING PROCESS %XTENSIVE RESEARCH HAS BEEN CONDUCTED ON INFORMING CONSUMERS 4HIS IS NOW BEING APPLIED IN HEALTHCARE SETTINGS 4HE MEANING OF COMPARATIVE QUALITY DATA TO PATIENTS AND CONSEQUENT IMPACT DEPENDS ON NUMEROUS FACTORS INCLUDING RELEVANCE OF THE MEASURES PUBLICATION FORMAT DATA COLLECTION
METHODOLOGIES AND THE SOURCE OF THE REPORTS;= 0UBLICATIONS OF COMPARATIVE QUALITY INFORMATION ARE FREQUENTLY CRITICIZED FOR ONLY REPORTING THE DATA MOST EASILY ACCESSIBLE AND QUANTIlABLE RATHER THAN THE INFORMATION MOST MEANINGFUL TO PATIENTS;= )NTERNATIONAL EXPERIENCE HAS FOUND THAT PATIENTS ARE OFTEN CONFUSED BY OR SKEPTICAL OF PUBLISHED REPORTS OF COMPARATIVE HEALTH DATA RESORTING TO ADVICE FROM FAMILY FRIENDS AND THEIR PHYSICIANS -OST PATIENTS SURVEYED AS PART OF THE ,0#0 SAID THEY WOULD GO TO THEIR '0 FOR GUIDANCE AND INFORMATION IN CHOOSING A HOSPITAL FOR SURGERY AND A LARGE PORTION REPORTED SEEKING INFORMATION ON THE )NTERNET;= 3TUDIES IN BOTH THE 5+ AND THE 53 FOUND THAT ON THE WHOLE PATIENTS DO NOT ACCESS PUBLISHED DATA WHEN MAKING HEALTHCARE DECISIONS 0ATIENTS IN THE 53 ARE OFTEN SKEPTICAL THAT INFORMATION ON DOCTORS PUBLISHED BY INSURANCE COMPANIES IS SKEWED TO FAVOR LOWER COST PROVIDERS 3IMILAR ISSUES OF TRUST EXIST IN THE 5+ SEE SIDEBAR h0UBLIC 2EPORTING IN %NGLANDv )N THE ABSENCE OF INDEPENDENT COMPREHENSIVE INFORMATION HOSPITAL MARKETING AND ADVERTISING MAY PLAY AN IMPORTANT ROLE IN INFORMING OR AT LEAST ENCOURAGING PATIENT CHOICE )F THIS FORM OF PATIENT INmUENCE IS TO BE AVOIDED APPROPRIATE ACCESSIBLE UNBIASED INFORMATION MUST BE DELIVERED TO PATIENTS;= 4HE INFORMATION AGE POSES NEW CHALLENGES AS WELL AS OPPORTUNITIES FOR HEALTHCARE QUALITY REPORTING;= 4HE )NTERNET IS A POWERFUL TOOL FOR HEALTH INFORMATION DISSEMINATION THAT IS ALREADY WIDELY USED )N A LARGE SCALE PHONE SURVEY OF APPROXIMATELY ADULTS BELOW AGE IN THE 53 PERCENT OF THOSE WITH REGULAR )NTERNET ACCESS REPORTED RETRIEVING DISEASE SPECIlC INFORMATION PERCENT LOOKED FOR INFORMATION ON PROVIDERS OR SERVICE AVAILABILITY AND PERCENT ACCESSED SEXUAL HEALTH INFORMATION;= !S WITH MOST FORMS OF INFORMATION DISSEMINATION INEQUALITIES IN ACCESS MAY RESULT 3TUDIES 0UBLIC 2EPORTING IN %NGLAND )NCREASED PUBLIC REPORTING OF QUALITY AND OUTCOME DATA IS CRITICAL TO THE .(3 REFORM AGENDA BUT SURVEYS HAVE REVEALED THAT WHEN 5+ PATIENTS ARE OFFERED A CHOICE OF PROVIDERS MOST RELY ON THE ADVICE OF THEIR '0;= 0UBLIC REPORTING DID NOT APPEAR IN THE 5+ IN ANY MEANINGFUL WAY UNTIL WITH THE INTRODUCTION OF A RATING SYSTEM FOR .(3 HOSPITALS THE STAR RATING SYSTEM 3URVEYS OF PATIENTS FOLLOWING INITIAL INTRODUCTION OF THE SYSTEM FOUND A GREAT DISTRUST OF GOVERNMENT PROVIDED INFORMATION AS OPPOSED TO INDEPENDENTLY REPORTED QUALITY DATA;= 4HIS LED TO THE INDEPENDENT PUBLICATION OF A SPECIAL NEWSPAPER SUPPLEMENT RANKING 5+ HOSPITALS 4HE ORGANIZATION THAT PUBLISHED THE RANKINGS h$R &OSTER v LATER LAUNCHED A 7EB BASED FORUM PROVIDING COMPARATIVE LOCALIZED INFORMATION ON PROVIDERS 2EPORTS FROM h$R &OSTERv HAVE BEEN POPULAR WITH PATIENTS DUE TO WIDE PUBLICATION AND AN INTERACTIVE REPORTING FORMAT BUT PATIENTS REMAIN SKEPTICAL OF ULTERIOR MOTIVES;=
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
O @SHDMSãB GN HBD ã@MCã@BSHU@SHNMãHMãGD @KSGB@QD SUGGEST THAT LOW INCOME ADULTS AND THE ELDERLY ARE CAPABLE OF lNDING AND USING ONLINE HEALTH INFORMATION TOOLS ONCE ACCESS IS MADE AVAILABLE;=
0RESENTATION OF )NFORMATION FOR #HOICE 0ATIENTS ARE ASKED TO MAKE CHOICES THROUGHOUT THEIR CONTACT WITH THE HEALTHCARE SYSTEM !S WELL AS HELPING PATIENTS UNDERSTAND THEIR CHOICES MOST HEALTH INFORMATION AIMS TO MOTIVATE PATIENTS TO MAKE RATIONAL DECISIONS;= )N MAKING DECISIONS PATIENTS ARE REQUIRED TO PROCESS A DEGREE OF TECHNICAL INFORMATION AND CONDUCT THEIR OWN RISK BENElT ANALYSIS ACROSS THE AVAILABLE OPTIONS;= 4HE WAY INFORMATION IS PRESENTED CAN DETERMINE HOW THAT INFORMATION IS PROCESSED AND USED BY PATIENTS IN DECISION MAKING
#OMBINED -EASURES AND !VERAGES 2ESEARCH ON DECISION MAKING AND INFORMATION PROCESSING HAS FOUND THAT INDIVIDUALS EXPERIENCE A SIGNIlCANT COGNITIVE BURDEN IN THE EFFORT TO INTEGRATE SEVERAL TYPES OF INFORMATION 4OO MUCH INFORMATION MAY IMPEDE ONES ABILITY TO MEANINGFULLY PROCESS ANY OF IT 7HEN PEOPLE ARE FACED WITH A LARGE VOLUME OF INFORMATION OR ARE TRYING TO USE COMPLEX INFORMATION TO INFORM A CHOICE THERE IS A TENDENCY TO MAKE THE PROCESS EASIER BY SIMPLY MAKING THAT CHOICE ON A SINGLE FACTOR (OWEVER IN REDUCING THE BURDEN THEY MAY NEGLECT POTENTIALLY IMPORTANT FACTORS AND IN THE PROCESS MAY COMPROMISE THEIR OWN SELF INTEREST )NFORMED CHOICES CAN BE IMPROVED HOWEVER BY PROVIDING CONSUMERS WITH INFORMATION DISPLAYS THAT MAKE IT EASIER TO UNDERSTAND AND INCORPORATE THE INFORMATION INTO CHOICES &OR EXAMPLE INFORMATION DISPLAYS THAT REDUCE THE COGNITIVE BURDEN TEND TO INCREASE THE USE OF THAT INFORMATION IN CHOICE "Y SUMMARIZING AND INTERPRETING DATA IT TAKES LESS EFFORT FOR THE USER TO UNDERSTAND AND APPLY THAT INFORMATION THAT IS BY DOING SOME OF THE COGNITIVE WORK FOR USERS IT IS ACTUALLY MORE LIKELY TO GET USED $ESIGN AND USE OF DECISION TOOLS MUST CONSIDER THE PATIENT INTENDING TO USE IT 2ESEARCH HAS SUGGESTED THAT OLDER ADULTS ARE LIKELY TO NEED EXTRA ASSISTANCE IN PROCESSING COMPARATIVE HEALTH INFORMATION;= )NDIVIDUAL CHARACTERISTICS SUCH AS AGE LITERACY AND CULTURAL OR SOCIAL FACTORS ARE ALSO CORRELATED WITH THE ABILITY TO PROCESS HEALTH INFORMATION AND TO CARRY OUT COMPLEX DECISION MAKING
#ONTEXTUALIZING $ECISIONS )NFORMATION PRESENTATION TECHNIQUES AND METHODS CAN HELP THE PATIENT CONSIDER THE REAL LIFE IMPLICATIONS OR EXPERIENCE OF A GIVEN CHOICE FOR EXAMPLE THE USE OF SHORT STORIES OR CASE STUDIES RATHER THAN DATA CHARTS AND lGURES )NFORMATION IN A NARRATIVE FORM BECOMES MORE EMOTIONALLY INTERESTING AND CAN BE DELIVERED
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
7ISCONSIN @1UALITY#OUNTS 2EPORT %FFECTIVE INFORMATION DISPLAY AND DISTRIBUTION TECHNIQUES WERE USED IN A COMPARATIVE PERFORMANCE REPORT OF HOSPITALS IN SOUTH CENTRAL 7ISCONSIN;= 4HE !LLIANCE A LARGE EMPLOYER PURCHASING COOPERATIVE IN -ADISON SPONSORED THE h1UALITY#OUNTSv REPORT ON HOSPITAL QUALITY AND SAFETY )N THE REPORT HOSPITALS WERE RANKED AS BETTER THAN EXPECTED FEWER DEATHS AND COMPLICATIONS AS EXPECTED OR WORSE THAN EXPECTED 4HE DATA CAME FROM THE 7ISCONSIN "UREAU OF (EALTH )NFORMATION INPATIENT PUBLIC USE DATA SETS lNDINGS WERE PUBLISHED IN LOCAL NEWSPAPERS SENT TO EMPLOYEES HOMES AND POSTED ONLINE 4HROUGH USE OF THE h1UALITY#OUNTSv REPORT CONSUMERS COULD CONVENIENTLY SEE AT A GLANCE WHICH HOSPITALS WERE HIGHLY RANKED WITH TOP TIER PERFORMERS HIGHLIGHTED BY A COLOR BAND AND DIFFERENT TYPES OF CARE SUCH AS OBSTETRICS AND CARDIAC CARE SHOWN AS WELL 4HE h1UALITY#OUNTSv REPORT WAS THE lRST OF ITS KIND AND HAD A SIGNIlCANT IMPACT ON PATIENT DECISION MAKING DUE IN PART TO ITS EASE OF USE AND WIDE DISTRIBUTION !FTER SEEING THE REPORT RESPONDENTS WERE ABLE TO DESCRIBE WHICH HOSPITALS ACHIEVED A HIGHER OR LOWER RANKING -OST CONSUMERS WHO SAW THE REPORT SAID THEY HAD EITHER SPOKEN TO OTHERS ABOUT IT OR PLANNED TO DO SO (OSPITALS CONCERNED ABOUT THE POTENTIAL IMPACT OF THE REPORT ON THEIR REPUTATION TOOK STEPS TO IMPROVE THEIR PERFORMANCE 4HE lNDINGS INDICATE THAT WHEN PUBLIC REPORTS ARE DESIGNED TO BE HIGHLY EVALUABLE BY CONSUMERS HOSPITALS WERE MOTIVATED TO IMPROVE THEIR PERFORMANCE;=
EFFECTIVELY WITH WELL STRUCTURED COMPUTER AIDED DECISION TOOLS THAT BREAK DOWN COMPLEX PROCESSES AND EXPERIENCES 4HE &OUNDATION FOR )NFORMED -EDICAL $ECISION -AKING HAS DESIGNED SEVERAL TOOLS AND DECISION AIDS SPECIlCALLY FOR COMMON CONDITIONS SUCH AS HEART DISEASE PROSTATE AND BREAST CANCER
$ISPLAYING )NFORMATION 4HE VISUAL PRESENTATION OF INFORMATION IS IMPORTANT TO HELPING PATIENTS MAKE WELL INFORMED DECISIONS 3TUDIES HAVE FOUND THAT THE COGNITIVE EFFORT REQUIRED TO PROCESS HEALTHCARE INFORMATION CAN BE FURTHER REDUCED BY DISPLAYING DATA IN SUCH A WAY AS TO HELP THE USER INTERPRET IT SUCH AS USING SYMBOLS THAT INDICATE WHAT IS hGOODv AND WHAT IS NOT IE USING SYMBOLS TO INDICATE GOOD AND POOR OPTIONS $ELIVERING INFORMATION IN AN EVALUATIVE MANNER CONVEYS hGOODBADv EMOTIONAL MEANING ! LARGE BODY OF CONTROLLED STUDIES HAS CONlRMED THE BENElT OF EVALUATIVE DISPLAYS OF INFORMATION /NE STUDY FOUND THAT BY PROVIDING CONSUMERS WITH VISUAL CUES SUCH AS STAR RATINGS OF QUALITY AND ORDERING SIMILARLY PRICED OPTIONS BY STAR RATING WITHIN EACH COST STRATA PATIENTS WERE MORE LIKELY TO CHOSE HIGHER QUALITY
O @SHDMSãB GN HBD ã@MCã@BSHU@SHNMãHMãGD @KSGB@QD OPTIONS EVEN WHEN THEY COST MORE THAN THOSE WHO DID NOT GET THE INFORMATION IN AN EVALUABLE FORMAT #OLOR HIGHLIGHTING OF TOP PERFORMERS WITHIN EACH CATEGORY HAS ALSO BEEN FOUND TO BE EFFECTIVE IN HELPING PATIENTS CHOOSE HIGHER PERFORMING HOSPITALS SEE %XHIBIT
0ATIENT !CTIVATION ! PATIENT LED HEALTH SYSTEM REQUIRES THAT INDIVIDUALS ARE MOTIVATED TO ACT AS DECISION MAKERS IN THEIR OWN HEALTHCARE AND EXERCISE CHOICE OF PROVIDERS AND HEALTHCARE OPTIONS 4HE CAPACITY OF PATIENTS TO MANAGE THEIR OWN HEALTH AND HEALTHCARE HAS BEEN RELIABLY MEASURED WITH THE 0ATIENT !CTIVATION -EASURE 0!- ;= 5SING THIS MEASURE PATIENTS SCORING HIGH IN ACTIVATION IE WITH THE KNOWLEDGE SKILLS AND CONlDENCE TO MANAGE ONES HEALTH WERE MORE LIKELY TO ENGAGE IN HEALTHY BEHAVIORS AND SELF MANAGEMENT;=
4HE 0!- HAS BEEN SPECIlCALLY DEVELOPED AND TESTED WITH PEOPLE WITH CHRONIC CONDITIONS $IABETES PATIENTS SCORING HIGH IN ACTIVATION WERE MORE LIKELY TO SELF MANAGE THEIR CONDITION WITH TECHNIQUES SUCH AS JOURNAL KEEPING 3IMILARLY ACTIVATED ARTHRITIS PATIENTS WERE MORE LIKELY TO EXERCISE AND AMONG THOSE WITH HIGH CHOLESTEROL ACTIVATED PATIENTS WERE MORE LIKELY TO ADHERE TO A LOW FAT DIET;= )T IS ESPECIALLY USEFUL TO UNDERSTAND HOW PATIENT ACTIVATION AS MEASURED BY THE 0!- CAN IMPROVE SELF MANAGEMENT AND SELF CARE BECAUSE PATIENTS WITH COSTLY LONG TERM CONDITIONS HAVE A HIGH FREQUENCY OF CONTACT WITH MANY FACETS OF THE HEALTH SYSTEM AND ARE AT INCREASED RISK OF ADVERSE EVENTS DUE TO COMMUNICATION FAILURES 4HESE PATIENTS ARE OFTEN REQUIRED TO TAKE MULTIPLE MEDICATIONS APPROPRIATELY AND MONITOR AND IMPLEMENT HEALTH AND LIFESTYLE CHANGES;= .EW RESEARCH IS CONSIDERING THE POSSIBILITY THAT ACTIVATED PATIENTS ARE MORE LIKELY TO ACT AS INFORMED CONSUMERS OF HEALTHCARE SERVICES BY SEEKING INFORMATION AND MAKING CHOICES BASED ON QUALITY AND COST EFFECTIVENESS
%XHIBIT @1UALITY#OUNTS USES SYMBOLS TO REDUCE COGNITIVE BURDEN 7HAT THE SYMBOLS MEAN &EWER MISTAKES COMPLICATIONS AND DEATHS THAN EXPECTED !VERAGE NUMBER OF MISTAKES COMPLICATIONS AND DEATHS -ORE MISTAKES COMPLICATIONS AND DEATHS THAN EXPECTED 2EGIONAL (OSPITALS
3URGERY
.ON 3URGERY
(IP+NEE
#ARDIAC
-ATERNITY
(OSPITAL !
(OSPITAL "
(OSPITAL #
(OSPITAL $
NA
(IP+NEE
#ARDIAC
-ATERNITY
#OMMUNITY (OSPITALS
3URGERY
.ON 3URGERY
(OSPITAL &
(OSPITAL '
(OSPITAL (
(OSPITAL )
(OSPITAL *
(OSPITAL +
(OSPITAL ,
(OSPITAL -
NA
(OSPITAL .
(OSPITAL /
(OSPITAL 0
NA
(OSPITAL 1
NA
2EPRODUCED WITH PERMISSION FROM (IBBARD * AND 0ETERS % h3UPPORTING )NFORMED #ONSUMER (EALTH #ARE $ECISIONS v !NNUAL 2EVIEW OF 0UBLIC (EALTH 6OL
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
O @SHDMSãB GN HBD ã@MCã@BSHU@SHNMãHMãGD @KSGB@QD
3UMMARY AND #ONCLUSION #URRENT RESEARCH WITH CHRONIC CONDITION PATIENTS IS REVEALING THAT ACTIVATED PATIENTS WITH THE KNOWLEDGE SKILLS AND CONlDENCE TO ENGAGE IN SELF MANAGEMENT CAN HAVE AN IMPORTANT IMPACT ON THEIR OWN TREATMENT OUTCOMES )F INDIVIDUAL HEALTH OUTCOMES CAN BE IMPROVED IN THIS WAY IT IS POSSIBLE THAT THE SAME PATIENTS MAY BE ABLE TO APPLY SKILLS AND RESOURCES TO DECISIONS ABOUT PROVIDERS ACTING AS INFORMED CONSUMERS OF HEALTH SERVICES 2ATIONAL INFORMED BEHAVIOR BY PATIENTS IS THE CRITICAL ELEMENT TO DRIVING EFlCIENCY AND CONTAINING COSTS IN A MARKET BASED APPROACH TO IMPROVEMENT THROUGH PATIENT CHOICE )N THIS WAY IT IS POSSIBLE THAT PATIENT CHOICE MAY NOT ONLY IMPROVE HEALTH OUTCOMES ON THE INDIVIDUAL LEVEL BUT PLAY A KEY ROLE IN CONTAINING COSTS AND INCREASING EFlCIENCY ON A SYSTEM LEVEL 0ATIENTS ARE THE LAST UNTAPPED RESOURCE IN THE HEALTHCARE SYSTEM "Y PROVIDING THE TOOLS AND RESOURCES THEY NEED TO MAKE BETTER DECISIONS PATIENTS CAN BECOME AGENTS OF CHANGE IN IMPROVING THE QUALITY OF THEIR CARE %NDNOTES h&OUNDATION 0ROCEDURES FOR $EVELOPMENT OF $ECISION !IDS v &OUNDATION FOR )NFORMED $ECISION -AKING "OSTON 2OSENTHAL - ET AL h0AYING FOR 1UALITY 0ROVIDERS )NCENTIVES FOR 1UALITY )MPROVEMENT v (EALTH !FFAIRS PP "URGE 0 ET AL ,ONDON 0ATIENT #HOICE 0ROJECT %VALUATION 2!.$ %UROPE #OULTER ! AND . LE -AISTRE , (ENDERSON h0ATIENTS %XPERIENCE OF #HOOS ING 7HERE TO 5NDERGO 3URGICAL 4REATMENT v 0ICKER )NSTITUTE ,ONDON +EMPER $ AND - -ETTLER h)NFORMATION 4HERAPY 0RESCRIBED )NFORMATION AS A 2EIMBURSABLE -EDICAL 3ERVICE v #ENTER FOR )NFORMATION 4HERAPY
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
+LEIN 2 h-ODELS OF -AN AND -ODELS OF 0OLICY v -ILBANK -EMORIAL &UND 1UARTERLY PP -ARSHALL - . AND 0 ' 3HEKELLE 2 ( "ROOK 3 ,EATHERMAN h$YING TO +NOW 0UBLIC 2ELEASE OF )NFORMATION ABOUT 1UALITY OF (EALTH #ARE v 3ANTA -ONICA 2!.$ -ARSHALL - AND 0 3HEKELLE ( $AVIES 0 3MITH h0UBLIC 2EPORTING ON 1UALITY IN THE 5NITED 3TATES AND THE 5NITED +INGDOM v (EALTH !FFAIRS PP ,LOYD ) h4HE "IG 3ELL 7HY ITS 4IME FOR (OSPITALS TO -ARKET 4HEMSELVES v /CTOBER (EALTH 3ERVICE *OURNAL PP "ATES $ AND ! 'AWANDE h4HE )MPACT OF THE )NTERNET ON 1UALITY -EASUREMENT v (EALTH !FFAIRS PP "RODIE - ET AL h(EALTH )NFORMATION THE )NTERNET AND THE $IGITAL $IVIDE v (EALTH !FFAIRS PP #OULTER ! AND 2 .YE 3 0OLLARD h7HAT 0ATIENTS 2EALLY 7ANT v 0OPULUS ,ONDON -AGEE ( AND , $AVIS ! #OULTER h0UBLIC 6IEWS ON (EALTHCARE 0ERFORMANCE )NDICATORS AND 0ATIENT #HOICE v *OURNAL OF THE 2OYAL 3OCIETY OF -EDICINE VOL PP 'USTAFSON $ ET AL h#ONSUMERS AND %VALUATION OF )NTERACTIVE (EALTH #OMMUNICATION !PPLICATIONS v !MERICAN *OURNAL OF 0REVENTIVE -EDICINE PP (IBBARD * AND % 0ETERS h3UPPORTING )NFORMED #ONSUMER (EALTH #ARE $ECISIONS v !NNUAL 2EVIEW OF 0UBLIC (EALTH VOL %MPLOYER (EALTHCARE !LLIANCE #OOPERATIVE h1UALITY #OUNTS #ON SUMER )NFORMATION FOR "ETTER (EALTH #ARE v -ADISON 7ISCONSIN (IBBARD * AND * 3TOCKARD - 4USLER h(OSPITAL 0ERFORMANCE 2EPORTS )MPACT ON 1UALITY -ARKET 3HARE AND 2EPUTATION v (EALTH !FFAIRS PP (IBBARD * h)MPROVING 1UALITY AND /UTCOMES BY 3UPPORTING 0ATIENT !CTIVATION v 5NIVERSITY OF /REGON (IBBARD * ET AL h$EVELOPMENT OF THE 0ATIENT !CTIVATION MEASURE CONCEPTUALIZING AND MEASURING ACTIVATION IN PATIENTS AND CONSUMERS v (EALTH 3ERVICES 2ESEARCH VOL P
1! 4HE 2OLE OF THE #ONSUMER IN 1UALITY ! $ISCUSSION 7ITH THE 3USAN ' +OMEN &OUNDATION "REAST CANCER PATIENTS RECEIVE RELATIVELY HIGH QUALITY CARE AND THE QUALITY SEEMS TO BE IMPROVING ACCORDING TO RECENT STUDIES &OR EXAMPLE A 2AND #ORP STUDY SHOWED THAT WHILE !MERI CANS RECEIVE RECOMMENDED CARE ONLY PERCENT OF THE TIME BREAST CANCER PATIENTS FARED MUCH BETTER RECEIVING RECOMMENDED CARE PERCENT OF THE TIME SEE %XHIBIT ;= -ORE RECENTLY 2AND #ORP RESEARCHERS FOUND EVEN BETTER NEWS FOR BREAST CANCER PATIENTS /N AVERAGE PATIENTS WITH BREAST CANCER RECEIVED PERCENT OF GENERALLY RECOMMENDED CARE BASED ON QUALITY CARE MEASURES ESTABLISHED BY THE RESEARCH TEAM;= (OW HAS CONSUMER INVOLVEMENT PLAYED A PART IN THIS "REAST CANCER PATIENTS ARE A VOCAL AND ACTIVE GROUP 4O EXPLORE THE ROLE OF PATIENTS IN ENHANCING QUALITY 0RICEWATERHOUSE#OOPERS SPOKE WITH $IANE "ALMA DIRECTOR OF PUBLIC POLICY AND #HERYL 0ERKINS -$ SENIOR CLINICAL ADVISOR FOR THE 3USAN ' +OMEN "REAST #ANCER &OUNDATION &OR NEARLY YEARS THE 3USAN ' +OMEN "REAST #ANCER &OUNDATION HAS BEEN A GLOBAL LEADER IN THE lGHT AGAINST BREAST CANCER THROUGH ITS SUPPORT OF INNOVATIVE RESEARCH AND COMMUNITY BASED OUTREACH PROGRAMS 7ORKING THROUGH A NETWORK OF 53 AND INTERNATIONAL AFlLIATES AND EVENTS LIKE THE +OMEN 2ACE FOR THE #URE¸ THE +OMEN &OUNDATION IS lGHTING TO ERADICATE BREAST CANCER AS A LIFE THREATENING DISEASE BY FUNDING RESEARCH GRANTS AND SUPPORTING EDUCATION SCREENING AND TREATMENT PROJECTS IN COMMUNITIES AROUND THE WORLD 0RICEWATERHOUSE#OOPERS (OW DO YOU DElNE QUALITY OF CARE FOR PATIENTS AND CONSUMERS #HERYL 0ERKINS 4HE BEST DElNITION IS EVIDENCE OF ADHERENCE TO THE STANDARDS OF BREAST CANCER CARE THAT EXIST ACROSS THE 5NITED 3TATES 7E ALSO AGREE THAT THERE IS A PERSONAL COMPONENT AS WELL AN ACCESS COMPONENT $IANE "ALMA 4HE POINT IS WE HAVE DIFlCULTY DElNING IT BECAUSE WE CANT DElNE IT THE SAME WAY FOR EVERY PATIENT #ERTAINLY YOU HAVE TO LOOK AT THE STANDARDS OF BREAST CANCER CARE BUT YOU ALSO HAVE TO LOOK AT IT SUBJECTIVELY n WHATS IMPORTANT TO THE PATIENT WHAT ARE THEIR NEEDS AND ARE THOSE NEEDS MET 0W# 7HAT IS THE ROLE OF THE PATIENT IN MANAGING AND ENHANCING QUALITY OF CARE #0 4HEY SHOULD BE AS INFORMED AND EDUCATED AS THEY CAN ABOUT THEIR MEDICAL DIAGNOSIS AND THE NUANCES OF THEIR OWN PARTICULAR BREAST CANCER THEIR TREATMENT OPTIONS AND THE OUTCOMES THEY CAN EXPECT )N ADDITION TO BEING INFORMED THEY CAN ASK QUESTIONS SEEK SECOND OPINIONS AND BE AN ADVOCATE FOR CHANGE WHEN THEY RUN INTO SITUATIONS THAT ARE LESS THAN OPTIMAL $" 7E ENCOURAGE OUR CONSTITUENTS TO MAKE THEIR VOICES HEARD BY ADVOCATING FOR VARIOUS LEGISLATIVE AND REGULATORY CHANGES THAT HAVE A POTENTIAL TO ENHANCE THE QUALITY OF CARE FOR BREAST
CANCER PATIENTS 0ATIENTS CAN ALSO BECOME EDUCATED ABOUT THEIR SPECIlC DISEASE UNDERSTAND THE CONCEPT OF PERSONALIZED MEDICINE AND WHAT THAT MEANS FOR BREAST CANCER TREATMENT LEARN THE QUESTIONS THAT NEED TO BE ASKED AND DEMAND MORE FROM THEIR INSURANCE COMPANIES )TS REALLY ABOUT BEING PROACTIVE IN THEIR HEALTHCARE AND MAKING SURE THAT THEY HAVE ALL THE ANSWERS TO THEIR VARIOUS QUESTIONS THAT WOULD FACTOR INTO THEIR HEALTHCARE DECISIONS 0W# 7HAT KINDS OF INFORMATION DO CONSUMERS NEED #0 0EOPLE NEED TO UNDERSTAND AS A hWELL PATIENTv WHAT THEIR PERSONAL RISK FACTORS ARE THEIR FAMILY HISTORY AND THE KINDS OF SCREENING THAT ARE RECOMMENDED FOR THEM )F THEY ARE DIAGNOSED WITH BREAST CANCER KNOWING THE PATHOLOGY OF THEIR CANCER WILL HELP THEM UNDERSTAND THEIR TREATMENT OPTIONS 4HERE ARE MANY DIFFERENT KINDS OF BREAST CANCER AND WERE INCREASINGLY LEARNING ABOUT THE NEED FOR INDIVIDUALIZED TREATMENT APPROACHES $" 0ATIENTS NEED TO KNOW WHAT RESOURCES THEY WILL HAVE FOR DEALING WITH SIDE EFFECTS WHAT KIND OF MEDICAL SUPPORT IS AVAILABLE AND HOW TO GET IT THEIR INSURANCE COVERAGE AND LONG TERM SURVIVOR ISSUES THAT MAY COME AS A CONSEQUENCE OF SOME OF THE TREATMENTS !S THE SCIENCE CHANGES THEY NEED TO KEEP ABREAST OF NEW OPTIONS THAT ARE UNFOLDING EVERY DAY FOR PATIENTS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! 0W# 7HAT DOES THE +OMEN &OUNDATION DO TO HELP PATIENTS MAKE DECISIONS AND SORT THROUGH THE INFORMATION THATS OUT THERE #0 7E PROVIDE A VARIETY OF EDUCATIONAL MATERIALS TRANSLATED INTO SEVERAL LANGUAGES 0EOPLE LEARN AND COMMUNICATE IN INDIVIDUAL WAYS 3O WE USE DIFFERENT APPROACHES ELECTRONIC PRINT INTERACTIVE ONE ON ONE SUPPORT CHAT ROOMS ON OUR WEBSITE 7E ALSO HAVE COMMUNITY AFlLIATES WHERE PATIENTS CONNECT AT THE LOCAL GRASSROOTS LEVEL 4HE APPROACH DEPENDS ON THE INDIVIDUAL ITS PERSONAL $" ! h4ALK TO 9OUR $OCTORv SECTION ON OUR WEBSITE IDENTIlES QUESTIONS THAT PATIENTS CAN USE IN AN OFlCE VISIT 7HILE WE HAVE COMPREHENSIVE INFORMATION ON OUR WEBSITE NOT EVERYONE HAS ACCESS TO THE )NTERNET AND SO OUR AFlLIATE NETWORK PLAYS A SIGNIlCANT ROLE IN REACHING AND EDUCATING MEMBERS OF THEIR LOCAL COMMUNITIES 7EVE ALSO DEVELOPED AN ELECTRONIC ADVOCACY NETWORK CALLED hE #HAMPIONSv THAT IS COMPRISED OF ABOUT ONLINE ADVOCATES WHO THROUGH OUR WEBSITE CAN CONTACT THEIR MEMBERS OF #ONGRESS ON SPECIlC ISSUES 7E HAVE A NUMBER OF AFlLIATES PARTICIPATING IN THAT PROGRAM SO WE ARE PROVIDING A STRUCTURE AND PRACTICAL WAYS FOR OUR CONSTITUENTS AFlLIATES AND THE GENERAL PUBLIC TO MAKE A DIFFERENCE IN BREAST CANCER POLICY 7E TRY TO MAKE IT AS SIMPLE AS POSSIBLE AND THE INFORMATION THAT WE INCLUDE IN OUR LETTERS IS WRITTEN IN VERY LAY FRIENDLY LANGUAGE SO THAT ALMOST ANYONE CAN UNDERSTAND IT 7E ALSO HAVE A h4ELL A &RIENDv COMPONENT TO OUR ONLINE COMMUNICATIONS WHICH ALLOWS US TO SHARE OUR BREAST CANCER MESSAGES WIDELY 4HIS HAS ALLOWED US TO RECRUIT TENS OF THOUSANDS OF NEW ADVOCATES AND GENERATE MORE SUPPORT
0W# !S A RESULT OF THE FOUNDATIONS EFFORT HOW DO YOU THINK QUALITY OF CARE HAS CHANGED FOR BREAST CANCER PATIENTS AND SURVIVORS #0 4HE OVERARCHING CHANGE OVER TIME HAS BEEN AWARENESS AND ACCESS TO TREATMENT THAT WOMEN DIDNT HAVE TO YEARS AGO !S A RESULT MORTALITY IS DECREASING AS SCREENING IS INCREASING AND CANCER IS BEING DIAGNOSED AT AN EARLIER STAGE 4HERE ARE OVER MILLION BREAST CANCER SURVIVORS ALIVE IN THIS COUNTRY TODAY 7E KNOW WE STILL HAVE ACCESS AND DISPARITY ISSUES BUT AWARENESS IS OUT THERE AND ITS CONTINUING TO MAKE A DIFFERENCE IN EARLY DIAGNOSIS $" 4HE +OMEN &OUNDATION HAS INVESTED MORE THAN MILLION IN RESEARCH EDUCATION SCREENING AND TREATMENT FUNDING SINCE ITS INCEPTION 7HEN THE FOUNDATION WAS STARTED IN THE TERM hBREAST CANCERv WAS NEVER SPOKEN ON THE mOORS OF THE (OUSE AND 3ENATE .OW hBREAST CANCERv IS SPOKEN FREELY BOTH ON #APITOL (ILL AND IN THE GENERAL PUBLIC AND ITS NOT SOMETHING TO BE EMBARRASSED ABOUT !S A WHOLE ) THINK OUR CULTURE HAS SHIFTED 0W# 7HAT KINDS OF RESEARCH HAS THE FOUNDATION HELPED TO SUPPORT $" 7E HAVE THREE PRIMARY FUNDING CATEGORIES BASIC CLINICAL AND TRANSLATIONAL RESEARCH 7E ARE ALSO FUNDING MORE DIRECTED RESEARCH PROPOSALS #0 7E ARE ALSO INTERESTED IN LOOKING AT NEW WAYS TO DO RESEARCH BECAUSE THE CLINICAL TRIALS AND DRUG DISCOVERY AND APPROVAL TAKE SO LONG AND PATIENTS ARE GOING THROUGH LIFE AND DEATH EXPERIENCES
%XHIBIT (EALTHCARE 1UALITY 2ECOMMENDED #ARE /N AVERAGE !MERICANS RECEIVE RECOMMENDED CARE ONLY OF THE TIME "REAST CANCER PATIENTS FARE MUCH BETTER THAN MOST 0ERCENT OF 2ECOMMENDED #ARE 2ECEIVED
/VERALL
"REAST #ANCER
(IP (YPER #ORONARY !STHMA $IABETES &RACTURE TENSION (EART $ISEASE
3OURCE % -C'LYNN ET AL h4HE 1UALITY OF (EALTH #ARE $ELIVERED TO !DULTS IN THE 5NITED 3TATES v 4HE .EW %NGLAND *OURNAL OF -EDICINE *UNE
1 5! , ) 4 9 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
0W# (OW CAN WHAT YOU HAVE DONE FOR BREAST CANCER BE LEVERAGED BY OTHER CONSUMER ADVOCACY GROUPS OR TO OTHER DISEASE TYPES TO ENGAGE AND ACTIVATE PATIENTS $" 7E OFTEN RECEIVE CALLS FROM OTHER DISEASE GROUPS BECAUSE OF THE FOUNDATIONS UNIQUE MODEL 7E ARE NOT A SERVICE PROVIDER 2ATHER WE FUND SERVICES 7E HAVE DOMESTIC AFlLIATES IN STATES ACROSS THE COUNTRY THAT PROVIDE MUCH NEEDED DOLLARS FOR EDUCATION SCREENING AND TREATMENT PROGRAMS AIMED AT lLLING THE GAPS IN THEIR LOCAL COMMUNITIES 7E ALSO HAVE THREE INTERNATIONAL AFlLIATES 4HE FOUNDATION RECEIVES CLOSE TO REQUESTS EVERY YEAR FROM PEOPLE WHO WANT TO ESTABLISH AN AFlLIATE 7E ARE VERY DELIBERATE IN DETERMINING WHEN AND WHERE AFlLIATES ARE ESTABLISHED 3INCE WE STRIVE NOT TO BE DUPLICATIVE A COMMUNITY NEEDS ASSESSMENT IS REQUIRED BEFORE WE ENTER INTO ANY AFlLIATE AGREEMENT )F SOMEONE ELSE IN THE COMMUNITY IS DOING IT AND DOING IT WELL WE WONT GO THERE BUT WE WILL FUND THEM 4HATS WHAT MAKES +OMEN UNIQUE "REAST CANCER ADVOCATES ARE A VERY VOCAL
1! GROUP 4HEY HAVE LEARNED HOW TO ORGANIZE THEY ARE VERY EFFECTIVE ADVOCATES AND THEY HAVE DONE A VERY GOOD JOB OF PERSONALIZING THE BREAST CANCER MESSAGE )TS BEEN A CRITICAL FACTOR IN GETTING THE SUPPORT THAT WEVE BEEN ABLE TO GET FOR THIS DISEASE
! SYSTEM OF ELECTRONIC MEDICAL RECORDS WILL PLAY AN IMPORTANT ROLE IN ENSURING THE DELIVERY OF QUALITY PATIENT CARE ESPECIALLY AS WE MOVE TOWARDS MORE PERSONALIZED MEDICINE 0W# !RE THERE OTHER CHANGES THAT YOUD LIKE TO SEE MADE AT THE NATIONAL LEVEL TO ENHANCE QUALITY $" 7E HAVE TO DO A BETTER JOB OF PROVIDING INTEGRATED CARE 7E NEED DOCTORS TO COMMUNICATE WITH ONE ANOTHER LOOK AT THE PATIENT COMPREHENSIVELY AND RENDER CARE ACCORDINGLY 0ATIENTS ALSO NEED BETTER COMMUNICATION FROM THEIR PHYSICIANS ! SYSTEM OF ELECTRONIC MEDICAL RECORDS WILL PLAY AN IMPORTANT ROLE IN ENSURING THE DELIVERY OF QUALITY PATIENT CARE ESPECIALLY AS WE MOVE TOWARDS MORE PERSONALIZED MEDICINE )F WE DO IT WELL SO THAT THE PRIVACY OF PATIENTS IS SUFlCIENTLY PRESERVED ELECTRONIC MEDICAL RECORDS COULD HELP EASE THE SUBSTANTIAL BURDEN ON CANCER PATIENTS OF HAVING TO ROUTINELY TRACK DOWN THEIR MEDICAL RECORDS 4HE AMOUNT OF TIME AND ENERGY THIS TAKES ESPECIALLY IN COMPLEX MEDICAL CASES SUCH AS CANCER IS EXORBITANT AND CAN BE A MAJOR CHALLENGE FOR VERY ILL PATIENTS 4HE LACK OF ELECTRONIC MEDICAL RECORDS MAY ALSO RESULT IN INACCURACIES IN A PATIENTS MEDICAL HISTORY #0 4HERE ARE ALSO THE ISSUES OF ACCESS AND DISPARITY AND THAT IMPACTS QUALITY ACROSS THE BOARD FOR PATIENTS )T WONT DO ANY GOOD TO HAVE THE BEST TECHNOLOGIES AND THE BEST TREATMENTS IF WE CANT GET THEM TO THE PATIENTS #OSTS OF THE TECHNOLOGIES AND DRUGS ARE BARRIERS TO A LOT OF PEOPLE !ND WE NEED MORE STANDARDIZATION IN PRACTICES SO THAT PEOPLE IN THE RURAL COMMUNITIES AND LARGER CITIES AND TEACHING INSTITUTIONS GET THE SAME STANDARDS OF CARE
0W# 7HERE DO YOU THINK WELL BE IN THE NEXT THREE TO lVE YEARS WITH RESPECT TO QUALITY #0 !S WE MOVE INTO THE FUTURE WELL SEE MORE INDIVIDUALIZED CARE AND TARGETED TREATMENTS &OR EXAMPLE RIGHT NOW WE HAVE DRUGS FOR PATIENTS WHO ARE ESTROGEN RECEPTOR POSITIVE VERSUS ESTROGEN RECEPTOR NEGATIVE (ERCEPTIN¸ WHICH IS FOR PATIENTS WITH (ER POSITIVE CANCER IS HAVING AN IMPACT ON SURVIVAL AND RECURRENCE RATES !S WE UNDERSTAND MORE ABOUT BREAST CANCER WELL SEE MORE TREATMENTS THAT ARE SPECIlCALLY TAILORED TO THE INDIVIDUAL TYPE OF BREAST CANCER $" "REAST CANCER IS A DISEASE OF AGING PATIENTS AND THE INmUX OF BABY BOOMERS TO THE PATIENT POPULATION COULD HAVE MAJOR IMPLICATIONS FOR ACCESS TO BREAST HEALTH AND BREAST CANCER QUALITY CARE 0W# 7HERE DO YOU THINK WELL BE IN ANOTHER YEARS 7ILL THE SITUATION BE SUBSTANTIALLY DIFFERENT BY THEN #0 !S WE MOVE TOWARDS MORE INDIVIDUALIZED MEDICINE WE HAVE TO MAKE SURE THAT THE HEALTHCARE SYSTEM CAN SUPPORT IT 7E ARE NOT THERE YET !ND WELL NEED RESEARCH TO SUPPORT IT 4HE STUDY POPULATION IS GOING TO BE SMALLER AND THE DRUGS ARE GOING TO BE AIMED AT A SMALLER GROUP OF PEOPLE 3O THE WHOLE PROCESS OF CLINICAL TRIALS IS GOING TO BE IMPACTED $" !S MORE PEOPLE SURVIVE LONGER WE NEED TO BETTER UNDERSTAND THE LONG TERM IMPACT OF BREAST CANCER AND BREAST CANCER CARE ON PATIENTS 4HERE ARE NUMEROUS HEALTH RELATED ISSUES STEMMING FROM SURGERY RADIATION AND CHEMOTHERAPY THAT WE AS CANCER PATIENTS OFTEN FACE 4HIS INCLUDES CHRONIC BACK AND OTHER PAIN CAUSED BY SCAR TISSUE CHEMO BRAIN ESTROGEN AND PROGESTERONE DEPRIVATION INFERTILITY ISSUES BONE LOSS AND NUMEROUS OTHER ISSUES THAT NEED TO BE MORE THOROUGHLY CONSIDERED n %NDNOTES -C'LYNN % ET AL *UNE h4HE 1UALITY OF (EALTH #ARE $ELIVERED TO !DULTS IN THE 5NITED 3TATES v 4HE .EW %NGLAND *OURNAL OF -EDICINE 0RESS RELEASE -AY h.ATIONAL 3TUDY ON #ANCER #ARE 1UALITY 3HOWS -AJORITY OF 0ATIENTS !RE 2ECEIVING 2ECOMMENDED 3TANDARDS OF #ARE v ACCESSED FROM WWWKOMENORG
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
"LOGS AND 3OCIAL -EDIA 4HE .EW #ITIZEN !RBITERS OF (EALTHCARE 1UALITY %XPLOSIVE GROWTH IN SOCIAL TECHNOLOGIES IS TRANSFORMING HEALTHCARE CONSUMERS DECISION MAKING PROCESSES (EALTHCARE ORGANIZATIONS MUST DElNE THEMSELVES IN SOCIAL MEDIA OR BE PREPARED TO FACE THE CONSEQUENCES
"Y $MITRIY +RUGLYAK 4HE -EDICAL "LOG .ETWORK
4HE 2OAD TO 4RANSPARENCY (EALTHCARE CONSUMERISM IS ON THE MARCH 4RANSFORMATION OF hTRADITIONAL PATIENTSv INTO hHEALTHCARE CONSUMERSv READY TO QUESTION HEALTHCARE INSTITUTIONS IS WELL UNDER WAY 4HE NEED FOR HEALTHCARE ORGANIZATIONS TO RESPOND AND ADAPT IS WIDELY ACKNOWLEDGED BY INDUSTRY LEADERS 4HE PACE AND SUCCESS OF THESE CHANGES DEPENDS ON PUTTING TRANSPARENT RELIABLE AND TRUSTWORTHY INFORMATION IN THE HANDS OF CONSUMERS 4HIS INFORMATION INCLUDES AVAILABILITY RELEVANCE QUALITY AND PRICING OF HEALTHCARE SERVICES HEALTHCARE PROVIDERS AND lNANCING PLANS 5NTIL RECENTLY THE PROGRESS TOWARD TRANSPARENCY RELIED SOLELY ON THE WILLINGNESS OF HEALTHCARE ORGANIZATIONS TO DISCLOSE THIS INFORMATION AND THE GOVERNMENTS ABILITY TO MANDATE 0REDICTABLY THE MOVEMENT HAS BEEN SLOW DUE TO THE INSTITUTIONAL AVERSION TO CHANGE "UT IN THE NEW RULES OF THE GAME ARE EMERGING
"LOGS AND 3OCIAL -EDIA ! .EW &ORCE 4HE hSECOND COMINGv OF THE )NTERNET DUBBED 7EB OR hREAD WRITE 7EB v EMPOWERS INDIVIDUALS TO BYPASS INSTITUTIONAL BARRIERS BY FREELY SHARING INFORMATION ONLINE 4HE NEW hSOCIAL TECHNOLOGYv ALREADY IRREVOCABLY TRANSFORMED NEWS POLITICS TECHNOLOGY AND ENTERTAINMENT INDUSTRIES (EALTHCARE IS THE NEXT SECTOR TO FEEL THE IMPACT WHICH IS ONLY STARTING TO FULLY TAKE SHAPE 4O UNDERSTAND WHAT IS HAPPENING LET US START WITH DElNITIONS 3OCIAL MEDIA IS THE BROADEST TERM COVERING THE FULL RANGE OF INDIVIDUAL PUBLISHING AND GLOBAL COMMUNICATION TECHNOLOGIES "LOGGING IS A SOCIAL MEDIA FORMAT STRUCTURED AS A PUBLIC PERSONAL DIARY OPEN TO LARGELY UNCENSORED COMMENTS AND INTERLINKING AND READILY ACCESSIBLE THROUGH 7EB SEARCH ACROSS THE GLOBE !CCORDING TO 4ECHNORATI WWWTECHNORATICOM THE LARGEST BLOG TRACKING SERVICE SEE %XHIBIT THE NUMBER OF BLOGS HAS GROWN EXPLOSIVELY FROM VIRTUALLY ZERO IN TO OVER MILLION IN !UGUST ;= 4HIS EXCLUDES RELATED FORMS OF PUBLIC SOCIAL MEDIA FOR EXAMPLE COMMUNITIES LIKE -Y3PACECOM MILLION PLUS MEMBERS #LASSMATESCOM MILLION PLUS AND &RIENDSTER COM MILLION PLUS TO NAME A FEW 4HE BLOGGING CONSUMERS ARE INCREASINGLY SPEAKING UP ON HEALTHCARE ISSUES SOME DEDICATING THEIR ENTIRE BLOGS TO DISSECTING SPECIlC TOPICS 0UBLICLY SHARING UNVARNISHED THOUGHTS
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
ON HEALTHCARE QUALITY RANKS HIGH ON THE BLOGGING HEALTHCARE CONSUMERS LIST OF INTERESTS 7ANT TO SEE AN INDICATION 4HE #%/ OF A LEADING PHARMA INDUSTRY ASSOCIATION RECENTLY REMARKED THAT HE IS MORE WORRIED ABOUT BLOGGERS IMPACT ON PHARMA THAN THE &$!S (E WAS REFERRING TO PATIENTS WHO CAN PUT THE REPUTATIONS OF DRUG COMPANIES ONLINE BY SHARING THEIR EXPERIENCES WITH THEIR MEMBERS PRODUCTS WITHOUT HAVING TO ASK ANYONES PERMISSION OR GET THROUGH THE EDITORIAL PROCESS OF TRADITIONAL PUBLICATIONS %VERY HEALTHCARE INSTITUTION MUST GET READY FOR THIS TYPE OF SCRUTINY
#ITIZEN (EALTHCARE %XPERTS -EET $IABETES -INE 4O ILLUSTRATE HOW BLOGGERS ARE BECOMING THE NEW OPINION LEADERS CONSIDER THE EXAMPLE OF !MY 4ENDERICH !MY WRITES $IABETES -INE DUBBED A h0ATIENT 4HOUGHT ,EADER "LOGv IN A RECENT COMPREHENSIVE REPORT ON HEALTH AND MEDICAL BLOGGING h4HE %MERGING (EALTHCARE "LOGOSPHERE 7HAT )S )T 7HY $OES )T -ATTER v BY %NVISION 3OLUTIONS ,,# A HEALTHCARE MARKETING COMMUNICATIONS CONSULTANCY WWWENVISIONSOLUTIONSNOWCOM $IAGNOSED WITH 4YPE DIABETES IN -AY !MY DECIDED TO START A BLOG TO CHRONICLE HER JOURNEY OF COPING WITH HER CHRONIC CONDITION AND SHARE THIS EXPERIENCE FOR THE BENElT OF FELLOW DIABETICS 4HE BLOGS NAME h$IABETES -INEv WWWDIABETESMINE COM SEE %XHIBIT WAS CHOSEN TO REmECT THE MISSION OF hBECOMING THE GOLDMINE OF DIABETES RELATED INFORMATIONv 4HROUGH WORD OF MOUTH OF HER READERS AND WITH THE HELP OF 'OOGLE SEARCH THE BLOG TOOK OFF AND DEVELOPED A LOYAL FOLLOWING &OR !MY THE EXPERIENCE OF WRITING A BLOG AND GETTING READERS COMMENTS AND SUPPORT IS THERAPEUTIC &OR HER READERS MANY OF WHOM ARE FELLOW DIABETICS IT IS A PEER TO PEER SOURCE OF PRACTICAL AND EXPERIENTIAL INFORMATION TOLD hAS IT ISv WITHOUT SPIN 7HAT DO THE DIABETES BLOGGERS LIKE !MY HERALD FOR THE HEALTHCARE INDUSTRY INCLUDING DRUG MAKERS DEVICE MANUFACTURERS AND OF COURSE THE PROVIDERS .OTHING LESS THAN A REVOLUTION IN THE HEALTHCARE DECISION MAKING PROCESS DRIVEN BY SHIFTING SOURCES OF AUTHORITY AND TRUST )F YOU ARE INVOLVED IN PROVIDING DIABETES CARE TAKE NOTE 0EOPLE HAVE ALWAYS MADE MOST OF THEIR HEALTHCARE DECISIONS
A KNF R ã@MCãR N B H@K ãLDCH@ãSGD ãMD VãBHSHY D Mã@QAHSD QRãNE ãGD @KSGB@QD ã PT @KHSX
%XHIBIT 4OTAL .UMBER OF "LOGS -ARCH n *ULY
3OURCE 4ECHNORATI HTTPWWWSIFRYCOMALERTSARCHIVESHTML
BASED ON ADVICE FROM THEIR FRIENDS FAMILY AND PHYSICIANS "UT BEFORE THE AGE OF BLOGS AND SOCIAL MEDIA WE HAVE BEEN LIMITED TO CONSULTING ONLY A HANDFUL OF PEOPLE WE COULD SHAKE HANDS WITH WHO WERE UNLIKELY TO HAVE THE DEPTH OF SPECIALIZED KNOWLEDGE 4HIS NECESSITATED RELIANCE ON THE hOFlCIALv SOURCES OF INFORMATION WHOSE AUTHORITY WAS HARD TO CHALLENGE WITH CONlDENCE .OWADAYS INQUIRING DIABETICS CAN EASILY lND $IABETES -INE ASSESS BLOGS TRUSTWORTHINESS BY THE LENGTH OF PUBLICATION AND THE READER FEEDBACK AND GET THE hSTRAIGHT SCOOPv ON WHAT IS AND IS NOT WORKING FOR THEIR PEER GROUP !CCORDING TO !MY BLOGGING CONlRMED HER NOTION THAT DOCTORS DO NOT KNOW EVERYTHING AND THE BEST SOURCE OF INFORMATION ON HOW TO MANAGE HER CONDITION ARE PEOPLE LIKE HER COOPERATING TO HELP ONE ANOTHER !MYS FAME OF BEING A LEADING DIABETES BLOGGER IS TRANSLATING INTO TRADITIONAL MEDIA 3HE IS COMPLETING HER BOOK +NOW 9OUR .UMBERS /UTLIVE 9OUR $IABETES TO BE PUBLISHED IN EARLY AND BASED TO A LARGE EXTENT ON MATERIALS PREVIOUSLY DISCUSSED ON HER BLOG
/RGANIZING THE 0OWER OF 3OCIAL -EDIA 4HE -EDICAL "LOG .ETWORK 7HILE THE POTENTIAL OF BLOGS AND SOCIAL MEDIA IN HEALTHCARE IS ENORMOUS MAKING GOOD ON THEIR FULL PROMISE TO CONSUMERS PROFESSIONALS AND ORGANIZATIONS REQUIRE A NEW MEDIA ECOSYSTEM
4HE -EDICAL "LOG .ETWORK WWWHEALTHVOICESCOM IS THE WORLDS lRST AND LARGEST ONLINE COMMUNITY OF HEALTH AND MEDICAL BLOGGERS 4HE VISION IS TO HELP BUILD BRIDGES BETWEEN HEALTHCARE BLOGGERS THE AUDIENCE AND THE INDUSTRY SEE %XHIBIT 4-".S CURRENT AND FUTURE SERVICES ARE TAILORED FOR THE INDIVIDUAL CONSUMERS AND PROFESSIONALS WHILE DESIGNED TO HELP HEALTHCARE ORGANIZATIONS ADAPT TO THE NEW ENVIRONMENT OF HEALTHCARE TRANSPARENCY AND TRUST (ELPING hNEWCOMERSv TO THE HEALTHCARE BLOGOSPHERE DISCOVER AND ENGAGE THE TOP MEDICAL BLOGGERS FROM ANYWHERE ON THE )NTERNET IS PART OF 4-".S GROWING PORTFOLIO OF OFFERINGS 4-". IS RAPIDLY GROWING INTO A hMAGNET HUBv ATTRACTING HEALTHCARE BLOGGERS WHO ARE LOOKING FOR AN EFFECTIVE CLEARINGHOUSE TO INCREASE THEIR REACH AND lND THEIR LOYAL AUDIENCES 4-". IS ALSO THE lRST PROFESSIONAL HEALTHCARE PUBLICATION PRODUCED IN BLOG FORMAT BY MULTIPLE AUTHORS 4HIS APPROACH COMBINES THE BEST OF OPENNESS AND AUTHENTICITY INDIVIDUAL BLOG AUTHORS BRING WITH THE PREDICTABILITY OF hFEATURED COLUMNv TITLES HELMED BY AUTHORITATIVE SUBJECT MATTER EXPERTS 4-".S FORMULA OF hBLOGGER FREEDOM MEETS EDITORIAL CULTIVATIONv IS MATCHED WITH THE GOAL OF ULTIMATELY COVERING EVERY SUBSTANTIVE HEALTHCARE TOPIC OF OUR TIMES !S THESE PLANS CONTINUE TO UNFOLD 4-". ALONG WITH PARTNERS PLANS TO SHOWCASE THE ROLE SOCIAL MEDIA WILL PLAY IN HEALTHCARE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
A KNF R ã@MCãR N B H@K ãLDCH@ãSGD ãMD VãBHSHY D Mã@QAHSD QRãNE ãGD @KSGB@QD ã PT @KHSX %XHIBIT $IABETES -INE 7EBSITE
"LOGGING HERALDS A REVOLUTION IN THE HEALTHCARE DECISION MAKING PROCESS DRIVEN BY SHIFTING SOURCES OF AUTHORITY AND TRUST THROUGH ONLINE SERVICES THAT BRING TOGETHER HEALTHCARE BLOGGERS CONSUMERS PROFESSIONALS AND INSTITUTIONS 4HESE SERVICES INCLUDE EDUCATION OFFERINGS TO HELP HEALTHCARE ORGANIZATIONS DEVELOP AND IMPLEMENT BLOGGING STRATEGIES 4-". IS ALSO CONDUCTING THE lRST GLOBAL RESEARCH STUDY OF BLOGGER OPINIONS COPRODUCED WITH %NVISION 3OLUTIONS HTTP WWWENVISIONSOLUTIONSNOWCOM
#ALLING !LL (EALTHCARE ,EADERS )F YOUR ROLE INVOLVES HEALTHCARE STRATEGY OR MARKETING SITTING ON THE SIDELINES OF THE BLOGGING REVOLUTION IS NO LONGER AN OPTION )F YOU DO NOT MAKE A CONSCIOUS EFFORT TO DElNE YOURSELF IN SOCIAL
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
MEDIA ON YOUR OWN TERMS PREPARE FOR OTHERS TO lLL THE VOID 4HIS INCLUDES THE PATIENTS THE PHYSICIANS THE COMPETITORS AND THE FORMER EMPLOYEES 4HE LARGER YOUR ORGANIZATION IS THE MORE LIKELY YOU ARE TO ATTRACT SCRUTINY ONLINE .O WONDER PHARMACEUTICAL COMPANIES ARE THE lRST ONES TO REALLY FEEL THE IMPACT "UT THE IMPERATIVE TO PREPARE AND RESPOND TO THE GROWTH OF OPEN MEDIA EQUALLY APPLIES TO HOSPITALS HEALTH PLANS MEDICAL DEVICE MANUFACTURERS AND PHYSICIAN GROUPS 4AKE INSPIRATION FROM HIGH TECH INDUSTRY LEADERS SUCH AS -ICROSOFT 3UN -ICROSYSTEMS 9AHOO AND 'OOGLE WHO SPONSOR CORPORATE BLOGS SUPPORT hUNOFlCIALv BLOGGING ACTIVITIES BY EMPLOYEES AND ENGAGE IN OTHER FORMS OF SOCIAL MEDIA 4HE POSITIVE PUBLICITY AUTHENTIC WORD OF MOUTH AND THE NEW hINSTITUTIONAL HUMAN FACEv THAT FOLLOW ARE HARD TO REPLICATE BY TRADITIONAL MARKETING %NDNOTE 4ECHNORATICOM HTTPWWWSIFRYCOMALERTSARCHIVESHTML ACCESSED 3EPTEMBER
A KNF R ã@MCãR N B H@K ãLDCH@ãSGD ãMD VãBHSHY D Mã@QAHSD QRãNE ãGD @KSGB@QD ã PT @KHSX %XHIBIT 4HE -EDICAL "LOG .ETWORK 7EBSITE
$MITRIY +RUGLYAK n #%/ #OMMUNITY 3TEWARD 4RUSTED-$ .ETWORK $MITRIY +RUGLYAK IS #%/ #OMMUNITY 3TEWARD OF 4RUSTED-$ .ETWORK HTTPTRUSTEDMD SOCIAL NETWORKING SERVICE DESIGNED TO EMPOWER TRUST BASED RELATIONSHIPS BETWEEN HEALTHCARE CONSUMERS PROFESSIONALS AND ORGANIZATIONS (E CHAIRS THE (EALTHCARE "LOGGING 3UMMIT HTTPTRUSTEDMDCONFERENCE WHICH IS THE PREMIER CONFERENCE ON HEALTHCARE BLOGS AND SOCIAL MEDIA HELD ONCE IN AND PLANNED THREE TIMES IN $MITRIY ALSO ORIGINATED (EALTH4RAIN THE h/PEN (EALTHCARE -ANIFESTOv HTTPTRUSTEDMDMANIFESTO WHICH LAID OUT A SET OF COMMON SENSE GUIDELINES FOR BLOG AND SOCIAL MEDIA ADOPTION BY HEALTHCARE ORGANIZATIONS AND GARNERED NUMEROUS ENDORSEMENTS $MITRIY IS PASSIONATE ABOUT THE POTENTIAL OF OPEN ONLINE COMMUNITIES TO IMPROVE HEALTH AND WELLNESS FOR CONSUMERS AND PRACTICE ENVIRONMENT FOR HEALTHCARE PROFESSIONALS !S A MILESTONE TO THAT VISION 4RUSTED-$ .ETWORK HAS ALREADY BECOME THE WORLDS LARGEST COMMUNITY OF HEALTH AND MEDICAL BLOGGERS 0RIOR TO 4RUSTED-$ $MITRIY HELD A VARIETY OF PRODUCT DEVELOPMENT AND MARKETING POSITIONS IN THE 3ILICON 6ALLEY (E CAN BE REACHED AT DKRUGLYAK TRUSTEDMD
4RUSTED-$ .ETWORK 4RUSTED-$ .ETWORK IS A SOCIAL NETWORKING SERVICE DESIGNED TO EMPOWER TRUST BASED RELATIONSHIPS BETWEEN HEALTHCARE CONSUMERS PROFESSIONALS AND ORGANIZATIONS &REE MEMBERSHIP OFFERS INDIVIDUALS PERSONAL PUBLISHING SEARCH COMMUNICATION AND REPUTATION MANAGEMENT TOOLS (EALTHCARE ORGANIZATIONS CAN SPONSOR PRIVATE SPACES AROUND COMMON INTERESTS AND AFlLIATIONS TO ENGAGE AND RECRUIT THEIR MEMBERSHIP 2EGISTER FOR FREE MEMBERSHIP TODAY #ONTACT $MITRIY +RUGLYAK 0HONE %MAIL DKRUGLYAK TRUSTEDMD 7EB HTTPTRUSTEDMD # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
! +EY 3TRATEGY FOR 3OLVING THE (EALTHCARE #RISIS )NTEGRATING 3ICK #ARE AND 7ELL #ARE )NTEGRATING SICK CARE AND WELL CARE IS AN ESSENTIAL STRATEGY FOR TRANSFORMING THE BROKEN !MERICAN HEALTHCARE INDUSTRY TO A VALUE BASED SYSTEM THAT PROVIDES HIGH QUALITY COST EFFECTIVE CARE
"Y 3TEPHEN % "ELLER .ATIONAL (EALTH $ATA 3YSTEMS 3ABATINI * -ONATESTI %3 %NTERPRISES
)NTRODUCTION (EALTHCARE IN THE 5NITED 3TATES IS IN CRISIS 4HERES A QUALITY CHASM ;= A KNOWLEDGE VOID ;= A HEALTH INFORMATION TECHNOLOGY GAP ;= A LEADERSHIP ABYSS;= AND A RIFT BETWEEN hSICK CAREv AND hWELL CAREv 4O SOLVE OUR HEALTHCARE CRISIS;= WE MUST TRANSFORM THE CURRENT SYSTEM BY MAKING FUNDAMENTAL CHANGES TO KEY POLICIES AND PRACTICES 4HIS TRANSFORMATION WOULD CHANGE !MERICAN HEALTHCARE FROM AN INEFlCIENT AND ERROR PRONE SYSTEM TO A VALUE BASED SYSTEM THAT SUPPORTS AND REWARDS HIGH QUALITY n AND AFFORDABLE CARE WHICH IS DELIVERED IN A SAFE TIMELY EFlCIENT AND COST EFFECTIVE MANNER )T WOULD BE ACCOMPLISHED USING A HIGH lDELITY;= HEALTHCARE MODEL THAT OFFERS lNANCIAL INCENTIVES AND HEALTH INFORMATION TECHNOLOGIES TO COLLABORATING NETWORKS OF PRACTITIONERS RESEARCHERS PATIENTS CONSUMERS HEALTH PLANS AND EMPLOYERS WHOSE EFFORTS INCLUDE INTEGRATING SICK CARE AND WELL CARE 4HESE NETWORKS WOULD REDUCE HEALTHCARE COSTS AND IMPROVE CARE QUALITY THROUGH #ONTINUAL LEARNING AND KNOWLEDGE BUILDING !DVANCED DECISION SUPPORT AND INFORMATION SHARING 5SE OF EVOLVING EVIDENCE BASED GUIDELINES 6ALUE BASED COMPETITION AND )NTEGRATED COORDINATED MULTIDISCIPLINARY CARE 3INCE IT IS BEYOND THE SCOPE OF THIS PAPER TO EXAMINE EVERY ASPECT OF THE SOLUTION WE PROPOSE WE WILL FOCUS OUR DISCUSSION ON SICK CARE AND WELL CARE INTEGRATION
$ElNING 3ICK #ARE 7ITH THE 3ICK #ARE $ELIVERY 4REE 4HE 3ICK #ARE $ELIVERY 4REE lGURE SEE %XHIBIT DEPICTS KEY COMPONENTS OF A PATIENT CENTERED ;= EVIDENCE BASED ;= PERSONALIZED;= SICK CARE DELIVERY MODEL &OLLOWING IS A DESCRIPTION OF THE TREE
2OOTS (EALTH 0ROBLEMS OF 0OPULATION 4HE lRST COMPONENT OF THIS SICK CARE APPROACH IS REPRESENTED BY THE ROOTS WHICH COMPRISE SIX CATEGORIES OF PHYSICAL AND PSYCHOLOGICAL PROBLEMS INCLUDING DISEASES ILLNESSES DYSFUNCTIONS AND TRAUMAS !CUTE HEALTH PROBLEMS ARE CHARACTERIZED BY SUDDEN ONSET AND SHORT DURATION WHICH PROGRESS RAPIDLY AND REQUIRE URGENT CARE !N ACUTE MYOCARDIAL INFARCTION HEART ATTACK AND A SERIOUS ACCIDENT VICTIM ARE EXAMPLES 3UBACUTE HEALTH PROBLEMS ARE DISTINGUISHED BY ABRUPT ONSET BUT HAVE LONGER DURATION OR CHANGE LESS RAPIDLY THAN ACUTE PROBLEMS %XAMPLES INCLUDE POST OPERATIVE CARE COMPLEX WOUND MANAGEMENT AND REHABILITATION FOR STROKE #HRONIC HEALTH PROBLEMS HAVE INDElNITE DURATION WHICH MAY PERSIST WITH VIRTUALLY NO CHANGE OVER TIME OR WHICH MAY LEAD TO COMPLICATIONS $IABETES DEPRESSION CONGESTIVE HEART FAILURE HEPATITIS AND ASTHMA ARE EXAMPLES 0HYSIOLOGICAL HEALTH PROBLEMS CONSIST OF ILLNESSES AND DYSFUNCTIONS IN ANY PART OF THE BODY
3TEPHEN % "ELLER 0H$ IS A LICENSED PSYCHOLOGIST PRACTITIONER RESEARCHER WRITER KNOWLEDGE MANAGEMENT EXPERT INFORMATION TECHNOLOGY INVENTOR SOFTWARE ARCHITECT AND PROGRAMMER AND ANALYTIC MODEL BUILDER (E IS PRESIDENT AND #%/ OF .ATIONAL (EALTH $ATA 3YSTEMS )NC A COMPANY THAT CREATES INNOVATIVE HEALTH INFORMATION TECHNOLOGIES AND IS A PRINCIPAL OF THE 0ATIENT (EALTH )NFORMATION .ETWORK 0(). #ONSORTIUM (E CAN BE REACHED AT SBELLER NHDSCOM 3ABATINI * -ONATESTI IS PRESIDENT OF %3 %NTERPRISES )NC A CONSULTING BUSINESS FOCUSING ON PROJECT MANAGEMENT SYSTEM INTEGRATION AND )4 TRAINING (E HAS OVER YEARS EXPERIENCE AS AN OPERATIONS MANAGER AND AN )4ENTERPRISE TRANSFORMATION SPECIALIST (IS COMPANY IS A PRINCIPAL OF THE 0(). #ONSORTIUM (E CAN BE REACHED AT SMONATESTI GMPEXPRESSNET
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD %XHIBIT 3ICK #ARE $ELIVERY 4REE %VIDENCE "ASED 0ATIENT #ENTERED #ARE 0EOPLE 0LACES AND 0ROCESSES
3OURCE .($3 %3 %NTERPRISES
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD
4HIS PROCESS REQUIRES A BIOPSYCHO SOCIAL @WHOLE PERSON APPROACH TO CARE WHERE BODY MIND SPIRIT AND ENVIRONMENT ARE ALL CONSIDERED IMPORTANT AND HANDLED ACCORDINGLY 0SYCHOLOGICAL HEALTH PROBLEMS CONSIST OF EMOTIONAL MENTAL OR BEHAVIORAL DISTURBANCES AND DISORDERS -IND "ODY "IOPSYCHOSOCIAL HEALTH PROBLEMS ARE RELATED TO THE INTERACTION BETWEEN PHYSIOLOGICAL AND PSYCHOLOGICAL FACTORS
4RUNK 3ICK #ARE $ELIVERY -ODELS 4HE NEXT COMPONENT ENCOMPASSES THE lVE SICK CARE DELIVERY MODELS WHICH ARE REPRESENTED BY THE 3ICK #ARE $ELIVERY 4REE TRUNK SHOWN IN %XHIBIT )NPATIENT #ARE FOCUSES ON TREATING PATIENTS IN HOSPITALS NURSING HOMES AND OTHER INPATIENT FACILITIES /UTPATIENT #ARE FOCUSES ON TREATING PATIENTS IN PROVIDERS OFlCES CLINICS AND OTHER OUTPATIENT FACILITIES -EDICAL"ODILY #ARE FOCUSES ON DELIVERY OF EMERGENCY MEDICAL CARE EG ACCIDENT VICTIMS INFECTIONS POISONING ETC AND NON EMERGENCY MEDICAL AND NON MEDICAL BODILY CARE EG ELECTIVE SURGERY CHIROPRACTIC DENTAL VISION ETC 0SYCHOLOGICAL #ARE FOCUSES ON DELIVERY OF MEDICALPSYCHIATRIC AND NON MEDICALPSYCHOLOGICAL CARE FOR MENTAL EMOTIONAL COGNITIVE AND BEHAVIORAL PROBLEMS "IOPSYCHOSOCIAL)NTEGRATIVE #ARE FOCUSES ON DELIVERY OF INTEGRATIVE MIND BODY CARE FOR PROBLEMS HAVING PHYSIOLOGICAL AND PSYCHOLOGICAL CAUSES OR CONSEQUENCES
"RANCHES #ATEGORIES OF 0EOPLE AND 0LACES 4HE BRANCHES OF THE 4REE DEPICT THE PEOPLE AND PLACES INVOLVED WITH SICK CARE 0ATIENTS AND THEIR &AMILIES ARE THE RECIPIENTS OF THE CARE (EALTHCARE 0ROFESSIONALS INCLUDING PROVIDERS AND RESEARCHERS ACROSS THE ENTIRE HEALTHCARE CONTINUUM DELIVER THE CARE OR STUDY THE OUTCOMES 0LACES 3ICK #ARE IS $ELIVERED INCLUDE HOSPITALS CLINICS PRIMARY CARE PHYSICIANS OFlCES SPECIALISTS OFlCES LABORATORIES AND ANY OTHER PLACES SICK CARE IS RENDERED
&LOWERS 3ICK #ARE 0ROCESSES 3ICK CARE DELIVERY PROCESSES FOCUS ON DIAGNOSING AND TREATING HEALTH PROBLEMS &LOWERS REPRESENT THE INPATIENT AND OUTPATIENT CARE PROCESSES )NPATIENT CARE PROCESSES FOR PHYSICAL AND PSYCHOLOGICAL HEALTH PROBLEMS INCLUDE EMERGENCY ROOMTRAUMA CENTER
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
CARE OBSTETRICS TESTS AND EXAMINATIONS ELECTIVE SURGERY AND PSYCHIATRIC CARE FOR SEVERELY DISTURBED PATIENTS /UTPATIENT CARE PROCESSES FOR PHYSICAL AND PSYCHO LOGICAL HEALTH PROBLEMS INCLUDE TESTS AND TREATMENTS FOR PHYSICAL AND PSYCHOLOGICAL PROBLEMS DURING OFlCE VISITS TO PRIMARY CARE PHYSICIANS AND SPECIALISTS AS WELL AS TO AMBULATORY CLINICS AND OTHER SUCH FACILITIES 4HESE SICK CARE DELIVERY PROCESSES ARE PATIENT CENTRIC AND UTILIZE EVOLVING EVIDENCE BASED PRACTICE GUIDELINES TO )MPROVE OUTCOMES CONTINUOUSLY %MPOWER HEALTHCARE CONSUMERS TO MAKE KNOWLEDGEABLE DECISIONS ABOUT THEIR OWN CARE BY BEING ACTIVE PARTICIPANTS IN A SHARED DECISION MAKING PROCESS 4REAT THE hWHOLE PERSON v BOTH PHYSICALLY AND PSYCHOLOGICALLY 4AILOR CARE TO EACH PERSONS SPECIlC NEEDS AND PREFERENCES #OORDINATE CARE AND FACILITATE COOPERATIVE COMMUNICATIONS ACROSS ALL PROVIDERS &OSTER COLLABORATION BETWEEN PRACTITIONERS AND RESEARCHERS -AXIMIZE SAFETY AND EFlCIENCY AND !SSURE PATIENT PRIVACY
"EES (EALTH )NFORMATION 4ECHNOLOGY 3UPPORTING 3ICK #ARE 4HE BEES ILLUSTRATE THE HEALTH INFORMATION TECHNOLOGIES NEEDED TO SUPPORT SICK CARE )MPORTANT SOFTWARE INCLUDES TOOLS FOR A DIAGNOSTIC DECISION SUPPORT B TREATMENT SELECTION AND PLAN OF CARE GENERATION DECISION SUPPORT C PLAN OF CARE EXECUTION ASSISTANCE VIA REMINDERS PROMPTS AND ALERTS HELPING TO AVOID ERRORS AND OMISSIONS AND OPTIMIZE WORK mOWS D CARE COORDINATION ACROSS MULTIPLE PROVIDERS INCLUDING CASE MANAGERS E OUTCOME DATA COLLECTION AND ANALYSIS F RESEARCH CLINICAL AND lNANCIAL MODEL DEVELOPMENT AND KNOWLEDGE MANAGEMENT G BUSINESS INTELLIGENCE AND H PROTECTING POPULATIONS IN EMERGENCIES SUCH AS EPIDEMICS AND BIOTERRORISM
$ElNING 7ELL #ARE 7ITH THE 7ELL #ARE $ELIVERY 4REE 4HE 7ELL #ARE $ELIVERY 4REE lGURE SEE %XHIBIT DEPICTS A COMMUNITY COLLABORATION APPROACH FOR IMPROVING HEALTH OUTCOMES AND REDUCING COST THROUGH CONSUMER EDUCATION AND WELLNESS PROGRAMS;= WHICH HELP PREVENT SERIOUS ILLNESSES AND COMPLICATIONS AND INCREASE PEOPLES WELL BEING AND QUALITY OF LIFE 4HIS WELL CARE APPROACH COMPLEMENTS AND AUGMENTS SICK CARE
2OOTS (EALTH 3TATUS OF 0OPULATIONS 4HE ROOTS OF THE 7ELL #ARE $ELIVERY 4REE REPRESENT THE lVE WELL CARE POPULATIONS (EALTHY POPULATIONS HAVE NO IDENTIlED HEALTH RISK
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD %XHIBIT 7ELL #ARE $ELIVERY 4REE #OMMUNITY #OLLABORATION FOR 7ELLNESS 0EOPLE 0LACES AND 0ROCESSES
3OURCE .($3 %3 %NTERPRISES # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD
4HIS INTEGRATED CARE STRATEGY PROMISES TO IMPROVE PEOPLES HEALTH AND REDUCE HEALTHCARE COSTS TO A GREATER DEGREE THAN EITHER SICK CARE OR WELL CARE ALONE
!T 2ISK POPULATIONS ARE PEOPLE WHO ARE AT RISK OF BECOMING ILL DUE TO THEIR PHYSICAL CONDITION EG OBESITY BEHAVIORS AND LIFESTYLE EG SMOKING ALCOHOL CONSUMPTION GENETIC PREDISPOSITIONS OR LIVING AND WORKING ENVIRONMENTS #HRONIC POPULATIONS ARE PEOPLE WITH CHRONIC CONDITIONS SUCH AS DIABETES FOR WHICH THERE IS AMPLE POTENTIAL FOR COMPLICATIONS AND WORSENING HEALTH #ATASTROPHIC ILLNESS POPULATIONS ARE PEOPLE WHO HAVE RECEIVED EMERGENCY TREATMENT EG ACCIDENT VICTIMS INFECTIONS POISONING OR INPATIENT TREATMENT OF SERIOUS MEDICAL INCLUDING PSYCHIATRIC CONDITIONS %ND OF ,IFE POPULATIONS ARE PEOPLE WHO HAVE NO HOPE OF RECOVERING THEY WILL ONLY GET WORSE AND DIE
4RUNK 7ELL #ARE $ELIVERY -ODELS 4HE FOUR WELL CARE DELIVERY MODELS ARE REPRESENTED BY THE TRUNK 0REVENTIVE -AINTENANCE FOCUSES ON DELIVERING PRIMARY PREVENTION SUCH AS PHYSICAL ACTIVITY NUTRITION STRESS RELIEF VACCINATIONS ETC THAT HELP PEOPLE AVOID HEALTH PROBLEMS AS WELL AS PROMOTING PEAK PERFORMANCE AND SECONDARY PREVENTION FOR AT RISK PERSONS TO PREVENT RECURRENCES OF HEALTH PROBLEMS SUCH AS AVOIDING RECURRENT CORONARY ARTERY DISEASE EVENTS IN A PERSON WITH A HISTORY OF THE ILLNESS 2ECOVERY2EHABILITATION FOCUSES ON ADHERENCE COMPLI ANCE TO DOCTORS ORDERS TO FOSTER RECOVERY REHABILITATION AND COMPLICATION AVOIDANCE FOR PATIENTS HAVING CHRONIC OR CATASTROPHIC HEALTH PROBLEMS #OMPASSIONATE (OME #ARE FOCUSES ON MAKING PEOPLE NEAR END OF LIFE AS COMFORTABLE AS POSSIBLE IN A SUPPORTIVE ENVIRONMENT WHERE THEY HAVE DIGNITY AND FAMILY SUPPORT &RAUD 0REVENTION IS USED FOR ALL POPULATIONS AND FOCUSES ON ASSURING THAT THE WELL CARE PROGRAMS ARE COMPLIANT WITH REGULATIONS AND THAT CARE IS RENDERED WITH INTEGRITY
"RANCHES #ATEGORIES OF 0EOPLE AND 0LACES 4HE BRANCHES DEPICT THE PEOPLE AND PLACE INVOLVED WITH WELL CARE #ONSUMERS 0ATIENTS AND THEIR &AMILIES ARE THE RECIPIENTS OF WELL CARE (EALTHCARE 0ROFESSIONALS ARE THOSE WHO DELIVER WELL CARE n INCLUDING WELLNESS COACHES SUCH AS SPECIALLY TRAINED PHYSICIAN ASSISTANTS NURSE PRACTITIONERS HOME HEALTH AIDES PERSONAL TRAINERS AND OTHER PRACTITIONERS n AS WELL AS RESEARCHERS WHO STUDY CARE OUTCOMES
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
0LACES WHERE 7ELL #ARE IS $ELIVERED INCLUDE WELL CARE FACILITIES COMMUNITY BASED ORGANIZATIONS WORKPLACES AND PRIMARY CARE PHYSICIANS OFlCES
&LOWERS 7ELL #ARE 0ROCESSES 4HE mOWERS REPRESENT THE WELL CARE DELIVERY PROCESSES WHICH ARE ASSOCIATED WITH THE WELL CARE DELIVERY MODELS 2ECOVERY2EHABILITATION AND 0REVENTIVE -AINTENANCE INCLUDE PROCESSES FOR A ONGOING RISK AND HEALTH STATUS ASSESSMENTS B ONGOING GENERATION OF PERSONAL HEALTH PLANS IDENTIFYING ANY RISK FACTORS PEOPLE MAY HAVE AS WELL AS PRIMARY AND SECONDARY PREVENTION PLANS OF ACTION IE HEALTH DIRECTIVES C HEALTH EDUCATION PRESENTING CONCRETE UNDERSTANDABLE ACTION STEPS AND PSYCHOLOGICAL COUNSELING FOR DEALING WITH PHYSICAL PROBLEMS AND PSYCHOLOGICAL STRESSORS D COMPLIANCE MOTIVATION INVOLVING ENCOURAGING AND REMINDING PEOPLE TO DO THE THINGS THAT WILL HELP THEM IMPROVE THEIR OWN HEALTH E ACCESS TO HEALTH COACHES FOR HEALTH INFORMATION AND ADVICE F OUTCOME STUDIES USED IN CONTINUOUS QUALITY IMPROVEMENT FEEDBACK LOOPS G COORDINATING CARE FOR PATIENTS WITH CATASTROPHIC HEALTH PROBLEMS SO MULTIDISCIPLINARY TEAMS CAN WORK TOGETHER EFFECTIVELY H PROMOTING ENVIRONMENTAL AND WORKPLACE SAFETY AND I ENCOURAG ING LIFESTYLE AND ATTITUDINAL CHANGES FOR PEAK PERFORMANCE #OMPASSIONATE (OME #ARE INCLUDES PROCESSES FOR HELPING INDIVIDUALS OBTAIN HOME CARE NURSING AND HOMEMAKING ASSISTANCE ARRANGES FOR TRANSPORTATION TO AND FROM DOCTOR APPOINTMENTS AND ADDRESSES THE PSYCHOLOGICAL SOCIAL AND SPIRITUAL WELL BEING OF PATIENTS AND FAMILIES &RAUD 0REVENTION HAS PROCESSES THAT HELP DETECT FRAUD BY ANALYZING THE SERVICES RENDERED IN LIGHT OF THE HEALTH STATUS ASSESSMENTS AND OUTCOMES
"EES (EALTH )NFORMATION 4ECHNOLOGY 3UPPORTING 7ELL #ARE 4HE BEES ILLUSTRATE THE HEALTH INFORMATION TECHNOLOGIES THAT SUPPORT WELL CARE 4HE SOFTWARE APPLICATIONS NEEDED INCLUDE TOOLS FOR A COLLECTING AND ANALYZING DATA FROM HEALTH RISK ASSESSMENTS AND HEALTH STATUS MONITORING B PERSONAL HEALTH PLAN CREATION USING EVIDENCE BASED WELL CARE GUIDELINES C PERSONAL HEALTH PLAN DELIVERY ASSISTANCE VIA REMINDERS PROMPTS AND ALERTS TO IMPROVE COMPLIANCE WITH PREFERRED INTERVENTIONS D COMMUNITY HEALTH PLAN DEVELOPMENT SHOWING HOW ORGANIZATIONS AND NEIGHBORHOODS CAN SUPPORT THE HEALTH OF INDIVIDUALS E RESEARCH AND KNOWLEDGE MANAGEMENT AND F BUSINESS INTELLIGENCE
)NTEGRATING 3ICK #ARE 7ELL #ARE (AVING DElNED THE BASIC COMPONENTS OF SICK CARE AND WELL CARE WE NOW TURN OUR ATTENTION TO THE ISSUE OF INTEGRATION )NSTEAD OF VIEWING SICK CARE AND WELL CARE AS TWO SEPARATE AVENUES IN THE ROAD TO HEALTH THE SOLUTION WE PROPOSE CALLS
@ ã J DX ã RS Q @SDFXãEN QãR N KUHMF ãSGDãGD@KSGB@QD ãBQHRHRãHMSD FQ@SHMFãR HBJ B@QD ã@MCãVD KK B@QD FOR DELIVERING BOTH IN AN INTEGRATED CARE DELIVERY SYSTEM 4HIS PROCESS INVOLVES A NEW KIND OF COORDINATION AND COLLABORATION BETWEEN A MEDICAL AND RELATED SICK CARE PRACTITIONERS FOCUSED ON THE DIAGNOSIS AND TREATMENT OF HEALTH PROBLEMS AND B WELL CARE PRACTITIONERS FOCUSED ON PREVENTION RECOVERY AND WELL BEING AS WELL AS PEAK PERFORMANCE )T REQUIRES A BIOPSYCHOSOCIAL hWHOLE PERSONv APPROACH TO CARE WHERE BODY MIND SPIRIT AND ENVIRONMENT ARE ALL CONSIDERED IMPORTANT AND HANDLED ACCORDINGLY;= 4HIS INTEGRATED CARE STRATEGY PROMISES TO IMPROVE PEOPLES HEALTH AND REDUCE HEALTHCARE COSTS TO A GREATER DEGREE THAN EITHER SICK CARE OR WELL CARE ALONE BECAUSE IT PROVIDES A SENSIBLE WAY TO KEEP PEOPLE HEALTHIER LONGER RECOVER FROM ILLNESS AND DYSFUNCTION MORE QUICKLY AND AVOID COMPLICATIONS OF CHRONIC DISEASE )T IS THEREFORE A CRUCIAL COMPONENT FOR SOLVING THE HEALTHCARE CRISIS BY REDUCING OVERALL EXPENDITURES (AVING A PATIENT PROFILE THAT INCLUDES A FULL MIND BODY WORK UP ALONG WITH AN INDIVIDUAL PLAN OF CARE FOCUSED ON KEEPING THE INDIVIDUAL HEALTHY SUPPLIES ESSENTIAL INFORMATION THAT ENABLES THE SICK CARE PRACTITIONER TO BETTER UNDERSTAND AND TREAT THE ROOT CAUSES OF ACUTE SUBACUTE AND CHRONIC AILMENTS USING CONVENTIONAL ALLOPATHIC APPROACHES AS NECESSARY
)N ADDITION THIS INFORMATION HELPS THE WELL CARE PRACTITIONER WORK WITH CLIENTS TO PREVENT HEALTH PROBLEMS AND RECURRENCES USING ECONOMICAL COMPLEMENTARY AND ALTERNATIVE NON ALLOPATHIC INTERVENTIONS "OTTOM LINE "Y INTEGRATING SICK CARE AND WELL CARE AS PER THE PROPOSED SOLUTION THE RESULT WOULD BE A REDUCTION IN OVERALL HEALTHCARE COSTS AN IMPROVEMENT IN HEALTH OUTCOMES AND AN INCREASE IN PEOPLES QUALITY OF LIFE AND PRODUCTIVITY 4HIS IS A VITAL STEP TOWARD SOLVING THE CURRENT HEALTHCARE CRISIS %NDNOTES HTTPWWWNASEDUONPIWEBEXTRANSFWEBCHASM 4HE FOLLOWING REFER TO PAGES LISTED IN THE TABLE OF CONTENTS AT HTTP WELLNESSWIKISPACESCOM 4HE +NOWLEDGE 6OID 4HE ()4 'AP 0ROBLEMS 2ELATING TO 0ROVIDER -OTIVATION AND (OW TO 3OLVE 4HEM 4HE #URRENT 3ITUATION 4ACTIC n )NCREASE (EALTHCARE &IDELITY 4ACTIC n &OCUS ON #ONSUMER #ENTERED 5NIVERSAL (EALTHCARE 4ACTIC n )MPROVE #ARE 1UALITY WITH %VIDENCE "ASED 0RACTICE 'UIDELINES 4ACTIC n $ELIVER 0ERSONALIZED #ARE 4ACTIC n /FFER #ONSUMER %DUCATION AND 7ELLNESS 0ROGRAMS 4ACTIC n $ELIVER "IOPSYCHOSOCIAL (EALTHCARE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1UALITY AND %MPLOYER "ENElT 0LAN $ESIGN !S HEALTHCARE COSTS CONTINUE TO SKYROCKET EMPLOYERS ARE EXPLORING NEW FRONTIERS IN BENElT DESIGN THAT ACTIVATE EMPLOYEES AND IN TURN INCREASE QUALITY
"Y "ARRY "ARNETT AND 7ILLIAM 2OSENBERG 0RICEWATERHOUSE#OOPERS
(EALTHY 7ORKERS FOR A (EALTHY "OTTOM ,INE "ECAUSE THE EDUCATED !MERICAN WORKER HAS COME TO EXPECT COMPREHENSIVE HEALTH BENElTS THE ABSENCE OR INADEQUACY OF A PROGRAM HINDERS A COMPANYS ABILITY TO ATTRACT AND RETAIN THE BEST PERSONNEL /NE OF THE GOALS OF A QUALITY PLAN IS TO REDUCE ABSENTEEISM AND IMPROVE PRODUCTIVITY &OR THIS REASON EMPLOYERS ARE INCREASINGLY MOTIVATED TO DESIGN EMPLOYEE BENElT PLANS THAT EMBRACE QUALITY TO KEEP EMPLOYEES HEALTHY MOTIVATED AND HIGH PERFORMING
4HE %VOLUTION OF "ENElT 0LANS (ISTORICALLY EMPLOYERS HAVE FOCUSED ON PROVIDING COMPETITIVE HEALTHCARE COVERAGE AT A REASONABLE COST "EFORE THE ADVENT OF MANAGED CARE BENElT PLANS WERE TYPICALLY STRUCTURED TO PAY FOR ANY LICENSED PROVIDER WITH THE ASSUMPTION THAT THE GOVERNMENT AS LICENSOR WOULD ENFORCE QUALITY %MPLOYERS WERE MORE INVOLVED IN THE INTRICACIES OF DETERMINING THE SCOPE AND LEVEL OF BENElTS IN HEALTH BENElT PLANS THAN IN MAKING SURE THE PLANS ENCOURAGED EMPLOYEES TO SEEK OUT QUALITY DOCTORS AND HOSPITALS /NE REASON FOR THIS FOCUS WAS A RELUCTANCE TO GET INVOLVED IN EMPLOYEES PERSONAL HEALTHCARE MATTERS (OWEVER PERHAPS THE MOST IMPORTANT REASON FOR SHYING AWAY FROM QUALITY OF CARE ISSUES WAS THE ABSENCE OF REAL MEASURES TO GUIDE THEM !S MANAGED CARE EVOLVED DURING THE S INSURERS NEGOTIATED FINANCIAL ARRANGEMENTS WITH HOSPITALS AND DOCTORS AND LISTED THEM IN hNETWORKv DIRECTORIES %MPLOYEES RECEIVED MORE BENEFITS IF THEY USED A PHYSICIAN LISTED IN THE DIRECTORY YET QUALITY CONSIDERATIONS WERE LIMITED TO ENSURING THAT THE PHYSICIANS LICENSING AND CERTIFICATION CREDENTIALS WERE IN ORDER 4IMES HAVE CHANGED $URING THE PAST YEARS THE PRESS HAS REPORTED ALARMING STUDIES ABOUT RATES OF MEDICAL ERRORS &OR EXAMPLE IN THE )NSTITUTE OF -EDICINE REPORTED THAT BETWEEN AND !MERICANS DIE ANNUALLY FROM MEDICAL ERRORS
n MORE PEOPLE THAN FROM BREAST CANCER !)$3 OR MOTOR VEHICLE ACCIDENTS;= )N THE #HICAGO 4RIBUNE REPORTED THAT POORLY TRAINED OR OVERWORKED NURSES WERE RESPONSIBLE FOR THE DEATHS OF PATIENTS AND INJURIES SINCE )T ALSO DESCRIBED AN ANALYSIS OF MILLION STATE AND FEDERAL COMPUTER RECORDS THAT INDICATED HOSPITALS WERE SACRIlCING PATIENT SAFETY FOR A BETTER BOTTOM LINE;= 2ECOGNIZING THE NEED TO ENCOURAGE IMPROVED QUALITY AND NOT JUST MEET MINIMUM STANDARDS IN THEIR HEALTH PLAN NETWORKS EMPLOYERS CREATED COALITIONS SUCH AS 4HE ,EAPFROG 'ROUP 4HE GOAL OF THESE GROUPS IS TO LAUNCH INITIATIVES THAT CREATE BREAKTHROUGH IMPROVEMENTS IN SAFETY QUALITY AND AFFORDABILITY BY MOBILIZING EMPLOYER PURCHASING POWER %MPLOYERS SUCH AS THOSE IN THE 0ACIlC "USINESS 'ROUP ON (EALTH HAVE ALSO RESPONDED BY LOOKING AT NEW BENElT PLAN DESIGNS TO INCREASE QUALITY
#ONTROLLING #OSTS )NCREASING 6ALUE /NE CHALLENGE IN CREATING SUCCESSFUL BENElT PLANS IS lNDING A WAY TO BE INNOVATIVE WITHOUT INCREASING COSTS !CCORDING TO A STUDY BY THE 'OVERNMENT !CCOUNTABILITY /FlCE '!/ RISING BENElT COSTS ARE FORCING PRIVATE EMPLOYERS AND EMPLOYEES TO MAKE DIFlCULT TRADE OFFS BETWEEN WAGES AND BENElTS 4HE LONG STANDING TRADITION OF EMPLOYER SPONSORED HEALTH BENElTS CAN NO LONGER BE SUSTAINED MOSTLY BECAUSE PRODUCTIVITY GROWTH WILL NOT LIKELY SUPPORT ESCALATING HEALTH INSURANCE COSTS 4HE '!/ STUDY TRACKED PRIVATE EMPLOYERS WAGES AND BENElTS FROM TO AND FOUND THAT REAL WAGES GREW BY PERCENT BUT WERE ECLIPSED BY BENElT COSTS WHICH GREW BY PERCENT;= 2ISING COSTS MAKE IT DIFlCULT FOR EMPLOYERS AND EMPLOYEES TO AFFORD HEALTHCARE MUCH LESS FOCUS ON QUALITY IN BENElT DESIGN )N RECENT YEARS THE PERCENTAGE OF WORKERS COVERED BY EMPLOYER SPONSORED HEALTH INSURANCE HAS DECLINED PARTICULARLY FOR SMALL EMPLOYERS "ETWEEN AND THE PERCENTAGE OF WORKERS COVERED BY SMALL EMPLOYERS THREE TO WORKERS DECLINED FROM TO PERCENT -EANWHILE COVERAGE AT LARGE lRMS OR MORE WORKERS HELD STEADY;= ,ARGER COMPANIES
"ARRY "ARNETT IS A PRINCIPAL WITH 0RICEWATERHOUSE#OOPERS AND HAS BEEN WORKING IN THE EMPLOYEE BENElTS HEALTHCARE ARENA FOR YEARS (E HAS A WEALTH OF EXPERIENCE IN WORKING WITH EMPLOYERS TO HELP THEM ESTABLISH THEIR EMPLOYEE HEALTHCARE STRATEGY (E CAN BE REACHED AT BARRYBARNETT USPWCCOM 7ILLIAM 2OSENBERG -(3! IS A DIRECTOR IN 0RICEWATERHOUSE#OOPERS (EALTHCARE PRACTICE 7ITH YEARS OF EXPERIENCE IN PUBLIC HEALTH GROUP HEALTH INSURANCE AND CONSULTING HE ADVISES LARGE EMPLOYERS HEALTH PLANS AND PHARMACEUTICAL COMPANIES (E CAN BE REACHED AT WILLIAMROSENBERG USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
P T@K HSXã@MCãD LOKNXD QãAD MD E HSãOK@MãCD RHFM HAVE THE RESOURCES TO EXPERIMENT WITH NEW BENElT DESIGNS THAT INCREASE QUALITY OF CARE WHILE MAINTAINING OR REDUCING COST LEVELS 4HEY ALSO HAVE THE PURCHASING POWER TO INmUENCE HEALTH PLANS DOCTORS AND HOSPITALS UNLIKE SMALLER COMPANIES THAT LACK THE CLOUT TO INmUENCE THE HEALTHCARE DELIVERY SYSTEM 4O DATE WORKERS HAVE LARGELY BEEN SHIELDED FROM THE COST OF MEDICAL CARE WHICH MAY CONTRIBUTE TO INAPPROPRIATE UTILIZATION )N TERMS OF CONSUMER SPENDING MEDICAL CARE CONSUMED PERCENT OF CONSUMER EXPENDITURES IN n THE EXACT SAME PERCENTAGE AS IN -OREOVER THE PERCENT OF CONSUMER EXPENDITURES ON MEDICAL CARE HAS VARIED LITTLE IN THE INTERIM;= !LTHOUGH HEALTHCARE SPENDING HAS ACCELERATED CONSIDERABLY THE AMOUNT THAT CONSUMERS SPEND RELATIVE TO OTHER ITEMS SUCH AS CARS CLOTHING OR HOUSING HAS INCREASED ABOUT THE SAME AMOUNT IN THEIR BUDGETS 4HE DIFFERENCE HAS BEEN PAID BY EMPLOYERS AND GOVERNMENT
4HE !CTIVATED #ONSUMER "ETTER AND MORE USEFUL CONSUMER INFORMATION IS CRITICAL TO A NEW PUSH TOWARD CONSUMERISM IN HEALTHCARE BENElT DESIGN 4ODAYS FORWARD THINKING COMPANIES ARE CRAFTING PLANS THAT ENCOURAGE EMPLOYEES TO BE BETTER CONSUMERS BY PURCHASING HEALTHCARE AS THEY WOULD OTHER IMPORTANT ITEMS THROUGH IMPROVED AWARENESS AND EDUCATION !LTHOUGH PROPONENTS DIFFER ON THE EXTENT TO WHICH HEALTHCARE CAN WORK LIKE OTHER MARKETS MOST EXPERTS AGREE ON THE DIRECTION OF DESIRABLE CHANGE 0RESIDENT "USH RECENTLY EMPHASIZED THE BENElTS OF BECOMING MORE INVOLVED h0EOPLE ARE ABLE TO SHOP BASED UPON PRICE AND QUALITY IN ALMOST EVERY ASPECT OF OUR LIFE WITH THE EXCEPTION OF HEALTHCAREv;= 3ARA #OLLINS 0H$ SENIOR PROGRAM OFlCER FOR THE 0ROGRAM ON THE &UTURE OF (EALTH )NSURANCE AT 4HE #OMMONWEALTH &UND AND +AREN $AVIS 0H$ PRESIDENT OF 4HE #OMMONWEALTH &UND RECENTLY TESTIlED BEFORE #ONGRESS 4RANSPARENCY AND BETTER PUBLIC INFORMATION ON COST AND QUALITY ARE ESSENTIAL FOR THREE REASONS TO HELP PROVIDERS IMPROVE BY BENCHMARKING THEIR PERFORMANCE AGAINST OTHER PROVIDERS TO ENCOURAGE PRIVATE INSURERS AND PUBLIC PROGRAMS TO REWARD QUALITY AND EFlCIENCY AND TO HELP PATIENTS MAKE INFORMED CHOICES ABOUT THEIR CARE;= #OLLINS AND $AVIS ALSO NOTED THAT hxIT IS UNREASONABLE TO EXPECT THAT INFORMATION ON PRICES TOTAL BILLS TOTAL COSTS TO PATIENTS AND INSURERS AND QUALITY WILL CAUSE THE HEALTHCARE MARKET TO PERFORM LIKE MARKETS FOR OTHER GOODS AND SERVICESv;= 4HIS IS THE CASE FOR A VARIETY OF REASONS INCLUDING FOR EXAMPLE THAT PATIENTS WILL NEVER HAVE THE SAME AMOUNT OF INFORMATION DOCTORS HAVE AND SOME HEALTHCARE DECISIONS ARE MADE UNDER EMERGENCY CONDITIONS 7HILE ONLY MILLION !MERICANS ARE CURRENTLY IN CONSUMER DIRECTED PLANS COMPARED WITH MILLION IN OTHER PRIVATE PLANS MANY INDUSTRY OBSERVERS EXPECT ENROLLMENT IN THESE NEW BENElT DESIGNS TO INCREASE /PPONENTS OF CONSUMER DIRECTED PLANS CLAIM THEY SIMPLY SHIFT COSTS FROM EMPLOYERS TO CONSUMERS 4HERE ARE HOWEVER ADVANTAGES TO INVOLVING EMPLOYEES lNANCIALLY IN MANAGING HEALTHCARE BENElTS !CCORDING TO A LANDMARK STUDY PUBLISHED BY THE 2!.$ #ORP IN THE S PEOPLE WILL CONSUME
MORE HEALTHCARE SERVICES WHEN CARE IS FREE AND FAR LESS WHEN THEY SHARE COSTS;= 0ROBLEMS CAN ARISE WHEN CONSUMERS FAIL TO DISTINGUISH BETWEEN DISCRETIONARY AND NONDISCRETIONARY CARE AS THEY REDUCE THEIR CONSUMPTION OF HEALTHCARE SERVICES &OR THIS REASON CONSUMER DIRECTED PLANS MUST BE CAREFULLY DESIGNED TO ENSURE THAT WORKERS n PARTICULARLY THOSE WITH CHRONIC DISEASE ANDOR LOWER INCOME n DO NOT FOREGO NECESSARY CARE
#REATIVE 0LAN $ESIGNS 0ROGRESSIVE COMPANIES ARE EXPERIMENTING WITH A VARIETY OF PLANS THAT MOTIVATE EMPLOYEES TO BECOME MORE INVOLVED IN MAKING HEALTHCARE CHOICES 4HESE PROGRAMS MIGHT INCLUDE CASH PAYMENTS OR DISCOUNTS ON SERVICES OR PREMIUMS 3OME EMPLOYERS PROVIDE INCENTIVES AND REWARDS FOR HEALTHY BEHAVIORS SUCH AS SMOKING CESSATION NUTRITIONAL COUNSELING AND HEALTH SCREENINGS 4HEIR GOAL IS TO ENCOURAGE EMPLOYEES TO BE MORE RESPONSIBLE FOR THEIR OWN HEALTH /THERS ARE REDUCING OUT OF POCKET COSTS FOR PRESCRIPTION DRUGS FOR CONDITIONS SUCH AS DIABETES SO THAT EMPLOYEES WILL BE MORE LIKELY TO TAKE NEEDED MEDICATIONS AND AVOID EXPENSIVE COMPLICATIONS #OMPANIES ARE EXPERIMENTING WITH BENElT PLAN DESIGNS AND DISEASE MANAGEMENT FOR ASTHMA HYPERTENSION AND MENTAL HEALTH AND DEPRESSION AS WELL
)NCENTIVES AND 0ENALTIES 3OME COMPANIES USE INCENTIVES TO ACTIVATE EMPLOYEES WHILE OTHERS USE PENALTIES FOR EXAMPLE CHARGING SMOKERS HIGHER PREMIUMS THAN NONSMOKERS )NCENTIVE PROGRAMS MIGHT INVOLVE REWARDING EMPLOYEES FOR COMPLETING A HEALTH RISK APPRAISAL AND THEN TAILORING CONDITION MANAGEMENT PROGRAMS AROUND THE RESULTS /R IT MIGHT MEAN CONTRIBUTING EXTRA MONEY TO A HEALTH REIMBURSEMENT ARRANGEMENT (2! BASED ON WHETHER WORKERS REACH CERTAIN GOALS SUCH AS LOSING A SPECIlED AMOUNT OF WEIGHT SUBJECT TO COMPLIANCE WITH ()0!! AND OTHER NONDISCRIMINATION RULES !S THESE PROGRAMS ARE QUITE NEW EMPLOYERS NEED TO ENSURE THEY COMPLY WITH APPLICABLE REGULATIONS AND CONTRACT WITH VENDORS THAT DEMONSTRATE A SUCCESSFUL TRACK RECORD IN ADMINISTRATION 4HE VERY BEST APPROACH TAILORS INCENTIVES THAT lT THE UNIQUE NEEDS OF THE POPULATION AND THE CULTURE OF AN ORGANIZATION 4O BE SUCCESSFUL BOTH INCENTIVE AND PENALTY BASED PROGRAMS NEED TO INFORM EMPLOYEES FULLY ABOUT THEIR RESPONSIBILITIES AND THE POSITIVE OUTCOMES OF PARTICIPATION -ANY COMPANIES ARE USING ONLINE TOOLS TO DISSEMINATE THIS PROGRAM INFORMATION 4HESE TOOLS MAY BE AS SOPHISTICATED AS A COMPANY HEALTHCARE PORTAL OR AS SIMPLE AS REFERRING EMPLOYEES TO AN EXTERNAL WEBSITE /THER COMPANIES USE WELLNESS COACHES OR NURSES TO PROMOTE BEHAVIOR MODIlCATION AND PROVIDE EDUCATION ABOUT DISEASE CONDITIONS 3OME EMPLOYERS ARE ALSO LEVERAGING RESOURCES IN SURROUNDING COMMUNITIES TO AUGMENT EMPLOYEE HEALTH BENElTS &OR EXAMPLE A COMPANY MIGHT PROVIDE AN INCENTIVE FOR STRESSED EMPLOYEES TO TAKE YOGA CLASSES OR mEX TIME TO VISIT A GYM OR GO RUNNING ,ARGE EMPLOYERS IN A CAMPUS SETTING MAY BUILD A lTNESS CENTER FOR EMPLOYEE USE )N THIS WAY HEALTHY BEHAVIORS BECOME PART OF EMPLOYEES LIFESTYLES # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXã@MCãD LOKNXD QãAD MD E HSãOK@MãCD RHFM
4IERED .ETWORKS )N ANOTHER INNOVATIVE BENElT PLAN DESIGN CALLED THE hTIERED NETWORK v HEALTH PLANS SELECT NETWORK PHYSICIANS BASED ON COST EFFECTIVENESS AND CLINICAL QUALITY 4IERED NETWORKS PROVIDE EMPLOYEES WITH lNANCIAL INCENTIVES TO CHOOSE MORE COST EFFECTIVE hHIGH PERFORMINGv DOCTORS AND HOSPITALS /NE OF THE COUNTRYS LARGEST INSURERS LAUNCHED A TIERED NETWORK IN AS A WAY TO CUT EMPLOYER COSTS AND OFFER MEMBERS MORE INFORMATION ABOUT PHYSICIANS AND THE COST OF MEDICAL CARE 4HE HEALTH PLAN CONSIDERS THE PHYSICIANS WHO BELONG TO THE NETWORK AS THE HIGHEST PERFORMERS AMONG THEIR SPECIALIST PEERS BASED ON COST AND QUALITY !N EMPLOYEE COULD CHOOSE FOR EXAMPLE TO SEE A NETWORK SPECIALIST FOR A LOWER CO PAYMENT OR PAY MORE TO SEE A DOCTOR WHO IS STILL IN THE NETWORK BUT NOT PART OF THE PROGRAM 4HE IDEA BEHIND THIS APPROACH IS THAT WORKERS WILL BUY INTO MORE RESTRICTIVE NETWORKS IN EXCHANGE FOR LOWER COSTS;=
(EALTH 3AVINGS !CCOUNTS )N A RECENT 3TATE OF THE 5NION ADDRESS FROM 0RESIDENT "USH HE PROPOSED STRENGTHENING HEALTH SAVINGS ACCOUNTS (3!S TO ENSURE INDIVIDUALS AND SMALL BUSINESS EMPLOYEES ARE ABLE TO BUY INSURANCE WITH THE SAME ADVANTAGES OF PEOPLE WORKING FOR LARGER EMPLOYERS "USH ALSO PROMISED TO DO MORE TO MAKE THIS COVERAGE PORTABLE SO WORKERS CAN SWITCH JOBS WITHOUT HAVING TO WORRY ABOUT LOSING THEIR INSURANCE;= 4HE (3! IS A TAX ADVANTAGED SAVINGS VEHICLE AVAILABLE TO TAXPAYERS TO PAY FOR CURRENT AND FUTURE MEDICAL EXPENSES SUCH AS INSURANCE DEDUCTIBLES AND CO INSURANCE "OTH EMPLOYEES AND EMPLOYERS CAN DEPOSIT FUNDS INTO AN (3! BUT TOTAL DEPOSITS CANNOT EXCEED FEDERAL LIMITS &UNDS NOT USED IN AN (3! CARRY OVER EACH YEAR AND REMAIN IN THE ACCOUNT UNLIKE mEXIBLE SPENDING ACCOUNT &3! BALANCES WHICH REQUIRE EMPLOYEES TO hUSE IT OR LOSE ITv;= ! PERSON MUST BE COVERED BY A QUALIlED HIGH DEDUCTIBLE HEALTH PLAN ($(0 TO BE ELIGIBLE TO MAKE DEPOSITS INTO AN (3! ($(0 PREMIUMS COST LESS THAN PREMIUMS FOR TRADITIONAL COVERAGE PRIMARILY BECAUSE OF THE MUCH HIGHER DEDUCTIBLES (IGH DEDUCTIBLES CAUSE PATIENTS TO THINK TWICE BEFORE SEEKING CARE BECAUSE THE MONEY TO PAY FOR CARE COMES OUT OF THEIR OWN POCKETS 4HINKING TWICE BEFORE GETTING CARE IS ONE STEP TOWARD MAKING HEALTHCARE MORE LIKE THE MARKET FOR OTHER GOODS AND SERVICES (3!S ARE STRICTLY REGULATED BY THE 53 4REASURY AND LACK THE mEXIBILITY OF OTHER TYPES OF CONSUMER DIRECTED HEALTH PLANS 4ODAY INNOVATIVE COMPANIES ARE ALSO OFFERING (2!S WHICH ARE SIMILAR TO (3!S BUT ARE MORE mEXIBLE AND APPEAL TO DIFFERENT TYPES OF EMPLOYERS /NE AREA OF INTEREST IS USING (2!S AS A VEHICLE TO REWARD DESIRED BEHAVIORS &OR EXAMPLE A COMPANY MIGHT REWARD AN EMPLOYEE FOR ENROLLING IN A WEIGHT LOSS OR DISEASE MANAGEMENT PROGRAM BY ADDING MONEY TO AN EMPLOYEES (2! #RITICS CLAIM HOWEVER THAT ($(0S WITH OR WITHOUT (3!S OR (2!S MAY DRIVE UP MEDICAL COSTS BECAUSE PEOPLE FACING A DOCTOR OFlCE VISIT RATHER THAN A CO PAYMENT MAY SKIP THE VISIT ENTIRELY POTENTIALLY SIDESTEPPING NECESSARY CARE BEFORE A DISEASE OR INJURY BECOMES MORE SERIOUS AND COSTLY TO TREAT !S EVIDENCE EMERGES ON THESE ISSUES PLAN SPONSORS ARE RESPONDING BY COVERING PREVENTIVE OR CHRONIC CARE ON A lRST DOLLAR
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
BASIS 5LTIMATELY THE GOAL IS TO PROVIDE INCENTIVES THAT REINFORCE PERSONAL RESPONSIBILITY FOR ONES OWN HEALTH WHILE CONTINUING TO PROVIDE ATTRACTIVE BENElTS
7HAT ,IES !HEAD (EALTHCARE BENElT DESIGN IS CURRENTLY A HOTBED OF CREATIVITY AND INNOVATION )N DESIGNING BENElTS TODAY THE BIGGEST CHALLENGE AHEAD IS BUILDING HIGH QUALITY PLANS THAT REINFORCE BETTER HEALTH BEHAVIORS AND CURB HEALTHCARE COSTS !CTIVATING CONSUMERS OFFERS PROMISE IN CONTROLLING COSTS BY MAKING EMPLOYEES MORE ACCOUNTABLE FOR THE HEALTHCARE DOLLARS THEY SPEND /THER STRATEGIES INCLUDE INCENTIVES ANDOR PENALTIES OFTEN IN COMBINATION WITH (2!S TO ENCOURAGE EMPLOYEE WELLNESS OR PARTICIPATION IN DISEASE MANAGEMENT PROGRAMS 4IERED NETWORKS OFFER AN ADDITIONAL OPTION TO ENCOURAGE COST EFFECTIVENESS AND QUALITY OF PHYSICIANS AND HOSPITALS )N THE PAST COMPANIES WERE RELUCTANT TO PUSH THE ENVELOPE ON QUALITY BENElT PLANS BECAUSE THEY DID NOT WANT TO INTERFERE WITH PERSONAL HEALTH DECISIONS (OWEVER RISING HEALTHCARE COSTS HAVE CAUSED TODAYS LEADING EMPLOYERS TO EXPLORE NEW BENElT PLAN DESIGNS THAT PROMOTE AN INVOLVED HEALTHY WORKFORCE %NCOURAGING EMPLOYEE INVOLVEMENT IN SUPPORT PROGRAMS AND CREATING A SHARED INTEREST IN VALUE BASED CONSUMPTION VARIES ACROSS EMPLOYERS AND IS A WORK IN PROGRESS (OWEVER ONE THING IS CERTAIN -UCH EXCITEMENT IN EXPERIMENTATION AND INNOVATION LIES AHEAD %NDNOTES h4HE #HASM IN 1UALITY 3ELECT )NDICATORS FROM 2ECENT 2EPORTS v )NSTITUTE OF -EDICINE HTTPWWWIOMEDU ID "ERENES - * h.URSING -ISTAKES +ILL )NJURE 4HOUSANDS v 3EPTEMBER 4HE #HICAGO 4RIBUNE HTTPWWWCHICAGOTRIBUNECOMNEWS SPECIALSCHI NURSING STORY CTRACK CSET TRUE h%MPLOYEE #OMPENSATION %MPLOYER 3PENDING ON "ENElTS (AS 'ROWN &ASTER 4HAN 7AGES $UE ,ARGELY TO 2ISING #OSTS FOR (EALTH )NSURANCE AND 2ETIREMENT "ENElTS v &EBRUARY 5NITED 3TATES 'OVERNMENT !CCOUNTABILITY /FlCE 2EPORT TO #ONGRESSIONAL 2EQUESTERS HTTPWWWGAOGOVHIGHLIGHTSDHIGHPDF h%MPLOYER (EALTH "ENElTS !NNUAL 3URVEY v 4HE +AISER &AMILY &OUNDATION AND (EALTH 2ESEARCH AND %DUCATIONAL 4RUST 3EPTEMBER P HTTPWWWKFFORGINSURANCEUPLOADPDF 0EAR 2 h!-! TO $EVELOP -EASURE OF 1UALITY OF -EDICAL #ARE n 0ACT 7ITH #ONGRESS (AS -EDICARE ,INK v &EBRUARY 4HE .EW 9ORK 4IMES 0RICEWATERHOUSE#OOPERS h"EHIND THE .UMBERS n -EDICAL #OST 4RENDS FOR v /CTOBER ANALYSIS BASED ON #ONSUMER %XPENDITURE $ATA n "UREAU OF ,ABOR AND 3TATISTICS AND .ATIONAL (EALTH %XPENDITURE $ATA n #ENSUS "UREAU AVAILABLE AT WWWPWCCOMHEALTHCARE #OLLINS 32 AND + $AVIS h4RANSPARENCY IN (EALTH #ARE 4HE 4IME HAS #OME )NVITED 4ESTIMONY %NERGY AND #OMMERCE #OMMITTEE v -ARCH 3UBCOMMITTEE ON (EALTH 53 (OUSE OF 2EPRESENTATIVES (EARING ON h7HATS THE #OST 0ROPOSALS TO 0ROVIDE #ONSUMERS WITH "ETTER )NFORMATION !BOUT (EALTHCARE 3ERVICE #OSTS v P AVAILABLE AT WWWCMWFORG )BID P +EELER % " h%FFECTS OF #OST 3HARING ON 5SE OF -EDICAL 3ERVICES AND (EALTH v 3UMMER *OURNAL OF -EDICAL 0RACTICE -ANAGEMENT PP 4HOMAS 3 , h!ETNA TO 2ANK 3PECIALISTS BY #OST 1UALITY v !UGUST %AST "AY "USINESS 4IMES HTTPWWWBIZJOURNALSCOM EASTBAYSTORIESSTORYHTML #OCHEO 3 h#AN (3!S ADD !PPLES TO THE 5SUAL $EPOSIT 0IE v !"! "ANKING *OURNAL PP
1! (OW #ORPORATE !MERICA #AN (ELP ,IFT #LINICAL 0ERFORMANCE ! $ISCUSSION 7ITH !RNIE -ILSTEIN AND "OB 'ALVIN %MPLOYERS ARE NOT ALWAYS THE lRST THING TO COME TO MIND WHEN DISCUSSING CLINICAL PERFORMANCE BUT CERTAIN EMPLOYERS HAVE DEVOTED SUBSTANTIAL RESOURCES TO THIS ISSUE !S A RESULT THEY HAVE MADE NATIONAL HEADLINES AND MAJOR STRIDES IN FOCUSING THE DEBATE ON HOW TO MEASURE AND PAY FOR HIGH QUALITY AND EFlCIENT CARE 4O DISCUSS HOW EMPLOYERS CAN INmUENCE HEALTHCARE PERFORMANCE TODAY AND IN THE FUTURE 0RICEWATERHOUSE#OOPERS INTERVIEWED TWO OF THE MOST INmUENTIAL CORPORATE LEADERS ON THIS TOPIC !RNIE -ILSTEIN -$ -0( IS MEDICAL DIRECTOR AT THE 0ACIlC "USINESS 'ROUP ON (EALTH A 3AN &RANCISCO BASED BUSINESS COALITION OF OF #ALIFORNIAS LARGEST EMPLOYERS ! FOUNDING BOARD MEMBER OF 4HE ,EAPFROG 'ROUP HE IS ALSO A -%$0!# COMMISSIONER AND CHIEF PHYSICIAN AT -ERCER (EALTH "ENElTS ! .EW %NGLAND *OURNAL OF -EDICINE ARTICLE ON PRIVATE HEALTH INSURANCE DESCRIBED HIM AS A hPIONEERv IN EMPLOYER EFFORTS TO ADVANCE QUALITY "OB 'ALVIN -$ IS DIRECTOR OF GLOBAL HEALTH AT 'ENERAL %LECTRIC '% '% WAS A FOUNDING MEMBER OF BOTH 4HE ,EAPFROG 'ROUP AND "RIDGES 4O %XCELLENCE TWO EMPLOYER LED EFFORTS DESIGNED TO IMPROVE QUALITY AND SAFETY IN HEALTHCARE 'ALVIN IS ALSO DIRECTOR OF HEALTHCARE VALUE INITIATIVES FOR THE (EALTH #ARE 0OLICY 2OUNDTABLE OF THE (2 0OLICY !SSOCIATION 4HE ASSOCIATION REPRESENTS CHIEF HUMAN RESOURCE OFlCERS OF MORE THAN LARGE EMPLOYERS AND THE ROUNDTABLE WAS FORMED SPECIlCALLY TO FOCUS ON HEALTHCARE COST AND QUALITY ISSUES 0RICEWATERHOUSE#OOPERS 7HAT DO YOU THINK ABOUT THE CURRENT STATE OF QUALITY IN THE 53 HEALTHCARE INDUSTRY "OB 'ALVIN 7E HAVE A BETTER SENSE OF QUALITY THAN IN THE PAST BECAUSE THERE ARE MORE METRICS AVAILABLE ) THINK THERES A GROWING COMFORT AMONG ALL SECTORS THAT YOU CAN ACTUALLY MEASURE THIS STUFF 4HAT ALL BEING SAID THE LEVEL OF QUALITY AND ) INCLUDE EFlCIENCY AS PART OF QUALITY IS FAR FAR BELOW WHERE IT SHOULD BE AND IMPROVING IT REPRESENTS A MAJOR OPPORTUNITY TO MAKE CARE MORE AFFORDABLE !RNIE -ILSTEIN &RAMED IN INDUSTRIAL TERMS !MERICAN HEALTHCARE QUALITY RELIABILITY STANDS AT TO 3IGMA )N ANY GIVEN INTERACTION IN THE HEALTHCARE SYSTEM THE CHANCE THAT YOULL GET EVIDENCE BASED TREATMENT AND WONT BE EXPOSED TO AN IMPLEMENTATION ERROR IS ROUGHLY PERCENT 0W# )S THERE ANY MOVEMENT TOWARD IMPROVING THIS !- 9ES HOWEVER THE RATE OF ASCENT IS VERY SLOW 4HE CURRENT IMPLICIT STRATEGY IS TO IMPROVE A VERY SHORT LIST OF PERFORMANCE MEASURES THAT MIGHT CONSTITUTE PERCENT OF WHAT WED NEED TO ATTAIN RELIABLE QUALITY OF CARE 7E NEED A SOLUTION THAT IS
BETTER SCALED TO THE MAGNITUDE OF THE PROBLEM MOVES QUICKLY TO RISK ADJUSTED OUTCOME MEASURES AND ADDRESSES STRUCTURAL NECESSITIES LIKE ROUTINE USE OF INDUSTRIAL ENGINEERS AND INTEROPERABLE ELECTRONIC HEALTH RECORDS WITH ROBUST DECISION SUPPORT FUNCTIONALITY 0W# 7HAT IS THE ROLE OF EMPLOYERS IN ENHANCING QUALITY "' %MPLOYERS HAVE TWO ROLES 4HE BIGGEST IS THAT SINCE THEYRE MAJOR PURCHASERS OF HEALTHCARE THEY CAN HELP SEND MESSAGES TO THE MARKET &OR EXAMPLE EMPLOYERS COULD ONLY CONTRACT WITH HEALTH PLANS THAT ARE DRIVING QUALITY BY USING INCENTIVES INFORMATION AND CHOICE 3ECONDLY THERES A COMMITMENT TO KEEPING EMPLOYEES HEALTHIER ) DOUBT WHETHER THIS WILL IMPACT HEALTHCARE COSTS BUT ITS IMPORTANT TO HAVE A MORE PRODUCTIVE WORKPLACE !LTHOUGH THERES A LOT GOING ON MOST EMPLOYEES ARE NOT CHANGING THEIR BEHAVIOR YET %MPLOYERS FAILURE TO FULLY EXERT THEIR POWER IS A MAJOR REASON FOR THE PROBLEMS THE HEALTHCARE SYSTEM IS IN TODAY ! WEAK BUY SIDE IN A COMPETITIVE SYSTEM IS A RECIPE FOR UNDER PERFORMANCE 4HERE ARE MANY REASONS FOR THIS FAILURE n SENIOR
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! MANAGEMENT AMBIVALENCE ABOUT TACKLING A COMPLEX TOPIC WITHOUT A SHORT TERM RETURN INADEQUATE RESOURCES IN THE BENElT DEPARTMENTS A LACK OF INTEREST IN ANYTHING OUTSIDE OF CORE PRODUCTS ETC ,ARGE EMPLOYERS CAN BE CATALYSTS BUT THEY NEED TO DO IT SO THAT THEY CAN LEVERAGE HEALTH PLANS AND THEN HAVE -EDICARE FOLLOW THE ;BEST= PRACTICES #HANGING CONSUMER BEHAVIOR IS A LONG TERM PROCESS BUT EMPLOYERS NEED TO ACT WITH A SENSE OF URGENCY IN THE SHORT TERM
)N COMPETITIVE INDUSTRIES THE SPOILS GO TO THE CUSTOMER AND THE PERFORMANCE LEADERS (OWEVER POORLY PERFORMING !MERICAN PHYSICIANS ARE NOT PREPARED TO ACCEPT THE PAIN EXPERIENCED BY POORLY PERFORMING AIRLINES OR CAR MAKERS !- 4HE MAJORITY ARE ON THE SIDELINES !CTIVE STRATEGIC EMPLOYERS ARE USING THREE TOOLS PERFORMANCE TRANSPARENCY AMONG PHYSICIANS AND HOSPITALS TIERED OR NARROW PROVIDER NETWORKS AND ZERO SUM RElNEMENTS OF THE PHYSICIAN PAYMENT SYSTEM SO THAT BETTER PERFORMANCE IS BETTER PAID WITHOUT ACCELERATING AMBIENT -$ INCOME GROWTH RATES 4RANSPARENCY IS SIMPLEST AND IT SHOULD BE THE lRST STEP 4IERED OR NARROW NETWORKS CAN BE DONE FOR EMPLOYERS BY HEALTH PLANS AND DOESNT REQUIRE COOPERATION FROM PROVIDERS 7ORKERS IN LOWER WAGE INDUSTRIES ARE MORE WILLING TO RESTRICT ACCESS TO A NARROWER NETWORK OF PROVIDERS IN EXCHANGE FOR MORE AFFORDABLE PREMIUMS AND POINT OF SERVICE COSTS !LTERED PHYSICIAN PAYMENT SYSTEMS ARE MORE DIFlCULT BECAUSE THEY REQUIRE PHYSICIAN CONSENSUS AND SIGNIlCANT ADMINISTRATIVE COMPLEXITY 7HAT IS A FAIR DIVISION OF THE SPOILS OF IMPROVED CLINICAL EFlCIENCY )N COMPETITIVE INDUSTRIES THE SPOILS GO TO THE CUSTOMER AND THE PERFORMANCE LEADERS (OWEVER POORLY PERFORMING !MERICAN PHYSICIANS ARE NOT PREPARED TO ACCEPT THE PAIN EXPERIENCED BY POORLY PERFORMING AIRLINES OR CAR MAKERS 0W# 7HAT IMPACT DO UNIONS HAVE "' )N THE INDUSTRIES IN WHICH THEY HAVE A LARGE PRESENCE THEY HAVE A LOT OF POTENTIAL TO EFFECT CHANGE )N GENERAL THOUGH UNIONS LOOK AT BENElTS AS A COMPENSATION ISSUE AND NOT FROM THE PERSPECTIVE OF WHAT THEYRE GETTING FROM THEIR DOLLARS WITH RESPECT TO QUALITY (OWEVER FOR THE 53 WORKFORCE AS A WHOLE FOR EVERY UNIONIZED PERSON THERE ARE NINE WHO ARE NOT 0W# %XECUTIVES INTERVIEWED IN A RECENT 0W# "AROM ETER SURVEY SEE A STRONG LINK BETWEEN THEIR COMPANIES HEALTH PLANS EMPLOYEE HEALTH STATUS AND EMPLOYEE PRODUCTIVITY 7HAT ARE YOUR VIEWS REGARDING THIS lNDING "' (EALTHIER EMPLOYEES ARE MORE PRODUCTIVE WITHOUT A DOUBT 4O THE EXTENT THAT THE COMPANYS BENElTS AND HEALTH PLANS FOCUS ON MANAGING DISEASE BETTER AND KEEPING PEOPLE HEALTHY THERE
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
IS A CLEAR LINK ) DO THINK HOWEVER THAT MOST DATA SHOW THAT EMPLOYERS ARE JUST PART OF A MUCH LARGER PUBLIC HEALTH EFFORT WHICH DRIVES IMPROVEMENTS IN POPULATION HEALTH ) THINK EMPLOYERS MAY BE OVERLY OPTIMISTIC ABOUT THEIR ABILITY TO IMPACT LIFESTYLE CHOICES "EHAVIORS ARE NOT EASY TO CHANGE ITS NOT EASY TO GET SOMEONE TO LOSE WEIGHT OR QUIT SMOKING 0LUS IF YOU LOOK CLOSELY AT THE DATA STRESS IS THE MAJOR FACTOR DRIVING PRODUCTIVITY LOSS AND IT IS HARDEST TO MANAGE THIS 4HE VAST NUMBER OF THE STUDIES ON THIS ISSUE n MANY OF WHICH ARE METHODOLOGICALLY DISAPPOINTING n ARE DONE BY COMPANIES SELLING PRODUCTS OR BY ENTHUSIASTS ,IFESTYLE BEHAVIORS CONTRIBUTE TO HEALTHCARE COSTS BUT THE QUESTION IS n WHAT IS THE EMPLOYERS ROLE HERE !- )TS AN IMPORTANT OBSERVATION )T SIGNALS THE FACT THAT CURRENT BENElT PLANS ARE MANAGED WITH AN OVERLY NARROW DASHBOARD )TS OBVIOUS ON ITS FACE THAT MAKING DECISIONS ON HEALTH BENElTS WITHOUT REGARD TO THE IMPACT ON EMPLOYEE HEALTH STATUS PRODUCTIVITY OR SATISFACTION IS NOT DEFENSIBLE OR IN SHAREHOLDERS INTERESTS .EVERTHELESS ITS OFTEN THE CASE !S (2 INFORMATION SYSTEMS ARE IMPROVED SO THAT EMPLOYERS CAN MORE EASILY SEE THE LINK BETWEEN HEALTH BENElTS PLANS EMPLOYEE HEALTH AND WORKFORCE CONTRIBUTION TO ENTERPRISE PROlTABILITY THIS WILL CHANGE 2IGHT NOW THE LINKS ARE TOO THEORETICAL TO ENGAGE MOST EMPLOYERS 0W# )N 0W#S SURVEY HEALTHCARE WAS RANKED LAST AMONG SEVERAL INDUSTRIES BEHIND CARS COLLEGES ELEC TRONICS AND HOTELS AS PROVIDING THE BEST DATA FOR CON SUMERS TO MAKE DECISIONS 7HATgS YOUR OPINION ON THIS "' ) AGREE /NE OF THE BIGGEST NEEDS WE HAVE IS TO PROVIDE INFORMATION AND MEET THE CONSUMERS WHERE THEY ARE 4O HELP THIS EMPLOYERS SHOULD CREATE A hNEW ,EAPFROGv BASED ON MEANINGFUL INFORMATION FOR CONSUMERS 7E DONT HAVE ANYONE LIKE ;PERSONAL lNANCE EXPERT= 3UZE /RMAN AND ITS BECOMING CLEARER THAT PEOPLE NEED A PERSONAL TOUCH WHEN IT COMES TO HEALTHCARE DECISIONS 4HERE ARE A SMALL NUMBER OF PEOPLE WHO MAKE DECISIONS BASED ON INFORMATION GATHERED THROUGH THE )NTERNET MOST OTHERS RELY ON THEIR DOCTORS 4HE NEXT STEP ONCE WEVE DEVELOPED CONSUMER FRIENDLY INFORMATION IS TO INCENTIVIZE PEOPLE TO USE IT 5NLESS WE TIE THE USE OF THIS INFORMATION TO SPECIlC lNANCIAL INCENTIVES AS IS THE CASE IN THE INDUSTRIES YOU MENTIONED IN YOUR QUESTION WE WONT SEE THE TYPE OF USAGE THAT WILL CHANGE THE SYSTEM !- )TS CORRECT )N ADDITION TO MORE PERFORMANCE MEASUREMENTS WE NEED MORE EMPHASIS ON ACTIVE CONSUMER DECISION SUPPORT TO USE THE MEASURES SUCCESSFULLY 4HE MAJORITY OF TODAYS PERFORMANCE MEASUREMENTS ARE ON WEBSITES THAT MOST PEOPLE DONT USE #ONSUMERS NEED MORE HELP &OR EXAMPLE ONE NATIONAL HEALTH PLAN HAS A TELEPHONE ROBOT THAT IS CONTINUOUSLY SCANNING 0"- INFORMATION TO IDENTIFY ENROLLEES WHO CAN SWITCH TO DRUGS THAT WILL COST THEM LESS )T CALLS SUCH ENROLLEES TELLS THEM WHAT THEY COULD SAVE AND SHOWS THEM HOW TO GO TO THE WEBSITE TO INITIATE CHANGE 4HE OPPORTUNITY COMES TO THEM 4HIS SYSTEM COULD BE EXPANDED TO SUPPORT EASIER SWITCHES TO BETTER PERFORMING PROVIDERS OR LINKAGE TO SELF MANAGEMENT RESOURCES #ONSUMERS NEED MORE HELP (EALTHCARE IS COMPLICATED
1! %MPLOYERS DONT HAVE THAT MUCH IMPACT IF THEY JUST FOCUS ON THEIR SPECIFIC POPU LATIONS BUT THEY CAN BE VERY EFFECTIVE CATALYSTS DRIVING CHANGE THROUGH THE HEALTH PLANS WITH WHOM THEY CONTRACT AND ULTIMATELY -EDICARE 0W# 7HAT WILL THE STATE OF QUALITY BE IN THREE TO lVE YEARS "' )T DEPENDS &OR EVERY COMPANY THAT IS PROGRESSIVE IN THIS AREA THERE ARE MANY MORE THAT ARE hASLEEP AT THE WHEELv -Y SENSE IS THAT THERE WILL BE SOME GAINS IN SOME AREAS BUT THE PACE OF INNOVATION AND COMPLEXITY IS SO FAST IN MEDICINE THAT ) FEAR WE WILL FALL BEHIND %MPLOYERS DONT HAVE THAT MUCH IMPACT IF THEY JUST FOCUS ON THEIR SPECIlC POPULATIONS BUT THEY CAN BE VERY EFFECTIVE CATALYSTS DRIVING CHANGE THROUGH THE HEALTH PLANS WITH WHOM THEY CONTRACT AND ULTIMATELY -EDICARE !- 4HERE WILL BE MODERATE IMPROVEMENT ON A SMALL SUBSET OF QUALITY MEASURES ! FEW ADVANCED PROVIDERS WILL BEGIN TO BREAK AWAY FROM THE PACK VIA )4 INVESTMENTS AND INDUSTRIAL ENGINEERING ASSISTANCE 4HEYLL DEMONSTRATE QUALITY AND COST IMPROVEMENTS THAT ARE hOFF THE CHARTv -UCH DEPENDS ON WHAT -EDICARE DOES BECAUSE THERE ARE UNDERAPPRECIATED SYNERGIES BETWEEN -EDICARE AND THE PRIVATE SECTOR 4HE PRIVATE SECTOR HAS MORE
mEXIBILITY 7HEN EXEMPLARY BOLDER ADVANCES BY THE PRIVATE SECTOR GET RESULTS THEY SURFACE WITHIN #-3 AND #ONGRESS AND AFFECT -EDICARE POLICY 0RIVATE SECTOR LEADERS BOOST THE GOVERNMENTS POLITICAL COURAGE TO MAKE CHANGES 3UBSEQUENT -EDICARE ADVANCES THEN HELP ENABLE FURTHER PRIVATE SECTOR ADVANCES 0W# (OW CAN EMPLOYERS WORK WITH OTHER SECTORS OF THE INDUSTRY "' 7HEN PURCHASERS AND PROVIDERS WORK IN COLLABORATION IT HAS A BIG IMPACT )4 ADOPTION COULD MAKE THE BIGGEST IMPACT ON QUALITY IN THE NEXT SEVERAL YEARS %VEN THOUGH IT WOULD COST A LOT THERES A STRONG 2/) 4HE EXECUTIVE BRANCH HAS SHOWN REAL LEADERSHIP IN PUSHING FOR INTEROPERABILITY AND REGIONAL HEALTH INFORMATION ORGANIZATIONS 2()/S (OWEVER THE lNANCING PROBLEM STILL HASNT BEEN CRACKED AND IT WILL BE THE BIG BARRIER /NE WAY EMPLOYERS COULD HELP IS BY PRESSURING HEALTH PLANS TO DIRECT PERFORMANCE BONUSES AROUND )4 !- 'EOGRAPHICALLY CONCENTRATED EMPLOYERS CAN BEGIN TO BUILD CLOSER BUSINESS PARTNERSHIPS WITH PHYSICIANS AND HOSPITALS WHO ARE READY TO ENGAGE IN MAJOR )4 ENABLED CLINICAL PROCESS REDESIGN !LL EMPLOYERS CAN AND SHOULD USE MORE 7ASHINGTON $# POLITICAL CAPITAL TO ENCOURAGE #ONGRESS AND THE ADMINISTRATION TO TRANSFORM -EDICARE INTO A LEADER IN PROVIDER PERFORMANCE TRANSPARENCY AND PERFORMANCE SENSITIVE PROVIDER SELECTION AND PAYMENT .EITHER -EDICARE NOR THE PRIVATE SECTOR IS STRONG ENOUGH TO CATALYZE HEALTH INDUSTRY TRANSFORMATION ALONE n
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
%MPLOYERS 5SE OF (EALTHCARE 1UALITY $ATA ! CORPORATE WELLNESS STRATEGY THAT PROVIDES EMPLOYEES WITH BETTER HEALTHCARE QUALITY DATA EDUCATION AND INCENTIVES CAN ADVANCE EXECUTIVE GOALS OF INCREASED WORKPLACE PRODUCTIVITY AND REDUCED HEALTH BENElT COSTS
"Y "ENJAMIN )SGUR AND #HRISTOPHER +USCHEL 0RICEWATERHOUSE#OOPERS
!
OF GLOBAL HEALTH AT 'ENERAL %LECTRIC NOTES THAT h7E ;EMPLOYERS= T A TIME WHEN THE NATION FACES DETERIORATING HEALTH FROM HAVE A BETTER SENSE OF QUALITY THAN IN THE PAST BECAUSE THERE ARE OBESITY AND OTHER BEHAVIORAL ISSUES ALMOST ONE IN lVE MORE METRICS AVAILABLE ) THINK THERES A GROWING COMFORT AMONG EXECUTIVES SAY THE HEALTH STATUS OF THEIR WORKFORCE HAS IMPROVED ALL SECTORS THAT YOU CAN ACTUALLY MEASURE THIS STUFFv ! GROWING OVER THE PAST TWO YEARS 4HIS IS ONE OF THE MORE REMARKABLE RESULTS NUMBER OF COMPANIES IS CONSIDERING OR OFFERING THEIR EMPLOYEES OF THE SURVEY BY THE 0RICEWATERHOUSE#OOPERS -ANAGEMENT INFORMATION ON HEALTHCARE QUALITY "AROMETER AND THE lRMS (EALTH 2ESEARCH )NSTITUTE (OW COULD SUCH IMPROVEMENT BE ACHIEVED !CCORDING TO THE SURVEY A MAJORITY OF THOSE EMPLOYERS REPORTING HEALTHIER EMPLOYEES 7HAT )S "EING $ONE OFFERED EMPLOYEE PROGRAMS OR INCENTIVES FOR A HEALTHY LIFESTYLE %MPLOYERS HAVE MIXED THOUGHTS ABOUT THEIR HEALTHCARE QUALITY AND PROVIDED INFORMATION ON HEALTHCARE 4HIS TWO PRONGED DATA 7HEN ASKED IF THEY BELIEVE THEIR PRESENT QUALITY DATA IS APPROACH n OF PROVIDING INCENTIVES AND INFORMATION n IS BECOMING RELIABLE EASY TO ACCESS INTERPRET AND ACT ON THE MOST FREQUENT PART OF A CORPORATE WELLNESS STRATEGY )N FACT TWO THIRDS OF EXECUTIVES SURVEYED BELIEVE THAT THE DESIGN OF THEIR $ESPITE THE IMPORTANCE OF THE INDUSTRY HEALTHCARE RANKED LAST COMPANIES HEALTH BENElT PLANS HAS A CONNECTION %XHIBIT IN HAVING GOOD QUALITY DATA FOR CONSUMERS TO THE OVERALL HEALTH STATUS OF THEIR EMPLOYEES 4HESE lNDINGS ARE BASED ON A SURVEY OF 7HICH INDUSTRIES DO COMPANIES VIEW AS HAVING GOOD QUALITY TOP EXECUTIVES AT LARGE 53 BASED MULTINATIONAL DATA THAT HELP CONSUMERS MAKE RELIABLE DECISIONS COMPANIES RELEASED BY 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER AND THE lRMS (EALTH 2ESEARCH )NSTITUTE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER IS A QUARTERLY SURVEY OF TOP EXECUTIVES IN LARGE 53 BASED MULTI NATIONAL BUSINESSES 4HE NEED FOR GOOD DATA ON QUALITY IN HEALTHCARE WAS A STRONG THEME IN THE SURVEY )F EMPLOYEES NEED TO BE RESPONSIBLE CONSUMERS THEY NEED GOOD INFORMATION (OWEVER EMPLOYERS SAID THAT OTHER INDUSTRIES ARE MUCH BETTER THAN HEALTHCARE IN PROVIDING QUALITY DATA SEE %XHIBIT 4HE !UTO #ONSUMER #OLLEGES (OTELS (EALTHCARE ELECTRONICS 5NIVERSITIES RESTAURANTS HEALTHCARE INDUSTRY RANKED LAST AMONG lVE OTHER INDUSTRIES FOR PROVIDING GOOD QUALITY DATA 3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY 4HE IMPORTANCE OF QUALITY DATA IS GROWING AMONG EMPLOYERS 2OBERT 'ALVIN -$ DIRECTOR
"ENJAMIN )SGUR -0!FF IS THE ASSISTANT DIRECTOR OF 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE (E FOCUSES ON THE DEVELOP MENT OF THOUGHT LEADERSHIP AND RESEARCH INITIATIVES FOR THE lRM AND CLIENTS (E CAN BE REACHED AT BENJAMINISGUR USPWCCOM #HRISTOPHER +USCHEL -! IS AN ASSOCIATE WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E RECEIVED A "! FROM "RANDEIS 5NIVERSITY IN IN ECONOMICS AND AN -! IN INTERNATIONAL ECONOMICS AND lNANCE FROM THE "RANDEIS )NTERNATIONAL "USINESS 3CHOOL IN (E CAN BE REACHED AT CHRISTOPHERMKUSCHEL USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
DLO KNXDQR ãT RD ãNE ãGD @KSGB@QD ãPT @KHSXãC@S@ %XHIBIT $O COMPANIES BELIEVE THEIR PRESENT QUALITY DATA IS RELIABLE EASY TO ACCESS INTERPRET AND ACT ON
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
%XHIBIT %MPLOYERS SEE A STRONG CORRELATION BETWEEN HEALTHCARE BENElT DESIGN EMPLOYEE HEALTH STATUS AND EMPLOYEE PRODUCTIVITY 0ERCENTAGE THAT BELIEVES THEIR COMPANIES HEALTHCARE BENElT DESIGN CONNECTS TO OVERALL EMPLOYEE HEALTH STATUS
0ERCENTAGE THAT BELIEVES THEIR EMPLOYEES HEALTH STATUS CONNECTS TO EMPLOYEE PRODUCTIVITY
9ES A GREAT DEAL OR SOMEWHAT -AY OR MAY NOT .O NO CONNECTION
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
ANSWER WAS hA MIXED BAGv SEE %XHIBIT /N THE POSITIVE SIDE MORE EXECUTIVES ANSWERED hYESv THAN hNOv VERSUS PERCENT 4HIS IS AN AREA THAT SOME EMPLOYERS ARE EXPLOITING WITH GREAT SUCCESS &OR EXAMPLE MANY COMPANIES ARE STARTING TO UTILIZE QUALITY DATA TO IDENTIFY HEALTH ISSUES THAT ARE SIGNIlCANT TO THEIR EMPLOYEES WHICH IN TURN HELP TO TARGET APPROPRIATE MEASURES AND PROGRAMS TO COMBAT THESE ISSUES 4HROUGH THIS AND OTHER INNOVATIVE PROGRAMS THE COMPANIES MAY BE ABLE TO DRASTICALLY REDUCE THE INmATIONARY COSTS OF HEALTHCARE PER WORKER !CCORDING TO THE SURVEY THE CORRELATION BETWEEN HEALTHCARE BENElT DESIGN EMPLOYEE HEALTH STATUS AND EMPLOYEE PRODUCTIVITY IS STRONG 3EVENTY SIX PERCENT OF RESPONDENTS AGREED THAT THEIR EMPLOYEES HEALTH STATUS CONNECTS TO EMPLOYEE PRODUCTIVITY 7HILE THIS MAKES INTUITIVE SENSE WHAT IS MORE STRIKING IS THAT ALMOST TWO THIRDS OF EMPLOYERS ALSO BELIEVE THAT THEIR COMPANIES HEALTHCARE BENElT DESIGN PLANS CONNECT TO OVERALL EMPLOYEE HEALTH STATUS INCLUDING PERCENT WHO SEE A GREAT CONNECTION AND PERCENT WHO SEE A PARTIAL ONE /NLY PERCENT BELIEVE THERE IS NO CONNECTION SEE %XHIBIT ! STRONG MAJORITY PERCENT OF EMPLOYERS SURVEYED CLAIM TO PROVIDE CHOICES IN HEALTH PLANS &URTHERMORE ALMOST A QUARTER EXPECT TO GIVE EMPLOYEES MORE CHOICES OVER THE NEXT TO MONTHS 2EGARDING THE TYPES OF CHOICES OFFERED PERCENT PROVIDE OPTIONS WITH DIFFERENT COST AND COVERAGE OPTIONS ALLOWING EMPLOYEES TO BETTER lND A PROGRAM THAT MEETS THEIR SPECIlC NEEDS AND BUDGET LIMITATIONS /VER PERCENT PROVIDE CHOICES WITH HEALTH SAVINGS ACCOUNTS AND MORE THAN HALF OFFER CHOICES FROM DIFFERENT INSURANCE COMPANIES !N ADDITIONAL PERCENT OFFER OTHER CHOICES AS WELL SEE %XHIBIT 4HE POSITIVE NEWS FROM EMPLOYERS RECOGNIZING THE UPSIDES OF HAVING STRONG BENElTS PLANS AND TRANSPARENT DATA NEEDS TO BE TEMPERED BY OTHER ANSWERS TO THE SURVEY &OR EXAMPLE FOR THOSE COMPANIES THAT PROVIDE PROGRAMS AND INCENTIVES TO MAINTAIN WELLNESS MORE THAN HALF DESCRIBED THE PROGRAMS AND INCENTIVES THEY OFFER TO EMPLOYEES AS MODERATE TO AVERAGE AND OVER A QUARTER DESCRIBE THEIR PROGRAMS AS LIMITED #OST REMAINS THE MOST IMPORTANT FACTOR IN DESIGNING EMPLOYEE BENElT PLANS ACCORDING TO THE SURVEY SEE %XHIBIT (OWEVER NEARLY PERCENT OF EMPLOYERS RANKED hCLINICAL OUTCOMESv AS IMPORTANT A SIGN THAT THEYRE LOOKING FOR VALUE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
DLO KNXDQR ãT RD ãNE ãGD @KSGB@QD ãPT @KHSXãC@S@ FROM HEALTHCARE SPENDING "Y TAKING INTO ACCOUNT OTHER MEASURES SUCH AS THE AVAILABILITY OF HEALTHCARE QUALITY DATA CURRENTLY PERCENT CONSIDER THIS A PRIORITY COMPANIES MAY BE ABLE TO REDUCE COSTS THROUGH IMPROVING EMPLOYEE HEALTH h4HERE IS AN IMPORTANT DISCONNECT BETWEEN THE MEASURES USED TO EVALUATE BENElTS PROGRAMS AND THOSE USED BY #&/S FOR lNANCIAL PERFORMANCE v NOTES $R 4HOMAS 0ARRY PRESIDENT OF )") h"Y THEIR NATURE lNANCIAL EXECUTIVES RESPOND TO THE NUMBERS 5NTIL BENElTS MANAGERS EXPRESS PROGRAM PERFORMANCE IN lNANCIAL TERMS FEW #&/S WILL UNDERSTAND THE FULL CONTRIBUTION OF MANAGING HEALTHCARE FOR ABSENCE AND DISABILITY MANAGEMENT DISEASE MANAGEMENT AND WELLNESS PROGRAMS TO THE BOTTOM LINEv;= !ND WHAT IS THE TYPE OF HEALTHCARE QUALITY DATA THAT COMPANIES VIEW AS IMPORTANT !CCORDING TO THE SURVEY APPROXIMATELY THREE QUARTERS OF RESPONDENTS VIEWED DRUGS AS IMPORTANT FOLLOWED BY HEALTH SYSTEMS AT PERCENT )NDIVIDUAL HOSPITALS INDIVIDUAL PHYSICIANS AND MEDICAL DEVICES COMPLETED THE SURVEY ANSWERS PERCENT PERCENT AND PERCENT RESPECTIVELY SEE %XHIBIT 2ECOGNIZING THE IMPORTANCE OF DATA ABOUT PERCENT OF RESPONDENTS ARE CONSIDERING INCREASING THE QUALITY AND SCOPE OF HEALTHCARE DATA THAT THEY ACQUIRE FOR INTERNAL USE AND FOR THEIR EMPLOYEES 4HIS IS AN AREA THAT HAS ROOM FOR IMPROVEMENT *UST SHY OF PERCENT OF COMPANIES ARE PROVIDING HEALTHCARE DATA TO EMPLOYEES /F THOSE THAT DO PERCENT TRACK HOW SATISlED THEIR EMPLOYEES ARE WITH THAT DATA SEE %XHIBIT
2ECOMMENDATIONS AND #ONCLUSION "Y MAKING BETTER DECISIONS EMPLOYEES CAN DRIVE DOWN HEALTHCARE COSTS HOWEVER IN ORDER TO MAKE THE DECISIONS EMPLOYEES NEED TOOLS n IN THE FORM OF INFORMATION n TO MAKE INFORMED DECISIONS 3EVERAL AVENUES CAN BE PURSUED TO PROVIDE BETTER INFORMATION ON HEALTHCARE QUALITY #OLLABORATE TO IMPROVE ALIGNMENT /PENING UP CHANNELS FOR COLLABORATION AMONG STAKEHOLDERS EMPLOYERS PAYERS lNANCIAL INSTITUTIONS AND EMPLOYEES CAN ALIGN INCENTIVES AND PROCESSES TO ACHIEVE RESULTS 0ROMOTE TRANSPARENCY %NCOURAGE PHYSICIANS HOSPITALS AND OTHER PROVIDERS TO PUBLISH PRICES AND QUALITY INDICATORS WORKING TO PROMOTE COMPARABILITY AND STANDARDIZATION OF RELEVANT METRICS )NCREASE COMMUNICATION )MPLEMENT TARGETED COMMUNICATIONS TO IMPROVE THE AMOUNT AND QUALITY OF HEALTH QUALITY AND COST INFORMATION PROVIDED TO EMPLOYEES WHEN THEY NEED IT
%XHIBIT OF EMPLOYERS ARE PROVIDING CHOICES IN HEALTH PLANS OF THESE ALMOST A QUARTER EXPECT TO GIVE EMPLOYEES MORE CHOICES OVER THE NEXT MONTHS )F THEY PROVIDE CHOICES WHAT OPTIONS DO COMPANIES PROVIDE EMPLOYEES IN HEALTHCARE PLANS
7 DIFF COST COVERAGE OPTIONS
&ROM DIFF INSURANCE COMPANIES
/THER
7 (3!S
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
%XHIBIT #OST REMAINS THE TOP PRIORITY FOR DESIGNING A HEALTH PLAN WHILE AVAILABILITY OF QUALITY DATA IS LAST 7HAT ARE COMPANIES TOP PRIORITIES IN DESIGNING EMPLOYEE HEALTHCARE PLANS 3CALE OF WITH BEING A TOP PRIORITY AND BEING A LOW PRIORITY
#OST
-EAN
1UALITY OF %ASE OF #HOICE OF 1UALITY OF #LINICAL !VAILABILITY PLANS SERVICE TO OUTCOMES OF DATA RE SERVICE FOR ADMIN QUALITY (2 DEPT EMPLOYEES CLAIMS
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
D L O KNX D Q R ã T R D ã N E ã G D @ K S G B @ Q D ã P T @ K H S X ã C @S@
!LTER FOCUS FROM COST TO VALUE 2ATHER THAN FOCUSING PRIMARILY ON COST THE FOCUS MUST SHIFT TO VALUE EFlCIENCY QUALITY OF OUTCOMES AND THE IMPACT ON PRODUCTIVITY $EVELOP DISCIPLINE IN EXECUTION #URRENTLY THERE IS SIGNIlCANT ACTIVITY WITHOUT SIGNIlCANT RESULTS #HANGES THEREFORE NEED TO BE EXECUTED WITH A MEASURABLE RIGOR AND ACCOUNTABILITY TO ENSURE THAT THE ACTIVITY TAKING PLACE IS FRUITFUL 4HIS PAPER WAS PUBLISHED AS A 0RICEWATERHOUSE #OOPERS (EALTH"RIEF IN *UNE 4HE (EALTH"RIEF CAN BE ACCESSED AT WWWPWCCOMHEALTHCARE
%NDNOTE
%XHIBIT $RUGS AND HEALTH SYSTEMS WERE THE TOP TWO TYPES OF QUALITY DATA RESPONDENTS VIEWED AS IMPORTANT 7HAT TYPES OF HEALTHCARE QUALITY DATA DO COMPANIES VIEW AS IMPORTANT
3MART0ROS h#&/S 2ECOGNIZE ,INK "ETWEEN (EALTH "ENElTS 0RODUCTIVITY AND 0ROlTS v HTTPWWWPRONET COMXXML
$RUGS
(EALTH SYSTEMS
)NDIVIDUAL HOSPITALS
)NDIVIDUAL PHYSICIAN
-EDICAL DEVICES
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
%XHIBIT !BOUT OF RESPONDENTS ARE CONSIDERING INCREASING THE QUALITY AND SCOPE OF HEALTHCARE DATA THAT THEY ACQUIRE FOR INTERNAL USE AND FOR THEIR EMPLOYEES ,OOKING AHEAD OVER THE NEXT MONTHS ARE EMPLOYERS CONSIDERING INCREASING THE QUALITY AND SCOPE OF HEALTHCARE DATA THAT
.OT CERTAIN
.OT CERTAIN
.O
.O
9ES
9ES
THEY ACQUIRE AND PROVIDE FOR INTERNAL USE
THEIR COMPANIES PROVIDE TO THEIR EMPLOYEE WORKFORCE
3OURCE 0RICEWATERHOUSE#OOPERS -ANAGEMENT "AROMETER 3URVEY
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
%MPLOYERS $IRECTIONS IN (EALTHCARE &INANCIAL -ANAGEMENT "Y MOVING FROM NEAR TERM @COST OF CARE ANALYSIS TO A BROADER PERSPECTIVE ON @DRIVERS OF HEALTH EMPLOYERS CAN REALIZE SIGNIlCANT IMPROVEMENTS IN EMPLOYEE HEALTH AND WORKPLACE PRODUCTIVITY
"Y 3USAN -ARGOLIS AND -ICHAEL 4HOMPSON 0RICEWATERHOUSE#OOPERS
)NTRODUCTION 0OOR QUALITY CAN BE EXPENSIVE 4HE -IDWEST "USINESS 'ROUP ON (EALTH IN COLLABORATION WITH THE *URAN )NSTITUTE ;= ESTIMATED THAT PERCENT OF THE COST OF HEALTHCARE BILLION PER YEAR CAN BE ATTRIBUTED TO POOR QUALITY INCLUDING THE RESULT OF OVERUSE MISUSE AND WASTE 2EGARDLESS OF THE HIGH COST PAID BY EMPLOYERS GOVERNMENT AND CONSUMERS POOR HEALTH OUTCOMES REMAIN )NDIRECT COSTS SUCH AS THE IMPACT ON WORKFORCE PRODUCTIVITY REPRESENT AN ADDITIONAL TO PERCENT OF THE NATIONAL HEALTH BILL;= $ESPITE THE WELL DOCUMENTED INTERRELATIONSHIP BETWEEN COST AND QUALITY MANY EMPLOYERS AND HEALTH PLANS HAVE FAILED TO ADEQUATELY INTEGRATE QUALITY MANAGEMENT INTO THE OVERALL lNANCIAL MANAGEMENT OF THEIR PLANS 4HIS DISCONNECT EXISTS FOR MANY REASONS INCLUDING COMPLEXITIES IN MEASURING QUALITY (OWEVER AS THE INDUSTRY MOVES FROM MANAGING THE COST OF CARING FOR SICK PEOPLE TO POPULATION BASED HEALTHCARE MANAGEMENT A MORE SOLID CONNECTION BETWEEN QUALITY AND lNANCIAL MANAGEMENT IS NEEDED TO IMPROVE PLANNING AND ACCOUNTABILITY 7HILE STILL A WORK IN PROGRESS THIS MORE INTEGRATED VIEW OF QUALITY PERFORMANCE AND lNANCIAL MANAGEMENT CAN SUPPORT A MORE DISCIPLINED AND SUSTAINABLE APPROACH TO IMPROVING HEALTH AND HEALTHCARE VALUE AND PERFORMANCE 4HIS PAPER PRIMARILY FOCUSES ON THE POINT OF VIEW OF PURCHASERS SINCE THEY ULTIMATELY HOLD THE RISK AND HAVE THE MOST AT STAKE lNANCIALLY (EALTH PLANS AND PROVIDERS WILL HAVE SOME PARALLELS AND DIFFERENCES IN HOW THEY VIEW lNANCIAL MANAGEMENT IN THIS CONTEXT DUE TO DIFFERENT lNANCIAL MOTIVATIONS )MPROVING lNANCIAL PERFORMANCE REQUIRES AN UNDERSTANDING AND MANAGEMENT OF THE DRIVERS THAT IMPACT HEALTH RISK AND COSTS )N QUALITY MANAGEMENT THE GOAL IS TO MANAGE AND REDUCE VARIATIONS IN THE RISK PROlLE OF THE POPULATION AND LESSEN OTHER DRIVERS OF HEALTHCARE COSTS
#URRENT 3TATE n 2ETROSPECTIVE &INANCIAL -ANAGEMENT )N THE 5NITED 3TATES THE PURCHASERS OF HEALTHCARE ARE PRIMARILY EMPLOYERS GOVERNMENT AND CONSUMERS 4YPICALLY THE MAJORITY OF MIDSIZE AND LARGE COMPANIES HAVE DESIGNED THEIR OWN BENElT PLANS SELF FUNDED THEM AND CONTRACTED WITH PAYERS FOR ADMINISTRATIVE SERVICES 7HILE HEALTH BENElTS COSTS ARE TYPICALLY THE SECOND OR THIRD LARGEST EXPENDITURE IN THESE ORGANIZATIONS THE lNANCIAL MANAGEMENT OF THEIR HEALTH PROGRAMS IS LESS SOPHISTICATED THAN THAT OF THEIR CORE BUSINESSES !LTHOUGH OVERSTATED ONE MIGHT VIEW THE TRADITIONAL FOCUS ON COSTS BY BOTH PURCHASERS AND PAYERS AS PREDICATED ON hPEOPLE GET SICKv AND hPROVIDERS TREATv &INANCIAL MANAGEMENT WITHIN THIS BASIC FRAMEWORK IS TO MINIMIZE THE COSTS OF THOSE TREATMENTS THROUGH NEGOTIATION OF PROVIDER FEES COORDINATION OF CARE AND REDUCTIONS IN ADMINISTRATIVE COSTS #ONSEQUENTLY TRADITIONAL VIEWS OF lNANCIAL MANAGEMENT FREQUENTLY FOCUSED ON PER CAPITA COSTS BY TYPE OF SERVICE WITH A POTENTIAL ADDED BREAKDOWN OF UNIT COSTS AND UTILIZATION RATES BY TYPE OF SERVICE AS WELL AS COST OF ADMINISTRATION
#OST OF #ARE -IND SET n &OCUSING ON ,AGGING )NDICATORS 4/4!, #/34 5.)4 #/34 8 54),):!4)/. 4HIS lNANCIAL FOCUS HAS BEEN SHORT SIGHTED FOCUSING SOLELY ON THE COST OF CARE AND NOT THE DRIVERS OF HEALTH 4HE SYSTEM HAS NOT REWARDED DISCIPLINE IN EXECUTION OR FOCUSED ON BEING PROACTIVE AND OBTAINING VALUE 4HE OPPORTUNITY IS TO GET BACK TO BASICS n UNDERSTANDING THE DRIVERS IN HEALTHCARE COSTS DEVELOPING METRICS THAT ACCURATELY MEASURE BOTH THE DRIVERS AND OUTCOMES AND USING THE METRICS TO EXECUTE INTEGRATED SYSTEMS OF CARE THAT LEAD TO IMPROVEMENTS IN HEALTH WELL BEING AND PRODUCTIVITY
3USAN -ARGOLIS -0( IS A DIRECTOR IN 0RICEWATERHOUSE#OOPERS 'LOBAL (UMAN 2ESOURCE !DVISORY 3ERVICE PRACTICE 3HE FOCUSES ON ASSISTING BOTH EMPLOYERS AND HEALTH PLANS IN DESIGNING IMPLEMENTING AND EVALUATING HEALTH BENElT PROGRAMS 3HE HAS OVER YEARS OF INDUSTRY EXPERIENCE WORKING ON DEVELOPING NEW STRATEGIES TO MANAGE COSTS AND IMPROVE QUALITY 3HE CAN BE REACHED AT SUSAN MARGOLIS USPWCCOM -ICHAEL 4HOMPSON A PRINCIPAL WITH 0RICEWATERHOUSE#OOPERS HAS OVER YEARS OF EXPERIENCE IN HEALTHCARE AND EMPLOYEE BENElTS AND CONSULTS WITH MAJOR EMPLOYERS AND HEALTH PLANS ON INTEGRATED HEALTH WELLNESS AND CONSUMERISM AND HEALTHCARE SUPPLY CHAIN MANAGEMENT STRATEGIES (E IS A &ELLOW OF THE 3OCIETY OF !CTUARIES AND SERVES AS ONE OF 0W#S NATIONAL THOUGHT LEADERS FOR HEALTHCARE CONSUMERISM STRATEGIES 0RIOR TO JOINING 0W# IN -IKE SERVED AS AN EXECUTIVE WITH A MAJOR HEALTH PLAN IN BOTH NATIONAL AND REGIONAL LEADERSHIP CAPACITIES (E CAN BE REACHED AT MICHAELTHOMPSON USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
DLO KNXDQR ãCHQDB SHN MRãHMãGD @KSGB@QD ãE HM@MBH@KãL@M@FD L D MS RATHER THE BY PRODUCT OF A NUMBER OF FACTORS ALONG A CONTINUUM )DENTIFYING THE DRIVERS OF COST REQUIRES (EALTH 3YMPTOMS (EALTHCARE 2EIMBURSEMENT UNDERSTANDING AND DRILLING DOWN AT EACH OF THESE "EHAVIORS $ISEASES 3ERVICES 2EWARDS POINTS ALONG THE SPECTRUM STARTING WITH HEALTH 2ISKS #ONDITIONS 4REATMENTS BEHAVIORS AND RISK FACTORS &INANCIAL BENElTS MANAGEMENT CAN NO LONGER LIMIT ITS FOCUS TO ANALYZING CLAIMS EXPERIENCE YEAR OVER YEAR TO IDENTIFY THE &UTURE 3TATE n 0ROACTIVE &INANCIAL LEADING DIAGNOSTIC CATEGORIES OR SERVICES OR FOCUSING ON HIGH -ANAGEMENT n %VALUATING (EALTH COST CLAIMANTS 4HE ABILITY TO EFFECTIVELY MANAGE PLAN PERFORMANCE 2ISKS AND $RIVERS WILL DEPEND ON THE ABILITY TO IDENTIFY AND MANAGE ROOT CAUSES 4HE NEW APPROACH TO MANAGING HEALTHCARE BENElTS INCORPORATES &INANCIAL MANAGEMENT NOW BECOMES AN EXECUTIVE DASHBOARD OF THE WHOLE POPULATION NOT JUST EMPLOYEES AND DEPENDENTS WHO LEADING AND LAGGING INDICATORS ALLOWING ROOT CAUSE IDENTIlCATION USE SERVICES )T ALSO HAS BOTH SHORT AND LONG TERM GOALS WHICH -ETRICS THAT HELP IN BETTER UNDERSTANDING RESOURCE CONSUMPTION FREQUENTLY INVOLVE ALIGNING INCENTIVES ! HEALTHCARE PROGRAM THAT IN THE CONTEXT OF UPSTREAM HEALTH AND HEALTHCARE DRIVERS ARE HAS QUALITY AT ITS CORE REQUIRES A MORE LONGITUDINAL INTEGRATED AND CURRENTLY BEING FOCUSED UPON #LAIMS DATA ARE NO LONGER RELIED MULTIDIMENSIONAL lNANCIAL MANAGEMENT PERSPECTIVE ON TO INFER POTENTIAL DRIVERS INSTEAD METRICS AND DATA SOURCES 7E NEED TO RECOGNIZE THAT TOTAL HEALTHCARE COSTS ARE NOT WHICH ARE MORE VALID AND TIMELY ARE BEING UTILIZED &OR EXAMPLE SIMPLY A FUNCTION OF UNIT COSTS AND THE NUMBER OF SERVICES BUT IDENTIFYING HIGH CHOLESTEROL AS A RISK FACTOR IN THE POPULATION HELPS TO IDENTIFY ONE OF THE ROOT CAUSES OF CARDIOVASCULAR DISEASE A LEADING HEALTHCARE AND DISABILITY COST %XHIBIT )DENTIFYING 2OOT #AUSES OF (EALTH #OSTS %XHIBIT ,EADING )NDICATOR AND /UTCOME -IND SET
(EALTH 3YSTEM $RIVERS
(EALTH "EHAVIORS 2ISKS
3YMPTOMS $ISEASES #ONDITIONS
(EALTHCARE 3ERVICES 4REATMENTS
2EIMBURSE MENTS 2EWARDS
!SSESS 3EGMENT -ETRICS
0REVENTION 7ELLNESS -ETRICS
0OPULATION (EALTH -ETRICS
%PISODES OF #ARE $ATA
#OST 5TILIZATION
#ONNECTING THE $OTS n )NTEGRATING THE $ATA 4HERE ARE MULTIPLE DATA SOURCES FOR INFORMATION AT EACH POINT ALONG THE SPECTRUM HEALTH PLAN VENDORS EG CLAIMS BASED DATA SPECIALTY VENDORS EG HEALTH RISK ASSESSMENTS BIOMETRIC TESTING RESULTS
%XHIBIT %XECUTIVE $ASHBOARD FOR (EALTH -ANAGEMENT -EASUREMENT #ATEGORIES
0REVENTION 7ELLNESS
0OPULATION (EALTH
%PISODES OF #ARE
#OST 5TILIZATION
%XAMPLES OF -ETRICS
-EMBERS WHO HAVE HIGH CHOLESTEROL -EMBERS WITH BODY MASS INDEX "-) PERCENT
0REVALENCE OF DIABETES )NCIDENCE OF LOW BACK CONDITIONS
4OTAL COST OF TREATING GLAUCOMA RESULTING FROM DIABETES
4OTAL COST OF TREATING BREAST CANCER
0ER CAPITA HEALTH COSTS
3HORT TERM AND LONG TERM DISABILITY COSTS
DAYS ABSENT
$ATA 3OURCES
(EALTH RISK ASSESSMENTS
/N SITE BIOMETRIC TESTING
)NTEGRATED ELECTRONIC MEDICAL RECORDS
2EADINESS TO CHANGE PROlLES COLLECTED THROUGH COACHES
)NTEGRATED CLAIMS AND
)NTEGRATED CLAIMS AND ELIGIBILITY DATA ELIGIBILITY DATA
2ESULTS OF PREDICTIVE MODELING
-EDICAL MANAGEMENT ACTIVITY DATA RELATED TO GAPS AND OPPORTUNITIES
%LECTRONIC MEDICAL RECORDS
,AB TESTING
.URSELINE AND CUSTOMER SERVICE PROlLES
0HYSICIANPROVIDER PROlLES FOR EFFECTIVE AND EFlCIENT CARE
)NTEGRATED CLAIMS AND ELIGIBILITY DATA
!BSENTEEISM COSTS
$ISABILITY AND WORKERS COMPENSATION COSTS
#OSTS OF PRESENTEEISM
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
DLO KNXDQR ãCHQDB SHN MRãHMãGD @KSGB@QD ãE HM@MBH@KãL@M@FD L D MS AND DATA PROVIDED BY THE EMPLOYER EG ABSENTEEISM DATA )NTEGRATING AND AGGREGATING THE DATA ACROSS MULTIPLE DATA SOURCES AND VENDORS TO PERFORM A NEEDS ASSESSMENT OF THE VARIOUS POPULATION SEGMENTS CAN HELP IDENTIFY OPPORTUNITIES FOR QUALITY IMPROVEMENT AND ULTIMATELY BETTER MANAGE lNANCIAL PLAN PERFORMANCE !NALYZING THE INTERRELATIONSHIPS BETWEEN THE HEALTH DRIVERS AND HEALTH AND PRODUCTIVITY OUTCOMES CAN HELP TO BUILD THE BUSINESS CASE FOR INTERVENTIONS &URTHERMORE THE DATA CAN BE STRATIlED TO BETTER IDENTIFY MEDICALLY AT RISK POPULATION SEGMENTS AND FOCUS INTERVENTIONS BASED ON A COMBINATION OF RISK AND SEVERITY OF ILLNESS DEMOGRAPHICS LOCATION SOCIAL FACTORS ETC
%XHIBIT !SSESSING /UTCOMES &ROM 6ARIOUS )NTERVENTIONS )DENTIlCATION !CTIVITY
(EALTH 0ROGRAMS
(EALTH )MPROVEMENT
#OST 2EDUCTIONS
s 7EB HITS s OF REFERRALS s OF CALLS s 0REDICTIVE MODELING s (EALTH RISK ASSESSMENTS
s (EALTH RISK OR CONDITION PREVALENCE BY POPULATION SEGMENT s !DOPTION RATES OF EVIDENCE BASED BEST PRACTICES
s 0OSITIVE TRENDING TRACKING OF POPULA TION HEALTH BEHAVIORS HEALTH STATUS s $ESIRED MIGRATION OF POPULATION BETWEEN STRATIlCATION LEVELS s $ECREASE IN NUMBER OF RISK FACTORS AND RESULTING COMORBIDITY FACTORS s $ECREASE IN PREVA LENCE OF CONDITIONS SUCH AS DIABETES AND CORONARY ARTERY DISEASE s $ECREASE IN PROGRESSION OF HEALTH RISK SUCH AS METABOLIC SYNDROME
s 2EDUCTION IN CLAIMS OR PREMIUMS FOR MEDICAL DISABILITY AND WORKERS COMPENSATION s )MPROVEMENTS IN PRODUCTIVITY EG REDUCED ABSENTEEISM AND PRESENTEEISM s 2EDUCTION IN ATTRITION
)NTERVENTION $EVELOPMENT AND !SSESSMENT 7HILE THE BASELINE DATA PROVIDE A MODEL OF THE CURRENT STATE THERE NEEDS TO BE A PARALLEL MODEL THAT DESCRIBES AND ASSESSES OUTCOMES FROM VARIOUS INTERVENTIONS THAT MAY TAKE PLACE SEE %XHIBIT )N MODELING THE EFFECT OF CARE MANAGEMENT INTERVENTIONS THE IMPACT MUST BE ASSESSED BASED ON THE PREVALENCE AND INCIDENCE OF DISEASE IN THE TARGET POPULATION THE PERCENTAGE OF THE TARGET POPULATION IDENTIlED REACHED AND ENGAGED AND LASTLY THE PERCENTAGE OF THE POPULATION COMPLYING WITH THE PROGRAMS OBJECTIVES
$EVELOPING A -ULTIYEAR &INANCIAL -IND SET !FTER METRICS ARE IDENTIlED BUDGETS AND GOALS CAN BE ESTABLISHED WITH A MULTIYEAR ORIENTATION 4HE GAP BETWEEN CURRENT PERFORMANCE AND THE OBSERVED hBEST PRACTICEv CAN BE DElNED AS THE OPPORTUNITY OR hENTITLEMENTv !S INTERVENTIONS ARE DEVELOPED AND MEASURABLE GOALS ESTABLISHED TO IMPROVE PERFORMANCE THEY CAN BE INTEGRATED INTO AN OVERALL THREE TO lVE YEAR lNANCIAL PLAN 7HILE THE MEASUREMENT OF IMPACT IS IMPERFECT THE ADVANTAGE OF THIS APPROACH IS THAT IT FORCES A RATIONAL DISCUSSION OF THE LIKELIHOOD OF SUCCESS THE ANTICIPATED TIME FRAME OF IMPACT THE INTERRELATIONSHIPS BETWEEN THE DRIVERS AND THE lNANCIAL OUTCOMES AND THE POTENTIAL INTERDEPENDENCIES OF VARYING INTERVENTIONS 0ERFORMANCE AND ACCOUNTABILITY CAN THEN BE ASSESSED AGAINST THE LEADING INDICATORS ON A REAL TIME BASIS AND ESTIMATED FOR DOWNSTREAM lNANCIAL IMPACT ON THE lNANCIAL PLAN
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
!N %XAMPLE OF !DOPTION ! "ROAD 0ERSPECTIVE ON $RIVERS OF (EALTH #ONSIDER THE EMPLOYER WHO THROUGH THE RESULTS OF THE HEALTH RISK ASSESSMENT COMPLETED BY PERCENT OF EMPLOYEES LEARNS THAT THE WORKFORCE HAS A HIGH PERCENTAGE OF MEMBERS WHO ARE OBESE 4HE HEALTH RISK ASSESSMENT DATA ARE CORROBORATED BY THE RESULTS OF ON SITE BIOMETRIC TESTING WHICH SHOWS A HIGH PERCENTAGE OF THE POPULATION WITH HIGH BODY MASS INDEXES 3TRATIFYING THE DATA THE EMPLOYER LEARNS THAT THE RISK FACTOR SEEMS TO BE MOST PREVALENT AMONG MALES AGE 4HE EMPLOYER AND ITS VENDOR ESTABLISH A NUMBER OF INTERVENTIONS AROUND REDUCING THE RATE OF OBESITY IN THE AT RISK POPULATION SUCH AS ESTABLISHING A FREE ON SITE WEIGHT LOSS PROGRAM PROVIDING HEALTHIER CHOICES IN THE CAFETERIA AND VENDING MACHINES AND PROVIDING TELEPHONIC PERSONAL COACHES TO HELP GUIDE MEMBERS TOWARD ACHIEVING THEIR WEIGHT LOSS GOALS 0RIOR TO BEGINNING THE INTERVENTIONS THE EMPLOYER SETS A BASELINE FOR THE PREVALENCE OF OBESITY AND PREDICTED ASSOCIATED COSTS INCLUDING HEALTHCARE OBESITY INCREASES THE DOWNSTREAM RISK OF DIABETES DISABILITY AND PRODUCTIVITY COSTS !SSESSING THE IMPACT OF THE INTERVENTIONS AND IDENTIFYING IMPROVEMENT OPPORTUNITIES NECESSITATES METRICS AT EACH POINT ALONG THE CARE CONTINUUM INCLUDING THE NUMBER OF AT RISK MEMBERS P EOPLE REFERRED SELF REFERRED OR THROUGH HEALTH RISK ASSESSMENT RESULTS FOR COACHING PARTICIPANTS IN THE PROGRAM AND PEOPLE WHO COMPLY WITH THE PROGRAM ,ASTLY THE EMPLOYER MEASURES THE IMPACT ON TOTAL COSTS -EASUREMENT SHOULD OCCUR PERIODICALLY DUE TO THE TIME SOME TIMES REQUIRED TO MODIFY AND SUSTAIN BEHAVIOR CHANGES
DLO KNXDQR ãCHQDB SHN MRãHMãGD @KSGB@QD ãE HM@MBH@KãL@M@FD L D MS %XHIBIT $ElNING THE /PPORTUNITY 'AP
#URRENT 0ERFORMANCE VS "EST /BSERVED %NTITLEMENT
0OPULATION (EALTH 2ISK #OHORTS
%PISODES OF #ARE
4YPE OF 3ERVICE
0ERCENT OF 0OPULATION #OST 0ER )NDIVIDUAL #OST 0ER 3ERVICE
#OST 0ER %PISODE 3EVERITY OF )LLNESS &REQUENCY
5NIT #OSTS 3ERVICES 0-0-
0URCHASERS AND 0AYERS n 3IMILARITIES $IFFERENCES AND /PPORTUNITIES
LEVEL OF COLLABORATION AND MUTUAL ACCOUNTABILITY WILL ULTIMATELY STRENGTHEN THE lNANCIAL PERFORMANCE OF THE PLAN
#ONCLUSION
4HE MOVE TOWARD A QUALITY BASED APPROACH TO MANAGING HEALTHCARE DEMANDS THAT THE lNANCIAL MANAGEMENT OF PERFORMANCE CHANGE !NALYZING OR TRACKING COST AND UTILIZATION INDICATORS IS NOT ENOUGH 4HE BAR NEEDS TO BE RAISED TO INCORPORATE OUTCOMES OF CARE HEALTH RISK AND ACTIVITY INDICATORS AT EACH POINT ALONG THE HEALTHCARE SPECTRUM )T IS JUST AS IMPORTANT TO THE lNANCIAL HEALTH OF A PLAN TO TRACK THE RISK FACTORS NUMBER OF SMOKERS OBESITY ETC AND PERFORM A NEEDS ASSESSMENT OF THE POPULATION AS IT IS TO TRACK HOW MANY HOSPITAL ADMISSIONS THERE WERE IN A GIVEN TIME PERIOD 4HE NEED TO TAKE A LONGER VIEW IN MEASURING PLAN PERFORMANCE IS ALSO CRITICAL #HANGING BEHAVIOR TAKES TIME AND REQUIRES DIFFERENT EXPECTATIONS THAN EVALUATING THE EFFECT OF INCREASING COPAYS )T IS BOTH A CHALLENGE AND AN OPPORTUNITY TO INCORPORATE THE hCAREv ELEMENT INTO THE lNANCIAL MANAGEMENT OF PLAN PERFORMANCE !N INTEGRATED APPROACH TO HEALTH AND lNANCIAL MANAGEMENT WILL ALSO HELP TO CREATE THE COMMON GROUND AMONG EMPLOYERS HEALTH PLANS AND PROVIDERS THAT WILL BE ESSENTIAL FOR A SUSTAINABLE QUALITY HEALTH SYSTEM
7HILE THE FOCUS OF THIS PAPER HAS BEEN ON EMPLOYERS IT IS WORTH NOTING SOME OF THE SIMILARITIES AS WELL AS DIFFERENCES IN MOTIVATIONS AND lNANCIAL MANAGEMENT BETWEEN PAYERS AND PURCHASERS 5NDERSTANDING THEIR RESPECTIVE ROLES PRESENTS AN OPPORTUNITY TO REALIGN THE INCENTIVES AND IMPROVE THE QUALITY AND lNANCIAL MANAGEMENT OF THE DELIVERY OF HEALTHCARE 4HERE IS AN OPPORTUNITY TO DEVELOP GREATER COMMON GROUND BETWEEN PAYERS AND PURCHASERS BY ESTABLISHING MORE COLLABORATIVE AND LONGER TERM RELATIONSHIPS AND ALIGNING INCENTIVES AND ACCOUNTABILITIES THAT LEVERAGE THE RELATIVE STRENGTHS OF EACH TO ULTIMATELY LEAD TO A MORE PROGRESSIVE APPROACH TO PERFORMANCE AND lNANCIAL MANAGEMENT !LIGNING INCENTIVES CAN PROVIDE DESIRED RETURNS FOR THE VARIOUS POPULATION SEGMENTS &OR EXAMPLE FOR THE WELL AND hWORRIED WELLv SEGMENTS INCENTIVES FOR HEALTH RISK ASSESSMENT PARTICIPATION PROVIDE RICH %NDNOTES DATA FOR MINING AND EARLY IDENTIlCATION OF RISK FACTORS v2EDUCING THE #OST OF 0OOR 1UALITY (EALTH #ARE 4HROUGH 2ESPONSIBLE )T IS TIME TO MOVE BEYOND THE TRADITIONAL APPROACH OF ESTABLI 0URCHASING ,EADERSHIP v !PRIL ND PRINTING 4HE -IDWEST SHING hPERFORMANCE GUARANTEESv THAT PENALIZE HEALTH PLANS FOR "USINESS 'ROUP ON (EALTH IN #OLLABORATION WITH THE *URAN )NSTITUTE )NC FAILURE TO MEET MINIMUM QUARTERLY ADMINISTRATIVE METRICS %MPLOYERS AND THE 3YVERN 'ROUP )NC WWWMBGHCOM AND PAYERS NEED TO DEVELOP AND IMPLEMENT NEW METRICS THAT )BID PROVIDE INCENTIVES THAT REmECT BOTH SHORT AND %XHIBIT %MPLOYER VS 0AYER 0ERSPECTIVES LONG TERM PLAN OBJECTIVES AROUND MANAGING THE %MPLOYERS 0AYERS HEALTH OF THE POPULATION (EALTH 2ISK %MPLOYEE POPULATION IS A GIVEN CANNOT #AN MANAGE RISK THROUGH TARGETED &OR EXAMPLE THESE METRICS SELECT FOR A DIFFERENT RISK PROlLE &OCUS IS OUTREACH AND CARE MANAGEMENT OR MIGHT INCLUDE INCREASING ON IMPROVING HEALTH RISK OVER TIME THROUGH CHARGING FOR IT THROUGH HIGHER PREMIUMS PARTICIPATION IN A CHRONIC POPULATION HEALTH MANAGEMENT PROGRAMS n VERY CONSCIOUS OF RISK SELECTION OBSTRUCTIVE PULMONARY 4IME &RAME (ISTORICALLY SHORTER TERM MIND SET BUT 3HORTER TERM MIND SET DUE TO DISEASE MANAGEMENT PRO SHIFTING TO LONGER TERM VIEW n TARGETING HIGHER MEMBER TURNOVER AND GRAM FROM TO HEALTHCARE SPENDING TRENDS ONE YEAR TERM COVERAGE PERCENT IN YEAR ONE 3TAKEHOLDER (AVE MOST INmUENCE ON hCONSUMERSv n (AVE TRADITIONALLY FOCUSED MORE ON AND TO PERCENT IN )MPACT EMPLOYEES AND DEPENDENTS LITTLE IMPACT hPROVIDERSv n SHIFTING FOCUS TOWARD YEAR TWO OR INCREASING ON PROVIDERS CONSUMERS BUT RELATIONSHIP IS THE PERCENTAGE OF THE LESS INTIMATE POPULATION THAT HAS ANNUAL PHYSICALS AND DEVELOPING #OST 4ARGETS &OCUSING ON HEALTHCARE COSTS AS WELL AS &OCUSING ON HEALTHCARE COSTS BUSINESS PRODUCTIVITY JOINT PLANS THAT WILL LEAD TO SUCH SUCCESSES 4HIS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1UALITY IN )NTEGRATED 4OTAL (EALTH -ANAGEMENT 4HOUGH MEDICAL MANAGEMENT FUNCTIONS ARE EVOLVING IN MANY COMPANIES THE SKILL TO FULLY EMBRACE A CULTURE OF COMPLETE INTEGRATION AND DELIVER THE INNOVATION REQUIRED TO TRULY UNLEASH QUALITY ACROSS THE HEALTHCARE CONTINUUM REMAINS ILLUSIVE
"Y -ARY !NN 3HEA *ACKIE -AZOWAY !NURAG 3HARMA AND $AVID 3ACHS 0RICEWATERHOUSE#OOPERS
*
OE 3MITH A YEAR OLD MALE COVERED BY A HEALTH INSURANCE PLAN HAS A HISTORY OF ASTHMA AND A PACK A DAY CIGARETTE HABIT THAT HAS BEEN TOUGH TO BREAK )N ADDITION TO ROUTINE CHECKUPS WITH HIS PRIMARY CARE PHYSICIAN 0#0 *OE VISITS THE HOSPITAL FREQUENTLY FOR ASTHMA mARE UPS WHEN A NEBULIZER FAILS TO CORRECT HIS BREATHING -ANY PLAYERS IN ADDITION TO *OES 0#0 ARE INVOLVED IN HIS HEALTHCARE (E SEES HOSPITAL PHYSICIANS AND NURSES WHEN HIS ASTHMA mARES UP ! PHARMACIST lLLS HIS MEDICATIONS AND CUSTOMER SERVICE REPRESENTATIVES AT HIS HEALTH PLAN HELP WHEN HE HAS QUESTIONS ABOUT COVERAGE !LL THESE PEOPLE WORK TO KEEP *OE HEALTHY .EVERTHELESS *OES HEALTH IS NOT IMPROVING AND THE COSTS TO INSURE HIM ARE CONTINUALLY CLIMBING )N A SUPPOSEDLY MODERN HEALTHCARE SYSTEM *OE FAILS TO RECEIVE HIGH QUALITY INTEGRATED CARE
"ETTER COMMUNICATION AND COORDINATION ACROSS ALL PROGRAMS IS STILL HOWEVER REQUIRED TO DEAL WITH MEMBERS WHO HAVE MULTIPLE COMORBIDITIES AND RISK FACTORS )N ADDITION ADVANCED ANALYTICAL AND REPORTING CAPABILITIES WITH A FOCUS ON QUALITY ASSESSMENT AND PERFORMANCE MEASUREMENT ARE REQUIRED TO OBTAIN A TRUE PICTURE OF HOW THE HEALTH OF PATIENTS IS PROGRESSING 4ODAY MOST MANAGEMENT INFORMATION SYSTEMS DO NOT TALK TO EACH OTHER AND COMPOUND THE PROBLEM WITH DISPARATE DATA SOURCES THAT INHIBIT PROPER INFORMATION SHARING AND INTEGRATION 0AYERS HAVE RECOGNIZED THE SIGNIlCANT BENElTS TO BE REALIZED BY A MORE INTEGRATED APPROACH TO CARE MANAGEMENT
4HE .EED FOR )NTEGRATED 4OTAL (EALTH -ANAGEMENT
!CROSS THE HEALTHCARE INDUSTRY EMPLOYERS PAYERS AND PROVIDERS ARE REALIZING THE NEED FOR A COMPREHENSIVE PATIENT CENTRIC APPROACH 4HE MODEL IS REPRESENTED BY A HEALTHCARE CONTINUUM IN WHICH MANAGEMENT OF BOTH THE MEMBERS AND THE WHOLE POPULATION IS REALIZED )NTEGRATING EPISODIC CARE MANAGEMENT WITH POPULATION HEALTH MANAGEMENT AND WELLNESS WOULD CREATE BETTER ACCESS TO TIMELY AND QUALITY HEALTH INFORMATION FOR ALL INVOLVED IN CARE DELIVERY INCLUDING THE PATIENT +EY COMPONENTS OF AN INTEGRATED TOTAL HEALTH MANAGEMENT MODEL ARE DEPICTED IN %XHIBIT !CCORDING TO 52!# AN INDEPENDENT NONPROlT ORGANIZATION THAT PROMOTES HEALTHCARE QUALITY THROUGH ACCREDITATION AND CERTIlCATION THE PERCENTAGE OF MEDICAL MANAGEMENT DEPARTMENTS
-EDICAL MANAGEMENT PROGRAMS TRADITIONALLY FOCUSED ON UTILIZATION MANAGEMENT TECHNIQUES WITH LIMITED EMPHASIS ON QUALITY AND RELATIVELY LITTLE FOCUS ON WELLNESS AND PREVENTION OR DISEASE MANAGEMENT 4HIS HOWEVER HAS CHANGED AS BED DAYS FALL TO ALL TIME LOWS -ANY OF THE EXISTING HEALTH MANAGEMENT PROCESSES HAVE SWITCHED FROM REACTIVE SUCH AS AUTHORIZING AND MANAGING HOSPITAL STAYS TO PROACTIVE CASE MANAGEMENT AND DISEASE MANAGEMENT PROGRAMS THAT HELP MEMBERS AVOID HOSPITALIZATION ALTOGETHER 4HIS EVOLUTION IS ILLUSTRATED IN %XHIBIT
!N %MERGING !PPROACH
-ARY !NN 3HEA -(3! IS A PRINCIPAL IN 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE -ARY !NN HAS OVER YEARS EXPERIENCE IN THE HEALTHCARE INDUSTRY 3HE WORKS WITH HEALTHCARE PAYERS AND SPECIALIZES IN PERFORMANCE IMPROVEMENT ACROSS THE AREAS OF MEDICAL MANAGEMENT PROVIDER CONTRACTING ADMINISTRATION AND CLAIM OPERATIONS 3HE CAN BE REACHED AT MARYANNSHEA USPWCCOM *ACKIE -AZOWAY 2. IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE FOCUSES ON QUALITY AND PROCESS IMPROVEMENT FOR MANAGED CARE ORGANIZATIONS AND HAS YEARS OF EXPERIENCE WORKING WITHIN HEALTH MANAGEMENT PROGRAMS FOR PAYERS 3HE ALSO ASSISTS THE EMPLOYERS IN EVALUATING AND CHOOSING HEALTH MANAGEMENT PROGRAMS FOR THEIR EMPLOYEE BENElT PLANS 3HE CAN BE REACHED AT JACKIEMAZOWAY USPWCCOM !NURAG 3HARMA -$ -(! -3 IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E HAS OVER lVE YEARS OF EXPERIENCE WORKING AS PROJECT MANAGER AND SUBJECT MATTER EXPERT IN THE AREAS OF MEDICAL MANAGEMENT AND CLINICAL INFORMATICS FOR NATIONAL AND REGIONAL PAYERS ACROSS THE COUNTRY (E CAN BE REACHED AT ANURAGSHARMA USPWCCOM $AVID 3ACHS ,#37 IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E HAS OVER YEARS COMBINED EXPERIENCE IN HEALTHCARE DELIVERY AND MANAGEMENT WORKING IN BOTH PROVIDER AND PAYER SETTINGS $AVID UNIQUELY APPLIES HIS CLINICAL AND BUSINESS ACUMEN IN PROVIDING ADVANCED SOLUTIONS TO HEALTH PLANS HOSPITALS EMPLOYERS AND OTHER HEALTHCARE PROVIDERS (E CAN BE REACHED AT DAVIDSACHS USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
P T@K HSXãHMãHMSDFQ@SD CãSNS@KãGD @KSGãL@M@FD L D MS %XHIBIT -EDICAL MANAGEMENT MODELS ARE EVOLVING
5TILIZATION -ANAGEMENT
2EFERRAL -ANAGEMENT 0RIOR !UTHORIZATION0RECERTIlCATION #ONCURRENT 2EVIEW $ISCHARGE 0LANNING #ASE -ANAGEMENT 2ETROSPECTIVE 2EVIEW!PPEALS 0HARMACY -ANAGEMENT
1UALITY -ANAGEMENT
# LINICAL 1UALITY )NDICATOR -ONITORING # REDENTIALING AND 2ECREDENTIALING $ ELEGATION /VERSIGHT
0OPULATION -ANAGEMENT
7ELLNESS 0ROGRAMS $EMAND -ANAGEMENT $ISEASE -ANAGEMENT
%XHIBIT )NTEGRATED 4OTAL (EALTH -ANAGEMENT 0ROGRAM #OMPONENTS
7ELLNESS 0REVENTION (EALTH 2ISK !SSESSMENT (EALTH )NFORMATION 0ATIENT %DUCATION 2ISK -ODIlCATION
%PISODIC #ARE -ANAGEMENT
0OPULATION (EALTH -ANAGEMENT
&OCUSED 0RECERTIlCATION 0RE ADMISSION %DUCATION 2EDUCED 5NWARRANTED 6ARIATION &OCUSED #ONCURRENT 2EVIEW $ISCHARGE 0LANNING 0OST $ISCHARGE /UTREACH
0ROACTIVE )DENTIlCATION 0ATIENT 3TRATIlCATION #ASE -ANAGEMENT #ONDITION -ANAGEMENT
#LINICAL &INANCIAL /UTCOMES WITH INTEGRATED CASE DISEASE AND UTILIZATION MANAGEMENT FUNCTIONS ROSE FROM PERCENT IN TO PERCENT IN #OMPANIES WITH INTEGRATED CASE AND UTILIZATION MANAGEMENT STAFF GREW FROM TO PERCENT DURING THE SAME TIME FRAME;= 4RUE INTEGRATION CAN BE ACHIEVED ONLY IF ALL THE STAKEHOLDERS OF THE CARE MANAGEMENT hVALUE CHAINv ARE ALIGNED EMPLOYERS
MEMBERS PAYERS PROVIDERS AND VENDORS !LIGNMENT OF INCENTIVES IS REQUIRED TO HARNESS THE MAXIMUM YIELD FROM MULTIPLE INTERDISCIPLINARY STAKEHOLDERS %MPLOYERS SHOULD COLLABORATE WITH PAYERS TO DESIGN PROGRAMS AND PROVIDE INCENTIVES FOR PARTICIPATION AND INVOLVEMENT IN CARE MANAGEMENT AND WELLNESS PROGRAMS 3OME EMPLOYERS OFFER CASH REWARDS FOR COMPLETION OF
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXãHMãHMSD FQ@SD CãSNS@KãGD @KSGãL @M@FD LD MS HEALTH RISK ASSESSMENTS AND OTHERS WAIVE COPAYS AND DEDUCTIBLES FOR CERTAIN CHRONICALLY ILL PATIENTS WHO CANNOT AFFORD THE DRUGS THAT CAN KEEP THEM STABLE -EMBERS SHOULD NOT ONLY BE MOTIVATED TO TAKE CONTROL OF THEIR CARE BUT ALSO BE EDUCATED TO MAKE INFORMED AND WISE DECISIONS RELATED TO THEIR HEALTH 0AYERS SHOULD FOCUS ON KEEPING THE MEMBER WELL IN ADDITION TO IDENTIFYING THE NEEDS AND RISK FACTORS BEFORE AN ACUTE EVENT HAPPENS 0AYERS SHOULD COLLABORATE WITH PROVIDERS TO SHARE DATA AND INFORMATION THAT THE PAYER MAY HAVE THAT THE PROVIDER DOES NOT HAVE 0AYERS SHOULD ALSO RECEIVE EVIDENCE BASED INFORMATION FROM PROVIDERS AND REWARD PHYSICIANS AND HOSPITALS THAT HAVE A FOCUS ON POSITIVE HEALTH MANAGEMENT OUTCOMES AND CREATE VALUE BASED COMPETITION AMONG STAKEHOLDERS
)MPROVED #LINICAL 1UALITY )MPROVED CLINICAL QUALITY IS A NATURAL BENElT OF INTEGRATED TOTAL HEALTH MANAGEMENT 4HE GOAL OF AN INTEGRATED TOTAL HEALTH MANAGEMENT PROGRAM IS TO IDENTIFY MEMBERS BEFORE THEIR HEALTH STATUS SPINS OUT OF CONTROL AND ASSURE THAT APPROPRIATE INTERVENTIONS ARE PUT IN PLACE EITHER BEFORE AN EPISODE OCCURS OR AT THE BEGINNING OF AN ILLNESS EVENT -EMBERS ARE TO BE IDENTIlED AT AN EARLY STAGE OF RISK SO THAT SECONDARY PREVENTION PRACTICES MAY BE ADOPTED AND COMPLICATIONS AVOIDED &OR EXAMPLE EMPLOYING EARLY INTERVENTIONS FOR A MEMBER WITH EARLY METABOLIC DISEASE CAN DELAY OR PREVENT THE PROGRESSION TO DIABETES AND ITS RELATED COMPLICATIONS &OR *OE 3MITH BETTER COLLABORATION AND EARLY INTERVENTION SUCH AS A SMOKING CESSATION PROGRAM EARLY IN HIS MEMBERSHIP COULD HAVE GIVEN HIM THE EDUCATION NEEDED TO PREVENT ACUTE EXACERBATIONS OF HIS ASTHMA 4HIS WOULD HAVE KEPT *OE HEALTHIER IN THE LONG TERM AND REDUCED THE CHANCE OF COMPLICATIONS OR COMORBIDITIES SUCH AS LUNG CANCER *OE WOULD HAVE SHOWN UP TO WORK REGULARLY AND BEEN MORE PRODUCTIVE AN ADDED BENElT FOR HIS EMPLOYER
#ARE %FlCIENCY /UTCOMES -ARKET DRIVERS FOR AN INTEGRATED TOTAL HEALTH MANAGEMENT MODEL ARE ALSO ECONOMIC CENTERING ON MORE PRODUCTIVE WORKERS AND LESS EXPENSIVE HEALTH SERVICES )N THE *OE 3MITH EXAMPLE A HEALTH RISK ASSESSMENT COULD HAVE TRIGGERED INTERVENTION BY A WELLNESS COACH TO HELP *OE QUIT SMOKING REDUCE THE CHANCE OF CHRONIC ASTHMA AND DECREASE HIS HOSPITAL VISITS &OR BOTH *OE AND HIS EMPLOYER WHO SHARES IN HIS INSURANCE COSTS PREVENTION OF ACUTE EXACERBATIONS AND FEWER HOSPITALIZATIONS AND %2 VISITS DRIVE DOWN INSURANCE PREMIUMS SO EARLY PREVENTION OR DETECTION IS lNANCIALLY BENElCIAL TO BOTH )NTEGRATED TOTAL HEALTH MANAGEMENT IS DESIGNED TO KEEP MEMBERS ON THE WELL SIDE OF THE CURVE )F THEY GO TO THE hSICKv SIDE OF THE CONTINUUM THEY COULD QUICKLY BE BROUGHT BACK TO A STABLE CONDITION USING FEWER EXPENSIVE MEDICAL SERVICES
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
%MPLOYERS ALSO WIN WITH THIS APPROACH AS GREATER EFlCIENCIES ENABLE PROGRAM IMPROVEMENTS THAT REACH MORE MEMBERS EARLIER IN THE DISEASE PROCESS ALLOWING FOR BETTER CONTROL OF CLAIMS DOLLARS )N TURN EMPLOYERS SPEND LESS AND REALIZE MORE PROlT TO CONTRIBUTE TO OTHER EMPLOYEE BENElTS
%VOLVING 4OWARD AN )NTEGRATED 4OTAL (EALTH -ANAGEMENT -ODEL 4HE SUCCESSFUL EVOLUTION TOWARD AN INTEGRATED TOTAL HEALTH MANAGEMENT MODEL REQUIRES FOUR COMPONENTS ! CLEAR VISION AND COMMITMENT TO THAT VISION )NTEGRATION OF DISPARATE DATA SOURCES INTO ACTIONABLE INFORMATION !LIGNMENT OF RESOURCES TO PROACTIVELY LEVERAGE THE POWER OF INTEGRATED INFORMATION AND #OORDINATION AND COMMUNICATION ACROSS THE VARIOUS STAKEHOLDERS PAYERS PROVIDERS EMPLOYERS VENDORS AND MEMBERS #OORDINATION BETWEEN TRADITIONAL MEDICAL MANAGEMENT PROGRAMS UTILIZATION MANAGEMENT CASE MANAGEMENT AND DISEASE MANAGEMENT IS JUST THE BEGINNING )NTEGRATED TOTAL HEALTH MANAGEMENT INVOLVES INTEGRATION OF THESE MEDICAL MANAGEMENT COMPONENTS ALONG WITH WELLNESS AND PREVENTION PHARMACY BEHAVIORAL HEALTH AND IN THE IDEAL MODEL DISABILITY AND WORKERS COMPENSATION MANAGEMENT FROM A PEOPLE PROCESS TECHNOLOGY AND CULTURAL PERSPECTIVE 4HE INTEGRATION HAS TO OCCUR WITH INTERNAL CONSTITUENTS AS WELL AS EXTERNAL CONSTITUENTS
6ISION ! HEALTH PLAN MUST HAVE A CLEAR VISION OF WHAT INTEGRATED TOTAL HEALTH MANAGEMENT MEANS TO THEM AS AN ORGANIZATION 4HE VISION MAY VARY FROM ONE ORGANIZATION TO THE NEXT )T WILL DEPEND ON ITS BOOK OF BUSINESS FULLY INSURED VERSUS ADMINISTRATIVE SERVICES ONLY GEOGRAPHY PRODUCT LINE MIX ETC !LTHOUGH ALL HEALTH PLANS HAVE STAFF ALLOCATED TO HEALTH MANAGEMENT TASKS THE MEDICAL MANAGEMENT TEAM RARELY HAS THE ABILITY TO CHAMPION ITS VALUE AND MEASURE ITS RESULTS ON AN ONGOING BASIS &OR THIS REASON SUCCESS WITHIN AN ORGANIZATION DEMANDS A COMMITMENT FROM THE TOP ! DEDICATED PROACTIVE STAFF HELPS BUT WILL NOT LIKELY ACHIEVE LONG TERM SUCCESS BY ITSELF )N ORDER FOR AN INTEGRATED TOTAL HEALTH MANAGEMENT APPROACH TO WORK THE VISION MUST COME FROM INNOVATIVE LEADERS WHO HAVE A BIG PICTURE VIEW OF THE FINANCIAL AND QUALITY BENEFITS TO BE GAINED ACROSS THE ORGANIZATION AND ACROSS THE STAKEHOLDERS !LIGNMENT OF PERFORMANCE GOALS AND INCENTIVES WITH THE STRATEGY IS CRITICAL TO ITS SUCCESS !WARENESS AND INTERNALIZATION OF THE SHARED VISION CUSTOMER CENTRIC STRATEGY AND CULTURAL VALUES NEEDED TO EXECUTE THE MODEL IS A NECESSITY !N INTEGRATED
P T@K HSXãHMãHMSD FQ@SD CãSNS@KãGD @KSGãL @M@FD LD MS TOTAL HEALTH MODEL REQUIRES SEVERAL NEW SKILLS AND COMPETENCIES AND A PLAN TO CLOSE THE TALENT AND RESOURCE GAP
!CTIONABLE )NFORMATION #REATING A CENTRALIZED DATA REPOSITORY IMPROVES ACCESS FOR HEALTH MANAGEMENT STAFF TO TRULY SHARE INFORMATION ! CASE MANAGER SHOULD HAVE ACCESS TO A MEMBERS COMPLETE INFORMATION FROM A SINGLE SOURCE 4HE COMPLETE VIEW SHOULD INCORPORATE INFORMATION FROM VARIOUS DATA SOURCES SUCH AS MEDICAL AND PHARMACY CLAIMS LAB BIOMETRIC AND DENTAL DATA AS WELL AS DATA FROM HEALTH RISK ASSESSMENTS CASE AND DISEASE MANAGEMENT PROGRAMS WELLNESS PROGRAMS AND THE RESULTS OF THE PREDICTIVE MODELING ACTIVITIES !DDITIONALLY THIS VALUABLE INFORMATION SHOULD BE COMMUNICATED TO THE PHYSICIAN TREATING THE MEMBER )NFORMATION SHARING IS ESPECIALLY IMPORTANT TO IDENTIFY POSSIBLE GAPS IN MEMBER CARE -OST HEALTH PLANS ARE RICH IN DATA BUT POOR IN INFORMATION 4HEY HAVE NOT YET FULLY DEVELOPED THE CAPABILITY OF MINING THE DATA TO ENABLE PREDICTIVE MODELING &OR EXAMPLE BY ESTABLISHING A PROCESS OF ANALYZING THE DATA HEALTH PLANS COULD PREDICT WHICH SERVICES MEMBERS WILL NEED AND CONDUCT PATIENT ASSESSMENTS AND PLAN INTERVENTIONS ACCORDINGLY 4HE DATA WOULD THEN REQUIRE MANIPULATION TO SHOW THE RESULTS OF THESE EFFORTS AS WELL AS THEIR IMPACT ON TRENDS AND QUALITY OF CARE 4HE IDEAL SYSTEM WOULD INTEGRATE DISABILITY DATA INTO THE PAYER DATABASE AND POPULATE A PERSONAL HEALTH RECORD THAT CAPTURES NOT ONLY THE MEDICAL EPISODES BUT ALSO THE LOST WORK TIME INFORMATION 4HIS WOULD PRESENT A MORE COMPLETE PICTURE OF MEMBERS EPISODES OF ILLNESS TO THOSE WHO ARE HELPING MEMBERS REACH A STATE OF WELLNESS &OR HEALTH PLAN MEMBERS AN INTEGRATED TOTAL MODEL OFFERS A SINGLE ADVOCATE TO HELP NAVIGATE THE COMPLEXITIES OF THE HEALTHCARE SYSTEM AND GAIN A BETTER UNDERSTANDING OF MEDICAL CONDITIONS AND TREATMENTS %FFECTIVE PAYER PROVIDER COLLABORATION IS A REQUIREMENT FOR THE REALIZATION OF THE OUTCOMES
2ESOURCE !LIGNMENT /NCE INFORMATION ANALYSIS HAS OCCURRED RESOURCES SHOULD BE ORGANIZED TO FOCUS ON DELIVERING PROGRAMS AND SERVICES THAT CAN MAINTAIN HEALTH AND MINIMIZE EPISODES OF ILLNESS $ATA ANALYSES CAN BE SLICED BY CUSTOMERS TO FACILITATE DEVELOPMENT AND IMPLEMENTATION OF CUSTOMER SPECIlC INTERVENTIONS STREAMLINING RESOURCES TO FOCUS ON ACTIONABLE ACTIVITIES VERSUS ASSUMING THAT ONE PROGRAM CAN MEET THE NEEDS OF ALL CUSTOMERS 4HROUGH AN INTEGRATED TOTAL HEALTH MANAGEMENT APPROACH PAYERS CAN REDUCE INTERNAL STAFF REDUNDANCY AND SERVICE DUPLICATION WHILE IMPROVING CAPACITY AND THE QUALITY OF SERVICE PROVIDED 4HE STAFFS VISION IS SHIFTED TO THINK ABOUT CUSTOMER VALUE "ECAUSE HEALTH MANAGEMENT PROGRAMS ALSO FEATURE A GREAT DEAL OF OVERLAP IT MAY BE MORE APPROPRIATE TO MEASURE AGGREGATE TRENDS AND THEN GIVE CREDIT TO ALL STAKEHOLDERS NOT JUST A SINGLE DEPARTMENT
#OORDINATION AND #OMMUNICATION )N THE PAST PROVIDERS AND PAYERS WERE RELUCTANT PARTNERS IN DISEASE MANAGEMENT PROGRAMS AND IN THE DAY TO DAY WORK OF CASE MANAGEMENT 0ROVIDERS SOMETIMES SAW DISEASE MANAGEMENT PROGRAMS AS INTRUSIVE AND DID NOT IMMEDIATELY TRUST PAYER INFORMATION 0AYERS HAVE ONLY JUST BEGUN TO REACH OUT TO ESTABLISH PROVIDER ADVISORY COMMITTEES AIMED AT ESTABLISHING A DIALOGUE AROUND THE BENElTS OF INTEGRATION 4HE POWER OF INFORMATION CAN DRAMATICALLY IMPACT THE PROVIDERS ABILITY TO DELIVER QUALITY CARE TO PATIENTS !CCESS TO THE SAME DATA A PAYER TRACKS EG PRESCRIPTION RElLLS CONSULTING PHYSICIAN VISITS AND DATA FROM CLAIMS THAT POINT TO MULTIPLE PROVIDERS TREATING A PHYSICIANS PATIENT OF WHICH HE SHE MAY BE UNAWARE ALLOWS A PROVIDER TO ADJUST TREATMENT PLANS AS NEEDED TO MEET A PATIENTS HEALTHCARE NEEDS /NE OF THE WAYS THAT PAYERS ARE BREAKING DOWN BARRIERS WITH PROVIDERS IS THROUGH PAY FOR PERFORMANCE PROGRAMS THAT PROVIDE BOTH lNANCIAL AND NONlNANCIAL INCENTIVES TO IMPROVE THE QUALITY AND EFlCIENCY OF HEALTHCARE SERVICES )NCENTIVES ARE ALSO OFFERED TO MEMBERS BY EMPLOYERS TO ENCOURAGE PARTICIPATION IN HEALTH AND WELLNESS PROGRAMS "Y ENCOURAGING EMPLOYEES TO ATTEND GROUP WEIGHT LOSS MEETINGS FOR EXAMPLE AN EMPLOYER COULD POTENTIALLY HEAD OFF EXPENSIVE DIABETES RELATED HEALTH COSTS /FFERING OPPORTUNITIES FOR EXERCISE SUCH AS DISCOUNTED RATES AT A lTNESS CENTER OR A COMPANY GYM IS A STRATEGY EMPLOYED BY SOME COMPANIES TO TRIM HEALTHCARE COSTS RESULTING FROM UNHEALTHY LIFESTYLES )NFORMATION SHARING IS KEY TO IDENTIFYING POSSIBLE GAPS IN MEMBER CARE )N A COLLABORATIVE ENVIRONMENT CASE MANAGERS NOTIFY PHYSICIANS ABOUT INCONSISTENCIES IN PATIENT DATA SUCH AS HEALTH RISK ASSESSMENT INFORMATION &OR EXAMPLE MOST PHYSICIANS DO NOT HAVE TIME TO SCREEN FOR DEPRESSION HOWEVER THE PRESENCE OF MENTAL HEALTH ISSUES CAN AFFECT MEDICAL OUTCOMES "Y ALERTING PHYSICIANS TO THIS KIND OF INFORMATION CASE MANAGERS HELP PATIENTS TO BE TREATED PROACTIVELY )NFORMATION SHARING ALSO MUST OCCUR INTERNALLY AND WITH OUTSOURCED VENDOR PROGRAMS 4RIGGERS FROM MULTIPLE SOURCES LIKE CUSTOMER SERVICE WORKSITE WELLNESS PROGRAMS HOUR NURSELINES ETC MUST BE INCORPORATED IN THE CASE lNDING ALGORITHMS
,OOKING !HEAD 4HE EMERGING PARADIGM OF INTEGRATED TOTAL HEALTH MANAGEMENT PROMISES TO UNITE ALL PLAYERS IN THE HEALTHCARE INDUSTRY IN A COLLABORATIVE ENVIRONMENT CENTERED ON THE WHOLE PATIENT AND THE WHOLE POPULATION )MPROVEMENTS IN BOTH lNANCIAL AND QUALITY OUTCOMES AWAIT 0AYERS AND PROVIDERS CAN ACHIEVE THIS INNOVATIVE CHANGE BY PUTTING A DISCIPLINED APPROACH INTO PLAY TO MAKE THE INTEGRATED TOTAL HEALTH MANAGEMENT VISION A REALITY AND CONTRIBUTE TOWARD A SUSTAINABLE HEALTHCARE SYSTEM %NDNOTE h$ESPITE "ARRIERS -#/S )NTEGRATE #ASE $ISEASE 5TILIZATION -ANAGEMENT &UNCTIONS v -ARCH -ANAGED #ARE 7EEK
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
)NTEGRATING -EDICAL AND 0RODUCTIVITY -ANAGEMENT !S GREATER RATES OF CHRONIC DISEASE KEEP EMPLOYEES OUT OF WORK IN RECORD NUMBERS AND TAKE A TOLL ON PRODUCTIVITY INNOVATIVE EMPLOYERS ARE CREATING INTEGRATED PROGRAMS TO IMPROVE THE QUALITY OF EMPLOYEE HEALTH
"Y *ACKIE -AZOWAY AND -ARY !NN 3HEA 0RICEWATERHOUSE#OOPERS
)
N THE WORKPLACE THE TERM hLOST TIMEv DOES NOT REFER TO A CLOCK THAT TICKS TOO SLOWLY OR A FEW MOMENTS STOLEN FROM A BUSY DAY )NSTEAD THE PHRASE IS USED BY COMPANIES TO DESCRIBE REAL LOSSES IN PRODUCTIVITY DUE TO EMPLOYEE HEALTH ISSUES ,ABOR TIME LOST DUE TO HEALTH REASONS COSTS !MERICAN COMPANIES APPROXIMATELY BILLION PER YEAR ACCORDING TO A STUDY BY THE #OMMONWEALTH &UND A FOUNDATION THAT WORKS TO IMPROVE HEALTHCARE QUALITY AND COVERAGE;= )MPROVED MANAGEMENT OF LOST TIME OFFERS A SIGNIlCANT OPPORTUNITY FOR COMPANIES TRYING TO REDUCE MEDICAL COSTS AND IMPROVE PRODUCTIVITY (OWEVER IT IS ONLY WHEN COMPANIES UNDERSTAND WHERE AND WHY THEY LOSE TIME THAT THEY CAN BEGIN TO EXPLORE THIS OPPORTUNITY 4ODAYS COMPLICATED HEALTHCARE DELIVERY AND lNANCING SYSTEM MAKES IT DIFlCULT FOR EMPLOYERS TO EFlCIENTLY INTEGRATE THEIR DISABILITY WORKERS COMPENSATION AND HEALTHCARE PROGRAMS INTO A SEAMLESS EFlCIENT SYSTEM OF CARE !S A RESULT LOST TIME BECOMES A PROBLEM THAT IS DIFlCULT TO MEASURE AND SOLVE
!BSENTEEISM COSTS EMPLOYERS MORE THAN JUST LOST WAGES #OMPANIES MAY HAVE TO PAY ANOTHER EMPLOYEE OVERTIME TO COVER THE ABSENT WORKER AND A LESS SKILLED SUBSTITUTE MAY NOT ALWAYS DELIVER THE SAME QUALITY OF WORK !LSO EXTRA ADMINISTRATIVE TIME IS REQUIRED TO SECURE REPLACEMENT EMPLOYEES OR REASSIGN WORK TO REMAINING EMPLOYEES 0RESENTEEISM OR WORKERS ON THE JOB WHOSE PRODUCTIVITY IS IMPAIRED BECAUSE OF ILLNESS OR OTHER MEDICAL CONDITIONS ALSO CONTRIBUTES TO LOST TIME ,AST YEAR THE *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION REPORTED THAT DEPRESSION COST 53 EMPLOYERS BILLION A YEAR IN REDUCED PERFORMANCE AT WORK;= AND THAT PAIN FROM PROBLEMS SUCH AS ARTHRITIS HEADACHES AND BACK PROBLEMS COST NEARLY BILLION;= 5NLIKE DISABILITY CLAIMS OR ABSENTEEISM WHICH ARE RELATIVELY EASY TO MEASURE PRESENTEEISM IS FAIRLY NEBULOUS )T IS EASY TO BENCHMARK WHEN EMPLOYEES FAIL TO SHOW UP FOR WORK BUT DIFlCULT TO MEASURE HOW A MEDICAL CONDITION MAY HINDER PERFORMANCE
4HE 0ROBLEM OF ,OST 4IME
4HE )MPACT ON 1UALITY
)N ADDITION TO LOST TIME DUE TO DISABILITY WORKERS TAKE TIME OFF BECAUSE OF ACCIDENTS ILLNESS LACK OF JOB SATISFACTION PERSONAL PROBLEMS lNANCIAL MARITAL SUBSTANCE ABUSE CHILD CARE ETC TRANSPORTATION PROBLEMS AND STRESS RELATED ILLNESSES SUCH AS DEPRESSION !CCORDING TO lNDINGS OF THE ANNUAL ##( 5NSCHEDULED !BSENCE 3URVEY 53 EMPLOYERS ARE STILL STRUGGLING TO lND EFFECTIVE SOLUTIONS THAT KEEP HEALTHY WORKERS ON THE JOB 4HE SURVEY REPORTED THAT THE RATE OF UNSCHEDULED ABSENTEEISM HAD CLIMBED TO A lVE YEAR HIGH OF PERCENT;= ,AST YEAR THE RATE OF UNSCHEDULED ABSENTEEISM BARELY BUDGED HOWEVER THE AVERAGE PER EMPLOYEE RATE ROSE TO COSTING SOME LARGE EMPLOYERS MORE THAN MILLION PER YEAR;=
-OST 53 COMPANIES JUGGLE A ROSTER OF VENDORS TO MANAGE THEIR EMPLOYEE BENElT NEEDS 5NFORTUNATELY EACH OPERATES INDEPENDENTLY !N EMPLOYEE HEALTH PLAN IS MANAGED BY ONE INSURER 3HORT TERM DISABILITY IS EITHER COVERED IN HOUSE OR BY A THIRD PARTY ADMINISTRATOR ,ONG TERM DISABILITY AND WORKERS COMPENSATION ARE ALSO MANAGED SEPARATELY ! SINGLE EMPLOYEE MAY HAVE MULTIPLE INSURANCE CLAIMS SCATTERED AMONG SEVERAL INSURERS BECAUSE THERE IS NO CENTRALIZED SYSTEM FOR BENElTS MANAGEMENT !LL OF THESE PLAYERS COLLECT MEDICAL DATA SEPARATELY RESULTING IN REDUNDANT RECORD KEEPING &RAGMENTED CASE MANAGEMENT ALSO OCCURS RESULTING IN INEFlCIENT UTILIZATION AND INCREASED SPENDING AS COORDINATION EFFORTS INEVITABLY OVERLAP
*ACKIE -AZOWAY 2. IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE FOCUSES ON QUALITY AND PROCESS IMPROVEMENT FOR MANAGED CARE ORGANIZATIONS AND HAS YEARS OF EXPERIENCE WORKING WITHIN HEALTH MANAGEMENT PROGRAMS FOR PAYERS 3HE ALSO ASSISTS EMPLOYERS IN EVALUATING AND CHOOSING HEALTH MANAGEMENT PROGRAMS FOR THEIR EMPLOYEE BENElT PLANS 3HE CAN BE REACHED AT JACKIEMAZOWAY USPWCCOM -ARY !NN 3HEA -(3! IS A PRINCIPAL IN 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE -ARY !NN HAS OVER YEARS EXPERIENCE IN THE HEALTHCARE INDUSTRY 3HE WORKS WITH HEALTHCARE PAYERS AND SPECIALIZES IN PERFORMANCE IMPROVEMENT ACROSS THE AREAS OF MEDICAL MANAGEMENT PROVIDER CONTRACTING ADMINISTRATION AND CLAIM OPERATIONS 3HE CAN BE REACHED AT MARYANNSHEA USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
HMSDF Q@SHMF ãLDCHB@Kã@MCãOQNCT BSHU HSXãL@M@FD L D MS $ElNITIONS 3HORT AND ,ONG TERM $ISABILITY 3HORT TERM DISABILITY INSURANCE PAYS A SALARY REPLACEMENT BENElT WHEN AN EMPLOYEE HAS A NON WORK RELATED DISABILITY BECAUSE OF AN ACCIDENT ILLNESS OR PREGNANCY 4HE EMPLOYER DETERMINES THE BENElT AMOUNT THE DAY BENElTS BEGIN AND THE MAXIMUM PERIOD FOR WHICH BENElTS ARE PAYABLE 3HORT TERM DISABILITY TYPICALLY COVERS AN EMPLOYEE FOR UP TO SIX MONTHS 3OME COMPANIES SELF INSURE MEANING THEY COVER THE COST OF PAYING THESE EMPLOYMENT BENElTS 2EGARDLESS OF WHETHER THEY SELF INSURE SOME EMPLOYERS OFTEN OUTSOURCE THE DAY TO DAY ADMINISTRATION OF THE PROGRAM ,ONG TERM DISABILITY INSURANCE USUALLY BEGINS AFTER THE SHORT TERM DISABILITY COVERAGE PERIOD ENDS COVERING A PORTION OF THE SALARY IF AN EMPLOYEE IS OUT OF WORK FOR AN EXTENDED PERIOD 4HE MAJORITY OF COMPANIES FULLY INSURE LONG TERM DISABILITY OUTSOURCING MANAGEMENT OF THE MEDICAL EPISODE CLAIMS PAYMENT AND PROCESSING AND COORDINATION OF THE EMPLOYEES TIME OFF 7ORKERS #OMPENSATION 7ORKERS COMPENSATION INSURANCE PAYS BENElTS REQUIRED UNDER A STATES WORKERS COMPENSATION LAW FOR MEDICAL CARE AND PHYSICAL REHABILITATION OF INJURED WORKERS )T ALSO REPLACES LOST WAGES IF WORKERS ARE HURT DURING WORK RELATED ACTIVITIES 3TATE LAWS WHICH VARY FROM STATE TO STATE GOVERN THE AMOUNT OF BENElTS PAID AND OTHER COMPENSATION PROVISIONS ! COMPANY MUST ABIDE BY LAWS IN EACH STATE WHERE IT HAS WORKERS SO FOR A LARGE CORPORATION WITH OFlCES ACROSS THE COUNTRY AN OUTSIDE WORKERS COMPENSATION SPECIALIST IS OFTEN THE BEST CHOICE TO ADMINISTER THESE CLAIMS
3EVERAL PROVIDERS MAY SERVE ONE MEMBER $UE TO STATE REGULATIONS A WORKER MAY SEE ONE SET OF HEALTH PLAN DOCTORS AND A DIFFERENT PHYSICIAN GROUP FOR A WORKERS COMPENSATION INJURY 4HIS ADDS ANOTHER LAYER OF PAYERS AND PROVIDERS TO AN INCREASINGLY COMPLEX NETWORK 4HE LACK OF FULLY INTEGRATED TECHNOLOGY SYSTEMS ALSO PREVENTS EFFECTIVE COORDINATION ,ACK OF INTEGRATED DATA PREVENTS EMPLOYERS AND PAYERS FROM SHARING INFORMATION THAT COULD BE LEVERAGED TO SPOT TRENDS WHICH COULD AID IN PLANNING AND DECISION MAKING )N ADDITION TO ADMINISTRATIVE INEFlCIENCY EMPLOYEE CARE SUFFERS #ONSIDER A FEMALE EMPLOYEE DIAGNOSED WITH BREAST CANCER WHO UNDERGOES A MASTECTOMY (ER DOCTOR WORKS WITH THE MEDICAL MANAGEMENT TEAM FROM HER COMMERCIAL HEALTH PLAN TO KEEP HER OUT OF WORK FOR TWO MONTHS TO ALLOW HER TO FULLY RECOVER FROM RECONSTRUCTIVE SURGERY AND BEGIN HER CHEMOTHERAPY AND RADIATION TREATMENTS ! DISABILITY MANAGEMENT NURSE IS ALSO HANDLING THE CASE AND CONVINCES THE PHYSICIAN TO ALLOW THE WOMAN TO GO BACK TO WORK PART TIME !FTER RETURNING TO WORK THE EMPLOYEE IS
FREQUENTLY ABSENT BECAUSE OF SCHEDULED TREATMENTS 7HILE AT WORK SHE FEELS NAUSEOUS AND FATIGUED FROM CHEMOTHERAPY SO SHE IS PRODUCTIVE ONLY HALF THE TIME )N THIS CASE THE LACK OF COORDINATION BETWEEN THE MEDICAL AND THE DISABILITY MANAGEMENT CASE MANAGERS HAS RESULTED IN A POOR HEALTHCARE EXPERIENCE FOR THE MEMBER A NONPRODUCTIVE EMPLOYEE RETURNING TO THE WORKFORCE DUPLICATION OF EFFORTS BETWEEN THE TWO NURSES AND INEFFECTIVE AND CONmICTING COMMUNICATION WITH THE TREATING PHYSICIAN !S ANOTHER EXAMPLE A GROUP OF )4 SYSTEMS DEVELOPERS MAY BE SUFFERING FROM FREQUENT ON THE JOB MIGRAINES WHICH MAY BE FROM LONG HOURS SPENT IN FRONT OF THEIR COMPUTERS )N THE CURRENTLY FRAGMENTED BENElTS MANAGEMENT SYSTEM THIS GROUP WOULD LIKELY NOT BE IDENTIlED AS HAVING A WORK RELATED HEALTH ISSUE DUE TO THE ABSENCE OF A DOCTORS DIAGNOSIS 0RODUCTIVITY FOR THIS GROUP MAY BE LOW BUT WOULD TYPICALLY NOT BE MEASURED THE COMPANY WOULD NOT REALIZE PERFORMANCE WAS BELOW PAR )F MULTIPLE EMPLOYEES WERE SEEING PHYSICIANS FOR MIGRAINES IT IS PROBABLE THAT THE INDIVIDUAL CLAIM DOLLARS PAID WOULD NOT TRIGGER A MANAGEABLE EVENT WITHIN PAYERS CLAIMS ORGANIZATIONS 4HE EMPLOYER WOULD NOT REALIZE THAT IN AGGREGATE THIS GROUP OF EMPLOYEES WAS CONTRIBUTING TO LOW PRODUCTIVITY IN THEIR DEPARTMENT 4HE INABILITY TO ANALYZE DATA AND TARGET THE CAUSES OF WORKER HEALTH PROBLEMS PREVENTS PROACTIVE MANAGEMENT 4HUS THE COST OF LOST TIME CONTINUES TO RISE NEGATIVELY IMPACTING BOTTOM LINE PROlT MARGINS AND THE ABILITY FOR MANY COMPANIES TO STAY COMPETITIVE IN A GLOBAL MARKETPLACE 53 WORKERS HAVE ALWAYS ENJOYED GENEROUS HEALTHCARE BENElTS FROM THEIR EMPLOYERS COMPARED TO THE REST OF THE WORLD HOWEVER THESE BENElTS ARE BECOMING INCREASINGLY EXPENSIVE AND DIFlCULT TO SUPPORT
4HE 3OLUTION )NTEGRATED "ENElTS -ANAGEMENT !N INTEGRATED BENElTS AND PRODUCTIVITY MANAGEMENT APPROACH WOULD DRIVE DOWN THE COSTS OF LOST TIME WHILE INCREASING THE QUALITY OF EMPLOYEE HEALTHCARE !S ILLUSTRATED IN %XHIBIT AN IDEAL PROGRAM WOULD MERGE AN EMPLOYEES MEDICAL RESULTS FROM HEALTH PLAN CLAIMS WITH DISABILITY RECORDS TO DETERMINE EXACTLY HOW MUCH TIME AND MONEY ARE BEING SPENT ON EMPLOYEE HEALTH ISSUES &OR EXAMPLE IF AN EMPLOYER SUSPECTED A HIGH INCIDENCE OF EMPLOYEE BACK PAIN TIME LOST FROM BACK INJURY AND RECORDS KEPT BY THE HEALTH PLAN THE SHORT TERM DISABILITY ADMINISTRATOR THE LONG TERM DISABILITY INSURER AND THE WORKERS COMPENSATION CARRIER WOULD BE ANALYZED AS AGGREGATED DATA )MAGINE TAKING THIS FURTHER BY FOLDING IN ABSENTEEISM DATA FROM EMPLOYEES WHO LEFT WORK FOR PHYSICAL THERAPY OR RECORDS OF WORKERS WHO WERE LESS PRODUCTIVE ON THE JOB DUE TO BACK PAIN 3O WHAT CAN A COMPANY DO TO MOVE TOWARD AN INTEGRATED BENElTS MANAGEMENT APPROACH
,INK THE 0AYERS 3OME INSURERS ARE ALREADY INTEGRATING PRODUCTS IN AN ATTEMPT TO HELP EMPLOYERS BETTER MANAGE BENElTS 3OME HAVE BEGUN PACKAGING MEDICAL DISABILITY PHARMACY AND BEHAVIORAL HEALTH
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
HMSDF Q@SHMF ãLDCHB@Kã@MCãOQNCT BSHU HSXãL@M@FD L D MS
%XHIBIT )NTEGRATING -EDICAL AND $ISABILITY -ANAGEMENT
COVERAGE TOGETHER TO GAIN SOME OF THE COST AND QUALITY BENElTS OF A MORE INTEGRATED APPROACH &OR EXAMPLE ONE LARGER INSURER HAS COUPLED A CHRONIC CARE MANAGEMENT PROGRAM WITH ITS DISABILITY PRODUCT THAT FOCUSES ON THE CONDITIONS THAT ARE THE LEADING CAUSE OF DISABILITY EG HEART DISEASE "Y FOCUSING ON CONTROLLING CHRONIC CONDITIONS ITS CUSTOMERS CAN DIRECTLY IMPACT THE NUMBER AND LENGTH OF DISABILITY CLAIMS AND THE ASSOCIATED MEDICAL COSTS REGARDLESS OF WHO IS PROVIDING THE HEALTH INSURANCE PROGRAM 4HE INSURER ALSO HAS DEVELOPED ON SITE DISABILITY MANAGEMENT THAT IT OFFERS AS PART OF ITS FULLY INSURED LONG TERM COVERAGE FOR EMPLOYERS WHO WANT TO RETAIN CONTROL OF ADMINISTERING THEIR SICK LEAVE OR SHORT TERM DISABILITY PROGRAMS )T HAS SEEN A REDUCTION IN SHORT TERM DISABILITY DURATIONS AND LONG TERM DISABILITY CLAIMS AS CASE MANAGEMENT NURSES ARE ABLE TO IDENTIFY SHORT TERM DISABILITIES THAT REQUIRE INTENSIVE CASE MANAGEMENT 4HE ONUS IS ON EMPLOYERS WHO DO NOT CHOOSE A PACKAGED PLAN FROM AN INNOVATIVE INSURER TO TAILOR AN INTEGRATED MANAGEMENT PLAN THAT TIES IN ALL PLAYERS AND ALLOWS DATA SHARING 4HEY CAN MAKE THIS HAPPEN BY INSISTING ON BETTER COORDINATION BETWEEN THE GROUP HEALTH PLAN AND DISABILITY VENDORS THROUGH IMPROVED COLLABORATION AS WELL AS CONNECTED TECHNOLOGY SYSTEMS AND DATA THAT ALLOW THE EMPLOYER TO IDENTIFY TRENDS IN MEDICAL CONDITIONS ACROSS CARRIERS AND PROGRAMS
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
'ATHER AND !NALYZE THE $ATA (ISTORICALLY BENElTS DATA HAVE BEEN MANAGED IN SEPARATE INFORMATION SILOS (EALTH AND WORKERS COMPENSATION FREQUENTLY ARE MANAGED WITHIN TWO DIFFERENT DEPARTMENTS OF AN EMPLOYER WITH THE WORKERS COMPENSATION MANAGED IN THE RISK MANAGEMENT AREA AND THE HEALTH BENElTS MANAGED THROUGH HUMAN RESOURCES OR THE BENElTS MANAGEMENT AREA 4HIS HAS FRAGMENTED THE VIEW OF KEY DRIVERS OF BOTH HEALTH AND PRODUCTIVITY ACROSS THE ORGANIZATION "Y AGGREGATING CLAIMS DATA A PAYER WOULD BE ABLE TO ANALYZE INFORMATION AND WORK CLOSELY WITH AN EMPLOYER TO DESIGN PROGRAMS THAT WOULD POSITIVELY IMPACT THE KEY EMPLOYEE HEALTH DRIVERS 4ODAY RELEVANT EMPLOYEE CLAIMS DATA PRODUCTIVITY METRICS AND MEMBER AND WORKFORCE SELF REPORTED DATA CAN BE SYNTHESIZED TO IDENTIFY ROOT CAUSES OF EMPLOYEE HEALTH ISSUES /NCE CLAIMS DATA HAVE BEEN AGGREGATED EMPLOYERS CAN WORK WITH PAYERS TO ANALYZE THE INFORMATION TO DETERMINE KEY EMPLOYEE HEALTH DRIVERS 4HESE DATA VARY BY DEMOGRAPHICS INDUSTRY AND GEOGRAPHY &OR EXAMPLE COMPANIES NEED TO RECOGNIZE THAT DEPRESSION IS THE LEADING CAUSE OF DISABILITY IN WOMEN;= !GE ALSO PLAYS A FACTOR (ALF OF !MERICANS AGED TO HAVE HIGH BLOOD PRESSURE n A MAJOR RISK FACTOR FOR HEART DISEASE AND STROKE n AND TWO IN lVE ARE OBESE ACCORDING TO h(EALTH 5NITED 3TATES v THE GOVERNMENTS ANNUAL REPORT TO THE PRESIDENT AND #ONGRESS ON !MERICAN HEALTH;= "Y PAYING ATTENTION TO EMPLOYEE DIFFERENCES COMPANIES CAN USE THIS INFORMATION TO IMPLEMENT CREATIVE WORKPLACE SOLUTIONS TO PREVENT OR LESSEN THE EFFECTS OF HEALTH ISSUES ON PRODUCTIVITY
#REATIVE 7ORKPLACE 3OLUTIONS !N EMPLOYER WITH A GREATER PERCENTAGE OF FEMALE WORKERS COULD FOR EXAMPLE IMPLEMENT DEPRESSION SCREENING TO HELP WOMEN lND WAYS TO COPE WITH DEPRESSION AND PREVENT IT FROM IMPACTING WORK TIME #OMPANIES WITH MANY EMPLOYEES OVER THE AGE OF COULD IMPROVE THE CAFETERIA MENU AND PROVIDE FREE NUTRITIONAL COUNSELING TO OVERWEIGHT WORKERS TO REDUCE THE RISK OF DIABETES AND HEART DISEASE "Y IMPLEMENTING PROACTIVE DISEASE MANAGEMENT PROGRAMS EMPLOYERS CAN REDUCE THE INCIDENCE OF EXPENSIVE TREATMENTS LATER ON 3OME COMPANIES ARE MAKING HEADWAY ON GATHERING THESE DATA HOWEVER ONE OF THE MOST SIGNIlCANT MISSING PIECES TO DATE HAS BEEN PRESENTEEISM INFORMATION (OW MANY FULL TIME WORKERS ARE ACTUALLY FUNCTIONING AT CAPACITY (OW MANY OTHERS ARE GIVING A SIX HOUR WORKDAY INSTEAD OF EIGHT BECAUSE OF CHRONIC OR EPISODIC AILMENTS SUCH AS MIGRAINES ASTHMA BACK PAIN DEPRESSION OR GASTROINTESTINAL PROBLEMS
HMSDF Q@SHMF ãLDCHB@Kã@MCãOQNCT BSHU HSXãL@M@FD L D MS )NNOVATIVE INSURERS ARE HELPING COMPANIES BETTER UNDERSTAND TIME LOST ON THE JOB FROM CHRONIC AILMENTS &OR EXAMPLE !ETNA RECENTLY LICENSED THE 7ORK ,IMITATION 1UESTIONNAIRE 7,1 FROM 4UFTS .EW %NGLAND -EDICAL #ENTER TO HELP EMPLOYERS BETTER UNDERSTAND EMPLOYEE HEALTH STATUS AND TO HELP WORKERS IMPROVE THEIR OWN HEALTH AND PRODUCTIVITY %MPLOYEES COMPLETE THE QUESTIONNAIRE INDEPENDENTLY TO MEASURE THE EFFECTS OF CHRONIC HEALTH CONDITIONS AFFECTING JOB PERFORMANCE 4HE DATA RESULTING FROM THE 7,1 SHOULD HELP EMPLOYERS WORK WITH PROVIDERS AND DISABILITY MANAGERS TO GAUGE THE MAGNITUDE AND EFFECT THAT CERTAIN HEALTH RELATED ISSUES SUCH AS ARTHRITIS HEADACHES AND BACK PROBLEMS HAVE IN THE WORKPLACE;= )MPROVED DATA ANALYSIS HELPS EMPLOYERS CREATE TARGETED ACTION PLANS TO REDUCE HEALTHCARE COSTS AND INCREASE WORKPLACE PERFORMANCE &OR EXAMPLE A STUDY FOUND THAT ONE QUARTER OF ALL ALLERGY SUFFERERS IN A BANKS CALL CENTER DID NOT TAKE ALLERGY MEDICATION WHICH WAS REmECTED AS A PERCENT REDUCTION IN PRODUCTIVITY DURING PEAK RAGWEED POLLEN SEASON 4HE COMPANY CONCLUDED THAT PROVIDING ALLERGY SUFFERERS WITH NON SEDATING ANTIHISTAMINES AT PER WEEK WOULD COST LESS THAN THE A WEEK LOSS IN PRODUCTIVITY PER WORKER;= )N ORDER TO DEVELOP CREATIVE SOLUTIONS BOTH PAYERS AND EMPLOYERS NEED TO BE mEXIBLE AND BUILD RESOURCEFUL INTERVENTION PROGRAMS TO MEET EMPLOYEE NEEDS ! COMPANY THAT ANALYZED ENOUGH DATA TO DISCOVER THAT A GREAT DEAL OF WORKERS JOB TIME WAS SPENT AT DOCTOR APPOINTMENTS COULD WORK WITH ITS HEALTH PLAN TO EXPAND THE NETWORK OF PROVIDERS IN THE GEOGRAPHIC AREA SURROUNDING THE WORKPLACE /R PERHAPS IT COULD CONSIDER REIMBURSING FOR PHYSICIAN OR NURSE TELEPHONIC CONSULTATIONS TO CUT TIME SPENT TRAVELING TO DOCTORS OFlCES ! COMPANY NOTICING A SPIKE IN BACK PAIN CLAIMS MIGHT ASK THE HEALTH PLAN TO ADD CHIROPRACTIC CARE AS A COVERED SERVICE OR PERHAPS PAY FOR MASSAGE THERAPY THROUGH A HEALTH REIMBURSEMENT ACCOUNT )NTEGRATED BENElTS MANAGEMENT PROVIDES ADVANTAGES ACROSS THE BOARD %MPLOYERS WIN WITH HEALTHIER EMPLOYEES IMPROVED MORALE AND INCREASED BUSINESS PERFORMANCE BASED ON BETTER QUALITY PRODUCTS AND SERVICES 0AYERS ALSO WIN BECAUSE THEY CAN INCREASE MEMBERSHIP REDUCE COSTS AND CREATE A COHESIVE RELATIONSHIP WITH EMPLOYERS BY OFFERING INTEGRATED SERVICES -EMBERS HAVE THE MOST TO GAIN BY RECEIVING BETTER QUALITY HEALTHCARE
4HE 0ROMISE OF )NTEGRATION &RAGMENTED BENElTS MANAGEMENT WILL FADE INTO THE PAST AS MORE EMPLOYERS SEE THE ADVANTAGES TO BE GAINED BY COORDINATING CARE AROUND EACH WORKER ! CONNECTED SYSTEM n ONE IN WHICH HEALTH AND DISABILITY INSURERS SHARE CASE MANAGEMENT EFFORTS AND DATA n IS THE INEVITABLE WAY OF THE FUTURE FOR COMPANIES SEEKING TO REDUCE HEALTHCARE COSTS AND BOOST EMPLOYEE PRODUCTIVITY )N ADDITION TO CONNECTING PAYERS AND THEIR PROCESSES SUCCESSFUL EMPLOYERS WILL MAKE DATA SHARING AND ANALYSIS A PRIORITY TO BUILD CREATIVE SOLUTIONS THAT BOOST WORKPLACE PERFORMANCE AND DELIVER A BETTER QUALITY OF EMPLOYEE HEALTHCARE
%NDNOTES $AVIS + ET AL h(EALTH AND 0RODUCTIVITY !MONG 53 7ORKERS v !UGUST 4HE #OMMONWEALTH &UND HTTPWWWCMWFORGUSR?DOC? DAVIS?HLT?PRODUCTIVITY?USWORKERSPDF h&OURTEENTH !NNUAL ##( 5NSCHEDULED !BSENCE 3URVEY v ##( )NCORPORATED HTTPWWWCCHCOMPRESSNEWSHASP h&IFTEENTH !NNUAL ##( 5NSCHEDULED !BSENCE 3URVEY #OSTLY 0ROBLEM OF 5NSCHEDULED !BSENTEEISM #ONTINUES TO 0ERPLEX %MPLOYERS v /CTOBER HTTPWWWCCHCOMPRESSNEWS HASP 3TEWART 7 & ET AL h#OST OF ,OST 0RODUCTIVE 7ORK 4IME !MONG 53 7ORKERS WITH $EPRESSION v *UNE *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION 3TEWART 7 & ET AL h,OST 0RODUCTIVE 4IME AND #OST $UE TO #OMMON 0AIN #ONDITIONS IN THE 53 7ORKFORCE v .OVEMBER *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION -URRAY # * , AND ! $ ,OPEZ EDS h4HE 'LOBAL "URDEN OF $ISEASE AND )NJURY 3ERIES 6OLUME ! #OMPREHENSIVE !SSESSMENT OF -ORTALITY AND $ISABILITY FROM $ISEASES )NJURIES AND 2ISK &ACTORS IN AND 0ROJECTED TO v #AMBRIDGE -ASS 4HE (ARVARD 3CHOOL OF 0UBLIC (EALTH ON BEHALF OF THE 7ORLD (EALTH /RGANIZATION AND THE 7ORLD "ANK (ARVARD 5NIVERSITY 0RESS HTTPWWWNIMHNIHGOVPUBLICAT BURDENCFM h(EALTH 5NITED 3TATES WITH #HARTBOOK ON 4RENDS IN THE (EALTH OF !MERICANS v $ECEMBER 0(3 #ENTERS FOR $ISEASE #ONTROL AND 0REVENTION PP h!ETNA AND 4UFTS .EW %NGLAND -EDICAL #ENTER TO (ELP %MPLOYERS -EASURE ,INK "ETWEEN (EALTH AND 0RODUCTIVITY v -ARCH HTTPWWWAETNACOMNEWSPR?HTM (EMP 0 h0RESENTEEISM !T 7ORK n "UT /UT OF )T v /CTOBER (ARVARD "USINESS 2EVIEW P
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1UALITY IN -EDICAID 0ROGRAMS .EW APPROACHES SUCH AS PAY FOR PERFORMANCE MAY IMPROVE THE QUALITY OF CARE FOR -EDICAID PATIENTS
"Y 3ANDRA (UNT 0RICEWATERHOUSE#OOPERS
3OME "ACKGROUND ON -EDICAID &OR MILLION LOW INCOME !MERICANS -EDICAID PROVIDES lNANCING FOR HEALTHCARE AND LONG TERM CARE SERVICES MORE THAN ANY OTHER SINGLE HEALTHCARE PROGRAM IN THE 53;= -EDICAID HOWEVER FACES SERIOUS lNANCIAL THREATS THAT ENDANGER THE HEALTH OF !MERICAS POOREST CITIZENS 4HE FEDERAL GOVERNMENT ESTIMATES NEARLY MILLION PEOPLE LACK COVERAGE;= IF -EDICAID FUNDING WERE CUT OR CAPPED THE NUMBER OF UNINSURED WOULD RISE DRAMATICALLY &OR THIS REASON HEALTHCARE ADVOCATES AND LEGISLATORS ARE LOOKING AT CREATIVE WAYS TO CONTROL THE GROWTH IN -EDICAID SPENDING WITHOUT COMPROMISING HEALTHCARE SERVICES -EDICAID IS EXPENSIVE COSTING TAXPAYERS APPROXIMATELY BILLION IN ;= 4O KEEP EXPENDITURES IN LINE WITH TAX REVENUES AND TO IMPROVE PATIENT OUTCOMES STATE -EDICAID AGENCIES HAVE BEGUN TO IMPLEMENT QUALITY STANDARDS TO INCREASE EFlCIENCY STREAMLINE OPERATIONS AND REDUCE SPENDING
-EDICAID AND -ANAGED #ARE !PPLYING MANAGED CARE PRINCIPLES TO -EDICAID IS ONE WAY PRACTITIONERS HAVE ATTEMPTED TO DELIVER QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER )N STATES BEGAN SETTING UP -EDICAID MANAGED CARE PROGRAMS TO ALLOW LOW INCOME RECIPIENTS GREATER EXPOSURE TO QUALITY HEALTHCARE SERVICES !T THE ONSET THESE PROGRAMS WERE PRIMARILY FOCUSED ON RECIPIENTS OF !ID TO &AMILIES WITH $EPENDENT #HILDREN NOW KNOWN AS 4EMPORARY !ID TO .EEDY &AMILIES OR 4!.& (OWEVER STATES NOW APPLY THE MANAGED CARE CONCEPT MORE WIDELY INCLUDING PEOPLE WITH SPECIAL NEEDS 7HEN A STATE CONTRACTS WITH A MANAGED CARE PLAN PAYMENTS ARE BASED ON A MONTHLY CAPITATION RATE PER -EDICAID ENROLLEE SIMILAR TO PAYING A PREMIUM FOR A COMMERCIAL MEMBER 4HESE RATES REFERENCE A SET OF HISTORICAL DATA AND HELP DETERMINE WHAT WILL BE PAID TO THE HEALTH PLAN )NCREASINGLY THESE PAYMENTS ARE ENHANCED BASED ON COMPLIANCE WITH A SET OF PERFORMANCE OBJECTIVES THAT SUPPORT PREVENTIVE CARE OR DISEASE MANAGEMENT
PROGRAMS 0LANS THAT MEET THESE CRITERIA MAY BE ELIGIBLE TO RECEIVE BONUSES
1UALITY "ARRIERS )NCORPORATING QUALITY INTO -EDICAID MANAGED CARE POSES CHALLENGES ON SEVERAL FRONTS &IRST THE BASIC PROGRAM STRUCTURE INVOLVES LIMITED OR NO COST SHARING AT THE POINT OF PURCHASE BY THE INDIVIDUAL !LTERNATIVELY MANY COMMERCIAL HEALTH PLANS USE TIERED COST SHARING TO PROVIDE INCENTIVES FOR MEMBERS TO USE PARTICULAR PROVIDERS AND QUALITY RANKINGS MAY BE ONE CRITERION USED TO DETERMINE THE LEVEL OF COPAYMENT 0ROVIDERS ARE ASSIGNED TO DIFFERENT LEVELS BASED UPON HOW WELL THEY PERFORM AND THEIR COMPENSATION "ECAUSE COST SHARING DIFFERENTIALS ARE LIMITED AND OFTEN UNENFORCEABLE IN -EDICAID PEOPLE CANNOT BE CHANNELED TOWARD SPECIlC PROVIDERS BASED ON DIFFERENCES IN COST SHARING SO OTHER APPROACHES TO DIRECTING INDIVIDUALS TO HIGH QUALITY PROVIDERS MUST BE CONSIDERED -EDICAID ALSO LACKS THE LEVERAGE OF COMMERCIAL HEALTH PLANS BECAUSE PROVIDER PAYMENT RATES ARE GENERALLY THE LOWEST OF ANY PAYMENT SOURCE !LTHOUGH THIS IS NOT TRUE IN EVERY PROGRAM AREA NAMELY PRESCRIPTION DRUGS -EDICAID IS USUALLY CONSIDERED TO BE THE LOWEST PAYER OVERALL !S A NATIONAL AVERAGE -EDICAID PAYS ONLY PERCENT OF WHAT -EDICARE PAYS FOR THE SAME SERVICES;= &OR THIS REASON SOME PHYSICIANS AVOID TAKING -EDICAID RECIPIENTS OTHERS VIEW CARING FOR THESE PATIENTS AS A COMMUNITY SERVICE 'EOGRAPHY ALSO MAKES IT DIFlCULT TO CHOOSE QUALITY PROVIDERS -EDICAID RECIPIENTS ARE TYPICALLY FOUND DISPROPORTIONATELY IN URBAN CENTERS BUT ALSO LIVE IN RURAL AREAS AND EACH GROUP FACES CHALLENGES IN ACCESSING CARE &OR EXAMPLE WHILE PERCENT OF !MERICANS LIVE IN RURAL AREAS ONLY PERCENT OF !MERICAN PHYSICIANS PRACTICE THERE ;= PRESENTING OBVIOUS ACCESS PROBLEMS &OR -EDICAID RECIPIENTS IT MAY BE EVEN MORE DIFlCULT TO OBTAIN ACCESS BECAUSE OF LOW PAYMENT RATES )N URBAN AREAS THERE ARE MANY PROVIDERS BUT WITH AN ABUNDANCE OF PATIENTS AVAILABLE TO DOCTORS -EDICAID PATIENTS SOMETIMES
3ANDRA (UNT -0! IS A PRINCIPAL WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE HAS MORE THAN YEARS EXPERIENCE PROVIDING CONSULTING SERVICES TO STATE HEALTHCARE PROGRAMS FOR LOW INCOME POPULATIONS WITH A PARTICULAR EMPHASIS ON -EDICAID MANAGED CARE AND OTHER WAIVER PROGRAMS 3HE CAN BE REACHED AT SANDRASHUNT USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
P T@K HSXãHMãLD CHB@HCãOQNFQ@LR HAVE DIFlCULTY lNDING PROVIDERS WHO WILL ACCEPT -EDICAID PAYMENT AMOUNTS
@4O WHAT EXTENT DO YOU HOLD THE PHYSICIAN ACCOUNTABLE 7HO IS ACCOUNTABLE 0HYSI CIANS ARE INmUENTIAL AND A GATEWAY TO CER TAIN BEHAVIORS SUCH AS VIOLENCE ALCOHOL ABUSE SMOKING AND OBESITY 4HE PHYSI CIAN EXAM OFFERS AN OPPORTUNITY TO CHANGE BEHAVIOR BUT IS ONLY WORTH DOING IF PHYSI CIANS HAVE THE TRAINING TOOLS AND TIME TO INmUENCE PATIENT BEHAVIOR n 0AUL $ #LEARY 0H$ (ARVARD -EDICAL 3CHOOL
0AYING FOR 0ERFORMANCE !LTHOUGH INCENTIVE BASED REIMBURSEMENT ALSO CALLED hPAY FOR PERFORMANCE v HAS BEEN AROUND FOR SOME TIME ON THE COMMERCIAL SIDE -EDICAID IS JUST BEGINNING TO ENDORSE THESE PROGRAMS TO CREATE MORE VALUE FOR DOLLARS SPENT &OR EXAMPLE THE STATE OF -ASSACHUSETTS RECENTLY INTRODUCED LEGISLATION THAT WILL PAY OUT MILLION TO HOSPITALS AND DOCTORS IN FOR IMPROVING CARE TO DIABETIC AND HEART DISEASED -EDICAID PATIENTS TO REDUCE HOSPITAL VISITS 0HYSICIANS WILL ALSO RECEIVE BONUSES FOR LIMITING THE USE OF EXPENSIVE IMAGING AND FOR REDUCING DISPARITY IN DELIVERY AND OUTCOMES OF PATIENT CARE;= -ORE THAN PERCENT OF -EDICAID BENElCIARIES ARE ENROLLED IN PRIVATE MANAGED CARE PLANS ;= AND THE MAJORITY OF PAY FOR PERFORMANCE EFFORTS ARE BEING MADE AT THE PLAN LEVEL 7ITH THESE PROGRAMS -EDICAID HOLDS MANAGED CARE PLANS ACCOUNTABLE FOR THE QUALITY OF SERVICES PROVIDED TO MEMBERS THROUGH SPECIlC PERFORMANCE CRITERIA SUCH AS PROVIDING PREVENTIVE CARE OR DISEASE MANAGEMENT )F THE PLANS MEET THE CRITERIA THEY ARE PAID THEIR USUAL PREMIUM PLUS A BONUS 4O MEET THE CRITERIA PLANS MAY EXTEND PAY FOR PERFORMANCE BY PASSING ALONG BONUSES TO DOCTORS FOR PRESCRIBING GENERIC DRUGS OR GIVING PATIENTS mU SHOTS (OSPITALS MIGHT SIMILARLY BE REWARDED FOR MEETING PERFORMANCE TARGETS &ACED WITH A lSCAL CRISIS THE STATE OF #ALIFORNIA DEVELOPED A PROGRAM USING lVE QUALITY MEASURES AND TWO MEASURES OF SAFETY NET PARTICIPATION TO IDENTIFY HIGH PERFORMING AND EFlCIENT HEALTH PLANS -EDICAID BENElCIARIES IN COUNTIES WHO DID NOT CHOOSE A HEALTH PLAN FOR THEMSELVES WERE AUTOMATICALLY ENROLLED IN ONE OF THE HIGH PERFORMING PLANS !N ANALYSIS PREPARED BY THE #ALIFORNIA (EALTH#ARE &OUNDATION AN INDEPENDENT GROUP COMMITTED TO IMPROVING #ALIFORNIAS HEALTHCARE DELIVERY AND lNANCING SYSTEMS CONCLUDED THAT AS A RESULT OF THE NEW PERFORMANCE BASED PLAN ASSIGNMENT ALGORITHM -EDI #AL MANAGED CARE ENROLLEES
WOULD BE ASSIGNED TO A BETTER HEALTH PLAN IN THE lRST YEAR AS ASSESSED BY SEVEN PERFORMANCE INDICATORS THAN THEY WOULD HAVE BEEN ASSIGNED OTHERWISE;= "EGINNING IN *ULY ,OUISIANA WILL START ITS lRST -EDICAID PAY FOR PERFORMANCE PROGRAM TO DRIVE ADOPTION OF ELECTRONIC MEDICAL RECORDS AND IMPROVE IMMUNIZATION RATES IN TODDLERS 4HE STATE IS ENHANCING PRIMARY CARE PHYSICIANS MONTHLY MANAGEMENT FEES BY CENTS PER MEMBER PER MONTH PMPM IF THEY ADOPT A CLINICAL INFORMATION SYSTEM AND REPORT ELECTRONICALLY AND IF THEY PARTICIPATE IN A PROGRAM THAT PROVIDES FREE VACCINES FOR LOW INCOME CHILDREN 0HYSICIANS WILL GET A CENT PMPM INCREASE IF THEY REACH THE TARGET VACCINATION RATE AND WILL GET A PMPM INCREASE IF THEY ACHIEVE A STRETCH GOAL &OR EXAMPLE A PHYSICIAN WHO TREATS -EDICAID RECIPIENTS COULD EARN OF ADDITIONAL REVENUE PER MONTH;=
0REVENTIVE #ARE IN !CTION -ANY OF THE PAY FOR PERFORMANCE -EDICAID PROGRAMS HAVE EVOLVED AROUND PREVENTIVE CARE 0REVENTIVE CARE IS BASED ON THE PREMISE THAT SPENDING MONEY UP FRONT ON PATIENT CARE WILL REAP RICH REWARDS LATER IN THE FORM OF REDUCED EMERGENCY CARE SERVICES (EALTH PLANS ARE COMPENSATED IN THE FORM OF BONUSES OR INCENTIVES PAID BY -EDICAID FOR IMPROVING THE RATE OF PREVENTIVE CARE WHILE THE STATES BENEFIT FROM LOWER TREND RATES )N 3EPTEMBER THE LARGEST PAY FOR PERFORMANCE EFFORT TO IMPROVE THE HEALTH OF BABIES AND TEENS WAS LAUNCHED IN #ALIFORNIA;= 4HE ,OCAL )NITIATIVE 2EWARDING 2ESULTS ,)22 PROJECT INVOLVED SEVEN HEALTH PLANS AND WAS PART OF A THREE YEAR NATIONAL INITIATIVE BY THE 2OBERT 7OOD *OHNSON &OUNDATION AND THE #ALIFORNIA (EALTH#ARE &OUNDATION TO TEST WHETHER PERFORMANCE INCENTIVES WOULD IMPROVE HEALTHCARE QUALITY 4HE SPECIlC PROJECT GOAL OF THE ,)22 WAS TO IMPROVE QUALITY AND ACCESS TO PREVENTIVE -EDICAID SERVICES BY INCREASING THE NUMBER OF WELL BABY VISITS AND ANNUAL ADOLESCENT VISITS #HILDREN COVERED UNDER -EDICAID ARE OFTEN TARGETED FOR PREVENTIVE CARE BECAUSE THEY TEND TO BE AT HIGHER RISK FOR SEVERAL ILLNESSES INCREASED INFANT MORTALITY AND DEVELOPMENTAL DELAYS 4HEY ARE ALSO MORE LIKELY TO SUFFER FROM LEAD POISONING AND ASTHMA COMPLICATIONS !S THESE CHILDREN MATURE THEY MAY CONFRONT SEXUALLY TRANSMITTED DISEASE SUBSTANCE ABUSE AND TEEN PREGNANCY 7ITHOUT CONSISTENT PREVENTIVE HEALTH SERVICES THESE CHILDREN WHO REPRESENT HALF OF THE -EDICAID POPULATION MAY FACE SERIOUS HEALTH PROBLEMS;= 4HE ,)22 PROJECT ADDRESSING THIS ISSUE PAID OUT MILLION INVOLVED PHYSICIANS AND AFFECTED BABIES TEENS AND PARENTS &IVE OF THE SEVEN PLANS SUCCEEDED IN IMPROVING THE RATE OF WELL BABY VISITS WITH INCREASES OF TO PERCENT 4EEN DOCTOR VISITS INCREASED FROM TO PERCENT AT SIX OF THE SEVEN PLANS 4HE ,)22 PROJECT CONCLUDED THAT PAY FOR PERFORMANCE CAN HELP -EDICAID IMPROVE PATIENT HEALTHCARE WITHOUT INCREASING EXPENDITURES;=
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXãHMãLD CHB@HCãOQNFQ@LR
@4HE QUALITY OF CARE MEASURES GENER ALLY DO NOT FOCUS ON ACCESS AS AN INDI CATOR OF QUALITY BUT ACCESS TO SERVICES IS AN ESSENTIAL ASPECT OF THE QUALITY OF OUR HEALTHCARE SYSTEM )F PATIENTS CANNOT ACCESS CARE NO MATTER HOW GOOD IT IS THEN THE SYSTEM IS FAILING %LIZABETH "RADLEY 9ALE 3CHOOL OF 0UBLIC (EALTH
0ROGRESS IN $ISEASE -ANAGEMENT /VER THE PAST SEVERAL YEARS STATES HAVE BEGUN TO CONTRACT WITH DISEASE MANAGEMENT COMPANIES TO IMPLEMENT PROGRAMS IN ASTHMA MANAGEMENT DIABETES MANAGEMENT AND CHRONIC OBSTRUCTIVE HEART AND PULMONARY DISEASE -ANY ARE SIMILAR TO PROGRAMS USED BY COMMERCIAL PLANS EXCEPT THAT THE -EDICAID POPULATION TENDS TO HAVE HIGHER RATES OF THESE DISEASES &ROM THIS STANDPOINT -EDICAID PROGRAMS OFFER HIGH POTENTIAL FOR YIELDING CONSIDERABLE SAVINGS #ONTRACTS ARE TYPICALLY SOLD TO THE STATES ON A BUDGET NEUTRAL BASIS AND THE MANAGEMENT COMPANIES GET PAID BY DEMONSTRATING A REDUCTION IN TREND &OR EXAMPLE !RKANSAS OFlCIALS REPORTED SOME SUCCESS FROM A YEAR LONG PROGRAM INVOLVING A GROUP OF PARTICIPANTS WHO WERE REQUIRED TO UNDERGO A ONE HOUR ASSESSMENT FOLLOWED BY HOURS OF GROUP OR INDIVIDUAL EDUCATIONAL SESSIONS 0ARTICIPANTS WERE TAUGHT HOW TO CONTROL THEIR DISEASE THROUGH BLOOD GLUCOSE MONITORING SELF EXAMS EXERCISE HEALTHY FOOD CHOICES AND IMPROVED COOKING HABITS 4HE STUDY FOUND THAT COUPLING SELF MANAGEMENT WITH NUTRITION EDUCATION CAN REDUCE RESOURCE UTILIZATION WITHIN A YEAR AND WILL PROBABLY IMPROVE DIABETES OUTCOMES OVER TIME AT LITTLE OR NO INCREMENTAL COST 2ESEARCHERS REPORTED THAT THE ESTIMATED SAVINGS IN DIABETES RELATED COSTS PROJECTED FROM OBSERVED PREPOST BLOOD GLUCOSE LEVELS WERE FOR EACH PERSON WHO COMPLETED THE PROGRAM OVER THREE YEARS 4HIS LARGELY OFFSET PROGRAM COSTS OF PER INITIAL PROGRAM PARTICIPANT RESULTING IN A NET COST PER PARTICIPANT OF OVER THREE YEARS 4HE RESEARCHERS CONCLUDED THAT IF REDUCTIONS IN DIABETES RELATED COSTS PERSIST BEYOND THREE YEARS THE PROGRAM MIGHT BE COST SAVING 4HE PROGRAM IS PROJECTED TO REDUCE DIABETES RELATED MORTALITY BY PERCENT AND MICROVASCULAR DISEASE EVENTS BY PERCENT OVER YEARS AMONG THOSE WHO COMPLETE IT;= 4HE $EPARTMENT OF (EALTH AND (OSPITALS IN ,OUISIANA OPERATES A -EDICAID #OMMUNITY#!2% QUALITY PROGRAM TO IMPROVE USE OF APPROPRIATE MEDICATIONS FOR CHILDREN WITH ASTHMA 4HEY ORIGINALLY PLANNED TO EDUCATE THE STAFF IN #OMMUNITY#!2% PRACTICES TO
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
PROVIDE EDUCATION FOR THEIR PATIENTS (OWEVER THEY FOUND THAT MORE HELP WAS NEEDED TO OBTAIN ACCEPTANCE OF THE PROGRAM .OW NURSES IN EACH OF NINE DESIGNATED REGIONS WITHIN THE STATE PROVIDE EDUCATIONAL SERVICES TO CHILDREN FAMILIES AND CAREGIVERS 3INCE INCEPTION OF THE PROGRAM THEY HAVE SEEN THE USE OF APPROPRIATE MEDICATIONS FOR TO YEAR OLDS WITH ASTHMA RISE FROM PERCENT IN THE lRST QUARTER OF TO PERCENT BY THE FOURTH QUARTER 4HE COMBINED RATE FOR TO YEAR OLDS WENT FROM TO PERCENT &OR ADULT -EDICAID RECIPIENTS THE DEPARTMENT HAS STARTED TELEPHONIC INTERVENTION WITH ASTHMA PATIENTS WHO HAVE BEEN IN THE %2 AT LEAST TWICE IN THE LAST SIX MONTHS AND HAS IMPLEMENTED A HOUR NURSE HELP LINE TO GIVE PATIENTS AN ALTERNATIVE TO THE EMERGENCY DEPARTMENT AS A lRST LINE OF DEFENSE IN THE EVENT OF PROBLEMS !LTHOUGH THE TELEPHONIC ASTHMA INTERVENTION PROGRAM IS STILL TOO NEW TO REPORT RESULTS IT ENROLLED OVER RECIPIENTS ,OUISIANA IS ALSO EXPERIMENTING WITH THE USE OF CLINICAL DECISION SUPPORT FOR MANAGING DIABETES IN THE -EDICAID POPULATION &OR PROVIDERS WITH LOW RATES OF HEMOGLOBIN TESTING NURSES DO CHART AUDITS PROVIDE EDUCATION AND OFFER A CLINICAL DECISION SUPPORT TOOL THAT LISTS REMINDERS OF WHAT EACH PERSON WITH DIABETES NEEDS n HEMOGLOBIN !C TESTED CHOLESTEROL CHECKED ETC 4HE STATE IS TESTING RESULTS OF CHART AUDITS VERSUS AUDITS AND EDUCATION VERSUS AUDITS EDUCATION AND DECISION SUPPORT FOR DIABETES MANAGEMENT 4HIS PROGRAM IS ALSO NEW BUT HAS HAD GOOD RECEPTION FROM PHYSICIANS;= 0ARTNERS (EALTHCARE 3YSTEM THE PARENT ORGANIZATION OF -ASSACHUSETTS 'ENERAL (OSPITAL AND "RIGHAM AND 7OMENS (OSPITAL HAS ALSO EXPERIMENTED WITH DISEASE MANAGEMENT AMONG -EDICAID RECIPIENTS TO DELIVER INTENSE PERSONALIZED CARE TO THE PERCENT OF PATIENTS WHO ACCOUNT FOR PERCENT OF ALL THEIR COSTS !LTHOUGH THEY ARE COMPENSATED FOR -EDICAID PATIENTS RATES ARE WELL BELOW ACTUAL COSTS SO DISEASE MANAGEMENT IS BEING PRACTICED IN AN EFFORT TO AVOID UNNECESSARY ADMISSIONS 4HE DISEASE MANAGEMENT TEAM IDENTIlES HIGH RISK PATIENTS AND EMAILS PHYSICIANS TO GIVE THEM THE OPTION OF NOT REFERRING IDENTIlED PATIENTS TO THE PROGRAM ONLY PERCENT OF PHYSICIANS OPT OUT .EXT NURSES CALL THE PATIENTS AND PERFORM AN ASSESSMENT 4HEY THEN EMAIL FEEDBACK TO PHYSICIANS ABOUT ISSUES UNCOVERED DURING THE INITIAL CALL )N THIS WAY THE NURSING TEAM ACTS AS CASE MANAGERS TO QUICKLY IDENTIFY PATIENTS WHO DO NOT UNDERSTAND DOCTORS INSTRUCTIONS 3O FAR 0ARTNERS (EALTHCARE HAS RECEIVED EXCEPTIONALLY POSITIVE INTERNAL AND EXTERNAL FEEDBACK ABOUT THE PROGRAM;=
5SING )NCENTIVES TO )NCREASE 0ATIENT #OMPLIANCE &ACTORS SUCH AS TRANSIENCE LANGUAGE BARRIERS LACK OF TRANSPORTATION AND WORK SCHEDULES OFTEN RESULT IN -EDICAID RECIPIENTS MISSING APPOINTMENTS 0ROVIDERS HAVE SAID THAT
P T@K HSXãHMãLD CHB@HCãOQNFQ@LR BONUSES SPUR THEM TO PERFORM OUTREACH ACTIVITIES TO UNDERSERVED POPULATIONS 0ATIENTS MAY ALSO NEED INCENTIVES "ECAUSE lNANCIAL INCENTIVES ARE VIEWED AS hINCOME v EXTRA MONIES RECEIVED BY -EDICAID BENElCIARIES CAN INCREASE THEIR INCOME ENOUGH TO BE DENIED ELIGIBILITY 3TATES MUST TYPICALLY APPROVE MEMBER INCENTIVES SOME INCLUDE -EDICAID INCENTIVE REGULATIONS IN THEIR MANAGED CARE CONTRACTS &OR EXAMPLE IN THE ,)22 PROJECT STATE APPROVALS WERE SECURED FOR THE 3AN &RANCISCO (EALTH 0LAN TO USE BOTH MOVIE TICKETS AND AN OUTREACH EFFORT INTO HIGH SCHOOLS TO INCREASE ADOLESCENT DOCTOR VISITS 2ESULTING DATA FOR THESE EFFORTS SHOWED ADOLESCENT WELL CARE RISE FROM TO PERCENT;=
-EASURING 0ERFORMANCE 7HEN MEASURING PERFORMANCE STANDARDIZED MEASURES ENSURE THAT FAIR COMPARISONS MAY BE MADE BETWEEN DIFFERENT ORGANIZATIONS (EALTH 0LAN %MPLOYER $ATA AND )NFORMATION 3ET (%$)3 IS A STANDARDIZED TOOL THAT MEASURES THE PERFORMANCE OF IMPORTANT ASPECTS OF CARE AND SERVICE AMONG HEALTH PLANS AND CAN BE USED TO MEASURE -EDICAID PROGRAM PERFORMANCE &OR EXAMPLE (%$)3 DATA WERE USED IN THE ,)22 PROJECT TO EVALUATE THE SUCCESS OF THE ADOLESCENT OUTREACH PROGRAM (%$)3 DATA WERE ALSO USED TO MEASURE THE NUMBER OF WELL BABY AND ADOLESCENT DOCTOR VISITS IN THE DIFFERENT HEALTH PLANS 3TANDARDIZED MEASUREMENTS LIKE (%$)3 PROVIDE A PLATFORM FOR COLLABORATION BETWEEN PAYERS AND PROVIDERS AND RAISE AWARENESS OF -EDICAID QUALITY INITIATIVES 4HIS HELPS SECURE BUY INS FROM PROVIDERS WHICH IS CRITICAL TO THE SUCCESS OF PAY FOR PERFORMANCE IN THE -EDICAID SYSTEM 7ITH LOW PAYMENT RATES AND PHYSICIAN SHORTAGES IN RURAL AREAS IT CAN BE DIFlCULT TO BUILD A RELIABLE PROVIDER NETWORK (%$)3 AND OTHER MEASUREMENTS MAKE PROVIDERS AWARE OF THE PERFORMANCE GAP THAT EXISTS IN TREATING -EDICAID PATIENTS )N THE ,)22 PROJECT FOR EXAMPLE THE 3AN &RANCISCO (EALTH 0LAN SENT PAYMENTS TO PHYSICIANS ACCORDING TO GOALS MET ALONG WITH A VOIDED CHECK WITH THE AMOUNT THE PROVIDER COULD HAVE RECEIVED IF PERFORMANCE HAD BEEN BETTER;=
4HE &UTURE OF 1UALITY IN -EDICAID !S THE POPULATION CONTINUES TO GROW IT IS UNREALISTIC TO EXPECT THAT -EDICAID WILL BE ABLE TO CUT BACK ON SPENDING 4HE ALTERNATIVE THEN LIES IN INCREASING THE QUALITY OF -EDICAID INTERACTIONS TO DECREASE THE COST OF LONG TERM CARE AND HELP PATIENTS LIVE LONGER HEALTHIER LIVES 7HILE PROVIDERS HAVE A STRONG DESIRE TO INCREASE THE QUALITY
OF CARE FOR -EDICAID ENROLLEES THEY FACE CHALLENGES FROM LOW REIMBURSEMENT AND THE COMPLEXITIES OF TREATING THESE PATIENTS 0AY FOR PERFORMANCE PROGRAMS SHOW A GREAT DEAL OF PROMISE BY PROMOTING THE CONCEPT OF PREVENTIVE CARE AND BY ENSURING THAT -EDICAID RECIPIENTS HAVE GREATER ACCESS TO A QUALITY NETWORK OF PROVIDERS !LTHOUGH PROGRESS STILL NEEDS TO BE MADE STATES CAN HELP BY TAKING ON MORE ADMINISTRATIVE DUTIES TO SUPPORT QUALITY INITIATIVES SUCH AS FACILITATING DISEASE MANAGEMENT PROGRAMS OR PROVIDING MORE OPERATIONAL SUPPORT TO THE HEALTH PLANS &UNDAMENTAL TO THIS APPROACH IS MEASURING PROVIDER PERFORMANCE TO ENSURE THAT QUALITY CRITERIA ARE BEING MET #OMMUNICATING PERFORMANCE RESULTS WILL REMIND PROVIDERS OF THE INCREASING NEED FOR QUALITY TREATMENT #OMMERCIAL PAY FOR PERFORMANCE PROGRAMS WILL CONTINUE TO BE THE MODEL FOR STATES IN THEIR EFFORTS TO INCREASE QUALITY AND CONTROL RISING COSTS -EDICAID HAS A GREAT DEAL OF INCENTIVE TO SUCCEED IN EFFORTS TO IMPROVE QUALITY AS STATES TAKE ON INCREASING RESPONSIBILITY FOR THE lNANCING AND DELIVERY OF CARE TO THOSE !MERICANS WHO NEED IT MOST %NDNOTES +AISER #OMMISSION ON -EDICAID AND THE 5NINSURED 4HE -EDICAID 0ROGRAM AT A 'LANCE 4HE (ENRY * +AISER &AMILY &OUNDATION -AY HTTPWWWKFFORGMEDICAIDUPLOADPDF )BID )BID !MERICAN !CADEMY OF 0EDIATRICS 53 -EDICAID &ACTS WWWAAPORG ADVOCACYWASHINGELECTIONSMFS?USPDF 2%35,43 4HE &ACTS ON (EALTH $ISPARITIES WWWRESULTSORGWEBSITE ARTICLEASP ID +OWALCZYK , h(EALTH ,EGISLATION 0UTS %MPHASIS ON 0AY FOR 0ERFORMANCE v !PRIL "OSTON 'LOBE (IGHSMITH . AND * 2 2OTHSTEIN h#(#3 "RIEF 2EWARDING 0ERFORMANCE IN -EDICAID -ANAGED #ARE v -ARCH #ENTER FOR (EALTHCARE 3TRATEGIES WWWCHCSORG 0UTTING 1UALITY TO 7ORK 2EWARDING 0LAN 0ERFORMANCE IN -EDI #AL -ANAGED #ARE #ALIFORNIA (EALTH#ARE &OUNDATION -AY HTTP WWWCHCFORGDOCUMENTSPOLICY0UTTING1UALITY4O7ORK2EPORTPDF 0RICEWATERHOUSE#OOPERS INTERVIEW WITH 2OXANE ! 4OWNSEND -$ -EDICAID -EDICAL $IRECTOR FOR ,OUISIANA -AY /EHLMANN 0 h#(#3 "RIEF 7ORKING WITH -EDICAID 0LANS TO )MPROVE 0REVENTIVE #ARE 3ERVICES FOR #HILDREN v -AY #ENTER FOR (EALTHCARE 3TRATEGIES WWWCHCSORG h!GGRESSIVE $IABETES %DUCATION 0ROGRAM -AKES 0OSITIVE )MPACT ON (EALTH OF -EDICAID 0ATIENTS v *UNE -EDICAL .EWS $AILY HTTPWWWMEDICALNEWSTODAYCOMMEDICALNEWSPHP NEWSID 0RICEWATERHOUSE#OOPERS INTERVIEW WITH 4HOMAS ( ,EE -$ NETWORK PRESIDENT FOR 0ARTNERS (EALTHCARE 3YSTEM !PRIL
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! !CHIEVING 0ATIENT #ENTRIC 1UALITY #ARE 4HROUGH 4ECHNOLOGY ! $ISCUSSION 7ITH +AISER 0ERMANENTE +AISER 0ERMANENTE +0 IS THE 53 LARGEST INTEGRATED HEALTHCARE ORGANIZATION "ASED IN /AKLAND #ALIF THE NONPROlT ORGANIZATION SERVES MILLION MEMBERS IN NINE STATES AND 7ASHINGTON $# +AISER 0ERMANENTE (EALTH#ONNECT4- IS THE NATIONS SINGLE LARGEST HEALTH INFORMATION TECHNOLOGY EFFORT ! MULTIBILLION DOLLAR INITIATIVE FOCUSED ON USING A COMMON SOFTWARE SYSTEM AND PROVIDING REAL TIME MEDICAL INFORMATION FOR ALL +AISER 0ERMANENTE REGIONS AND FACILITIES THE SYSTEMWIDE PROJECT HAS BEEN UNDER WAY SINCE AND IS EXPECTED TO BE FULLY IMPLEMENTED BY THE END OF )N ADDITION +AISER 0ERMANENTE RECENTLY LAUNCHED A PILOT PROGRAM CALLED h4HE ST #ENTURY #ARE )NNOVATION 0ROJECT v WITH THE GOAL OF TRANSFORMING THE PRIMARY CARE ENABLED BY +0 (EALTH#ONNECT AND FURTHERING EFFORTS TO DELIVER CARE IN A MORE PATIENT CENTRIC MANNER %NHANCING QUALITY HAS AN IMPORTANT ROLE IN THIS SYSTEM ACCORDING TO +AISERS EXECUTIVES 4O UNDERSTAND WHAT THE SYSTEM HAS LEARNED TO DATE 0RICEWATERHOUSE#OOPERS INTERVIEWED ,OUISE ,IANG -$ SENIOR VICE PRESIDENT FOR QUALITY AND CLINICAL SYSTEMS SUPPORT AND 2UTH "RENTARI PROGRAM MANAGER ABOUT THE +0 (EALTH#ONNECT 0ROGRAM
0RICEWATERHOUSE#OOPERS (OW DOES +AISER 0ERMANENTE DElNE QUALITY ,OUISE ,IANG 4HERE ISNT A SIMPLE ANSWER 7E NOW TALK ABOUT BIG 1 QUALITY WHICH HAS lVE ELEMENTS CLINICAL OUTCOMES SERVICE RISK MANAGEMENT RESOURCE STEWARDSHIP AND PATIENT SAFETY )N THE PAST IF YOU SAID QUALITY PEOPLE ASSUMED YOU MEANT ONLY CLINICAL OUTCOMES )F YOU MEANT SERVICE YOU TALKED ABOUT SERVICE SEPARATELY 4HE CURRENT DElNITION INCLUDES ALL THE ELEMENTS THAT MEMBERS OR PATIENTS CARE ABOUT )TS BEEN SOMEWHAT OF A MARKETING TOOL TO SEPARATE SAFETY FROM QUALITY RECENTLY AND FOR THE LIFT THAT IT HAS PROVIDED TO SAFETY ) APPLAUD IT BUT ) THINK ITS AN ARTIlCIAL DISTINCTION 0W# 4HE DIFFERENTIATION BETWEEN CLINICAL AND SERVICE QUALITY SEEMS TO BE A STICKY ISSUE 9OU GO OUT TO THE PATIENT AND YOU TALK ABOUT QUALITY AND THE lRST THING THEY COME BACK WITH IS SERVICE 3O HOW DO YOU GET TO THE ACTUAL CLINICAL PART IN TERMS OF MEASUREMENT ,, 4HE EXPERIENCE HAS BEEN FRUSTRATING BECAUSE SO FAR IT DOES NOT APPEAR THAT CONSUMERS MAKE CHOICES BASED ON CLINICAL QUALITY 7E HAVE NOT lGURED OUT HOW TO PROVIDE CLINICAL OUTCOME DATA THAT IS MEANINGFUL TO PATIENTS 3O HOW DO YOU MAKE CLINICAL INFORMATION MEANINGFUL 7HEN ) ARRIVED AT +AISER 0ERMANENTE
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
WE WERE DESCRIBING CLINICAL QUALITY IN THE USUAL WAY 7HEN WE TALKED ABOUT DIABETES WE TALKED ABOUT THE HEMOGLOBIN !CS 7ELL WHAT IS A HEMOGLOBIN !C WHY DOES IT MATTER AND WHO SHOULD CARE ;)T IS A BLOOD GLUCOSE TEST FOR DIABETES MANAGEMENT AMONG OTHER THINGS= 7E BEGAN OVERHAULING CHRONIC DISEASE REPORTS SO THEY REmECT OUTCOMES THAT ARE MEANINGFUL TO EVERYONE )NSTEAD OF TALKING ABOUT HEMOGLOBIN !CS WE ARE TALKING ABOUT AMPUTATIONS AVOIDED 9OU DONT NEED A MEDICAL DEGREE TO UNDERSTAND WHY THAT IS IMPORTANT AND WHAT DIRECTION THAT OUGHT TO BE GOING )F YOU WANT PEOPLE TO PAY ATTENTION YOU HAVE TO PUT IT IN TERMS THEY UNDERSTAND *UDGING BY PEOPLES BEHAVIOR QUALITY MEASUREMENT IS NOT MEANINGFUL YET )F IT WERE THEY WOULD BE MAKING CHOICES DIFFERENTLY 0W# +0 (EALTH#ONNECT USES TECHNOLOGY TO ENABLE COMMUNICATION BETWEEN THE CLINICIAN AND THE PATIENT (OW DO YOU REIMBURSE A CLINICIAN FOR TIME SPENT ON NEW MODES OF COMMUNICATION ,, 4HE STRENGTH OF A HEALTHCARE SYSTEM LIKE +AISER 0ERMANENTE IS THAT THE VAST MAJORITY OF OUR PATIENTS ARE STILL LARGELY PREPAID SO WE CAN lGURE OUT WHAT MAKES THE MOST SENSE FOR THEIR CARE AND DO IT 4HEREFORE WE HAVENT NEEDED TO MAKE CHANGES TO CLINICIAN REIMBURSEMENT AS WE HAVE OFFERED NON VISIT OPTIONS TO PATIENTS
1! 2UTH "RENTARI /UR TEAMS ARE LOOKING AT ALTERNATIVES TO THE FACE TO FACE VISIT 7ITH +0 (EALTH#ONNECT WE CAN DO A FOLLOW UP WITH A PATIENT THAT SAVES THE PATIENT THE COMMUTE AND THE PARKING HASSLE #LINICIANS CAN HAVE THE CONVERSATION WRITE THE NOTE WRITE ANY FOLLOW UP ORDERS IF NECESSARY AND BE DONE AT THE END OF THE TELEPHONE CONVERSATION 0ART OF WHAT WERE DOING WITH THE TECHNOLOGY IS LOOKING AT OUTREACH TO OUR MEMBERS AND BUILDING CAPACITY WITHIN THE DAY )F A CLINICIAN IS JUST DOING THE URGENT OFlCE WORK THEN HOW DO WE DO ALL THE OTHER OUTREACH WORK (OW DOES THAT RELATE TO ELECTRONIC CARE ) DONT THINK ANYBODY KNOWS THE RIGHT COMBINATION FOR HEALTH SERVICES PROVIDED VIA THE TELEPHONE OFlCE OR AN E VISIT 7ERE LOOKING AT WHAT REALLY MAKES SENSE AND WHEN WE NEED TO BRING THE PATIENT IN FOR THAT PHYSICAL EXAM 4HE OTHER TENET IS TRYING TO GIVE THE PATIENT THE CHOICE AROUND HOW THEY WANT TO HAVE INTERACTIONS $O THEY WANT TO COME IN $O THEY WANT E VISITS $O THEY WANT TELEPHONE VISITS OR GROUP VISITS
/UR PHYSICIANS HAVE CHOSEN +AISER 0ERMANENTE BECAUSE WE ARE EVIDENCE BASED AND THEY WANT TO HAVE THE FLEXIBILITY TO DO WHAT MAKES SENSE 4HE TECHNOLOGY MAKES IT EASIER TO HAVE THE CORRECT INFORMATION IMMEDIATELY AVAILABLE SO ONE OF THE THINGS WERE DESIGNING RIGHT NOW IS AN AUGMENTA TION TO THE MEDICAL RECORD )TS CALLED
AND IF THE PHYSICIANS ATTITUDE IS h4HIS IS GREAT ) CAN SHOW YOU HOW YOUR GLUCOSE IS DOING BECAUSE THE COMPUTER LETS ME CREATE A CHART RIGHT HERE 3O LETS TALK ABOUT WHAT THIS MEANS FOR YOU v THEN PATIENTS ARE VERY PLEASED WITH THE ELECTRONIC MEDICAL RECORD 4HE KEY DRIVER TO CLINICIAN ADOPTION AND SATISFACTION IS NOT NECESSARILY RELATED TO THE CLASSIC CLINICIAN DEMOGRAPHICS )TS TRUE THAT IF YOU GREW UP USING COMPUTERS ITS A LITTLE BIT EASIER AND ) THINK THAT SOME OF THE YOUNGER GENERATION IS MORE USED TO MULTITASKING 2EADING THE INFORMATION IN THE COMPUTER FORMATTING ASKING QUESTIONS LISTENING TO THE PATIENTS ANSWERS AND THEN RECORDING THE INFORMATION IS PRETTY COMPLICATED 7E DEVELOP SPECIAL TRAINING ON HOW TO HELP CLINICIANS WITH THAT WHILE MAINTAINING FOCUS ON THE PATIENT 2" /NE OF THE THINGS THAT WE HAVE ON THE HORIZON IS ONLINE PROXY ACCESS TO MEDICAL RECORDS BY ADULT CHILDREN FOR THEIR SENIOR PARENTS )TS A MAJOR SUPPORT TO HELP YOUR PARENTS BY BEING ABLE TO SEE WHAT THE DOCTOR IS REALLY SAYING /BVIOUSLY THAT REQUIRES LEGAL PERMISSION BUT THE SOFTWARE GIVES US THAT ABILITY AND THAT ADULTS hCHILDv CAN BE ANYWHERE IN THE COUNTRY 4HEY DONT HAVE TO BE A +AISER 0ERMANENTE MEMBER ,, /UR CORE PRINCIPLE IS THAT ITS THE PATIENT WHO DECIDES 7E NEVER WANT TO BE IN THE POSITION OF SAYING h9OU SHOULD HAVE A PHONE VISIT v OR h9OU SHOULD HAVE SECURE MESSAGING v IF THATS NOT YOUR CHOICE /UR GOAL IS TO INCREASE THE MENU OF CHOICES FOR PATIENTS AND WE BELIEVE STRONGLY THAT SECURE MESSAGING ;EMAIL= AND E VISITS ARE MOST APPROPRIATE IN THE CONTEXT OF AN ESTABLISHED RELATIONSHIP
0W# )S THIS LED BY THE TECHNOLOGY OR DOES THE TECHNOL OGY ENABLE THE THINKING AROUND THE INNOVATION 2" 4HATS SOMETHING WE STRUGGLE WITH -Y PERSPECTIVE IS THAT IT HAS TO BE DRIVEN BY OPERATIONAL LEADERS )F THE TECHNOLOGY FOLKS TRY TO DRIVE IT ITS NOT GOING TO BE SUCCESSFUL )NNOVATION IS OFTEN CREATED FROM THE GROUND UP BECAUSE CHANGE MANAGEMENT IS A HUGE THING 7E HAVE LOTS OF CONVERSATIONS IN THE ORGANIZATION AROUND WHETHER +0 (EALTH#ONNECT IS A TOOL A FOUNDATION OR hWHAT IS ITv )T IS A MAJOR CHANGE THOUGH FOR THE ORGANIZATION AND FOR MIDDLE MANAGEMENT
0W# )S +0 (EALTH#ONNECT AN ENABLER FOR MORE FOCUS ON EVIDENCE BASED MEDICINE ,, /UR PHYSICIANS HAVE CHOSEN +AISER 0ERMANENTE BECAUSE WE ARE EVIDENCE BASED AND THEY WANT TO HAVE THE mEXIBILITY TO DO WHAT MAKES SENSE 4HE TECHNOLOGY MAKES IT EASIER TO HAVE THE CORRECT INFORMATION IMMEDIATELY AVAILABLE SO ONE OF THE THINGS WERE DESIGNING RIGHT NOW IS AN AUGMENTATION TO THE MEDICAL RECORD )TS CALLED hCONTEXT SPECIlC SEARCHv 7HEN YOURE IN THE EXAM ROOM WITH A PATIENT AND YOU HAVE A PATIENT AND YOU WANT TO LOOK FOR A SPECIlC ARTICLE OR INFORMATION YOU DONT WANT TO BE SEARCHING THROUGH THE ENTIRE WEBSITE 3O WEVE DEVELOPED A FEATURE WHICH WILL SEARCH AND BRING FORWARD THE MOST LOGICAL INFORMATION BASED ON THE CLINICAL INFORMATION IN THE CHART 7E WANT TO MAKE IT AS EASY AS POSSIBLE SO THERE REALLY ISNT ANY BARRIER /UR CARE MANAGEMENT INSTITUTES MOTTO IS h-AKE THE RIGHT THING EASY TO DOv %VERYTHING WE PUT IN THE SYSTEM IS DEVELOPED APPROVED AND ADOPTED BY OUR MEDICAL GROUP LEADERSHIP
0W# 3TICKING WITH THAT THEME OF TECHNOLOGY AND IN TERACTION WITH THE PATIENT +AISER HAS WORKED WITH THE COMPUTER AS THE THIRD PERSON IN THE ROOM AND YOU PUT TOGETHER SOME PRETTY DETAILED HELPFUL HINTS ON HOW TO WORK WITH A PATIENT AND THE COMPUTER 7HAT ARE SOME LESSONS LEARNED ,, 7E HAVE FOUND THAT SUCCESSFUL ACCEPTANCE IS NOT ACTUALLY DRIVEN BY PATIENTS 4HE KEY DETERMINANT IS THE PHYSICIANS ATTITUDE
0W# 4HE 53 HEALTHCARE SYSTEM PAYS FOR VOLUME NOT QUALITY AND THATS SOMETHING THAT WEVE BEEN WRESTLING WITH FOR A LONG TIME 7HEN AND HOW DO YOU THINK WE WILL START PAYING FOR QUALITY AND NOT VOLUME ,, 7E NEED TO DECIDE WHETHER WE ARE GOING TO PAY FOR ACTUAL OUTCOMES OR PAY FOR PROCESS MEASURES 3O MUCH IS DRIVEN OFF ADMINISTRATIVE DATA AND THAT IS A PROBLEM BECAUSE ADMINISTRATIVE DATA HAS LONG BEEN KNOWN TO HAVE DRAWBACKS IN TERMS OF WHAT IT
@CONTEXT SPECIFIC SEARCH
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! 7HATS VERY CLEAR IS THAT WHEN PATIENTS HAVE REAL INFORMATION THE KIND OF INFOR MATION THAT CLINICIANS HAVE THEY MAKE BETTER DECISIONS 4HEY MAKE MORE IN FORMED DECISIONS AND THEY ARE HAPPIER WITH THE OUTCOME ESPECIALLY WHEN THE OUTCOME IS LESS THAN IDEAL BECAUSE THEY BELIEVE THEY HAD THE FACTS CONSID ERED THE RISKS AND MADE A CHOICE REALLY REmECTS )F WERE GOING TO MOVE THE SYSTEM AND GET THE BEST VALUE WE OUGHT TO BE PAYING FOR ACTUAL CLINICAL OUTCOMES !T THE END OF THE DAY DID THE PATIENT LIVE LONGER $ID HE HAVE A BETTER LIFE )TS AN ARGUMENT FOR ELECTRONIC MEDICAL RECORDS ;%-2S= SO WE CAN EASILY MEASURE CLINICAL OUTCOMES 7HEN ARE WE GOING TO GET THERE ) THINK AS LONG AS HEALTH PLANS ARE THE MAJOR SOURCE OF DATA AND THEYRE RELIANT ON ADMINISTRATIVE DATA WERE GOING TO BE PAYING FOR THE WRONG THINGS 5NTIL WE HAVE SIGNIlCANT ADOPTION OF %-2S WERE GOING TO BE SWIRLING AROUND LIKE WE HAVE FOR THE LAST OR YEARS ) ALSO THINK THAT IF PAYERS WANT TO USE THEIR LEVERAGE THEY CAN IN FACT BE THE CARROT FOR THE INVESTMENT IN %-2S 0W# 0ART OF WHAT WERE TALKING ABOUT IS DEMYSTIFY ING HEALTHCARE FOR THE PATIENT n GETTING A LANGUAGE WHERE THEY CAN UNDERSTAND THEIR CHOICES 7HAT IS THE PATIENTS ROLE 3HOULD WE EXPECT SOMETHING DIFFERENT FROM THE PATIENT ,, 7E HAVE AS AN INDUSTRY BY AND LARGE ONLY LEVERAGED HALF OF A TWO PARTY RELATIONSHIP 7HATS VERY CLEAR IS THAT WHEN PATIENTS HAVE REAL INFORMATION THE KIND OF INFORMATION THAT CLINICIANS HAVE THEY MAKE BETTER DECISIONS 4HEY MAKE MORE INFORMED DECISIONS AND THEY ARE HAPPIER WITH THE OUTCOME ESPECIALLY WHEN THE OUTCOME IS LESS THAN IDEAL BECAUSE THEY BELIEVE THEY HAD THE FACTS CONSIDERED THE RISKS AND MADE A CHOICE 7E NEED TO EQUIP PATIENTS TO UNDERSTAND THEIR HEALTH AND THEIR HEALTHCARE OPTIONS 4HATS ONE OF THE THINGS WERE TESTING IN OUR ST #ENTURY #ARE )NNOVATION 0ROJECT /NE OF THE CORE THEMES IS h(OME IS THE HUBv 4HE KEY MESSAGE IS THAT THE PATIENT IS IN OUR FACILITIES ONLY A COUPLE HOURS A YEAR %VEN VERY SICK PATIENTS ARENT WITH US THAT OFTEN 3O WHAT ABOUT ALL THAT OTHER TIME 4HE ONLY PEOPLE WHO CAN HAVE AN EFFECT ON THAT ARE NOT US BUT THE PATIENT AND THEIR FAMILY 5NLESS WE ARE PAYING ATTENTION TO SUPPORTING THEM IT IS VERY HARD TO SIGNIlCANTLY IMPROVE OUTCOMES )F YOU LIVE WITH YOUR DISEASE DAYS A YEAR YOU KNOW A LOT MORE ABOUT DETAILED SPECIlCS THAN A CLINICIAN WHO MAY HAVE MORE TECHNICAL INFORMATION BUT WHO SEES YOU FOR AN HOUR AND ONLY GETS A SLIVER OF INFORMATION ABOUT WHAT ALL THE ISSUES ARE !N ASTHMATIC KNOWS WHAT THE TRIGGERS TO HIS DISEASE ARE (E KNOWS HOW IT FEELS (E KNOWS WHAT TIPS HIM OVER AND HE KNOWS
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
HOW TO PREVENT ATTACKS 7EVE NEVER TAPPED INTO THAT KNOWLEDGE AND PARTNERSHIP EFFECTIVELY !S A START TO LEVERAGE PATIENTS IN IMPROVING OUTCOMES WE HAVE DEVELOPED A BROCHURE THAT WEVE GIVEN PATIENTS GOING INTO THE HOSPITAL TO EXPLAIN SOME OF OUR SAFETY PROCESSES AND PROCEDURES 4HEY ARE PROVIDED INFORMATION ABOUT WHAT THEY SHOULD EXPECT AND INSTRUCTED THAT IF ITS NOT HAPPENING THEY NEED TO SPEAK UP &OR EXAMPLE IF SOMEONE IS ABOUT TO EXAMINE YOU AND YOU HAVE NOT SEEN THEM WASH THEIR HANDS YOU SHOULD ASK -AYBE THEY WASHED THEM RIGHT OUTSIDE THE ROOM BUT WHAT WERE DOING IS ASKING THE PATIENT TO HELP ENSURE THE BEST CLINICAL OUTCOMES 0W# 7HAT HAS BEEN THE REACTION OR THE IMPRESSIONS OF CLINICIANS TO THAT !RE THEY READY FOR MORE EMPOW ERED CONSUMERS ,, )TS IMPERATIVE THAT WE MAKE IT CLEAR WHAT THE EXPECTED BEHAVIORS AND ACTIONS ARE WITH THE CLINICIANS lRST )TS A TIMING ISSUE n ARE WE READY TO BE CHALLENGED IF NEED BE BY OUR PATIENTS /UR HEAD OF SAFETY WANTS TO DO WHAT SOME AUTOMOBILE COMPANIES HAVE DONE FOR YEARS n HE WANTS ANY PATIENT TO BE ABLE TO hSTOP THE LINEv ) THINK ITS A VERY PROVOCATIVE IDEA BUT WERE NOT QUITE READY (OWEVER WE ARE READY FOR PATIENTS TO BE ASSERTIVE AND WE THINK THAT ENGAGING THE PATIENT IS VERY IMPORTANT TO IMPROVING CLINICAL OUTCOMES 0W# 7HAT OTHER TYPES OF QUALITY RELATED INNOVATIONS IS +AISER 0ERMANENTE INVOLVED IN ,, 7E ARE DEVELOPING THE ABILITY TO PORT INFORMATION FROM THE PATIENTS ONLINE HEALTH RISK ASSESSMENT INTO THE ELECTRONIC MEDICAL RECORD WITH THEIR PERMISSION 7E WILL DESIGNATE SPECIlC INFORMATION WHICH CAN TRIGGER VARIOUS RESPONSES ON OUR PART BASED ON INFORMATION FROM THE RISK ASSESSMENT !DDITIONALLY WE WILL BE DEVELOPING AN ORGANIZATIONWIDE FUNCTIONAL STATUS INSTRUMENT TO REmECT PATIENT CENTERED NEEDS &INALLY WE ARE DEVELOPING AN INTEGRATED TOOL TO REmECT ALL OF A PARTICULAR PATIENTS CLINICAL ISSUES 2IGHT NOW WE HAVE SEPARATE DIABETIC AND CARDIAC REGISTRIES 2" 7E CAN MISS ISSUES BECAUSE WERE NOT CONNECTED AND WE DONT SEE IT IN THAT LONGITUDINAL WAY 7E SEE IT IN A SPECIALTY AN EPISODE A HOSPITALIZATION ,, &OR EXAMPLE OUR DIABETIC AND CARDIAC REGISTRIES MAY HIGHLIGHT A PATIENTS DIABETIC PROBLEM FOR THE CLINICIAN OR NURSE AND THEN SOME TIME LATER THEIR CARDIAC PROBLEM 7E WANT TO DEVELOP AN INTEGRATED CARE RECOMMENDATION CUSTOMIZED FOR INDIVIDUAL PATIENTS CONSIDERING ALL OF THEIR CLINICAL ISSUES 0W# (OW DO YOU PLAN INNOVATIONS ,, 7E PICK EARLY ADOPTERS AND GIVE THEM APPROPRIATE SUPPORT AND OPPORTUNITY )N OUR ST #ENTURY #ARE )NNOVATION 0ROJECT THEY HAVE TIME DURING THEIR WORKDAYS TO MEET AS TEAMS AND lGURE OUT WHAT CHANGES THEYRE GOING TO MAKE 7EVE GIVEN THEM ANALYTIC SUPPORT SO THAT THEY DONT HAVE TO DO THEIR OWN DATA COLLECTION AND ANALYSIS 4HE WHOLE PRINCIPLE IS CREATING SUPPORT AND PERMISSION TO TRY ANYTHING 7E HAVE CREATED SPACE BY GIVING RESOURCES LEADERSHIP SUPPORT AND EXPERT ADVISORS n
4HE 0AY FOR 0ERFORMANCE ,ANDSCAPE ! DRAMATIC INCREASE IN THE NUMBER OF PAY FOR PERFORMANCE PROGRAM SPONSORS MARKS A SIGNIlCANT SHIFT TOWARD ALIGNMENT OF QUALITY CARE AND SERVICE REIMBURSEMENT n A KEY DRIVER OF FUTURE lNANCIAL CLINICAL AND QUALITY IMPROVEMENTS
"Y (INDY 3HAMAN AND 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
7
HEN THE )NSTITUTE OF -EDICINE WHICH ADVISES THE NATION ON SCIENCE AND HEALTH POLICY MATTERS RECOMMENDED THAT PROVIDERS AND PAYERS hBETTER ALIGN QUALITY WITH REIMBURSEMENT v THE EARTH DIDNT MOVE IMMEDIATELY;= "UT THE SHIFT WAS UNDER WAY SETTING UP A DRAMATIC CHANGE IN HOW HEALTH SERVICES AND TREATMENTS ARE PAID !CCORDING TO A STUDY CONDUCTED BY -ED 6ANTAGE THE NUMBER OF PAY FOR PERFORMANCE PROGRAM SPONSORS HAS SIGNIlCANTLY INCREASED 4HIRTY lVE PROGRAMS WERE IN PLACE IN IN IN AND BY 4HESE PROGRAMS ARE ESTIMATED TO COVER MORE THAN MILLION BENElCIARIES;= "Y MANY INDICATIONS THE HEALTHCARE INDUSTRY IS APPROACHING A SURGE IN QUALITY REPORTING AND PAY FOR PERFORMANCE INITIATIVES 2ESEARCH REVEALS THAT PERCENT OF HEALTH LEADERS THINK PAY FOR PERFORMANCE MODELS WILL BE THE NORM FOR HEALTHCARE DELIVERY IN THE NEXT lVE TO YEARS;= !T ITS CORE PAY FOR PERFORMANCE ENCOURAGES QUALITY AND PATIENT SATISFACTION THROUGH PAYMENT INCENTIVES 5LTIMATELY PAY FOR PERFORMANCE IS INTENDED TO DRIVE LASTING AND MEANINGFUL IMPROVEMENTS IN lNANCIAL CLINICAL AND SATISFACTION PERFORMANCE #OMMON ELEMENTS OF THESE PROGRAMS INCLUDE %VIDENCE BASED CLINICAL MEASURES 0ATIENT SAFETY MEASURES 0ATIENT SATISFACTION MEASURES %FlCIENCY MEASURES )NFORMATION TECHNOLOGY INFRASTRUCTURE &INANCIAL INCENTIVES AND 0AYMENT CALCULATIONS ! PAY FOR PERFORMANCE NATIONAL STANDARD DOES NOT EXIST SO PLANS VARY IN THE METHODS USED TO MEASURE AND REWARD QUALITY /NE HEALTH PLANS PAY FOR PERFORMANCE SCORECARD IS SHOWN IN %XHIBIT 4HIS SCORECARD FROM "LUE #ROSS AND "LUE 3HIELD OF )LLINOIS COULD BE DESCRIBED AS A hBEST OF BREEDv IN THAT IT COMBINES MEASURES FROM SEVERAL SOURCES ! PROVIDERS SCORE WILL DETERMINE THE LEVEL
OF INCREASE RECEIVED IN THE FOLLOWING YEARS NEGOTIATION WITH THE PLAN h7E HAVE WORKED COLLABORATIVELY WITH PROVIDERS TO DEVELOP A PROGRAM THAT REWARDS SUPERIOR PERFORMANCE !S A RESULT WE ARE SEEING IMPROVEMENTS IN THE OVERALL QUALITY OF CARE v SAID "RAD "UXTON DIVISIONAL SENIOR VICE PRESIDENT HEALTH CARE MANAGEMENT FOR (EALTH #ARE 3ERVICE #ORP WHICH OPERATES "LUE #ROSS AND "LUE 3HIELD PLANS IN )LLINOIS .EW -EXICO /KLAHOMA AND 4EXAS (E CONTINUES h!BOUT EIGHT YEARS AGO WE STARTED MEASURING OUTCOMES FOR MEMBERS IN OUR (-/ 7E LOOKED AT (%$)3 RESULTS AND TIED IT TO AN INCENTIVE POOL AND REPORTED THE RESULTS TO OUR MEMBERS 2ESULTS IMPROVED BY OVER PERCENT IN SOME CASESv -OREOVER THE PAY FOR PERFORMANCE MOVEMENT IS A RELATIVELY RECENT ONE WITH THE OLDEST PROGRAMS DATING BACK ONLY FOUR YEARS !ND DIFFERENT GEOGRAPHIC REGIONS VARY IN THEIR IMPLEMENTATION OF AND READINESS FOR PAY FOR PERFORMANCE DEPENDING ON THE DEGREE OF PAYER AND PROVIDER CONSOLIDATION AND EXISTENCE OF AN INFORMATION TECHNOLOGY BACKBONE TO SUPPORT DATA COLLECTION AND REPORTING SEE %XHIBITS AND ! FEW OF THE LARGER MORE ESTABLISHED PAY FOR PERFORMANCE PROGRAMS HAVE STARTED TO YIELD RESULTS "RIDGES 4O %XCELLENCE "4% n &OUNDED IN BY A NOT FOR PROlT COALITION OF LARGE EMPLOYERS "4% INCLUDES THREE SUBCOMPONENTS THAT PROVIDE BONUSES TO PHYSICIANS WHO MEET CRITERIA IN DIABETES CARE CARDIOVASCULAR CARE AND PATIENT CARE MANAGEMENT 0ARTICIPATION IS VOLUNTARY FOR PHYSICIANS AND THE PROGRAM REQUIRES PHYSICIANS TO PASS ASSESSMENTS ESTABLISHED BY THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE 5NLIKE MOST PAY FOR PERFORMANCE PROGRAMS THAT PULL DATA FROM INSURANCE CLAIMS THE PROGRAM USES DATA OBTAINED FROM MEDICAL CHARTS 4HE PHYSICIAN OFlCE PROGRAM REWARDS PHYSICIANS ON ELEMENTS SUCH AS PATIENT ACCESS AND COMMUNICATION ELECTRONIC PRESCRIBING INTEROPERABILITY OF ELECTRONIC SYSTEMS PERFORMANCE REPORTING AND IMPROVEMENT 4OP PERFORMING PHYSICIANS RECEIVE A PERCENT INCREASE IN REIMBURSEMENT FOR THE
(INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM 4IM 7ILSON -$ IS A FAMILY DOCTOR IN THE 5NITED +INGDOM !FTER WORKING AT THE HIGHEST LEVEL IN GOVERNMENT HE MOVED TO 0RICEWATERHOUSE#OOPERS WHERE HE IS SENIOR ADVISOR ON CLINICAL PERFORMANCE IMPROVEMENT (E HAS PUBLISHED EXTENSIVELY ON THE SUBJECTS OF QUALITY AND SAFETY (E CAN BE REACHED AT TIMWILSON UKPWCCOM # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGDãO @X ENQ OD QE NQL @MBD ãK@MCRB@OD %XHIBIT "LUE #ROSS AND "LUE 3HIELD OF )LLINOIS !NNUAL (OSPITAL 0ROlLE (OSPITAL 2ESULTS ,EAPFROG )#5 0HYSICIAN 3TAFlNG )03 3TANDARD 3UBMISSION OF SURVEY TO ,EAPFROG FOR PUBLIC REPORTING 0ROGRESS TOWARD MEETING THE ,EAPFROG )03 STANDARD ,EAPFROG #OMPUTER 0HYSICIAN /RDER %NTRY #0/% 3TANDARD 3UBMISSION OF SURVEY FOR PUBLIC REPORTING 0ROGRESS TOWARD MEETING THE ,EAPFROG #0/% STANDARD .ATIONAL 1UALITY &ORUM 3AFE 0RACTICES 3UBMISSION OF SURVEY TO ,EAPFROG ON SAFE PRACTICES OR PARTICIPATION IN 4EXAS -EDICAL )NSTITUTE OF 4ECHNOLOGY TEST BED AND SUBMISSION OF SURVEY WITH PERMISSION TO RELEASE QUARTILE TO "#"3), 0ROGRESS TOWARD MEETING THE ,EAPFROG .1& SAFE PRACTICES STANDARD (OSPITAL -EMBER 3URVEY /VERALL SATISFACTION COMPOSITE SCORE BASED ON / VERALL HOW WOULD YOU RATE THE QUALITY OF CARE YOU RECEIVED IN THE HOSPITAL DURING YOUR STAY %XCELLENT OR 6ERY 'OOD 7 OULD YOU RETURN TO THIS HOSPITAL FOR CARE IN THE FUTURE $ElNITELY 9ES OR 0ROBABLY 9ES ( OW LIKELY WOULD YOU BE TO RECOMMEND THIS HOSPITAL TO A FRIEND OR RELATIVE $ElNITELY 2ECOMMEND OR 0ROBABLY 2ECOMMEND %DUCATION AND #OORDINATION OF #ARE #OMPOSITE 3CORE 4HIS SCORE IS BASED ON THE FOLLOWING QUESTIONS 2 ATE YOUR INVOLVEMENT WITH DECISION MAKING ABOUT YOUR CARE %XCELLENT OR 6ERY 'OOD 2 ATE THE EDUCATION YOU WERE GIVEN ABOUT YOUR MEDICAL CONDITION %XCELLENT OR 6ERY 'OOD & OR MEMBERS RECEIVING MEDICATION RATE THE EDUCATION YOU RECEIVED ABOUT YOUR MEDICATIONS %XCELLENT OR 6ERY 'OOD & OR MEMBERS THAT RECEIVED DIAGNOSTIC TESTS RATE THE EXPLANATION OF WHAT WOULD HAPPEN DURING YOUR TESTS %XCELLENT OR 6ERY 'OOD & OR MEMBERS THAT RECEIVED WRITTEN DISCHARGE INSTRUCTIONS RATE YOUR UNDERSTANDING OF THESE INSTRUCTIONS %XCELLENT OR 6ERY 'OOD & OR MEMBERS UNDERGOING SURGERY RATE THE EDUCATION YOU RECEIVED ABOUT THE PURPOSE AND RISKS OF YOUR SURGERY %XCELLENT OR 6ERY 'OOD $ ID YOU RECEIVE EDUCATION ABOUT ANY NEW MEDICATIONS PRESCRIBED 9ES $ ID YOU RECEIVE INSTRUCTIONS FOR A FOLLOW UP VISIT TO YOUR PHYSICIAN 9ES %FlCIENCY 5TILIZATION EFlCIENCY 4HE RATIO OF ACTUAL !,/3 TO PREDICTED !,/3 BASED ON -ILLIMAN 53! 7ELL -ANAGED -ODEL FOR THE HOSPITALS CASE MIX IS REPORTED !DMINISTRATIVE EFlCIENCY 0 ERCENT OF "#"3), CLAIMS SUBMITTED ELECTRONICALLY . UMBER OF PAPER CLAIMS THAT ARE DUPLICATE )NQUIRIES ( OSPITAL HAS 4(). /NLINE ( OSPITAL INQUIRY TO CLAIMS RATIO !(21 )NDICATORS 3ELECTED INFECTIONS DUE TO MEDICAL CARE 0OSTOPERATIVE PULMONARY EMBOLISM OR DEEP VEIN THROMBOSIS 0OSTOPERATIVE RESPIRATORY FAILURE 0OSTOPERATIVE SEPTICEMIA /BSTETRIC TRAUMA n VAGINAL DELIVERY WITHOUT INSTRUMENT $ECUBITUS ULCER !CCIDENTAL PUNCTURE OR LACERATION &AILURE TO RESCUE )NPATIENT QUALITY INDICATORS MORTALITY RATES FOR ACUTE MYOCARDIAL INFARCTION CONGESTIVE HEART FAILURE ACUTE STROKE GASTROINTESTINAL HEMORRHAGE HIP FRACTURE PNEUMONIA
-AX 0OINTS 0OSSIBLE
0OINTS %ARNED
#ONTINUED ON THE NEXT PAGE
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
SGDãO @X ENQ OD QE NQL @MBD ãK@MCRB@OD %XHIBIT CONTINUED "LUE #ROSS AND "LUE 3HIELD OF )LLINOIS !NNUAL (OSPITAL 0ROlLE 0HYSICIAN 3URVEY /VERALL QUALITY OF CARE 0HARMACY PROVIDES MEDS CORRECTLY !DEQUACY OF NUMBER OF NURSES !CCURACY OF PROCESSING DOCTOR ORDERS 1UALITY OF DISCHARGE PLANS 4IMELY IMPLEMENTATION OF ORDERS 4IMELINESS OF IMAGELAB REPORTS MEETS NEEDS FOR CLINICAL DECISIONS (OSPITAL TAKES APPROPRIATE STEPS TO PROTECT SAFETY OF PATIENTS 2. STAFF HAS NECESSARY CLINICAL SKILLS TO PROVIDE APPROPRIATE CARE FOR SPECIlC UNITS IN WHICH THEY WORK (OSPITAL 1UALITY !LLIANCE #-3 *#!(/ !CUTE -YOCARDIAL )NFARCTION !SPIRIN AT ARRIVAL !SPIRIN PRESCRIBED AT DISCHARGE !#% INHIBITOR FOR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION "ETA BLOCKER AT ARRIVAL "ETA BLOCKER PRESCRIBED AT DISCHARGE 0#) WITHIN MINUTES OF ARRIVAL !DULT SMOKING CESSATION ADVICECOUNSELING (EART &AILURE ,EFT VENTRICULAR FUNCTION ASSESSMENT !#% INHIBITOR FOR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION $ISCHARGE INSTRUCTIONS !DULT SMOKING CESSATION ADVICECOUNSELING 0NEUMONIA /XYGENATION ASSESSMENT 0NEUMOCOCCAL VACCINATION STATUS !DULT SMOKING CESSATIONADVICE COUNSELING )NITIAL ANTIBIOTIC WITHIN HOURS AFTER ARRIVAL -OST APPROPRIATE INITIAL ANTIBIOTIC "LOOD CULTURES PERFORMED BEFORE lRST ANTIBIOTIC RECEIVED IN HOSPITAL 3URGICAL )NFECTION 0REVENTION 0REVENTIVE ANTIBIOTIC HOUR BEFORE INCISION 0REVENTIVE ANTIBIOTIC STOPPED WITHIN HOURS AFTER SURGERY 3TRUCTURAL )NDICATORS 0ERCENTAGE OF PHYSICIANS ON MEDICAL STAFF WHO ARE BOARD CERTIlED !CCREDITATION STATUS 0ARTICIPATION IN 3TATE AND .ATIONAL 1UALITY )MPROVEMENT )NITIATIVES %XTRA #REDIT IE !MERICAN (EART !SSNS 'ET WITH THE 'UIDELINES !## DATABASE 343 DATABASE )() ,IVES #AMPAIGN 4/4!, 0/33)",% 0/).43
SUBSET OF THEIR PATIENTS THAT ARE INVOLVED IN THE PROGRAM #URRENTLY THE "4% PROGRAM SERVES PATIENTS ACROSS DIFFERENT MARKETS;= !S OF &EBRUARY THE PROGRAM HAD AWARDED APPROXIMATELY MILLION TO PARTICIPATING PHYSICIANS;= /N AN ANNUAL BASIS THE COST FOR DIABETIC CARE BY A PARTICIPATING ENDOCRINOLOGIST WAS LESS WITH MOST OF THE SAVINGS FROM A REDUCTION IN INPATIENT COSTS;= )NTEGRATED (EALTHCARE !SSOCIATION )(! n ! CONSORTIUM OF SEVEN LARGE #ALIFORNIA HEALTH PLANS AND MEDICAL GROUPS THE )(! PROGRAM IS THE LARGEST PAY FOR PERFORMANCE PROGRAM IN THE COUNTRY )(! USES A QUALITY SCORECARD STRUCTURE THAT COVERS THREE BROAD CATEGORIES CLINICAL QUALITY PATIENT SATISFACTION AND INFORMATION TECHNOLOGY )4 INVESTMENT WHICH ACCOUNT FOR PERCENT
(OSPITAL 2ESULTS
-AX 0OINTS 0OSSIBLE
0OINTS %ARNED
PERCENT AND PERCENT OF THE TOTAL SCORE RESPECTIVELY;= %IGHTY SEVEN PERCENT OF THE GROUPS REPORTING ALL CLINICAL MEASURES IMPROVED THEIR OVERALL CLINICAL SCORE BY AN AVERAGE OF PERCENTAGE POINTS BETWEEN AND ;= )(!S PERFORMANCE RESULTS HAVE SHOWN A CORRELATION BETWEEN )4 AND CLINICAL SCORES )(! FOUND THAT PHYSICIAN GROUPS THAT RECEIVED FULL CREDIT ON )4 MEASURES HAD CLINICAL SCORES THAT WERE ABOUT NINE PERCENTAGE POINTS HIGHER THAN MEDICAL GROUPS THAT SHOWED NO EVIDENCE OF )4 ADOPTION;= )N THE ORGANIZATION PAID OUT MILLION TO PHYSICIANS WHO MET QUALITY STANDARDS;= #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3 n #-3 HAS TWO MAJOR HOSPITAL PAY FOR PERFORMANCE INITIATIVES UNDER WAY THE (OSPITAL 1UALITY )NITIATIVE AND THE 0REMIER (OSPITAL 1UALITY
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
SGDãO @X ENQ OD QE NQL @MBD ãK@MCRB@OD %XHIBIT 0AY FOR 0ERFORMANCE 2EADINESS 2ANKING
.OTE 4HIS MAP IDENTIlES PAY FOR PERFORMANCE READINESS OF THE LARGEST METROPOLITAN STATISTICAL AREAS IN THE 53 BASED ON POPULATION SIZE 4HOSE AREAS WITH A HIGHER DEGREE OF CONSOLIDATION AMONG THEIR HEALTH PLANS HOSPITALS AND PHYSICIANS ACCORDING TO DATA OBTAINED FROM (EALTH,EADERS -3! 2EPORTS AND AN ESTABLISHED INFORMATION TECHNOLOGY INFRASTRUCTURE IE THEY WERE IN )NTELS RANKING OF THE TOP WIRELESS CITIES OBTAINED AT HTTPWWWINTELCOMPERSONALWIRELESSUNWIREDCITIESINDEXHTM WERE RATED AS MORE READY FOR PAY FOR PERFORMANCE
)NCENTIVE $EMONSTRATION 0ROJECT 5NDER THE (OSPITAL 1UALITY )NITIATIVE ELIGIBLE HOSPITALS CAN RECEIVE THEIR FULL ANNUAL UPDATE UNDER THE INPATIENT PROSPECTIVE PAYMENT SYSTEM IF THEY SUBMIT DATA ON QUALITY MEASURES FOR ACUTE MYOCARDIAL INFARCTION HEART FAILURE AND PNEUMONIA THESE ARE THE SAME MEASURES THAT FORM THE hSTARTER SETv OF THE VOLUNTARY REPORTING EFFORT ESTABLISHED BY THE (OSPITAL 1UALITY !LLIANCE /THERWISE ELIGIBLE HOSPITALS THAT DO NOT PARTICIPATE IN THE INITIATIVE BY REPORTING THE REQUIRED DATA BY THE ESTABLISHED DEADLINES WILL RECEIVE A PERCENTAGE POINT REDUCTION IN THEIR ANNUAL -EDICARE PAYMENT UPDATE )N HOSPITALS NOT REPORTING ON AN EXPANDED SET OF MEASURES WILL RECEIVE A PERCENTAGE POINT REDUCTION IN THEIR PAYMENT UPDATE;= #-3 SECOND HOSPITAL INCENTIVE PROGRAM THE 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION 0ROJECT BEGAN IN AND INVOLVES MORE THAN HOSPITALS 0REMIER A NATIONAL GROUP PURCHASING ORGANIZATION MANAGES THE PROJECT WHICH COLLECTS DATA ON MORE THAN QUALITY MEASURES RELATING TO ACUTE MYOCARDIAL INFRACTION HEART FAILURE CORONARY ARTERY BYPASS GRAFT PNEUMONIA AND HIP AND KNEE REPLACEMENT (OSPITALS SCORING IN THE TOP PERCENT FOR A GIVEN SET OF QUALITY MEASURES RECEIVE A PERCENT -EDICARE PAYMENT BONUS FOR THE ASSOCIATED $2' 4HOSE SCORING IN THE NEXT HIGHEST PERCENT RECEIVE A PERCENT BONUS ! lRST YEAR REPORT /CTOBER TO 3EPTEMBER OF THE DEMONSTRATION SHOWED THAT THE QUALITY OF CARE PROVIDED BY PARTICIPATING HOSPITALS IMPROVED SIGNIlCANTLY IN EACH OF THE lVE
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
CLINICAL AREAS 4HE GREATEST IMPROVEMENTS WERE IN PNEUMONIA WHERE THE OVERALL AVERAGE COMPOSITE QUALITY SCORE #13 RATE INCREASED PERCENT 4HE LOWEST CHANGE IN THE #13 WAS A PERCENT INCREASE IN ACUTE MYOCARDIAL INFARCTION 4HE DEMONSTRATION IS CURRENTLY IN ITS THIRD YEAR AND HOSPITALS IN THE BOTTOM PERCENT MUST EXCEED A QUALITY SCORING THRESHOLD OR BE SUBJECT TO REDUCTIONS OF OR PERCENT OF THEIR #-3 REIMBURSEMENT;= !DDITIONAL PAY FOR PERFORMANCE PROJECTS OPERATED BY #-3 INCLUDE THE 0HYSICIAN 'ROUP 0RACTICE $EMONSTRATION WHICH BEGAN IN !PRIL WITH LARGE PHYSICIAN GROUPS AND THE #HRONIC #ARE )MPROVEMENT PILOT PROGRAM THAT IS TESTING A POPULATION BASED MODEL OF DISEASE MANAGEMENT )N THE LATTER PROVIDERS RECEIVE A MONTHLY PER BENElCIARY FEE FOR MANAGING CHRONICALLY ILL BENElCIARIES WITH ADVANCED CONGESTIVE HEART FAILURE ANDOR COMPLEX DIABETES 4HE -EDICARE -ODERNIZATION !CT --! MANDATES ADDITIONAL PROGRAMS THAT #-3 WILL IMPLEMENT IN THE FUTURE 4HE -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION --! SECTION IS A THREE YEAR PAY FOR PERFORMANCE PROGRAM WITH SMALL AND MEDIUM SIZED PHYSICIAN PRACTICES TO PROMOTE THE ADOPTION AND USE OF HEALTH INFORMATION TECHNOLOGY TO IMPROVE THE QUALITY OF PATIENT CARE FOR CHRONICALLY ILL -EDICARE PATIENTS 4HE -EDICARE (EALTH #ARE 1UALITY $EMONSTRATION --! SECTION IS A lVE YEAR PROGRAM IN WHICH PHYSICIAN GROUPS INTEGRATED HEALTH SYSTEMS AND REGIONAL COALITIONS ENHANCE QUALITY BY IMPROVING
SGDãO @X ENQ OD QE NQL @MBD ãK@MCRB@OD %XHIBIT -ARKETS -OST 2EADY FOR 0AY FOR 0ERFORMANCE AND 3OME OF 4HEIR !CTIVITIES -3! "OSTON -!
0OPULATION
#HARLOTTE .# #OLUMBUS /( $ENVER #/ +ANSAS #ITY -/ -ILWAUKEE 7) -INNEAPOLIS -. 3ACRAMENTO #!
3AN $IEGO #!
3AN &RANCISCO #!
0AY FOR 0ERFORMANCE 0ROGRAMS "RIDGES 4O %XCELLENCE -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION (-/ "LUE 'ROUP 0ERFORMANCE )NCENTIVE 0ROGRAM 1UALITY )NCENTIVES 2EWARDING 2ESULTS "RIDGES 4O %XCELLENCE #HARLOTTE (EALTH #ARE #OLLABORATION 0ROJECT "RIDGES 4O %XCELLENCE "RIDGES 4O %XCELLENCE 0HYSICIAN 'ROUP 0ARTNERS 0ROGRAM %MPLOYEE 'ROUP (EALTH "ENElT 0ROGRAM "RIDGES 4O %XCELLENCE /UTCOMES 2ECOGNITION 0ROGRAM )NTEGRATED (EALTHCARE !SSOCIATION -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION 00/ 0HYSICIAN 1UALITY AND )NCENTIVE 0ROGRAM )NTEGRATED (EALTHCARE !SSOCIATION -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION 00/ 0HYSICIAN 1UALITY AND )NCENTIVE 0ROGRAM )NTEGRATED (EALTHCARE !SSOCIATION -EDICARE #ARE -ANAGEMENT 0ERFORMANCE $EMONSTRATION 00/ 0HYSICIAN 1UALITY AND )NCENTIVE 0ROGRAM
PATIENT SAFETY REDUCING VARIATIONS IN UTILIZATION BY APPROPRIATE USE OF EVIDENCE BASED CARE AND BEST PRACTICE GUIDELINES ENCOURAGING SHARED DECISION MAKING AND USING CULTURALLY AND ETHNICALLY APPROPRIATE CARE 5+ &AMILY $OCTOR #ONTRACT n )N WHAT HAS BEEN DESCRIBED AS THE LARGEST PAY FOR PERFORMANCE EXPERIMENT IN THE WORLD FAMILY PRACTITIONERS NOW RECEIVE BONUSES FOR ACHIEVING CERTAIN QUALITY METRICS; = 4HE CONTRACT WAS GROUNDBREAKING IN MANY WAYS INSTEAD OF BEING ON THE LIST OF AN INDIVIDUAL DOCTOR PATIENTS WERE REGISTERED WITH THE WHOLE PRACTICE TEAM !S WITH THE PREVIOUS CONTRACT MOST PAYMENTS STEM FROM THE NUMBER OF PATIENTS ON A PRACTICE LIST (OWEVER UNDER THE NEW CONTRACT THE NUMBER IS WEIGHTED FOR SOCIOECONOMIC STATUS AGE AND SEX OF THE PATIENTS )N ADDITION INCOME CAN BE BOOSTED BY AS MUCH AS PERCENT DEPENDING ON ACHIEVEMENT OF DIFFERENT INDICATORS FOR SPECIlC CHRONIC DISEASES LIKE DIABETES CORONARY HEART DISEASE AND ASTHMA !T THE LOWEST END OF THE SCALE POINTS ARE AWARDED FOR SIMPLE THINGS LIKE HAVING A DISEASE REGISTRY -ORE POINTS ARE AWARDED FOR PROCESS MEASURES LIKE TAKING BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION 4HE HIGHEST POINTS ARE AWARDED FOR PROXY OUTCOME MEASURES LIKE SUCCESSFULLY CONTROLLING BLOOD PRESSURE BELOW A TARGET IN A SIGNIlCANT NUMBER OF THE TARGET GROUP )N ALL PRACTICES CAN GAIN POINTS WITH EACH POINT BEING WORTH AROUND AND THEN MULTIPLIED UP OR DOWN ACCORDING TO THE NUMBER OF PATIENTS WITH EACH CHRONIC DISEASE A PREVALENCE FACTOR 4HE RESULTS HAVE BEEN IMPRESSIVE WITH MOST PRACTICES ACHIEVING MORE THAN POINTS AND MANY ACHIEVING THE MAXIMUM 4HE POSITIVE INTERPRETATION IS THAT MORE PATIENTS WILL GET EVIDENCE BASED CARE AND HEALTH INEQUALITIES WILL NARROW 4HE CONTRACT HAS LED TO A PERCENT PAY RAISE FOR MANY PHYSICIANS 4HE MAGNITUDE OF THE CHANGE CAUGHT THE GOVERNMENT BY SURPRISE BECAUSE THE BUDGET EXPECTED PRACTICES TO ACHIEVE AROUND
POINTS !S A RESULT THE CONTRACT WAS RECENTLY RENEGOTIATED WITH A SLIGHTLY DIFFERENT POINT SYSTEM AND A TWO YEAR PAY FREEZE %NDNOTES h#ROSSING THE 1UALITY #HASM ! .EW (EALTH 3YSTEM FOR THE ST #ENTURY v )NSTITUTE OF -EDICINE .ATIONAL !CADEMY 0RESS h0ROVIDER PAY FOR PERFORMANCE NATIONAL STUDY RESULTS v -ED 6ANTAGE AVAILABLE AT HTTPWWWMEDVANTAGEINCCOM0DF-6? ?00?.ATIONAL?3TUDY?2ESULTS %XEC?3UMMARYPDF ()-33 6ANTAGE 0OINT 3URVEY *ANUARY HTTPWWWBRIDGESTOEXCELLENCEORG ACCESSED ON "RIDGES 4O %XCELLENCE %XECUTIVE 3UMMARY &EBRUARY &EBRUARY HTTPWWWBRIDGESTOEXCELLENCEORGBTEPDF%XECUTIVE? 3UMMARY?&EBRUARY??2EPORT? PDF "RIDGES 4O %XCELLENCE HTTPWWWBRIDGESTOEXCELLENCEORGPDF 4HESIS?COMPLETE? ?EDITPDF !DVANCING 1UALITY 4HROUGH #OLLABORATION 4HE #ALIFORNIA 0AY FOR 0ERFORMANCE 0ROGRAM ! 2EPORT ON THE &IRST &IVE 9EARS AND A 3TRATEGIC 0LAN FOR THE .EXT &IVE 9EARS &EBRUARY HTTPWWWIHAORG WPPDF )BID )BID h3IDEBAR (EALTH 'ROUPS 5SE )4 TO )MPROVE 0ATIENT #ARE v #OMPUTERWORLD &EBRUARY HTTPWWWCOMPUTERWORLDCOM DATABASETOPICSBUSINESSINTELLIGENCESTORY HTML h2EPORTING (OSPITAL 1UALITY $ATA FOR !NNUAL 0AYMENT 5PDATE v #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES HTTPWWWCMSHHS GOV(OSPITAL1UALITY)NITS?(OSPITAL2(1$!05ASP4OP/F0AGE ACCESSED -AY #ENTERS FOR -EDICARE -EDICAID 3ERVICES #-3 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION 0ROJECT n 0ROGRAM /VERVIEW AND +EY &INDINGS FROM 9EAR /NE !PRIL HTTPWWWITPREMIERINCCOM ALLQUALITYHQIRESOURCES(1)WHITEPAPER PDF 2OLAND - h,INKING PHYSICIANS PAY TO THE QUALITY OF CAREnA MAJOR EXPERIMENT IN THE 5NITED +INGDOM . %NGL * -ED 3EPTEMBER PP 7ILSON 4 AND - 2OLAND # (AM h4HE CONTRIBUTION OF GENERAL PRACTICE AND THE GENERAL PRACTITIONER TO .(3 PATIENTS v * 2 3OC -ED VOL PP n # ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
"LUE #ROSS AND "LUE 3HIELD OF -INNESOTA (EALTHCARE &ACTS¸ ! .EW -ODEL FOR (OSPITAL 2EPORTING "ASED ON #ONSUMER %NGAGEMENT 2ETHINKING QUALITY METRICS FROM THE CONSUMERS POINT OF VIEW MEANS USING FAMILIAR LANGUAGE FORMATS AND TOOLS TO SUPPORT INFORMED PARTICIPATION IN THE HEALTHCARE DECISION MAKING PROCESS
"Y -ARY!NN 3TUMP AND 4AMARA , 9OUNG "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA
/
VER THE PAST DECADE AN INCREASING AMOUNT OF ATTENTION HAS BEEN PAID TO PERFORMANCE MEASUREMENT OF THE 5NITED 3TATES HEALTHCARE SYSTEM PARTICULARLY IN THE FORM OF hREPORT CARDSv 5NTIL RECENTLY MOST EFFORTS TO GATHER AND DISTRIBUTE INFORMATION ON QUALITY OF CARE HAVE CENTERED ON THE HEALTH PLAN OR ORGANIZATIONAL ACCREDITATION REQUIREMENTS 7HILE THESE EFFORTS PROVIDE READY INFORMATION FOR HEALTHCARE PROFESSIONALS CONSUMERS ARE LEFT WITH LITTLE OR NO QUALITY INFORMATION ABOUT HEALTHCARE PROVIDERS WHETHER INDIVIDUAL PHYSICIANS CLINICS HOSPITALS OR NURSING HOMES #ONSUMERS NEED QUALITY INFORMATION SPECIlCALLY DESIGNED TO ASSIST IN THE HEALTHCARE DECISION MAKING PROCESS; = 4HIS ARTICLE DESCRIBES A NEW CONSUMER INFORMATION TOOL DESIGNED TO MEET THAT NEED (EALTHCARE &ACTS WWWHEALTHCAREFACTSORG $EVELOPED BY "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA (EALTHCARE &ACTS IS FUELED BY THE IDEA THAT INCREASED CONSUMER PARTICIPATION IN HEALTHCARE MEANS MOVING TOWARD THE IDEA OF hBEST lTv AND hVALUEv FOR INDIVIDUAL CONSUMERS )NSTEAD OF EMPLOYERS HEALTH PLANS OR GOVERNMENT DETERMINING WHICH PROVIDERS ARE hBESTv AND SUBSEQUENTLY STEERING CONSUMERS TO THOSE PROVIDERS (EALTHCARE &ACTS INFORMS THE CONSUMERS EQUIPPING THEM TO MAKE THE lNAL DECISION (EALTHCARE &ACTS CURRENTLY PROVIDES INFORMATION FOR HOSPITALS IN -INNESOTA AND ,OUISIANA AND A PRIMARY CLINIC VERSION IN -INNESOTA WAS INTRODUCED IN !UGUST 7E ENVISION (EALTHCARE &ACTS AS AN EVER GROWING SUITE OF INFORMATIONAL TOOLS TO HELP CONSUMERS CHOOSE AMONG THE FULL RANGE OF HEALTHCARE PROVIDERS ACROSS THE 5NITED 3TATES
(OSPITAL 2EPORT #ARDS (EALTHCARE &ACTS IS NOT THE lRST ATTEMPT TO PROVIDE INFORMATION ABOUT HEALTHCARE QUALITY TO CONSUMERS "OTH FEDERAL AND STATE AGENCIES HAVE ATTEMPTED TO PRESENT CONSUMERS WITH A VARIETY OF INFORMATION REGARDING QUALITY AND MORTALITY; = )N EACH CASE CONSUMERS DID NOT USE THE INFORMATION !FTER FOUR YEARS OF PUBLISHED RISK ADJUSTED MORTALITY RATES FOR EVERY HOSPITAL SURGEON AND SURGICAL GROUP PERFORMING OPEN HEART SURGERY IN 0ENNSYLVANIA ONLY PERCENT OF PATIENTS SURVEYED KNEW THE INFORMATION EXISTED PRIOR TO SURGERY LESS THAN PERCENT REPORTED THAT THE INFORMATION HAD MADE AN IMPACT ON THEIR SELECTION OF PROVIDER;= #ONSUMERS ALSO DID NOT RESPOND TO SIMILAR INFORMATION MADE AVAILABLE BY THE STATE OF .EW 9ORK ;= .O CLEAR DIFFERENCE IN MARKET SHARE FOR HIGH OR LOW MORTALITY RATE HOSPITALS OCCURRED AFTER THE RELEASE OF THE INFORMATION;= )N CONTRAST TO MORE SPECIlC INFORMATION ABOUT MORTALITY RATES SOME HOSPITAL PERFORMANCE REPORTING HAS RATED HOSPITALS OVERALL OR BY CONDITION OR PROCEDURE )NTERNET SITES SUCH AS (EALTH'RADESCOM 53.EWSCOM AND #AL(OSPITALSORG PRESENT SUMMARIZED RATINGS OF HOSPITALS USING DATA FROM A RANGE OF SOURCES INCLUDING -EDICARE BILLING DATA AND PATIENT SURVEYS 7HILE THIS METHOD PROVIDES CONSUMERS WITH INFORMATION THAT MAY PROVE USEFUL TO SOME EXTENT CONSUMERS ARE OFTEN FORCED TO WADE THROUGH VOLUMES OF INFORMATION OR ARE PROVIDED WITH SUMMARY SCORES BUT WITH NO MEANS OF OBTAINING MORE SPECIlC INFORMATION ABOUT THE FACILITY
-ARY!NN 3TUMP 2. "3 IS SENIOR VICE PRESIDENT AND CHIEF INNOVATION OFlCER "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA AND PRESIDENT #ONSUMER !WARE ! PASSIONATE ADVOCATE FOR HEALTHCARE REFORM SHE HAS ENGAGED EMPLOYERS HEALTHCARE PROVIDERS AND POLICY MAKERS IN VIEWING HEALTHCARE FROM THE CONSUMERS PERSPECTIVE AND ENCOURAGING INNOVATIONS IN THE DELIVERY OF HIGH QUALITY AFFORDABLE HEALTHCARE 3HE CAN BE REACHED AT -ARY!NN?3TUMP BLUECROSSMNCOM 4AMARA , 9OUNG 0H$ IS A RESEARCH CONSULTANT FOR #ONSUMER !WARE AND A HEALTHCARE BLOGGER 3HE PREVIOUSLY SUPPORTED A VARIETY OF PRIVATE STATE AND COMMUNITY HEALTH SYSTEMS INCLUDING THE 4ERRITORY OF 'UAM PROVIDING PROGRAM DEVELOPMENT AND EVALUATION SERVICES 3HE CAN BE REACHED AT 4AMARA?,?9OUNG BLUECROSSMNCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
AK TDãB QN R R ã@MCãAK TDãRGHD KCãNE ãL HMMD RNS@ãGD @KSGB@QD ãE@BSR Ø !LTHOUGH STUDIES INDICATE THAT CONSUMERS HAVE NOT FOUND EARLY ATTEMPTS AT HOSPITAL PERFORMANCE REPORTS USEFUL CONSUMERS DO IN FACT HAVE AN APPETITE FOR MORE INFORMATION ON HEALTHCARE PROVIDERS; = 7HILE THAT INFORMATION TENDS TO COME PRIMARILY FROM FRIENDS AND FAMILY CONSUMERS DO INDICATE AN OPENNESS TO RECEIVING RELIABLE HEALTHCARE QUALITY INFORMATION FROM AN EXTERNAL SOURCE AS WELL; = )N FACT A THIRD OF ADULTS SEEKING ONLINE INFORMATION ABOUT HEALTHCARE SAY THAT THE INFORMATION DOES HAVE AN INmUENCE ON SUBSEQUENT HEALTHCARE DECISIONS;= 4HESE lNDINGS SUGGEST ROOM FOR INNOVATION IN PROVIDER PERFORMANCE REPORTING AND EVIDENCE THAT IF PRESENTED WELL AND ACCOMPANIED BY EDUCATIONAL EFFORTS NEW TOOLS WILL BE FAVORABLY RECEIVED BY CONSUMERS
%XHIBIT (EALTHCARE &ACTS¸
#ONTEXT #ONSUMER %NGAGEMENT 2ECOGNIZING THE TRUE IMPORTANCE OF CONSUMER ENGAGEMENT AND EMPOWERMENT THE (EALTHCARE &ACTS DEVELOPMENT TEAM WORKED TO CREATE A TOOL THAT TRULY REmECTS CONSUMER NEEDS 4HE IDEA OF THE CONSUMERPATIENT AS KEY STAKEHOLDER IS NOT A NEW CONCEPT BUT THE RECENT )NSTITUTE OF -EDICINE )/- REPORT h#ROSSING THE 1UALITY #HASM v SOLIDIlED THE IMPORTANCE OF RECOGNIZING THE PATIENTS CENTRAL ROLE IN DElNING AND EVALUATING QUALITY HEALTHCARE;= 4HE )/- lNDINGS INDICATE THAT THE HEALTHCARE SYSTEM NEEDS TO VIEW ITSELF THROUGH THE EYES OF THE PATIENT !S SUCH ANY USEFUL INFORMATIONAL TOOL MUST BE ABLE TO MEET PATIENTS AT THEIR LEVEL ! TRULY EFFECTIVE TOOL WILL INCLUDE THE ITEMS OF MOST INTEREST TO CONSUMERS AND REmECT CONSUMER HEALTH LITERACY IN THE LEVEL OF COMPLEXITY AND THE OVERALL DESIGN )N AN ATTEMPT TO RESPOND CONSTRUCTIVELY TO CONSUMER RESEARCH lNDINGS AND KEEP THE ULTIMATE GOAL OF CONSUMER ENGAGEMENT IN MIND WE ADOPTED SEVERAL OPERATING PRINCIPLES (EALTHCARE &ACTS MUST BE RECOGNIZABLE AND INVITING AND NOT INTIMIDATING ACCOMPANIED BY EDUCATION AND OTHER CONSUMER AWARENESS TO MAXIMIZE IMPACT PLATFORM INDEPENDENT AND DELIVERABLE THROUGH A VARIETY OF CHANNELS BASED ON WHAT CONSUMERS WANT TO KNOW NOT WHAT WE CAN MEASURE PRESENTED IN A hBEST lTv FORMAT AND NOT AS A PRESCRIPTIVE REPORT CARD AND ABLE TO SUPPORT AN ENTIRE DECISION MAKING PROCESS
2ECOGNIZABLE AND )NVITING (EALTHCARE &ACTS IS PATTERNED AFTER THE SIMPLE RECOGNIZABLE INFORMATION TEMPLATE FOUND ON EVERY FOOD AND BEVERAGE PRODUCT SOLD IN THE 5NITED 3TATES SEE %XHIBIT 4HE .UTRITION &ACTS LABEL IS A FAMILIAR LAYOUT AND CONSUMERS HAVE BEEN SUCCESSFULLY USING IT SINCE ;= 4HE CONCISE ABBREVIATED FORMAT KEEPS CONSUMERS FROM BEING INUNDATED WITH INFORMATION AND LIMITS THE CONTENT TO NO MORE THAN ONE PAGE WITH ADDITIONAL PAGES FOR EDUCATION ON THE TOOL INCLUDING DElNITIONS
4HE USE OF THE NUTRITION LABEL ALSO ALLOWED THE (EALTHCARE &ACTS TEAM TO CAPITALIZE ON THE EASE OF COMPARISON THAT THE .UTRITION &ACTS LABEL AFFORDS 3INCE CONSUMERS HAVE GROWN ACCUSTOMED TO USING .UTRITION &ACTS INFORMATION IN COMPARING SIMILAR PRODUCTS (EALTHCARE &ACTS PROVIDES A SIMILAR EASE OF USE
%DUCATION AND !WARENESS ! CRITICAL COMPONENT OF CONSUMER CHOICE IS EDUCATION (ISTORICALLY CONSUMERS HAVE GENERALLY NOT UNDERSTOOD QUALITY INFORMATION WHICH SUGGESTS THAT NEW INITIATIVES MUST BE MUCH MORE PROACTIVE IN EDUCATING THE INTENDED AUDIENCE;= #OMPREHENSION DRIVES SALIENCE CONSUMERS TEND TO DISCOUNT INFORMATION THEY DO NOT UNDERSTAND; = (EALTHCARE &ACTS CONTAINS SEVERAL PAGES OF CONSUMER EDUCATION INCLUDING A CONSUMER FRIENDLY DESCRIPTION OF ALL METRICS "LUE #ROSS LAUNCHED A NONTRADITIONAL MARKETING CAMPAIGN THAT INCLUDED ACTORS DRESSED IN HOSPITAL GOWNS WALKING THROUGH THE SKYWAYS OF DOWNTOWN -INNEAPOLIS IN THE CROWDS AT AN ."! BASKETBALL GAME AND AT VARIOUS GROCERY STORES 4HE hGOWN WALKERSv HANDED OUT MINI CEREAL BOXES WITH A SAMPLE (EALTHCARE &ACTS ON ONE SIDE AND A COLORFUL CARTOON DRAWING ON THE OTHER THE BOXES CONTAINED A (EALTHCARE &ACTS REFRIGERATOR MAGNET AND BROCHURE 4HE NONTRADITIONAL MARKETING EFFORTS HELPED STIMULATE INTEREST IN (EALTHCARE &ACTS IN A NEW EYE CATCHING WAY -ORE STANDARD MARKETING EFFORTS SUCH AS NEWSPAPER AND RADIO ADVERTISEMENTS WERE CONDUCTED AS FOLLOW UPS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
AK TDãB QN R R ã@MCãAK TDãRGHD KCãNE ãL HMMD RNS@ãGD @KSGB@QD ãE@BSR Ø
0LATFORM )NDEPENDENT (EALTHCARE &ACTS WAS DESIGNED TO BE PLATFORM INDEPENDENT ABLE TO BE DISTRIBUTED THROUGH THE 7EB OR IN HARD COPY 7HILE THE )NTERNET SERVES AS A NATURAL HOME FOR (EALTHCARE &ACTS WWW HEALTHCAREFACTSORG NOT ALL CONSUMERS HAVE READY ACCESS OR FEEL COMFORTABLE USING THAT MEDIUM !S SUCH WE ENSURED THAT (EALTHCARE &ACTS WAS DEPLOYABLE IN HARD COPY AND AVAILABLE THROUGH PARTICIPATING HOSPITALS INCLUDED IN EMPLOYEES HEALTH PLAN OFFERINGS AND SHARED AS PART OF A NEW ENROLLEES BENElT PACKAGE 7ITHIN THE ONLINE VERSION THE USER HAS READY ACCESS TO A VAST AMOUNT OF INFORMATION IN A RELATIVELY UNCLUTTERED FORMAT AND IS ABLE TO DRILL DOWN FOR MORE SPECIlC INFORMATION (EALTHCARE &ACTS LINKS TO OTHER COMPLEMENTARY SITES AND PROVIDES A RELATIVE EASE OF UPDATING AND DISTRIBUTING OF INFORMATION
"Y KEEPING THE HEALTH PLAN IN THE BACK GROUND THE INFORMATION WILL SPEAK FOR ITSELF AND "LUE #ROSS WILL SERVE AS AN @INFOMEDIARY NOT AN ARBITER OF WHERE PATIENTS SEEK CARE "ASED ON #ONSUMER &EEDBACK 4HE (EALTHCARE &ACTS TEAM CONVENED DOZENS OF CONSUMER DESIGN GROUPS WHERE CONSUMERS EXPERIENCED MOCK UPS OF THE TOOL AND GAVE EXTENSIVE FEEDBACK &OR EACH ITEM THE TEAM ASSESSED THE LEVEL OF COMPREHENSION AND EDITED OR REMOVED CONFUSING ITEMS AND ITEMS OF NO INTEREST TO CONSUMERS #ONSUMERS CONSISTENTLY EXPRESSED THEIR OWN UNIQUE PERSPECTIVE ABOUT HOW INTERESTING AND RELEVANT INFORMATION IS WHEN IT COMES TO HEALTHCARE CHOICES THOSE IDEAS WERE OFTEN QUITE DIFFERENT FROM THOSE OF HEALTHCARE hINSIDERSv !S A RESULT THE TEAM INCORPORATED NEW ITEMS SPECIlCALLY REQUESTED BY CONSUMERS &OR EXAMPLE CONSUMERS REQUESTED A h.EIGHBORHOOD 3AFETY 3CORE v TO GIVE AN IDEA OF THE STATE OF THE NEIGHBORHOOD IN WHICH THE HOSPITAL IS LOCATED #ONSUMERS ALSO WANTED TO KNOW THE PERCENT OF HOSPITAL BEDS LOCATED IN PRIVATE ROOMS AND THAT INFORMATION WAS ALSO INCORPORATED
@"EST &IT 0HILOSOPHY !S MENTIONED ABOVE THE NEWEST WAVE OF HOSPITAL REPORTING OFTEN PRODUCES RATINGS FOR HOSPITALS BASED ON A LETTER GRADE OR ONE TO FOUR STARS SUGGESTING THAT THERE IS A hBESTv HOSPITAL 2ATINGS CAN BE CONFUSING ESPECIALLY IF THEY ARE CONTRADICTORY $UE TO DIFFERENCES IN METHODOLOGIES RATINGS ACROSS DIFFERENT HOSPITAL PROlLES CAN APPEAR INCONSISTENT OR CONTRADICTORY &OR EXAMPLE IN A RECENT LIST OF TOP 53 HOSPITALS 53 .EWS AND 7ORLD 2EPORT LISTED THE -AYO HOSPITALS AS .O IN ORTHOPEDICS /LMSTED -EDICAL #ENTER ALSO IN 2OCHESTER -INN WAS NOT LISTED !NOTHER SOURCE OF QUALITY INFORMATION (EALTH'RADESCOM GAVE -AYO
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
HOSPITALS ONE STAR IN THE AREA OF TOTAL KNEE REPLACEMENT SURGERY WHILE /LMSTED RECEIVED THREE STARS IN THE SAME PERIOD OF TIME 0ERHAPS MORE IMPORTANTLY THOUGH RATINGS FAIL TO GIVE THE IMPRESSION THAT THERE ARE ASPECTS OF A PROVIDERS PRACTICE THAT MIGHT APPEAL TO PEOPLE DIFFERENTIALLY AND INmUENCE INDIVIDUAL DECISIONS TO SEEK CARE h"EST lTv IS MORE IN LINE WITH A PHILOSOPHY OF PATIENT CENTERED CARE RESPECTING THE VALUES AND PREFERENCES OF INDIVIDUAL PATIENTS AS SUGGESTED BY THE )/- REPORT /NE ITEM ON (EALTHCARE &ACTS FOR EXAMPLE IS THE HOSPITALS RELIGIOUS AFlLIATION 3OME FOCUS GROUP MEMBERS INDICATED THAT THEY WOULD SEEK SERVICES FROM A RELIGIOUS INSTITUTION WITH NEAR DISREGARD FOR ANY OTHER INFORMATION LISTED ABOUT THAT HOSPITAL
"LUE #ROSS AS @)NFOMEDIARY (EALTHCARE &ACTS IS NOT A MARKETING VEHICLE PROMINENTLY FEATURING "LUE #ROSS (EALTHCARE &ACTS DOES NOT CONTAIN DATA ON "LUE #ROSS MEMBERS ONLY 4HE ONLY ITEM ON (EALTHCARE &ACTS THAT PERTAINS SOLELY TO "LUE #ROSS MEMBERSHIP IS THE hPRICEv COMPONENT WHICH WE DEVELOPED INTERNALLY USING ADMINISTRATIVE DATA ALL OTHER ITEMS ARE SELF REPORTED BY THE HOSPITALS ON THEIR ENTIRE BOOK OF BUSINESS "LUE #ROSS POSITION AS A LARGE HEALTH PLAN WITH PRE EXISTING RELATIONSHIPS ALLOWED THE (EALTHCARE &ACTS TEAM TO ENGAGE PROVIDERS COLLECT DATA AND DISTRIBUTE THE INFORMATION TO THE PUBLIC "Y KEEPING THE HEALTH PLAN IN THE BACKGROUND THE INFORMATION WILL SPEAK FOR ITSELF AND "LUE #ROSS WILL SERVE AS AN hINFOMEDIARY v NOT AN ARBITER OF WHERE PATIENTS SEEK CARE
-ARKET 2ESPONSE (EALTHCARE &ACTS IS ENVISIONED AS A SUITE OF INFORMATIONAL TOOLS THAT HELP CONSUMERS CHOOSE HEALTHCARE PROVIDERS 7ITH THE ADVENT OF CONSUMER DIRECTED ANDOR TIERED BENElT PRODUCTS THAT EMPLOYERS ARE ANTICIPATING OFFERING IN THE FUTURE LARGE EMPLOYEE GROUPS HAVE RESPONDED FAVORABLY TO (EALTHCARE &ACTS AS IT PROVIDES EMPLOYEES INFORMATION ON PROVIDERS BEFORE THEY CRITICALLY NEED IT (EALTHCARE &ACTS IS A TOOL THAT CAN EASE CONSUMERS INTO THINKING ABOUT ALL THE CHOICES THEY HAVE TO MAKE WHEN MORE OF THEIR OWN DOLLARS ARE AT STAKE 4HE HOSPITALS AND CLINICS INCLUDED IN (EALTHCARE &ACTS ALSO RESPONDED FAVORABLY /UR APPROACH FROM THE BEGINNING WAS TO BE AS COLLABORATIVE AS POSSIBLE FROM GARNERING SUPPORT AT THE EXECUTIVE LEVEL TO WORKING WITH QUALITY IMPROVEMENT AND CLINICAL STAFF ON THE DATA DElNITIONS FOR THE ITEMS CONTAINED IN (EALTHCARE &ACTS 0ROVIDERS WERE READY TO THINK ABOUT THEMSELVES FROM THE CONSUMERS POINT OF VIEW AND DESCRIBE THEIR VALUE /NE -INNEAPOLIS HOSPITAL EXECUTIVE CALLED (EALTHCARE &ACTS A hCLEAR START v NOTING THAT PHYSICIANS hFAILED TO DELIVER SOMETHING THE PUBLIC COULD USE AND NOW ITS BEING DELIVERED FOR USv;= 4HE INTENTION IS THAT TO THE GREATEST EXTENT POSSIBLE PROVIDERS WILL VIEW THE (EALTHCARE &ACTS EFFORT AS A PARTNERSHIP AND TAKE OWNERSHIP OF IT PERHAPS EVEN USING THE (EALTHCARE &ACTS SHEET AS MARKETING MATERIAL
AK TDãB QN R R ã@MCãAK TDãRGHD KCãNE ãL HMMD RNS@ãGD @KSGB@QD ãE@BSR Ø
(EALTHCARE &ACTS MAY ALSO SERVE AS A CATALYST FOR INTERNAL CHANGES WITHIN HOSPITALS AS THEY BEGIN TO COMPARE THEMSELVES WITH THEIR PEERS 4HE HOPE IS THAT (EALTHCARE &ACTS MAY ALSO SERVE AS A CATALYST FOR INTERNAL CHANGES WITHIN HEALTHCARE PROVIDERS AS THEY BEGIN TO COMPARE THEMSELVES WITH THEIR PEERS /NE STATED PURPOSE OF PROVIDER REPORTING IS TO SPUR QUALITY IMPROVEMENT WITHIN THE PROVIDER ORGANIZATION INDEED SOME BELIEVE THAT PROVIDER ORGANIZATIONS BENElT THE MOST FROM PERFORMANCE DATA BECAUSE OF INTERNAL PROCESS AND OUTCOMES IMPROVEMENTS THAT ORGANIZATIONS ARE ABLE TO MAKE UPON COMPARING THEMSELVES TO A BENCHMARK;= !S PROVIDERS COMPARE THEIR SERVICE MIX TO THAT OF THEIR COMPETITORS THEY MAY CHOOSE TO NARROW THEIR SERVICE OFFERINGS POSITIONING THEMSELVES AS A CENTER OF EXCELLENCE IN A PARTICULAR AREA SUCH AS HEART CARE !LTERNATIVELY THEY MAY CHOOSE TO ADD TO THEIR CURRENT OFFERINGS FOR EXAMPLE ADDING A PAIN MANAGEMENT PROGRAM TO BE MORE COMPETITIVE !FTER A CONSUMER REPORT ON HOSPITALS IN -ISSOURI WAS PUBLISHED HOSPITALS THAT DID NOT OFFER CERTAIN BABY CARE SERVICES SUCH AS AN INFANT CAR SEAT PROGRAM AND BREAST FEEDING EDUCATION IMPLEMENTED SUCH SERVICES;= 7HEN THE STATE OF .EW 9ORK PUBLISHED THE MORTALITY DATA FOR OPEN HEART SURGERY MENTIONED EARLIER CONSUMERS MAY NOT HAVE BEEN SUBSTANTIALLY IMPACTED BUT EVIDENTLY THE PRACTITIONERS WERE; = )N THE FOLLOWING THREE YEARS .EW 9ORK HAD THE COUNTRYS LOWEST MORTALITY OPEN HEART SURGERY MORTALITY RATES (OPEFULLY SIMILAR CHANGES WILL HAPPEN HERE
#ONCLUSION (EALTHCARE &ACTS ADDRESSES THE GROWING DEMAND AND NEED FOR HEALTHCARE TRANSPARENCY )N ORDER TO EMPOWER CONSUMERS TO MAKE INFORMED DECISIONS WHEN SELECTING A HEALTHCARE PROVIDER OR HEALTH PLAN EVALUATING TREATMENT OPTIONS OR PLANNING A PROCEDURE (EALTHCARE &ACTS ATTEMPTS TO VIEW QUALITY FROM THE PATIENT PERSPECTIVE "Y PROVIDING INFORMATION CONSUMERS INDICATE IS IMPORTANT TO HEALTHCARE DECISIONS IN A FORMAT THAT IS ACCESSIBLE AND UNDERSTANDABLE TO THE INTENDED AUDIENCE "LUE #ROSS OF -INNESOTA HAS PUT A STAKE IN THE GROUND FOR A NEW WAY TO APPROACH PERFORMANCE REPORTING !S CONSUMERS BECOME EVER MORE INFORMATION SAVVY (EALTHCARE &ACTS WILL EVOLVE TO MEET THOSE NEEDS %NDNOTES ,UBALIN *3 AND , $ (ARRIS +OJETIN h7HAT $O #ONSUMERS 7ANT AND .EED TO +NOW IN -AKING (EALTH #ARE #HOICES v -EDICAL #ARE 2ESEARCH AND 2EVIEW SUPP PP
3HALLER $ ET AL h#ONSUMERS AND 1UALITY $RIVEN (EALTH #ARE ! #ALL TO !CTION v (EALTH !FFAIRS PP 3CHAUFmER ( ( AND * + -ORDAVSKY h#ONSUMER 2EPORTS IN (EALTH #ARE $O 4HEY -AKE A $IFFERENCE v !NNUAL 2EVIEW OF 0UBLIC (EALTH PP -ARSHALL - . ET AL h4HE 0UBLIC 2ELEASE OF 0ERFORMANCE $ATA 7HAT $O 7E %XPECT TO 'AIN ! 2EVIEW OF THE %VIDENCE v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP -ENNEMEYER 34 -! -ORRISEY AND ,: (OWARD h$EATH AND 2EPUTATION (OW #ONSUMERS !CTED 5PON (#&! -ORTALITY )NFORMATION v )NQUIRY PP 3CHNEIDER %# AND ! - %PSTEIN h5SE OF 0UBLIC 0ERFORMANCE 2EPORTS ! 3URVEY OF 0ATIENTS 5NDERGOING #ARDIAC 3URGERY v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP )BID *HA ! + AND ! - %PSTEIN h4HE 0REDICTIVE !CCURACY OF THE .EW 9ORK 3TATE #ORONARY !RTERY "YPASS 3URGERY 2EPORT #ARD 3YSTEM v (EALTH !FFAIRS PP #HASSIN -2 h!CHIEVING AND 3USTAINING )MPROVED 1UALITY ,ESSONS FROM .EW 9ORK 3TATE AND #ARDIAC 3URGERY v (EALTH !FFAIRS PP h.ATIONAL 3URVEY ON !MERICANS AS (EALTH #ARE #ONSUMERS !N 5PDATE ON THE 2OLE OF 1UALITY )NFORMATION v 4HE +AISER &AMILY &OUNDATION !GENCY FOR (EALTH #ARE 2ESEARCH AND 1UALITY -ENLO 0ARK #! +AISER &AMILY &OUNDATION 2OBINSON 2 AND - "RODIE h5NDERSTANDING THE 1UALITY #HALLENGE FOR (EALTH #ONSUMERS 4HE +AISER!(#02 3URVEY v *OINT #OMMISSION *OURNAL ON 1UALITY )MPROVEMENT PP h#ONSUMER $EMAND FOR #LINICAL 1UALITY 4HE 'IANT !WAKENS v $ELOITTE AND 4OUCHE )RVING 4EXAS 6(! "AKER , 4 ( 7AGNER 3 - 3INGER AND - + "UNDORF h5SE OF THE )NTERNET AND E MAIL FOR (EALTH #ARE )NFORMATION 2ESULTS FROM A .ATIONAL 3URVEY v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP h#ROSSING THE 1UALITY #HASM ! .EW (EALTH 3YSTEM FOR THE 4WENTY lRST #ENTURY v )NSTITUTE OF -EDICINE 7ASHINGTON .ATIONAL !CADEMY 0RESS HTTPWWWCFSANFDAGOV^LRDTPAWARDHTML %PSTEIN ! - h0UBLIC 2ELEASE OF 0ERFORMANCE $ATA ! 0ROGRESS 2EPORT &ROM THE &RONT v *OURNAL OF THE !MERICAN -EDICAL !SSOCIATION PP (IBBARD * h5SE OF /UTCOME $ATA BY 0URCHASERS AND #ONSUMERS .EW 3TRATEGIES AND .EW $ILEMMAS v *OURNAL FOR 1UALITY IN (EALTH #ARE PP 3MITH 3$ h"LUE #ROSS )SSUING (OSPITAL 2EPORT #ARD v 4HE "USINESS *OURNAL -INNEAPOLIS3T 0AUL #HASSIN - 2 h!CHIEVING AND 3USTAINING )MPROVED 1UALITY ,ESSONS FROM .EW 9ORK 3TATE AND #ARDIAC 3URGERY v (EALTH !FFAIRS PP h4HE 0REDICTIVE !CCURACY OF THE .EW 9ORK 3TATE #ORONARY !RTERY "YPASS 3URGERY 2EPORT #ARD 3YSTEM v (EALTH !FFAIRS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! 1UALITY 0AY FOR 0ERFORMANCE AND THE 2OLE OF #-3 ! $ISCUSSION 7ITH 4RENT (AYWOOD -ANY INDUSTRY OBSERVERS VIEW PAY FOR PERFORMANCE PROGRAMS AS HAVING TREMENDOUS POTENTIAL TO IMPROVE THE QUALITY OF HEALTHCARE 4HE #ENTERS FOR -EDICARE -EDICAID 3ERVICES #-3 BY VIRTUE OF ITS LARGE NUMBER OF ENROLLEES HAS A LARGE INmUENCE ON THE HEALTHCARE lNANCIAL INCENTIVES IN GENERAL AND PAY FOR PERFORMANCE SPECIlCALLY #-3 HAS SEVERAL MAJOR PAY FOR PERFORMANCE INITIATIVES UNDER WAY AND PLANNED INCLUDING THE (OSPITAL 1UALITY )NITIATIVE AND THE 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION 0ROJECT n AS DESCRIBED IN THE PAPER IN THIS BOOK h4HE 0AY FOR 0ERFORMANCE ,ANDSCAPEv 0RICEWATERHOUSE#OOPERS RECENTLY SPOKE WITH 4RENT (AYWOOD -$ *$ DEPUTY CHIEF CLINICAL OFlCER OF THE /FlCE OF #LINICAL 1UALITY AND 3TANDARDS AT THE #ENTERS FOR -EDICARE -EDICAID 3ERVICES REGARDING THE STATE OF QUALITY AND #-3 PAY FOR PERFORMANCE PROGRAMS
0RICEWATERHOUSE#OOPERS 7HEN YOU THINK ABOUT HEALTH CARE QUALITY IN ITS CURRENT STATE HOW FAR DO YOU THINK WEVE COME 4RENT (AYWOOD ) THINK WERE STILL IN OUR EARLIER PHASES DESPITE THE FOUNDATION THAT HAS BEEN LAID &IRST YOU NEED THE DEVELOPMENT OF HEALTH RESEARCH AND THATS BEEN THE FOCUS 7HERE WERE STARTING TO MOVE IS TO DETERMINE hSO WHAT DOES THAT MEAN v .OW THAT WE THINK WERE ABLE TO DElNE QUALITY HOW ARE WE GOING TO ACTUALLY UTILIZE THAT ACROSS THE ACTIVITIES OF THE MARKETPLACE WHETHER THAT BE QUALITY REPORTING 1) ACTIVITIES OR PAY FOR PERFORMANCE !LL OF THIS IS SOMEWHAT IN ITS INFANCY 7E HAVE A LOT TO LEARN 7ERE IN THE EARLY PHASES BUT ITS POSITIVE THAT WERE HAVING THIS FOCUS ON QUALITY WHERE WE DIDNT BEFORE 3O ) AM OPTIMISTIC ABOUT WHERE WERE HEADED 0W# 7HO DO YOU THINK ARE SOME OF THE FRONT RUNNERS THAT ARE DRIVING THAT NEW PERSPECTIVE ON QUALITY 4( 7ELL OBVIOUSLY ) WORK AT #-3 SO )M BIASED x 4HE REASON WHY )M SOMEWHAT BIASED TOWARDS #-3 IS NOT JUST BECAUSE ) WORK HERE BUT BECAUSE ONE OF THE BENElTS OF THE PUBLIC SECTOR GETTING INTO THE ACT IS THAT WE CAN SET STANDARDS ! LOT OF THINGS HAPPEN AT THE LOCAL LEVEL BUT WHEN IT COMES TIME TO ACTUALLY SET STANDARDS AND ALLOW FOR SOME MOVEMENT TO OCCUR YOU ARE REALLY COMING BACK 4HE REASON WHY PEOPLE ASKED -EDICARE TO TAKE THE LEAD ON SOME FACTORS IS BECAUSE OF OUR ABILITY TO BRING SOME STANDARDIZATION TO THE PROCESS AND GET EVERYONE TO UNDERSTAND
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
WHERE WERE HEADED COLLECTIVELY 3O THATS PROBABLY THE UNIQUE ASPECT OF WHAT -EDICARE CAN BRING TO THESE DIFFERENT ACTIVITIES BOTH AS A PURCHASER AND IN TERMS OF OUR ACTIVITIES WITH OUR BENElCIARY POPULATION (OWEVER NO MATTER WHERE YOU GO YOURE GOING TO HEAR PEOPLE TALK ABOUT THE WORK THAT THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT "RIDGES 4O %XCELLENCE ,EAPFROG 'ROUP .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE *OINT #OMMISSION ON THE !CCREDITATION OF (EALTHCARE /RGANIZATIONS !MERICAN -EDICAL !SSOCIATION AND .ATIONAL 1UALITY &ORUM HAVE DONE WITH RESPECT TO THE MEASUREMENT ACTIVITY AND HOW THAT REALLY HELPED TO ALSO BUILD THE LANDSCAPE 4HE )NSTITUTE OF -EDICINE WITH THEIR CONTINUED REPORTING FOCUS ON MEDICAL ERRORS IN h#ROSSING THE 1UALITY #HASMv AND SETTING UP THE ANNOUNCEMENT OF PRIORITY AREAS REALLY TOOK ON A LEADERSHIP ROLE IN DElNING QUALITY %VEN THE #OMMONWEALTH &UND 2OBERT 7OOD *OHNSON #ALIFORNIA (EALTHCARE %NDOWMENT AND OTHER PHILANTHROPIC ORGANIZATIONS HAVE REALLY SUPPORTED A LOT OF THEIR RESEARCH IN THIS PARTICULAR AREA 9OU ALSO HAVE OUR SISTER AGENCY !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21 WHICH AGAIN HAS FUNDED A LOT OF EVIDENCED BASED RESEARCH IN THIS PARTICULAR AREA TO HELP LAY THE INFRASTRUCTURE 3O YOULL ;OFTEN HEAR OF= !(21 WHICH HELPED ;WITH= THE RESEARCH AND QUALITY )N ADDITION YOU MAY HAVE REGIONAL COALITIONS TARGETING QUALITY SUCH AS THE -ASSACHUSETTS (EALTHCARE 1UALITY 0ARTNERS AND THE )NTEGRATED (EALTHCARE !SSOCIATION IN #ALIFORNIA 2IGHT NOW YOU HAVE A LOT OF PEOPLE THAT ARE LEADING
1! 0AY FOR PERFORMANCE IS REALLY A WAY TO ALIGN OUR PAYMENT AND FINANCIAL INCENTIVES TO SUPPORT OUR PROFESSIONAL GOALS )N DESIGNING THE PROGRAMS THERE ARE A LOT OF ISSUES INVOLVED 0W# 3PECIlCALLY HOW CAN #-3 INmUENCE IMPROVEMENTS IN QUALITY 4( 7E HAVE MORE LEVERS WHEN IT COMES TO QUALITY THAN A LOT OF OTHER ORGANIZATIONS 7E HAVE SEVEN DIFFERENT LEVERS THAT WE CAN PULL TO REALLY MOVE THE QUALITY AGENDA FORWARD TECHNICAL ASSISTANCE OR QUALITY IMPROVEMENT IN THE ORGANIZATION REWARDS VIA PERFORMANCE IE PAY FOR PERFORMANCE PUBLIC RECOGNITION ACTIVITIES INCLUDING PUBLIC REPORTING OF INFORMATION AND HIGHLIGHTING KEY PEOPLE COVERAGE DETERMINATIONS THAT IMPACT QUALITY AND PROVIDE ACCESS TO HIGHER QUALITY SERVICES KEY PARTNERSHIPS WITH EXTERNAL STAKEHOLDERS REGULATIONS AND CERTIlCATION THAT SET CONDITIONS OF PARTICIPATION AND RESEARCH AND DEMONSTRATION 0W# 7HAT ARE THE OBJECTIVES OF #-3 PAY FOR PERFORMANCE DEMONSTRATIONS 4( 4HERE ARE A LOT OF DIFFERENT THINGS MIXED UP IN THE TERM hPAY FOR PERFORMANCEv "UT AT THE END OF THE DAY WHAT WERE NORMALLY TALKING ABOUT IS ALIGNING OUR PAYMENT OF lNANCIAL INCENTIVES TO SUPPORT OUR PROFESSIONAL ASPIRATIONS OF QUALITY IN HEALTH OUTCOMES 3O THE REASON WHY WE HAVE SO MANY DIFFERENT LEVERS IS BECAUSE THERE ARE A LOT OF DIFFERENT THINGS IN THE SYSTEM THAT WE CAN DO TO ACTUALLY TRY TO ACCOMPLISH THAT GOAL THAT ALIGNMENT )TS VERY STRAIGHTFORWARD 0AY FOR PERFORMANCE IS REALLY A WAY TO ALIGN OUR PAYMENT AND lNANCIAL INCENTIVES TO SUPPORT OUR PROFESSIONAL GOALS )N DESIGNING THE PROGRAMS THERE ARE A LOT OF ISSUES INVOLVED &IRST YOU ALWAYS HAVE TO HAVE THE MEASURES 9OU THEN MUST HAVE A DATA INFRASTRUCTURE PROCESS FOR THE COLLECTION OF THAT INFORMATION )N ADDITION THE RECIPIENT OF THE DATA MUST HAVE A COMPATIBLE INFRASTRUCTURE SO THAT THEY CAN ACTUALLY SEE THE INFORMATION /N THE BACK END YOU MAY HAVE SOME PROCESS TO VERIFY AND VALIDATE IT !ND THEN lNALLY YOU NEED TO LINK THAT TO SOME PAYMENT AND CUT THE CHECK 3O IF NOTHING ELSE ALL OF OUR EFFORTS ARE REALLY PUTTING IN PLACE THE INFRASTRUCTURE AND TESTING DIFFERENT PORTIONS OF THOSE ACTIVITIES ACROSS THE BOARD 6ARIOUS PORTIONS OF OUR PROJECTS FOCUS ON DIFFERENT ASPECTS OF THE INFRASTRUCTURE DEPENDING UPON THE DESIGN "UT ITS REALLY GETTING A LOT OF THAT INFRASTRUCTURE IN PLACE AND TESTING SOME OF THAT INFRASTRUCTURE 0W# (OW WERE THE INCENTIVES IN THE PAY FOR PERFORMANCE PILOTS ESTABLISHED 4( !T MINIMUM THERE ARE THREE DIFFERENT WAYS TO REWARD SOMETHING 9OU CAN REWARD RELATIVE QUALITY YOU CAN REWARD
ABSOLUTE THRESHOLDS OR YOU CAN REWARD IMPROVEMENT -OST GROUPS UNDERSTAND RELATIVE QUALITY PRETTY EASILY 4HAT IS HOW WE TAKE OUR BOARD EXAMINATIONS 9OU LOOK AROUND THE ROOM AND SEE IF THERE ARE THREE PEOPLE YOU CAN BEAT 4HATS RELATIVE QUALITY IRRESPECTIVE OF WHO WAS SMART OUTSIDE THE ROOM BUT JUST RELATIVE TO SOME DElNED PEER GROUP 4HE 0REMIER DEMONSTRATION HAS THAT TYPE OF DESIGN 4HE ABSOLUTE THRESHOLD IS THE SECOND MODEL WHICH THE 0HYSICIAN 'ROUP $EMONSTRATION HAS 4HEN QUALITY IMPROVEMENT IS THE THIRD ONE THAT A LOT OF PEOPLE ARE ALSO FOCUSING ON WHICH IS HOW WELL DID ) DO IN COMPARISON TO MY OWN HISTORICAL BENCHMARKING AND WHETHER OR NOT YOU SHOULD MAKE PAYMENT FOR THAT 3O THESE ARE ALL THE PUBLIC POLICY OPTIONS THAT PEOPLE ARE LOOKING AT FOR A VARIETY OF REASONS 3OME ARE LOOKING AT THOSE JUST FROM THE IMPACT FOR THOSE DIRECTLY INVOLVED BUT ALSO IN TERMS OF WHAT IS THE BIGGEST BENElT TO THE PUBLIC AT LARGE )N OTHER WORDS IF YOU LOOK AT JUST ABSOLUTE THRESHOLDS MAYBE YOURE GOING TO ONLY INCENTIVIZE THOSE PEOPLE THAT ARE ALREADY DOING WELL BUT MAYBE YOU SHOULD INCENTIVIZE IMPROVEMENT INSTEAD n THATS WHERE WERE HAVING A LOT OF THE LOW QUALITY 3OME SUCH AS -ED0AC ARE RECOMMENDING COMBINING ABSOLUTE THRESHOLDS AND QUALITY IMPROVEMENT 0W# &OR THE 0REMIER DEMONSTRATION SPECIlCALLY WHAT WERE THE OBJECTIVES AND THE RESULTS TO DATE 4( 7ITH 0REMIER ONE OF THE THINGS THAT WE WANTED TO DO IS TO EXPLORE HOW THIS CAN BE DONE #AN WE GET BEYOND THE MEASURES THAT HOSPITALS REPORTED AT THE TIME #AN WE ALSO INCLUDE OUTCOME MEASURES AND NOT JUST PROCESS MEASURES 4HEN lNALLY DOES A lNANCIAL INCENTIVE FOR REPORTING HAVE THE TYPE OF IMPACT THAT ACTUALLY SHOWS SOME MOVEMENT 3O WHAT THE 0REMIER DESIGN DID WAS TO ALLOW US TO TEST THAT !LSO THE NOTION WAS THAT BY GETTING ALL THOSE HOSPITALS TOGETHER WE WOULD BE ABLE TO SHARE LESSONS LEARNED n AKIN TO WHAT !(21 DOES WITH PRACTICE LEARNING NETWORKS WHERE YOU ESTABLISH A COMMUNITY FOR THOSE HOSPITALS TO LEARN FROM OTHER HOSPITALS 7E ARE ALREADY SEEING IMPROVEMENTS ACROSS ALL THE CLINICAL CONDITIONS 7E ALREADY SAW CLEAR IMPROVEMENTS IN YEAR ONE AND THAT IS GOING TO BE THE TREND IN YEAR TWO AND ULTIMATELY IN YEAR THREE AS WELL 0W# 7HAT ISSUES AND UNANSWERED QUESTIONS ARE COMING UP IN YOUR EXPERIENCE WITH THE PAY FOR PERFORMANCE PROJECTS TO DATE 4( 3OME DATA ISSUES THAT WERE TRYING TO WORK THROUGH ARE GOING TO HAVE AN IMPACT LONG TERM &OR INSTANCE ONE ISSUE THAT IS GOING TO COME UP DOWN THE ROAD ABOUT PAY FOR PERFORMANCE IS HOW DO YOU REALLY WEIGHT WHAT YOU DO FOR OUTCOMES AND PROCESS MEASURES (OW DO YOU AGGREGATE THAT DATA AND HOW DO YOU WEIGHT IT APPROPRIATELY 4HERE WILL CONTINUE TO BE LESSONS LEARNED ALSO AROUND HOW FAR YOU NEED TO GO WITH A PARTICULAR MEASURE )N OTHER WORDS IF THE THRESHOLD IS SUCH THAT IN ORDER TO GO FROM BEING IN THE TOP TWO DECILES YOUVE GOT TO GO FROM TO IS THAT THE TYPE OF BEHAVIOR WE WOULD WANT TO INCENTIVIZE OR DO WE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
1! NEED TO CONSIDER OTHER WAYS OF GETTING AT THAT TYPE OF ISSUE )S IT WORTH THE RESOURCES JUST TO MOVE PERCENT
&ROM A PUBLIC PERSPECTIVE STANDPOINT WHAT WE REALLY WANT TO DO IS NOT LIMIT YOUR CHOICES BUT INCREASE THOSE CHOICES BY ACTUALLY HAVING MORE QUALITY PROVID ERS OUT THERE FOR YOU TO SELECT FROM 3O THAT IS WHY IT CONTINUES TO BE IMPORTANT THAT WE FOCUS ON QUALITY IMPROVEMENT ACTIVITY AND DISSEMINATING BEST PRACTICE INFORMATION SO THAT WE REALLY DO EXPAND CHOICES FOR BENElCIARIES AND NOT NECES SARILY LIMIT CHOICES BY SAYING THAT THERE ARE ONLY ONE OR TWO DOCS THAT CAN REALLY PERFORM THIS WELL 4HERE IS ALSO GOING TO BE THE ISSUE OF WHAT TO DO WHEN THERE ARE A BUNCH OF MEASURES WITHIN A PARTICULAR CONDITION AND SAY HYPOTHETICALLY FOUR OUT OF lVE MEASURES ARE PRETTY EQUAL BUT THEN THERE IS ONE MEASURE WHERE THERE WAS VARIATION "Y DEFAULT THAT ONE IS GOING TO BE WEIGHTED MORE BECAUSE THAT IS WHERE THE VARIATIONS ARE 3O WHEN YOU SEE THAT TYPE OF ISSUE THEN THE QUESTION BECOMES WHETHER THAT IS THE TYPE OF MEASURE YOU WANT TO HAVE THAT TYPE OF IMPACT OR NOT ! BIGGER ISSUE IS TO MAKE CERTAIN THAT THERE ARE NO UNINTENDED CONSEQUENCES 7E NEED TO MAKE CERTAIN THERE ARE NOT PERVERSE INCENTIVES TO SELECT FOR CERTAIN PATIENT POPULATIONS OR TO SELECT FOR CERTAIN GEOGRAPHIC LOCALES OR TO EVEN CONSIDER STRUCTURAL ISSUES ABOUT THE WAY IN WHICH PRACTICES MAY BE DESIGNED &OR EXAMPLE LARGER GROUP PRACTICES HAVE MORE RESOURCES AND INFRASTRUCTURE WHILE SMALLER PRACTICES THAT ARE TRYING TO DO THE RIGHT THING TO SERVE UNDERSERVED COMMUNITIES WOULD HAVE A HARD TIME TRYING TO CREATE THE SAME LEVEL OF INFRASTRUCTURE TO SUPPORT THE PAY FOR PERFORMANCE PROGRAMS 7ERE STILL WORKING THROUGH ALL OF THESE TYPES OF ISSUES WITH THESE DEMONSTRATIONS
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
0W# !S WE LOOK TO THE FUTURE WE ALSO ARE FACING A SHORTAGE OF CLINICAL MANPOWER 3O WE HAVE AN ISSUE AIMED AT TRYING TO DIRECT PEOPLE MORE TOWARD THE QUAL ITY PROVIDERS (OW DO WE RECONCILE THAT WITH ACCESS ESPECIALLY IN AN ENVIRONMENT WHERE WERE FACING A SUPPLY SHORTAGE 4( 7HAT WE REALLY WANT TO DO IS TO NOT NECESSARILY SAY THIS IS THE ONE AND ONLY PLACE THAT YOU REALLY SHOULD GO FOR THIS PROCEDURE BUT INSTEAD LOOK AT HOW WE CAN ACTUALLY MAKE EVERYONE A HIGHER QUALITY PROVIDER &ROM A PUBLIC PERSPECTIVE STANDPOINT WHAT WE REALLY WANT TO DO IS NOT LIMIT YOUR CHOICES BUT INCREASE THOSE CHOICES BY ACTUALLY HAVING MORE QUALITY PROVIDERS OUT THERE FOR YOU TO SELECT FROM 3O THAT IS WHY IT CONTINUES TO BE IMPORTANT THAT WE FOCUS ON QUALITY IMPROVEMENT ACTIVITY AND DISSEMINATING BEST PRACTICE INFORMATION SO THAT WE REALLY DO EXPAND CHOICES FOR BENElCIARIES AND NOT NECESSARILY LIMIT CHOICES BY SAYING THAT THERE ARE ONLY ONE OR TWO DOCS THAT CAN REALLY PERFORM THIS WELL 4HE OTHER ISSUE ALONG THOSE LINES IS THAT IF WE CAN FOCUS ON PREVENTION AND EVEN SELF CARE FOR BENElCIARIES WE CAN ADDRESS ACCESS ISSUES )F THE BENElCIARIES ARE MORE EDUCATED AND MORE ACTIVATED ABOUT THEIR OWN PARTICULAR CONDITION PARTICULARLY FOR SOME CHRONIC CONDITIONS THEY CAN SELF MANAGE SOME OF THEIR CARE VERSUS REQUIRING HANDS ON INVOLVEMENT OF HIGH LEVEL SKILLED CLINICIANS 0W# 7HERE DO YOU THINK WE WILL BE WITH RESPECT TO QUALITY IN THE NEXT lVE TO YEARS 4( ) DElNITELY THINK WE WILL HAVE GONE BEYOND THIS PRELIMINARY TRIAL PHASE 7E STILL HAVE A LOT TO LEARN ) JUST THINK lVE YEARS IS NOT A LONG TIME WHEN YOURE TALKING ABOUT RESEARCHING HEALTHCARE SERVICES AND IMPLEMENTING WHAT WEVE LEARNED 7E WOULD HAVE TO COMPLETE THIS EARLIER TRAINING PHASE CONTINUE THE QUALITY MOVEMENT AND OBVIOUSLY HAVE PUBLIC SUPPORT 7E WANT TO HAVE ALL THAT ACTIVITY 4HE ONLY BIG UNKNOWN IS JUST HOW STABLE OR UNSTABLE THE COST DOLLARS WILL BE AS IT DICTATES WHERE WE GO 3O IF WE CONTINUE TO HAVE RUNAWAY COSTS THEN THE FOCUS ON QUALITY IS ALWAYS GOING TO BE SOMEWHAT AT RISK 7EVE GOT TO MAKE CERTAIN THAT WE FOCUS ON PREVENTION AND BETTER OUTCOMES TO REALLY DEAL WITH SOME OF THIS HIGH UTILIZATION ) THINK WE HONESTLY HAVE A WAYS TO GO EVEN lVE YEARS FROM NOW BUT WELL HAVE MOST OF THE ANSWERS ON WHAT HAS WORKED AND WHAT HASNT NECESSARILY WORKED n
1UALITY AS A "USINESS -ODEL 7HILE ARGUMENTS CONTINUE OVER THE COST EFFECTIVENESS OF QUALITY IMPROVEMENT INITIATIVES FOR SOME DISEASES AND CONDITIONS THE BUSINESS MODEL ALREADY EXISTS IN THE TREATMENT OF THE NATIONS .O KILLER CARDIOVASCULAR DISEASE "Y "RETT - (ICKMAN 0RICEWATERHOUSE#OOPERS
4
HE ESTIMATED DIRECT AND INDIRECT COSTS OF CARDIOVASCULAR DISEASES #6$ INCLUDING STROKE IN THE 5NITED 3TATES IN WERE BILLION;= !CCORDING TO CURRENT ESTIMATES APPROXIMATELY MILLION 53 RESIDENTS HAVE AT LEAST ONE #6$ OR CONDITION SUCH AS HIGH BLOOD PRESSURE 4HAT TOTAL INCLUDES AN ESTIMATED MILLION WITH HIGH BLOOD PRESSURE MORE THAN MILLION WITH CORONARY HEART DISEASE AND MILLION HEART ATTACK SURVIVORS )N ADDITION MILLION 53 RESIDENTS ARE LIVING WITH THE AFTERMATH OF STROKE THE LEADING CAUSE OF LONG TERM SERIOUS DISABILITY AND ANOTHER MILLION HAVE HEART FAILURE;= ! -ARCH STUDY IN 4HE .EW %NGLAND *OURNAL OF -EDICINE REPORTED THAT OVERALL PATIENTS RECEIVED LESS THAN PERCENT OF RECOMMENDED CARE FOR CHRONIC AND ACUTE CONDITIONS 0ATIENTS ARE GETTING ABOUT HALF THE CARE THAT GUIDELINES INDICATE THEY NEED;= #6$ WHICH INCLUDES CORONARY ARTERY DISEASE HEART ATTACK HEART FAILURE AND STROKE IS A LEADING CAUSE OF HOSPITAL ADMISSIONS 0OOR QUALITY #6$ CARE CAN BE DEBILITATING FOR A PATIENT BUT IT CAN ALSO SEVERELY IMPACT INSTITUTIONS 3TUDIES HAVE SHOWN THAT PATIENTS WHO ARE NOT TREATED TO GUIDELINES STANDARDS ARE MORE LIKELY TO BE READMITTED;= 4HIS IS A PARTICULAR CONCERN FOR INDIVIDUALS WITH HEART FAILURE THE LEADING CAUSE OF HOSPITALIZATION IN THE ELDERLY AND A FREQUENT CAUSE OF COSTLY READMISSION )N ONE STUDY OF CARDIOVASCULAR CARE IN SIX %UROPEAN COUNTRIES CHRONIC HEART FAILURE PATIENTS WHOSE TREATMENT MOST CLOSELY FOLLOWED GUIDELINES FOR DRUGS SUCH AS !#% INHIBITORS BETA BLOCKERS AND SPIRONOLACTONE A hWATER PILLv USED TO TREAT HIGH BLOOD PRESSURE AND mUID RETENTION CAUSED BY VARIOUS CONDITIONS INCLUDING HEART DISEASE HAD LESS THAN HALF THE RATE OF HOSPITALIZATIONS OVER SIX MONTHS AS DID PATIENTS WHOSE TREATMENT HAD THE LOWEST ADHERENCE TO GUIDELINES VERSUS PERCENT;=
4HE 6ALUE OF 1UALITY $ATA IS BEGINNING TO ACCRUE IN SUPPORT OF QUALITY AS A GOOD BUSINESS MODEL NOT JUST FROM A COST BUT ALSO A BENElTS STANDPOINT (IGH
QUALITY OFTEN RESULTS IN BETTER OUTCOMES IMPROVED OPERATING EFlCIENCIES SHORTENED AVERAGE LENGTH OF STAYS !,/3 AND REDUCED READMISSIONS )N THIS PAY FOR PERFORMANCE WORLD OF EDUCATED HEALTHCARE CONSUMERS WHO VOTE WITH THEIR FEET QUALITY CARE CAN ALSO TRANSLATE INTO INCREASED MARKET SHARE (OSPITALS WITH HIGHER QUALITY EXCEL FROM A BUSINESS STANDPOINT &OR EXAMPLE 3OLUCIENTS 4OP (OSPITALS LIST WHICH IDENTIlES TOP PERFORMING HOSPITALS ON QUALITY AND lNANCIAL METRICS FOUND THAT ITS BENCHMARK HOSPITALS DID SIGNIlCANTLY BETTER COMPARED WITH THEIR PEERS IN SEVERAL AREAS INCLUDING THE PERCENT LOWER MORTALITY AND PERCENT LOWER COMPLICATION RATES 4HE BENCHMARK HOSPITALS ALSO HAD PERCENT SHORTER !,/3 PERCENT LOWER EXPENSES PER DISCHARGE AND MORE THAN THREE TIMES THE PROlTABILITY VERSUS PERCENT COMPARED WITH THEIR NON BENCHMARK PEERS )N ADDITION BENCHMARK HOSPITALS HAD INCREASED GROWTH OF PERCENT COMPARED WITH A SLIGHT INCREASE IN GROWTH OF PERCENT FOR NON BENCHMARK PEERS;= (EART AND BLOOD VESSEL DISEASE REPRESENTS AN ENORMOUS SEGMENT OF HEALTHCARE EXPENDITURES AS WELL AS A PROMISING POTENTIAL LEVER FOR REDUCING COSTS 4HIS ISSUE WILL UNDOUBTEDLY GET MORE ATTENTION IN LIGHT OF THE RECENT -EDICARE TRUSTEES REPORT PREDICTING THE EXHAUSTION OF THE -EDICARE (OSPITAL )NSURANCE 4RUST &UND BY TWO YEARS EARLIER THAN THE PREVIOUS YEARS ESTIMATE;= )N THE !MERICAN (EART !SSOCIATION !(! PROJECTED A LARGE INCREASE IN #6$ HOSPITAL ADMISSIONS DUE TO THE AGING 53 POPULATION )N RESPONSE THE !(! AND THE AFlLIATED !MERICAN 3TROKE !SSOCIATION SET A GOAL TO REDUCE #6$ DEATH DISABILITY AND RISK FACTORS BY PERCENT BY ROUGHLY THE TIME THE lRST BABY BOOMERS WILL RETIRE h4HE !(! ESTIMATES THAT IT COULD ACHIEVE AT LEAST TWO THIRDS OF ITS GOAL OF A PERCENT REDUCTION IN CORONARY HEART DISEASE DEATH DISABILITY AND RISK FACTORS IF MOST HOSPITALIZED PATIENTS WERE TREATED ACCORDING TO GUIDELINES v SAID 7ARREN 3KEA 0H$ NATIONAL DIRECTOR OF THE !MERICAN (EART !SSOCIATIONS PERFORMANCE AND DECISION SUPPORT STRATEGIES
"RETT - (ICKMAN -"! #0! IS A PARTNER IN 0RICEWATERHOUSE#OOPERS !DVISORY 3ERVICES AND NATIONAL LEADER OF THE (EALTH )NDUSTRIES 3TRATEGY AND 0LANNING PRACTICE (E HAS MORE THAN YEARS OF EXPERIENCE IN THE HEALTHCARE INDUSTRY INCLUDING ALIGNING INCEN TIVES PARTNERSHIPS AND JOINT VENTURES BETWEEN HOSPITALS AND PHYSICIANS (E IS ALSO A #ERTIlED 0UBLIC !CCOUNTANT LICENSED IN )LLINOIS AND )NDIANA (E CAN BE REACHED AT BRETTMHICKMAN USPWCCOM
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
P T@K HSXã@Rã@ãAT RHMD RRãLNCD K
'ET 7ITH THE 'UIDELINES n !N !PPROACH FOR )MPROVING #ARDIAC #ARE )N RESPONSE THE !(! DEVELOPED 'ET 7ITH THE 'UIDELINES3- '74' A 7EB BASED TOOL FOR IN HOSPITAL MEDICAL MANAGEMENT AND QUALITY IMPROVEMENT THAT FOLLOWS A PATIENT FROM INTAKE TO DISCHARGE -ORE THAN HOSPITALS ACROSS THE COUNTRY ARE USING ONE OR MORE OF THE MODULES WHICH STEM FROM EVIDENCE BASED GUIDELINES FROM THE !(!S COMPENDIUM OF 3CIENTIlC 'UIDELINES AND 3TATEMENTS (OSPITALS THAT HAVE IMPLEMENTED THE PROGRAM REPORT MEASURABLE IMPROVEMENTS IN PATIENT OUTCOMES AND OFTEN INCREASED OPERATIONAL EFlCIENCIES DUE TO BETTER OPERATIONAL WORK mOW CONTINUITY OF CARE AND LOWER OPERATING COSTS '74' CONSISTS OF THREE MODULES CORONARY ARTERY DISEASE WHICH INCLUDES ACUTE HEART ATTACK AND ISCHEMIC HEART DISEASE '74' #!$ HEART FAILURE '74' (& AND STROKE '74' 3TROKE !T THE CENTER OF '74' IS THE 0ATIENT -ANAGEMENT 4OOL4- WHICH GIVES HOSPITALS MUCH OF THE POWER OF ELECTRONIC MEDICAL RECORDS ON A 7EB BASED LOW COST SYSTEM THAT REQUIRES NO OUTLAYS FOR SOFTWARE -OST OF THE DATA CAN BE ENTERED THROUGH A SIMPLE POINT AND CLICK INTERFACE &OR EXAMPLE WHEN A PATIENT ARRIVES IN THE %2 HOSPITAL STAFF CAN USE THE SIMPLE INTERFACE TO ENTER DATA ON MEDICAL HISTORY n PRIOR HEART ATTACK DIABETES SMOKING ETC n AND CURRENT PRESCRIPTIONS SUCH AS CHOLESTEROL LOWERING DRUGS !FTER THE PATIENT IS DIAGNOSED WITH A CARDIOVASCULAR CONDITION SUCH AS CORONARY ARTERY DISEASE STROKE OR HEART FAILURE THE PROGRAM PROVIDES SPECIlC PROMPTS CHECKLISTS AND DECISION SUPPORT FOR MEDICAL STAFF AT EVERY STAGE OF THE HOSPITAL EXPERIENCE 4HE PROGRAM IS DESIGNED TO PROVIDE AN INDIVIDUAL APPROACH BASED ON A PATIENTS MEDICAL HISTORY AND RISK FACTORS HIGH CHOLESTEROL HIGH BLOOD PRESSURE ETC THAT REmECTS THE MOST CURRENT EVIDENCE BASED GUIDELINES THAT SCIENTIlC RESEARCH HAS SHOWN TO HAVE THE BEST PATIENT OUTCOMES &ROM THERE '74' PROVIDES PATIENT SPECIlC PROMPTS CHECKLISTS AND DECISION SUPPORT FOR MEDICAL STAFF AT EVERY STEP OF THE HOSPITAL EXPERIENCE TO HELP HOSPITALS ENSURE THAT EACH PATIENTS CARE MEETS GUIDELINES FROM THE !(! AND !MERICAN #OLLEGE OF #ARDIOLOGY 4HE INTERFACE IS UPDATED WHENEVER THE GUIDELINES ARE REVISED !T DISCHARGE THE PROGRAM GENERATES EDUCATIONAL MATERIALS FOR PATIENTS WHICH ENABLES HOSPITAL STAFF TO TAKE ADVANTAGE OF THE hTEACHABLE MOMENTv 2ESEARCH HAS SHOWN THAT PATIENTS ARE MOST LIKELY TO CHANGE BEHAVIORS AND COMPLY WITH GUIDELINES FOLLOWING A MEDICAL CRISIS )N ADDITION A DISCHARGE LETTER IS GENERATED TO A PATIENTS PRIMARY CARE PHYSICIAN TO COMPLETE THE COMMUNICATIONS LOOP '74' CAN BE USED BY HOSPITALS TO SUBMIT DATA REQUIRE MENTS TO #-3 AND *OINT #OMMISSION ON THE !CCREDITATION OF
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
(EALTHCARE /RGANIZATIONS )N ADDITION FOR INTERNAL ANALYSIS AND QUALITY IMPROVEMENT INITIATIVES HOSPITAL STAFF CAN ACCESS REAL TIME HOSPITAL SPECIlC AND PEER GROUP AGGREGATE BENCH MARKING REPORTS THAT CAN BE PRINTED OR DOWNLOADED FOR INCORPORATION IN PRESENTATIONS OR TO TRACK THE PROGRESS OF QUALITY IMPROVEMENT INITIATIVES "ECAUSE THE PROGRAM WAS CREATED TO MEET THE !(!S HEALTH IMPROVEMENT GOALS RATHER THAN AS A REVENUE GENERATING VENTURE THE THREE MODULES '74' #!$ '74' (& AND '74' 3TROKE EACH COST ABOUT ANNUALLY 4HE REST OF THE PROGRAM COMES AT NO EXTRA CHARGE TO A HOSPITAL )MPLEMENTATION COSTS ARE FAIRLY INSIGNIlCANT -ANY HOSPITALS ARE ABLE TO IMPLEMENT THE PROGRAMS WITHOUT ADDING STAFF SIMPLY BY REALIGNING DUTIES !NALYSIS SHOWS THAT EVEN IN A WORST CASE SCENARIO IN WHICH A HOSPITAL WOULD ADD ONE STAFF POSITION n A MEDICAL DIRECTORSHIP n AND HOLD ONE WORKSHOP TO EXPLAIN THE PROGRAM AND GET THE CROSS DISCIPLINED TEAM ORIENTED THE COST TO IMPLEMENT ALL THREE MODULES IS LESS THAN %XAMPLE 4ECHNOLOGYLICENSING ALL MODULES 3TAFF EMPLOYEE 0HYSICIAN LEADERSHIP 7ORKSHOP 4OTAL )N ADDITION TO TRAINING MODULES AVAILABLE ON THE WEBSITE THE !(! PROVIDES STEP BY STEP GUIDELINES ON HOW TO FORM A MULTIDISCIPLINARY TEAM THAT LEADS EACH HOSPITALS '74' PROGRAM AND PROVIDE WORKSHOPS WITH #-% CREDITS FOR HOSPITAL STAFF h7E TEACH HOSPITALS TO USE THE DATA AND REPORTS TO MONITOR THEIR PROCESSES AND REPORT ON HOW THEY ARE DOING TO MEET THEIR BENCHMARKS 7E HELP THEM RE ENGINEER THEIR PROCESSES AND THE PROGRAM LETS THEM REPEATEDLY MEASURE TO SEE IF THE CHANGES ARE MAKING A DIFFERENCE v 3KEA SAID h7HEN A HOSPITAL DOES A GOOD JOB ON '74' IT IS USUALLY DUE TO THE '74' LEADERSHIP TEAM CHANGING THE INSTITUTIONS CULTURE SO THAT EVERYONE IS ACCOUNTABLE FOR PATIENTS BEING DISCHARGED ACCORDING TO THE GUIDELINES 7E HAVE HEARD OF A HOSPITAL WARD CLERK IN ESSENCE TACKLING THE CHIEF OF MEDICINE WHO WAS ATTEMPTING TO LEAVE ON A &RIDAY NIGHT BECAUSE A PATIENT DID NOT RECEIVE A KEY THERAPY v 3KEA SAID
4RANSITIONING TO 0AY FOR 0ERFORMANCE -ORE COMMERCIAL PAYERS ARE ADDING '74' TO THEIR PAY FOR PERFORMANCE SCORECARDS )N ADDITION '74' HAS HELPED MANY HOSPITALS PREPARE FOR THE PAY FOR PERFORMANCE 00 MODEL THAT OFTEN REQUIRES IMPROVED COMPLIANCE 4HE STAKES AND THE MONEY ARE INCREASING &OR INSTANCE THE MORE THAN PARTICIPANTS IN THE 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION RECENTLY SHARED IN A PERCENT MARKET BASKET ADJUSTMENT OR INCREASE IN -EDICARE PAYMENTS GIVEN TO THE TOP PERCENT OF HOSPITALS;= h4WO PERCENT DOESNT
P T@K HSXã@Rã@ãAT RHMD RRãLNCD K SOUND LIKE MUCH BUT SOME HOSPITAL EXECUTIVES TOLD ME THEIR PAYOUTS WERE APPROACHING SEVEN lGURES ANNUALLY v 3KEA SAID )N THIS AGE OF TRANSPARENCY WHEN FORMERLY PROPRIETARY INFORMATION ON QUALITY IS MOVING ONTO THE )NTERNET AND CONSUMERS ARE BEING ENCOURAGED TO USE IT TO GUIDE THEIR HEALTHCARE CHOICES THE LINK BETWEEN OUTCOMES AND lNANCIAL PERFORMANCE IS UNDENIABLE (IGHER QUALITY CAN LEAD TO INCREASED MARKET SHARE WHICH CAN RESULT IN HIGHER VOLUME AND INCREASED MARGINS /NE LARGE HOSPITAL CHAIN WITH A 001UALITY CONTRACT WITH A NATIONAL PAYER REALIZED A PERCENT VOLUME INCREASE COMPARED TO A PERCENT VOLUME LOSS FOR NONPARTICIPANTS %XPERIENCE WITH THIS PROGRAM HAS ILLUSTRATED THE IMPORTANCE OF THE FOLLOWING ISSUES IN IMPLEMENTING QUALITY PROGRAMS # 3UITE AS ,EADERSHIP 6OICE 4HE EASIEST WAY TO EFFECT CHANGE IS THROUGH A TEAM APPROACH !LIGN ALL LEVELS OF YOUR ORGANIZATION AROUND THE SAME GOAL BY MAKING QUALITY A CLEAR FOCUS -ANY ON THE CLINICAL mOOR ARE ENERGETIC PATIENT ADVOCATES WHO ARE PASSIONATE ABOUT QUALITY CARE (ARNESS THAT ENERGY AND PASSION /F COURSE THERE ARE ALWAYS SOME PEOPLE IN ANY ORGANIZATION WHO RESIST CHANGE OF ANY KIND 4HATS WHY IT IS CRUCIAL FOR THE # SUITE TO SET THE TONE 4HEN LEADERS AT EVERY LEVEL CAN BE ENLISTED TO HELP LEAD THE CHANGE 0HYSICIAN )NVOLVEMENT AND !LIGNMENT 0HYSICIANS DO NOT RESPOND WELL TO A TOP DOWN APPROACH (OWEVER BECAUSE THEY TEND TO BE NATURAL LEADERS THEY OUGHT TO BE INVOLVED FROM THE START IN ANY QUALITY INITIATIVE (OSPITALS MUST PARTNER WITH PHYSICIANS ON MANY LEVELS TO CREATE A SUSTAINABLE HEALTHCARE SYSTEM 00 FORCES INSTITUTIONS TO ALIGN INCENTIVES FOR PHYSICIANS BUT IT MUST BE DONE CAREFULLY TO AVOID VIOLATING REGULATIONS ,EADERSHIP MEANS MAKING MAJOR STRIDES IN MEDICAL STAFF RELATIONS AND FUTURE ALIGNMENT IN THE FORM OF QUALITY AND PERFORMANCE INITIATIVES IS GROWING RAPIDLY AND PRODUCING SIGNIlCANT AND SUSTAINABLE BENElTS #ULTURE OF 1UALITY AND 4RANSPARENCY n 0UBLISH OR 0ERISH 4HE MOVE TO TURN CONSUMERS INTO EDUCATED HEALTHCARE SHOPPERS AND THE RISE OF 7EB BASED REPORTING IS FUELING THE DRIVE TO GREATER TRANSPARENCY "EING AVERAGE IS NOT GOOD ENOUGH IF THE NEAREST COMPETITOR IS ABOVE AVERAGE AND IT IS AVAILABLE FOR EVERYONE TO SEE )T IS NOT ENOUGH TO IMPROVE QUALITY /NCE THAT GOAL IS ACCOMPLISHED LET THE WORLD KNOW BY INCLUDING SUCCESSES IN MARKETING #ONTINUOUS 1UALITY )MPROVEMENT AND 0ROCESS 2EDESIGN 3TANDARDIZATION MEANS ELIMINATING VARIABILITY 3TANDARDIZATION IS A CRUCIAL STEP ON THE ROAD TO SUSTAINABILITY )F THERE ARE A DOZEN PHYSICIANS DOING THE SAME PROCEDURE A DOZEN DIFFERENT WAYS THERE IS A PROBLEM %VIDENCE BASED MEDICINE SUGGESTS THAT PATIENTS TREATED IN A STANDARD WAY BASED ON THE EVIDENCE WILL RECEIVE THE BEST OUTCOMES #ONSTANTLY MEASURE EVALUATE AND RElNE 0ROCESSES ARE ALSO IMPORTANT TO CONSIDER 0ROCESSES THAT NO LONGER WORK SHOULD BE RE ENGINEERED AND THOSE THAT DO lNE TUNED
$ATA $ATA $ATA AND -ORE $ATA /NCE THE SYSTEMS ARE STANDARDIZED AND THE DATA ARE COLLECTED IT IS NECESSARY TO RE EVALUATE AND RElNE THEM IN A QUALITY IMPROVEMENT APPROACH TO PATIENT CARE 4HE SYSTEM WILL NEVER BE STATIC IT WILL CONSTANTLY EVOLVE 4HE STANDARDS THEMSELVES WILL CONTINUE TO TRANSFORM AND ORGANIZATIONS WITH THE BEST TEAMS WILL BE BETTER POSITIONED TO RIDE THE WAVES OF HEALTHCARE CHANGE
! #HALLENGE AND AN /PPORTUNITY #6$ IS THE LEADING CAUSE OF DEATH AND DISABILITY IN THIS COUNTRY RESULTING IN STAGGERING COSTS 9ET THIS CHALLENGE IS ALSO AN OPPORTUNITY BECAUSE OF MOUNTING EVIDENCE THAT HOSPITALS WITH THE HIGHEST QUALITY ALSO EXCEL FROM A BUSINESS STANDPOINT '74' CAN BE VIEWED AS A METAPHOR FOR THE 53 HEALTHCARE SYSTEM 7HEN PATIENTS ARE DISCHARGED AFTER SURVIVING HEART ATTACKS THE PROGRAM TAKES ADVANTAGE OF THAT TEACHABLE MOMENT 4HE 53 MEDICAL SYSTEM IS ALSO EXPERIENCING A CRISIS )T HAS BEEN ASSAILED FOR PROVIDING HAPHAZARD POOR QUALITY CARE AT A VERY HIGH PRICE &OR 53 HOSPITALS THIS IS ANOTHER TEACHABLE MOMENT 4HE TAKE HOME MESSAGE 1UALITY IS JUST GOOD BUSINESS 3MART HOSPITAL SYSTEMS AND THEIR EXECUTIVES ARE HEEDING THAT MESSAGE '74' CAN BE USED IN A QUALITY INITIATIVE THAT SHIFTS RESPON SIBILITY FROM A FEW TO EVERYONE 4HE RESULT OF MAKING EVERYONE RESPONSIBLE FOR TREATING TO GUIDELINES IS THAT PATIENTS AND THEIR HOSPITALS WILL BE HEALTHIER 4HIS PAPER WAS PREPARED WITH THE ASSISTANCE OF $EBORAH 7ORMSER %NDNOTES 4HOM 4 ET AL h(EART $ISEASE AND 3TROKE 3TATISTICS n 5PDATE v !MERICAN (EART !SSOCIATION $ALLAS #IRCULATION PP E E HTTPCIRCAHAJOURNALSORGCGICONTENTSHORTE )BID P -C'LYNN % ET AL h4HE 1UALITY OF (EALTH #ARE $ELIVERED TO !DULTS IN THE 5NITED 3TATES v *UNE 4HE .EW %NGLAND *OURNAL OF -EDICINE HTTPCONTENTNEJMORGCGICONTENTABSTRACT +OMAJDA - ET AL h!DHERENCE TO GUIDELINES IS A PREDICTOR OF OUTCOME IN CHRONIC HEART FAILURE THE -!(,%2 SURVEY v %UR (EART * PP )BID 3OLUCIENT 4OP (OSPITALS¸ .ATIONAL "ENCHMARKS FOR 3UCCESS %VANSTON 3OLUCIENT P h !NNUAL 2EPORT OF THE "OARDS OF 4RUSTEES OF THE &EDERAL (OSPITAL )NSURANCE AND &EDERAL 3UPPLEMENTARY -EDICAL )NSURANCE 4RUST &UNDS v 7ASHINGTON $# P 2EWARDING 3UPERIOR 1UALITY #ARE 4HE 0REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION #ENTERS FOR -EDICARE -EDICAID 3ERVICES &ACT 3HEET 7ASHINGTON $# HTTPWWWCMSHHSGOV(OSPITAL 1UALITY)NITSDOWNLOADS(OSPITAL0REMIER&3PDF
0OWERED BY /UTCOME #AMBRIDGE -ASS
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
! 0ROVIDER ,ED !PPROACH TO 0AY FOR 0ERFORMANCE 4HE .ATIONAL #ARE 4RANSACTION #ONSORTIUM 7HILE MANY BELIEVE THAT @PAYING FOR PERFORMANCE WILL SOON BECOME THE NORM THE PLETHORA OF PROGRAMS AND REPORTING REQUIREMENTS IS CREATING CONFUSION AND ADMINISTRATIVE BURDENS FOR PROVIDERS 4HE SOLUTION REQUIRES BOTH COORDINATION AND INCREASED PARTICIPATION BY PROVIDERS "Y $AVID ,EVY 0RICEWATERHOUSE#OOPERS
0
AY FOR PERFORMANCE 00 PROGRAMS HAVE ENTERED THE HEALTHCARE MARKET AS A WAY TO INCENTIVIZE QUALITY CARE )N ROUGHLY ONE THIRD OF PAYERS HAD IMPLEMENTED SOME TYPE OF A 00 REIMBURSEMENT METHOD;= (OWEVER THE PROLIFERATION OF THESE PROGRAMS IS CHALLENGING TO PROVIDERS THAT ARE STRUGGLING TO KEEP UP WITH AN EVER EXPANDING LIST OF QUALITY METRICS TO REPORT 7HILE MANY PERFORMANCE MEASURES OVERLAP THE CURRENT STATE OF THESE PROGRAMS IS A COMBINATION OF MULTIPLE METRICS DElNITIONS AND STRUCTURES 4HE INDUSTRY IS ATTEMPTING TO IDENTIFY MEASURES THAT ARE CLINICALLY RELEVANT AND CORRELATED WITH QUALITY AND OUTCOMES 0ERFORMANCE MEASUREMENTS ARE EVOLVING AND HAVE MULTIPLE USES IN ADDITION TO PAYMENT INCENTIVES SUCH AS DATA COLLECTION PUBLIC REPORTING AND QUALITY IMPROVEMENT .OTED IN THE RECENT )NSTITUTE OF -EDICINE )/- REPORT h0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT v PUBLIC AND PRIVATE STAKEHOLDERS HAVE LAUNCHED MULTIPLE EFFORTS TO CREATE HEALTHCARE QUALITY IMPROVEMENT MEASURES FOR MEDICAL PROFESSIONALS;= 7HILE INDUSTRY LEADERS BELIEVE THAT hPAYING FOR PERFORMANCEv WILL BECOME THE NORM IN THE NEXT DECADE SOME BARRIERS TO UNIVERSAL ADOPTION EXIST -ULTIPLE QUALITY AND DATA STANDARDS &RAGMENTED AND DISORGANIZED REPORTING REQUIREMENTS ,ACK OF COORDINATION BETWEEN QUALITY ORGANIZATIONS PAYER GROUPS AND PROVIDERS ,ACK OF TRUST BETWEEN PROVIDERS AND PAYERS 3TATISTICALLY UNRELIABLE DATA #OST OF COLLECTION AND REPORTING OF QUALITY MEASURES AND 5RGENT NEED FOR ALIGNMENT OF DISPARATE PERFORMANCE MONITORING INITIATIVES 4HE PROLIFERATION OF 00 PROGRAMS LACKS CONTEXTUAL NETWORKS AND CONNECTIONS RESULTING IN PROVIDERS FEELING OVERBURDENED BY ADMINISTRATIVE RESPONSIBILITIES 0HYSICIANS AND HOSPITALS HAVE VOICED MULTIPLE BARRIERS TO THEIR ACCEPTANCE OF 00 INITIATIVES
AND THEIR ATTITUDES TOWARD 00 VARY WIDELY 3HORTCOMINGS RAISED BY THE MEDICAL COMMUNITY INCLUDE ,ACK OF MEASURES ON DISPARITIES IN CARE n IN GENERAL PERFORMANCE MEASURES DO NOT INCLUDE MEASURES OF PATIENT ACCESS AND EQUITY OF CARE ,ACK OF ATTENTION TO PATIENT VARIATIONS n SUCH AS PATIENT TREATMENT PATTERNS AND CASE MIX /VEREMPHASIS OF CERTAIN MEDICAL SPECIALTIES n SUCH AS CARDIOLOGY WHILE OTHER MEDICAL SPECIALTIES ARE NOT INCLUDED IN ANY MEASURES ,IMITATION BY THE PAYERS MARKET SHARE n PHYSICIANS HAVE GREATER INCENTIVES TO PARTICIPATE IN A 00 PROGRAM SPONSORED BY A HEALTH PLAN THAT COVERS A LARGE PORTION OF THEIR PATIENT MIX $IFlCULTY IN IMPLEMENTATION BY SMALL PHYSICIAN PRACTICES n THAT LACK THE RESOURCES AND INFRASTRUCTURE NEEDED TO SYSTEMATICALLY REPORT PERFORMANCE DATA AND &RAGMENTED OR NONEXISTENT INFRASTRUCTURE n FOR COLLECTING AND REPORTING QUALITY MEASURES IS FRAGMENTED OR NOT ESTABLISHED !DDRESSING THESE ISSUES WILL REQUIRE GREATER PARTICIPATION FROM PHYSICIANS TO ENSURE THAT MEASURES ARE MEANINGFUL TO A LARGER GROUP OF PHYSICIANS NOT JUST PHYSICIAN SUBGROUPS 4HE )/- REPORT ADDRESSED MANY OF THESE BARRIERS AND ISSUES OF CURRENT PERFORMANCE MEASUREMENT 4HE )/- MADE THE OBSERVATION hTHE NATION DOES NOT YET HAVE A COHERENT INTEGRATED SYSTEM FOR ESTABLISHING MEASURING AND TRACKING THE PERFORMANCE OF THE HEALTHCARE SYSTEM )N FACT THERE IS GROWING CONCERN IN SOME QUARTERS THAT THE CURRENT FRAGMENTED APPROACH COULD CREATE A CONFUSING DUPLICATIVE YET STILL INCORPORATED SET OF ACTIVITIES THAT WOULD ABSORB TOO MANY RESOURCESxv )T ALSO STATED h)F QUALITY IMPROVEMENTS INITIATIVES ARE TO ACHIEVE THEIR FULL POTENTIAL A CONCERTED NATIONAL EFFORT TO CONSOLIDATE HEALTHCARE PERFORMANCE MEASUREMENT AND REPORTING ACTIVITIES WILL BE ESSENTIALv;= /NE
$AVID ,EVY -$ IS A MANAGING DIRECTOR LEADING 0RICEWATERHOUSE#OOPERS $IGITAL (EALTH PRACTICE (E ALSO LED THE ,OUISIANA 2ECOVERY !UTHORITY PROJECT FOR THE RECOVERY OF THE POST +ATRINA HEALTHCARE SYSTEM (E WAS THE FOUNDER CHAIRMAN AND #%/ OF &RANKLIN (EALTH )NC A LEADING DISEASE MANAGEMENT COMPANY IN THE AREA OF COMPLEX ILLNESS (E IS TRAINED AS A FAMILY PHYSICIAN AND EPIDEMIOLOGIST AND FOUNDED AND MANAGED A HIGHLY SUCCESSFUL GROUP PRIMARY CARE PRACTICE IN "ERGEN #OUNTY .EW *ERSEY (E CAN BE REACHED AT DAVIDLLEVY USPWCCOM
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
@ãO QN UHCDQ K DCã @OOQN@BGãSNãO@XãE NQãOD QE NQL @MBD OF THE MAJOR RECOMMENDATIONS OF THE REPORT WAS THE FORMATION THE .ATIONAL 1UALITY #OORDINATION "OARD .1#" AS AN INDEPENDENT FEDERAL ENTITY WITHIN THE 53 $EPARTMENT FOR (EALTH AND (UMAN 3ERVICES 4HE .1#" WOULD WORK WITH PUBLIC AND PRIVATE STAKEHOLDERS TO CREATE A NATIONAL SYSTEM FOR PERFORMANCE MEASUREMENT AND REPORTING 3IMILAR TO THE )/- NATIONAL HEALTHCARE LEADERS SUPPORT THE EXISTENCE OF SUCH AN ORGANIZATION
@4HE WORK OF THE )/- IS PREDICATED ON THE IDENTIFICATION AND ANALYSIS OF AN EVIDENCE BASE THAT IS AS ROBUST COMPREHENSIVE AND OBJECTIVE AS POSSIBLE 7E BELIEVE THAT THAT SHOULD BE THE BASIS FOR DISCUSSION AND ACTION BY ALL STAKEHOLDER GROUPS n *OHN # 2ING -$ DIRECTOR OF THE BOARD ON HEALTHCARE SERVICES OF THE )NSTITUTE OF -EDICINE 2ECENTLY 0RICEWATERHOUSE#OOPERS INITIATED AN EFFORT TO ADDRESS THE STRUCTURAL ISSUES IDENTIlED BY THE )/- 4HE lRM APPROACHED SOME OF THE NATIONS LEADING PROVIDER ORGANIZATIONS TO JOIN IN A FEASIBILITY STUDY TO ELUCIDATE HOW TO CREATE AN ENTITY WITH ATTRIBUTES OF THE )/-S .ATIONAL 1UALITY #OORDINATION "OARD 0RELIMINARILY NAMED THE .ATIONAL #ARE 4RANSACTION #ONSORTIUM THE GROUPS AIM IS TO RECOMMEND SCOPE GOVERNANCE SOURCE AND USES OF DATA TECHNOLOGY INFRASTRUCTURE CAPITAL REQUIREMENTS AND A SUSTAINABLE BUSINESS MODEL )F SUCCESSFUL THIS CONSORTIUM COULD LAY A PRIVATE SECTOR FOUNDATION FOR THE VISION ENCAPSULATED BY THE )/-S .1#" WHILE INCLUDING ALL OF THE RELEVANT STAKEHOLDERS SUCH AS PROVIDERS PAYERS CONSUMERS AND GOVERNMENT )N ADDITION IT COULD NONCOMPETITIVELY WORK WITH REGULATORS SUCH AS THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE PROFESSIONAL SOCIETIES AND OTHER INITIATIVES UNDER A SINGLE FRAMEWORK 4HE NEED FOR QUALITY AND SAFETY STANDARDS EMERGED AS A KEY FEATURE OF SUSTAINABLE HEALTH SYSTEMS ACCORDING TO A RECENT STUDY (EALTH#AST PUBLISHED BY 0RICEWATERHOUSE#OOPERS 4HE RESEARCH DERIVED FROM DISCUSSIONS AROUND THE COUNTRY WITH LARGE PROVIDER GROUPS HOSPITAL SYSTEMS PAYERS REGULATORS PROFESSIONAL SOCIETIES AND PATIENT ADVOCACY GROUPS WAS A GLOBAL SURVEY OF OVER HEALTHCARE LEADERS IN COUNTRIES &URTHER OBSERVATIONS EMANATING FROM DISCUSSIONS WITH INDUSTRY LEADERS SUPPLEMENT THIS RESEARCH AND SUGGEST THAT A PRIVATE SECTOR INITIATIVE SUCH AS A CARE TRANSACTION CONSORTIUM COULD BE REALIZED ,EADING PROVIDERS IN THE 53 ARE WILLING TO TAKE THE LEAD IN THE DEVELOPMENT OF THIS IDEA
%NLIGHTENED PAYERS ARE PREPARED TO SUPPORT IT 2EGULATORS GOVERNMENTAL AGENCIES AND PATIENT ADVOCACY GROUPS WOULD BE INTERESTED IN PARTICIPATING AND 0RICEWATERHOUSE#OOPERS COULD SERVE AS A TRUSTED THIRD PARTY BETWEEN ALL STAKEHOLDERS 4HE .ATIONAL #ARE 4RANSACTION #ONSORTIUM COULD REPRESENT A SIGNIlCANT STEP IN ORGANIZING INmUENTIAL PARTIES TO COLLABORATE IN NATIONAL HEALTHCARE QUALITY IMPROVEMENT 4HE MAJORITY OF 00 PROGRAMS TO DATE HAVE BEEN DESIGNED AND ADMINISTERED BY EMPLOYER COALITIONS AND INSURANCE COMPANIES /FTEN PROVIDERS HAVE BEEN ON THE RECEIVING END OF THE PERFORMANCE MEASURES $ESPITE SOME PROVIDER LED EFFORTS HOSPITALS OVERALL INVOLVEMENT IN THE DEVELOPMENT OF PERFORMANCE MEASURES AND 00 STRUCTURES HAS BEEN LIMITED 4HE .ATIONAL #ARE 4RANSACTION #ONSORTIUM THEREFORE OFFERS AN OPPORTUNITY FOR PROVIDERS TO ESTABLISH AN OPEN TRANSPARENT AND LEARNING MODEL OF QUALITY IMPROVEMENT MUCH LIKE THAT SEEN IN OTHER INDUSTRIES SUCH AS COMMERCIAL AVIATION ! PROVIDER LED CONSORTIUM COULD ALSO OFFER A VEHICLE FOR PROVIDING AN INCLUSIVE OPPORTUNITY FOR ALL PHYSICIANS FOR CARE IMPROVEMENT CONTINUING MEDICAL EDUCATION PROFESSIONAL RECREDENTIALING AND GREATER INCOME )T COULD ALSO REPRESENT A PROVIDER LED INDUSTRY VOICE FOR A CONSISTENT PERFORMANCE REWARD STRUCTURE )N ACHIEVING THIS GOAL IT WOULD $RIVE INDUSTRY STANDARDIZATION AROUND MEANINGFUL USABLE AND REWARDABLE QUALITY MEASURES 2EDUCE THE ADMINISTRATIVE BURDEN ON PROVIDERS AND PAYERS 2EPRESENT A hVOICEv FOR ALL LICENSED PHYSICIANS AND 0ROVIDE ONGOING MONITORING AND VALIDATION OF MEASURES 0RIVATE SECTOR LED CONSORTIA HAVE PROVEN TO BE A USEFUL WAY FOR OTHER INDUSTRIES TO COOPERATE WITH ONE ANOTHER TO BRING VALUE TO ALL OF THEIR STAKEHOLDERS 0RICEWATERHOUSE#OOPERS HAS PARTICIPATED IN MANY SUCH CONSORTIA PARTICULARLY IN THE lNANCIAL SERVICES INDUSTRY THAT HAVE ENABLED MANY OF THE DAILY lNANCIAL TRANSACTIONS THAT MOST TAKE FOR GRANTED 4HESE INCLUDE THE GLOBAL TRANSFER OF MONEY ELECTRONIC SETTLEMENT OF SECURITIES TRADING GLOBAL SECURITY AND AUTHENTICATION OF IDENTITY AND OTHERS )N ALL CASES 0RICEWATERHOUSE#OOPERS ACTED AS A TRUSTED THIRD PARTY INTERMEDIARY GARNERING THE TRUST FROM ALL PARTIES AND HELPING EXECUTE WITH INTEGRITY AND INDEPENDENCE !S THE HEALTHCARE INDUSTRY REALIGNS AROUND THE QUALITY AND VALUE OF SERVICES TO PATIENTS AN INTEGRAL PIECE OF THE PUZZLE WILL NECESSARILY MEAN TRANSPARENT AND VALID QUALITY MEASURES THAT ALL STAKEHOLDERS CAN USE WITH CONlDENCE )T IS HOPED THAT THE .ATIONAL #ARE 4RANSACTION #ONSORTIUM WILL PLAY A USEFUL ROLE IN THIS EFFORT %NDNOTES h0AY FOR 0ERFORMANCES 3MALL 3TEPS OF 0ROGRESS v 0RICEWATERHOUSE#OOPERS h0ERFORMANCE -EASUREMENT !CCELERATING )MPROVEMENT v )NSTITUTE OF -EDICINE )BID
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
0AY FOR 0ERFORMANCE AND "EYOND ! 2ECIPE FOR )MPROVING (EALTHCARE ! FUNDAMENTAL REFORM TO PROVIDER PAYMENT IS NEEDED THAT WILL DRIVE PAY FOR PERFORMANCE METHODS FORWARD AND LEAD THE WAY TO A MYRIAD OF IMPROVEMENTS IN DELIVERING TODAYS HEALTHCARE
"Y &RAN¥OIS DE "RANTES "RIDGES 4O %XCELLENCE
)
N $R ,ALUDE;= RECEIVED A LETTER OFFERING HIM A lNANCIAL BONUS FROM EMPLOYERS IN HIS COMMUNITY FOR THE QUALITY OF CARE HE WAS DELIVERING TO HIS DIABETIC PATIENTS 4O QUALIFY FOR THE BONUS $R ,ALUDE HAD TO RANDOMLY SELECT MEDICAL RECORDS FOR OF THOSE PATIENTS /NCE THE SELECTION WAS COMPLETE HE WOULD THEN NEED TO RECORD KEY MEASURES OF THEIR HEALTH STATUS AS WELL AS THE CARE THEY HAD RECEIVED AND REPORT IT TO THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1! &OR $R ,ALUDE THE QUALIFYING PROCESS SEEMED SIMPLE AND REQUIRED FEW HOURS OF WORK )N RETURN HE WOULD BE GETTING SEVERAL THOUSAND DOLLARS BECAUSE HE WAS CONlDENT IN THE QUALITY OF CARE HE WAS DELIVERING TO HIS PATIENTS (OWEVER AFTER GOING THROUGH THE RECORDS HE REALIZED HE WOULD NOT QUALIFY FOR THE REWARD 4HE AVERAGE BLOOD PRESSURE CHOLESTEROL LEVEL AND BLOOD SUGAR LEVEL OF HIS PATIENTS WERE NOT AS GOOD AS HE HAD INITIALLY THOUGHT AND NOT GOOD ENOUGH FOR HIM TO RECEIVE THE BONUS )N FACT HIS AVERAGE SCORE OF PERCENT WAS ALMOST IDENTICAL TO THE AVERAGE SCORE OF PHYSICIANS THAT HAD BEEN STUDIED BY "ETH -C'LYNN;= $R ,ALUDE REALIZED HE NEEDED TO IMPROVE INTERNAL PROCESSES AND SYSTEMS SO THAT HIS OFlCE COULD SYSTEMATICALLY mAG DIABETICS KEEP A LOG OF THEIR HEALTH STATUS AND ALLOW HIM TO FOCUS ON THE SUBSET OF PATIENTS WHO WERE NOT MONITORING THEIR DIABETES APPROPRIATELY /NCE THESE CHANGES WERE IMPLEMENTED $R ,ALUDE AND HIS STAFF NO LONGER WAITED FOR PATIENTS TO SHOW UP AT THE OFlCE BUT TOOK A PROACTIVE APPROACH AND REACHED OUT TO INDIVIDUAL PATIENTS TO GATHER FEEDBACK ON THEIR VITAL SIGNS AND ENCOURAGE REGULAR OFlCE VISITS "Y $R ,ALUDES AVERAGE PATIENT SCORES HAD DRAMATICALLY IMPROVED AND HE WAS ABLE TO QUALIFY FOR RECOGNITION AND THE BONUS $R ,ALUDE TRANSFORMED HIS PRACTICE BECAUSE HE KNEW THAT IT WAS THE RIGHT THING TO DO FOR HIS PATIENTS AND THE QUALITY OF CARE HE WAS DELIVERING TO THEM (E DID NOT DO IT SIMPLY FOR THE MONETARY REWARDS THOUGH THE INCENTIVES GAVE HIM THAT MUCH MORE OF A REASON TO RE EVALUATE THE QUALITY OF HIS CARE 5P UNTIL THAT POINT $R ,ALUDE REALLY DID NOT HAVE A REASON TO QUESTION HIS PERFORMANCE AS A PHYSICIAN .OW HE HAS
A SYSTEM IN PLACE THAT TELLS HIM HOW HE IS DOING AND HELPS HIM TARGET HIS EFFORTS $R ,ALUDES STORY HAS BEEN REPEATED THROUGHOUT THE COUNTRY BY SEVERAL THOUSANDS OF PHYSICIANS WHO HAVE BEEN PARTICIPATING IN PROGRAMS THAT ENCOURAGE THEM TO DELIVER BETTER CARE 4HESE PROGRAMS HAVE BEEN CALLED PAY FOR PERFORMANCE TO DISTINGUISH THEM FROM THE MORE COMMON WAY OF PAYING FOR CARE TODAY PAY FOR VOLUME FEE FOR SERVICE 4HE BETTER KNOWN PAY FOR PERFORMANCE EFFORTS INCLUDE THE )NTEGRATED (EALTHCARE !SSOCIATIONS )(!S 00;= EFFORT IN #ALIFORNIA AND "RIDGES 4O %XCELLENCE ;= WHICH IS ACTIVE IN SEVERAL STATES ON THE %AST #OAST AND IN THE CENTRAL REGION OF THE COUNTRY "RIDGES 4O %XCELLENCE "4% IS A NOT FOR PROlT ORGANIZATION THAT DESIGNS AND CREATES PROGRAMS THAT ENCOURAGE PHYSICIANS AND PHYSICIAN PRACTICES TO DELIVER SAFER MORE EFFECTIVE AND EFlCIENT CARE BY GIVING THEM lNANCIAL AND OTHER INCENTIVES TO DO SO
,ESSONS ,EARNED IN 00 "4%S MOST IMPORTANT LESSONS LEARNED DURING ITS INITIAL PILOTS WHICH LASTED THREE YEARS ALL OF WHICH HAVE BEEN PRESENTED TO MEMBERS OF THE )NSTITUTE OF -EDICINES 3UBCOMMITTEE ON 0AY FOR 0ERFORMANCE PRESENTED TO MEMBERS OF #ONGRESS THROUGH HEARINGS AND PUBLISHED IN A NUMBER OF JOURNALS AND ARTICLES ARE THAT )NCENTIVES MATTER AND THE SIZE OF THE INCENTIVE HAS A RELATIONSHIP TO A PHYSICIANS DECISION TO PARTICIPATE IN CARE PROCESS IMPROVEMENT )N GENERAL INCENTIVES MUST BE GREATER THAN OR EQUAL TO THE COST OF CHANGE OR AT THE VERY LEAST SUFlCIENT TO SIGNIlCANTLY CONTRIBUTE TO THE COST OF CHANGE &OR EXAMPLE A MULTI SPECIALTY GROUP PRACTICE IN !LBANY .9 WAS ABLE TO DEFRAY ABOUT A QUARTER OF THE MILLION INVESTMENT IN A NEW CLINICAL INFORMATION SYSTEM DUE TO THE lNANCIAL INCENTIVES RECEIVED THROUGH "4% 4HE PRACTICES WHOSE CARE PROCESSES WERE RE ENGINEERED ACHIEVED SIGNIlCANT IMPROVEMENTS IN THE MANAGEMENT OF PATIENTS WITH CHRONIC CONDITIONS %XHIBIT ILLUSTRATES BOTH POINTS OVERALL THERE IS A STATISTICALLY SIGNIlCANT DIFFERENCE BETWEEN THE MEAN REWARDS AVAILABLE FOR
&RAN¥OIS DE "RANTES IS THE NATIONAL COORDINATOR FOR "RIDGES 4O %XCELLENCE "4% AN ORGANIZATION FOCUSED ON REWARDING PHYSICIANS FOR BETTER QUALITY CARE )N THAT CAPACITY HE IS RESPONSIBLE FOR CREATING AND DEVELOPING NEW PROGRAMS FOR "4% AND FOR SUPERVISING THE IMPLEMENTATION OF "4% PROGRAMS IN DIFFERENT REGIONS IN THE COUNTRY -R DE "RANTES CAN BE REACHED AT &RANCOISDE"RANTES BRIDGES TOEXCELLENCEORG
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
O@XãEN QãO DQEN QL@MB Dã@MCãAD XNMCã@ãQD BHOD ãE NQãHL OQNU HMFãGD @KSGB@QD %XHIBIT -EAN 0ATIENT #OUNTS FOR 2ECOGNIZED AND .ONRECOGNIZED 0HYSICIANS -ARKET 0ROGRAM #INCINNATI $IABETES ,OUISVILLE $IABETES "OSTON $IABETES "OSTON ()4 3YSTEMS .9 #AP 2EG ()4 3YSTEMS
T VALUE
P LEVEL SIGN
.ONRECOGNIZED 0HYSICIAN -EAN 0ATIENT #OUNT
2ECOGNIZED 0HYSICIAN -EAN 0ATIENT #OUNT
RECOGNIZED PHYSICIANS AND NONRECOGNIZED PHYSICIANS IN EACH PILOT REGION SIZE PATIENT COUNT IS A PROXY FOR SIZE OF BONUS THERE IS A SIGNIlCANT DIFFERENCE BETWEEN THE MEAN PATIENT COUNT FOR PHYSICIANS RECOGNIZED FOR ADOPTING NEW SYSTEMS OF CARE AND THE PATIENT COUNT FOR PHYSICIANS BEING RECOGNIZED FOR DIABETES EXCELLENCE ONLY 7ITH RESPECT TO THIS SECOND POINT THE AVERAGE INVESTMENT FOR A PRACTICE OF THREE PHYSICIANS TO ADOPT NEW CLINICAL INFORMATION AND PATIENT MANAGEMENT SYSTEMS IS 4HE COSTS AND BENElTS OF PARTICIPATING IN AN INCENTIVE PROGRAM MUST BE KNOWN UP FRONT 0RACTICES n OR INDIVIDUAL PHYSICIANS WHO ARE ASKED TO INVEST BOTH TIME AND MONEY IN THAT PRACTICE TO IMPROVE THEIR PERFORMANCE n MUST HAVE A GOOD ESTIMATE OF THE BENElTS THEY WILL DERIVE FROM THAT EFFORT;= &OR EXAMPLE A GROUP OF PHYSICIANS IN $ELAWARE DECIDED NOT TO PARTICIPATE IN A "4% IMPLEMENTATION BECAUSE THEY ESTIMATED THAT THE BENElTS OF MEETING THE THRESHOLD FOR THE REQUIRED PERFORMANCE MEASURES EXCEEDED THE INITIAL INVESTMENT THEY WOULD HAVE TO MAKE TO ALLOW THEM TO MEET THE PERFORMANCE MEASURES 3ELF ASSESSMENT OF PERFORMANCE AND ITS VALIDATION BY AN INDEPENDENT THIRD PARTY IS A VERY POWERFUL AGENT OF CHANGE 0HYSICIANS AND PHYSICIAN PRACTICES THAT ARE ASKED TO PARTICIPATE IN A "4% IMPLEMENTATION MUST PERFORM A SELF AUDIT OF THEIR CURRENT PERFORMANCE 4HIS EFFORT WHILE TIME CONSUMING CREATES THE ROAD MAP FOR CHANGE &OR EXAMPLE $R ,ALUDE DISCOVERED THROUGH HIS SELF ASSESSMENT THAT HIS COMPLIANCE WITH GOOD STANDARDS OF CARE FOR HIS PATIENTS WITH DIABETES WAS PERCENT FAR BELOW THE PERCENT THRESHOLD REQUIRED FOR INCENTIVES 4HIS DISCOVERY MOTIVATED HIM EVEN MORE THAN THE lNANCIAL REWARDS TO RE ENGINEER HIS PRACTICE OF CARE FOR THOSE PATIENTS AND THE IMPROVEMENTS ACHIEVED IN UNDER A YEAR WERE SIGNIlCANT BOTH IN TERMS OF QUALITY OF CARE FOR THE PATIENTS AND THE COST OF CARE !DDITIONALLY INSTEAD OF HAVING HIS PERFORMANCE ASSESSED BY A PAYER WHO WOULD ONLY LOOK AT A PORTION OF HIS PATIENT PANEL $R ,ALUDES PERFORMANCE WAS ASSESSED BY THE .#1! VIA A REPRESENTATIVE SAMPLE OF HIS ENTIRE PANEL
(IGH QUALITY CARE CAN BE COST EFFECTIVE CARE 7HILE THERE IS CLEARLY NO CORRELATION TODAY BETWEEN QUALITY AND COST OF CARE "4%S ANALYSES OF CLAIMS DATA COMPARING PATIENTS THAT ARE SEEN BY "4% RECOGNIZED PHYSICIANS AND THOSE THAT GO TO NONRECOGNIZED PHYSICIANS SHOW CONCLUSIVELY THAT THEIR AVERAGE SEVERITY ADJUSTED COST OF CARE IS LOWER BY ABOUT TO PERCENT &OR EXAMPLE PATIENTS WITH DIABETES HAVE AVERAGE YEARLY COSTS OF ABOUT SEE %XHIBIT 0ATIENTS GOING TO RECOGNIZED PHYSICIANS HAVE COSTS OF ABOUT ;= 4HE DIFFERENCE COMES FROM LOWER RATES OF AVOIDABLE HOSPITALIZATIONS OR VISITS TO THE EMERGENCY ROOM WHICH IS A RESULT OF MORE FREQUENT PHYSICIAN OFlCE VISITS 4HIS IS A CLEAR SIGN THAT THE CARE THE PHYSICIAN IS DELIVERING IS MORE PROACTIVE AND IMPROVES THE CONSISTENCY OF CARE BEING DELIVERED TO PATIENTS 4HESE lNDINGS ARE IN LINE WITH A NUMBER OF STUDIES THAT EVALUATED THE ACTUARIAL IMPACT OF MEETING CERTAIN PERFORMANCE THRESHOLDS;= )N THESE STUDIES THE ABILITY FOR THE PHYSICIAN TO DEMONSTRATE GOOD CONTROL OF INTERMEDIATE OUTCOMES SUCH AS BLOOD PRESSURE AND CHOLESTEROL RESULTED IN SIGNIlCANT SAVINGS %XHIBIT INDICATES THE ACTUARIAL VALUE OF CONTROLLING INTERMEDIATE OUTCOMES FOR PATIENTS WITH DIABETES;= 4HE AVERAGE SAVINGS ESTIMATES ARE NOT FULLY ADDITIVE
"EST 0RACTICES IN 00 "OTH "4% AND THE )(! HAVE COMMON ELEMENTS THAT ARE RESPONSIBLE FOR THEIR SUCCESS THEY USE STANDARD PERFORMANCE MEASURES THEY REPRESENT MULTISTAKEHOLDER EFFORTS THAT BRING TOGETHER A LARGE GROUP OF PAYERS AND PURCHASERS TO MAKE REWARDS MEANINGFUL TO PHYSICIANS THEY USE INDEPENDENT THIRD PARTY ORGANIZATIONS TO MEASURE THE PERFORMANCE OF THE PHYSICIANS THEY PROVIDE PHYSICIANS WITH CLEARLY DElNED BENElTS WHICH HELPS THE PHYSICIANS DETERMINE THE VALUE OF PARTICIPATING AND THEY ENCOURAGE PHYSICIANS TO ADOPT BETTER SYSTEMS OF CARE INCLUDING HEALTH INFORMATION TECHNOLOGY TO SYSTEMATICALLY IMPROVE THE DELIVERY OF CARE
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
O@XãEN QãO DQEN QL@MB Dã@MCãAD XNMCã@ãQD BHOD ãE NQãHL OQNU HMFãGD @KSGB@QD %XHIBIT !VERAGE %PISODE #OST FOR 0ATIENTS 3EEN BY 0HYSICIANS 2ECOGNIZED FOR %XCELLENCE IN $IABETES #ARE #OMPARED 7ITH 0ATIENTS 3EEN BY .ONRECOGNIZED 0HYSICIANS
BETTER BUT WE CAN AND SHOULD GO A GIANT STEP FURTHER ALL THE WAY TO COMPREHENSIVE PAYMENT REFORM )T IS UPON THIS CONCEPT THAT 02/-%4(%53 WAS DEVELOPED
02/-%4(%53 "EYOND 00
$IABETES #OSTS /NLY .ONRECOGNIZED 0HYSICIANS 2ECOGNIZED 0HYSICIANS
)N EVERY INDUSTRY SECTOR ORGANIZATIONS ARE REWARDED WHEN THEY IMPROVE THE VALUE OF THE SERVICES THEY DELIVER OR PRODUCTS THEY MAKE 4HIS IS NOT THE CASE IN HEALTHCARE )N HEALTHCARE FOR THE MOST PART ONLY THE VOLUME OF TRANSACTIONS IS REWARDED IRRESPECTIVE OF THE QUALITY OF THE CARE DELIVERED )N FACT IN MANY INSTANCES GENERATING A HIGHER VOLUME OF EXPENSIVE SERVICES CAN IMPLICITLY REWARD POOR QUALITY;= 0AY FOR PERFORMANCE IS AN ATTEMPT TO CHANGE THAT DYNAMIC BY INTRODUCING A COUNTERING INCENTIVE )TS IMPACT DEPENDS ON THE FACTORS LISTED ABOVE MAINLY THE SIZE OF THE INCENTIVE RELATIVE TO A PHYSICIANS OR HOSPITALS TOTAL REVENUES 4HE SMALLER THE INCENTIVE IN PERCENTAGE TERMS THE LOWER THE IMPACT 7HILE NO FORMAL STUDIES HAVE YET CLEARLY ANSWERED THIS ISSUE THERE IS A LOT OF EMPIRICAL DATA THAT SUGGEST THAT PHYSICIANS WILL STRONGLY RESPOND TO INCENTIVES THAT REPRESENT PERCENT OR MORE OF THEIR TOTAL REVENUES;= 4HIS IS BECAUSE CHANGE IS DIFlCULT AND MAINTAINING THE STATUS QUO IS FOR THE MOST PART EASY #HANGE CAN ONLY OCCUR IF THE BENElT OF THAT CHANGE IS GREATER THAN THE BENElT OF THE STATUS QUO OR IF THE STATUS QUO IS SO UNCOMFORTABLE THAT IT MAKES THE PROSPECT OF CHANGE MORE APPEALING 4ODAY THE STATUS QUO IS UNCOMFORTABLE FOR EMPLOYERS WHICH MAKES THE PROSPECT OF EXPERIMENTING WITH CHANGES IN PAYMENT APPEALING 9ET FOR MANY PHYSICIANS THE STATUS QUO WHILE NOT IDEAL IS NOT SO UNCOMFORTABLE AS TO OVERCOME THE PERCEIVED RISK OF CHANGE 7E CAN ALL CONTINUE TO PAY FOR VOLUME AND BECOME EVER MORE UNCOMFORTABLE OR WE CAN START RECOGNIZING THAT PHYSICIANS AND HOSPITALS ARE LIKE ANY OTHER ECONOMIC ENTITY IN THE ECONOMY 4HEY RESPOND TO INCENTIVES AND THE ONES WE HAVE NOW ARE QUITE POOR "4%S AND THE )(!S 00 PROGRAMS HAVE SHOWN US WE CAN DO
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
2ATHER THAN REPLACING THE TWO MAIN PAYMENT MODELS PREVALENT IN THE 5NITED 3TATES n FEE FOR SERVICE AND CAPITATION n 02/-%4(%53 0AYMENT;= ADDRESSES THEIR SHORTCOMINGS 4HE MODEL ATTEMPTS TO CREATE A PAYMENT ENVIRONMENT WHERE DOING THE RIGHT THINGS FOR THE PATIENT HELPS PROVIDERS AND INSURERS ALSO DO WELL FOR THEMSELVES 4HIS IS ACCOMPLISHED BY PAYING PROVIDERS FOR THE QUANTITY OF CARE THAT IS RECOMMENDED BY WELL ESTABLISHED GUIDELINES AND EVIDENCE /VERALL 02/-%4(%53 IS NOT AN ENTIRELY NEW CONCEPT #ASE RATES AND GLOBAL FEES WHICH ARE ITS CENTRAL ELEMENTS HAVE BEEN AROUND FOR DECADES "UT THERE ARE THREE IMPORTANT INNOVATIONS INCLUDED IN 02/-%4(%53 THAT CLEARLY DIFFERENTIATE IT FROM PRIOR MODELS 4HE BASIS FOR THE CASE RATES IS EVIDENCE BASED GUIDELINES AND INCLUDES ADJUSTMENTS FOR PATIENT SEVERITY OF DISEASE %XEMPLARY PERFORMERS CAN GET MORE THAN PERCENT OF THE CASE RATE #LINICAL INTEGRATION AROUND THE CARE OF THE WHOLE PATIENT n NOT JUST PARTS n IS EXPLICITLY ENCOURAGED AND REWARDED THROUGH A COMPREHENSIVE SCORECARD THAT INCLUDES MEASURES OF CLINICAL PROCESS AND OUTCOMES OF CARE PATIENT EXPERIENCE WITH CARE RECEIVED AND IN MANY INSTANCES COST EFlCIENCY )T IS DESIGNED TO ACCOMMODATE A WIDE RANGE OF PHYSICIAN SPECIALTIES HOSPITALS OTHER HEALTHCARE PROVIDERS AND THE MANY WAYS THEY ARE ORGANIZED TO DELIVER CARE n FROM LARGE INTEGRATED DELIVERY NETWORKS TO INDIVIDUAL PRACTITIONERS ! TEAM OF EXPERTS IN HEALTHCARE ECONOMICS LAW POLICY PLAN OPERATIONS AND PERFORMANCE MEASUREMENT CAREFULLY DESIGNED THESE INNOVATIONS IN AN EFFORT TO HELP PLANS AND PURCHASERS RESPOND TO ONE OF THE MAIN CHALLENGES SET FORTH BY THE )NSTITUTE OF -EDICINES SERIES OF REPORTS ON THE QUALITY OF CARE IN !MERICA;= TO REFORM A TOXIC PAYMENT SYSTEM /NE PURPOSE OF 02/-%4(%53 IS TO CREATE A SETTING THAT IMPROVES THE WORK ENVIRONMENT FOR PROVIDERS AND IMPROVES QUALITY OF CARE FOR PATIENTS 4HAT REFORM CAN ONLY OCCUR BY UNDERSTANDING THE ROOT CAUSES FOR THE FAILURE OF THE CURRENT PAYMENT MODELS AND DESIGNING PROCESSES THAT WILL MITIGATE THEIR EFFECTS WHILE ENCOURAGING THE RIGHT BEHAVIORS &OR EXAMPLE BROAD BASED CAPITATION SHIFTS INSURANCE RISK FROM INSURERS TO PROVIDERS 02/-%4(%53 SPECIlCALLY AVOIDS HOLDING PROVIDERS ACCOUNTABLE FOR INSURANCE RISK )T DOES HOLD THEM ACCOUNTABLE FOR THEIR ABILITY TO PROVIDE EXCELLENT CARE 3IMILARLY FEE FOR SERVICE SHIFTS THE RESPONSIBILITY FOR PRUDENT AND WISE USE OF RESOURCES FROM PROVIDERS TO INSURERS 02/-%4(%53 HOLDS PROVIDERS ACCOUNTABLE FOR THE EFlCIENT USE OF RESOURCES BUT IT FREES THEM TO MANAGE THOSE RESOURCES IN ANY WAY THEY SEE lT AND REMOVES CURRENT ARTIlCIAL BARRIERS TO INNOVATE
O@XãEN QãO DQEN QL@MB Dã@MCãAD XNMCã@ãQD BHOD ãE NQãHL OQNU HMFãGD @KSGB@QD %XHIBIT !CTUARIAL 6ALUE OF #ONTROLLING )NTERMEDIATE /UTCOMES FOR $IABETES 0ATIENTS
#LINICAL -EASURE
!NNUAL 3AVINGS 0ER $IABETIC 0ATIENT
-AX
0OOR #ONTROL 'OOD #ONTROL
MM (G MM (G
MGDL MGDL
(B!C CONTROL
"LOOD PRESSURE CONTROL
,$, CONTROL
.EPHROPATHY ASSESSMENT
%YE EXAMINATION
.OTATION OF SMOKING STATUS AND CESSATION ADVICE OR TREATMENT
#OMPLETION OF LIPID PROlLE
&OOT EXAMINATION
3ELF ASSESSMENT OF PERFORMANCE AND ITS VALIDATION BY AN INDEPENDENT THIRD PARTY IS A VERY POWERFUL AGENT OF CHANGE )MPLEMENTING 02/-%4(%53 0AYMENT WILL REQUIRE CREATING AN OPERATIONAL INFRASTRUCTURE AN hENGINEv THAT CAN BOLT ON TO EXISTING PLAN CLAIMS PAYMENT SYSTEMS TO PERFORM THE FOLLOWING lVE TASKS %STABLISH SEVERITY ADJUSTED EVIDENCE BASED CASE RATES %#2S $ETERMINE THE APPROPRIATE ALLOCATION OF THOSE CASE RATES ACROSS DIFFERENT TYPES OF PROVIDERS TREATING THE SAME PATIENT 4RACK THE PERFORMANCE OF ALL PROVIDERS CARING FOR THE PATIENT COVERED BY THE %#2 2ECONCILE ALL PAYMENTS TO REWARD GOOD PERFORMANCE AND #REATE A SCORECARD TO REPORT AND PAY FOR QUALITY AND EFlCIENCY 4HERE ARE SIGNIlCANT COMPLEXITIES CONTAINED WITHIN EACH OF THESE lVE TASKS AND IT WILL TAKE A SUBSTANTIAL AMOUNT OF EFFORT TO MAKE EACH OPERATIONAL AND THIS EFFORT IS WELL UNDER WAY 3EVERAL ORGANIZATIONS HAVE COMMITTED TO CREATING THE CRITICAL COMPONENTS OF THE ENGINE )N ADDITION MEMBERS OF MEDICAL PROFESSIONAL SOCIETIES ARE CONTRIBUTING TO BUILDING OUT %#2S AND SEVERAL REGIONS ARE DESIGNING IMPLEMENTATION PROGRAMS TO TEST 02/-%4(%53 !LTHOUGH THERE ARE CLEAR LIMITATIONS TO WHAT CAN BE COVERED UNDER THE SCOPE OF %#2S TODAY SPECIALTY SOCIETIES AND OTHER MEDICAL PROFESSIONAL ORGANIZATIONS WILL LIKELY RISE TO A NEW
CHALLENGE IF THE VALIDITY OF THE MODEL IS PROVEN TO DEVELOP ADDITIONAL CLINICAL PRACTICE GUIDELINES THAT TAKE INTO ACCOUNT THIS APPLICATION AND CAN FORM THE BASIS FOR CASE RATES COVERING THE MAJORITY OF CONDITIONS AND PROCEDURES
0OWERING 5P #ONSUMER $IRECTED (EALTHCARE (EALTH BENElTS REFORM WITHOUT PAYMENT REFORM OR PAYMENT REFORM WITHOUT HEALTH BENElTS REFORM IS ONLY HALF OF THE SOLUTION 7E NEED BOTH TO BE IN PLACE 4ODAY WE ARE IN A SITUATION WHERE BENElTS REFORM HAS MOVED MUCH FASTER THAN PAYMENT REFORM AND SO PAYMENT REFORM NEEDS TO CATCH UP (EALTH BENEFITS REFORM HAS CHANGED THE LEVEL OF SENSITIVITY CONSUMERS HAVE TOWARD THE COST OF CARE BY INCREASING CONSUMERS RESPONSIBILITY FOR MEETING DEDUCTIBLES AND MAKING HIGH CO INSURANCE PAYMENTS ! HEALTHCARE COST SURVEY SHOWS THAT MORE THAN PERCENT OF ALL HEALTH PLAN ENROLLEES OF LARGE COMPANIES ARE IN A HIGH DEDUCTIBLE PLAN AND A &ORRESTER 2ESEARCH SURVEY ESTIMATED THAT CLOSE TO MILLION !MERICANS WOULD BE IN A CONSUMER DIRECTED HEALTH PLAN #$(0 IN ;= !S A RESULT CONSUMERS ARE EAGERLY SEARCHING FOR COMPARATIVE INFORMATION ON THE COST AND QUALITY OF CARE THEY ARE INCREASINGLY PAYING FOR BUT CAN ONLY SOMETIMES FIND RELEVANT INFORMATION ON QUALITY AND VERY SELDOM ON COST;= )N RESPONSE TO THIS SITUATION POLICY MAKERS FROM THE PRESIDENT TO MEMBERS OF #ONGRESS HAVE ASKED THAT PRICES OF UNITS OF CARE SERVICES BE MADE PUBLIC AND THERE ARE A NUMBER OF EFFORTS TO PUBLISH RATES FOR RADIOLOGY SERVICES OR OFlCE VISITS;= (OWEVER BECAUSE CARE IS MOSTLY PAID FOR AFTER THE SERVICES HAVE BEEN
# ( !04 % 2 1 5!, ) 4 9 # / . 5 . $ 2 5 -
O@XãEN QãO DQEN QL@MB Dã@MCãAD XNMCã@ãQD BHOD ãE NQãHL OQNU HMFãGD @KSGB@QD DELIVERED AND THERE IS A VERY HIGH DEGREE OF VARIATION IN THE QUANTITY OF SERVICES DELIVERED TO A PATIENT CONSUMERS CAN ONLY ESTIMATE THEIR TOTAL ANTICIPATED COSTS OF CARE .OT ONLY IS IT AN ESTIMATED COST BUT TO GATHER THE NECESSARY INFORMATION IS VERY DIFlCULT &OR ALL INTENTS AND PURPOSES THERE IS NO RELEVANT hPRICEv FOR CONSUMERS TO LOOK AT AND FROM WHICH TO ESTIMATE THEIR EXPECTED COSTS OF CARE
7E CAN AND SHOULD GO A GIANT STEP FURTHER ALL THE WAY TO COMPREHENSIVE PAYMENT REFORM 4AKE 3ALLY *ONES WHO HAS RECENTLY BEEN DIAGNOSED WITH 3TAGE BREAST CANCER 7HAT ARE THE ESTIMATED COSTS OF HER CARE (ER ONCOLOGIST MAY PUBLISH OFlCE VISIT COSTS BUT THAT WILL NOT INCLUDE THE COST OF ANY ADJUVANT THERAPY 4HE REALITY IS THAT THE CURRENT MODE OF PAYING FOR PHYSICIAN SERVICES HOSPITAL STAYS PRESCRIPTION DRUGS DIAGNOSTIC STUDIES AND ANY OTHER HEALTHCARE SERVICE IS NOT DESIGNED FOR PRICING TRANSPARENCY )T WAS DESIGNED TO WORK IN THE CURRENT FEE FOR SERVICE AND CAPITATION PAYMENT SYSTEM WHICH ITSELF IS A REmECTION OF CURRENT PREVAILING FORMS OF HEALTHCARE INSURANCE PLANS %#2S SHOULD PROVIDE CONSUMERS WITH THE PRICE TRANSPARENCY THAT THEY REALLY NEED "Y HAVING ACCESS TO CASE RATES THAT ENCOMPASS ALL THE CARE REQUIRED TO TREAT THEIR CONDITION A CONSUMER CAN TRULY COMPARE THE COST OF CARE FROM ONE PROVIDER TO ANOTHER !RMED WITH ROBUST DATA ON BOTH THE FINANCIAL AND QUALITY PERFORMANCES OF PHYSICIANS AND HOSPITALS CONSUMERS CAN BECOME THE ARBITERS OF THEIR CARE IN MUCH THE SAME WAY THEY HAVE BECOME THE ARBITERS FOR ALL OTHER PURCHASING DECISIONS ,ETS TAKE 3ALLY *ONES AGAIN !S SOON AS THE DIAGNOSIS OF 3TAGE BREAST CANCER HAS BEEN CONlRMED 3ALLY IS ADVISED OF THE %#2 FOR HER CONDITION AND SHE CAN LOOK UP THE CASE RATES THAT ARE PUBLISHED BY HER PLAN FOR EACH OF THE PROVIDERS IN THE PLANS NETWORK 3HE CAN DETERMINE UP FRONT WHAT HER TOTAL EXPENSES WILL BE AND BUDGET ACCORDINGLY 4IED TO QUALITY INFORMATION ON EACH PROVIDER 3ALLY CAN NOW MAKE A DECISION AS A REAL CONSUMER AS SHE DOES IN ALL OTHER ASPECTS OF HER LIFE #REATING A MARKET IN HEALTHCARE THAT WILL DELIVER CONSISTENT VALUE TO ALL ITS PARTICIPANTS CANNOT BE DONE IN THE CURRENT PAYMENT AND BENElTS ENVIRONMENT -OVEMENT TOWARD HEALTH BENElTS THAT
1 5!,)4 9 # / . 5 . $ 2 5 - # (!04% 2
ENCOURAGE PATIENTS TO ACT MORE LIKE CONSUMERS AND MOVEMENT TOWARD A PAYMENT SYSTEM THAT ENCOURAGES THE CONTINUOUS PURSUIT OF QUALITY AND COST EFFECTIVENESS MUST BE THE TWIN GOALS OF ALL EMPLOYERS AND HEALTH PLAN ADMINISTRATORS -ANY HAVE ALREADY EMBRACED THESE GOALS MANY MORE SHOULD
%NDNOTES ,ALUDE !PRIL PERSONAL COMMUNICATION WITH AUTHOR -C'LYNN ET AL h4HE 1UALITY OF (EALTH #ARE $ELIVERED TO !DULTS IN THE 5NITED 3TATES v .%*- P WWWIHAORG WWWBRIDGESTOEXCELLENCEORG 2OSENTHAL ET AL h%ARLY %XPERIENCE 7ITH 0AY FOR 0ERFORMANCE v /CT *!-! P "RIDGES 4O %XCELLENCE h%VALUATION OF THE $IABETES #ARE ,INK v &EBRUARY-ARCH HTTPWWWBRDGESTOEXCELLENCORGBTEPDF $020?%VAL?PDF AND PRESS RELEASE *ULY h#ALIFORNIA 0AY FOR 0ERFORMANCE 2ESULTS 3HOW )MPROVEMENTS IN (EALTH #ARE 1UALITY v )NTEGRATED (EALTH #ARE !SSOCIATION HTTPWWWIHAORGHTM h$IABETES #ARE !NALYSIS n 3AVINGS %STIMATE "RIDGES 4O %XCELLENCE $ECEMBER HTTPWWWBRIDGESTOEXCELLENCEORGBTEPDF$#,? ANALYSISPDF *AMES " PRESENTATION AT THE .ATIONAL 00 3UMMIT &EBRUARY DE "RANTES & h0ROVIDER )NCENTIVE -ODELS FOR )MPROVING THE 1UALITY OF #ARE v REPORT TO THE )/- 3UBCOMMITTEE ON 0AY FOR 0ERFORMANCE -AY HTTPWWWIOMEDU#-3 ASPX AND "AILIT ET AL -ARCH .ATIONAL (EALTH #ARE 0URCHASING )NSTITUTE HTTPWWWBRIDGESTOEXCELLENCEORGBTEWP?PROMETHEUSHTM h#ROSSING THE 1UALITY #HASM ! .EW (EALTH 3YSTEM FOR THE ST #ENTURY v )NSTITUTE OF -EDICINE -ARCH HTTPWWWIOMEDU #-3ASPX 4OWERS 0ERRIN 3EPTEMBER SEE THE FOLLOWING 52, TO REQUEST A COPY OF THE REPORT HTTPWWWTOWERSPERRINCOMHRSERVICES PUBLICATIONSTEMPLATESREQUEST?HCCSASP 0UBLICATION (EALTH #ARE #OST 3URVEY .OVEMBER &ORRESTER 2ESEARCH h!N %ARLY ,OOK AT #$(0 -EMBERS v HTTPWWWFORRESTERCOM2ESEARCH$OCUMENT %XCERPT HTML (ENRIKSEN ET AL h4HE 3TATE OF THE -ARKET FOR /NLINE (EALTHCARE #OST )NFORMATION 4OOLSv -ARCH REPORT TO THE #ALIFORNIA (EALTH #ARE &OUNDATION AND h(EALTH #ARE 0OLL v (ARRIS )NTERACTIVE !PRIL HTTPWWWHARRISINTERACTIVECOMNEWSNEWSLETTERSWSJHEALTHNEWS 73*/NLINE?()?(EALTH #ARE0OLLVOL?ISSPDF 7HITE (OUSE ANNOUNCEMENT ON 3TRENGTHENING (EALTH #ARE -AY HTTPWWWWHITEHOUSEGOVINFOCUSHEALTHCARE !ETNA 0RESS 2ELEASE !UGUST HTTPWWWAETNACOMNEWSPR? HTM /UTPATIENT 3ERVICES COST REPORT FOR ,OUISIANA (OSPITALS HTTPWWWLAHEALTHINFORMORGINDEXHTML
1! 0HYSICIANS 0ERSPECTIVES ON 1UALITY ! $ISCUSSION 7ITH 'ORDON -OORE $AVID #HIN AND 4IM 7ILSON 0HYSICIANS HAVE AN OBVIOUS AND DIRECT ROLE IN INmUENCING THE QUALITY OF CARE DELIVERY 0RICEWATERHOUSE#OOPERS RECENT (EALTH#AST SURVEY FOUND THAT A LARGE PROPORTION OF HEALTH LEADERS VIEW THE PHYSICIAN PATIENT RELATIONSHIP AS HAVING A MAJOR ROLE IN ENHANCING QUALITY SEE %XHIBIT 4O DISCUSS HOW PHYSICIANS CAN INmUENCE HEALTHCARE PERFORMANCE TODAY AND IN THE FUTURE 0RICEWATERHOUSE#OOPERS INTERVIEWED THREE PHYSICIAN THOUGHT LEADERS ON THIS TOPIC 4HIS PAPER REPRESENTS PHYSICIAN PERSPECTIVES AND PERSONAL OPINIONS ON QUALITY AND DOES NOT PORTRAY THE POSITIONS OR RECOMMENDATIONS OF 0RICEWATERHOUSE#OOPERS 'ORDON -OORE -$ -0( IS PROFESSOR OF !MBULATORY #ARE AND 0REVENTION AT (ARVARD -EDICAL 3CHOOL (IS RESEARCH AND WRITINGS ARE IN THE AREAS OF MANAGEMENT OF HEALTHCARE ORGANIZATIONS DESIGN OF INTERNATIONAL HEALTHCARE SYSTEMS DELIVERY OF AMBULATORY HEALTH SERVICES HEALTH POLICY EFFECTIVENESS OF PRIMARY CARE AND EDUCATIONAL STRATEGIES IN HEALTHCARE (E HAS PUBLISHED MORE THAN ARTICLES AND CHAPTERS $R -OORE WAS THE MEDICAL DIRECTOR AND CHIEF OPERATING OFlCER OF (ARVARD #OMMUNITY (EALTH 0LAN AND THE DIRECTOR OF TEACHING PROGRAMS AT (ARVARD 0ILGRIM (EALTHCARE (E DIRECTED THE .EW 0ATHWAY 0ROJECT AT (ARVARD -EDICAL 3CHOOL AND WAS RESPONSIBLE FOR THE DESIGN IMPLEMENTATION AND ADMINISTRATIVE DIRECTION OF (ARVARDS INNOVATIVE NEW CURRICULUM (E HAS ALSO SERVED ON THE -ASSACHUSETTS 0UBLIC (EALTH #OUNCIL AND TWO STUDY SECTIONS IN THE .ATIONAL #ENTER FOR (EALTH 3ERVICES 2ESEARCH $R -OORE HAS BEEN THE OUTSIDE NATIONAL EVALUATOR OF THE (EALTH OF THE 0UBLIC 0ROGRAM OF THE 2OCKEFELLER &OUNDATION AND 4HE 0EW #HARITABLE 4RUSTS AND DIRECTED THE EVALUATION OF THE 2OBERT 7OOD *OHNSON &OUNDATIONS NATIONAL INITIATIVE 0REPARING 0HYSICIANS FOR THE &UTURE $R -OORE HAS STARTED HIS OWN COMPANY 2X#EL WHOSE PRODUCTS ARE DESIGNED TO IMPROVE THE COST EFFECTIVENESS OF HEALTHCARE BY IMPROVING THE WORK OF DOCTORS AND HOSPITALS (E IS A GRADUATE OF (ARVARD -EDICAL #OLLEGE AND (ARVARD -EDICAL 3CHOOL (E CAN BE REACHED AT GORDON?MOORE HMSHARVARDEDU $AVID #HIN -$ IS A NATIONAL PARTNER WHO LEADS MAJOR STRATEGIC PLANNING AND OPERATIONS IMPROVEMENT ENGAGEMENTS FOR INSURERS ACADEMIC MEDICAL CENTERS AND LARGE EMPLOYERS IN THE (EALTHCARE !DVISORY 0RACTICE OF 0RICEWATERHOUSE#OOPERS ,,0 $R #HIN IS A PHYSICIAN EXECUTIVE WITH MORE THAN YEARS OF EXPERIENCE IN MANAGED CARE OPERATIONS HOSPITALPHYSICIAN NETWORK DEVELOPMENT AND THE MANAGEMENT OF LARGE MEDICAL GROUP PRACTICES "EFORE JOINING 0RICEWATERHOUSE#OOPERS $R #HIN WAS THE PRESIDENT OF .OVALIS #ORP A PRIVATELY HELD COMPANY THAT FRANCHISED (-/S ON A TURNKEY BASIS AND SERVED ON THE BOARD OF "AXTER )NTERNATIONAL )NC 0RIOR TO THOSE POSITIONS $R #HIN WAS THE PRESIDENT AND MEDICAL DIRECTOR OF THE (EALTH #ENTERS $IVISION OF THE (ARVARD #OMMUNITY (EALTH 0LAN A STAFF MODEL (-/ PROVIDING HEALTHCARE TO RESIDENTS IN EASTERN -ASSACHUSETTS (E CAN BE REACHED AT DAVIDCHIN USPWCCOM 4IM 7ILSON -$ HAS PRACTICED FOR YEARS AS A FAMILY DOCTOR IN THE 5+ AND WAS RECOGNIZED IN AS THE YOUNGEST &ELLOW BY ASSESSMENT OF THE 2OYAL #OLLEGE OF 'ENERAL 0RACTITIONERS '0 )N THE SAME YEAR HIS PRACTICE WAS ONE OF THE lRST TO RECEIVE A #HARTER -ARK FROM THE #ABINET /FlCE $R 7ILSON ESTABLISHED UNITS TO SUPPORT '0 COMMISSIONING AND THE 2OYAL #OLLEGE OF '0S 1UALITY 5NIT !S A SENIOR POLICY ANALYST FOR THE 5+ DEPARTMENT OF HEALTH STRATEGY UNIT HE HELPED DEVELOP THE .ATIONAL (EALTH 3ERVICE .(3 IMPROVEMENT PLAN AND CREATED POLICIES INCLUDING THE LONG TERM CONDITIONS STRATEGY PRACTICE BASED COMMISSIONING AND THE FUTURE OF PRIMARY CARE $R 7ILSON WAS A (ARKNESS &ELLOW WITH THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT AND AT (ARVARD -EDICAL 3CHOOL !S A SENIOR ADVISOR FOR CLINICAL PERFORMANCE WITH 0W# HE CONTINUES TO ADVISE THE 5+ DEPARTMENT OF HEALTH ON A RANGE OF PROJECTS INCLUDING PERFORMANCE IMPROVEMENT AND CLINICAL SERVICE RECONlGURATION FOR THE .(3 (E CAN BE REACHD AT TIMWILSON UKPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
1! 0RICEWATERHOUSE#OOPERS (OW DO PHYSICIANS PERCEIVE QUALITY 7HAT ARE THEIR MAJOR ISSUES WITH RESPECT TO QUALITY 'ORDON -OORE 4HERE IS A MAJOR DISJUNCTION BETWEEN ESPOUSED ATTITUDES TOWARDS QUALITY AND REAL ATTITUDES 0HYSICIANS CANT DENY THAT THERE ARE QUALITY PROBLEMS LACED THROUGHOUT THE SYSTEM TODAY (OWEVER THE ESPOUSED POSITION ENDS UP BEING VERY DIFFERENT -OST DOCTORS VIEW THEMSELVES AS BEING IN THE UPPER PERCENTILE OF QUALITY AND TO ADMIT THERE IS A PROBLEM COULD EXPOSE THEM TO MALPRACTICE AND LESSEN THEIR AUTONOMY )T WOULD TAKE A HIGH TOLERANCE OF COGNITIVE DISSONANCE FOR THEM TO ACCEPT A PROBLEM WITHIN THEIR OWN PRACTICE BECAUSE WHY IN THE WORLD WOULD ANYBODY STAY IN A PRACTICE THAT THEY DID NOT CONSIDER hTHE BEST v 3O THERE ARE A LOT OF REASONS WHY EVEN IF THEY DEEPLY FELT THAT THERE WERE QUALITY PROBLEMS THEY WOULDNT EXPRESS IT IN A PUBLIC FASHION
5NTIL WE GET IN THE CENTER OF THE FLOW OF CLINICAL INFORMATION OUR ABILITY TO EVEN BEGIN TO ASK WHAT IS QUALITY AND WHAT ARE ITS CORRELATES IS GOING TO BE ONLY HALF ANSWERED
4IM 7ILSON 4HATS BACKED UP BY PATIENT DATA )F YOU ASK PATIENTS WHETHER THEY THINK THERE ARE PROBLEMS WITH PHYSICIANS THEY ALL SAY hNOv 4HEY THINK THEIR PHYSICIAN IS A WONDERFUL PERSON AND VERY GOOD BUT IF YOU ASK THEM IN GENERAL IF THERE IS A PROBLEM WITH PHYSICIANS AND INDIVIDUAL DOCTORS WELL YES THERE ARE PROBLEMS BUT ITS NOT THEIR PHYSICIAN )T IS INTERESTING THAT THIS WORKS AT A PERSONAL LEVEL FOR THE PATIENT JUST AS IT DOES FOR PHYSICIANS 2ESEARCH IN !USTRALIA AND THE 5+ HAS SHOWN THAT NURSES VALUE STANDARDIZATION AS A DRIVER OF POLICY WHEREAS DOCTORS VALUE AUTONOMY AND INDIVIDUALIZATION 4HE VIEW THAT hQUALITY IS THE CARE THAT ) PROVIDEv IS NOT FAR OFF THE MARK FROM THE WAY THAT MANY PHYSICIANS THINK $AVID #HIN 4HE OTHER WAY THAT PHYSICIANS DElNE QUALITY IS IN THE SOMEWHAT TONGUE IN CHEEK WAY n hHIGH QUALITY IS THE WAY ) PRACTICEv n WHICH IS A BARRIER IN TERMS OF QUALITY IMPROVEMENT 0W# )S THERE A LACK OF ACCOUNTABILITY OR INFORMATION OR BOTH '- 4HERE CERTAINLY IS A LACK OF REAL DATA $OCTORS IN GENERAL HAVE BEEN IMMUNE TO THE IDEA THAT THERE WOULD BE DATA THAT GOT CLOSE TO WHAT THEY DO %VEN WITH STATISTICAL EPIDEMIOLOGIC CLAIMS BASED DATA DOCTORS TEND TO SAY THEY ARE NO GOOD AND THEREFORE SHOULDNT BE USED 4HATS A LITTLE DIFFERENT HOWEVER THAN AN ATTITUDE OF FEELING NOT ACCOUNTABLE $OCTORS FEEL SUPER ACCOUNTABLE MAYBE EVEN TOO ACCOUNTABLE FOR RESULTS IN A TERRAIN
WHERE OUTCOMES OFTENTIMES HAVE MORE TO DO WITH THE PATIENT AND THE SYSTEM THAN THEY DO WITH THE DOCTORS PROFESSIONAL QUALITIES -OST DOCTORS FEEL QUITE ACCOUNTABLE FOR THE RESULTS THAT THEY GET BUT THEY DONT WANT SOMEBODY ELSE MEASURING IT 47 4HE SITUATION IN FAMILY PRACTICE IN THE 5+ IS THAT THE QUALITY FRAMEWORK IS ESSENTIALLY A LARGE PAY FOR PERFORMANCE CONTRACT FOR FAMILY DOCTORS 4HEY HAVE TO BE MEASURED TO BE PAID &AMILY DOCTORS EARN POINTS THAT ARE VERY CLOSELY LINKED TO VERY SPECIlC OUTCOME AND PROXY OUTCOME MEASURES 3O FOR EXAMPLE CLINICAL RECORDS ARE EXAMINED FOR HOW FAMILY DOCTORS ARE CONTROLLING BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION 4HEY GET A FEW POINTS AND A SMALL PAYMENT FOR MEASURING PATIENTS BLOOD PRESSURE BUT A MUCH LARGER PAYMENT IF THEY BOTH MEASURE BLOOD PRESSURE AND KEEP IT UNDER CONTROL 4HEN THEY RECEIVE EVEN HIGHER PAYMENT LEVELS IF A CERTAIN PROPORTION OF THEIR HYPERTENSIVE PATIENT POPULATION HITS THE TARGET FOR BLOOD PRESSURE CONTROL )NTERESTINGLY SOME DOCTORS ARE VERY HAPPY BECAUSE THEY ARE GETTING PAID FOR THE WORK THEY WANT TO DO AND THEREFORE SEEM CONTENT WITH THE EXTERNAL MEASUREMENT THIS INVOLVES 4HE RESULT IS THAT 5+ FAMILY DOCTORS ARE THE HIGHEST PAID IN THE WORLD NOW 4HERE IS ALSO A DEGREE OF COMPETITION DOCTORS ARE STARTING TO COMPARE HOW MANY POINTS THEYVE GOT 4HERES A SENSE OF PRIDE AT BEING BEST EVEN THOUGH THIS DATA IS COLLECTED REMOTELY $# )N TERMS OF THE DATA COLLECTION PROCESS EXCEPT FOR MAYBE THE 5+ WHERE YOU HAVE SOME WIDESPREAD ADOPTION OF ELECTRONIC MEDICAL RECORDS %-2S AMONG PRIMARY CARE THERE REALLY IS NOT AN INFRASTRUCTURE TO COLLECT THE INFORMATION )TS VERY CUMBERSOME AND IT TAKES TWO TO HAVE SUCCESSFUL COMPLIANCE WITH GUIDELINES 4HE DOCTOR HAS TO USE THE GUIDELINE AND THE PATIENT ALSO HAS TO ADHERE TO IT 4HE LITERATURE WOULD INDICATE THAT FOR MOST THINGS THAT WE AS DOCTORS PRESCRIBE THERES ABOUT A PERCENT ADHERENCE RATE 3O WE HAVE A SITUATION WHERE AN INDIVIDUAL DOCTOR SAYS h7AIT YOU WANT ME TO BE ACCOUNTABLE FOR QUALITY BUT NOT ONLY DO ) NOT HAVE AN INCENTIVE TO DO SO BUT NEITHER DOES THE PATIENTv 0W# 7HERE DO YOU THINK THE SOLUTION RESIDES 7HAT DO YOU THINK NEEDS TO BE DONE TO HAVE THE PHYSICIANS EMBRACE AND ENHANCE QUALITY '- 7E WILL ONLY EMBRACE QUALITY IN A SERIOUS WAY WHEN WERE ABLE TO MEASURE WHAT MIGHT BE VIEWED AS REAL QUALITY AS DOCTORS PERCEIVE IT AND THEN LINK PAY FOR PERFORMANCE TO THAT )N THAT SENSE ) THINK THAT %NGLAND AND PROBABLY THE 53 TO A LESSER DEGREE ARE MOVING IN THE RIGHT DIRECTION 5NTIL WE GET IN THE CENTER OF THE mOW OF CLINICAL INFORMATION OUR ABILITY TO EVEN BEGIN TO ASK WHAT IS QUALITY AND WHAT ARE ITS CORRELATES IS GOING TO BE ONLY HALF ANSWERED 7HILE ITS A VERY INTERESTING EXPERIMENT FOR EXAMPLE IN %NGLAND TO HAVE THE INDICATORS IF YOU ASKED ME WHAT PERCENT OF GENERAL PRACTICE QUALITY THOSE INDICATORS REPRESENT ) WOULD HAVE TO GUESS THAT IT WOULD BE A VERY SIGNIlCANT MINORITY ) DONT BELIEVE WERE GOING TO MAKE A LOT OF PROGRESS UNTIL WE ARE ACTUALLY COLLECTING REAL DOCTOR DATA AND MOVING AWAY FROM CLAIMS BASED OR OTHER FORMS OF SECONDARY INFORMATION "UT ON
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
1! INITIATIVES THAT MAY BE A LITTLE DIFFERENT /NE IS THAT PHARMACY BENElT MANAGERS ARE INCORPORATING A LOT OF INFORMATION ABOUT PHYSICIAN PRESCRIBING HABITS AND THOSE mOWS ARE NOW BECOMING MORE AUTOMATED 4HEYRE PROBABLY AMONG THE MOST AUTOMATED TRANSACTIONS IN THE HEALTHCARE INDUSTRY AND WE CAN QUICKLY ASSEMBLE SOMEONES MEDICAL PROlLE BY JUST TAKING A LOOK AT THE MEDICINES THAT HE OR SHE IS TAKING ,ABORATORY DATA IS GOING THE SAME WAY AND PEOPLE ARE LEVERAGING THOSE DEVELOPMENTS INTO DISEASE MANAGEMENT COMPANIES THAT SOME OF THE LARGE INSURANCE COMPANIES HAVE ACQUIRED 4HE FEATURES OF THESE CARE MANAGEMENT COMPANIES IS THAT THEY MINE THESE DATABASES ON A NIGHTLY BASIS ALMOST IN REAL TIME TO PICK UP PATTERNS OF CARE n EITHER OMISSIONS OF CARE OR COMMISSIONS OF PROBLEMS n TO REACH OUT TO PATIENTS PROACTIVELY 3OME MODELS REACH OUT TO THE DOCTOR lRST WHILE OTHER MODELS REACH OUT TO THE PATIENT DIRECTLY )TS KIND 0W# 9OU TALK ABOUT THE mOW OF CLINICAL INFORMATION OF A SUPERSTRUCTURE IMPOSED ON THE CURRENT SYSTEM THAT MIGHT $O YOU MEAN SPECIlCALLY ELECTRONIC MEDICAL RECORDS IMPROVE QUALITY 4HERE ARE SIGNIlCANT EXPERIMENTS TO WIRE UP '- 4HE KIND OF INFORMATION THAT WERE INTERESTED IN IS LEVERAGED REGIONAL DELIVERY SYSTEMS IN A WAY THAT THEY CAN TALK TO EACH OTHER OFF ORDER ENTRY NOT OFF THE HISTORICAL OR PHYSICAL EXAMINATION &INALLY MANY HOSPITALS ARE MOVING TO THE ARCHIVAL KIND OF %-2 WHICH IS THE WAY THE ARCHIVAL RECORD GENERALLY WORKS 3O WHAT ) THAT PROVIDES THE INFRASTRUCTURE TO ASSEMBLE QUALITY INFORMATION MEAN IS AN ELECTRONIC PROCESS mOW INFRASTRUCTURE n THE ELECTRONIC IN A FAIRLY EFlCIENT WAY 7HEN IT BECOMES REINFORCED BY PAY FOR MEDICAL RECORD IS KIND OF A MISNOMER AND IT GETS US OFF IN THE PERFORMANCE YOU MIGHT HAVE SOMETHING WRONG DIRECTION )T MOVES US TOWARDS THE HIGH EFFORTLOW YIELD 47 $ATA IS CLEARLY IMPORTANT BUT ITS ALWAYS GOING TO BE ONLY PART OF )4 INFRASTRUCTURE RATHER THAN THE LOW EFFORTHIGH YIELD OR ONE COMPONENT OF IMPROVING QUALITY 4HE IMPORTANT AREAS THAT HIGH EFFORTHIGH YIELD SECTOR WHERE WE NEED TO BE ARE YET UNTAPPED ARE ADDRESSING HOW PHYSICIANS ARE GOING TO $# )M SEEING SOME DEVELOPMENTS THAT ARE ENCOURAGING IN BE FULLY ENGAGED AND HOW THE PHYSICIANPATIENT RELATIONSHIP TERMS OF lNALLY GETTING OFF THE DIME ON QUALITY INFORMATION AND IS GOING TO BE USED TO IMPROVE QUALITY 4HE DATA THAT WE CAN COLLECT IS ALWAYS GOING TO BE A SMALL PART OF THE %XHIBIT 4HE PHYSICIAN PATIENT RELATIONSHIP IS A MAJOR KEY BIGGER QUALITY PICTURE 9OU CAN MEASURE MORE TO IMPROVING QUALITY OF CARE BUT YOU CANNOT ALWAYS ANALYZE MORE 9OU GET TO THE POINT WHERE YOU CAN ONLY FOCUS YOUR 0OTENTIAL OF 3TAKEHOLDERS TO %LIMINATE 7ASTEFUL ATTENTION ON A CERTAIN NUMBER OF AREAS )M A VERY 3PENDING IN (EALTHCARE 'LOBAL 2ESULTS STRONG ADVOCATE OF ACTUALLY EMPOWERING PATIENTS MORE GIVING THEM A GREATER ROLE IN DETERMINING AND DRIVING THEIR HEALTHCARE ) THINK THAT WILL GET PHYSICIANS ATTENTION IN A DIFFERENT KIND OF WAY '- 4HERES THE OLD SAYING h4HE MEASURABLE DRIVES OUT THE IMPORTANT v AND THERE IS AN ELEMENT OF THAT 4HERE ARE SO MANY DIFFERENT ASPECTS )N THE 53 OF WHAT MIGHT BE VIEWED AS QUALITY n ACCESS 0HYSICIANS PSYCHOSOCIAL RELATIONSHIPS THE DIAGNOSIS OF WERE ILL FORMED PROBLEMS n THAT ARE REALLY ULTIMATELY 0ATIENTS GOING TO BE VERY DIFlCULT TO MEASURE 4HERES A VERY STRONG ARGUMENT TO BE MADE THAT IF IN FACT YOU PUT IN TOO MANY SPECIlC MEASUREMENTS AND CALL THAT QUALITY THEN WHAT WILL HAPPEN IS THAT DOCTORS WILL MEET THOSE TARGETS 4HEYRE VERY SMART PEOPLE AND VERY CLEVER AND OVER TIME THE OTHER ATTRIBUTES THAT YOU WANT IN QUALITY MIGHT VERY WELL DEGRADE 4HAT WOULD BE A TREMENDOUS LOSS 4HERE MAY BE SOME UNINTENDED CONSEQUENCES 3OURCE 0RICEWATERHOUSE#OOPERS (EALTH#AST 3URVEY AND ITS IMPORTANT TO LOOK FOR THOSE 4HE ATTITUDES THE POSITIVE SIDE ONCE DOCTORS BELIEVE THAT COLLECTING THAT DATA IS A EASY TO DO B HEAVILY LINKED TO THEIR ABILITY TO DO GOOD WORK AND THEN C VERY STRONGLY CORRELATED WITH THEIR INCOME WE WILL CREATE WHAT MIGHT BE VIEWED AS A VIRTUAL CYCLE 7E WILL COLLECT MORE AND BETTER DATA AND WILL BE BETTER ABLE TO CORRELATE THAT WITH IMPORTANT CLINICAL PROCESSES AND OUTCOMES PATIENT SATISFACTION INCLUDED AND START TRULY GETTING A BETTER HANDLE ON MEASURING QUALITY 4HE lRST STEP IS TO lND A WAY EASILY TO GET INSIDE THE mOW OF REAL CLINICAL DATA AND INFORMATION AND THEN TO REWARD THOSE DOCTORS WHO ARE ABLE TO ACHIEVE POSITIVE RESULTS "ETTER DOCTORS WILL MOVE IN THAT DIRECTION AND THEY WILL DRAG ALONG THE DOCTORS THAT ARE PERHAPS NOT QUITE SO HIGH ON THE QUALITY SCORES BUT WHO WILL NEED TO GET IN THE BUSINESS OF MEASURING AND IMPROVING IF THEY WANT TO KEEP UP WITH THEIR COLLEAGUES
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
1! AND THE VALUES OF DOCTORS n THEIR SENSE OF WHAT WE WOULD CALL PROFESSIONALISM AND PROFESSIONAL RESPONSIBILITY n ARE SUCH AN IMPORTANT PART OF THE OVERALL MIX OF QUALITY THAT WEVE GOT TO BE VERY CAREFUL TO KEEP OUR EYE ON THE FULL PICTURE AS MUCH AS WE CAN AND NOT RELY OVERLY ON SOME OF THE SPECIlC MEASURES
)F YOU LOOK AT THE UNDERLYING CONDITIONS THAT MAKE FOR AN EFFECTIVE MARKET IN OTHER DOMAINS LIKE BUYING A CAR OR A HOUSE THESE ARE REALLY SORELY MISSING IN MEDICAL CARE
0W# 7HAT CAN BE DONE TO HELP EMPOWER THE PATIENT 47 4HE KEY IS THAT AND THIS IS OFTEN UNDERESTIMATED YOU CAN COACH PATIENTS 9OU CAN COACH THEM TO ASK VERY PARTICULAR QUESTIONS THAT HELP THEM TO MAKE BETTER USE OF THEIR TIME WITH A PHYSICIAN 9OU CAN ALSO GIVE THEM DECISION SUPPORT TOOLS TO AID THEM TO MAKE CHOICES THAT SUIT THEM BEST '- ) DONT THINK WE HAVE ENOUGH MARKET FORCES TO EMPOWER PATIENTS -EDICINE IS AN ASYMMETRIC MARKETPLACE )F YOU LOOK AT THE UNDERLYING CONDITIONS THAT MAKE FOR AN EFFECTIVE MARKET IN OTHER DOMAINS LIKE BUYING A CAR OR A HOUSE THESE ARE REALLY SORELY MISSING IN MEDICAL CARE )F YOU DEVELOP A TYPE OF GUIDE OR FEEDBACK ABOUT DOCTORS YOU CAN BEGIN TO CREATE TRANSPARENCY THAT WOULD MAKE PATIENTS FAR BETTER CONSUMERS AND WHICH WOULD INCLUDE ASPECTS OF TECHNICAL QUALITY AS WELL AS SERVICE AND RELATIONSHIP QUALITY )N SYSTEMS IN WHICH THE PATIENT IS NOT AT COST RISK IT WILL BE VERY HARD TO ACTIVATE CONSUMER DRIVEN MARKET FORCES TO MAKE THE SYSTEM BETTER "UT THERE IS QUITE GOOD EVIDENCE THAT AS YOU BEGIN TO GET AT LEAST A LITTLE BIT OF lNANCIAL SKIN IN THE GAME THAT PATIENTS WILL DECIDE ABOUT WHERE TO GO BASED ON VALUE NOT JUST ON PERCEIVED QUALITY 7E DO NOT KNOW YET HOW BEST TO USE MARKET FORCES IN DRIVING QUALITY BUT THATS GOING TO BE THE MAJOR TRANSFORMATION THAT OCCURS IN THE NEXT YEARS AND PAY FOR PERFORMANCE IS ONLY OPENING THE DOOR JUST A CRACK 7E HAVE A LONG WAY TO GO ON THIS BUT THE THING THAT INTERESTS ME MOST IS NOT JUST GETTING CONSUMERS IN THE GAME BUT EMPOWERING THEM TO IMPROVE THE SYSTEM RATHER THAN WORKING OFF SECONDARY OR MARGINAL DATA WITHOUT ANY BENElTS TO BEING GOOD SHOPPERS 0W# 7HAT DO YOU THINK THE QUALITY LANDSCAPE WILL LOOK LIKE IN THREE TO lVE YEARS $# !T A MACRO LEVEL IN THE 5NITED 3TATES ANYWAY ) DONT THINK THREE TO lVE YEARS IS GOING TO BE MUCH TIME FOR A CHANGE )N SOME AREAS WELL SEE A CONmUENCE OF LOCAL %-2 INITIATIVES THAT TIE TOGETHER ENLIGHTENED EMPLOYERS OR INSURANCE COMPANIES THAT ARE WILLING TO GO WITH PAY FOR PERFORMANCE ON THE PROVIDER SIDE
AND HIGH DEDUCTIBLE HEALTH PLANS THAT PUT MORE SKIN IN THE GAME FOR THE PATIENTS ON THE OTHER SIDE 4HEN YOU MIGHT SEE SOME INTERESTING OUTCOMES IN THAT THREE TO lVE YEAR TIME FRAME 47 7E TEND TO OVERESTIMATE WHATS GOING TO HAPPEN IN THE NEXT FEW YEARS AND UNDERESTIMATE WHATS GOING TO HAPPEN IN YEARS 4HERE IS SOMETHING THATS GOING TO HAPPEN AROUND THE AVAILABILITY OF INFORMATION BOTH QUALITY DATA THAT WEVE TALKED ABOUT BUT ALSO AROUND INFORMATION ABOUT DIFFERENT MEDICAL CONDITIONS AND THE BEST FORM OF MANAGEMENT THAT IS GOING TO DRIVE THE QUALITY AGENDA IN WAYS WE CANNOT CURRENTLY CONCEIVE 4HE FACT THAT YOURE GOING TO BE ABLE TO SEE THE QUALITY OF YOUR PHYSICIAN IS PRETTY IMPORTANT ADDED TO WHICH YOULL BE ABLE TO COMMUNICATE WITH YOUR PHYSICIAN DIFFERENTLY 4HINGS ARE GOING TO BE VERY DIFFERENT IN YEARS BECAUSE OF THE )NTERNET BECAUSE OF MOBILE INFORMATION 4HE WHOLE THING WILL BE TRANSFORMED IN TERMS OF COMMUNICATION RELATIONSHIPS AND THE INFORMATION AVAILABLE '- 4O TALK ABOUT QUALITY AS A SINGLE MEASURE WEAKENS THE THINKING THAT NEEDS TO GO ON 7E SHOULD BE THINKING ABOUT VALUE THAT IS THE OUTPUTS AND BY THAT ) MEAN PATIENT SATISFACTION AND TECHNICAL QUALITY AND ACTUAL OUTCOMES FROM THE WORK THAT WE DO "UT IT SHOULD BE RELATED TO COST 7HETHER THE INDIVIDUAL PAYS n IN WHICH CASE YOU HAVE AN INDIVIDUAL DRIVEN MARKETPLACE n OR WHETHER THE NATION STATE OR A COMPANY PAYS TO TAKE COST OUT OF THE EQUATION AND ONLY TALK ABOUT QUALITY IS REALLY ONLY HALF THE DISCUSSION 3O ) WOULD NUMBER ONE MAKE A PLEA ABOUT THAT .UMBER TWO ) THINK WHAT WELL SEE IN THE NEXT THREE TO lVE YEARS ARE POCKETS OF THINGS THAT ARE INTERESTING BUT WHAT WILL HAPPEN MORE BROADLY IS THAT DATA WILL BECOME MORE AVAILABLE )N EVERY lELD WHETHER IT WAS THE TELEPHONE OR COMPUTERS WHEN THEY WERE lRST INVENTED n WHAT WE DO WHEN WE HAVE SOMETHING NEW AVAILABLE IS TO DUPLICATE WHAT WEVE DONE BEFORE !ND THEN AFTER ABOUT TO YEARS YOU BEGIN TO SEE OUT OF THE BOX THINGS THAT TRANSFORM THE NATURE OF AN INDUSTRY 'OOGLE OR E"AY WOULD BE GOOD EXAMPLES OF USES OF DATA OR INFORMATION CREATING EXCHANGES THAT NOBODY REALLY HAD PREDICTED AT THE BEGINNING OF THE DIGITAL )NTERNET 7EB AGE 7E DONT KNOW WHAT THE WILD CARDS OR THE TRANSFORMATIVE OR DISRUPTIVE USES OF DATA WILL BE 7E CAN SAY THAT THERE WILL BE MORE DATA )T WILL BE UBIQUITOUS )T WILL ATTEMPT TO TRY TO DESCRIBE PERFORMANCE ) HOPE IT DESCRIBES VALUE NOT JUST QUALITY "UT WHAT WE DONT KNOW ARE THE UBIQUITOUS WAYS THAT THE CAPITALISTS OR SMART POLICY PLANNERS WILL USE THAT TO DO THINGS THAT YOU CANT EVEN CONCEIVE OF RIGHT NOW )TS IMPORTANT FOR US TO KEEP OUR EYES OPEN AND BEGIN TO LOOK FOR THOSE SORTS OF DISRUPTIVE USES BECAUSE THOSE ARE THE THINGS THAT WILL TRANSFORM THIS CONVERSATION INTO SOMETHING THATS MUCH MORE INTERESTING 3OMEBODY WILL COME UP WITH REALLY A TRANSFORMATIVE BRILLIANT IDEA THAT WILL DIFFUSE VERY RAPIDLY IN THE GLOBAL MARKET OF HEALTHCARE THAT WE LIVE IN 4HATS GOING TO BE THE EXCITING STUFF TO LOOK AT n 4HIS PAPER REPRESENTS PHYSICIAN PERSPECTIVES AND PERSONAL OPINIONS ON QUALITY AND DOES NOT PORTRAY THE POSITIONS OR RECOMMENDATIONS OF 0RICEWATERHOUSE#OOPERS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
7ORKING 4OGETHER 0HYSICIANS AND (OSPITALS 0ARTNERING FOR 1UALITY )MPROVEMENT 4HE AMBULATORY CARE ENVIRONMENT IS PRODUCING MEANINGFUL EXAMPLES OF DOCTOR HOSPITAL COLLABORATIONS DESIGNED TO ADVANCE PARTICIPANTS GOALS FOR INTEGRATED HEALTHCARE DELIVERY REGULATORY COMPLIANCE AND lNANCIAL PERFORMANCE "Y *EFF "OOTH "RETT - (ICKMAN AND "RIAN -ATSON 0RICEWATERHOUSE#OOPERS
#REATING 2ESULTS 4HROUGH #OLLABORATION !S KEY INDUSTRY AND GOVERNMENTAL BODIES PROGRESSIVELY EMBRACE QUALITY AS A MEASURE OF HEALTHCARE DELIVERY PERFORMANCE AN INCREASED FOCUS ON ACCOUNTABILITY HIGH PERFORMANCE AND QUALITY LEADERSHIP HAS LED TO SUCCESSFUL COLLABORATIONS BETWEEN HOSPITALS AND PHYSICIANS IN THE AMBULATORY SETTING 7HILE SUCH VENTURES OFTEN HINGE ON lNANCIAL CONSIDERATIONS A FOCUS ON QUALITY IMPROVEMENT LEADS TO MORE THAN COST REDUCTION )T CREATES A DYNAMIC NEW PARADIGM FOR DRIVING CULTURAL CHANGES ALIGNING lNANCIAL INCENTIVES AND FULlLLING EXPECTATIONS FOR HEALTHCARE DELIVERY 0ROVIDER VARIABILITY AND A COMPLEX REGULATORY SETTING HAVE LED TO A SOMEWHAT CAUTIOUS ENVIRONMENT WITH RESPECT TO COLLABORATION #OLLABORATION ALSO FACES ENORMOUS CULTURAL OBSTACLES CREATED BY A TRADITIONAL CONmICT 0HYSICIANS SEEK MORE CONTROL AND HOSPITALS FEAR LOSING IT )N THIS ENVIRONMENT MANY HOSPITALS MOVE SLOWLY IF AT ALL PRIMARILY BECAUSE THEY LACK A CLEAR UNDERSTANDING OF AND COMFORT WITH COMPLICATED REGULATORY CONSIDERATIONS 0HYSICIANS CONSEQUENTLY GROW FRUSTRATED BY AN INABILITY TO AFFECT ADMINISTRATIVE OR OPERATING INEFlCIENCIES PARTICULARLY WHEN THOSE INEFlCIENCIES DECREASE THEIR PRODUCTIVITY IN A WORLD OF DECLINING REIMBURSEMENT RATES $ESPITE SUCH ECONOMIC PRESSURES PHYSICIANS OFTEN RESIST lNANCIAL ARRANGEMENTS THAT LACK ALIGNMENT AROUND GOVERNANCE CLINICAL MANAGEMENT AND OPERATIONS 3UCH ARRANGEMENTS ARE NOT SUSTAINABLE BECAUSE WITHOUT TRUE ALIGNMENT PHYSICIANS AND HOSPITALS MAY WORK WITH CONmICTING OR DISJOINTED PURPOSES POTENTIALLY CREATING NEGATIVE IMPACTS FROM CLINICAL AND SERVICE STANDPOINTS &OR EXAMPLE PHYSICIANS MAY HAVE LITTLE MOTIVATION TO ADHERE TO BENCHMARKS SUCH AS ON TIME STARTS FOR SURGERY OR FULL
UTILIZATION OF BLOCK TIME RESERVATION OF TIME IN ADVANCE ON THE SURGERY SCHEDULE AT HEALTHCARE FACILITIES IN WHICH THEY HAVE NO PARTICIPATION IN GOVERNANCE OR OWNERSHIP 7HEN PHYSICIANS HOLD A VESTED INTEREST IN OVERALL PERFORMANCE THEY BECOME MORE COMPLIANT WITH PROCESS MEASURES SUCH AS lRST CASE STARTS SUPPLY USAGE PROTOCOLS AND OTHER STANDARDIZATIONS )N ANOTHER EXAMPLE PHYSICIANS AND HOSPITALS ACTIVELY COLLABORATING THROUGH A CARDIOLOGY SERVICE LINE MANAGEMENT COMPANY OFTEN ARE ABLE TO WORK TOGETHER TO MEET OR EXCEED NATIONAL hDOOR TO BALLOONv MEASURES AND GOALS OF ABOUT MINUTES $OOR TO BALLOON TIME STARTS WITH A PATIENTS ARRIVAL BY AMBULANCE AT THE HOSPITAL EMERGENCY ROOM AND ENDS WHEN THE HEART ARTERY IS OPENED WITH BALLOON ANGIOPLASTY IN A CARDIAC CATHETERIZATION LAB h$OOR TO BALLOONv IN A STANDARD HOSPITAL MANAGED SETTING CAN BE AS HIGH AS THREE TO FOUR HOURS A TIME DURING WHICH PRECIOUS HEART MUSCLE MAY BE IRREPARABLY DAMAGED /THER EXAMPLES OF MECHANISMS FOR ALIGNING PERFORMANCE AND INCENTIVES INCLUDE THE USE OF UNDER ARRANGEMENT JOINT VENTURES FOR AREAS SUCH AS GASTROINTESTINAL AND IMAGING SERVICES !PPRECIATING THE BENElTS FOR ALL STAKEHOLDERS PROGRESSIVE HOSPITALS AND PHYSICIANS IN SOME MARKETS HAVE MOVED ASSERTIVELY INTO THE COLLABORATIVE ARENA 4HOSE SEEKING TO JOIN THE TREND SHOULD EXAMINE THEIR OWN BUSINESS CASES AND CREATE A UNIQUE APPROACH FOR THEIR MARKETS %VERY MARKET HAS DIFFERENT QUALITIES AND CHARACTERISTICS EACH COLLABORATIVE RELATIONSHIP MUST ACCOMMODATE AND LEVERAGE THEM 2EGARDLESS OF THE APPROACH PHYSICIAN PARTICIPANTS NEED TO PROVIDE ACTIVE MANAGEMENT WITH A DIRECT IMPACT ON QUALITY TO MEET REGULATORY SCRUTINY &UNDAMENTALLY SUCCESS DEPENDS NOT ON REGULATIONS
*EFF "OOTH IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE (E HAS OVER YEARS EXPERIENCE WITH THE HEALTHCARE PROVIDER MARKET PRINCIPALLY IN THE AREAS OF STRATEGY lNANCE PERFORMANCE IMPROVEMENT PHYSICIAN PARTNERING PAY FOR PERFORMANCE AND TRANSACTIONS (E CAN BE REACHED AT JEFFQBOOTH USPWCCOM "RETT - (ICKMAN -"! #0! IS A PARTNER IN 0RICEWATERHOUSE#OOPERS !DVISORY 3ERVICES AND NATIONAL LEADER OF THE (EALTH )NDUSTRIES 3TRATEGY AND 0LANNING PRACTICE (E HAS MORE THAN YEARS OF EXPERIENCE IN THE HEALTHCARE INDUSTRY INCLUDING ALIGNING INCENTIVES PARTNERSHIPS AND JOINT VENTURES BETWEEN HOSPITALS AND PHYSICIANS (E IS ALSO A #ERTIlED 0UBLIC !CCOUNTANT LICENSED IN )LLINOIS AND )NDIANA (E CAN BE REACHED AT BRETTMHICKMAN USPWCCOM "RIAN -ATSON -(! IS A DIRECTOR IN 0RICEWATERHOUSE#OOPERS (EALTHCARE 'ROWTH PRACTICE (E HAS OVER YEARS EXPERIENCE PARTICULARLY OPERATIONAL IN THE HEALTHCARE INDUSTRY WITH FOCUS ON THE PLANNING DEVELOPMENT AND OPERATION OF FREESTANDING OUTPATIENT AND INPATIENT MEDICAL SERVICES )N ADDITION HE HAS SIGNIlCANT EXPERIENCE IN THE DESIGN AND CONSTRUCTION OF FACILITIES OFFERING SPECIALTY HOSPITAL AMBULATORY SERVICES AND PHYSICIAN MEDICAL OFlCE PROGRAMS (E CAN BE REACHED AT BRIANDMATSON USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
VNQJHMFãSNFDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S BUT ON ALL PARTIES REACHING A CLEAR UNDERSTANDING OF THEIR OPTIONS AND DEVELOPING CONSENSUS ON THE APPROACH THAT BEST FULlLLS THE BUSINESS CASE FOR BOTH
"ASIC -ODELS FOR )NTEGRATION 4HE FULL MENU OF FUNDAMENTAL MODELS FOR HOSPITAL AND PHYSICIAN COLLABORATION OFFERS A WIDE RANGE OF OPPORTUNITIES -OST DO NOT DIRECTLY ALIGN QUALITY INITIATIVES WITH INCENTIVES AND OTHERS OFFER ONLY A lNITE MECHANISM FOR PARTNERING !S SHOWN IN %XHIBIT THERE ARE A NUMBER OF OPTIONS FOR PARTNERSHIP DEPENDING ON THE DESIRED LEVEL OF INTEGRATION &OR EXAMPLE THE LOWEST LEVEL OF INTEGRATION INCLUDES MEDICAL DIRECTORSHIPS AND OTHER CONTRACTUAL ARRANGEMENTS WITH PHYSICIANS /THER MODELS INCLUDE -EDICAL DIRECTORSHIPS STIPENDS AND MANAGEMENT CONTRACTS FOR PHYSICIANS 'AIN SHARING FOR SHORT TERM IMPROVEMENTS TO ACHIEVE SAVINGS OR OPERATING EFlCIENCIES 0ERFORMANCE OR TAXABLE BONDS THAT ALLOW PHYSICIANS TO PARTICIPATE IN CAPITAL INVESTMENTS UNDER CERTAIN CIRCUMSTANCES ,EASING OF SPACE TIME OR TECHNOLOGY BY PHYSICIANS FROM HOSPITALS -ANAGEMENT COMPANIES SUCH AS THOSE THROUGH WHICH HOSPITALS AND PHYSICIANS ACTIVELY MANAGE AN ENTIRE SERVICE LINE OR A DElNED OR SPECIlC PORTION OF THE SERVICE
5NDER ARRANGEMENT JOINT VENTURES THROUGH WHICH PHYSICIANS AND HOSPITALS INVEST IN A NEW COMPANY THAT OPERATES CERTAIN SERVICES ON BEHALF OF THE HOSPITAL %QUITY JOINT VENTURES SUCH AS OUTPATIENT SURGERY CENTERS IN WHICH PHYSICIANS AND HOSPITALS HAVE FULLY INVESTED AND &ULLY INTEGRATED DELIVERY SYSTEMS THROUGH WHICH HOSPITALS DIRECTLY EMPLOY PHYSICIANS /F THE MODELS SERVICE LINE MANAGEMENT AND UNDER ARRANGEMENT JOINT VENTURES ARE INCREASINGLY POPULAR AMONG HOSPITALS AND PHYSICIANS 4HESE MODELS CAN ALSO SERVE AS STEPPING STONES TO HIGHER LEVELS OF INTEGRATION -AJOR DRIVERS ARE THE PROLIFERATION OF PAY FOR PERFORMANCE PROGRAMS AND THE EVER INCREASING NEED FOR HOSPITALS AND PHYSICIANS TO ALIGN AROUND A COMPREHENSIVE SET OF SERVICES 4HESE MODELS ULTIMATELY COULD BE THE FOUNDATION FOR SUCCEEDING IN A PAY FOR PERFORMANCE REIMBURSEMENT ENVIRONMENT )N ORDER FOR THESE MODELS TO BE SUCCESSFUL IT IS IMPERATIVE THAT lNANCE AND LEGAL COUNSEL BE INVOLVED IN THE KEY DECISION MAKING PROCESS TO ASSESS EXPECTED RESULTS AND POTENTIAL PITFALLS ! STRONG LINE OF COMMUNICATION MUST EXIST AMONG ALL PARTIES 3ERVICE LINE MANAGEMENT COMPANIES SUCH AS CARDIOVASCULAR hCENTERS OF EXCELLENCE v ENABLE PHYSICIANS TO HOLD LEADERSHIP POSITIONS TO INmUENCE AND IMPROVE DAY TO DAY CLINICAL MANAGEMENT AND OPERATIONS &OCUSING ON ALIGNING INCENTIVES THROUGH A STRONG RELATIONSHIP WITH QUALITY AND OUTCOMES THE
%XHIBIT /PTIONS FOR (OSPITAL 0HYSICIAN )NTEGRATION 3COPE OF (OSPITAL 0HYSICIAN )NTEGRATION @!LIGNED )NCENTIVE 3YSTEMS
%XAMPLES
%XAMPLES
%XAMPLES
%XAMPLES
%XAMPLES
%XAMPLES
%XAMPLES
EDICAL $ 2' ULTIPLE 2 EAL %STATE # 6 $ IGESTIVE ) 0/0 $IRECTORS 3PECIlC (EALTH $IAGNOSTIC $ISEASE 3ERVICE 3YSTEMS #ENTER #ENTER OF ,INES 3 ERVICE # ATH ,AB THROUGHOUT %XCELLENCE ( !GREEMENTS ) 0/0 EART 3TENTS THE #OUNTRY # ARDIO )MAGING (OSPITAL % 2 / RTHOPEDIC VASCULAR #ENTER WITHIN A #ONTRACTS )MPLANTS #ENTER OF (OSPITAL % XCLUSIVE 3 ERVICE ,INE %XCELLENCE USCULO !GREEMENTS 3PECIlC $ EPARTMENT SKELETAL s #ARDIOLOGY OF 3URGERY #ENTERS s /RTHOPEDICS s 'YNECOLOGY s 0ULMONOLOGY s 3URGERY s /NCOLOGY
%XAMPLES
%XAMPLES
) MAGING ! 3#S
# LEVELAND #LINIC
0 (/S
+ AISER
3 PECIALTY (OSPITALS
3 ISTERS OF 3T &RANCIS
' ENERAL (OSPITALS
. EUROSCIENCES # ANCER #ENTER OF #ENTERS %XCELLENCE . EUROSCIENCE / RTHOPEDICS 3ERVICE ,INE
#ENTERS OF %XCELLENCE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
VNQJHM FãSN FDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S %XHIBIT 3ERVICE ,INE -ANAGEMENT #OMPANY 4YPICAL -ANAGEMENT #ONTRACT #OMPENSATION #OMPONENTS
"ASE -ANAGEMENT &EE &INANCE #OMMITTEE 0ARTICIPATION "OARD 0ARTICIPATION
-EDICAL $IRECTOR &EES /PERATING #OMMITTEE 0ARTICIPATION
$AY TO $AY /PERATIONS /VERSIGHT
)NCENTIVE #OMPENSATION
/PERATIONAL %FlCIENCY )NCENTIVES "UDGETARY /BJECTIVES
.EW 0ROGRAM $EVELOPMENT 1UALITY OF 3ERVICE )NCENTIVES
3UBJECT TO LEGAL AND REGULATORY LIMITATIONS
MODEL CREATES SHARED MANAGEMENT RESPONSIBILITY FROM TOP TO BOTTOM FOR POLICIES PROCEDURES AND PROTOCOLS 0HYSICIANS AND HOSPITALS ACTIVELY MANAGE STAFF TOGETHER 4HEY CREATE MEASURE AND ADDRESS CLINICAL EXCELLENCE AND PATIENT SATISFACTION ISSUES #OMPENSATION FOR PHYSICIANS TYPICALLY INVOLVES A lXED COMPONENT WITH INCENTIVES ALIGNED AROUND OPERATIONAL EFlCIENCY SERVICE EXCELLENCE BUDGETARY OBJECTIVES AND NEW PROGRAM DEVELOPMENT )N THIS SETTING COLLABORATORS CAN CHOOSE FROM A WIDE RANGE OF METRICS TO MEASURE HOW WELL THEY MANAGE SERVICES TOGETHER 4HEY CAN ORGANIZE THOSE METRICS AROUND STANDARD MECHANISMS SUCH AS SURVEYS OR CREATE NEW MECHANISMS FOR DEMONSTRATING IMPROVEMENTS OVER TIME AGAINST BENCHMARKS OR INITIAL INTERNAL PERFORMANCE BASELINES %XHIBIT PRESENTS THE TYPICAL COMPONENTS FOR A SERVICE LINE MANAGEMENT COMPANY !N EXAMPLE OF AN UNDER ARRANGEMENT JOINT VENTURE WOULD BE A CANCER CENTER OPERATED BY PHYSICIANS THROUGH AN ARRANGEMENT WITH THE HOSPITAL 0HYSICIANS UNDERTAKE GREATER RISK AND THEREFORE
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
ENJOY GREATER OPPORTUNITY FOR HIGHER RETURNS 4HIS APPROACH HAS BECOME POPULAR IN THE AMBULATORY ARENA PRIMARILY AROUND SURGERY AND MEDICAL IMAGING AS HOSPITALS PUSH SUCH SERVICES PHYSICALLY CLOSER TO PHYSICIANS TO MAKE THEM MORE EFlCIENT 4HROUGH THIS MODEL PHYSICIANS ASSUME GREATER RESPONSIBILITY FOR MANAGING EVERY ASPECT OF THE SERVICE AND OWN THE COMPANY FROM A REVENUE AND EXPENSE STANDPOINT 4HE UNDER ARRANGEMENT JOINT VENTURE HOLDS RESPONSIBILITY FOR MANAGING THE FACILITY STAFF SUPPLIES EQUIPMENT AND OTHER ASPECTS OF THE BUSINESS 4YPICALLY COMPENSATION INVOLVES A FEE SCHEDULE FOR SERVICES BASED ON FAIR MARKET VALUE CONSIDERATIONS AND ACCOUNTING FOR INCREASED EXPOSURE TO RISK !DDITIONAL INCENTIVES IN THIS MODEL GENERALLY DO NOT FEATURE AS PROMINENTLY AS THEY DO IN SERVICE LINE MANAGEMENT COMPANY SETTINGS %XHIBIT ILLUSTRATES THE ORGANIZATIONAL STRUCTURE FOR AN UNDER ARRANGEMENT VENTURE 7HICHEVER MODEL OR COMBINATION OF MODELS IS CHOSEN COLLABORATION WORKS BEST WHEN FOCUSED UPON ACCOUNTABILITY AND
VNQJHM FãSNFDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S QUALITY n THE MOST RELEVANT STRUCTURE FOR MUTUAL BENElT n RATHER THAN ON CREATING A MECHANISM FOR MANAGING REGULATORY CONCERNS 3OME PARTNERS MAY CHOOSE HIGHLY INTEGRATED APPROACHES /THERS MAY DETERMINE THAT LOWER LEVELS OF INTEGRATION WORK BEST 0OTENTIAL PARTNERS SHOULD EXERCISE CARE AND SELECTIVITY WHEN CHOOSING WHERE TO COLLABORATE SO THEY CAN CREATE LONG TERM VALUE 0ARTNERS SHOULD NOT ATTEMPT TO ENLIST IN EVERYTHING BUT FOCUS ON HOW TO AGGREGATE AND EFFECTIVELY LEVERAGE SELECT SERVICES 4HEY SHOULD BALANCE TRADE OFFS CREATE A TRANSPARENT PROCESS AND SET CLEAR AND REALISTIC TIMELINES EXPECTATIONS PRINCIPLES AND POLICIES TO GENERATE BENElTS FOR ALL CONSTITUENCIES 0ARTNERS MUST ALSO MANAGE MANY NUANCES FROM STATE REGULATIONS
TO CUSTOMER PREFERENCES )N THIS RESPECT EXTERNAL EXPERTS CAN PROVIDE SUBSTANTIAL VALUE TO THE PROCESS 0HYSICIANS AND HOSPITALS CAN LEVERAGE EXPERTS EXPERIENCE AND USE THEM AS SOUNDING BOARDS TO REMAIN TRUE TO THEIR STRATEGY AND EXERCISE THE mEXIBILITY REQUIRED TO RECOGNIZE AND CORRECT ERRORS ALONG THE WAY )N ADDITION EXTERNAL RESOURCES CAN SERVE AS EFFECTIVE INFORMED INTERMEDIARIES TO RESOLVE CULTURAL DIFFERENCES "Y APPROACHING THE CHALLENGE FROM A SYSTEMS AND CULTURE PERSPECTIVE PHYSICIANS AND HOSPITALS CAN BECOME KEY PLAYERS IN EACH OTHERS SUCCESS 0HYSICIANS CAN PROMOTE AND ASSIST IN RECRUITMENT FOR HOSPITALS )NCREASED TRUST CAN BREAK DOWN BARRIERS AND FOSTER ACTIVE PARTICIPATION BY PHYSICIANS 7ORKING
%XHIBIT /RGANIZATIONAL 3TRUCTURE FOR AN 5NDER !RRANGEMENT 6ENTURE
-EMBERS (OSPITAL 8 /WNERSHIP
9 /WNERSHIP
)NVESTOR 0HYSICIANS AND 'ROUPS
!MBULATORY 3URGERY #ENTER
"OARD OF -ANAGERS (OSPITAL 0HYSICIANS
-EDICAL !DVISORY #OMMITTEE -!#
1UALITY !SSURANCE 1! #OMMITTEE 5TILIZATION 2EVIEW 52 #OMMITTEE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
VNQJHMFãSN FDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S TOGETHER PHYSICIANS AND HOSPITALS CAN CREATE NEW BUSINESS IN EXISTING AND NEW MARKETS AND GENERATE VOLUME AND REVENUE GROWTH #APITAL RESOURCES CAN BE POOLED AND NEW IDEAS FOR DELIVERING CARE REALIZED %ACH CAN SPUR NEW WAYS TO REMAIN COMPETITIVE 4HE hWIN WINv INCENTIVE MOTIVATES BOTH PARTIES TO SUCCEED
@#AREGIVERS NEED TO UNDERSTAND hTHE BETTER MY OUTCOME THE BETTER ) GET PAIDv )T SHOULD BE SOMEWHAT LIKE OTHER SERVICES ONE BUYS 0EOPLE PAY FOR BETTER QUALITY 4HOSE CONCEPTS NEED TO TIE TO HEALTHCARE REIMBURSEMENT )T SHOULD NOT JUST BE DRIVEN BY THE NUMBER OF UNITS PERFORMED n "RAD "UXTON DIVISIONAL SENIOR VICE PRESIDENT (EALTH #ARE -ANAGEMENT (EALTH #ARE 3ERVICE #ORPORATION
)NTEGRATING THE 1UALITY &OCUS #ONSUMERISM INCREASINGLY INmUENCES THE HEALTHCARE MARKET AS BETTER EDUCATED PATIENTS GAIN GREATER ACCESS TO DATA ABOUT PHYSICIANS AND HOSPITALS SPECIlCALLY QUALITY AND OUTCOME DATA #OMPANIES THAT OBTAIN AND SELL DATA FOR EXAMPLE WILL CONTINUE TO ASSESS PROVIDERS QUALITY PERFORMANCE AND INmUENCE PATIENT DECISIONS (OSPITALS AND PHYSICIANS CANNOT STOP THE USE OF DATA BUT THEY CAN IMPROVE THE NATURE OF INFORMATION USED BY CONSUMERS BY WORKING TOGETHER TO GATHER REPORT AND COMMUNICATE RELEVANT STANDARDIZED DATA THAT DEMONSTRATE A QUALITY FOCUS AND QUALITY IMPROVEMENT -EANINGFUL QUALITY DATA WILL THEN BECOME PART OF THE CULTURE AND LEAD TO THE MOST SUCCESSFUL KIND OF lNANCIAL INCENTIVE WHEN PROVIDERS RECEIVE MORE FOR IMPROVING QUALITY FOR PATIENTS #ONSUMERS WILL ALWAYS SEEK THE BEST IN QUALITY
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
4O DATE MOST INITIATIVES IN HOSPITAL PHYSICIAN PARTNERING HAVE FOCUSED ON CLINICAL PROGRAM DEVELOPMENT SUCH AS BUILDING SURGERY CENTERS AND CLINICS RATHER THAN ON QUALITY IMPROVEMENT #LINICAL ADVANCEMENTS PROMOTE THIS APPROACH TO IMPROVING PATIENT CARE AND SATISFACTION BY AFFORDING INPATIENT OUTCOMES IN AN OUTPATIENT SETTING )N THIS RESPECT CLINICAL CONSIDERATIONS HAVE DRIVEN NONCLINICAL MEASURES CUSTOMER SATISFACTION FROM THE PERSPECTIVES OF PATIENT PHYSICIAN AND EMPLOYEE OPERATIONAL EFFECTIVENESS AND EFlCIENCY AND PRODUCTIVITY 4HEY ALSO CONTINUE TO DRIVE BUDGETARY PERFORMANCE AND NEW PROGRAM DEVELOPMENT 4HROUGH SUCH INITIATIVES KEY PLAYERS WILL CREATE A CORE SET OF ANSWERS TO THE hWHAT IS QUALITY v QUESTION AND DEVELOP A STANDARD APPROACH TO MEASURING QUALITY AS PHYSICIANS HOSPITALS PATIENTS AND PAYERS BUY IN TO THE SAME OUTCOME METRICS %ITHER BY CONSUMER CHOICE OR PAYER INCENTIVE QUALITY BASED lNANCIAL REWARDS WILL ARRIVE ONE WAY OR THE OTHER 4HIS IS THE BEST ARGUMENT FOR HOSPITAL PHYSICIAN COLLABORATION
$OS AND $ONTS 3UCCESSFUL COLLABORATION BETWEEN PHYSICIANS AND HOSPITALS STARTS WITH A SIMPLE LIST OF DOS AND DONTS $O "E PROACTIVE )NVOLVE EXTERNAL COUNSEL AND THE PAYER &OCUS ON THE PATIENT AND )NITIATE DIALOGUE $ONT !CT IN ISOLATION 3ACRIlCE LONG TERM GAINS FOR SHORT TERM EXPEDIENCY 5SE REGULATIONS AS AN EXCUSE FOR NOT MOVING FORWARD !LLOW BAD DATA TO CREATE FALSE CONCLUSIONS AND IMPROPER ACTIONS AND 4HINK THE WHOLE THING WILL SIMPLY GO AWAY %NDNOTE HTTPWWWADVOCATEHEALTHCOMCORPHEALTHABOUTVALUE2EPORT
VNQJHM FãSN FDSGDQãOGXRHBH@MRã@M C ã G N ROH S@ K Rã O@ Q S M D Q H M Fã E N Q ã P T @ KH S Xã H LOQ N U D LD M S !DVOCATE (EALTH 0ARTNERS ! CASE STUDY IN ALIGNING PHYSICIANS AND HOSPITALS FOR QUALITY;=
!DVOCATE (EALTH #ARE IS A MULTIHOSPITAL SYSTEM THAT IS THE LARGEST PROVIDER OF HEALTHCARE SERVICES IN #HICAGO AND THE SECOND LARGEST PRIVATE SECTOR EMPLOYER IN )LLINOIS 3YSTEM LEADERS FORMED !DVOCATE (EALTH 0ARTNERS !(0 A CARE MANAGEMENT AND MANAGED CARE CONTRACTING JOINT VENTURE BETWEEN THE HOSPITALS AND SELECT PHYSICIANS FROM THE MEDICAL STAFF )T IS COMPRISED OF A NETWORK OF PHYSICIANS IN UNIQUE PRACTICE SITES SERVING EIGHT HOSPITAL CAMPUSES CAPITATED LIVES AND 00/ PATIENTS !(0 ESTABLISHED A CLINICAL INTEGRATION PROGRAM THAT COMBINES EVIDENCE BASED MEDICINE INFORMATION SYSTEMS AND QUALITY IMPROVEMENT TECHNIQUES UNDER PAY FOR PERFORMANCE INCENTIVES WITH A GOAL OF IMPROVING CARE FOR PATIENTS AND DEMONSTRATING VALUE TO EMPLOYERS INSURANCE COMPANIES AND GOVERNMENT REGULATORS 4HE PROGRAM IS COMPRISED OF SEPARATE INITIATIVES SEE %XHIBIT LEVERAGING THE RECOMMENDATIONS OF SEVERAL NATIONAL QUALITY ORGANIZATIONS INTO DISEASE SPECIlC CARE MANAGEMENT PROGRAMS AND TARGETED DEPLOYMENT OF HEALTHCARE TECHNOLOGIES %XHIBIT #LINICAL )NTEGRATION 0ROGRAM )NITIATIVES !STHMA /UTCOMES
$EPRESSION 3CREENING OF THE #HRONICALLY )LL
'ENERIC 0RESCRIBING
%FFECTIVE 5SE OF (OSPITAL 2ESOURCES
3MOKING #ESSATION %DUCATION 0ROGRAM
$IABETIC #ARE /UTCOMES
0HARMACEUTICAL &ORMULARY 5SAGE
/RTHOPEDIC )MPLANT )NITIATIVE
#ONGESTIVE (EART &AILURE /UTCOMES
$EEP 6EIN 4HROMBOPHLEBITIS 0REVENTION
E)#5¸ 0ARTICIPATION
(OSPITAL 1UALITY )NDICATORS
#ORONARY !RTERY $ISEASE /UTCOMES
#OMMUNITY !CQUIRED 0NEUMONIA -ANAGEMENT
(OSPITALIST 0ROGRAM 0ARTICIPATION
1UALITY )MPROVEMENT !CTIVITY
#ARDIOVASCULAR $ISEASE !MBULATORY /UTCOMES
/BSTETRICS 2ISK 2EDUCTION
#OMPUTERIZED 0HYSICIAN /RDER %NTRY
0HYSICIAN %DUCATION 2OUNDTABLES
4HE PROGRAM HAS REALIZED MEASURABLE IMPROVEMENTS IN QUALITY )N !(0 PAID OUT OVER MILLION IN PERFORMANCE BASED BONUSES TO PHYSICIANS THROUGH INITIATIVES WITH MAJOR BENElTS INCLUDING PERCENT INCREASE IN GENERIC USAGE OVER TWO YEARS PERCENT IMPROVEMENT IN BETA BLOCKER PERCENT IMPROVEMENT IN !#% INHIBITORS USAGE FROM TO PERCENT MORE CHRONICALLY ILL PATIENTS SCREENED FOR DEPRESSION THAN THE PUBLISHED COMMUNITY STANDARD PERCENT OF !(0 PATIENTS WHO WERE CURRENT OR RECENT SMOKERS PROVIDED SMOKING CESSATION EDUCATION PERCENT BETTER RATE OF CONTROL THAN NATIONAL PERFORMANCE LEVELS FOR DIABETIC CARE AND PERCENT OF ASTHMA DISEASE REGISTRY PATIENTS RECEIVING A CUSTOMIZED TREATMENT PLAN IN !(0 REQUIRES THAT AFlLIATED PHYSICIANS BE CONNECTED BY LEADING EDGE INFORMATION TECHNOLOGIES )N PERCENT OF !(0S PHYSICIANS HAD HIGH SPEED )NTERNET ACCESS 4HE
!(0 BOARD MANDATED CONNECTIVITY AS A REQUIREMENT FOR CONTINUED MEMBERSHIP IN AND BY YEARS END PERCENT OF !(0 PHYSICIANS HAD HIGH SPEED )NTERNET ACCESS IN THEIR OFlCES 4HIS INCREASE IN CONNECTIVITY IS ILLUSTRATED IN %XHIBIT 0HYSICIANS HAVE ONLINE ACCESS TO CLINICAL PATHWAYS CONSULTATIONS WITH COLLEAGUES AND UP TO DATE HEALTH PLAN INFORMATION 4HEY CAN ALSO ACCESS !DVOCATE HOSPITALS CLINICAL DATA REPOSITORY ELECTRONIC MEDICAL RECORDS COMPUTERIZED PHYSICIAN ORDER ENTRY SYSTEM ELECTRONIC DATA INTERCHANGE %$) LIBRARY RESOURCES AND ELECTRONIC REFERRALS 4HIS CONNECTIVITY PROVIDED TANGIBLE COST SAVINGS EG BY CONNECTING ALL OF ITS PHYSICIANS AND OFFERING %$) SERVICES !(0 WAS ABLE TO REDUCE ITS CLAIMS ADMINISTRATIVE STAFF COSTS BY PERCENT IN ONE YEAR 4HIS HELPED TO OFFSET INVESTMENTS IN THE CLINICAL INFORMATION PROGRAM IT CURRENTLY HAS A DEDICATED STAFF OF &4%S AND MAKE IT SELF SUPPORTING 7HILE OTHER HEALTH ORGANIZATIONS HAVE TRIED UNSUCCESSFULLY TO SUPPLY PHYSICIANS WITH INFORMATION TECHNOLOGY !(0 #ONTINUED ON THE NEXT PAGE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
VNQJHMFãSNFDSGDQãOGXRHBH@MRã@MCãGNROHS@KRãO@QSMDQHMFãENQãPT@KH SXãHLOQNUDLDMS !DVOCATE (EALTH 0ARTNERS ! CASE STUDY IN ALIGNING PHYSICIANS AND HOSPITALS FOR QUALITY;= CONTINUED %XHIBIT #ONNECTIVITY OF !DVOCATES -EDICAL 3TAFF
0ERCENT OF 0HYSICIANS 7ITH (IGH 3PEED )NTERNET
"ETHANY
#HRIST
'OOD 'OOD 3AMARITAN 3HEPHERD
)LLINOIS -ASONIC
3OURCE !DVOCATE (EALTH 0ARTNERS
TOOK THE INITIATIVE TO ACTUALLY MAKE IT HAPPEN h7E WENT OUT AND INVENTORIED EACH OF THE OFlCES TO IDENTIFY WHAT THEIR OPTIONS WERE FOR CONNECTIVITY OFFERED THEM THE CHOICES AND THEN LITERALLY MADE THE ARRANGEMENTS WITH THE TELECOMMUNICATIONS COMPANIES TO BRING IT IN TO INSTALL IT AND THEN TRAIN THE PHYSICIANS STAFF TO USE IT v SAYS ,EE " 3ACKS -$ PRESIDENT OF !DVOCATE (EALTH 0ARTNERS h/NCE THE PHYSICIANS STARTED USING IT THEY SAW HOW IT CAN POSITIVELY IMPACT THEIR EFlCIENCY AND PRACTICE 7E HAVENT HAD ANY COMPLAINTS ABOUT THE COSTv !(0 SUPPORTS ITS MEMBER PHYSICIANS IN OTHER WAYS AS WELL )N !(0 STARTED USING THE !DVOCATE CALL CENTER FOR OUTBOUND CALLS AND DOING DIRECT MAILINGS TO NONCOMPLIANT PATIENTS !(0 SENDS QUARTERLY REPORT CARDS TO PHYSICIANS AND DETAILED DElNITIONS OF THE QUALITY MEASURES TO IMPROVE PERFORMANCE h9OU HAVE TO BE CREDIBLE AND QUICKLY EARN THE TRUST OF THE PHYSICIANS AND THEIR OFlCE STAFF THAT THE DATA YOU ARE DISPLAYING IS AN ACCURATE REmECTION OF WHAT YOU ARE DOING )TS THE COMBINATION OF DOING IT CORRECTLY AND EDUCATING THEM BECAUSE EVERYBODY THINKS THEY ARE DOING A MUCH BETTER JOB THAN THEY ARE REALLY DOING v SAYS 3ACKS (E CONTINUES h4HE INDEPENDENT PHYSICIANS ESPECIALLY LIKE THE SUPPORT THAT THEY ARE GETTING THE DEMONSTRATION OF IMPROVEMENTS IN CARE -Y HOPE IS THAT WITH THE DATA WE ARE GIVING BACK TO OUR PHYSICIANS AND THE INFRASTRUCTURE
1 5!,)49 # / . 5 . $ 2 5 - # (!04% 2
,UTHERAN
3OUTH 3UBURBAN
4RINITY
/VERALL 0(/
!(#
$REYER
9% #) 0ROGRESS 2EPORT ST #) 0ROGRESS 2EPORT ND #) 0ROGRESS 2EPORT
SUPPORT THEY WILL OVERCOME CHALLENGES AND CONTINUE TO IMPROVE PERFORMANCEv 3ACKS HOPES TO SHOW THAT QUALITY CAN BE A COMPETITIVE DIFFERENTIATOR FOR !(0 4ODAY MOST OF THE COMMERCIAL MANAGED CARE PLANS IN THE #HICAGO AREA PROVIDE PAY FOR PERFORMANCE FUNDING TO !(0 UNDER THE CLINICAL INTEGRATION PROGRAM h/UR HOPE IS THAT ITS EASIER TO DO YOUR MANAGED CARE WORK THROUGH !DVOCATE (EALTH 0ARTNERS AND AS A RESULT YOUD WANT TO DO IT THROUGH US ) HAVE ALWAYS SAID TO OUR BOARD AND LEADERSHIP TEAM THAT WE NEED TO EARN THE BUSINESS AND KEEP RE EARNING IT v SAYS 3ACKS !DDITIONALLY !(0S 3ACKS CONSIDERS THAT IT WILL JUST BE A MATTER OF TIME UNTIL -EDICARE REQUIRES PAY FOR PERFORMANCE ON A WIDE SCALE BASIS AND WANTS TO BE PREPARED TO HELP AFlLIATED PHYSICIANS SUCCEED ON THOSE QUALITY METRICS !(0 FORMALLY ASSESSES THE CLINICAL INTEGRATION PROGRAM EACH YEAR AND MAKES CHANGES BASED ON ACHIEVEMENT OF GOALS AND FEEDBACK FROM PATIENTS PHYSICIANS EMPLOYERS AND INSURERS !(0S GOAL IS TO EVOLVE THE PROGRAM IN MANAGEABLE AND MEASURABLE INCREMENTS EACH YEAR h$ONT TRY TO DO EVERYTHING AT ONCE OR ON DAY ONE v 3ACKS ADVISES h7E STARTED WITH A FAIRLY SIMPLE PROGRAM THAT YOU COULD SHOOT SOME HOLES IN AS OPPOSED TO TRYING TO DESIGN THE PERFECT PROGRAM BECAUSE THAT PROBABLY WOULD HAVE SUNK US "UT OUR GOAL WAS TO MAKE IT WORK SHOW THAT WE CAN IMPROVE CARE LEARN FROM IT AND ADD THINGS IN AN INCREMENTAL FASHIONv
)MPROVING (EALTHCARE 1UALITY IN THE 0EDIATRIC !MBULATORY %NVIRONMENT 5SING A SYSTEMS APPROACH AND TOOLS SUCH AS COMPUTER SIMULATION CAN IMPROVE QUALITY OF CARE IN A PEDIATRIC AMBULATORY ENVIRONMENT
"Y 3HAMITA #HAKRABORTY AND !NTHONY $ 3LONIM #HILDRENS .ATIONAL -EDICAL #ENTER
(
EALTHCARE QUALITY HAS INCREASED IN IMPORTANCE FOR HEALTHCARE CLINICIANS AND ADMINISTRATORS ALIKE 7HILE EFFORTS AIMED AT IMPROVING THE DELIVERED SERVICES FOR INDIVIDUALS AND POPULATIONS HAVE MATURED THEY ARE STILL PRIMARILY FOCUSED ON THE INPATIENT ARENA WHERE HIGH RISK CARE IS DELIVERED TO VULNERABLE PATIENTS !S HEALTHCARE QUALITY EXPANDS ITS ROLE BEYOND THE WALLS OF THE ACUTE CARE HOSPITAL THERE IS A NEED TO TRANSITION THE TECHNIQUES THAT HAVE RELEVANCE FOR AN OUTPATIENT PRACTICE AND TO CAPITALIZE ON NEW AND INNOVATIVE STRATEGIES THAT WILL BE USEFUL ACROSS OUTPATIENT SERVICE LINES 4HIS MANUSCRIPT DESCRIBES OUR USE OF ONE SUCH TOOL COMPUTER SIMULATION FOR IMPROVING THE QUALITY OF CARE THAT WE DELIVER TO OUR PEDIATRIC OUTPATIENTS
3ETTING #HILDRENS .ATIONAL -EDICAL #ENTER IS A HEALTHCARE SYSTEM THAT IS NATIONALLY AND INTERNATIONALLY KNOWN FOR DELIVERING PEDIATRIC PRIMARY AND SPECIALTY CARE #HILDRENS (OSPITAL IS THE MAIN FACILITY SITED IN 7ASHINGTON $# )T HOUSES INPATIENT BEDS AND PRIMARY CARE AND SPECIALTY OUTPATIENT CLINICS #HILDRENS THROUGH THE #HILDRENS 2ESEARCH )NSTITUTE DEVELOPS AND USES INNOVATIVE STRATEGIES FOR TREATING PEDIATRIC ILLNESS AND INJURY INCLUDING THE METHODS APPLIED HERE USING COMPUTER SIMULATION TO IMPROVE HEALTHCARE DELIVERY #HILDRENS 2EGIONAL /UTPATIENT #ENTERS 2/#S ARE A KEY COMPONENT OF #HILDRENS .ATIONAL -EDICAL #ENTER #.-# -ORE THAN PEDIATRIC SPECIALTY SERVICES ARE PROVIDED AT SIX CENTERS SURROUNDING THE 7ASHINGTON $# METROPOLITAN REGION 4HESE CENTERS PROVIDE CARE TO AN ANNUAL VOLUME OF NEARLY AMBULATORY PATIENTS AND HELP TO ENSURE THAT CHILDREN HAVE ACCESS TO #HILDRENS PROVIDERS WITH PEDIATRIC EXPERTISE IN THE COMMUNITIES IN WHICH THEY LIVE
2ESEARCH &OUNDATIONS 4WO COMPLEMENTARY BODIES OF RESEARCH HAVE RELEVANCE TO HEALTHCARE QUALITY GENERALLY AND THE USE OF SIMULATION MODELS SPECIlCALLY 4HE lRST IS THE HEALTH SERVICES RESEARCH FRAMEWORK OF STRUCTURE PROCESS AND OUTCOME PROMULGATED lRST BY $ONABEDIAN 4HE SECOND IS SYSTEMS THEORY AND ITS RELEVANCE TO DRIVING IMPROVEMENTS THROUGHOUT COMPLEX ORGANIZATIONS
3TRUCTURE 0ROCESS AND /UTCOME 3TRUCTURE IS COMMONLY THOUGHT OF AS THE hBRICKS AND MORTARv OF A HEALTHCARE ORGANIZATION BUT IT REALLY EXTENDS WELL BEYOND THE PHYSICAL COMPOSITION TO INCLUDE THE AVAILABILITY ORGANIZATION AND lNANCING OF HEALTHCARE PROGRAMS INCLUDING HUMAN CAPITAL 3TRUCTURE MUST ALSO ACCOUNT FOR THE CHARACTERISTICS OF THE POPULATIONS AND ENVIRONMENTS THAT ARE SERVED 0ROCESS REFERS TO THE INTERACTIONS BETWEEN PATIENTS AND THE MEMBERS OF THEIR HEALTHCARE TEAM )T IS IMPORTANT TO REMEMBER THAT PATIENTS ARE ALSO INCREASINGLY INTERACTING WITH TECHNOLOGY IN A SERIES OF PROCESSES THAT MUST BE ACCOUNTED FOR WHEN CONSIDERING OPPORTUNITIES TO IMPROVE HEALTHCARE DELIVERY AND AMELIORATE RISK /UTCOMES ARE THE RESULTANT EFFECTS OF THE HEALTHCARE EXPERIENCE 7HEN CONSIDERING OUTCOMES IN SIMULATION IT IS IMPORTANT TO DElNE THE MODELING PERSPECTIVE 4HE IMPORTANCE OF PERSPECTIVE BECOMES CLEARER AS THE SECOND RESEARCH FOUNDATION SYSTEMS THEORY IS CONSIDERED
3YSTEMS 4HEORY !DMINISTRATORS CLINICIANS PAYERS AND PATIENTS EACH VIEW THE DELIVERY OF HEALTHCARE THROUGH THEIR OWN INDIVIDUAL hLENS v WHICH DEPENDS IN PART ON THEIR BACKGROUND AND THE GOALS ESTABLISHED FOR A PARTICULAR HEALTHCARE INTERACTION &OR EXAMPLE WHEN A
3HAMITA #HAKRABORTY IS A PHARMACIST BY BACKGROUND AND HAS A -ASTER OF 3CIENCE IN HEALTH ADMINISTRATION 3HE IS THE ADMINISTRATOR IN THE #ENTER FOR #LINIC %FFECTIVENESS AT #HILDRENS .ATIONAL -EDICAL #ENTER AND WORKS CLOSELY WITH $R 3LONIM IN AREAS SUCH AS CLINIC OPERATIONS IMPROVEMENT AND HEALTHCARE QUALITY INITIATIVES 3HE IS A MEMBER OF THE !MERICAN #OLLEGE OF (EALTHCARE %XECUTIVES 3HE CAN BE REACHED AT SCHAKRAB CNMCORG !NTHONY $ 3LONIM -$ $R0( IS AN INTENSIVE CARE PHYSICIAN AND THE EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS AT #HILDRENS .ATIONAL -EDICAL #ENTER AND VICE CHAIRMAN OF 0EDIATRICS OF THE 'EORGE 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE IN 7ASHINGTON $# )N ADDITION TO HIS MEDICAL EDUCATION AND TRAINING HE HAS A DOCTORATE IN HEALTHCARE ADMINISTRATION AND PERFORMS RESEARCH IN HEALTHCARE QUALITY AND PATIENT SAFETY (E IS GRANT FUNDED FROM !(21 FOR THIS WORK $R 3LONIM IS A &ELLOW IN THE !MERICAN #OLLEGE OF 0HYSICIAN %XECUTIVES AND THE !MERICAN #OLLEGE OF #RITICAL #ARE -EDICINE (E CAN BE REACHED AT ASLONIM CNMCORG
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
HLOQNUHMFãGD@KSGB@QDãP T@K H S Xã H M ã S G D ã OD C H @S Q H B ã @ LA T K @SN Q Xã D M U H Q N M LD M S SERVICE LINE ADMINISTRATOR IS CONSIDERING OPTIMAL OUTCOMES FROM THE SERVICE LINE THERE ARE LIKELY TO BE CLINICAL lNANCIAL AND OPERATING METRICS ASSOCIATED WITH THEIR WORK THAT ASSIST IN DECISION MAKING (OWEVER IF THE SAME SERVICE LINE ADMINISTRATOR HAS A CHILD THAT BECOMES A PATIENT WITH A DISEASE REQUIRING CARE FROM THAT SERVICE LINE THE PERSPECTIVE CHANGES #LINICAL OUTCOMES AT THE LEVEL OF THE INDIVIDUAL RATHER THAN AT THE LEVEL OF THE SERVICE LINE TAKE PRECEDENCE AND ARE SUPERIOR TO THE lNANCIAL OUTCOMES OF THE SERVICE LINE 7HEN PERFORMING SIMULATION THE MODELING TEAM NEEDS TO MAINTAIN THEIR LENS FOCUSED ON THE FUNCTIONING OF THE ENTIRE SYSTEM
/PPORTUNITIES TO CAPITALIZE ON THE TOOLS PROVIDED BY OTHER INDUSTRIES SHOULD BE CONSIDERED AND STUDIED 4HE HEALTHCARE SYSTEM IS ORGANIZED HIERARCHICALLY INTO MULTIPLE LEVELS 3YSTEMS THEORY POSES TWO DISCRETE hLEVELSv FOR THAT ORGANIZATION n THE MACROSYSTEM AND THE MICROSYSTEM 4HE MACROSYSTEM PROVIDES THE STRUCTURAL COMPONENTS PROCESSES AND OUTCOMES THAT ARE HELD IN ASCENDANCY OVER THE MICROSYSTEM -ICROSYSTEMS REPRESENT FUNCTIONALLY DISCRETE YET INTEGRATED UNITS WITHIN THE MACROSYSTEM AND HAVE A STRUCTURE PROCESSES AND OUTCOMES OF THEIR OWN BUT ALSO RELY HEAVILY ON THE ABILITY OF
THE MACROSYSTEM TO FUNCTION SO THAT THE MICROSYSTEM OUTCOMES CAN BE ACHIEVED WWWCLINICALSYSTEMSORG 7HILE AT lRST GLANCE THIS SEEMS LIKE AN INTUITIVE APPROACH IT IS A CRITICAL lRST STEP THAT ESTABLISHES THE FOUNDATION FOR MODEL BUILDING )MPROVEMENTS IN SIMULATION NEED TO BE ACCOMPLISHED WITH A PERSPECTIVE THAT FOCUSES ON THE SYSTEM TO AVOID WHAT IS COMMONLY REFERRED TO AS THE hPROCESS PARADOX v WHERE SEEMINGLY GOOD PROCESS IMPROVEMENT WORK AT THE MICROSYSTEM LEVEL WHICH IS OFTEN EASILY PERFORMED AND MEASURED FAILS TO ACHIEVE SUSTAINABLE RESULTS 7ORK THAT IS FOCUSED TOO SPECIlCALLY ON INDIVIDUAL MICROSYSTEMS WITHOUT ACCOUNTING FOR THE BROADER FRAME OF REFERENCE OF THE MACROSYSTEM ARE LIKELY TO CAUSE PERTURBATIONS IN OTHER MICROSYSTEMS THAT WILL ONLY BE DISCOVERED AND WORKED ON AT SOME FUTURE DATE )N OUR WORK THE MACROSYSTEM WAS DElNED AS THE FUNCTIONING OF ONE OF THE 2/#S AND THE MICROSYSTEMS WERE THE INDIVIDUAL PHYSICIAN PRACTICES AND THE AMBULATORY SURGERY CENTER WITHIN THE 2/# SEE %XHIBIT 4HESE PRACTICES ARE INTERDEPENDENT IN ACHIEVING THE OUTCOMES AT THE MACROSYSTEM BECAUSE EACH RELIES ON SHARED SPACE AND RESOURCES &OR EXAMPLE IF ONE SPECIALTY NEEDS TO EXPAND ITS PRESENCE IN A PARTICULAR LOCATION THERE NEEDS TO BE EITHER AN EXPANSION OR A REORGANIZATION OF THE OTHER PRACTICES TO ACCOMMODATE THIS PRESENCE 4HE STRUCTURE PROCESS AND OUTCOME RELATIONSHIPS DISCUSSED ABOVE ARE OPERATIVE NOT ONLY AT THE LEVEL OF THE MACROSYSTEM BUT ALSO WITHIN AND BETWEEN THE MICROSYSTEMS
%XHIBIT -ODEL $EPICTING THE 2EGIONAL /UTPATIENT #ENTER MACROSYSTEM AND THE !MBULATORY 3URGERY #ENTER MICROSYSTEM 5NDER %VALUATION
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
HLOQNUHMFãGD@KSGB@QDãP T@K H S Xã H M ã S G D ã OD C H @S Q H B ã @ LA T K @SN Q Xã D M U H Q N M LD M S %XHIBIT -ODEL $EPICTING 0ATIENT &LOW IN THE !MBULATORY 3URGERY #ENTER 3UPERIMPOSED ON THE !CTUAL &LOOR 0LAN 7ITH 3PECIlED ,OCATIONS 2OUTES AND 2ESOURCES
3IMULATION ! 4OOL FOR 0ERFORMANCE )MPROVEMENT
THAN EXPERIMENTING ON THE ACTUAL SYSTEM PARTICULARLY WHERE PATIENTS MAY BE AT RISK
7HAT )S 3IMULATION
3TEPS FOR 0ERFORMING A 3UCCESSFUL 3IMULATION 0ROJECT
3IMULATION IS A POWERFUL TOOL THAT USES COMPUTERIZED MODELS OF HEALTHCARE SYSTEMS TO MAKE DESIGN DECISIONS AND PERFORMANCE ENHANCEMENTS )T HAS AS ITS OUTPUT CLINICAL BUSINESS AND SERVICE PERFORMANCE TARGETS LINKED THROUGH PROCESSES USING A SHARED INFORMATION PLATFORM
7HY 5SE 3IMULATION 3IMULATION PROVIDES AN EFFECTIVE METHOD OF ANALYSIS THAT IS FORMAL AND PREDICTIVE )T IS A METHOD OF ANALYZING THE IMPACT OF POTENTIAL PROCESS CHANGES PRIOR TO THEIR IMPLEMENTATION 4HE BENElTS INCLUDE AN ABILITY TO ACCURATELY PREDICT SYSTEM PERFORMANCE IDENTIFY RESOURCE NEEDS AND CONSTRAINTS IDENTIFY NEW OR UNPERCEIVED RISK POINTS CREATED BY THE REDESIGN AND TO EXAMINE ALTERNATIVE COURSES OF ACTION BY RUNNING THE MODEL THROUGH YEARS OF OPERATIONS IN A MATTER OF MINUTES 4HIS ALLOWS A MANAGER TO ACCURATELY PREDICT OUTCOMES AND MAKE INFORMED AND EFFECTIVE MANAGEMENT AND OPERATIONAL DECISIONS "Y USING A SYSTEMS APPROACH THAT FOCUSES ON DESIGN DETAILS SIMULATION CAN CAPTURE SYSTEM INTERDEPENDENCIES ACCOUNT FOR VARIABILITY IN THE SYSTEM AND PROVIDE DATA ON MULTIPLE PERFORMANCE MEASURES WITH RESULTS THAT ARE QUANTITATIVE AND EASY TO UNDERSTAND 4HE MODELS ARE VISUALLY APPEALING AND ENGAGE THE INTEREST OF THE FRONT LINE STAFF IN hREAL LIFE SCENARIOSv 4HESE MODELS ARE LESS COSTLY LESS TIME CONSUMING AND LESS DISRUPTIVE
! SIMULATION PROJECT IS SIMILAR TO OTHER PROJECTS THAT NEED TO BE MANAGED IN THE ORGANIZATION ! TEAM NEEDS TO BE CHARTERED WITH CLEAR OBJECTIVES SCOPE OUTCOMES AND TIME LINES 4HE TEAM SHOULD BE MULTIDISCIPLINARY TO PROVIDE APPROPRIATE EXPERTISE IN HOW EACH OF THE MICROSYSTEMS WORK 4HIS WILL SUPPORT A BETTER UNDERSTANDING OF THE MACROSYSTEMS FUNCTIONING AND ALLOW SPECIlCATION OF THE SIMULATION WORK 4HE NEXT MAJOR STEP IS TO BEGIN MODELING THE SYSTEM 4HERE ARE TWO COMPONENTS TO THIS STEP &IRST A hWALK THROUGHv OF THE PROCESS WITH THE MAJOR STAKEHOLDERS AND A MAPPING OF MICROSYSTEM LEVEL PROCESSES AND THEIR RELATIONSHIP TO THE MACROSYSTEM MUST OCCUR .EXT THE TEAM NEEDS TO CONSIDER THE DATA REQUIREMENTS FOR THE EXERCISE 2EAL LIFE OR HISTORICAL DATA WHENEVER POSSIBLE NEED TO BE INCLUDED IN THE MODELING TO PROVIDE REALISTIC PROJECTIONS 4HE DATA MAY BE OBTAINED FROM TIME STUDIES ELECTRONIC BUSINESS OR CLINICAL SYSTEMS 4HE DATA DISTRIBUTIONS EG 7EIBULL OR 'AUSSIAN WITH THEIR DESCRIPTIVE STATISTICAL ELEMENTS EG MEAN AND STANDARD DEVIATIONS NEED TO BE COLLECTED 4HESE QUANTITATIVE ELEMENTS ARE TAUGHT AS A PART OF QUANTITATIVE IMPROVEMENT METHODS LIKE 3IX 3IGMA AND ALLOW THE MODEL TO REALISTICALLY REPRESENT THE SYSTEM UNDER STUDY BASED UPON DATA FROM PAST PERFORMANCE AND THE CURRENT PROCESS MAPS 4HE LITERATURE CAN ALSO PROVIDE IMPORTANT DATA FOR PROJECTS THAT HAVE BEEN PERFORMED AT OTHER ORGANIZATIONS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
HLOQNUHMFãGD@KSGB@QDãP T@K H S Xã H M ã S G D ã OD C H @S Q H B ã @ LA T K @SN Q Xã D M U H Q N M LD M S ! MODELING PROGRAM SUCH AS -EDMODEL WWWPROMODELCOM CAN ASSIST WITH THESE STEPS AND PROVIDES THE OPPORTUNITY TO UPLOAD mOOR PLANS AND SYSTEM DESIGNS THAT REPLICATE THE ACTUAL LOCATION AND PROCESS SEE %XHIBIT /NCE THE MODEL IS BUILT AN IMPORTANT STEP IS VALIDATION 4HIS REQUIRES THAT THE COMPOSITE DATA AND PROCESS PIECES BE VERIlED BY THE TEAM INCLUDING THE FRONT LINE STAFF 4HE MODEL CAN THEN BE RUN THROUGH SEVERAL ITERATIONS TO DETERMINE THAT IT REPRESENTS THE REAL LIFE OR hBASEv STATE OF THE SYSTEM -ULTIPLE hWHAT IFv SCENARIOS CAN NOW BE RUN BY MAKING CHANGES TO THE EXISTING MODEL &OR EXAMPLE IF THE NUMBER OF STAFF IN THE CLINIC IS DOUBLED HOW WILL THAT AFFECT CAPACITY COST PER PATIENT VISIT AND THROUGHPUT 4HESE SCENARIOS CAN BE mOWED THROUGH YEARS OF OPERATIONS TO PROVIDE DATA ON THE KEY ELEMENTS OF INTEREST #OMPARISONS OF THESE SCENARIOS AND THE DATA GENERATED BY THEM TO THE BASE STATE ALLOW APPROPRIATE MANAGEMENT DECISIONS TO BE MADE /NCE CONVINCED THAT THE CHANGES IDENTIlED THROUGH MODELING CAN LEAD TO OPERATIONAL IMPROVEMENTS THE IMPLEMENTATION OF THOSE CHANGES NEEDS TO OCCUR 7HILE CULTURE CHANGE AND REORGANIZATION CAN BE A DIFlCULT PROCESS THE MODEL HELPS TO PROVIDE A PICTORIAL REPRESENTATION OF CURRENT VERSUS FUTURE PRACTICE AND PROVIDES THE DATA THAT DEMONSTRATE THE LIKELIHOOD OF IMPROVEMENTS 4HIS IS A VERY POWERFUL TOOL FOR PERSUADING STAFF OF THE BENElTS OF CHANGE
/VERVIEW OF #.-#S /UTPATIENT #LINIC 3IMULATION 0ROJECT 4HE #ENTER FOR #LINICAL %FFECTIVENESS AT #HILDRENS .ATIONAL -EDICAL #ENTER HAS BECOME FAMILIAR WITH THE USE OF SIMULATION
SOFTWARE AS A MEANS OF BOTH IMPROVING CLINICAL OPERATIONS AND PERFORMING CLINICAL RESEARCH 4HE #ENTER CHARTERED AND FACILITATED THE PROJECT TEAM ESTABLISHED THE PROJECT SCOPE COLLECTED THE REPRESENTATIVE DATA PERFORMED THE SYSTEMS ANALYSIS AND IMPLEMENTED THE CHANGES $ElNING THE 0ROJECT 3COPE 4HE KEY COMPONENT OF THIS SIMULATION PROJECT WAS TO UNDERSTAND THE VALUE OF EXPANDING OUR EXISTING AMBULATORY SURGERY CENTER WITHIN ONE OF OUR 2/#S 4HE PROJECT TEAM WAS INTERESTED IN PATIENT mOW CAPACITY THROUGHPUT STAFlNG AND THE INCREMENTAL SURGERIES WITH A VARIETY OF DIFFERENT APPROACHES RECOGNIZING THAT AN AMBULATORY SURGERY CENTER DIFFERS IN MANY WAYS FROM A HOSPITAL BASED OPERATING ROOM IN TERMS OF CASE MIX AND RESOURCES 4HE PERSPECTIVE OF THIS PROJECT USED THE 2/# AS THE MACROSYSTEM AND THE AMBULATORY SURGERY CENTER AS THE MICROSYSTEM SEE %XHIBITS AND )T IS IMPORTANT TO REMEMBER THAT AN ANALYSIS OF THE STRUCTURE PROCESS AND OUTCOMES OF BOTH THE MICRO AND MACROSYSTEMS NEEDS TO OCCUR TO EFFECTIVELY IMPROVE THE SYSTEM !NALYSIS OF INDIVIDUAL MICROSYSTEMS ALLOWS THE PROJECT WITH A LARGE SCOPE TO BE BROKEN DOWN INTO MANAGEABLE COMPONENTS "UILDING THE -ODEL 4HE lRST STEP TO IMPROVING THE AMBULATORY SURGERY CENTER EXPERIENCE WAS TO UNDERSTAND THE PROCESS IN DETAIL FROM THE PEOPLE THAT WORK AND ARE TREATED IN THE AMBULATORY SURGERY CENTER AND TO IDENTIFY OPPORTUNITIES FOR CHANGE AS THE PROCESS IS SPECIlED !N OVERVIEW OF THE PROCESS WAS CREATED 4HEN DETAILED
%XHIBIT 2ESULTS 3UMMARY #OMPARING THE "ASE -ODEL 7ITH 3CENARIOS AND
+EY )NDICATORS
%XITS
"ASE -ODEL
3CENARIO )NCREASE CLINIC HOURS BY HR
)MPACT ON +EY )NDICATORS 3CENARIO
3CENARIO !DD PREP ROOM !DD /2 !DD TECH .URSES 3URGEON AND !NESTHESIOLOGIST #LINIC HRS AM PM
)MPACT ON +EY )NDICATORS 3CENARIO
5TILIZATION /2 MINUTES
!VERAGE TIME IN SYSTEM MINUTES
!VERAGE TIME WAITING IN SYSTEM MINUTES
!VERAGE TIME BLOCKED IN SYSTEM MINUTES
!VERAGE TIME IN WAITING ROOM MINUTES
1 5!, ) 49 # / . 5 . $ 2 5 - # # ( ! 0 4 % 2
HLOQNUHMFãGD@KSGB@QDãP T@K H S Xã H M ã S G D ã OD C H @S Q H B ã @ LA T K @SN Q Xã D M U H Q N M LD M S PROCESS mOWS WERE MAPPED TO EACH OTHER 3OME DATA COLLECTION NEEDED TO OCCUR BY WATCHING THE PROCESS THROUGH RANDOM TIME STUDIES BUT FOR THE MOST PART WE RELIED ON DATA ELEMENTS THAT WERE CAPTURED AS A PART OF ROUTINE OPERATIONS USING ELECTRONIC SYSTEMS TO SUPPLY THE DATA WHENEVER POSSIBLE 4HE FOLLOWING DATA ELEMENTS REPRESENT A SAMPLE OF THE DATA USED TO DEVELOP THE MODEL 0ATIENT $ATA VOLUME CANCELLED APPOINTMENTS NO SHOW RATES AND ARRIVAL PATTERNS &ACILITIES )NFORMATION LAYOUT ROOM USE DATA n PREOPERATIVE OPERATING ROOM AND POSTOPERATIVE CAPACITY AND UTILIZATION 2ESOURCE $ATA STAFlNG INFORMATION REGARDING THE NUMBER OF PHYSICIANS NURSES /2 TECHNICIANS APPOINTMENT SLOTS PER SESSION VACANCIES PER SESSION AND 0ROCESSING )NFORMATION CHECK IN AND REGISTRATION TIMES PATIENT INTAKE TIME PROCEDURE TIMES RECOVERY TIMES TIME SEEN BY THE PHYSICIAN WAIT TIMES BETWEEN STEPS DOWNTIMES FOR CLEANUP AND STAFF BREAKS 4HE DATA FROM THE ABOVE PARAMETERS WERE USED TO DEVELOP A SIMULATION MODEL USING 0ROMODELS -EDMODEL SOFTWARE HTTP WWWPROMODELCOMPRODUCTSMEDMODEL SEE %XHIBIT "ASED UPON THE CURRENT CONlGURATION OF THE SYSTEM THROUGH BOTH PROCESS AND DATA THE VARIABLES WERE ORGANIZED INTO MODEL INPUTS INCLUDING THE DIFFERENT PATIENT LOCATIONS PATIENT TYPES PROCESSES AND RESOURCES WITH THEIR APPROPRIATE STATISTICAL DISTRIBUTIONS AND SPECIlCATIONS AND OUTPUT VARIABLES RESULTING FROM THE EXECUTION OF THE PROGRAM AND CORRESPONDING TO THE TARGETED OUTCOMES OF INTEREST 4HE MODEL WAS THEN VALIDATED WITH STAFF AND MODIlED TO REPRESENT THE BASE CASE BEFORE DIFFERENT SCENARIOS WERE RUN 3IMULATIONS WERE RUN WITH THE EXISTING CONDITIONS AND BY CHANGING VARIABLES SUCH AS STAFlNG BED SPACE AND PATIENT ARRIVAL PATTERNS 4HE OUTPUTS FOR THE SCENARIOS WERE COMPARED USING PERFORMANCE METRICS SUCH AS TOTAL PATIENT THROUGHPUT TIME WAIT TIMES AND lNANCIAL GAIN FROM THE CHANGE TO THE PROCESS !N EXAMPLE OF THE DIFFERENT OUTPUT ELEMENTS FROM THE SCENARIOS AS COMPARED WITH THE hBASE CASEv IS SHOWN IN %XHIBIT 3EVERAL REPLICATIONS OF THE MODEL WERE RUN TO SIMULATE PATIENT mOW IN AN hAS IS STATE v AND THE KEY INDICATORS FROM THE SIMULATION INCLUDED ,OCATION UTILIZATION WAITING ROOM OPERATING ROOM POST OP RECOVERY ROOMS ETC 2ESOURCE UTILIZATION !VERAGE TIME THE PATIENT IS IN THE SYSTEM AND !VERAGE PATIENT WAITING TIME 4HE lRST SCENARIO SOUGHT TO UNDERSTAND THE INCREMENTAL PATIENT VISITS IF WE INCREASED OUR SURGERY CENTERS DAILY HOURS BY ONE HOUR 7E NOTED THAT PATIENT VOLUME INCREASED BY PERCENT AND AVERAGE WAITING TIME IN THE SYSTEM AND AVERAGE TIME IN THE WAITING ROOM DECREASED ! SECOND SIMULATION WAS RUN TO UNDERSTAND THE NEED FOR A SECOND OPERATING ROOM 7E ADDED AN ADDITIONAL OPERATING ROOM WITH THE EXISTING RESOURCES AND NOTED THAT IT DID NOT SIGNIlCANTLY AFFECT THE KEY INDICATORS .EXT IN ORDER TO TRULY UNDERSTAND THE IMPACT OF AN ADDITIONAL /2 WE ADDED A PRE OPERATIVE AREA AND
ADDITIONAL RESOURCES TO MEET THE DEMAND !LTHOUGH OPERATING ROOM UTILIZATION WAS REDUCED BY PERCENT THE PATIENT THROUGHPUT AND WAIT TIMES IMPROVED DRAMATICALLY BY PERCENT AND PERCENT RESPECTIVELY THEREBY INCREASING THE NUMBER OF PATIENTS SEEN IN THE AMBULATORY SURGERY CENTER IN A GIVEN DAY BY PERCENT AND PROVIDING SOME OPPORTUNITIES TO IMPROVE PATIENT SATISFACTION /F IMPORTANCE THE MARGINAL EXPENSES FROM THIS STAFlNG MODEL NEEDED TO BE JUSTIlED BY THE INCREMENTAL PATIENT REVENUE 4HESE COST PROJECTIONS ARE INCLUDED AS THE MODEL CONTINUES TO EVOLVE
#ONCLUSION )F SUCCESS IN THE IMPROVEMENT OF QUALITY FOR PATIENTS IS TO BE ACHIEVED OPPORTUNITIES TO CAPITALIZE ON THE TOOLS PROVIDED BY OTHER INDUSTRIES SHOULD BE CONSIDERED AND STUDIED 3IMULATION IS ONE SUCH TOOL THAT HAS THE ABILITY TO ASSIST CLINICIANS AND ADMINISTRATORS IN MAKING DECISIONS ABOUT THEIR OPERATIONS FOR COMPLEX SYSTEMS )T IS BEST USED IF THERE IS A CLEAR OPERATIONAL DECISION THAT NEEDS TO BE MADE AND THERE ARE NUMEROUS INTERDEPENDENT PROCESSES THAT CAN BE WELL DElNED AT THE LEVEL OF THE SYSTEM $R 3LONIM IS SUPPORTED IN PART BY !(21 +/ (3 2ECOMMENDED 2EADING #ARSON *3 )) h)NTRODUCTION TO -ODELING AND 3IMULATION v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE #ENTENO - AND - #ARILLO h#HALLENGES OF )NTRODUCING 3IMULATION AS A $ECISION -AKING 4OOL v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE #LINICAL -ICROSYSTEMS WWWCLINICALMICROSYSTEMSORG $ONABEDIAN ! h%VALUATING THE 1UALITY OF -EDICAL #ARE v -ILBANK -EMORIAL &UND 1UARTERLY PP $RONZEK 2 h#ONDUCTING A 3UCCESSFUL (EALTHCARE 3IMULATION 0ROJECT v 3(3 -% &ORUM %LDABI 4 AND 2 0AUL h! 0ROPOSED !PPROACH FOR -ODELING (EALTHCARE 3YSTEMS FOR 5NDERSTANDING v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE h&UTURE OF THE /PERATING 2OOM 4HE #HANGING &ACE OF THE /2 v 4HE !DVISORY "OARD #OMPANY (ARRELL # " 'HOSH 2 "OWDER h3IMULATION 5SING 0ROMODEL v ND %D -C'RAW (ILL )NGALLS 2 h)NTRODUCTION TO 3IMULATION v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE WWWPROMODELCOMPRODUCTSMEDMODEL -ERKLE * h#OMPUTER 3IMULATION ! -ETHODOLOGY TO )MPROVE THE %FlCIENCY IN THE "ROOKE !RMY -EDICAL #ENTER &AMILY #ARE #LINIC v !MERICAN #OLLEGE OF (EALTHCARE %XECUTIVES AVAILABLE AT HTTPWWW ACHEORGMBERSHIPADVTOFELLOWCASERPTSMERKLECFM !CCESSED -AY 0ALL ' h4HE 0ROCESS #ENTERED %NTERPRISE n 4HE 0OWER OF #OMMITMENTS v #2# 0RESS ,,# 2USSELL 2 " 4AYLOR /PERATIONS -ANAGEMENT n 1UALITY AND #OMPETITI VENESS IN A 'LOBAL %NVIRONMENT TH %D *OHN 7ILEY 3ONS )NC 3ADOWSKI $ h4IPS FOR 3UCCESSFUL 0RACTICE OF 3IMULATION v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE 3ANCHEZ 3 h!"#S OF /UTPUT !NALYSIS v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE 3ARGENT 2 h6ERIlCATION AND 6ALIDATION OF 3IMULATION -ODELS v 0ROCEEDINGS OF THE 7INTER 3IMULATION #ONFERENCE # ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
!CHIEVING 1UALITY 4HROUGH #USTOMER 3ERVICE !S DECISION MAKING RESPONSIBILITY SHIFTS FROM PAYER TO PATIENT HOSPITALS PHYSICIAN GROUPS AND OTHER HEALTHCARE ORGANIZATIONS NEED TO BECOME MORE SERVICE ORIENTED AND EXPAND THEIR UNDERSTANDING OF @QUALITY TO ENCOMPASS THE ENTIRE PATIENT CARE EXPERIENCE "Y -ARGARET 3TOVER 0RICEWATERHOUSE#OOPERS
#
ONSUMER PERCEPTIONS OF THE HEALTHCARE INDUSTRY HAVE DETERIORATED OVER THE LAST NINE YEARS )N THIS YEARS (ARRIS 0OLL¸ CONSUMERS WHO WERE ASKED WHETHER INDUSTRIES WERE GENERALLY DOING A GOOD JOB OR A BAD JOB OF SERVING THEIR PATIENTS GAVE HOSPITALS A PERCENT POSITIVE RATING AN PERCENT DROP FROM LAST YEAR;= 4HAT PUTS HOSPITALS FAR BELOW SUPERMARKETS AND SLIGHTLY BELOW ONLINE RETAILERS IN PERCEIVED CUSTOMER SATISFACTION;= )N HEALTHCARE PATIENTS ARE THE CUSTOMERS OR AT LEAST ONE SEGMENT OF CUSTOMERS 4HEIR SATISFACTION IS AN IMPORTANT DETERMINANT OF THE LEVEL OF QUALITY CARE DELIVERED 4HIS PAPER EXPLORES MANY OF THE VITAL REASONS HEALTH ORGANIZATIONS NEED TO IMPROVE CUSTOMER SERVICE /NE SIGNIlCANT DRIVER THOUGH NOT THE MAIN ONE IS TO MITIGATE RISK FROM MALPRACTICE LAWSUITS (OSPITALS AND PHYSICIANS THAT DEAL WITH PATIENTS RESPECTFULLY HANDLE COMPLAINTS EARNESTLY AND QUICKLY AND PROVIDE A GENERALLY SATISFACTORY PATIENT EXPERIENCE CAN PREVENT OR MITIGATE MANY MALPRACTICE CLAIMS -ALPRACTICE RISK IS NOT NECESSARILY PREDICTED BY PATIENT CHARACTERISTICS COMPLEXITY OF ILLNESS COMORBIDITIES OR PHYSICIANS TECHNICAL SKILLS )NSTEAD RISK APPEARS TO BE RELATED TO PATIENTS DISSATISFACTION WITH THEIR PHYSICIANS ABILITY TO COMMUNICATE EFFECTIVELY ESTABLISH RAPPORT PROVIDE ACCESS TO SERVICES AND ADMINISTER CARE CONSISTENT WITH THE PATIENTS EXPECTATIONS;= (OSPITALS NEED TO PARTNER WITH PHYSICIANS TO ENHANCE PATIENT INTERACTIONS AND RELATIONSHIPS 0ATIENT SATISFACTION HAS MANY BENElTS FOR CLINICIANS AND PATIENTS ALIKE 0ATIENTS WHO ARE MORE SATISlED WITH THEIR HEALTHCARE EXPERIENCES MAY BE MORE LIKELY TO COMPLY WITH TREATMENT AND MEDICATION INSTRUCTIONS AND HAVE BETTER LONG TERM OUTCOMES
,ISTENING TO 0ATIENTS 4O INCREASE PATIENT SATISFACTION IT IS IMPORTANT TO LISTEN TO WHAT PATIENTS SAY %NGAGING PATIENTS AND CLINICIANS IN CANDID DISCUSSIONS IS A GOOD PLACE TO START &OR EXAMPLE PATIENTS ARE LESS INTERESTED IN HOTEL LIKE AMENITIES FROM PROVIDERS THAN IN COMPREHENSIVE QUALITY HEALTHCARE THAT IS ACCESSIBLE
ACCOUNTABLE COORDINATED AND PROVIDES CONTINUITY OF CARE;= %XHIBIT ILLUSTRATES THESE PATIENTS EXPECTATIONS
%NHANCING #USTOMER 3ERVICE (IGH PERFORMING PROVIDERS HAVE ADOPTED KEY ATTITUDES AND ATTRIBUTES NECESSARY TO CREATE SATISlED PATIENTS EDUCATING PATIENTS ABOUT THEIR MEDICAL CONDITIONS ROLES AND RESPONSIBILITIES AS HEALTHCARE CONSUMERS AND GIVING ALL STAKEHOLDERS n PATIENTS PHYSICIANS NURSES CLINICIANS AND OTHER HEALTHCARE STAFF n THE SERVICES AND RESOURCES THAT ARE MOST IMPORTANT TO THEM
%MPLOYEES &IRST AND &OREMOST 3ATISlED PATIENTS BEGIN WITH SATISlED EMPLOYEES %MPLOYEES WHO FEEL VALUED n WHO lND THEIR JOBS ENJOYABLE LESS BURDENSOME AND WITH FEWER IMPEDIMENTS TO DOING THE WORK THEY WERE TRAINED TO DO n CAN TREAT PATIENTS WELL AND DELIVER SUPERIOR CARE RESULTING IN PATIENTS WHO ARE BOTH HAPPIER AND HEALTHIER 4HIS INCLUDES NOT JUST NURSES AND CLINICIANS BUT ALL EMPLOYEES %VEN A TELEPHONE SCHEDULER CREATES A LASTING lRST IMPRESSION THAT CAN DRAMATICALLY AFFECT THE PATIENTS PERCEPTION OF THE OVERALL EXPERIENCE 3TUDIES SUGGEST THAT PATIENT SATISFACTION WITH THE HOSPITAL EXPERIENCE IMPROVES WHEN NURSES SPEND AN EXTRA MOMENT COMFORTING A PATIENT AND HIS OR HER FAMILY AS THEY DEAL WITH A DIFlCULT HEALTHCARE ISSUE AND WHEN BUSINESS OFlCE WORKERS POST PAYMENT CORRECTLY %MPLOYEES WHO FEEL VALUED AND ARE RECOGNIZED AS INTEGRAL MEMBERS OF THE HEALTHCARE TEAM ARE BETTER ABLE TO GIVE PATIENTS QUALITY CARE AND A CARING ATTITUDE;=
2EWARDING %XCELLENCE (EALTHCARE ORGANIZATIONS NEED TO PROVIDE INCENTIVES FOR EMPLOYEES TO DO THEIR BEST WORK 2ELEVANT PERFORMANCE METRICS AND REWARDS FOR ACHIEVING BENCHMARKS HELP EMPLOYEES SEE THAT THEIR JOBS ARE IMPORTANT 3UPERVISORS SHOULD CONTINUALLY MONITOR PERFORMANCE IN CLINICAL AND BUSINESS RELATED AREAS AND REWARD EMPLOYEES AND BUSINESS UNITS WHEN THEY PERFORM WELL 2ECOGNITION SHOULD BE VISIBLE IN SOME WAY AND WHEN PRACTICAL INVOLVE EMPLOYEE FAMILIES (OSPITALS BENElTING FROM THE
-ARGARET 3TOVER IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE FOCUSES ON ACADEMIC MEDICAL CENTERS AND FACULTY PRACTICES AND HAS OVER YEARS EXPERIENCE LEADING AND ADVISING PHYSICIAN PRACTICES IN MEDICAL SCHOOLS AND HEALTH SYSTEM SETTINGS 3HE CAN BE REACHED AT MARGARETSTOVER USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
@BGHDUHMFãP T@ KH S Xã S G Q N T FG ã B T RSN LD Q ã RD Q U H B D %XHIBIT #USTOMER %XPECTATIONS &ROM THE (EALTHCARE %XPERIENCE
!##%33
!##/5.4!"),)49
0ATIENTS WANT PROVIDERS WHO DELIVER
0ATIENTS WANT PROVIDERS WHO ARE
1UALITY CARE FOR INSURED UNINSURED AND SELF PAY PATIENTS
#OMPETENT
#ONVENIENCE IN CARE DELIVERY
'OOD COMMUNICATORS
0ATIENT PORTALS PROVIDING ACCESS TO EMAIL TEST RESULTS ELECTRONIC HEALTH RECORDS %(2S SCHEDULING ETC
)NVESTED IN THE RELATIONSHIP WITH PATIENTS
2ESPECTFUL TREATMENT
%FlCIENT AND EFFECTIVE
0ATIENT ADVOCATES
!BLE TO INTEGRATE PATIENT VALUES IN THE PLANS FOR CARE
'EOGRAPHIC PROXIMITY
#//2$).!4)/. /& #!2%
#/.4).5)49 /& #!2%
0ATIENTS WANT PROVIDERS WHO ARE
0ATIENTS WANT PROVIDERS WHO ARE
)NVOLVED IN ORCHESTRATING THEIR SERVICES
#APABLE OF PROVIDING A LONGER TERM RELATIONSHIP WITH PATIENTS
#OMMITTED TO KEEPING THEIR DOORS OPEN TO ALL PATIENTS WHO NEED CARE
2ESPONSIVE AND TECHNICALLY COMPETENT
2ESPECTFUL OF PATIENTS VALUES AND DECISION MAKING POTENTIAL WHEN MANAGING THEIR CARE
!BLE TO CREATE ANDOR MANAGE AND USE AN ONLINE ELECTRONIC HEALTH RECORD +NOWLEDGEABLE ABOUT EACH PATIENTS HISTORY AND UNIQUE RESPONSES TO MEDICAL AND HEALTHCARE DELIVERY
5P FRONT DETERMINATION OF COSTS AND lNANCIAL RESPONSIBILITY #OMMUNICATION PROlCIENCY IN OTHER LANGUAGES CULTURES 4OLERANCE FOR VISITS WITHOUT APPOINTMENTS %ASILY UNDERSTANDABLE INFORMATION !CCESS DURING VULNERABLE PERIODS OF TRANSITIONS #ONlDENTIALITY
EXPERIENCES OF WORLD CLASS BUSINESSES IN OTHER INDUSTRIES HAVE FOUND THE FOLLOWING REWARDS AND INCENTIVES TO BE EFFECTIVE;=
SUSTAINABLE WEAVING SERVICE AND SATISFACTION PRINCIPLES INTO THE CULTURE OF THE ORGANIZATION AND ITS PROCESSES
%MPLOYEE OF THE MONTH PROGRAMS BASED ON MEASURABLE CRITERIA NOT POPULARITY %MPLOYEE NEWSLETTERS THAT HIGHLIGHT EMPLOYEES WHO HAVE DONE SOMETHING EXCEPTIONAL TO IMPROVE A PATIENTS OUTCOME OR EXPERIENCE OR HAD A SIGNIlCANT IMPACT ON THEIR COMMUNITY 3TAFF AND FAMILY PICNICS !NNUAL AWARDS DINNERS AND 4ICKETS TO MOVIESSPORTSENTERTAINMENT )F A PATIENT TAKES THE TIME TO THANK AN EMPLOYEE IN A LETTER THAT SHOULD BE CELEBRATED IN A VISIBLE FASHION )F A DEPARTMENT ACHIEVES AN INDUSTRY BENCHMARK FOR OUTSTANDING PERFORMANCE SEIZE THAT OPPORTUNITY FOR A CELEBRATION 3URVEYING EMPLOYEES TO lND OUT WHAT KINDS OF REWARDS AND RECOGNITION PROGRAMS WILL HAVE MEANING FOR THEM WILL ENHANCE THE POSITIVE IMPACT OF THOSE PROGRAMS 2ECOGNITION OF EXCELLENCE ALIGNS THE PRINCIPLES OF CUSTOMER SERVICE WITH PERCEIVED JOB RESPONSIBILITIES 2EWARDING EXCELLENCE IN A FASHION THAT INVOLVES THE ORGANIZATIONS LEADERSHIP SAVES CUSTOMER SERVICE INITIATIVES FROM BEING DISMISSED AS THE hmAVOR OF THE MONTHv AND DESTINED FOR OBLIVION AND MAKES THEM
4RAINING 4HOSE 7HO 7ILL 5SE THE 4RAINING 3ERVICE TRAINING SHOULD START BY DIRECTLY INVOLVING THE EMPLOYEES YOU SEEK TO EDUCATE %MPLOYEES ON THE FRONT LINES OFTEN HAVE STRONG OPINIONS ABOUT WHEN AND HOW THE TRAINING SHOULD BE DELIVERED )NVOLVING THEM IN THE PROCESS OF DESIGNING AND PLANNING TRAINING WILL HELP THEM FEEL VALUED AND PASSIONATE ABOUT IMPLEMENTING AN EFFECTIVE TRAINING PROGRAM AND DESIGNING THE RIGHT KIND OF CUSTOMER SERVICE APPROACH FOR THE ORGANIZATION 4RAINING SHOULD INCLUDE SKILL DEVELOPMENT IN AREAS SUCH AS PHONE ETIQUETTE BUT ALSO TARGET THE DEVELOPMENT OF SOME OF THE SOFTER SKILLS SUCH AS UNDERSTANDING HOW THEY COME ACROSS ON THE PHONE 4OO MANY TRAINING PROGRAMS TELL THE EMPLOYEES WHAT THEY SHOULD DO BUT DO NOT HELP THE EMPLOYEES RECOGNIZE WHAT THEY ARE DOING AND PRACTICE NEW WAYS TO DO IT !S AN EXAMPLE MANY FRONT DESK EMPLOYEES FEEL VERY UNCOMFORTABLE ASKING FOR COPAYS PARTICULARLY IF IT IS NEW TO THEM !N EFFECTIVE TRAINING PROGRAM INVOLVES SCRIPTING AND ROLE PLAYING THIS RESPONSIBILITY 2EMEMBER THAT EMPLOYEES DISDAIN AFTER HOURS TRAINING 4RAINING THAT THE EMPLOYER VALUES WILL BE VALUED MORE BY EMPLOYEES IF
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
@BGHDUHMFãP T@ KH S Xã S G Q N T FG ã B T RSN LD Q ã RD Q U H B D !PPRECIATING THE )NHERENT 6ARIABILITY OF THE /UTPATIENT %XPERIENCE 4HE INPATIENT ENVIRONMENT INVOLVES A RELATIVELY SIMILAR GROUP OF ACTIVITIES PROVIDED TO RELATIVELY SIMILAR GROUPS OF PATIENTS IN RELATIVELY SIMILAR SURROUNDINGS /N AVERAGE hINPATIENTv MEANS AN OLDER ADULT ENGAGED IN A MULTIDAY STAY IN THE HOSPITAL FOR A COMPLEX PROCEDURE OR SET OF PROCEDURES WHICH MAY BE EVALUATIVE THERAPEUTIC OR INTERVENTIONAL )N THIS CONTEXT PATIENTS SHARE SIMILAR EXPERIENCES AND EXPECTATIONS AND PROVIDERS CAN INCORPORATE FAIRLY STANDARD QUALITY MEASUREMENTS FOR ONGOING IMPROVEMENT #ONVERSELY THE OUTPATIENT POPULATION REPRESENTS A LARGE HIGHLY VARIED GROUP OF INDIVIDUALS WITH EQUALLY VARIED EXPECTATIONS %VEN WHEN OUTPATIENTS SHARE CHARACTERISTICS SUCH AS AGE AND INCOME OTHER FACTORS COME INTO PLAY SUCH AS CULTURAL BACKGROUND &OR EXAMPLE THE POPULATION OF SOUTHERN &LORIDA REGARDLESS OF AGE AND INCOME LEVEL DEMONSTRATES A VERY HIGH NO SHOW RATE WHILE PATIENTS IN THE HEARTLAND VIRTUALLY NEVER SKIP APPOINTMENTS /UTPATIENT EXPERIENCES FURTHER DIVERGE ALONG A BROAD CONTINUUM n FROM AN ANNUAL PHYSICAL WITH A PRIMARY CARE PHYSICIAN OR FOLLOW UP MAMMOGRAPHY AT A RADIOLOGY PRACTICE TO A HOUR HOSPITALIZATION IN A DISTANT ACADEMIC MEDICAL INSTITUTION FOR A CARDIOVASCULAR PROCEDURE OR AN UNANTICIPATED VISIT TO THE LOCAL EMERGENCY DEPARTMENT %$ FOLLOWING AN AUTOMOBILE ACCIDENT /UTPATIENT SERVICES ARE DELIVERED IN A WIDE RANGE OF ENVIRONMENTS MOST RECENTLY INCLUDING THE LOCAL DRUGSTORE 0ROVIDERS INCLUDE A BROAD ARRAY OF PHYSICIANS NURSES TECHNICIANS CLINICS AND HOSPITALS (OSPITAL SETTINGS THEMSELVES VARY FROM LARGE ACADEMIC MEDICAL INSTITUTIONS WITH MULTIPLE FACILITIES TO SMALL CRITICAL ACCESS FACILITIES %VEN THE )NTERNET HAS BECOME AN OUTPATIENT SETTING AS COMMUNICATION TECHNOLOGY CREATES NEW WAYS FOR PROVIDERS TO INTERACT WITH PATIENTS 0HYSICIANS MAY USE EMAIL TO COMMUNICATE TEST RESULTS WITH PATIENTS FOR EXAMPLE IN LIEU OF REQUIRING AN OFlCE VISIT (OSPITALS MAY COMMUNICATE PRE VISIT DATA VIA WEBSITES INSTEAD OF MAILING PAPER TO PATIENTS HOMES 0ATIENT PERCEPTIONS OF QUALITY TIE CLOSELY TO THEIR LEVELS OF ANXIETY AND THE OUTPATIENT EXPERIENCE REmECTS WIDE RANGES OF PATIENT ANXIETY 4HE FUNDAMENTAL TENDENCY OF AN INPATIENT PERSPECTIVE TO CHARACTERIZE ANY OUTPATIENT EXPERIENCE AS hNOT THAT SERIOUSv BECAUSE IT MAY NOT BE LIFE THREATENING GROSSLY MISCONSTRUES HOW PATIENTS VIEW THEIR EXPERIENCES AND CONSEQUENTLY WHAT THEY EXPECT IN TERMS OF PROVIDER PERFORMANCE ,EVELS OF ANXIETY AND CONSEQUENT PERCEPTIONS OF QUALITY VARY AS GREATLY AS OUTPATIENTS VARY FROM EACH OTHER 7E ASSUME THAT A YEAR OLD WOMAN IS LESS ANXIOUS DURING AN HOUR LONG ROUTINE PHYSICAL THAN A YEAR OLD MAN UNDERGOING A DAY LONG CARDIOVASCULAR PROCEDURE IN THE HOSPITAL n UNTIL WE UNDERSTAND THAT THE WOMAN SUFFERS FROM GENERALIZED ANXIETY DISORDER !LTHOUGH THE OUTPATIENT ENVIRONMENT BY ITS VERY NATURE PRESENTS MORE CHALLENGES THAN THE INPATIENT SETTING FOR IDENTIFYING MEASURING AND MANAGING QUALITY ISSUES ALL PATIENTS hDElNEv QUALITY n OFTEN THROUGH VERY BASIC QUESTIONS &OR EXAMPLE h7AS THE FACILITY CLEAN 7ERE THE PEOPLE NICE #OULD ) lND MY WAY AROUND EASILY $ID ) HAVE TO ANSWER THE SAME QUESTIONS OVER AND OVER AGAIN 7AS ) TREATED WELL v -OST PATIENTS JUDGE EACH EXPERIENCE BY THE ANSWERS TO SUCH QUESTIONS NOT BY THE AGE OF THE #4 EQUIPMENT THE DOCTORS PUBLISHING CREDENTIALS OR ERUDITE STATISTICS /NE OF THE KEYS IS APPRECIATING THAT THERE ARE INCONSISTENT DElNITIONS FOR hCLEAN v hNICE v ETC )N MANY CASES A PATIENTS MEASURE OF QUALITY MAY NOT EVEN RELATE TO RESULTS &OR EXAMPLE A PATIENT MAY PERCEIVE HER MAMMOGRAPHY APPOINTMENT AS REmECTING THE HIGHEST QUALITY INDEPENDENT OF WHETHER SHE HAS TO RETURN FOR MORE IMAGING )NSIDE THE %$ ONE PATIENT MAY FEEL ENORMOUSLY GRATEFUL TO SEE A PHYSICIAN WITHIN FOUR HOURS WHILE ANOTHER WILL BEGIN COMPLAINING WITHIN MINUTES 7HATEVER THE CASE THOSE INSIDE THE EXPERIENCE DO THE BEST JOB OF DElNING IT FOR THE PURPOSE OF IMPROVING ITS QUALITY 4HE ABILITY TO GAUGE THE OUTPATIENT EXPERIENCE FURTHER RELATES TO THE NATURE OF THE LOCAL HEALTHCARE MARKET )N SOPHISTICATED MARKETS FOR EXAMPLE PATIENTS EXPECT PHYSICIANS TO PLAY INTO THE EQUATION )F THE HEALTHCARE MARKETS CONSTITUENCY CARES ABOUT TIME SPENT AS A WHOLE IT MIGHT NOT MATTER TO MOST PATIENTS IF IT TAKES SECONDS TO GET FROM THE PARKING LOT TO PRE OP CARE WHEN THEY MUST WAIT FOR AN HOUR TO SEE A PHYSICIAN )N CONTRAST IF A HOSPITAL CANNOT CONTROL THE TIME IT TAKES FOR PHYSICIANS TO SEE PATIENTS BECAUSE OF MARKET FRAGMENTATION THEN THAT HOSPITAL MIGHT CHOOSE TO CREATE FEATURES THAT MAKE WAITING MORE ACCEPTABLE INCLUDING THE COMFORT OF THE FURNITURE THE EASE OF ACCESS TO BEVERAGES AND THE AVAILABILITY OF POPULAR READING MATERIALS "ECAUSE OF THE SIGNIlCANT DIFFERENCES BETWEEN OUTPATIENT AND INPATIENT SETTINGS AND BETWEEN OUTPATIENTS AND INPATIENTS ASSESSING AND IMPROVING THE QUALITY OF OUTPATIENT SERVICES CANNOT BE ACCOMPLISHED FROM AN INPATIENT PERSPECTIVE 0ROVIDERS NEED TO CHALLENGE THE ASSUMPTIONS OF A TRADITIONAL HOSPITAL MIND SET IN ORDER TO EFFECTIVELY ADDRESS QUALITY IN THE OUTPATIENT SETTING
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
@BGHDUHMFãP T@ KH S Xã S G Q N T FG ã B T RSN LD Q ã RD Q U H B D IT IS CONDUCTED DURING BUSINESS HOURS 4HE PEOPLE WHO DO THE WORK hIN THE TRENCHESv WILL TAKE RESPONSIBILITY FOR DOING IT WELL AND FOR SUGGESTING IMPROVEMENTS IF THAT EXPECTATION AND LEVEL OF RESPECT IS AFFORDED TO THEM
@#ONSUMERS HAVENT HAD ENOUGH INFLU ENCE IN THE NATIONAL QUALITY AGENDA FOR A VARIETY OF REASONS $ISCUSSIONS ABOUT MEASURES ARE VERY TECHNICAL AND CONSUMERS ARE TYPICALLY UNDERREPRE SENTED IN DIALOGUES WHERE THE AGENDA IS SET n "ARBARA ! 2UDOLPH 0H$ DIRECTOR OF LEAPS AND MEASURES FOR THE ,EAPFROG 'ROUP
3IMULATING THE .EW %NVIRONMENT 0HYSICIAN OFlCES ADMITTING AND THE EMERGENCY DEPARTMENT REPRESENT THE FRONT DOOR OF THE ORGANIZATION (OW EMPLOYEES IN THESE VENUES MAKE INITIAL CONTACT WITH PATIENTS WILL GREATLY INmUENCE OVERALL PATIENT SATISFACTION WITH THE ORGANIZATION 4RAINING WORKS BEST WHEN IT IS DESIGNED TO ENABLE LEARNERS TO BECOME PROlCIENT IN CLEARLY DElNED SKILLS %FFECTIVE TRAINING WILL DEMONSTRATE HOW A SKILL IS PROPERLY PERFORMED THEN ALLOW LEARNERS TO PRACTICE ESPECIALLY IN AN ENVIRONMENT THAT SIMULATES THE SITUATION IN WHICH THE NEW SKILL WILL BE USED 4O TRAIN FRONT DESK PERSONNEL TO HANDLE PATIENTS AND THEIR lNANCIAL MATTERS MORE EFFECTIVELY SOME ORGANIZATIONS HAVE SET UP SIMULATION CENTERS WITH REALISTIC FRONT DESK ENVIRONMENTS 3MALL GROUPS OF EMPLOYEES COME TO THE SIMULATION CENTER AND REHEARSE THEIR NEW FRONT DESK PROCESSES WITH THEIR COLLEAGUES )N THIS WAY THEY LEARN NOT ONLY THE TECHNICAL SKILLS REQUIRED OF THEIR POSITION BUT ALSO MASTER SOFTER SKILLS SUCH AS EYE CONTACT TONE BODY LANGUAGE AND EXPRESSIONS OF CARING AND CONCERN n CREATING POSITIVE lRST IMPRESSIONS IN THEIR NEW ROLES AS PATIENT ADVOCATES IN A SERVICE INDUSTRY 4RAINING SHOULD ALSO PROVIDE JOB SATISFACTION AND CAREER MOBILITY FOR EMPLOYEES %MPLOYEES IN ENTRY LEVEL POSITIONS NEED A CAREER LADDER THAT CAN BE CONSTRUCTED BY BUILDING TIERS WITHIN POSITIONS BASED ON EDUCATION QUALIlCATIONS AND JOB PERFORMANCE )F A JOB POSITION REQUIRES THE INDIVIDUAL TO INTERFACE WITH INSURANCE COMPANIES AND HANDLE MEDICAL CORRESPONDENCE COMPLETING A CERTIlCATE COURSE IN MEDICAL TERMINOLOGY SHOULD EARN AN EMPLOYEE A CHANGE IN TITLE AND A MODEST RAISE IN PAY IF IT IS NOT A REQUIRED JOB SKILL "UILDING OPPORTUNITIES FOR CAREER ADVANCEMENT MAKES
EMPLOYEES FEEL MORE VALUED WHICH INCREASES THE LIKELIHOOD THEY WILL STAY LONGER AND CONTRIBUTE SIGNIlCANTLY TO THE ORGANIZATION
5SING @-YSTERY 3HOPPERS /NE TECHNIQUE THAT HOSPITALS HAVE BORROWED FROM OTHER SERVICE INDUSTRIES IS THE hMYSTERY SHOPPERv SURVEY 0ATIENT IMPERSONATORS MYSTERY SHOPPERS ARE HIRED TO INTERACT WITH THE HOSPITAL IN A NUMBER OF WAYS AND REPORT THE HOSPITALS PERFORMANCE )F PATIENTS HAVE TROUBLE SCHEDULING APPOINTMENTS OVER THE PHONE INTERACT WITH EMPLOYEES WHO SEEM DISTRACTED OR UNHELPFUL WAIT TOO LONG TO BE SEEN OR CONSISTENTLY SUFFER FROM OTHER PROBLEMS OR IRRITATIONS THAT DETRACT FROM THE CARE EXPERIENCE MYSTERY SHOPPERS CAN HELP UNCOVER THESE WEAKNESSES -YSTERY SHOPPERS CAN REVEAL THE UNEXPECTED ,AST YEAR THE #ALIFORNIA (EALTH #ARE &OUNDATION COMMISSIONED A STUDY OF HOSPITAL PRICING IN #ALIFORNIA IN WHICH MYSTERY SHOPPERS POSED AS UNINSURED PATIENTS NEEDING A TEST OR PROCEDURE 4HE STUDY REVEALED HUGE COMMUNICATION GAPS BETWEEN HOSPITALS AND PATIENTS;=
#ONCLUSION (EALTHCARE PROVIDERS ARE LEARNING FROM OTHER SERVICE INDUSTRIES HOW TO FOCUS ON PATIENT SATISFACTION 0ROVIDING QUALITY SERVICE MEANS PROVIDING BOTH QUALITY CLINICAL CARE AND AN EXCELLENT PATIENT CARE EXPERIENCE (EALTHCARE ORGANIZATIONS THAT CONSISTENTLY DELIVER HIGH QUALITY PLEASANT MEDICAL CARE TO PATIENTS THEREBY EARN RESPECT AND LOYALTY FROM BOTH PATIENTS AND THEIR PHYSICIANS DELIVERING BOTH MARKET GROWTH AND RISK MITIGATION IN AN INCREASINGLY COMPETITIVE AND LITIGIOUS INDUSTRY %NDNOTES h3UPERMARKETS "ANKS #OMPUTER 3OFTWARE #OMPANIES AND 0ACKAGED 'OODS 4OP THE ,IST OF )NDUSTRIES $OING A 'OOD *OB FOR 4HEIR #ONSUMERS v !PRIL BY (ARRIS 0OLL 2OCHESTER .9 HTTPSEVPRNEWSWIRECOMPUBLISHING INFORMATION SERVICES .945 HTML )BID (ICKSON ' AND # &EDERSPIEL * 0ICHERT # -ILLER * 'AULD *AEGER 0 "OST h0ATIENT #OMPLAINTS AND -ALPRACTICE 2ISK v *UNE *!-! P !DAPTED FROM h0RIMARY #ARE !DVOCACY 4OOLKIT v BY 0RIMARY #ARE 3OCIETY h#ONSUMERS AND 0RIMARY #ARE v #ARY ! AND " 'OLDBERG 3 -C$ANIEL ((. RESEARCH 3ENGIN + + h4HE 2ELATIONSHIP "ETWEEN *OB 3ATISFACTION OF 2EGISTERED .URSES AND 0ATIENT 3ATISFACTION IN !CUTE #ARE (OSPITALS v DISSERTATION SUBMITTED TO THE 5NIVERSITY OF 0ENNSYLVANIA HTTP REPOSITORYUPENNEDUDISSERTATIONS!!) !DAPTED FROM 7AYS TO 2EWARD %MPLOYEES .ELSON " 7ORKMAN 0UBLISHING #OMPANY .EW 9ORK h0RICE #HECK 4HE -YSTERY OF (OSPITAL 0RICING v $ECEMBER #ALIFORNIA (EALTH #ARE &OUNDATION
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
4HE +EY TO )MPROVING 1UALITY 3AVING ,IVES AND 2EDUCING ,AWSUITS 'ALLUP RESEARCH SHOWS THAT HIRING AND DEVELOPING TALENTED NURSES AND ENGAGING CURRENT HEALTHCARE EMPLOYEES CORRELATES WITH IMPROVED QUALITY AND SAFER HEALTHCARE
"Y $EBORAH ! 4OTO 4HE 'ALLUP /RGANIZATION
(
EALTHCARE LEADERS SPEND MILLIONS OF DOLLARS AND DEDICATE VAST AMOUNTS OF TIME AND RESOURCES TO PROVIDE THEIR PATIENTS WITH THE HIGHEST QUALITY CARE POSSIBLE 4HIS QUEST FOR QUALITY IS CONSTANT (EALTHCARE LEADERS SEARCH INCESSANTLY FOR NEW DEVELOPMENTS AND IMPROVEMENTS IN TECHNOLOGY IN AN ATTEMPT TO OFFER THEIR PATIENTS THE MOST THOROUGH AND RElNED CARE POSSIBLE 4HESE LEADERS ARE DRIVEN BY THEIR ORGANIZATIONS MISSIONS TO DELIVER EXCELLENT HEALTHCARE BUT IT IS ALSO TRUE THAT SAFER HIGHER QUALITY CARE POSITIVELY INmUENCES lNANCIAL RESULTS 'ALLUP HAS ANALYZED DATA FROM MORE THAN YEARS OF INTERVIEWS WITH PATIENTS PHYSICIANS AND EMPLOYEES 4HESE DATA CONlRM THAT HIGH QUALITY CARE PREDICTS BETTER lNANCIAL PERFORMANCE FOR HEALTHCARE PROVIDERS BOTTOM LINES 0ATIENTS WHO RECEIVE CARE THAT IS FREE OF AVOIDABLE COMPLICATIONS ARE MORE LIKELY TO SPEAK POSITIVELY ABOUT THEIR HEALTHCARE EXPERIENCE n AND THEY ARE MORE LIKELY TO RETURN FOR FUTURE SERVICES n THUS INCREASING A HOSPITALS REVENUES #ONVERSELY COSTS RISE WHEN A PATIENTS CARE GOES AWRY AS ILLUSTRATED BY THE FOLLOWING lNDINGS !CCORDING TO A STUDY BY THE 5NIVERSITY OF -ISSOURI LOW QUALITY NURSING HOMES DIRECT CARE COSTS ARE PERCENT HIGHER THAN THOSE OF HIGH QUALITY ORGANIZATIONS ! RECENT -EDSTAT STUDY REPORTS THAT ON AVERAGE A GENERAL SURGERY WITHOUT COMPLICATIONS COSTS A HOSPITAL ABOUT n BUT COSTS RISE TO MORE THAN WHEN MULTIPLE COMPLICATIONS OCCUR 4HE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21 REPORTS THAT MEDICAL ERRORS ARE RESPONSIBLE FOR INJURY IN AS MANY AS ONE OUT OF EVERY HOSPITAL PATIENTS AN ESTIMATED TO PATIENTS DIE FROM MEDICAL ERRORS EACH YEAR )N A LARGE TEACHING HOSPITAL ERRORS IN HEALTHCARE HAVE BEEN CONSERVATIVELY ESTIMATED TO COST MORE THAN MILLION PER YEAR AND PREVENTABLE HEALTHCARE RELATED ERRORS COST THE 53 ECONOMY UP TO BILLION EACH YEAR
4HESE AND OTHER NEGATIVE REPERCUSSIONS OF POOR CARE ON HEALTHCARE PROVIDERS BUSINESS OUTCOMES ARE ENOUGH TO LEAD HEALTHCARE LEADERS FROM ALL FACETS OF THE INDUSTRY TO ASK THE SAME QUESTION )S THERE A FAIL PROOF SOLUTION FOR DELIVERING NEAR PERFECT QUALITY TO PATIENTS 4HE ANSWER IS NO (OWEVER DECADES OF 'ALLUP RESEARCH AND STATISTICAL ANALYSIS HAVE UNCOVERED TWO FACTORS THAT POSITIVELY AFFECT SAFE QUALITY HEALTHCARE HIRING AND DEVELOPING TALENTED NURSES AND ENGAGING NURSES AND OTHER HEALTHCARE EMPLOYEES IN THEIR WORK
3ELECTING THE 2IGHT 0EOPLE -OST HEALTHCARE LEADERS RECOGNIZE THAT POOR HIRING PRACTICES CAN PROVE DISRUPTIVE EVEN IN THE BEST RUN HEALTHCARE FACILITIES (OWEVER 'ALLUPS EXPERIENCE SHOWS THAT MOST ORGANIZATIONS TYPICALLY UNDERESTIMATE THE ADVERSE EFFECT OF HIRING NURSES WHO ARE NOT THE RIGHT lT LEADING TO lNANCIAL AND QUALITY COSTS SUCH AS LOWER PERSONAL PRODUCTIVITY AMONG NURSES INCREASED TURNOVER OF NURSING STAFF AND INCREASED MEDICAL ERRORS AND PROBLEMS WITH PATIENT CARE 'ALLUP HAS STUDIED THE RELATIONSHIP BETWEEN PEOPLES NATURAL TALENTS AND PERFORMANCE IN VARIOUS JOBS FOR MORE THAN YEARS 'ALLUPS METHODS FOR ASSESSING AND DEVELOPING EMPLOYEES HAVE BEEN RElNED THROUGH WORK WITH HUNDREDS OF THOUSANDS OF EMPLOYEES IN A WIDE VARIETY OF ORGANIZATIONS AND INDUSTRIES 4HIS WEALTH OF EXPERIENCE HAS LED TO A SCIENTIlC METHODOLOGY FOR THE DEVELOPMENT OF TALENT ASSESSMENTS THAT ARE PREDICTIVE OF JOB SUCCESS 4HIS WORK IS FOUNDED ON THE BELIEF THAT A PERSONS NATURAL TALENTS ARE STRONGLY PREDICTIVE OF FUTURE PERFORMANCE 'ALLUPS RESEARCH DEMONSTRATES THAT TOP PERFORMERS IN ALL JOBS THINK SPEAK AND ACT DIFFERENTLY FROM THEIR COUNTERPARTS n AVERAGE AND POOR PERFORMERS 4HE 'ALLUP .URSE)NSIGHT» A STANDARDIZED 7EB BASED SELECTION INSTRUMENT BASED ON THIS RESEARCH IS DESIGNED TO
$EBORAH ! 4OTO IS GLOBAL PRACTICE LEADER HEALTHCARE FOR 4HE 'ALLUP /RGANIZATION 3HE IS RESPONSIBLE FOR LEADING 'ALLUPS HEALTHCARE CONSULTING PRACTICE INCLUDING RESEARCH AND DEVELOPMENT TECHNOLOGY INNOVATION MARKETING AND CLIENT RELATIONSHIP MANAGEMENT 3HE SPECIALIZES IN THE AREAS OF CUSTOMER AND EMPLOYEE ENGAGEMENT TALENT BASED SELECTION STRENGTHS BASED DEVELOPMENT AND COMPREHENSIVE ORGANIZATIONAL IMPROVEMENT 3HE CAN BE REACHED AT $EBORAH?4OTO 'ALLUPCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
SGDãJDX ãSN ãHLOQ N UHMFãPT @ KH S X ã R@U H M Fã K H U D Rã @ M C ã Q D C T B H M Fã K@V RT H S R HELP HOSPITALS lND AND SELECT HIGHLY TALENTED NURSES 4OP NURSES EXHIBIT CERTAIN RECURRING PATTERNS OF TALENTS n INNATE THOUGHTS FEELINGS AND BEHAVIORS n AND .URSE)NSIGHT OFFERS HOSPITAL OR NURSE MANAGERS A CLEAR IDEA ABOUT THE TALENTS OF NURSING CANDIDATES SUCH AS ATTENTION TO DETAIL EMPATHY AND SELF CONlDENCE AND WHETHER THOSE CANDIDATES ARE THE RIGHT lT FOR THE JOB /NE 'ALLUP CASE STUDY OF A HEALTHCARE PROVIDER FOUND THAT USING .URSE)NSIGHT AND OTHER 'ALLUP CONSULTING SERVICES
PRODUCED NUMEROUS POSITIVE CHANGES TO SOME OF THE MOST VITAL BUSINESS ORIENTED ASPECTS OF NURSE SELECTION 5SING THESE TOOLS SAVED THE PROVIDER TIME DURING THE APPLICATION PROCESS WHICH WAS REDUCED FROM THREE WEEKS TO HOURS AND PRODUCED A POOL OF hTALENT CERTIlEDv APPLICANTS WHO HAD ALREADY lNISHED THEIR ASSESSMENTS AND COULD BE CONTACTED FOR INTERVIEWS WHEN NURSING POSITIONS BECAME AVAILABLE 4HE HEALTHCARE PROVIDER SAW THE NUMBER OF APPLICANTS AND THE NUMBER OF HIRES INCREASE WHILE BOTH VACANCY AND TURNOVER AMONG REGISTERED NURSES DECREASED
%XHIBIT %MPLOYEE %NGAGEMENT !VOIDABLE $EATHS
-ORTALITY )NDEX ,EAST %NGAGED RD 1UARTILE
ND 1UARTILE -OST %NGAGED
#ORRELATION REGRESSION ANALYSIS OF %NGAGEMENT 'RAND-EAN AND -ORTALITY )NDEX STATISTICALLY SIGNIlCANT AT N ¹ 4HE 'ALLUP /RGANIZATION 0RINCETON .* !LL RIGHTS RESERVED
%XHIBIT %MPLOYEE %NGAGEMENT !VOIDABLE #OMPLICATIONS
#OMPLICATION )NDEX ,EAST %NGAGED RD 1UARTILE
ND 1UARTILE -OST %NGAGED
#ORRELATION REGRESSION ANALYSIS OF %NGAGEMENT 'RAND-EAN AND #OMPLICATION )NDEX STATISTICALLY SIGNIlCANT AT N ¹ 4HE 'ALLUP /RGANIZATION 0RINCETON .* !LL RIGHTS RESERVED
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
SGDãJDX ãSN ãHLOQ N UHMFãPT @ KH S X ã R@U H M Fã K H U D Rã @ M C ã Q D C T B H M Fã K@V RT H S R %XHIBIT %MPLOYEE %NGAGEMENT -ALPRACTICE ,OSS ,EAST %NGAGED ND 1UARTILE
RD 1UARTILE -OST %NGAGED
¹ 4HE 'ALLUP /RGANIZATION 0RINCETON .* !LL RIGHTS RESERVED
'ALLUPS RESEARCH DEMONSTRATES THAT TOP PERFORMERS IN ALL JOBS THINK SPEAK AND ACT DIFFERENTLY FROM THEIR COUNTERPARTS )N FACT TURNOVER DECREASED FROM TO PERCENT IN JUST THE lRST YEAR THAT THIS PROVIDER WORKED WITH .URSE)NSIGHT AND 'ALLUP 7HEN HEALTHCARE PROVIDERS IDENTIFY THE OPTIMAL SET OF EMPLOYEE TALENTS THAT CONTRIBUTES TO OUTSTANDING PERFORMANCE AND USE THESE TALENTS TO GUIDE HIRING DECISIONS THEY ARE EQUIPPED TO ENHANCE INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE LEADING TO BETTER BUSINESS AND CLINICAL OUTCOMES
%NGAGING THE 2IGHT 0EOPLE )DENTIFYING AND HIRING THE RIGHT EMPLOYEES IS JUST THE lRST STEP HEALTHCARE LEADERS CAN TAKE IN THE SEARCH FOR CONSISTENT QUALITY CARE 'ALLUPS RESEARCH lNDS THAT WHILE THERE ARE MANY FACTORS THAT INmUENCE QUALITY OUTCOMES THE ENGAGEMENT LEVEL OF NURSING PROFESSIONALS AND PHYSICIANS HAS AN ACUTE IMPACT %MPLOYEE ENGAGEMENT AS MEASURED BY 'ALLUPS 1¹ SURVEY ;= IS THE LEVEL AT WHICH EMPLOYEES IN ANY INDUSTRY OR JOB ARE PSYCHOLOGICALLY COMMITTED TO THEIR ROLES AND WORKPLACES +EEP IN MIND THAT hENGAGEMENTv IS MORE THAN WHETHER EMPLOYEES LIKE THEIR JOBS OR ARE SATISlED WITH THEIR MANAGER OR BENElTS %NGAGEMENT IS A MEASURE OF THE DEGREE TO WHICH EMPLOYEES HAVE AN EMOTIONAL BOND TO THEIR JOBS AND THEIR EMPLOYERS 'ALLUP HAS PRODUCED RESEARCH SHOWING THAT ENGAGED EMPLOYEES IN NUMEROUS INDUSTRIES AND POSITIONS ARE MORE PRODUCTIVE THAN THEIR COUNTERPARTS INCLUDING
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
BEING MORE PROlTABLE MORE CUSTOMER FOCUSED SAFER AND LESS LIKELY TO LEAVE THEIR ORGANIZATIONS &OR HEALTHCARE PROVIDERS THESE FACTORS AFFECT NOT ONLY lNANCIAL SUCCESS BUT THEY CAN BE THE DIFFERENCE BETWEEN EXCELLENT CARE AND GRAVE CONSEQUENCES ! RECENT 'ALLUP STUDY EXAMINED THE KEY FACTORS THAT INmUENCE AVOIDABLE DEATHS AND COMPLICATIONS AS WELL AS THE HUMAN INmUENCE ON PATIENT SAFETY AND HEALTHCARE QUALITY 4HE STUDY FOUND THAT HOSPITALS WITH HIGHER NURSE ENGAGEMENT HAVE A STATISTICALLY LOWER MORTALITY INDEX SEE %XHIBIT AND COMPLICATION INDEX SEE %XHIBIT %ACH INDEX IS THE CALCULATED DIFFERENCE BETWEEN WHAT ACTUALLY OCCURS IN A HOSPITAL AND THE OUTCOMES THAT ARE EXPECTED BASED ON THE TYPE OF PATIENTS WHO ARE ADMITTED TO THAT PROVIDER )N FACT A REGRESSION ANALYSIS OF THE RELATIONSHIPS IN THE DATA OF MORE THAN HOSPITALS IDENTIlED NURSE ENGAGEMENT AS THE TOP PREDICTOR OF BOTH MORTALITY AND COMPLICATION RATES ACROSS HOSPITALS 3O WHILE MORTALITY OR COMPLICATIONS ARE SOMETIMES INEVITABLE DUE TO A PATIENTS CONDITION ENGAGED NURSES REDUCE THE NUMBER OF UNEXPECTED DEATHS AND ADVERSE OUTCOMES RELATED TO CARE %NGAGEMENT ALSO HAS A SIGNIlCANT EFFECT ON OTHER SPECIlC QUALITY INDICATORS &OR EXAMPLE A 'ALLUP STUDY COMPARING NOSOCOMIAL INFECTION RATES AT AN INTERNATIONALLY ACCLAIMED MEDICAL INSTITUTION FOUND THAT BLOODSTREAM INFECTIONS WERE TIMES HIGHER AMONG PATIENTS TREATED BY LESS ENGAGED UNITS 4HE SAME STUDY FOUND THAT PATIENTS OF LESS ENGAGED UNITS WERE TIMES MORE LIKELY TO GET SURGICAL SITE INFECTIONS THAN THOSE TREATED BY ENGAGED UNITS %MPLOYEE ENGAGEMENT NOT ONLY AFFECTS THE QUALITY OF PATIENT CARE ENGAGEMENT ALSO HAS A MARKED lNANCIAL IMPACT ON HEALTHCARE PROVIDERS 6OLUNTARY TURNOVER IS LOWER AMONG ENGAGED NURSES THAN AMONG DISENGAGED NURSES 'ALLUP DATA ALSO SHOW
SGDãJDX ãSN ãHLOQ N UHMFãPT @ KH S X ã R@U H M Fã K H U D Rã @ M C ã Q D C T B H M Fã K@V RT H S R
%MPLOYEE ENGAGEMENT NOT ONLY AFFECTS THE QUALITY OF PATIENT CARE IT ALSO HAS A MARKED FINANCIAL IMPACT ON HEALTHCARE PROVIDERS THAT THE LESS ENGAGED NURSES ARE THE MORE HOSPITALS STAND TO LOSE IN MALPRACTICE CLAIMS IN FACT HOSPITALS WITH THE LEAST ENGAGED NURSES PAY APPROXIMATELY MILLION MORE ANNUALLY IN MALPRACTICE CLAIMS THAN HOSPITALS WITH THE MOST ENGAGED NURSES SEE %XHIBIT !GAIN RECOGNIZING THAT THERE ARE MULTIPLE FACTORS IN THESE CLAIMS DATA SHOW THAT WHEN HOSPITAL LEADERS FOCUS ON CREATING A MORE ENGAGING WORKPLACE FOR NURSES THE HOSPITAL PAYS OUT LESS IN LEGAL SUITS FOR MALPRACTICE CLAIMS
3ELECTION AND %NGAGEMENT IN !CTION 4HESE AND OTHER lNDINGS FROM 'ALLUP ANALYSIS POINT TO EMPLOYEE ENGAGEMENT AS A CRITICAL FACTOR IN ENSURING SAFE HIGH QUALITY HEALTHCARE FOR A PROVIDERS PATIENTS 'ALLUP CONSULTS WITH HEALTH CARE PROVIDERS ACROSS THE COUNTRY TO HELP THEM UNDERSTAND THE LINKS BETWEEN SELECTION AND ENGAGEMENT 4HE GOAL OF THIS PARTNERSHIP IS FOR HEALTHCARE LEADERS TO REALIZE CONSISTENT QUALITY CARE ALONG WITH INCREASINGLY POSITIVE BUSINESS RESULTS -EDICAL #ENTER OF 0LANO 4EXAS IS ONE EXAMPLE OF SELECTION AND ENGAGEMENT IN ACTION MAKING THESE KINDS OF POSITIVE DIFFERENCES -EDICAL #ENTER OF 0LANO A (OSPITAL #ORPORATION OF !MERICA (#! FACILITY OFFERS MORE THAN PATIENT BEDS IN THE $ALLAS &ORT 7ORTH AREA ! *ANUARY 'ALLUP -ANAGEMENT *OURNAL ARTICLE REPORTED ON THE lVE YEAR TREK DURING WHICH THE -EDICAL #ENTER OF 0LANO OVERCAME HIGH STAFF TURNOVER AND COMPETITION FROM DOZENS OF OTHER HEALTHCARE PROVIDERS IN ITS AREA TO BECOME AN INDUSTRY LEADER )N THE YEAR BEFORE LEADERS AT THE FACILITY BEGAN WORKING WITH 'ALLUP STAFF TURNOVER WAS AT PERCENT OVERALL AND ABOUT PERCENT AMONG lRST YEAR EMPLOYEES n A LOSS OF ABOUT PEOPLE 4HIS CONSTANT mUX OF NURSES AND OTHER EMPLOYEES WAS COSTING THE FACILITY MONEY AND IT LED OFlCIALS TO BEGIN WORKING WITH 'ALLUP TO IMPLEMENT NURSE SELECTION AND EMPLOYEE ENGAGEMENT PRACTICES 4HE -EDICAL #ENTER OF 0LANO DECIDED lRST TO FOCUS ON EMPLOYEE ENGAGEMENT WHICH MEANT THE FACILITY WOULD USE 'ALLUPS 1 SURVEY TO MEASURE ITS EMPLOYEES CURRENT STATE OF ENGAGEMENT 7HEN THE HOSPITAL TOOK ITS INITIAL READING OF ENGAGEMENT IN JUST PERCENT OF EMPLOYEES WERE ENGAGED PERCENT WERE NOT ENGAGED AND PERCENT WERE ACTIVELY DISENGAGED ,EADERS AT THE -EDICAL #ENTER OF 0LANO WORKED WITH 'ALLUP CONSULTANTS TO FOCUS ON EACH OF THE 1 SURVEY ITEMS TO HELP IDENTIFY AND CHANGE NEGATIVE PRACTICES AT THE HOSPITAL 4HIS INCLUDED USING 'ALLUPS TALENT SELECTION TOOLS BEGINNING IN THE SPRING OF WHICH PAID IMMEDIATE DIVIDENDS TO THE FACILITY
h7ITHIN DAYS AFTER WE IMPLEMENTED THE SELECTION TOOLS WE STARTED SEEING TURNOVER NUMBERS GO DOWN ESPECIALLY THE NUMBERS ASSOCIATED WITH lRST YEAR EMPLOYEES 4HESE WERE THE EMPLOYEES WE WANTED TO KEEP BECAUSE WE HAD IDENTIlED THAT THEY POSSESSED THE TALENTS WE NEEDED v SAID *ERRY -C-ORROUGH VICE PRESIDENT OF HUMAN RESOURCES AT THE -EDICAL #ENTER OF 0LANO -C-ORROUGH ADDED THAT USING SUCH A TOOL HELPS BECAUSE IT IS SO DIFlCULT TO lND NURSES WHO CAN FACE THE CHALLENGES OF A TOUGH lELD LIKE HEALTHCARE AND STILL PROVIDE GREAT PATIENT CARE 4HROUGH THE END OF THE -EDICAL #ENTER OF 0LANO HAD SUCCEEDED IN IMPROVING ENGAGEMENT AMONG ITS EMPLOYEES WITH PERCENT OF ITS EMPLOYEES ENGAGED PERCENT NOT ENGAGED AND JUST PERCENT ACTIVELY DISENGAGED n A STARK CONTRAST TO ITS lRST RESULTS lVE YEARS EARLIER 4HE IMPORTANCE OF THIS INCREASE IS OBVIOUS ACCORDING TO LEADERS AT THE FACILITY h4HERE IS A DElNITE TIE BETWEEN OUR IMPROVEMENT IN NURSE ENGAGEMENT AND QUALITY OUTCOMES v SAID #ATHY $YKE VICE PRESIDENT OF NURSING OPERATIONS FOR THE -EDICAL #ENTER OF 0LANO h!N ENGAGED NURSE GOES THE EXTRA MILE TO ENSURE THE PROVISION OF SAFE COMPETENT AND COMPASSIONATE CAREv 3ANDY (AIRE CHIEF NURSING OFlCER AT THE FACILITY AGREED SAYING h4HERE IS NO QUESTION THAT NURSE ENGAGEMENT AFFECTS QUALITY 7EVE INITIATED SHARED GOVERNANCE COUNCILS ON EVERY NURSING UNIT TO IMPROVE CARE BASED ON THE INPUT AND THE DECISIONS OF THE BEDSIDE NURSE n NOT TOP DOWN DIRECTIVES !LLOWING NURSES A VOICE IN THEIR PRACTICE NOT ONLY FOSTERS ENGAGEMENT BUT ALSO QUALITY OUTCOMESv 4HESE RESULTS ARE POSITIVE AND INSPIRING BUT ULTIMATELY THERE NEEDS TO BE AN IMPACT ON HOSPITALS BUSINESS OUTCOMES !S THE ENGAGEMENT LEVELS AND THE SELECTION PROCESSES AT THE -EDICAL #ENTER OF 0LANO INCREASED IN QUALITY SO TOO DID THE HOSPITALS PROlTS )N THE FACILITY REACHED MILLION IN GROSS REVENUE
"OTTOM ,INE 0OSITIVE lNANCIAL OUTCOMES ALONG WITH STATISTICS SHOWING LOWER MORTALITY AND COMPLICATION INDEXES AND LOWER TURNOVER RATES ARE JUST A FEW REASONS WHY HEALTHCARE INSTITUTIONS MUST SERIOUSLY FOCUS ON SELECTING AND ENGAGING THE RIGHT PEOPLE (EALTHCARE COMPANIES WILL CONTINUE TO DEVELOP NEW TECHNOLOGIES AND RElNE STRATEGIES FOR INCREASING QUALITY n AND THESE INNOVATIONS DO INmUENCE QUALITY (OWEVER SELECTING AND ENGAGING THE RIGHT PEOPLE MUST BE KEY STRATEGIC INITIATIVES FOR HEALTHCARE LEADERS IF THEY TRULY WANT TO TRANSFORM THE QUALITY OF THEIR ORGANIZATIONS %NDNOTE 'ALLUPS 1¸ SURVEY MEASURES KEY AREAS THAT CONSISTENTLY RELATE TO EMPLOYEE RETENTION PRODUCTIVITY PROlTABILITY CUSTOMER LOYALTY AND SAFETY "ASED ON MORE THAN YEARS OF IN DEPTH RESEARCH AND APPLICATION THESE AREAS HAVE BEEN DISTILLED INTO STATEMENTS THAT n ON THE BASIS OF EMPLOYEE AGREEMENT OR DISAGREEMENT n PROVIDE INSIGHTS INTO THE HEALTH OF A COMPANY
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
1UALITY AND THE 2EVENUE #YCLE (EALTHCARE PROVIDERS ARE REALIZING THAT TO BE REGARDED AS QUALITY INSTITUTIONS THEY MUST BE MORE PATIENT FRIENDLY IN THE WAY PATIENTS MUST ACCESS MEDICAL SERVICES AND THE MEANS THROUGH WHICH SERVICES ARE PAID "Y *OSEPH - !LBIAN *IM (ORNE AND "ELLINDA # -INKNER 0RICEWATERHOUSE#OOPERS
(
OSPITALS EXPEND GREAT EFFORT TO MONITOR EVALUATE AND IMPROVE THE SAFETY AND QUALITY OF THE CARE THEY DELIVER MEASURED BY POSITIVE CLINICAL TREATMENT AND OUTCOME INDICATORS (OWEVER A CUSTOMER CENTRIC DElNITION OF QUALITY MUST ENCOMPASS THE OVERALL PATIENT EXPERIENCE 0ROVIDERS NEED TO BROADEN THEIR DElNITION OF QUALITY TO INCLUDE THE ADMINISTRATIVE AND lNANCIAL ACTIVITIES ASSOCIATED WITH THE PATIENT CARE ENCOUNTER 4RANSPARENCY IN PRICING ADMINISTRATIVE ACTIVITIES AND OTHER FACTORS ALSO AFFECT A PATIENTS BROADER EVALUATION OF QUALITY 4HE INCREASING PREVALENCE OF HIGH DEDUCTIBLE HEALTH PLANS ($(0S AND CONSUMER DIRECTED HEALTH PLANS #$(0S OFTEN INCORPORATING HEALTHCARE SAVINGS ACCOUNTS (3!S OR HEALTH REIMBURSEMENT ARRANGEMENTS (2!S MEAN JUST ONE THING 0ATIENTS ARE PAYING FOR MORE OF THEIR HEALTHCARE EXPENSES OUT OF POCKET 'IVEN THESE TRENDS PROACTIVE PROVIDERS NEED TO BE ABLE TO DEMONSTRATE HIGH QUALITY AND REASONABLE COST AND HAVE THE ABILITY TO DETERMINE THE PATIENTS lNANCIAL RESPONSIBILITY AND COLLECT IT OR AGREE UPON lNANCIAL ARRANGEMENTS BEFORE OR AT THE TIME OF SERVICE 0ATIENTS DO NOT CURRENTLY AND PERHAPS NEVER WILL CHOOSE HEALTHCARE PROVIDERS IN THE SAME WAY THEY SHOP FOR OTHER PRODUCTS AND SERVICES .EVERTHELESS PATIENTS AND REGULATORS ARE INCREASINGLY DEMANDING THAT PROVIDERS MAKE AVAILABLE PRICING AND QUALITY DATA 0ATIENT CENTRIC ACCESS AND SERVICE DELIVERY PRACTICES OR THE LACK THEREOF HAVE NOT YET APPRECIABLY AFFECTED PATIENT VOLUME AT HOSPITALS SURVEYED BY 0RICEWATERHOUSE#OOPERS IN CONJUNCTION WITH THE (EALTHCARE &INANCIAL -ANAGEMENT !SSOCIATION (&-!
SEE SIDEBAR ;= BUT IMPROVING THE PATIENTS HOSPITAL EXPERIENCE IS INCREASINGLY SEEN AS A MARKET DIFFERENTIATOR
#HALLENGES AND "URDENS FOR 0ROVIDERS &EW INSURED PATIENTS UNDERSTAND THEIR HEALTH BENElTS OR THE ACTUAL TOTAL COST OF THE MEDICAL SERVICES THEY RECEIVE -ANY DO NOT KNOW OR UNDERSTAND THEIR COVERAGE RULES LIMITATIONS AND EXCLUSIONS OUT OF POCKET RESPONSIBILITIES OR EXPECTED COSTS FOR EITHER INPATIENT OR OUTPATIENT SERVICES !S AN EXAMPLE IN A STUDY RELEASED BY 'REAT 7EST (EALTHCARE IN !UGUST PARTICIPANTS AVERAGE PREDICTION PRICE OF A (ONDA !CCORD WAS WITHIN OF ACTUAL COST HOWEVER THEIR PREDICTION OF A FOUR DAY HOSPITAL STAY WAS OFF BY ;= 2IGHT NOW TRADITIONAL BILLING AND PRICING PRACTICES REVOLVE AROUND -EDICARE -EDICAID AND MANAGED CARE PLANS !S OF THE ROUGHLY MILLION !MERICANS INSURED BY ($(0S WERE STILL A RELATIVELY SMALL MINORITY PERCENT OF PRIVATELY INSURED ADULTS UNDER AGE HAD DEDUCTIBLES OF OR MORE ;= 4HIS PICTURE HOWEVER IS CHANGING RAPIDLY $EDUCTIBLES COPAYS AND COINSURANCE COSTS ARE INCREASING SIGNIlCANTLY EVEN IN TRADITIONAL HEALTH PLANS 4HE ANNUAL AMOUNT OF PER PERSON SPENDING FOR HEALTHCARE HAS INCREASED FROM IN TO A PROJECTED FOR ;= 0ROVIDERS INTERESTED IN PROTECTING OR GAINING MARKET SHARE MUST PREPARE FOR THE FAST APPROACHING TIME WHEN PATIENTS WILL SCRUTINIZE AND BASE THEIR HEALTHCARE DECISIONS AND THEIR SPENDING ON PERFORMANCE METRICS
*OSEPH - !LBIAN -"! IS A PARTNER IN 0RICEWATERHOUSE#OOPERS (EALTHCARE #ONSULTING PRACTICE AND HAS YEARS OF EXPERIENCE WITH HEALTHCARE AND ENTREPRENEURIAL COMPANIES (E SPECIALIZES IN OPERATIONS IMPROVEMENT AND lNANCIAL MANAGEMENT DRAWING FROM HIS ADMINISTRATIVE AND CONSULTING EXPERIENCE WITHIN THE HEALTHCARE INDUSTRY (E ALSO HAS EXTENSIVE EXPERIENCE IN OPERATIONAL AND lNANCIAL PLANNING ENGAGEMENTS AND LEADS 0W#S PROVIDER CONSUMERISM EFFORTS (E CAN BE REACHED AT JOEALBIAN USPWCCOM *IM (ORNE IS A MANAGING DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E HAS OVER YEARS OF HEALTHCARE INDUSTRY EXPERIENCE IN PERFORMANCE IMPROVEMENT IN HOSPITAL REVENUE CYCLE CLINICAL DOCUMENTATION AND QUALITY AND lNANCIAL MANAGEMENT (E CAN BE REACHED AT JIMHORNE USPWCCOM "ELLINDA # -INKNER IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE 3HE HAS YEARS OF EXPERIENCE IN THE HEALTHCARE INDUSTRY FOCUSING ON TRAINING AND DEVELOPMENT IN THE AREAS OF THE HOSPITAL AND PROVIDER REVENUE CYCLE AS WELL AS PAYER OPERATIONS 3HE CAN BE REACHED AT BELLINDACMINKNER USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
PT@KHS Xã @ M C ã S G D ã Q D U D M T D ã BXB KD -ANY HEALTHCARE PROVIDERS HAVE ALREADY BEEN WORKING TO STREAMLINE AND INTEGRATE THEIR ADMITTING SCHEDULING AND REVENUE CYCLE PROCESSES TO INCREASE PATIENT SATISFACTION -OTIVATED BY QUALITY CONSIDERATIONS AS WELL AS THE DESIRE TO REDUCE POTENTIAL BAD DEBT THEY ARE ADDING HUMAN AND TECHNOLOGICAL RESOURCES TO MOVE hBACK OFlCEv FUNCTIONS TO THE PRE SERVICE PHASE OF A PATIENTS HOSPITAL EXPERIENCE 7HEN A PHYSICIAN OR PATIENT CALLS TO REGISTER FOR OR SCHEDULE SERVICES HOSPITAL EMPLOYEES ARE BEGINNING TO ASK THE RIGHT QUESTIONS ABOUT A PATIENTS COVERAGE lNANCIAL RESPONSIBILITY AND ABILITY TO PAY ,EGISLATORS ARE CALLING FOR HOSPITALS TO CHANGE THEIR PRACTICES IN ORDER TO FAIRLY AND COMPLETELY REPORT THEIR COMMUNITY BENElT AND CLARIFY THEIR POLICIES TO CLEARLY DISTINGUISH CHARITY CARE FROM BAD DEBT
@0ATIENTS LOOK AT HOW THEY ARE TREATED AND THEY NOTICE TECHNICAL QUALITY MORE THAN PEOPLE REALIZE PARTICULARLY WHEN THEY SEE A LACK OF COORDINATION BETWEEN THEIR DOCTORS n -ARGARET % /+ANE PRESIDENT OF THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1! (IGH PERFORMING HOSPITALS ARE FOCUSED ON ENHANCING SYSTEMS AND PROCEDURES TO BE ABLE TO ROUTINELY PROVIDE REALISTIC ESTIMATES OF WHAT A PATIENTS MEDICAL SERVICES WILL COST HOW MUCH WILL BE COVERED BY INSURANCE AND HOW MUCH THE PATIENT WILL HAVE TO PAY OUT OF POCKET FOR NONEMERGENCY NONCOMPLICATED HOSPITAL SERVICES 4HESE PRICES ARE OFTEN QUITE DIFFERENT FROM HOSPITAL hLISTv CHARGES DUE TO NEGOTIATED MANAGED CARE CONTRACTUAL DISCOUNTS MAKING AVERAGE CHARGES FOR SIMILAR CASES SOMEWHAT IRRELEVANT $ISCUSSIONS REGARDING PATIENT lNANCIAL RESPONSIBILITY CAN BE STRESSFUL SO IT MAKES SENSE TO HANDLE lNANCIAL MATTERS IN ADVANCE 4HEN WHEN PATIENTS ARRIVE AT THE HOSPITAL THEY CAN FOCUS ON THE CLINICAL ENCOUNTERS WITH CAREGIVERS RATHER THAN ADMINISTRATIVE TRANSACTIONS WITH lNANCIAL MANAGERS %VENTUALLY FOR MANY STANDARD PROCEDURES PATIENTS WILL BE ABLE TO GO TO A PROVIDERS WEBSITE INPUT A PHYSICIAN PROVIDED DIAGNOSIS PROCEDURE DESCRIPTION AND INSURANCE DETAILS AND RECEIVE A REPORT SUMMARIZING ANTICIPATED COSTS AND A BREAKDOWN OF THEIR COSTS AND WHAT THEIR INSURER WILL PAY 4HEY WILL THEN BE ABLE TO REGISTER FOR AND SCHEDULE SERVICES FROM A HOME COMPUTER PAY THEIR RESPONSIBLE PORTIONS IN ADVANCE OR ON THE DAY OF SERVICE CHECK IN BY USING A POINT OF SERVICE KIOSK AND GO DIRECTLY TO THE CLINICAL SERVICE AREA KEEPING WAIT TIMES TO A MINIMUM
)N A FEW YEARS SUCH A SCENARIO MAY BE COMMONPLACE BUT IT IS NOT TODAY -ANY IMPEDIMENTS HAMPER SUCH A COMPREHENSIVE PATIENT CENTRIC SERVICE MODEL THOUGH IN SOME ISOLATED LOCATIONS AROUND THE COUNTRY THESE CAPABILITIES ARE IN PLACE /NE CHALLENGE IS THAT PAYERS LACK THE PROCESSES AND TECHNOLOGY TO PROVIDE REAL TIME INFORMATION ABOUT A PATIENTS ELIGIBILITY AND DEDUCTIBLE STATUS 0ROVIDERS ARE TRYING TO SERVE AS FACILITATORS OBTAINING DATA FROM THE PAYER ADDING IN THEIR COST ESTIMATES AND HELPING PATIENTS UNDERSTAND HOW MUCH IS COVERED AND HOW MUCH THEY WILL BE HELD RESPONSIBLE FOR PAYING 0ROVIDERS HAVE MADE CONSIDERABLE PROGRESS IN IMPROVING PRE REGISTRATION AND PRE SERVICE ACTIVITIES 4HEY HAVE BEGUN TO ASSESS THE NEED TO CHANGE JOB DESCRIPTIONS COMPETENCIES AND THE ORGANIZATIONAL STRUCTURE OF THEIR REVENUE CYCLE TEAMS 2EGISTRATION PROFESSIONALS WILL NEED TO UNDERSTAND AND GUIDE PATIENTS THROUGH THE INTRICACIES OF THEIR INSURANCE PLANS IN PARTICULAR HIGH DEDUCTIBLE CONSUMER DIRECTED HEALTH PLANS 4HEY WILL NEED TO LEARN HOW TO HANDLE PATIENTS UNACCUSTOMED TO PAYING FOR SERVICES BEFORE THE INSURANCE HAS PAID 3OME PROVIDERS ARE CONSIDERING EXPANDING THE ROLE OF THE lNANCIAL COUNSELOR SO THEY CAN COUNSEL PATIENTS ON NEW OPTIONS FOR PAYING THEIR MEDICAL BILLS 0ROVIDING PATIENT FRIENDLY lNANCIAL PRACTICES AT THE BEGINNING OF A PATIENT RELATIONSHIP IS VITAL TO CREATING A LOYAL POPULATION OF SATISlED CUSTOMERS AND A DISCREET AND COMPASSIONATE CLINICAL EXPERIENCE
!TTRIBUTES OF A 0ATIENT #ENTRIC 3ERVICE -ODEL 0ATIENT !CCESS AND 3CHEDULING -ANY HEALTHCARE ORGANIZATIONS ARE WORKING TO REORGANIZE RESTRUCTURE AND RE ENGINEER SCHEDULING PROCESSES FOR ALL INPATIENT AND OUTPATIENT SERVICES $EMOGRAPHIC MEDICAL AND INSURANCE DATA NEED TO BE SHARED ACROSS THE ENTIRE DELIVERY NETWORK SO THAT FOR EXAMPLE A PATIENT WHO IS SENT BY HER PHYSICIAN TO A DIAGNOSTIC LAB FOR BLOOD WORK THEN TO A RADIOLOGY FACILITY FOR AN 8 RAY OR TO THREE DIFFERENT DEPARTMENTS WITHIN THE SAME HOSPITAL WILL NOT HAVE TO REPEAT THE INFORMATION SHE HAS ALREADY PROVIDED AT ANOTHER LOCATION 0RE lNANCIAL CLEARANCE AND CONVENIENCE ARE ALSO IMPORTANT AND SOME ORGANIZATIONS ARE ADDRESSING THIS ANGLE OF PATIENT SATISFACTION BY BUILDING 7EB BASED PORTALS THAT ALLOW PATIENTS TO BOOK APPOINTMENTS IN REAL TIME VIA SELF SERVICE TECHNOLOGIES /THER PROVIDERS ARE COORDINATING THEIR RESOURCES THROUGHOUT THEIR SYSTEMS SO THAT THEY ARE CAPABLE OF PROVIDING SERVICES AT THE PATIENTS CONVENIENCE
"ILLING 0RICING TRANSPARENCY OR LETTING PATIENTS KNOW THE TOTAL COST OF SERVICES COMPONENTS OF THE TOTAL COST AND THEIR UP FRONT lNANCIAL RESPONSIBILITY IS BECOMING INCREASINGLY IMPORTANT TO CONSUMERS 4HE OBJECTIVE IS TO GIVE PATIENTS EASY ACCESS TO UNDERSTANDABLE INSURANCE SPECIlC INFORMATION THAT ENABLES
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
PT@KHS Xã @ M C ã S G D ã Q D U D M T D ã BXB KD 7HAT 0ATIENTS 7ANT 0RICEWATERHOUSE#OOPERS RECENTLY CONDUCTED A SURVEY ON BEHALF OF THE (&-! IN SUPPORT OF (&-!S 0ATIENT &RIENDLY "ILLING 0ROJECT )NITIATIVE FOCUSING ON CONSUMERISM IN HEALTHCARE WHICH INCLUDED SPONSOR ORGANIZATIONS n HOSPITALS HEALTH SYSTEMS INTEGRATED DELIVERY NETWORKS AND PHYSICIAN PRACTICES n CONSIDERED TO BE PROGRESSIVE IN ADDRESSING CONSUMER ISSUES FROM THE PROVIDER PERSPECTIVE 4HE REPORT SUGGESTS STRATEGIES THAT PROVIDERS OUGHT TO CONSIDER IN ORDER TO FACILITATE PATIENT ACCESS AND SCHEDULING BECAUSE 0ATIENTS LIKE THE EXPERIENCE OF CONVENIENT SCHEDULING ACROSS THE HEALTH SYSTEMPHYSICIAN NETWORK 0ATIENTS DO NOT LIKE MULTIPLE LENGTHY PHONE CALLS OR CONVERSATIONS WITH POORLY TRAINED STAFF WHO CANNOT RELIABLY ACCESS THE INFORMATION NEEDED TO SCHEDULE APPOINTMENTS COMPLETE NECESSARY FORMS AND PROVIDE INFORMATION ON THE COVERAGE AND COST OF THEIR SPECIlC SERVICE REQUIREMENTS -ANY CONSUMERISM FOCUSED RETAIL ORIENTED PATIENTS WANT TO BE ABLE TO SCHEDULE SERVICES AT TIMES THAT ARE CONVENIENT FOR THEM -ANY PATIENTS FAVOR HAVING MORE mEXIBILITY IN THE SCHEDULING PROCESS 0ATIENTS DO NOT WANT TO PROVIDE lNANCIAL AND DEMOGRAPHIC INFORMATION MULTIPLE TIMES DURING THEIR ENCOUNTER WITH THE HEALTHCARE SYSTEM 0ATIENTS DO NOT APPRECIATE FREQUENT AND UNNECESSARY REPEATED REQUESTS FOR INFORMATION THAT SHOULD BE SHARED THROUGHOUT THE SYSTEM AND ACCESSIBLE TO MEDICAL PERSONNEL AT EVERY POINT OF CONTACT 4HE REPORT ALSO SUGGESTS STRATEGIES FOR ACHIEVING SIMPLIlED CHARGE AND PAYMENT STRUCTURES AGREEMENT ON PAYMENT EXPECTATIONS AND PAYMENT TERMS AND APPROPRIATE STAFF SUPPORTS BECAUSE 0ATIENTS WANT TO RECEIVE BILLS THAT ARE EASY TO UNDERSTAND !DDITIONALLY PATIENTS DESIRE ACCURATE COMMUNICATION IN REGARD TO THE AMOUNT THEY OWE AND THAT IT BE BASED ON A RATIONAL AND UNDERSTANDABLE CHARGE AND REIMBURSEMENT SYSTEM 0ATIENTS PREFER SUMMARY COST INFORMATION RATHER THAN OVERLY DETAILED BILLS THAT CORRESPOND TO INCOMPREHENSIBLE ITEMS IN THE CHARGE DESCRIPTION MASTER #$- 0ATIENTS WANT TO UNDERSTAND THEIR INSURANCE COVERAGE AND ESTIMATED lNANCIAL RESPONSIBILITY AS EARLY IN THE PROCESS AS POSSIBLE 0ATIENTS APPRECIATE FRIENDLINESS HELPFULNESS AND PROFESSIONALISM !T THE POINT OF REGISTRATION AND DURING THE MEDICAL ENCOUNTER PATIENTS DESIRE FOCUSED PROVIDERS 0ATIENTS WANT PROACTIVE COMMUNICATION WITH THEIR PHYSICIANS AND PROVIDERS #OMMUNICATION PERTAINING TO BOTH CLINICAL AND lNANCIAL DETAILS OUGHT TO BE OF A CONSTRUCTIVE AND BALANCED NATURE
THEM TO DETERMINE THE COSTS OF THEIR OWN HEALTHCARE IN ADVANCE OF RECEIVING NONEMERGENCY AND NONCOMPLICATED SERVICES %MERGENCY ADMISSIONS SHOULD RECEIVE HOUR TURNAROUND OF COVERAGE INFORMATION AND PAYMENT EXPECTATIONS 4RADITIONALLY PATIENTS HAVE HAD LITTLE CONTROL OVER WHAT GETS CHARGED TO THEIR ACCOUNTS AND BECAUSE THEY HAVE NOT BEEN INVOLVED IN THE lNANCIAL ASPECT OF THEIR CARE THERE HAS BEEN LITTLE INCENTIVE TO TAKE RESPONSIBILITY TO PARTICIPATE 4ODAY MANY PATIENTS ARE WILLING TO TAKE THE RESPONSIBILITY TO PARTICIPATE IN THEIR OWN HEALTHCARE DECISIONS AND TO HELP CONTROL THE COSTS OF THEIR CARE 0ATIENTS OFTEN RECEIVE BILLS THAT ARE DIFlCULT TO UNDERSTAND AND RARELY CORRESPOND TO THE HOSPITALS EXPECTED PAYMENT FOR SERVICES SUPPLIES AND RESOURCES &OR MOST PATIENTS SUCH ITEMIZED BILLS ARE MEANINGLESS AT BEST AND CAUSE FOR SOURED RELATIONS WITH PROVIDERS &ORWARD LOOKING PROVIDERS ARE WORKING TO RATIONALIZE AND SIMPLIFY THEIR PRICING STRUCTURES BY RE ESTABLISHING RATES BASED ON A RELATIONSHIP TO MARKET
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
RATES OR OFFERING SERVICE PACKAGES (OWEVER REDESIGNING A HOSPITALS ENTIRE CHARGE STRUCTURE IS DIFlCULT BECAUSE PROVIDERS HAVE HISTORICALLY COMPUTED CHARGES USING COMPLEX ALGORITHMS DESIGNED TO ASSURE THAT THE REIMBURSEMENT RECEIVED FROM PAYERS WITH NEGOTIATED CONTRACTS IS SUFlCIENT TO COVER THE OPERATING COSTS AND UNCOMPENSATED CARE (OSPITALS ALSO NEED TO ASSESS PRICE CONSIDERATIONS FOR INPATIENT VERSUS OUTPATIENT SERVICES 2ADIOLOGY FACILITIES IMAGING CENTERS URGENT CARE CLINICS AND OTHER AMBULATORY SERVICE CENTERS HAVE A VOLUME AND COST STRUCTURE THAT MAY ENABLE THEM TO PRICE THEIR SERVICES BELOW WHAT MOST HOSPITALS MUST CHARGE (OSPITALS MAY NEED TO CHALLENGE CURRENT OUTPATIENT PRICING POLICIES DEPENDING ON CURRENT CAPACITY AND DEMAND ANDOR CHALLENGE THE ABILITY TO hSTEERv PRICE SENSITIVE CONSUMERS TO OUTPATIENT FACILITIES TO REMAIN COMPETITIVE WITH THESE FREESTANDING FACILITIES 7ITH INCREASING SCRUTINY OF PRICING HOSPITAL EXECUTIVES ARE LOOKING FOR TECHNOLOGIES AND PRACTICES THAT WILL LET THEM GO BEYOND
PT@KHS Xã @ M C ã S G D ã Q D U D M T D ã BXB KD
@&OR SO MANY CONDITIONS PEOPLE DONT HAVE TIME TO COMPARISON SHOP 4HEY RELY ON REPUTATION AND WORD OF MOUTH (OWEVER PUBLIC REPORTING IS IMPORTANT TO GET PROVIDERS TO UNDERSTAND HOW THEY ARE PERFORMING AND HOW THEY COMPARE AGAINST PEERS AND LEAD THEM TO MAKE NEEDED IMPROVEMENTS -ARIBETH 3HANNON DIRECTOR OF THE HOSPITALS AND NURSING HOMES PROGRAM OF THE #ALIFORNIA (EALTH#ARE &OUNDATION MERELY POSTING THEIR #$-S AND LISTS OF APPROPRIATE SERVICES FOR EACH DIAGNOSIS RELATED GROUP ON A WEBSITE ACCESSIBLE TO PATIENTS 4HEY HOPE TO PROVIDE MORE ACCURATE INDIVIDUALIZED COST PROJECTIONS AND ESTIMATES OF A PATIENTS lNANCIAL RESPONSIBILITY BY TAKING INTO ACCOUNT THE SPECIlC PLAN DETAILS NECESSARY TO CALCULATE PAYER AND PATIENT lNANCIAL RESPONSIBILITIES VIA COMMUNICATION WITH THAT PATIENTS INSURANCE COMPANY /NE BARRIER IS THAT MEDICAL COMPLICATIONS AND COMORBIDITIES CAN SUBSTANTIALLY INCREASE THE COST OF A PATIENTS HOSPITALIZATION OR OTHER CARE 3IMILAR TO ESTIMATES FOR AUTOMOTIVE REPAIR WHERE THE MECHANIC CANT BE SURE HOW MUCH THE REPAIR WILL COST UNTIL HE hDIAGNOSES THE PROBLEM v ANTICIPATED BILLING FOR A PATIENTS HEALTHCARE WILL OFTEN NEED ADJUSTMENT OR SUPPLEMENTATION FOLLOWING THE PATIENTS DISCHARGE
)NFORMATION AND %DUCATION )N ADDITION TO UNDERSTANDABLE PRICING INFORMATION PATIENTS INCREASINGLY WANT TO COMPARE PROVIDERS QUALITY RATINGS ! NUMBER OF GOVERNMENT AND PRIVATE WEBSITES ARE STARTING TO PROVIDE SCORECARDS ON HOSPITALS 4HE INDUSTRY IS CURRENTLY ENGAGED IN MUCH DISCUSSION ABOUT WHO SHOULD TAKE THE LEAD IN PROVIDING PATIENTS THIS INFORMATION 3OME PROVIDERS THAT WERE INTERVIEWED FOR THE JOINT 0W#(&-! SURVEY INDICATED THAT PATIENTS hTRUSTv INFORMATION MORE WHEN IT COMES DIRECTLY FROM THE HOSPITAL
(OWEVER PROVIDERS CAN ONLY GIVE INFORMATION ABOUT THEIR OWN PERFORMANCE
4EAMWORK 0ATIENT FRIENDLY PRACTICES WILL REQUIRE IMPROVED TRANSMISSION OF INFORMATION BETWEEN PHYSICIANS AND HOSPITALS &OR A HOSPITAL TO ACCURATELY ESTIMATE A PATIENTS OUT OF POCKET EXPENSES PRIOR TO SERVICE IT MUST HAVE INFORMATION ON DIAGNOSIS AND APPROPRIATE CLINICAL PROCEDURES FROM THE PHYSICIAN ALONG WITH ANY INSURANCE INFORMATION THE PATIENT HAS ALREADY PROVIDED (OSPITALS ALSO DEPEND ON PHYSICIAN PERFORMANCE FOR THEIR QUALITY RANKINGS ! HOSPITAL IS EVALUATED IN PART ON ITS CLINICAL OUTCOMES AND THESE ARE AN AGGREGATE OF PHYSICIANS OUTCOMES AND HOW EFlCIENTLY THEY PRACTICE (OSPITALS AND PHYSICIANS NEED TO COLLABORATE AND EDUCATE EACH OTHER TO DELIVER GOOD OUTCOMES AND EFlCIENT CARE
)TS THE 0ATIENT &IRST ,AST !LWAYS 0RICING AND QUALITY TRANSPARENCY ARE GOING TO BE CRITICALLY IMPORTANT IN THE EMERGING HEALTHCARE SYSTEM (OWEVER ALL QUALITATIVE ASPECTS OF THE SERVICE ENCOUNTER INCLUDING PATIENT SATISFACTION ARE CRITICAL COMPONENTS TO THE VALUE EQUATION 0ATIENTS AND THEIR PHYSICIANS BOTH WANT QUALITY SERVICE AND VALUE FOR MONEY SPENT $ELIVERING PATIENT FRIENDLY QUALITY OF CARE AND THE RESPECTFUL HELPFUL DISPOSITION OF lNANCIAL MATTERS ARE VITAL IN CREATING SATISlED PATIENTS %NDNOTES h#ONSUMERISM IN (EALTH #ARE !N )NITIATIVE OF THE 0ATIENT &RIENDLY "ILLING 0ROJECT v 3UMMER (EALTHCARE &INANCIAL -ANAGEMENT !SSOCIATION h#ONSUMER !TTITUDES 4OWARD (EALTH #ARE v 'REAT 7EST (EALTHCARE !UGUST HTTPWWWGREATWESTHEALTHCARECOM#3TUDIES AND3URVEYS$OCUMENT,IBRARY'REAT 7EST(EALTHCARE#ONSUMER !TTITUDES3URVEY?PDF 4HE #OMMONWEALTH &UND "IENNIAL (EALTH )NSURANCE 3URVEY HTTPWWWCMWFORGPUBLICATIONSPUBLICATIONS?SHOWHTM DOC? ID h3NAPSHOT (EALTHCARE #OSTS v %DITION #ALIFORNIA (EALTH#ARE &OUNDATION -ARCH $ATA 3OURCE #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3 /FlCE OF THE !CTUARY ACCESSED AT HTTP WWWCHCFORGDOCUMENTSINSURANCE(EALTH#ARE#OSTSPDF
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
1! 5SING 3IX 3IGMA TO )MPROVE 1UALITY IN (EALTHCARE ! 2OUNDTABLE $ISCUSSION @4O IMPROVE IS TO CHANGE TO BE PERFECT IS TO CHANGE OFTEN n 3IR 7INSTON #HURCHILL FORMER PRIME MINISTER 5+
3USAN -C'ANN "EN -ILES !DRIENNE -ASTER "LACK "ELT -ASTER "LACK %LBERFELD -ASTER "LACK "ELT AT 6IRTUA (EALTH "ELT AT 3T *OHN (EALTH $ETROIT AND DIRECTOR AT 6IRTUA (EALTH !LSO PROJECT OF STRATEGIC TEAM DIRECTOR FOR PARTNERSHIP BUILDING A NEW HOSPITAL IN .OVA -ICHIGAN
%D 0OPOVICH VICE PRESIDENT OF ENTERPRISE EXCELLENCE AT "OCA 2ATON &LORIDA #OMMUNITY (OSPITAL
3
IX 3IGMA A DATA DRIVEN QUALITY IMPROVEMENT METHODOLOGY ORIENTED TOWARD STRIVING FOR PERFECTION HAS BEEN ADAPTED BY MANY INDUSTRIES INCLUDING HEALTHCARE 3IX 3IGMA ALLOWS AN ORGANIZATION TO QUANTIFY HOW MANY hDEFECTSv ARE IN A PROCESS THE DEFECTS CAN BE SYSTEMATICALLY ELIMINATED TO ZERO 3IX 3IGMA %XHIBIT 3IGMA 0ERFORMANCE ,EVELS n /NE TO 3IX 3IGMA 3IGMA ,EVEL
$EFECTS 0ER -ILLION /PPORTUNITIES $0-/
4ABLE TAKEN FROM I3IX3IGMA ACCESSED *UNE AVAILABLE AT HTTPWWWISIXSIGMACOMLIBRARYCONTENTCAASP
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
*IM +ARAGIORGIS 'LENN #ROTTY MANAGING DIRECTOR -$ CHIEF OPERATING OFlCER FOR BUSINESS #HARLESTON !REA TRANSFORMATION ()0 (EALTH 0LAN -EDICAL #ENTER
$EBBIE 9OUNG VICE PRESIDENT OF QUALITY 'REEN "ELT #HARLESTON !REA -EDICAL #ENTER
IS ACHIEVED WHEN THERE ARE NO MORE THAN DEFECTS PER MILLION OPPORTUNITIES IN A PROCESS;= 4HE FUNDAMENTAL OBJECTIVE OF 3IX 3IGMA IS TO IMPLEMENT A MEASUREMENT BASED STRATEGY THAT FOCUSES ON PROCESS IMPROVEMENT AND VARIATION REDUCTION )N INDUSTRIES IT IS A VEHICLE FOR STRATEGIC CHANGE AND AN ORGANIZATIONAL APPROACH TO PERFORMANCE EXCELLENCE 4HE METHODOLOGY IS ADMINISTERED BY 3IX 3IGMA 'REEN "ELTS AND 3IX 3IGMA "LACK "ELTS BOTH ARE MONITORED BY 3IX 3IGMA -ASTER "LACK "ELTS )T IS ESTIMATED THAT 3IX 3IGMA "LACK "ELTS SAVE COMPANIES APPROXIMATELY PER PROJECT AND CAN COMPLETE FOUR TO SIX PROJECTS PER YEAR;= 4HE 3IX 3IGMA PROCESS IS COMPRISED OF SIX PERFORMANCE LEVELS NOTED IN %XHIBIT ;= #REATED BY -OTOROLA IN THE S 3IX 3IGMA HAS BEEN USED BY ORGANIZATIONS TO IMPLEMENT TACTICAL MEANS FOR QUALITY IMPROVEMENT !LTHOUGH -OTOROLA BENElTED SIGNIlCANTLY FROM USE OF 3IX 3IGMA ACHIEVING SAVINGS OF MORE THAN BILLION ;= IT WAS NOT UNTIL THAT *ACK 7ELCH #%/ OF 'ENERAL %LECTRIC '% MADE 3IX 3IGMA FAMOUS BY IMPLEMENTING IT THROUGHOUT '%;= "ECAUSE OF ITS HEAVY RELIANCE ON STATISTICAL TOOLS 3IX 3IGMA REQUIRES DETAILED AND OFTENTIMES CONSUMING ANALYTICS )T IS TYPICALLY USED FOR COMPLEX PROBLEMS OTHER APPROACHES ARE
1! AVAILABLE FOR SIMPLER PROBLEMS &OR EXAMPLE +AIZEN IS USED TO DEVELOP TACTICAL QUICK lXES THROUGH USE OF PROCESS MAPPING AND BASIC hBLOCKING AND TACKLINGv TOOLS ,EAN -ANUFACTURING ,EAN CAN BE USED WHEN THE SITUATION REQUIRES A FOCUS ON SPEED ELIMINATION OF WASTE STANDARDIZATION AND mEXIBILITYRESPONSIVENESS
+EY $EFINITIONS '%S COMPANYWIDE IMPLEMENTATION WHICH HELPED BRING RECOGNITION TO THE 3IX 3IGMA METHOD ALSO CONTRIBUTED TO THE COMMON USE OF TERMINOLOGY WITHIN THE PROGRAM 4HE FOLLOWING LIST DESCRIBES FREQUENTLY USED TERMS WITHIN THE METHODOLOGY;=
1UALITY !PPROACHES AND -ODELS $ESIGN FOR 3IX 3IGMA n ! SYSTEMATIC METHODOLOGY UTILIZING TOOLS TRAINING AND MEASUREMENTS FOR THE DESIGN OF PRODUCTS AND PROCESSES THAT MEETS CUSTOMER EXPECTATIONS AND CAN BE PRODUCED AT 3IX 3IGMA QUALITY LEVELS $ElNE -EASURE !NALYZE )MPROVE AND #ONTROL $-!)# n ! PROCESS FOR CONTINUED IMPROVEMENT 4HIS PROCESS IS UTILIZED WITH EXISTING PROCEDURES THAT FALL BELOW SPECIlCATION AND ARE IN NEED OF INCREMENTAL IMPROVEMENT )T IS SYSTEMATIC SCIENTIlC AND FACT BASED 4HIS CLOSED LOOP PROCESS ELIMINATES UNPRODUCTIVE STEPS OFTEN FOCUSES ON NEW MEASUREMENTS AND APPLIES TECHNOLOGY FOR IMPROVEMENT $ElNE -EASURE !NALYZE $ESIGN AND 6ERIFY n 4HIS PROCESS IS USED TO DEVELOP NEW PROCESSES OR PRODUCTS AT 3IX 3IGMA QUALITY LEVELS 7ORK /UT» n /NE TO THREE DAY SESSIONS DESIGNED TO GATHER ORGANIZATIONAL STAKEHOLDERS TOGETHER SO THAT MAJOR ISSUES CAN BE DISCUSSED AND ACTION TAKEN
+EY 1UALITY 4OOLS
3UPPLIERS )NPUTS 0ROCESS /UTPUTS AND #USTOMER n %NABLES A TEAM TO HAVE AN OVERALL VIEW OF A PROCESS 5SUALLY UTILIZED DURING THE MEASUREMENT POINT OF $-!)# ! TOOL THAT IS USED TO CLASSIFY ANY AND ALL ASPECTS OF ANY GIVEN PROCESS IN ORDER TO PERFECT THE PROCESS PRIOR TO BEGINNING WORK 3TATISTICAL 0ROCESS #ONTROL n 4HE APPLICATION OF STATISTICAL METHODS TO ANALYZE DATA AND STUDY AND MONITOR PROCESS CAPABILITY AND PERFORMANCE 4REE $IAGRAM n 'RAPHICALLY SHOWS ANY BROAD GOAL BROKEN DOWN INTO DIFFERENT LEVELS OF DETAILED ACTIONS )T ENCOURAGES TEAM MEMBERS TO EXPAND THEIR THINKING WHEN CREATING SOLUTIONS
1UALITY 4ERMS "LACK "ELT n ,EADER OF A TEAM RESPONSIBLE FOR MEASURING ANALYZING IMPROVING AND CONTROLLING KEY PROCESSES THAT INmUENCE CUSTOMER SATISFACTION ANDOR PRODUCTIVITY GROWTH "LACK "ELTS ARE FULL TIME POSITIONS #ONTROL n 4HE STATE OF STABILITY NORMAL VARIATION AND PREDICTABILITY 0ROCESS OF REGULATING AND GUIDING OPERATIONS AND PROCESSES USING QUANTITATIVE DATA #RITICAL TO 1UALITY #RITICAL h9v n %LEMENT OF A PROCESS OR PRACTICE WHICH HAS A DIRECT IMPACT ON ITS PERCEIVED QUALITY 4HESE ARE ALSO REFERRED TO AS CRITICAL CUSTOMER REQUIREMENTS $EFECTS n 3OURCES OF CUSTOMER IRRITATION $EFECTS ARE COSTLY BOTH TO CUSTOMERS AND TO MANUFACTURERS OR SERVICE PROVIDERS %LIMINATION OF DEFECTS CAN YIELD COST BENElTS 'REEN "ELT n 3IMILAR TO "LACK "ELT BUT NOT A FULL TIME POSITION -ASTER "LACK "ELT n )NDIVIDUALS RESPONSIBLE FOR THE REVIEW AND MENTORSHIP OF "LACK "ELTS 3ELECTION CRITERIA FOR -ASTER "LACK "ELTS INCLUDE QUANTITATIVE SKILLS AND THE ABILITY TO TEACH AND MENTOR -ASTER "LACK "ELTS ARE FULL TIME POSITIONS 6ARIANCE n ! CHANGE IN A PROCESS OR BUSINESS PRACTICE THAT MAY ALTER ITS EXPECTED OUTCOME
$EFECTS PER -ILLION
#ONTROL #HART n -ONITORS VARIANCE IN A PROCESS OVER TIME AND ALERTS THE BUSINESS TO UNEXPECTED VARIANCE WHICH MAY CAUSE DEFECTS $EFECT -EASUREMENT n !CCOUNTING FOR THE NUMBER OR FREQUENCY OF DEFECTS THAT CAUSE LAPSES %XHIBIT -ANUFACTURING ORIENTED QUALITY IMPROVEMENT APPROACHES IN PRODUCT OR SERVICE QUALITY LIKE 3IX 3IGMA ARE BEING ADAPTED FOR HEALTHCARE 0ARETO $IAGRAM n &OCUSES ON EFFORTS OR THE PROBLEMS THAT HAVE THE GREATEST POTENTIAL FOR "REAST CANCER SCREENING n IMPROVEMENT BY SHOWING RELATIVE FREQUENCY /UTPATIENT !"8 FOR COLDS ANDOR SIZE IN A DESCENDING BAR GRAPH "ASED ON .OSOCOMIAL INFECTIONS THE PROVEN 0ARETO PRINCIPLE PERCENT OF THE (OSPITALIZED PATIENTS INJURED THROUGH NEGLIGENCE SOURCES CAUSE PERCENT OF ANY PROBLEMS 0OST -)
BLOCKERS 0ROCESS -APPING n )LLUSTRATED DESCRIPTION OF !IRLINE BAGGAGE HANDLING HOW THINGS GET DONE WHICH ENABLES PARTICIPANTS $ETECTION !DVERSE DRUG !NESTHESIA RELATED TREATMENT OF TO VISUALIZE AN ENTIRE PROCESS AND IDENTIFY AREAS FATALITY RATE DEPRESSION EVENTS OF STRENGTH AND WEAKNESS )T HELPS REDUCE CYCLE 53 )NDUSTRY TIME AND DEFECTS WHILE RECOGNIZING THE VALUE OF "EST IN #LASS INDIVIDUAL CONTRIBUTIONS 2OOT #AUSE !NALYSIS n 3TUDY OF THE ORIGINAL REASON FOR NONCONFORMANCE WITH A PROCESS LEVEL DEFECTS 7HEN THE ROOT CAUSE IS REMOVED OR CORRECTED THE NONCONFORMANCE WILL BE ELIMINATED @#HANGE IS THE LAW OF LIFE !ND THOSE WHO LOOK ONLY TO THE PAST OR PRESENT ARE CERTAIN TO MISS THE FUTURE n *OHN & +ENNEDY TH PRESIDENT OF THE 5NITED 3TATES OF !MERICA
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
1! )N #OMMONWEALTH (EALTH #ORPORATION IN +ENTUCKY BECAME ONE OF THE lRST HEALTHCARE PROVIDERS TO ADOPT 3IX 3IGMA ON A SYSTEM WIDE BASIS;= !DOPTIONS BY OTHER HEALTHCARE ORGANIZATIONS HAVE SINCE GAINED MOMENTUM HOWEVER IMPACT ON QUALITY ACROSS THE CONTINUUM OF CARE IS STILL BEING DISCOVERED %XHIBIT ILLUSTRATES DEFECT LEVELS FOR MANY HEALTHCARE PROCESSES ! ROUNDTABLE DISCUSSION WAS HELD FOR A GROUP OF HEALTHCARE ORGANIZATIONS WHO HAVE REALIZED THE BENElTS OF 3IX 3IGMA AND CHAMPIONED IT 4HE ROUNDTABLE PARTICIPANTS WERE ASKED A SERIES OF QUESTIONS TO REmECT HOW 3IX 3IGMA HAS SHAPED THE FUTURE OF HEALTHCARE QUALITY WITHIN THEIR ORGANIZATIONS AND WHAT FACTORS ARE CRITICAL FOR SUCCESSFUL ADOPTION 4HE FOLLOWING TRANSCRIPT SUMMARIZES THEIR EXPERIENCES AND LESSONS LEARNED 0RICEWATERHOUSE#OOPERS (OW DOES YOUR ORGANIZATION APPLY THE 3IX 3IGMA METHODOLOGY 7HAT PROJECTS HAVE YOU IMPLEMENTED AND WHAT RESULTS HAVE YOU ACHIEVED 'LENN #ROTTY 7E STARTED 3IX 3IGMA SIX YEARS AGO TO TACKLE COMPLEX ISSUES AND THOSE CROSSING MULTIPLE AREAS AND DEPARTMENTS IN THE ORGANIZATION 7E USE IT FOR PROJECTS THAT HAVE A VALUE TO THE ORGANIZATION OF OR MORE 4HE PROJECTS USUALLY RANGE IN DURATION FROM THREE TO SIX MONTHS 7E HAVE A 3IX 3IGMA TEAM THAT DIFFERENT FOLKS IN THE ORGANIZATION HAVE USED ON A VARIETY OF PROJECTS RANGING FROM WORK ON OUR SUPPLY CHAIN TO MANY QUALITY ISSUES 7E PUT THE 3IX 3IGMA TEAM ON ALL OF THE #-3 QUALITY INDICATORS !-) ;ACUTE MYOCARDIAL INFARCTION= PNEUMONIA BYPASS HIP AND KNEE AND HEART FAILURE CARE AND HAVE ACHIEVED QUALITY IMPROVEMENTS 7E ALSO USE 3IX 3IGMA TO lND DOLLARS TO HELP MANAGE THE NEXT YEARS BUDGET 4HE PROJECTS RETURN APPROXIMATELY MILLION A YEAR !DRIENNE %LBERFELD /UR hCARDIAC MEDv PROJECT IS LOOKING AT ADMINISTRATION OF MEDICATIONS FOR PATIENTS WITH EITHER AN !-) OR CONGESTIVE HEART FAILURE DIAGNOSIS 7E CAME UP WITH A TASK FORCE AND APPOINTED A DIRECTOR OF hPROGRAMS OF EXCELLENCEv FOR CARDIOLOGY AND THEY STARTED WORKING TOGETHER AND LOOKING AT THE DATA "Y MIDYEAR THEY HAD DEPLOYED 3IX 3IGMA RESOURCES 7E HAD A PROJECT TEAM THAT WAS INTERDISCIPLINARY WITH PHYSICIAN CHAMPIONS CASE MANAGEMENT MEDICAL RECORDS NURSING AND PARAMEDICS ON THE TEAM -EANWHILE WE WORKED WITH THE PHYSICIAN CHAMPIONS TO lX THE PROCESSES UNDERNEATH 4HE PHYSICIANS ARE IMPORTANT BECAUSE A LOT OF IT HAD TO DO NOT WITH THE CARE WE WERE DELIVERING BUT WITH DOCUMENTATION ISSUES 7HEN WE WENT IN TO THE PROJECT THE PHYSICIANS QUESTIONED THE DATA THAT WE WERE REPORTING TO #-3 KNOWING THAT THIS DATA WAS GOING TO BECOME AVAILABLE TO THE PUBLIC 7E WENT THROUGH A FORMAL PROCESS OF LOOKING AT THE INTEGRITY AND ACCURACY OF THE DATA /UR DATA WAS BEING COLLECTED BY OUTCOMES ANALYSTS SOME OF WHOM HAVE BEEN DOING THE JOB FOR YEARS WHO ARE TRAINED NURSES AND DO CHART REVIEW POST DISCHARGE BASED ON THE CRITERIA 3O THEY FELT VERY CONlDENT THAT THEY KNEW WHAT THEY WERE DOING WHEN THEY WERE REVIEWING CHARTS 7E LOOKED AT CHARTS AND HAD THE SAME FOUR PEOPLE REVIEW EACH OF THEM 4HEY AGREED WITH EACH OTHER ONLY PERCENT OF THE TIME AND THEY WERE ONLY PERCENT ACCURATE FOR #-3 GUIDELINES 4HIS WAS THE BIG hUH OHv
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 04 % 2
NOBODY WAS REVIEWING THE CHARTS IN THE SAME MANNER 4HEY WERE LOOKING AT THE SAME DATA BUT INTERPRETING IT DIFFERENTLY /N ANOTHER PROJECT WE BROUGHT IN ,EAN FOR #4 SCAN PRODUCTIVITY 7E LOOKED AT ONE OF OUR FACILITIES TO SEE HOW LONG IT TOOK FOR US TO DO A HEAD OR ABDOMINAL #4 SCAN 7E HAD SOME BENCHMARK NUMBERS AND WANTED TO SEE HOW WE WERE DOING WITH THAT 7E DID OUR PROCESS MAP )T CAME OUT TO BE STEPS FROM THE STRETCHER CROSSING THE THRESHOLD INTO THE ROOM TO THE STRETCHER LEAVING THE ROOM 7E HAD A LOT OF VARIATION 7E GOT IT DOWN TO STEPS AND WE WERE ABLE TO MEET THE BENCHMARKS .ONE OF THAT DATA COULD BE COLLECTED ELECTRONICALLY 7E ACTUALLY HAD TO HAVE DATA COLLECTORS ON SITE COLLECTING THE DATA %D 0OPOVICH 7EVE HAD ONE PROJECT IN WHICH WE SIGNIlCANTLY REDUCED THE DIAGNOSTIC JOURNEY TIME IN OUR CENTER FOR BREAST CARE FROM ABOUT EIGHT WEEKS DOWN TO TWO AND A HALF HOURS DRASTICALLY SHORTENING THE TIME TO BEGIN TREATMENT FOR SUSPECTED CANCERS 7E HAVE AN ALL DIGITAL FACILITY AND ARE ABLE TO DO SOME UNIQUE THINGS 7EVE TAKEN ON AN EFFORT TO STREAMLINE THE mOW IN OUR LABORATORY 7E HAD ANOTHER PROJECT IN THE EMERGENCY DEPARTMENT IN WHICH WE CUT OUR CYCLE TIME BY ABOUT PERCENT OR MORE &OR EXAMPLE OUR DOOR TO REGISTRATION TIME WAS REDUCED FROM TO MINUTES 3OME OF OUR OTHER PROJECTS INCLUDE STREAMLINING THE BENElT PROCESS IN (2 ELECTRONIC LEARNING IN OUR LIFELONG LEARNING CENTER RESPONDING TO CALL BELL REQUESTS IN OUR PATIENT ROOMS REGISTRATION ERROR REDUCTION BILLING ERROR REDUCTION AND IMPROVEMENT IN OUR GUEST RELATIONS DEPARTMENT IN TERMS OF COMPLAINT RESOLUTION -OREOVER WE HAVE APPLIED $ESIGN FOR 3IX 3IGMA APPROACHES TO NEW FACILITY DESIGN INCLUDING CHANGING THE LAYOUTS AND SCHEMATICS FOR OUR NEW CANCER CENTER !PPLICATION TO OUR NEW COMMUNITY AFlLIATED TEACHING HOSPITAL WILL SERVE AS A CATALYST FOR CREATING A SAFE HOSPITAL BY DESIGN "EN -ILES 7ERE JUST ABOUT TO COMPLETE OUR THIRD YEAR WITH 3IX 3IGMA HERE AT 3T *OHN (EALTH )NITIALLY WE ROLLED IT OUT AT TWO PRIMARY SITES AND AFTER OUR lRST PROJECTS WERE SUCCESSFUL WE DECIDED TO TAKE THIS INITIATIVE SYSTEMWIDE !SIDE FROM CHOOSING THE RIGHT METRIC FOR EACH PROJECT WEVE HAD QUITE AN EDUCATION OVER THE PAST FEW YEARS WITH REGARD TO MATCHING THE RIGHT METHODOLOGY AGAINST THE ISSUE THAT WE ARE FACING )NITIALLY WE WERE TRYING TO TACKLE EVERY PROBLEM WE ENCOUNTERED EXCLUSIVELY THROUGH THE USE OF 7ORK /UT OR THE $-!)# PROCESS 7E FOUND ,EAN TO BE AN ABSOLUTELY PHENOMENAL COMPLEMENT TO THE STATISTICAL RIGOR OF THE 3IX 3IGMA METHODOLOGY ITSELF AND WE HAVE WITNESSED A GREATER ABILITY TO ADDRESS KEY BUSINESS METRICS THROUGH THE USE OF VALUE STREAM ANALYSIS 4HE MAPS THAT WE CREATE ALLOW US TO STUDY AND BETTER UNDERSTAND THE mOW ASSOCIATED WITH THESE KEY METRICS FROM START TO lNISH )N TURN WE ARE ABLE TO CORRECTLY MATCH THE CORRECT APPROACH FOR EACH SEGMENT OF THE VALUE STREAM BE IT THROUGH ,EAN $-!)# OR 7ORK /UT /UR SINGLE GREATEST IMPACT HAS BEEN IN THE EMERGENCY DEPARTMENT ;%$= 2ATHER THAN ATTACKING THIS ISSUE FROM AN INTUITIVE STANDPOINT WE CREATED A VALUE STREAM MAP AT EACH SITE AND MAPPED BOTH THE INPATIENT AND OUTPATIENT %$ mOWS 7E FOUND A STRONG CORRELATION BETWEEN INPATIENT BED AVAILABILITY AND THROUGHPUT TIMES IN THE %MERGENCY $EPARTMENT !S A
1! RESULT WEVE SEEN A TREMENDOUS REDUCTION IN BOTH THE AVERAGE AND THE VARIATION OF OUR THROUGHPUT TIMES )N SOME CASES THESE IMPROVEMENTS HAVE EXCEEDED PERCENT 7HILE THESE IMPROVEMENTS ARE READILY SEEN IN OUR MONTHLY DASHBOARD REPORTS WE ARE ENCOURAGED TO SEE THIS EFFECT ALSO REmECTED IN OUR PATIENT SATISFACTION SCORES 0W# (OW HAVE YOU USED 3IX 3IGMA TO FOSTER COLLABORATION WITHIN YOUR OWN ORGANIZATION '# )N A NUMBER OF 3IX 3IGMA PROJECTS WE HAD TO DO A LOT OF EXPLAINING WITH THE SURGEONS ANESTHESIA AND CERTIlED REGISTERED NURSE ANESTHETISTS TO EDUCATE AND DEMONSTRATE THE VALUE OF THE PROCESSES 7E FOUND YOU NEED TO DEMONSTRATE THE VALUE BECAUSE WE HAD SO MANY SKEPTICS AND PEOPLE SAYING h/H HERE IS ANOTHER mAVOR OF THE DAY v AND h4HIS WILL GO AWAY IF ) JUST IGNORE IT LONG ENOUGHv 3O ) MADE IT A REQUIREMENT TO GET THIS TRAINING 4HEN AS MORE AND MORE PEOPLE WERE TRAINED THEY SAID h4HIS IS REALLY VALUABLE ) CAN USE THIS METHODOLOGY AND ) SEE RESULTS FROM ITv $EBBIE 9OUNG ) THINK ONE OF THE BIG THINGS FOR US IS THAT IT IS DATA DRIVEN !NYTIME WE START A PROJECT WE GET BASELINE DATA 3O WE KNOW EXACTLY WHERE OUR ISSUES ARE *IM +ARAGIORGIS 'IVEN THAT 3IX 3IGMA REPRESENTS CHANGE AND A BREAK FROM PAST PRACTICES )M NOT SO CONCERNED ABOUT THOSE STAKEHOLDERS WHO OPENLY RESIST COLLABORATION BECAUSE IT GIVES US THE OPPORTUNITY TO LISTEN TO THEIR CONCERNS )N CONTRAST THOSE STAKEHOLDERS WHO QUIETLY RESIST BECAUSE THEY FEEL THREATENED CAN TRULY UNDERMINE CHANGE INITIATIVES AND THEIR EXISTENCE NEEDS TO BE ACKNOWLEDGED 4O ACHIEVE COLLABORATION DURING OUR DEPLOYMENT WEVE HAD TO COMMUNICATE OVER AND OVER AGAIN THAT A 3IX 3IGMA PROJECT IS INTENDED TO EXAMINE A PROCESS PROBLEM IMPLEMENT A SOLUTION AND THEN CONCLUDE ONCE THE PROCESS OWNER IS CAPABLE OF SUSTAINING THE IMPROVEMENT 4HIS WAS MADE EASIER BY lRST BUILDING RELATIONSHIPS WITH SEVERAL PROGRESSIVE PROCESS OWNERS WHO WERE ACTIVELY ENGAGED IN IMPROVING THEIR OPERATIONS /NCE PERCENT OF THE STAKEHOLDERS BOUGHT IN TO 3IX 3IGMA AND ITS INHERENT NEED FOR COLLABORATION TO ACHIEVE SUCCESS MOST OF THE OTHERS FOLLOWED 3USAN -C'ANN 7E HELD A 7ORK /UT WITH TWO OF OUR MAJOR PAYERS AND IN THIS PARTICULAR PROCESS WE RECOGNIZED THAT NOT ONLY DO WE HAVE OUR INTERNAL ISSUES BUT WE ALSO HAD AN EXTERNAL CUSTOMER 7E NEEDED TO MAKE SURE THAT ANY CHANGES WE WERE GOING TO MAKE IN OUR BILLING PROCESS WERE NOT GOING TO AFFECT OUR ABILITY TO GET PAID IN THE LONG RUN 3UBSEQUENTLY WE MADE SURE THAT WHEN WE LOOKED AT OUR BILLING PROCESS INTERNALLY IT WOULD NOT IMPACT THE WAY THINGS WERE RECEIVED ON THE OTHER END BY THE PAYERS !S A RESULT WE CONDUCTED A HALF DAY 7ORK /UT WITH EACH OF THEM )T WAS REALLY PHENOMENAL BECAUSE THEY ;THE PAYERS= WERE TAKEN ABACK BY WHAT WE WERE DOING INTERNALLY 7HAT ALSO EXCITED THEM WAS THAT WE ARE WORKING SO HARD TO IMPROVE THIS PROCESS AND THAT THEY ULTIMATELY WOULD BENElT FROM THE WORK WE WERE DOING TO STREAMLINE OUR PROCESSES
7HAT ARE THE CRITICAL SUCCESS FACTORS FOR IMPLEMENTING A 3IX 3IGMA PROJECT '# %ACH PROJECT HAS TO RETURN TO THE ORGANIZATION AT LEAST OF IMPROVEMENT TO THE BOTTOM LINE AND WE HAVE THIS VERIlED BY lNANCE )T HAS TO IMPROVE THE QUALITY AND SAFETY OF PROCESSES OR PROCEDURES IF ITS RELATED TO A CLINICAL ISSUE AND IT HAS TO SOLVE COMPLEX ISSUES ACROSS THE ORGANIZATION "- /NE OF THE SINGLE GREATEST FACTORS IS IDENTIFYING AND SUPPORTING THE ROLE OF THE PROCESS OWNER )T IS ESSENTIAL TO HAVE THIS PERSON INVOLVED ON A TEAM AS WELL AS ENSURE THAT EVERYONE UNDERSTANDS THEIR PERSONAL ACCOUNTABILITY TO SUSTAIN THESE IMPROVEMENTS OVER TIME ! SECOND KEY FACTOR IS HAVING THE lNANCE FUNCTION ENGAGED )TS MORE THAN JUST HAVING THEM DETERMINE WHETHER THE DOLLARS ARE HARD OR SOFT 9OU NEED TO TRULY PARTNER WITH THEM AND HAVE THEM HELP IDENTIFY WHERE THE KEY AREAS OF OPPORTUNITY ARE '# 3IX 3IGMA PROVIDES AN INDUSTRIAL STRENGTH QUALITY IMPROVEMENT METHODOLOGY 4HE VOICE OF THE CUSTOMER WILL HELP HEALTHCARE PROVIDERS FULlLL THE )/-S SIX AIMS FOR PATIENT CARE )T PROVIDES A WAY TO STANDARDIZE AND A METHODOLOGY FOR RELIABLE CARE n THE PURPOSE OF THE SIX QUALITY AIMS OF THE )NSTITUTE OF -EDICINE n %NDNOTES HTTPWWWGECOMENCOMPANYCOMPANYINFOQUALITYWHATISHTM HTTPWWWISIXSIGMACOMSIXSIGMASIX?SIGMAASP HTTPWWWISIXSIGMACOMLIBRARYCONTENTCAASP HTTPWWWISIXSIGMACOMLIBRARYCONTENTCAASP )BID !DAPTED FROM HTTPWWWGECOMENCOMPANYCOMPANYINFOQUALITY GLOSSARYHTM HTTPWWWGEHEALTHCARECOMTWZHPROD?SOLHCAREPDFGEPDF
!CHIEVING 1UALITY 4HROUGH 3IX 3IGMA ,ESSONS ,EARNED 5TILIZING 3IX 3IGMA IT IS ESTIMATED A COMPANY CAN SAVE APPROXIMATELY TO MILLION PER PROJECT DEPENDING ON THE TYPE OF PROJECT AND CAN SAVE A COMPANY ON AVERAGE MILLION TO MILLION PER YEAR BASED ON THE NUMBER OF PROJECTS UNDERTAKEN AND THE SIZE OF THE ORGANIZATION )MPLEMENTING 3IX 3IGMA REQUIRES A SIGNIlCANT lNANCIAL AND ADMINISTRATIVE INFRASTRUCTURE $ElNING AND TRACKING A PROBLEM IS KEY TO SUCCESSFUL IMPLEMENTATION %NSURING THAT PROBLEMS ARE ANALYZED WITH CORRECT DATA IS CRITICAL 2ESULTING PROJECTS ELIMINATE NONVALUE ADDED STEPS 3IX 3IGMA CAN HELP DECREASE THE TOTAL NUMBER OF STEPS IN A PROCESS BY AS MUCH AS PERCENT 3IX 3IGMA IS LEADERSHIP DEVELOPMENT )T CAN USE PEOPLE FROM VARIOUS BACKGROUNDS AND CHANGE THEIR METHOD OF THINKING
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
4HE 2OLE OF !CCREDITATION IN 1UALITY "Y SETTING OBJECTIVE AND MEASURABLE STANDARDS ACCREDITATION PROVIDES MORE THAN A mOOR FOR QUALITY 4HE ACCREDITATION PROCESS ITSELF PROVIDES AN OPPORTUNITY FOR HEALTH ORGANIZATIONS TO CRITICALLY EXAMINE THEIR QUALITY AND IMPLEMENT CHANGES TO IMPROVE THEIR PERFORMANCE "Y 2ICHARD ' "ATTAGLIA 0RICEWATERHOUSE#OOPERS
0
HYSICIANS AND HEALTHCARE ORGANIZATIONS OFTEN ASSUME THAT THEY ARE PROVIDING HIGH QUALITY CARE AND DO NOT RECOGNIZE AREAS OF DElCIENCY UNTIL THEY START TO MEASURE THEMSELVES 4HE ACCREDITATION PROCESS BY REQUIRING THAT THEY HOLD THEMSELVES ACCOUNTABLE TO AN OBJECTIVE SET OF QUALITY MEASURES PROVIDES AN OPPORTUNITY FOR SELF EXAMINATION AND QUALITY IMPROVEMENT "Y RECOGNIZING ACCREDITATION AS A PROCESS RATHER THAN AN EVENT PHYSICIANS AND HOSPITALS CAN INCORPORATE QUALITY IMPROVEMENT INTO THEIR ROUTINE CLINICAL AND ADMINISTRATIVE ACTIVITIES
!CCREDITATION n 4HE "ASICS %VERY DAY IN !MERICA MILLIONS OF PEOPLE SEE A DOCTOR VISIT A HOSPITAL OR CHOOSE A NEW INSURANCE PLAN -OST RECEIVE EXCELLENT CARE WITH GOOD RESULTS "UT OCCASIONALLY SOMETHING GOES WRONG -EDICAL ERRORS OCCUR THAT SHOULD HAVE BEEN PREVENTED 0ATIENTS ARE DIAGNOSED OR TREATED INCORRECTLY 4HE mAWS OF THE 53 HEALTHCARE SYSTEM AND THE FACT THAT IT DEPENDS ON PRIVATELY OWNED INSTITUTIONS AND ORGANIZATIONS HAVE GIVEN RISE TO ACCREDITATION !CCREDITATION IS ACCOMPLISHED THROUGH PRIVATE AGENCIES THAT MONITOR PROVIDERS AND PAYERS TO ENSURE QUALITY HEALTHCARE 7HILE A GROWING NUMBER OF ORGANIZATIONS ARE INVOLVED IN HEALTHCARE ACCREDITATION THE TWO LARGEST ARE THE *OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS *#!(/ AND THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE .#1! *#!(/ ACCREDITS HOSPITALS AND OTHER HEALTHCARE ORGANIZATIONS INCLUDING HOME CARE AGENCIES LONG TERM CARE FACILITIES AND AMBULATORY CARE PROVIDERS;= .#1! EVALUATES HEALTH PLANS BASED ON THEIR EFFECTIVENESS OF QUALITY IMPROVEMENT ASSESSMENT OF CREDENTIALS AND QUALIlCATIONS OF HEALTH PROFESSIONALS APPLICATION OF UTILIZATION MANAGEMENT PROGRAMS
PROMOTION AND PROTECTION OF MEMBERS RIGHTS AND OUTCOMES OF STANDARDIZED PERFORMANCE MEASURES -ORE THAN THREE QUARTERS OF (-/ ENROLLEES IN THE 53 ARE IN .#1! ACCREDITED PLANS;= ! COMPELLING REASON PROVIDERS AND PAYERS SEEK ACCREDITATION IS lNANCIAL *#!(/ HAS hDEEMED STATUS v WHICH MEANS THAT BY PASSING *#!(/ SURVEYS HOSPITALS ARE ELIGIBLE FOR -EDICARE REIMBURSEMENT WHICH ON AVERAGE MAKES UP ABOUT PERCENT OF A HOSPITALS REVENUES -ANY STATES ALSO RELY ON *#!(/ ACCREDITATION AS A SUBSTITUTE FOR HAVING THEIR OWN REGULATORY SURVEY PROGRAMS "ECAUSE ACCREDITATION IS OFTEN LINKED TO -EDICARE CERTIlCATION HOSPITALS THAT DO NOT PASS THEIR SURVEYS OFTEN SPEND HUNDREDS OF THOUSANDS OF DOLLARS IN PRODUCTIVITY AND CONSULTING FEES TO ACHIEVE COMPLIANCE *#!(/ ALLOWS HOSPITALS DENIED ACCREDITATION TO APPEAL WHICH TAKES SEVERAL WEEKS )F A HOSPITALS APPEAL IS DENIED IT MAY REAPPLY AFTER NINE MONTHS /N THE HEALTH PLAN ACCREDITATION SIDE MANY EMPLOYERS REQUIRE THEIR HEALTH PLAN VENDORS TO RECEIVE .#1! ACCREDITATION !FTER RECEIVING ACCREDITATION MOST PAYERS AND PROVIDERS PUBLICIZE THIS FACT SUPPORTING THE BELIEF THAT PUBLIC RECOGNITION IS ALSO A SIGNIlCANT DRIVER OF ACCREDITATION ! SEAL OF APPROVAL FROM A WELL KNOWN ACCREDITING BODY PROVIDES BOTH PAYERS AND PROVIDERS WITH A COMPETITIVE ADVANTAGE IN THE MARKETPLACE
)NCREASED 3CRUTINY )MPROVED 1UALITY !S ACCREDITATION HAS BECOME THE ACCEPTED NORM A GREATER EMPHASIS ON PATIENT OUTCOMES HAS REPLACED THE PREVIOUS PREOCCUPATION WITH STRUCTURE AND PROCESS /VER THE LAST DECADE THE ACCREDITING ORGANIZATIONS WORKED ON COORDINATING CONSISTENT MEASUREMENTS BETWEEN INSTITUTIONS AND AMONG HEALTH PLANS
2ICHARD ' "ATTAGLIA -$ &!#0 IS A MANAGER IN 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES !DVISORY PRACTICE (E FOCUSES ON QUALITY IMPROVEMENT IN HEALTHCARE WITH A SPECIAL INTEREST IN THE ROLE OF ACCREDITATION AS A TOOL TO IMPROVE QUALITY 7ITH YEARS OF HEALTHCARE INDUSTRY EXPERIENCE HE HAS HELD LEADERSHIP POSITIONS IN BOTH PAYER AND PROVIDER ORGANIZATIONS (E CAN BE REACHED AT RICHARDGBATTAGLIA USPWCCOM (INDY 3HAMAN -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE 3HE LED THE EDITORIAL CONTENT DEVELOPMENT FOR 4HE 1UALITY #ONUNDRUM 3HE HAS OVER YEARS EXPERIENCE IN DEVELOPING RESEARCH AND THOUGHT LEADERSHIP FOR THE HEALTHCARE INDUSTRY AND HAS PUBLISHED EXTENSIVELY ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PERFORMANCE IMPROVEMENT AND REPORTING OPERATIONAL AND lNANCIAL BENCHMARKING ELECTRONIC HEALTH RECORDS AND CLINICAL INFORMATION SYSTEMS MARKET TRENDS STRATEGY DEVELOPMENT AND COLLABORATION 3HE CAN BE REACHED AT HINDYSHAMAN USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
SGDãQ N KDã N E ã @ B B Q D C H S@S H N M ã H M ã P T @ K H S X )N THIS WAY *#!(/ AND .#1! ARE COMPARING APPLES TO APPLES WHEN THEY LOOK AT PERFORMANCE OUTCOMES 4HE RESULT IS COMPARABLE POPULATIONS BEING MEASURED WITH OUTCOMES THAT ARE NOW A MORE RELIABLE INDICATOR OF TRUE QUALITY )N THE EARLY S .#1! TOOK OVER RESPONSIBILITY FOR ENHANCING THE (EALTH 0LAN %MPLOYER $ATA AND )NFORMATION 3ET (%$)3 A STANDARDIZED TOOL THAT MEASURES THE PERFORMANCE OF IMPORTANT ASPECTS OF CARE AND SERVICE AMONG HEALTH PLANS %MPLOYERS CONSULTANTS AND EVEN CONSUMERS NOW USE (%$)3 DATA TO CHOOSE HEALTH PLANS (%$)3 RESULTS ARE REVIEWED BY OUTSIDE AUDITORS TO ENSURE VALIDITY 3OME STATES HAVE EVEN STARTED TO MANDATE THAT (%$)3 MEASURES FOR THE -EDICAID POPULATION BE REPORTED TO THE STATES AND TO THE PUBLIC !S MEASUREMENT AND REPORTING BECAME MORE SOPHISTICATED THE ACCREDITATION PROCESS HAS GROWN MORE TRANSPARENT 0RIOR TO THE S SCORING MECHANISMS AND MEASUREMENT DETAILS WERE SEEN AS AN IMPENETRABLE BLACK BOX n WITH NO PLAYERS OTHER THAN THE ACCREDITING ORGANIZATIONS ABLE TO SEE INSIDE TO TRULY UNDERSTAND HOW PROGRAMS WERE MEASURED 2ESPONDING TO PRESSURE FROM #ONGRESS AND THE PUBLIC IN *#!(/ BEGAN REPORTING MORE DATA ABOUT PATIENT SAFETY .#1! ALSO MADE SCORING GUIDELINES AVAILABLE THAT WERE USED TO ASSIST ACCREDITATION DECISION MAKING )N ADDITION CRITERIA HAVE BECOME MORE STRINGENT OVER THE LAST YEARS SO ACHIEVING ACCREDITATION IS NO LONGER SEEN AS SIMPLY A RUBBER STAMP !LTHOUGH IT RARELY REVOKES A HOSPITALS ACCREDITATION *#!(/ HAS RAISED THE BAR BY CONTINUALLY INTRODUCING NEW STANDARDS TO HELP HOSPITALS BECOME SAFER AND MORE EFFECTIVE .#1! HAS SIMILARLY RAISED THE hINDUSTRY BARv 4HE NATURAL AND DESIRED OUTCOME OF AN INCREASED EMPHASIS ON MEASUREMENT IS IMPROVED PATIENT SAFETY 7HEN HOSPITALS FAIL TO PROTECT PATIENTS THE RESULT CAN BE A PUBLIC RELATIONS DISASTER AND INCREASED CONSUMER AWARENESS AND WARINESS )N THE LAST DECADE REPORTS OF HOSPITALS AMPUTATING THE WRONG LIMBS OR PATIENT DEATHS FROM MISADMINISTRATION OF MEDICINE HAS INCREASED PUBLIC SCRUTINY OF INSTITUTIONS PAVING THE WAY FOR ACCREDITING BODIES LIKE *#!(/ TO PROMOTE CHANGES TO INCREASE QUALITY AND SAFETY ! RELATIVELY RECENT CHANGE THAT HAS HELPED HOSPITALS IMPROVE QUALITY IS THAT *#!(/ VISITS ARE NOW UNSCHEDULED AND OFTEN UNEXPECTED 9EARS AGO A HOSPITAL WOULD HAVE MONTHS TO TWEAK OPERATIONS BEFORE A SURVEY 4ODAY SURVEYORS ARRIVE UNANNOUNCED REQUIRING HEALTHCARE INSTITUTIONS TO INCORPORATE QUALITY PRINCIPLES INTO THE WAY THEY DELIVER SERVICES ON A DAILY BASIS (OSPITALS THAT OPERATE IN A STATE OF hREADINESSv ARE MORE LIKELY TO CORRECTLY IMPLEMENT POLICIES AND PROCEDURES THAT DIRECTLY CORRELATE TO INCREASED CLINICAL QUALITY AND PATIENT SAFETY !NOTHER TREND IS THAT HOSPITALS ARE NOW PRACTICING MORE SELF REPORTING THAN EVER BEFORE )NSTEAD OF FOCUSING ON A SURVEY EVENT EVERY THREE YEARS INSTITUTIONS HAVE DEVELOPED AN ONGOING RELATIONSHIP WITH *#!(/ BY REGULARLY DELIVERING OPERATIONAL DATA 3ELF REPORTING CAUSES HOSPITALS TO REGULARLY CONSIDER HOW THEY DO BUSINESS AND CONDUCT PATIENT CARE SUPPORTING A CONTINUOUS FOCUS ON IMPROVING QUALITY
! 0ROACTIVE !PPROACH TO 1UALITY /NE OF THE MOST SIGNIlCANT BENElTS OF ACCREDITATION HAS BEEN THE GROWTH OF EVIDENCE BASED MEDICINE %MPHASIZING TREATMENT GUIDELINES BASED ON OBJECTIVE TESTS OF EFlCACY AND SAFETY PUBLISHED IN PEER REVIEWED SCIENTIlC LITERATURE EVIDENCE BASED MEDICINE SUPPORTS THE CONCEPT OF ACCREDITATION SINCE ACCREDITING BODIES CAN OBJECTIVELY DETERMINE WHETHER ACCEPTED GUIDELINES ARE BEING FOLLOWED "Y USING PERFORMANCE DATA WITH REGARD TO GUIDELINES AND BEST PRACTICES TO GUIDE QUALITY IMPROVEMENT EFFORTS BOTH PAYERS AND PROVIDERS BENElT KEEPING THEIR ACCREDITATIONS CURRENT AND MOST IMPORTANTLY ENHANCING PATIENT OUTCOMES )NCREASED PATIENT SAFETY IS A NATURAL OUTGROWTH OF PROACTIVE MEDICAL MANAGEMENT "Y ENSURING THAT PROCESSES ARE CONSISTENT AND SAFE FROM THE OUTSET PROVIDERS CAN BUILD SAFETY INTO PROGRAMS UP FRONT TO MINIMIZE HEALTH RISKS TO BOTH PATIENTS AND PATIENTS FAMILIES &OR EXAMPLE A HOSPITAL WITHOUT A lRE SAFETY PROGRAM MIGHT ENDANGER BOTH PATIENTS AND VISITORS IF A lRE WERE TO OCCUR ! CLINIC WITHOUT AN INFECTIOUS DISEASE POLICY DRAMATICALLY INCREASES THE RISK OF SPREADING INFECTIONS AMONG PATIENTS AND EMPLOYEES !N ONGOING QUALITY PROGRAM ENSURES PATIENT SAFETY AND MINIMIZES RISK FOR HOSPITALS )N ADDITION TO IMPROVING QUALITY AND SAFETY ACCREDITATION HAS RAISED AWARENESS OF PATIENTS RIGHTS #OMPETITIVE PRESSURES ON PAYERS AND PROVIDERS TO INCREASE QUALITY OF SERVICE HAS BEEN A WAKE UP CALL FOR ORGANIZATIONS TO REMEMBER WHO THEY ARE SERVING n CONSUMERS n AND THAT THESE CONSUMERS CHOOSE WHICH FACILITIES AND WHICH HEALTH PLANS GET THEIR BUSINESS &OR EXAMPLE IF A HEALTH PLAN INAPPROPRIATELY DENIES COVERAGE TO AN INDIVIDUAL AND DOES NOT HAVE APPROPRIATE MECHANISMS TO ENSURE MEMBER APPEAL RIGHTS ACCREDITATION SURVEYORS DEEM THIS AS UNACCEPTABLE AND NONCOMPLIANT WITH .#1! STANDARDS 3TANDARDIZED QUALITY MEASURES HAVE ALSO HELPED CONSUMERS COMPARE PROVIDERS AND PAYERS FOR EASIER DECISION MAKING 4HE FACT THAT MUCH OF THIS INFORMATION IS NOW PUBLICLY REPORTED INCREASES CONSUMER ACCESS AND EXERTS PRESSURE ON ALL HEALTHCARE PLAYERS TO PERFORM 0ATIENTS ALSO HAVE THE OPPORTUNITY TO REGISTER COMPLAINTS WITH *#!(/ AND #-3 0ATIENTS CAN FEEL CONlDENT THEIR ISSUES WILL BE INVESTIGATED AND ADDRESSED AS WELL
+EY 3UCCESS &ACTORS IN 0URSUING !CCREDITATION 4O PERFORM APPROPRIATELY AND RECEIVE ACCREDITATION ORGANIZATIONS SHOULD KEEP THESE KEY FACTORS IN MIND )NCORPORATE THE INTENT AND PRINCIPLES OF THE ACCREDITATION PROGRAM INTO EVERYDAY WORK !CCREDITATION CANNOT BE VIEWED AS A STAND ALONE FOCUS OR AN ADD ON TO A NINE TO lVE WORKDAY )T IS ALSO NOT THE SOLE RESPONSIBILITY OF COMPLIANCE OFlCERS 4RUE QUALITY EFFORTS MUST TOUCH EVERY DEPARTMENT AND INCORPORATE ONGOING IMPROVEMENT PROCESSES AND PROGRAMS INTO EVERY CORNER OF THE ORGANIZATION
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
SGDãQ N KDã N E ã @ B B Q D C H S@S H N M ã H M ã P T @ K H S X !DOPT A MULTIDISCIPLINARY APPROACH TO IMPROVEMENT RATHER THAN FOCUS ON INDIVIDUAL DEPARTMENTS 7HEN *#!(/ VISITS A HOSPITAL SURVEYORS TRACE A PATIENTS PATH THROUGHOUT A HOSPITAL STAY TO DETERMINE WHERE ERRORS MAY HAVE OCCURRED ! COMMUNICATION BREAKDOWN ALONG THAT PATH FOR EXAMPLE BETWEEN THE PHARMACY AND THE CARDIAC CARE UNIT INDICATES A WEAK LINK IN THE PATIENT CARE CHAIN THAT NEEDS TO BE RESOLVED )NTEGRATE DATA SYSTEMS TO PROMOTE EASY INFORMATION ACCESS 4HIS ALLOWS EVALUATION OF COMPLEX SYSTEMS AND PROGRAMS AND ENABLES GROUPS WITHIN AN ORGANIZATION TO USE MORE THAN ONE SET OF DATA TO SOLVE A PROBLEM !PPOINT ONE PERSON OR A GROUP OF PEOPLE TO KEEP UP WITH CHANGING STANDARDS AND NEW LITERATURE TO ENSURE THAT A MODIlCATION OR PATIENT SAFETY GOAL IS NOT MISSED 'ET THE #%/ AND GOVERNING BOARD INVOLVED SO THAT CHANGE MANAGEMENT CAN OCCUR FROM THE TOP DOWN ,EADERSHIP DISCONNECTED FROM THE MANAGEMENT OF ACCREDITATION WILL NOT BE PREPARED TO DEAL WITH THESE SURVEYORS #ONSIDER IDENTIFYING A WELL VERSED ORGANIZATIONAL LEADER OR CONSULTANT TO INTEGRATE THE INTENT OF THE STANDARDS INTO PRACTICAL BUSINESS PROCESSES 4HIS INDIVIDUAL SHOULD BE ABLE TO CLEARLY COMMUNICATE IMPROVEMENTS AND POSITIVE CULTURE CHANGES AS THEY OCCUR
/N THE (ORIZON $ESPITE THE MANY POSITIVE ASPECTS OF ACCREDITATION IT IS NOT A TOPIC WITHOUT CONTROVERSY /PPONENTS QUESTION THE VALUE OF ACCREDITATION GIVEN THE CONSIDERABLE FEES PAID TO ACCREDITING BODIES AS WELL AS THE AMOUNT OF STAFF TIME AND OTHER RESOURCES SPENT TO COMPLY 0ROPONENTS OF ACCREDITATION ARGUE THAT IMPROVEMENTS HAVE TAKEN PLACE AND THAT PATIENTS ARE NOW SAFER BECAUSE OF IT &OR EXAMPLE *#!(/S CHANGE TO UNANNOUNCED VISITS WAS DRIVEN IN LARGE PART BY INCREASED ATTENTION TO PATIENT SAFETY ISSUES )MPROVING PATIENT SAFETY WAS ALSO THE IMPETUS FOR THE INCREASE IN SELF REPORTING BY HOSPITALS
/RGANIZATIONS THAT RECOGNIZE ACCREDITATION AS A PROCESS NOT AN EVENT WILL APPLY ACCREDITATION PRINCIPLES AS AN INGRAINED PART OF DOING BUSINESS )N ADDITION TO MAKING THE WORK OF ACCREDITATION EASIER INTEGRATING A CULTURE OF QUALITY WILL INEVITABLY IMPROVE PATIENT OUTCOMES !S ACCREDITING BODIES CONTINUE TO ENHANCE MEASUREMENTS AND STANDARDS HOSPITALS AND INSURERS WILL BECOME MORE EFlCIENT KEEPING COSTS DOWN AND INCREASING CONSUMER SATISFACTION 4HE MOST IMPORTANT BENElTS OF ACCREDITATION IMPROVED CLINICAL QUALITY AND PATIENT SAFETY WILL CONTINUE TO KEEP PATIENTS IN THE FOREFRONT AND HOLD PAYERS AND PROVIDERS ACCOUNTABLE FOR DELIVERING QUALITY HEALTHCARE;= %NDNOTES 0ERSONAL COMMUNICATION *UNE *#!(/ !CCREDITATION #ERTIlCATES OFlCE HTTPWWWNCQAORG#OMMUNICATIONS0UBLICATIONSOVERVIEWNCQAPDF .EURATH 0 h3TUDY -EDICARE -EDICAID PAYMENTS DRIVE UP EMPLOYEE INSURANCE COSTS v 0UGET 3OUND "USINESS *OURNAL ACCESSED AT HTTPSEATTLE IZJOURNALSCOMSEATTLESTORIESDAILYHTML PAGE h+EY &INDINGS OF 'ALLUP 3URVEY !WARENESS OF AND !TTITUDES TOWARD "OARD #ERTIlCATIONS OF 0HYSICIANS v !MERICAN "OARD OF )NTERNAL -EDICINE EMBARGOED ON !UGUST HTTPWWWABMSORGDOWNLOADS NEWSGALLUPPOLLKEYlNDINGSPDF ACCESSED !PRIL 'REINER !# AND % +NEBEL EDS h(EALTH 0ROFESSIONS %DUCATION ! "RIDGE TO 1UALITY v )NSTITUTE OF -EDICINE 3ECTISH 4 # AND % , :ALNERAITIS # #ARRACCIO AND 2 % "EHRMAN h4HE STATE OF PEDIATRICS RESIDENCY TRAINING ! PERIOD OF TRANSFORMATION OF GRADUATE MEDICAL EDUCATION v 0EDIATRICS VOL PP h7HAT IS -AINTENANCE OF #ERTIlCATION -/# v !MERICAN "OARD OF -EDICAL 3PECIALTIES ACCESSED ON -AY HTTPWWWABMSORG $OWNLOADS0UBLICATIONS 7HAT PERCENTIS PERCENT-/#PDF 3TEINBOOK 2 h2ENEWING "OARD #ERTIlCATION v .%*- VOL PP h!WARENESS OF AND !TTITUDES TOWARD "OARD #ERTIlCATION OF 0HYSICIANS v !UGUST 4HE 'ALLUP /RGANIZATION FOR 4HE !MERICAN "OARD OF )NTERNAL -EDICINE HTTPWWWABIMORGRESOURCESPRESSGALLUP?REPORT PDF ACCESSED -AY HTTPWWWABIMORGRESOURCESPRESSGALLUP? REPORTPDF ACCESSED -AY
0HYSICIAN #ERTIlCATION 0HYSICIAN CERTIlCATION ALTHOUGH VOLUNTARY IS INCREASINGLY BECOMING THE GOLD STANDARD THAT STAKEHOLDERS USE TO JUDGE CLINICAL COMPETENCE AND QUALITY OF PHYSICIAN CARE 7HILE THEY MAY NOT UNDERSTAND THE RIGORS OF BOARD CERTIlCATION CONSUMERS DO RECOGNIZE ITS IMPORTANCE ! 'ALLUP SURVEY REVEALED THAT PERCENT OF CONSUMERS WOULD SELECT A BOARD CERTIlED PHYSICIAN RATHER THAN A PHYSICIAN WHO WAS NOT BOARD CERTIlED BUT WAS RECOMMENDED BY FRIENDS ANDOR FAMILY;= $ESPITE THE APPREHENSION OF ADDITIONAL ADMINISTRATIVE WORK PHYSICIAN LEADERS RECOGNIZE THE MOVEMENT TOWARD QUALITY REPORTING AND ARE TAKING THE LEAD IN IDENTIFYING NEW QUALITY IMPROVEMENT CERTIlCATION REQUIREMENTS BEFORE THEY ARE SET BY OTHER ORGANIZATIONS 4HE )NSTITUTE OF -EDICINES )/- REPORT h(EALTH 0ROFESSIONS %DUCATION ! "RIDGE TO 1UALITY v OUTLINED lVE COMPETENCIES THAT CERTIlCATION ORGANIZATIONS SHOULD OFFER TO
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
ENSURE PHYSICIANS DEVELOP AND MAINTAIN PROlCIENCY 4HE lVE AREAS IDENTIlED INCLUDE;= $ELIVERING PATIENT CENTERED CARE 7ORKING AS PART OF INTERDISCIPLINARY TEAMS 0RACTICING EVIDENCE BASED MEDICINE &OCUSING ON QUALITY IMPROVEMENT AND 5TILIZING INFORMATION TECHNOLOGY TO IMPROVE QUALITY )N RESPONSE THE !CCREDITATION #OUNCIL OF 'RADUATE -EDICAL %DUCATION AND THE !MERICAN "OARD OF -EDICAL 3PECIALTIES !"-3 DEVELOPED COMPETENCY STANDARDS THAT ARE ALIGNED WITH THOSE OF THE )/-S RECOMMENDATIONS;= -ORE THAN PERCENT OF PHYSICIANS IN SPECIALTIES ARE BOARD CERTIlED;= !"-3 AND OTHER PHYSICIAN SPECIALTY BOARDS HAVE RECENTLY MADE VAST EFFORTS TO DEVELOP GUIDELINES AND SET CREDENTIALING REQUIREMENTS CENTERED ON IMPROVING THE QUALITY OF PATIENT CARE #ONTINUED ON THE NEXT PAGE
SGDãQ N KDã N E ã @ B B Q D C H S@S H N M ã H M ã P T @ K H S X 0HYSICIAN #ERTIlCATION CONTINUED
1UALITY 2EQUIREMENTS FOR #ERTIlCATION )N *ANUARY 4HE !MERICAN "OARD OF )NTERNAL -EDICINE !")- AND !"-3 PHASED IN A QUALITY IMPROVEMENT REQUIREMENT AS A CONDITION FOR CERTIlCATION AND RECERTIlCATION )NTERNISTS ARE NOW REQUIRED TO COMPLETE PRACTICE PERFORMANCE EVALUATIONS TO BE RECERTIlED h4HE "OARDS INCLUDING !")- ARE AMONG THE FEW EXISTING ORGANIZATIONS THAT BOTH PHYSICIANS AND THE PUBLIC VALUE HIGHLY 4HE PROFESSION IS SETTING STANDARDS FOR ITSELF 7E ARE TRANSFORMING WHAT IT MEANS TO BE A BOARD CERTIlED SPECIALIST v SAYS #HRISTINE + #ASSEL -$ PRESIDENT AND #%/ OF !")- !")- PROVIDES ONLINE MODULES AND TOOLS FOR PHYSICIANS TO COLLECT AND REPORT SELF EVALUATIONS AND MEASURE PRACTICE PERFORMANCE 4HE NEW CERTIlCATION STANDARDS EXHIBIT HOW THE ORGANIZATION IS TRANSFORMING hWHAT IT MEANS TO BE A BOARD CERTIlED SPECIALIST THAT THE PHYSICIAN IS CURRENT WITH KNOWLEDGE AND COMMUNICATING THIS TO PATIENTS DURING TREATMENT v ACCORDING TO #ASSEL 4HE INCREASING USE OF SIMULATED PATIENTS AND CLINICAL SITUATIONS PARTICULARLY IN ANESTHESIA IN THE TRAINING OF MEDICAL STUDENTS AND RESIDENTS IS ALSO A GROWING TREND 4HIS IS NOT DISSIMILAR TO mIGHT SIMULATORS FOR PILOTS 4HIS SIMULATION TECHNOLOGY MAY BE LEVERAGED FOR PRACTICE PERFORMANCE EVALUATIONS IN THE FUTURE 5SE OF SIMULATION IN QUALITY IMPROVEMENT IS DISCUSSED FURTHER IN THE PAPER IN THIS BOOK h)MPROVING (EALTHCARE 1UALITY IN THE 0EDIATRIC !MBULATORY %NVIRONMENTv )N ADDITION TO BROADENING CREDENTIAL REQUIREMENTS !")- IS WORKING WITH CONSUMER GROUPS TO IMPROVE COMMUNICATION EFFORTS BETWEEN THE BOARD AND CONSUMERS !S EXPLAINED BY #ASSEL h)NFORMATION IS AVAILABLE FOR FREE FOR CONSUMERS )T ;BOARD CERTIlCATION= IS OFTEN TAKEN FOR GRANTED AND IS BELOW THE RADAR SCREENv /NE OF !")-S IMMEDIATE ACTION STEPS IS TO MAKE BOARD CERTIlCATION AND RECERTIlCATION RESULTS MORE ACCESSIBLE AND hUSER FRIENDLYv FOR CONSUMERS )N ANOTHER INITIATIVE !")- IS BECOMING ACTIVELY INVOLVED WITH QUALITY ORGANIZATION LEADERS IN PAY FOR PERFORMANCE INITIATIVES 4HE ORGANIZATION IS COLLABORATING WITH "RIDGES 4O %XCELLENCE COMMERCIAL INSURERS AND #-3 TO PROVIDE MEMBERS WITH CREDIT TOWARD THEIR RECERTIlCATION FOR PARTICIPATION IN PAY FOR PERFORMANCE PROGRAMS
4IME ,IMITED #ERTIlCATION "ECAUSE EVIDENCE SUGGESTS THAT THE KNOWLEDGE AND SKILLS OF PRACTICING PHYSICIANS DIMINISH OVER TIME SPECIALTY BOARDS ARE MOVING TOWARD TIME LIMITED RECERTIlCATION PROGRAMS;= 7HILE SOME SPECIALTY GROUPS LIKE THE !MERICAN "OARD OF 3URGERY HAVE REQUIRED TIME LIMITATION ON CERTIlCATION AND RE EXAMINATION SINCE THE S OTHERS HAVE ONLY RECENTLY MOVED TO THAT PRACTICE )N MEDICAL SPECIALTY BOARDS COLLECTIVELY AGREED TO ISSUE TIME LIMITED PHYSICIAN CERTIlCATION WITH RECERTIlCATION REQUIREMENTS IN INTERVALS OF YEARS OR LESS
&UTURE $IRECTIONS OF -EDICAL #ERTIlCATION "OARDS IN THE 1UALITY -OVEMENT #-3 INTENT TO EMBED PAY FOR PERFORMANCE INTO -EDICARE REIMBURSEMENT HAS LED PHYSICIANS TO INCREASE THEIR INPUT IN THE DEVELOPMENT OF QUALITY MEASURES &OR EXAMPLE MULTIPLE BOARDS ARE INVOLVED IN DEVELOPING PERFORMANCE MEASURES THROUGH THE !MERICAN -EDICAL !SSOCIATIONS 0HYSICIAN #ONSORTIUM FOR 0ERFORMANCE )MPROVEMENT 4HE RECENT ATTENTION TO PAY FOR PERFORMANCE HAS LED PHYSICIANS TO INCREASE THEIR INPUT IN THE DEVELOPMENT OF QUALITY MEASURES !S NOTED BY !")-S #ASSEL h4HE FOCUS NEEDS TO BE ON THE WHOLE RANGE OF ;MEDICAL= CONDITIONS AND NOT JUST SELECTED OUTCOMESv -EDICAL CERTIlCATION BOARDS ARE BEST SUITED TO UNDERSTAND THE CLINICAL ISSUES THAT RELATE TO COLLECTION OF CLINICAL DATA DESIGN OF PERFORMANCE MEASURES AND ESTABLISHMENT OF CARE GUIDELINES -EDICAL CERTIlCATION BOARDS ARE ALSO BEGINNING TO RESPOND TO THE NEEDS OF CONSUMERS #URRENTLY THERE ARE LIMITED PUBLIC RESOURCES THAT DESCRIBE PHYSICIANS BOARD CERTIlCATION STATUS THEIR SPECIALTY CERTIlCATION AND RECERTIlCATION STATUS !"-3 MAINTAINS A DIRECTORY OF BOARD CERTIlED MEDICAL SPECIALTIES THAT CAN BE ACCESSED ON ITS WEBSITE OR VIA A TOLL FREE NUMBER 4HE WEBSITE LISTS THE BOARD IN WHICH THE PHYSICIAN OBTAINED GENERAL AND SUBSPECIALTY CERTIlCATION (OWEVER THE WEBSITE DOES NOT LIST THE YEAR IN WHICH THE PHYSICIAN OBTAINED CERTIlCATION )N A 'ALLUP POLL SURVEY ONLY ONE THIRD OF CONSUMERS ACTIVELY RESEARCH OR INQUIRE ABOUT PHYSICIANS CERTIlCATION;= 9ET AS SOPHISTICATED CONSUMERS INCREASE THEIR USE OF THE )NTERNET TO OBTAIN MEDICAL INFORMATION THE DEMAND FOR ACCESS TO LICENSED AND CREDENTIALED PHYSICIANS MAY INCREASE n "Y (INDY 3HAMAN 0RICEWATERHOUSE#OOPERS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
2ESHAPING (OSPITAL 4HROUGHPUT !CCELERATING A PATIENTS JOURNEY THROUGH THE HOSPITAL MEANS HAVING SENIOR LEADERSHIP CLINICIANS AND SUPPORT STAFF TALKING WITH EACH OTHER SWEATING THE DETAILS AND CASTING A WIDE NET WHEN SEARCHING FOR BOTTLENECKS TO UNCLOG AND SOLVE "Y *OAN $EMING -URPHY 0RICEWATERHOUSE#OOPERS
-
OST HOSPITALS URGENTLY NEED TO IMPROVE PATIENT mOW %XCESSIVE WAIT TIMES FOR EMERGENCY TREATMENT OR AN INPATIENT BED ARE A COMMON ISSUE IN HOSPITALS ACROSS THE COUNTRY "ACKUPS IN PATIENT mOW POTENTIALLY DIMINISH QUALITY OF CARE COMPROMISE PATIENT SAFETY UNNECESSARILY EXTEND PATIENTS LENGTHS OF STAY AND RESULT IN DISCHARGED PATIENTS WHO MAY BE DISSATISlED WITH THEIR HOSPITAL EXPERIENCES )MPROVING A PATIENTS WHOLE HOSPITAL EXPERIENCE INVOLVES ELIMINATING DELAYS AND STREAMLINING PATIENT mOW BETWEEN CLINICAL DEPARTMENTS AS WELL AS UTILIZING TECHNOLOGY SOLUTIONS TO ENABLE THE SHARING OF INFORMATION ABOUT THE PATIENTS STATUS THROUGHOUT THE ENTIRE ORGANIZATION
4HE 0ROBLEM )SNT 7HERE 9OU 4HINK ! HOSPITAL HAS MANY GATEWAYS WHERE BACKUPS CAN BE MOST VISIBLE AND MOST DETRIMENTAL TO THE HOSPITALS ABILITY TO PROVIDE PROMPT QUALITY CARE 4HE EMERGENCY DEPARTMENT %$ ADMITTING SURGERY AND DIAGNOSTIC DEPARTMENTS USUALLY REQUEST BEDS INDEPENDENTLY 4O COMPLICATE MATTERS FURTHER PATIENTS ARE OFTEN ADMITTED DIRECTLY FROM PHYSICIANS OFlCES OR TRANSFERRED FROM OTHER HOSPITALS OR OTHER INPATIENT mOORS 4HOUGH IT MAY SEEM REASONABLE TO SEEK THE REMEDY FOR THROUGHPUT PROBLEMS IN THE DEPARTMENTS WHERE THE BACKUPS OCCUR THE hBROKENv PROCESS CAN TYPICALLY BE FOUND FURTHER DOWN THE SERVICE CHAIN 4HIS GENERALLY INVOLVES AVAILABILITY OF DIAGNOSTIC TESTING TRANSPORTATION OF PATIENTS CLEANING AND PREPARING ROOMS NOTIlCATION OF DEPARTMENTS UPSTREAM WHEN BEDS ARE AVAILABLE OR ANY OF NUMEROUS KEY INTERRELATED PROCESSES THAT CAN BACK UP PATIENTS AT THEIR POINTS OF ENTRY 0ATIENT mOW BACKS UP BECAUSE OF SYSTEMWIDE PROBLEMS THAT CANNOT BE
SOLVED SIMPLY BY WORKING HARDER OR BY ADDING BEDS AND STAFF;= 0ROCESSES THROUGHOUT THE HOSPITAL AND BEYOND NEED TO BE EXAMINED AND REDESIGNED TO USE THE HOSPITALS AVAILABLE BEDS AND OTHER RESOURCES AS EFlCIENTLY AS POSSIBLE 0ATIENT CAPACITY IN RESOURCE INTENSIVE UNITS SUCH AS THE %$ SURGERY AND )#5 DEPENDS GREATLY ON THE LENGTHS OF STAY IN THE UNIT &OR EXAMPLE THE EFFECT OF AN EIGHT TO HOUR DECREASE IN AVERAGE LENGTH OF STAY FOR A GIVEN )#5 EQUATES TO THE ADDITION OF THREE )#5 BEDS;= &INDING AND lXING THROUGHPUT PROBLEMS REQUIRES COMMU NICATION AND BUY IN FROM DEPARTMENTS AND INDIVIDUALS THROUGHOUT THE ORGANIZATION (OSPITALS THAT HAVE EXPERIENCED THE EXPLORATIONS AND CHANGES NECESSARY TO IMPROVE PATIENT mOW STATE THEY NEVER REALIZED HOW MUCH HARD WORK WOULD BE INVOLVED OR HOW FAR REACHING THESE CHANGES COULD BE;=
-ANY 4RADE OFFS 4HROUGHPUT 3HOULDNT "E /NE OF 4HEM 0ATIENT CARE INVOLVES MANY PEOPLE PROCESSES AND A GREAT NUMBER OF HANDOFFS OF PATIENTS AND PATIENT INFORMATION FROM ONE DEPARTMENT OR CLINICIAN TO ANOTHER )NFORMATION mOWING ACROSS DEPARTMENTS INSTRUCTIONS BEING ACTED UPON AND NOTIlCATIONS BEING RETURNED ALL INVITE DELAYS "ROKEN PROCESSES ANYWHERE THAT IMPERFECTLY SUPPORT A HOSPITALS VAST ARRAY OF lNANCIAL CLINICAL AND LOGISTICAL FUNCTIONS CAN CAUSE BACKUPS AND DELAYS IN EXPEDITIOUSLY TREATING PATIENTS HAVING THEM DISCHARGED IN A TIMELY MANNER AND ENABLING THE HOSPITAL TO lLL EACH BED WITH ANOTHER PATIENT !N INTEGRATED HOSPITAL SYSTEM THAT SCHEDULES DIAGNOSTIC AND THERAPEUTIC PROCEDURES FOR PATIENTS IN THE MOST
*OAN $EMING -URPHY 2. -3 -"! IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE WITH OVER YEARS EXPERIENCE IN THE INDUSTRY 3HE HAS SIGNIlCANT EXPERIENCE IN LEADING CLIENTS IN DESIGNING AND IMPLEMENTING OVERALL OPERATIONAL CHANGES IN HOSPITALS PARTICULARLY FOCUSING ON PATIENT THROUGHPUT AND HOSPITALWIDE PROCESS REDESIGN 3HE CAN BE REACHED AT JOAN EDEMING MURPHY USPWCCOM 6ICKI 0RINCE 7RIGHT -"! IS A CONSULTANT WITH 0RICEWATERHOUSE#OOPERS ,,0 IN #ANADA 3HE SPECIALIZES IN THE AREA OF HEALTHCARE BUSINESS DEVELOPMENT INCLUDING THE INTEGRATION OF PUBLIC AND PRIVATE CARE DELIVERY SYSTEMS AND LIFE SCIENCE PRODUCT SERVICE PROVIDERS 3HE HAS OVER YEARS EXPERIENCE IN WORKING WITH ORGANIZATIONS TO IMPROVE ORGANIZATIONAL EFlCIENCY THROUGH STRATEGY STRUCTURE PROCESS AND PEOPLE DEVELOPMENT 3HE CAN BE REACHED AT VICKIPRINCE WRIGHT CAPWCCOM 4OM 7ONG IS A PARTNER WITH 0RICEWATERHOUSE#OOPERS AND LEADS THE !DVISORY PRACTICES FOR (EALTHCARE AND )4 !DVISORY IN "RITISH #OLUMBIA 4OM IS A CHARTERED ACCOUNTANT WITH OVER YEARS OF EXPERIENCE IN PROVIDING HEALTHCARE )4 AND BUSINESS ADVISORY SERVICES TO CLIENTS IN #ANADA (E COMBINES HIS BUSINESS EXPERIENCE WITH HIS UNDERSTANDING OF TECHNOLOGIES TO WORK WITH EXECUTIVES AT A STRATEGIC LEVEL TO IDENTIFY OPPORTUNITIES TO IMPROVE PERFORMANCE AND THE RESULTING OUTCOMES (E CAN BE REACHED AT TOMWONG CAPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
Q DRG@OH M Fã G N ROH S@ K ã S G Q N T FG OT S LOGICAL SEQUENCE CAN SIGNIlCANTLY REDUCE DELAYS;= !LL PATIENT CARE PROCESSES NO MATTER WHAT DEPARTMENT IS INVOLVED SHOULD FOCUS ON THE COMMON GOAL OF FACILITATING PATIENT mOW THROUGHOUT THE ORGANIZATION "EYOND BEING A SOURCE OF AGGRAVATION THROUGHPUT ISSUES CAN AFFECT QUALITY OF CARE (OSPITALS JUDGED TO BE HIGH PERFORMING IN BOTH lNANCIAL AND QUALITY MEASURES DIAGNOSE PATIENTS ACCURATELY TREAT THEM RAPIDLY AND APPROPRIATELY AND DISCHARGE THEM TO THEIR HOMES OR CARE SETTINGS WHEN IMMEDIATELY PRACTICAL ,ONG LENGTHS OF STAY POTENTIALLY PUT QUALITY AND PATIENT SAFETY AT RISK AND OFTEN IMPACT THE BOTTOM LINE SINCE PAYER REIMBURSEMENTS WILL NOT ALWAYS COVER PATIENT STAYS BEYOND ESTABLISHED BENCHMARKS
!TTACKING THE 4HROUGHPUT #HALLENGE #URING THROUGHPUT ISSUES REQUIRES HOSPITAL LEADERSHIP AT THE MOST SENIOR LEVEL INCLUDING THE #%/ PHYSICIAN LEADERSHIP AND THE CHIEF NURSING OFlCER 4HESE EXECUTIVES MUST BE DEEPLY INVOLVED IN THE PROCESS OF MOTIVATING AND MANAGING CHANGE THROUGHOUT THE ORGANIZATION %XPLICIT AND ONGOING EXECUTIVE LEADERSHIP CREATES A SENSE OF URGENCY FOR ACCELERATING PATIENT mOW AND MOVES EMPLOYEES BEYOND RATIONALES FOR INACTION SUCH AS h4HIS IS NOT GOING TO WORK v OR h)M DOING MY PART DEPARTMENT 8 IS THE SOURCE OF DELAYSv ! SUCCESSFUL INITIATIVE REQUIRES STRONG LEADERSHIP TO KEEP PEOPLE ENGAGED AND CONTINUALLY LOOKING AT WAYS TO IMPROVE PERFORMANCE METRICS "ROKEN PRACTICES THAT SLOW DOWN PATIENT mOW CAN OCCUR EVEN BEFORE A PATIENT ENTERS THE HOSPITAL 0HYSICIANS CAN HAVE A GREAT IMPACT ON THROUGHPUT BUT USUALLY EXHIBIT MORE INTEREST IN BEING EFlCIENT WITH THEIR OWN TIME THAN UNDERSTANDING HOW THEY CAN EXPEDITE A PATIENTS TRAVEL FROM ADMITTANCE TO DISCHARGE &OR EXAMPLE ALTHOUGH SOME PHYSICIANS LIKE TO ADMIT PATIENTS TO THE HOSPITAL FOR PARTICULAR DIAGNOSTIC TESTS MANY OF THESE TESTS COULD BE PERFORMED ON AN OUTPATIENT BASIS )N OTHER INSTANCES %XHIBIT %FFECTIVE 0ATIENT 4HROUGHPUT
THE HOSPITAL MAY NOT BE THE BEST SETTING FOR PROVIDING A PATIENT THE APPROPRIATE LEVEL OF CARE )N HOSPITALS WITH AGGRESSIVE CASE MANAGEMENT PROGRAMS CASE MANAGERS CONFER WITH PHYSICIANS IN MAKING ADMITTING AND DISCHARGE DECISIONS 'ETTING THE RIGHT PATIENTS INTO THE HOSPITAL IMPROVES THE SPEED AND QUALITY OF TREATMENT FOR THOSE WHO REALLY NEED TO BE THERE /NCE THE RIGHT PATIENTS ARE ADMITTED PHYSICIANS CAN FURTHER HELP BY ISSUING DISCHARGE ORDERS EARLY IN THE DAY SO THAT PATIENTS DO NOT HAVE TO SPEND AN EXTRA DAY IN THE HOSPITAL WHILE ORDERS ARE PROCESSED AND DISCHARGE INSTRUCTIONS PREPARED 'ETTING PHYSICIANS TO UNDERSTAND THAT THEIR BEHAVIORS CAN SLOW PATIENT mOW IS A DIFlCULT BUT VITAL TASK 0HYSICIANS RESPOND WELL TO DATA (OSPITALS CAN ENCOURAGE THESE NEW PRACTICES BY MAKING PHYSICIANS AWARE OF PATIENT BENElTS COLLECTING RELEVANT METRICS ABOUT PHYSICIAN BEHAVIOR AND POSTING A PERFORMANCE hDASHBOARDv FOR ALL TO SEE 3TRATEGIES SUCH AS THESE MAY HELP MOTIVATE PHYSICIANS TO MEET OR EVEN EXCEED hBEST PRACTICEv PERFORMANCE STANDARDS
7ORKING /UT THE $ETAILS )N A HOSPITAL ONE PERSON OR ONE MISSED COMMUNICATION CAN CAUSE SIGNIlCANT DELAYS ! BUSY NURSE FAILS TO NOTIFY HOUSEKEEPING TO CLEAN A DIRTY BED !N ACCEPTING mOOR NURSE IS UNAVAILABLE TO TAKE A REPORT FROM ADMITTING OR THE %$ ! TRANSPORTER TAKES TOO MUCH TIME GETTING A PATIENT FROM ONE PLACE TO ANOTHER 2ESULTS FROM ANCILLARY TESTS TAKE TOO LONG TO APPEAR ON THE PATIENTS CHART 4HESE ALL CONTRIBUTE TO LONG WAIT TIMES FOR ADMITTANCE AND EXCESSIVE LENGTHS OF STAY 4HE KEY IS TO GET ALL THE STAKEHOLDERS TALKING TOGETHER CONNECTING THE DOTS TO SEE WHERE OPPORTUNITIES EXIST TO STREAMLINE HANDOFFS AND OVERLAPS BETWEEN AREAS ! THROUGHPUT INITIATIVE CALLS ON NURSES PHYSICIANS CLINICIANS ORDERLIES HOUSEKEEPING AND CLERICAL STAFF AND HOSPITAL ADMINISTRATORS TO BE ORGANIZED THINK ABOUT THE PATIENTS EXPERIENCE AND ANTICIPATE WHERE BOTTLENECKS ARE LIKELY TO OCCUR !LL NEED TO BROADEN THEIR VISION TO SEE hTHE BIG PICTUREv FROM THE PATIENTS PERSPECTIVE 2ESOLVING THROUGHPUT PROBLEMS NECESSITATES GOING THROUGH THE DETAIL OF PROCESSES IMPACTING PATIENT mOW 4HESE PROCESSES START PRIOR TO HOSPITAL ADMISSION AND EXTEND THROUGH DISCHARGE AS SHOWN IN %XHIBIT &OR EXAMPLE IF %$ NURSES HAVE TO WAIT TOO LONG FOR BUSY mOOR NURSES TO TAKE A PATIENT REPORT PERHAPS A FAX MACHINE OR VOICE MAIL CAN ALLEVIATE THE PROBLEM 0ART OF THE PROCESS REDESIGN SHOULD INCLUDE SUCH DETAIL AS LOCATION OF THE FAX MACHINE AND DIRECTIONS FOR USE (OW WILL WE MONITOR THE NEW PROCESS TO MAKE SURE IT WORKS (OW DO WE TRAIN THE PEOPLE WHO WILL USE IT /NLY PENETRATING TO THIS LEVEL OF INTRICATE AND PERHAPS EXCRUCIATING DETAIL WILL RESULT IN CHANGES THAT ARE EFFECTIVE AND SUSTAINABLE
4HROUGHPUT 0RACTICES 4HE FOLLOWING PRACTICES HAVE PROVEN SUCCESSFUL IN IMPROVING PATIENT mOW THROUGH LEADING HOSPITALS 2EVIEW ALL PATIENTS FOR APPROPRIATENESS OF ADMISSION PRIOR TO INPATIENT ADMISSIONS AT ALL POINTS OF ENTRY # ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
Q DRG@OH M Fã G N ROH S@ K ã S G Q N T FG OT S +EY 3TEPS TO A 3UCCESSFUL 0ATIENT 4HROUGHPUT )NITIATIVE (OSPITALS WORKING TO REMEDY THROUGHPUT PROBLEMS AND PATIENT mOW BACKUPS NEED TO ( AVE A CLEAR VISION OF THE CHALLENGES THAT NEED TO BE ADDRESSED ' ET STAKEHOLDERS TO BUY IN TO THE EFFORT AS EARLY AS POSSIBLE ) NVOLVE STAFF THROUGHOUT THE HOSPITAL IN REDESIGNING PROCESSES AND PRACTICES $ EVELOP BENCHMARKS AND METRICS TO EVALUATE PERFORMANCE ( OLD PEOPLE ACCOUNTABLE FOR ACHIEVING MEASURABLE RESULTS $ EVELOP A THOROUGH TRAINING PROGRAM 3OURCE "RICKMAN * -IKOS + 0ENNELL & $UGAN * $EMING -URPHY * AND ,OPEZ & h3TRAIGHT 4ALK .EW !PPROACHES IN (EALTHCARE v -ODERN (EALTHCARE 3EPT SPECIAL ADVERTISING SECTION AND EDUCATIONAL SUPPLEMENT PROVIDED BY 0RICEWATERHOUSE#OOPERS
)DENTIFY POST ACUTE RESOURCES EARLY IN THE HOSPITAL STAY AND WITHIN ESTABLISHED GUIDELINES %STABLISH A WELL DElNED DISCHARGE PLAN FOR EACH PATIENT BEGINNING WITH ADMISSION !CTIVELY MANAGE LENGTH OF STAY 2EDESIGN %$ OPERATIONS TO FACILITATE PATIENT mOW FROM ENTRY POINT TO DISPOSITION INCLUDING ADMISSION TO THE HOSPITAL /PTIMIZE SURGICAL SERVICES TO ENSURE EASY ACCESS FOR SURGEONS AND PATIENTS )NSTITUTE AN INTEGRATED SOLUTION TO IDENTIFY EMPTY BEDS GET THEM CLEANED AND MAKE THEM AVAILABLE TO PATIENTS AND %NHANCE COORDINATION AND COLLABORATION BETWEEN NURSING AND CASE MANAGEMENT FROM ADMISSION TO DISCHARGE
4HIS INFORMATION CAN BE CAPTURED ELECTRONICALLY SUMMARIZED ON A hDASHBOARDv AND PUT ON A lLE THAT CAN BE VIEWED BY ALL AREAS 4O BE MEANINGFUL THE DATA MUST BE COMPARED TO INDUSTRY BENCHMARKS AND THESE COMPARISONS OFTEN CALCULATED AS PERCENTILE SCORES SHOULD ALSO BE PART OF A FREQUENTLY UPDATED ELECTRONIC DASHBOARD %NCOURAGING PEOPLE TO COMPARE THEIR DEPARTMENTAL AND PERSONAL PERFORMANCES TO NATIONAL STANDARDS HELPS TO KEEP PATIENT mOW A CONSTANT PRIORITY AND GIVES THE HOSPITAL AN ONGOING REPORT ON THE SUCCESS OF THEIR EFFORTS TO BOOST THROUGHPUT
#ONCLUSION (ASTENING A PATIENTS JOURNEY THROUGH THE HOSPITAL INVOLVES GETTING THE RIGHT PATIENTS INTO THE RIGHT BEDS THEN HAVING THE RIGHT PEOPLE DO THE RIGHT THINGS AT THE RIGHT TIMES %FFECTIVE COLLABORATION AND COMMUNICATION AMONG ALL HOSPITAL DEPARTMENTS WITH A COMMON FOCUS ON THE PATIENT INITIATES THE CHANGES THAT WILL BROADEN EVERY STAFFS PERSPECTIVE 7ORKING OUT THE DETAILS OF THROUGHPUT ISSUES THEN CAPTURING AND PUBLICIZING RELEVANT PERFORMANCE METRICS WILL CREATE AND SUSTAIN IMPROVED PATIENT THROUGHPUT AND MAXIMIZE UTILIZATION OF THE HOSPITALS RESOURCES %NDNOTES (ARADEN # AND 2 2ESAR h0ATIENT &LOW IN (OSPITALS 5NDERSTANDING AND #ONTROLLING IT "ETTER v 3UMMER &RONTIERS OF (EALTH 3ERVICES -ANAGEMENT P )BID P "RICKMAN * AND + -IKOS & 0ENNELL * $UGAN * $EMING -URPHY & ,OPEZ h3TRAIGHT 4ALK .EW !PPROACHES IN (EALTHCARE v 3EPT -ODERN (EALTHCARE SPECIAL ADVERTISING SECTION AND EDUCATIONAL SUPPLEMENT PROVIDED BY 0RICEWATERHOUSE#OOPERS ,AMBERT - h)MPROVEMENTS AND )NNOVATION IN (OSPITAL /PERATIONS ! +EY TO /RGANIZATIONAL (EALTH v 3UMMER &RONTIERS OF (EALTH 3CIENCES P
4HE 2OLE OF 4ECHNOLOGY 4ECHNOLOGY ENABLES OPTIMUM THROUGHPUT 2ADIO FREQUENCY IDENTIlCATION 2&)$ TAGS ON PATIENTS THAT TRACK THEIR WHEREABOUTS IN THE HOSPITAL GLOBAL POSITIONING SYSTEM LOCATORS TO TRACK MEDICAL EQUIPMENT %$ TRACKING TOOLS SPECIAL CELL PHONES AND VOICE MAIL SYSTEMS TO ENHANCE COMMUNICATIONS ELECTRONIC BED BOARDS AND AUTOMATED NOTIlCATION SYSTEMS ALL HELP HOSPITALS TO BOOST THROUGHPUT /NCE A PROCESS HAS BEEN IDENTIlED AS NEEDING TO BE lXED THE NEXT STEP IS TO LINK THE REVISED PROCESS WITH A TECHNOLOGY THAT WILL SUPPORT IT 4ECHNOLOGY PROVIDES ENORMOUS POSSIBILITIES FOR ENABLING FASTER BETTER AND MORE RELIABLE PATIENT mOW PROCESSES
3USTAINING 3UCCESS 0EOPLE WILL CONTINUE DOING THE RIGHT THINGS BEYOND THE EXCITEMENT OF AN INITIATIVE FOR CHANGE ONLY IF THEY ARE CONTINUALLY MOTIVATED TO SEEK IMPROVEMENT IN PATIENT THROUGHPUT 4O KEEP CHANGE AT THE FOREFRONT HOSPITALS NEED TO CONTINUOUSLY MONITOR RELEVANT PERFORMANCE METRICS SUCH AS LENGTHS OF STAY DISCHARGE TIMES WAIT TIMES IN %$ AND ADMITTING TRANSPORT TIMES TURNAROUND TIME FOR ANCILLARY TESTING AND EVEN THE TIME SPENT CLEANING A BED
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
3YMPTOMS OF !ILING 0ATIENT &LOW 0ROCESSES (OSPITALS KNOW WHEN THROUGHPUT PROBLEMS ARE IMPACTING THEIR CLINICAL AND lNANCIAL PERFORMANCE 4HE DIAGNOSIS IS AS OBVIOUS AS THE CURE IS ELUSIVE 3YMPTOMS PRESENT THEMSELVES MOST VISIBLY AT GATEWAYS OR ACCESS POINTS TO MEDICAL SERVICES 3YMPTOMS OF THROUGHPUT PROBLEMS OR BACKUPS INCLUDE , ONG WAIT TIMES IN EMERGENCY DEPARTMENT %$ OR INPATIENT ADMITTING (IGH PERCENTAGE OF %$ PATIENTS LEAVING WITHOUT BEING SEEN ,7"3 ,OW PATIENT SATISFACTION ,OW PHYSICIAN SATISFACTION $IFlCULTY TRANSFERRING PATIENTS OUT OF THE )#5 ANDOR THE 0!#5 ,ONG LENGTHS OF STAY ,/3 $ISCHARGES LATE IN THE AFTERNOON OR EARLY EVENING ,ENGTHY TURNAROUND TIMES FOR ANCILLARY TESTING
Q DRG@OH M Fã G N ROH S@ K ã S G Q N T FG OT S 2ICHMOND (EALTH 3ERVICES !RTHROPLASTY 2EDESIGN 2ICHMOND (OSPITAL IS A COMMUNITY HOSPITAL LOCATED NEAR 6ANCOUVER #ANADA !S A SITE FOR ARTHROPLASTY SURGERY WITHIN A REGIONAL NETWORK 2ICHMOND WAS EXPERIENCING A CONVERGENCE OF INCREASING DEMAND LIMITED RESOURCES AND INCREASING COSTS 7AITING TIMES FOR HIP AND KNEE REPLACEMENTS RANGED FROM NEARLY NINE TO ALMOST MONTHS AND DEMAND WAS PROJECTED TO INCREASE BY PERCENT OVER THE NEXT YEARS &ROM A PATIENT CARE PERSPECTIVE RESEARCH INDICATES THAT PATIENTS WHO RECEIVE SURGERY WITHIN SIX MONTHS FARE BETTER MEANING THE CURRENT RANGE OF WAITING TIMES WAS SIMPLY NOT ACCEPTABLE 4HE WAITING TIME WAS CONTRIBUTING TO INCREASED DOWNSTREAM CARE COSTS BOTH IN TERMS OF PATIENT OUTCOMES AND OPERATING EXPENSES !DDITIONAL FUNDING TO REDUCE THE WAIT LISTS HAD BEEN MADE AVAILABLE HOWEVER THE TEAM AT 2ICHMOND (OSPITAL UNDERSTOOD THAT SIMPLY APPLYING ONE TIME FUNDING TO THE SITUATION WOULD NOT PRODUCE A SUSTAINABLE IMPROVEMENT (OSPITAL LEADERS ESTABLISHED A PROJECT TO HANDLE THESE CASES MORE EFlCIENTLY OVER THE LONG TERM 4HE OVERRIDING OBJECTIVE WAS TO PROVIDE BETTER OUTCOMES AND IMPROVED ACCESS FOR PATIENTS AS WELL AS OVERALL REDUCTIONS IN COSTS PER CASE %ARLY BENCHMARKING IDENTIlED AN h 4OTAL *OINT /2 $AYv IN TWO /2S AS A BEST PRACTICE WITHIN WORLD CLASS FACILITIES WHICH WERE GENERALLY LARGE TEACHING HOSPITALS ANDOR DEDICATED ARTHROPLASTY CENTERS h7E ASKED OURSELVES WHAT WE COULD DO TO BE AS GOOD AS THE BEST IN THE WORLD n WITHIN THE CONSTRAINTS OF A COMMUNITY HOSPITAL 4HE PILOT ;PROJECT= PROVED THAT WE COULD DO IT n THAT WE COULD PROVIDE THE RIGHT TREATMENT TO THE RIGHT PATIENTS WITH GOOD OUTCOMES WITHIN A COST CERTAIN ENVIRONMENT v SAID +EN (UGHES -$ ONE OF THE PROJECT LEADERS )N A COMMUNITY SETTING FEWER RESOURCES AND THE LACK OF A hDEDICATED ARTHROPLASTY TEAMv MEANT THAT THE ENTIRE CONTINUUM OF CARE WOULD NEED TO BE ENGAGED IN ENABLING THE INCREASE IN PATIENT mOW FROM AN AVERAGE OF THREE JOINT REPLACEMENTS IN ONE /2 TO EIGHT JOINT REPLACEMENTS IN TWO /2S IN A SINGLE DAY ! MULTIDISCIPLINARY TEAM WAS ASSEMBLED TO ADDRESS THE ENTIRE CONTINUUM OF CARE FOR ARTHROPLASTY PATIENTS FROM THE PREOPERATIVE THROUGH ACUTE AND TO THE POST OPERATIVE PHASES )T WAS TASKED WITH CREATING A COMMON UNDERSTANDING OF THE CURRENT SITUATION IMPLEMENTING A NUMBER OF EVALUATIVE MECHANISMS TO UNDERSTAND THE BASELINE AND THE BENCHMARKS AND REDESIGNING AN INTEGRATED PROCESS THAT PUT PATIENT NEEDS AT THE CENTER !CCORDING TO #INDY 2OBERTS ANOTHER PROJECT LEADER h#OORDINATING A MULTIDISCIPLINARY APPROACH TO PROCESS IMPROVEMENT IS KEY %VERY AREA THAT HAS POTENTIAL IMPACT ON THE PATIENTS JOURNEY THROUGHOUT THE ARTHROPLASTY ENCOUNTER FROM THE DECISION TO HAVE SURGERY TO COMPLETION OF POST OP REHABILITATION WAS INVOLVED AT SOME POINT IN REDESIGNING THE MODEL 4HIS INCLUDED SUPPORT STAFF THAT NEVER ACTUALLY CAME IN CONTACT WITH THE PATIENT TO CLINICIANS WITH HANDS ON INVOLVEMENTv 0ATIENTS WERE ENGAGED IN FOCUS GROUPS AND INPUT FROM PROVIDERS AND SUPPORT SERVICES WAS SOUGHT IN ORDER TO ENSURE A PROCESS THAT ADDRESSED BOTH PATIENT AND PROVIDER NEEDS 4HE CONTINUUM OF CARE WAS INTEGRATED FROM PREOPERATIVE IDENTIlCATION OF NEEDS TO SURGICAL BOOKING AND BED MAPPING THROUGH SURGERY POST OPERATIVE AND COMMUNITY CARE AND REHABILITATIVE CARE 3TANDARD SYSTEMS INCLUDING SURGICAL ASSESSMENTS PRIORITIZATION TOOLS AND INSTRUMENTATION SETS ALLOWED STAFF TO STREAMLINE INTERNAL PROCESSES 3UPPORTING THE WORK WAS THE DEVELOPMENT OF A RAPID RECOVERY PLAN THAT INTEGRATED CLINICAL PATHWAYS FROM VARIOUS DISCIPLINES AND IDENTIlED APPROPRIATE SURGICAL PATIENTS FOR FAST TRACKING )N THE FOCUS GROUPS PATIENTS HAD IDENTIlED THE NEED TO BE BETTER PREPARED FOR SURGERY 3UBSEQUENTLY A SERIES OF EDUCATIONAL PROGRAMS AND PRE OPERATIVE ASSESSMENTS WERE ESTABLISHED !T THE CENTER OF THE REDESIGNED PROCESS IS A COORDINATED STAGGERED SCHEDULING APPROACH WHEREBY TWO /2S WORKING CONCURRENTLY ENABLE TWO SURGEONS TO WALK BETWEEN ROOMS TO HELP EACH OTHER AT CRUCIAL TIMES DURING SURGERY 4HE PROJECT HAS DEMONSTRATED RESULTS A PERCENT INCREASE IN ARTHROPLASTY CASES FROM TO CASESYEAR A PERCENT OVERALL WAITLIST REDUCTION AND A PERCENT DECREASE IN WAIT TIME FOR SURGERY !T THE BEGINNING OF THE PROJECT PATIENTS WERE WAITING A MEDIAN TIME OF WEEKS 0RESENTLY THEY ARE WAITING A MEDIAN TIME OF WEEKS AND EFlCIENCY ON SURGICAL UNITS HAS IMPROVED BY PERCENT LENGTH OF STAY WAS REDUCED TO FOUR DAYS FOR HIP RECONSTRUCTION AND THREE DAYS FOR KNEE RECONSTRUCTION 3URGERY TIMES HAVE BEEN REDUCED FROM HOURS TO 4HE TEAM DEVELOPED AN hARTHROPLASTY PLAN v A TOOL KIT THAT LAYS OUT BOTH THE CLINICAL AND ADMINISTRATIVE PROCESSES PROVIDES A COSTING FRAMEWORK THAT COVERS CAPITAL AND RESOURCE REQUIREMENTS AND PROVIDES EXAMPLES OF THE CORRESPONDING TOOLS REQUIRED TO ENABLE THE PROCESSES 4HE TOOL KIT HAS ENABLED THE ARTHROPLASTY PLAN TO TAKE ON A REGIONAL PERSPECTIVE AND IMPLEMENTATION IN OTHER SITES IS NOW UNDER WAY !DDITIONALLY OTHER FACILITIES OUTSIDE OF THE REGION HAVE REQUESTED THE KIT AND ARE LOOKING FOR WAYS TO ADAPT THE MODEL TO THEIR OWN UNIQUE ENVIRONMENTS h7E NEEDED TO BROADEN OUR APPROACH TO CARE DELIVERY n WITH INCREASED ATTENTION TO THE PREOPERATIVE PERIOPERATIVE ASSESSMENT EDUCATION AND FOLLOW UP CARE PROCESSES WE HAVE ACHIEVED BOTH A MORE EFlCIENT AS WELL AS A MORE PRODUCTIVE CARE DELIVERY MODEL THAT IS SUSTAINABLE v SAYS *EFF #OLEMAN -$ AND CHIEF OPERATING OFlCER "Y 6ICKI 0RINCE 7RIGHT AND 4OM 7ONG 0RICEWATERHOUSE#OOPERS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
)MPROVING THE %MERGENCY $EPARTMENT %XPERIENCE %MERGENCY ROOMS n OFTEN OVERCROWDED AS HOSPITALS INCREASINGLY BECOME !MERICAS HEALTHCARE SAFETY NET n CAN ADOPT PATIENT FOCUSED STRATEGIES TO IMPROVE EVERY PATIENTS EXPERIENCE WITH EMERGENCY CARE AND DELIVER CARE OF EXTRAORDINARY QUALITY
"Y 0ATRICIA -ICHAELS AND *UDITH ! 2UNK 0RICEWATERHOUSE#OOPERS
$
ESPITE THE CHALLENGES FACED BY EMERGENCY DEPARTMENTS %$ PATIENTS CONTINUE TO EXPRESS SATISFACTION WITH THE CARE RECEIVED;= 0ATIENTS GENERALLY BELIEVE %$S PROVIDE QUALITY CARE THE STAFF IS CONCERNED FOR THEIR WELFARE AND THE WAIT TIME TO RECEIVE TREATMENT IS REASONABLE;= (OWEVER THAT IS ONLY THE GOOD NEWS -OST PEOPLE ALSO BELIEVE THAT %$S ARE APPROACHING A CRISIS SITUATION BECAUSE OF OVERCROWDING 4HIS IS A CRISIS THAT MOST EMERGENCY PHYSICIANS BELIEVE IS ALREADY MANIFEST;= (OSPITALS NATIONWIDE WHICH ARE INCREASINGLY BECOMING !MERICAS HEALTHCARE SAFETY NET ARE BEING CHALLENGED TO DO MORE WITH LESS &ORTUNATELY THERE IS A GREAT DEAL HOSPITALS CAN DO TO DECOMPRESS %$S AND IMPROVE EVERY PATIENTS EXPERIENCE WITH EMERGENCY CARE WHILE CONTINUING TO DELIVER CARE OF EXTRAORDINARY QUALITY -ORE !MERICANS DEPEND ON %$S THAN EVER BEFORE $URING THE PAST DECADE HOSPITAL %$ VISITS INCREASED PERCENT TO MILLION VISITS IN .EARLY PERCENT OF THE POPULATION REPORTED AT LEAST ONE %$ VISIT UP FROM PERCENT A DECADE EARLIER 5NFORTUNATELY DURING THIS SAME PERIOD THE NUMBER OF HOSPITAL %$S IN THE 53 DECREASED BY ABOUT PERCENT )T IS NO WONDER MANY %$ ADMINISTRATORS FEEL THAT THEIR DEPARTMENTS ARE BURSTING AT THE SEAMS ! RECENT REPORT BY THE 'OVERNMENT !CCOUNTABILITY /FlCE FOUND KEY PERFORMANCE INDICATORS THAT TELL AN %$ WHEN CROWDING IS OCCURRING;= .UMBER OF HOURS THAT AN %$ DIVERTS AMBULANCES TO OTHER FACILITIES 0ROPORTION OF PATIENTS AND LENGTH OF TIME THAT PATIENTS BOARD IN THE %$ AWAITING AN INPATIENT BED AND 0ROPORTION OF PATIENTS WHO LEAVE THE %$ BEFORE RECEIVING A MEDICAL EVALUATION USUALLY BECAUSE THEY ARE TIRED OF WAITING
%XCESSIVE VOLUME SLOW PATIENT mOW AND INEFlCIENT BED MANAGEMENT THROUGHOUT THE HOSPITAL AFFECT THE PERFORMANCE OF THE %$ 4HIS IS LIKELY THE CASE BECAUSE BACKUPS AND DELAYS ARE TYPICALLY EXPERIENCED IN THE %$ BEFORE ANY OTHER DEPARTMENT WHEN THE HOSPITAL IS OPERATING AT FULL CAPACITY;= 0ATIENTS DISSATISlED WITH LONG WAITS MAY LEAVE THE %$ BEFORE BEING EXAMINED BY A PHYSICIAN OR CHOOSE TO GO TO A DIFFERENT PROVIDER IN THE FUTURE .EARLY PERCENT OF %$ VISITS END WITH THE PROSPECTIVE PATIENT WALKING AWAY;= 3OME %$S EXPERIENCE RATES AS HIGH AS PERCENT OF THEIR %$ VISITS ENDING IN THE PATIENT LEAVING WITHOUT TREATMENT ,7/4 4HE ,7/4 RATE IS A KEY METRIC FOR HOSPITALS AS THEY MEASURE THE EFFECTIVENESS AND EFlCIENCY OF THEIR %$S (OSPITALS WITH PROGRAMS TO EXPEDITE PATIENT mOW THROUGH THE %$ CAN IMPROVE THAT STATISTIC TO LESS THAN PERCENT $IVERSIONS CAN ALSO TAKE THEIR TOLL IN ADMISSIONS 4HE %$ IS TYPICALLY THE SOURCE OF MORE THAN PERCENT OF HOSPITAL ADMISSIONS;=
4HE %$ &ROM THE 0ATIENTS 0OINT OF 6IEW 0ATIENTS EXPECT TO WAIT IN THE %$ (OW LONG THEY EXPECT TO WAIT IS THE SUBJECT OF MANY STUDIES BUT PATIENTS DElNITELY BECOME DISTRESSED WHEN WAIT TIMES IN THE %$ STRETCH BEYOND TWO HOURS 4HIS CAN BE MITIGATED IF PATIENTS FEEL THEY ARE BEING ATTENDED TO OR IF THEY ARE WAITING FOR TEST RESULTS OR FOR SOME MEDICAL REASON %NHANCEMENTS TO CUSTOMER SATISFACTION WITH THE %$ EXPERIENCE START WELL OUTSIDE THE %$ ITSELF -OST %$ PATIENTS DRIVE THEMSELVES TO THE HOSPITAL OR ARE BROUGHT IN BY FAMILY OR FRIENDS #OPING WITH PARKING COMPLEXITIES OR DISTANT LOTS CAN MAKE AN INHERENTLY STRESSFUL EXPERIENCE MUCH WORSE !MPLE PARKING NEAR THE %$
0ATRICIA -ICHAELS 2. -3. IS A DIRECTOR WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE FOCUSES ON HOSPITAL OPERATIONS AND PROCESS IMPROVEMENT AND HAS OVER YEARS EXPERIENCE IN THE ADMINISTRATION AND DELIVERY OF PATIENT CARE SERVICES 3HE HAS DIRECTED PERFORMANCE IMPROVEMENT CARE MANAGEMENT AND PATIENT CARE ENGAGEMENTS IN MULTIHOSPITAL SYSTEMS ACADEMIC MEDICAL CENTERS AND COMMUNITY HOSPITALS 3HE CAN BE REACHED AT PATRICIACMICHAELS USPWCCOM *UDITH ! 2UNK 2. -%D IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE 3HE HAS EXTENSIVE EXPERIENCE IN HEALTHCARE IN A VARIETY OF SETTINGS 3HE CURRENTLY FOCUSES ON PATIENT THROUGHPUT AND QUALITY WITH EXPERTISE IN CASE MANAGEMENT PATIENT mOW AND EMERGENCY DEPARTMENT SERVICES 3HE CAN BE REACHED AT JUDITHARUNK USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
HLOQNUHMFãSGDãD LD Q FD M BXã C D O@ Q S LD M S ã D W OD Q H D M B D ENTRANCE SHOULD BE AVAILABLE FOR PATIENTS AND THEIR FAMILIES &REE VALET PARKING AT THE %$ ENTRANCE MINIMIZES CONCERNS ABOUT PARKING AND LOSING TRACK OF A LOVED ONE %ASY TO UNDERSTAND SIGNS AND OTHER DIRECTIONAL MARKERS SUCH AS BOLD STRIPES ON WALLS AND mOORS SHOULD HELP PEOPLE NAVIGATE EASILY TO THE %$ /NCE PATIENTS ARRIVE IN THE %$ HUMAN INTERACTION IS OFTEN SOUGHT ! CONCIERGE OR GREETER OFTEN A TRAINED VOLUNTEER MAY HELP TO BEGIN THE HOSPITAL EXPERIENCE ON A CARING SENSITIVE NOTE OFFERING PERSONAL ASSISTANCE AND INFORMATION ABOUT WHAT THE PATIENT CAN EXPECT BASED ON KNOWLEDGE OF %$ OPERATIONS AND WHAT IS GOING ON THAT DAY 4HIS lRST FACE IS OFTEN THE CONSTANT FOR THE FAMILY SOMEONE WHO IS WILLING AND ABLE TO RESPOND TO THE SMALLEST OF DETAILS
@/UR ORGANIZATION HAS DEFINED QUALITY AS THE DEGREE TO WHICH YOU ACHIEVE YOUR MISSION COMPATIBLE OUTCOMES 4HIS DEFINITION ENCOMPASSES ANY BODYS WORK EG CASHIER CAFETERIA WORKERS PARKING STAFF AS WELL AS THE CLINICAL STAFF ETC n !NTHONY $ 3LONIM -$ $R0( EXECUTIVE DIRECTOR OF THE #ENTER FOR #LINICAL %FFECTIVENESS AT THE #HILDRENS .ATIONAL -EDICAL #ENTER IN 7ASHING TON $# AND ASSOCIATE PROFESSOR AND VICE CHAIRMAN DEPARTMENT OF PEDIAT RICS 4HE 'EORGE 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE .OT ONLY IS HUMAN INTERACTION IMPORTANT BUT ALSO THE HEALTHCARE SETTING ITSELF 4HE WAITING AREA SHOULD OFFER A COMFORTABLE ENVIRONMENT WITH PRIVATE AREAS SAFE PLAY NOOKS FOR CHILDREN CLEAN CONTEMPORARY FURNITURE CURRENT MAGAZINES AND VENDING MACHINES 4HE WAITING ROOM SHOULD NOT HOWEVER SUBTLY IMPRESS PATIENTS AS A PLACE TO SPEND A GREAT DEAL OF TIME n NO PLUSH FURNISHINGS COUCHES LONG ENOUGH FOR SLEEPING MICROWAVES OR HOME LIKE CONVENIENCES #ONCERNS FOR PRIVACY SHOULD ALSO BE CONSIDERED %$S AND WAITING ROOMS SHOULD BE DESIGNED WITH PRIVATE AREAS WHERE THE STAFF CAN INTERACT WITH PATIENTS AND THEIR FAMILIES SEPARATELY FROM OTHER WAITING PATIENTS 4REATMENT NEEDS SHOULD ALSO TAKE PLACE IN ROOMS THAT AFFORD PATIENTS PRIVACY %$ NURSES ADDITIONALLY OFTEN TRY TO EXHIBIT DISCRETION BY CALLING PATIENTS TO BE REGISTERED OR
ADMITTED BY ONLY THEIR lRST NAMES 4HE ETHNIC RELIGIOUS AND CULTURAL DIVERSITY OF PATIENTS MUST BE KEPT IN MIND %$ STAFF MEMBERS NEED TRAINING TO FAMILIARIZE THEMSELVES WITH VARIOUS BELIEFS FOOD RULES TABOOS FOLK REMEDIES ATTITUDES TOWARD GENDER AND OTHER FACTORS THAT AFFECT PATIENT INTERACTIONS 5NINTENTIONAL BUT UNINFORMED ACTS SUCH AS A MALE PHYSICIAN EXAMINING A -USLIM WOMAN OR FAILING TO RECOGNIZE THE DIETARY PRACTICES OF ORTHODOX *EWS CAN BE DEEPLY OFFENSIVE TO THESE PATIENTS AND AFFECT ALL EXPERIENCES FROM THAT POINT FORWARD %$ STAFF MUST ENGAGE ALL PATIENTS IN A HELPFUL NONJUDGMENTAL WAY AND IN CONVERSATIONAL FASHION GATHER THE MEDICAL AND REGISTRATION INFORMATION NEEDED SO THAT CLINICIANS CAN BEGIN CARING FOR THEM 2EGISTRATION IN THE %$ SHOULD NOT BE VIEWED AS AN UNPLEASANT TASK EITHER BY THE STAFF OR THE PATIENTS )NFORMATION CAN BE GATHERED IN STEPS AT A REGISTRATION DESK IN THE WAITING ROOM AND AT THE PATIENTS BEDSIDE IN THE TREATMENT ROOM 3EVERAL HOSPITALS AROUND THE COUNTRY ADVERTISE A WAITING TIME GUARANTEE IN THEIR %$S OFFERING PASSES TO RESTAURANTS OR ENTERTAINMENT IF PATIENTS WAIT MORE THAN MINUTES TO SEE A PERSON WITH CLINICAL DECISION MAKING AUTHORITY 4HIS WAITING TIME MAY REPRESENT AN UPPER LIMIT AFTER WHICH PATIENTS ARE LIKELY TO BECOME ANXIOUS OR IRRITATED IF NO ONE SEEMS TO BE ADDRESSING THEIR MEDICAL PROBLEMS 7HETHER HOSPITALS TRY TO ACHIEVE SOME SORT OF ARBITRARY TIME LIMIT THEY CAN RELIEVE SOME OF THE DISSATISFACTION OF WAITING BY ADOPTING THE h$ISNEY APPROACH v WHICH ACTS ON THE PROPOSITION THAT WAITING IS MORE AGREEABLE IF THE %$ STAFF MEMBERS VERBALLY COMMUNICATE SOME REALISTIC EXPECTATION OF HOW LONG THE WAIT WILL BE AND PATIENTS HAVE SOME PRODUCTIVE OR INTERESTING WAYS TO SPEND THE TIME %$ STAFF CAN OBTAIN REGISTRATION AND MEDICAL INFORMATION PREPARE THE PATIENT FOR TESTING THAT THE PHYSICIAN WILL NEED FOR DIAGNOSIS AND ANSWER THE PATIENTS QUESTIONS AND CONCERNS n ALL WHILE THE PATIENT AWAITS TRIAGE AND TREATMENT IN THE %$ WAITING ROOM 0ATIENTS ARE NOT INTERESTED IN HEARING ABOUT HOW BUSY THE %$ IS EACH PATIENT WANTS TO BE TREATED AS THE ONLY PATIENT NEEDING CARE %$ STAFF MEMBERS NEED TO BE TRAINED TO INTERACT WITH PATIENTS ON A ONE TO ONE BASIS KEEPING THE INTERACTION FOCUSED ON EACH PATIENTS INDIVIDUAL CLINICAL NEEDS 4RIAGING PATIENTS ALSO RELIEVES %$ CROWDING AND ENSURES AN EFlCIENT USE OF RESOURCES 3OME TRIAGE PRACTICES INCLUDE 3ENDING LESS ILL PATIENTS TO OTHER DEPARTMENTS 0ATIENTS WHO PRESENT WITH SUB ACUTE SYMPTOMS CAN OFTEN BE TREATED AT A MORE CONVENIENT TIME IN A BETTER EQUIPPED PLACE )F FOR EXAMPLE A PHYSICIAN DETERMINES THAT A PATIENT NEEDS A STRESS TEST TO DETECT A POTENTIAL CARDIAC PROBLEM THE %$ NURSE CAN QUICKLY SCHEDULE THE PROCEDURE AT THE NEARBY URGENT CARE DEPARTMENT FREEING THE RESOURCES OF THE %$ %LECTRONIC BEDBOARD AND TRACKING SYSTEMS % $ CLINICIANS CAN KEEP TRACK OF INPATIENT BEDS AND THE LOCATION OF EVERY %$ PATIENT IN THE HOSPITAL %LECTRONIC MONITORING AND TRACKING LETS %$ NURSES QUICKLY lND BEDS FOR PATIENTS WHO ARE SERIOUSLY ILL
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
HLOQNUHMFãSGDãD LD Q FD M BXã C D O@ Q S LD M S ã D W OD Q H D M B D &AST 4RACK AND %XPRESS #ARE PROGRAMS 0ROGRAMS SUCH AS &AST 4RACK ACKNOWLEDGE THAT SOME PATIENTS WILL USE THE %$ FOR PRIMARY CARE AND OTHERS WILL HAVE RELATIVELY MINOR INJURIES THAT STILL REQUIRE IMMEDIATE ATTENTION 4HESE PROGRAMS ASSIGN SUCH PATIENTS TO RECEIVE PROMPT ATTENTION FROM PRIMARY CARE PHYSICIANS PHYSICIAN ASSISTANTS OR NURSE PRACTITIONERS WHO USE STANDARD PROTOCOLS AND WHO CAN TREAT THEM QUICKLY AT FAR LESS COST THAN TYING UP %$ BEDS AND RESOURCES
4HROUGHPUT AND 0ATIENT #ARE %$ PATIENTS PROGRESS THROUGH FOUR BASIC STAGES INTERVIEW EXAMINATION DIAGNOSIS AND DISPOSITION 4HE MORE QUICKLY THESE PROCESSES HAPPEN THE BETTER THE OUTCOMES AND PATIENT SATISFACTION 7HEN THE %$ MUST COLLABORATE WITH OTHER DEPARTMENTS FOR ANCILLARY TESTING THESE INTERACTIONS NEED TO TAKE PLACE SWIFTLY AND RELIABLY -ETRICS WORTH MONITORING INCLUDE THE TIME NEEDED TO ADMINISTER TESTS AND TO DELIVER TEST RESULTS 7HERE NECESSARY THE HOSPITAL MUST RE ENGINEER PRACTICES TO ACHIEVE BEST PRACTICE BENCHMARKS )N AN EFFORT TO SHORTEN THE TIME REQUIRED FOR ANCILLARY TESTING SOME HOSPITALS ESPECIALLY THOSE WITH LARGE PATIENT VOLUMES LOCATE TESTING RESOURCES EITHER WITHIN OR IMMEDIATELY NEXT TO THE %$ 2ADIOLOGICAL TESTING DIAGNOSTIC IMAGING AND ROUTINE LABORATORY TESTS CAN BE CONDUCTED WITHIN THE %$ .EW MEDICAL TECHNOLOGY ENABLES %$ NURSES TO ADMINISTER AND ANALYZE BLOOD TESTS AT THE PATIENTS BEDSIDE $ELAYS IN GETTING AN %$ PATIENT ADMITTED CAN OFTEN BE SHORTENED SUBSTANTIALLY BY AN hADMISSIONS TEAMv THAT INCLUDES A PHYSICIAN STATIONED IN THE %$ TO CONDUCT AN ADMISSION WORKUP WRITE ADMISSION ORDERS AND TAKE THE PATIENT TO THE APPROPRIATE INPATIENT mOOR !NOTHER APPROACH IS FOR THE %$ STAFF TO ALERT THE hADMISSION TEAMv WHO WILL MEET THE PATIENT ON THE INPATIENT UNIT TO PERFORM THE ADMISSION WORKUP 4HE CLINICAL INTERACTION BETWEEN PHYSICIANS AND NURSES SIGNIlCANTLY AFFECTS THROUGHPUT 7HEN NURSES AND PHYSICIANS TRUST EACH OTHERS CLINICAL JUDGMENT NURSES WILL ANTICIPATE WHAT CLINICAL INFORMATION AND TESTING A PHYSICIAN WILL NEED %XPERIENCED %$ NURSES ARE ABLE TO ORDER TESTS FROM SPECIlC PROTOCOLS;=
%$ 0RACTICES n 4HE 'OOD THE "AD AND THE 5GLY 0RACTICES THAT PATIENTS DONT LIKE INCLUDE @"OARDING 0ATIENTS DO NOT LIKE BEING hBOARDED v OR TEMPORARILY STORED ON A BED WITHIN THE %$ WAITING FOR AN INPATIENT BED;= 0ATIENTS FEEL NEGLECTED WHEN THEY ARE BOARDED IN THE %$ %VIDENCE SUGGESTS THAT CARE IS SAFER IF THE PATIENT IS PLACED IN A HALLWAY BED ON THE DESIGNATED INPATIENT UNIT;= -OVING PATIENTS BACK AND FORTH ) N SOME BUSY %$S PATIENTS MAY BE BROUGHT IN TO TREATMENT ROOMS FOR EXAMINATION AND DIAGNOSTIC TESTS AND SENT BACK TO THE WAITING ROOM TO AWAIT TEST RESULTS OR THE AVAILABILITY OF A
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
PHYSICIAN TO EVALUATE THEM 4HIS MAY HELP TO FREE UP %$ BEDS BUT IS A MAJOR SOURCE OF DISSATISFACTION TO PATIENTS
#ONCLUSION .O HOSPITAL DEPARTMENT EARNS AS MUCH ADMIRATION WHEN THINGS GO RIGHT OR HARMS THE HOSPITALS REPUTATION AS MUCH WHEN THINGS GO WRONG AS THE %$ 7HEN PATIENTS MUST WAIT IN THE %$ FOR LONG PERIODS BEFORE RECEIVING MEDICAL TREATMENT OR RESPOND TO THE SAME QUESTIONS FOUR DIFFERENT TIMES FROM FOUR DIFFERENT PEOPLE WHEN THEY ARE hBOARDEDv IN %$ STORAGE ROOMS AND HALLWAYS WAITING FOR INPATIENT BEDS OR WHEN %$ STAFF FAIL TO CONVEY USEFUL INFORMATION AND A SYMPATHETIC ATTITUDE PATIENTS LOSE FAITH THAT THEY ARE RECEIVING ADEQUATE MEDICAL CARE !LTHOUGH SOME PROBLEMS THAT MANIFEST 0RACTICES THAT ENHANCE THE PATIENT EXPERIENCE INCLUDE !SKING QUESTIONS ONCE 2EPEATEDLY ASKING THE SAME QUESTIONS IRRITATES PATIENTS 4HEY FEEL THAT NO ONE IN THE LONG CHAIN OF CAREGIVERS SHARES PATIENT MEDICAL INFORMATION WITH ANYONE ELSE 2EGISTRATION ADMISSION DEMOGRAPHIC AND MEDICAL INFORMATION ABOUT EACH PATIENT NEEDS TO BE INTEGRATED INTO A COMPREHENSIVE INFORMATION SYSTEM ACCESSIBLE TO ALL WHO COME INTO CONTACT WITH THAT PATIENT 3OME CIRCUMSTANCES MAY REQUIRE THAT THE SAME QUESTION BE ASKED MULTIPLE TIMES SUCH AS AN -2) PATIENT QUERIED ABOUT A PACEMAKER OR A PATIENT ABOUT TO GO UNDER ANESTHESIA ASKED ABOUT THE TIME OF HIS LAST MEAL )N THESE CIRCUMSTANCES QUESTIONERS SHOULD EXPLAIN WHY THE ANSWER IS SO IMPORTANT THAT IT MUST BE VERIlED MORE THAN ONCE 3ENSITIVITY TOWARD COLLECTING COPAYS -OST HOSPITALS DO NOT COLLECT COPAYS IN THE %$ BEFORE SERVICES ARE RENDERED BUT BEFORE PATIENTS LEAVE (OWEVER PATIENTS DO NEED TO BE GUIDED BACK TO REGISTRATION SO THEIR COPAYS CAN BE COLLECTED AND lNANCIAL RESPONSIBILITY DETERMINED #LINICIANS SHOULD NOT BE ASKED TO TAKE ON THE RESPONSIBILITY OF ASKING PATIENTS FOR MONEY (ELP FOR THE UNINSURED AND UNDERINSURED 3OCIAL WORKERS AND CASE MANAGERS SHOULD BE AVAILABLE IN THE %$ TO WORK WITH THE GROWING POPULATION OF WORKING POOR PATIENTS WHO LACK HEALTH INSURANCE 4HESE %$ PERSONNEL CAN CONNECT INDIGENT PATIENTS TO COMMUNITY RESOURCES PROVIDE lNANCIAL COUNSELING AND OFFER OTHER IMPORTANT SERVICES;= &OLLOWING UP 4HE %$ NURSE SHOULD GIVE CLEAR DISCHARGE INSTRUCTIONS TO PATIENTS #OMPLIANCE WITH THESE INSTRUCTIONS IS OFTEN IMPORTANT TO A GOOD OUTCOME SO THE NURSE SHOULD TAKE THE TIME TO ASK QUESTIONS THAT VALIDATE THAT THE PATIENT UNDERSTANDS THE INSTRUCTIONS
HLOQNUHMFãSGDãD LD Q FD M BXã C D O@ Q S LD M S ã D W OD Q H D M B D THEMSELVES IN THE %$ RESULT FROM BROKEN PROCESSES ELSEWHERE IN THE HOSPITAL AND lNANCIAL CONSTRAINTS GENERALLY PRECLUDE EXPANDING THE %$ OR ADDING INPATIENT BEDS PATIENT FOCUSED STRATEGIES IMPLEMENTED BY A PROFESSIONAL CARING AND WELL TRAINED %$ STAFF CAN MAKE STAYS SHORTER SIGNIlCANTLY INCREASE PATIENT SATISFACTION ENHANCE THE QUALITY OF CARE THE HOSPITAL PROVIDES AND CAPTURE LOST REVENUE AS THE ,7/4 PERCENT DECREASES %NDNOTES -C)NTURFF " AND . -C#LESKEY h0UBLIC /PINION 3TRATEGIES +EY &INDINGS FROM 4WO .ATIONAL 3URVEYS ON BEHALF OF THE !MERICAN #OLLEGE OF %MERGENCY 0HYSICIANS v *ULY P )BID )BID P -C#AIG , AND # "URT .ATIONAL (OSPITAL !MBULATORY -EDICAL #ARE 3URVEY %MERGENCY $EPARTMENT 3UMMARY #$# !DVANCE $ATA FROM 6ITAL AND (EALTH 3TATISTICS -AY .O P HTTP WWWCDCGOVNCHSDATAADADPDF h4ACKLING THE #APACITY #RISIS 3UCCESSFUL "ED -ANAGEMENT 3TRATEGIES v (&- -ARCH P HTTPMPTMCKESSONCOMARTICLESHFMA?BED MGMTPDF -C#AIG , AND # "URT .ATIONAL (OSPITAL !MBULATORY -EDICAL #ARE 3URVEY %MERGENCY $EPARTMENT 3UMMARY #$# !DVANCE $ATA FROM 6ITAL AND (EALTH 3TATISTICS -AY .O P HTTP WWWCDCGOVNCHSDATAADADPDF )BID ,ARABEE * ET AL h0REDICTORS OF 0ATIENT 3ATISFACTION WITH )NPATIENT .URSING #ARE v 2ESEARCH IN .URSING (EALTH VOL P -C)NTURFF " AND . -C#LESKEY h0UBLIC /PINION 3TRATEGIES +EY &INDINGS FROM 4WO .ATIONAL 3URVEYS ON BEHALF OF THE !MERICAN #OLLEGE OF %MERGENCY 0HYSICIANS v *ULY P h4ACKLING THE #APACITY #RISIS 3UCCESSFUL "ED -ANAGEMENT 3TRATEGIES v (&- -ARCH P HTTPMPTMCKESSONCOMARTICLES HFMA?BEDMGMTPDF h!CTS OF #HARITY #HARITY CARE STRATEGIES FOR HOSPITALS IN A CHANGING LANDSCAPE v 0RICEWATERHOUSE#OOPERS (EALTH 2ESEARCH )NSTITUTE
-INUTE #LINIC !S HEALTHCARE COSTS CONTINUE TO RISE CONSUMERS AND PAYERS SEARCH FOR ALTERNATIVES FOR AFFORDABLE QUALITY CARE 4HE GROWING RETAIL SEGMENT OF HEALTHCARE MAY AID IN THIS CAUSE 4HIS SEGMENT CONTINUES TO GROW WITH ONE STOP CLINICS THAT ARE GENERALLY OPEN SEVEN DAYS A WEEK DIAGNOSING AND TREATING A LIMITED SCOPE OF COMMON ILLNESSES 4HE LARGEST SUCH CHAIN -INUTE#LINIC FOCUSES ON MEDICAL CONDITIONS SUCH AS STREP THROAT MONO mU BLADDER INFECTIONS AND VACCINATIONS 4HE NURSE PRACTITIONERS WHO STAFF THE CLINICS LEVERAGE THEIR KNOWLEDGE THROUGH REPETITIVE DIAGNOSES OF SIMILAR CASES WITHIN A LIMITED SCOPE OF PRACTICE h1UALITY OF CARE IS OUR .O CONCERN v SAYS -ICHAEL (OWE #%/ OF -INUTE#LINIC WHICH HAS OPENED NEARLY SUCH CLINICS IN DRUGSTORES AND OTHER RETAIL OUTLETS SEE %XHIBIT FOR A DECISION TREE THAT SHOWS HOW -INUTE#LINIC MAINTAINS QUALITY "Y SEGMENTING ROUTINE CARE TO NURSE PRACTITIONERS DOCTORS CAN CONCENTRATE ON ATYPICAL CONDITIONS THEREBY PROVIDING A BETTER FOCUS OF CARE THROUGHOUT THE HEALTHCARE LANDSCAPE h0HYSICIANS NOW MORE THAN EVER ARE GOING TO BECOME AWARE OF CONSUMERS AND WILL NEED TO DEVELOP A PATIENT CENTRIC MENTALITY v SAYS -INUTE#LINICS (OWE A FORMER #%/ OF THE !RBYS FAST FOOD CHAIN
%XHIBIT 1UALITY $ECISION 4REE AND #HECKLIST FOR -INUTE#LINIC $O WE TREAT THIS
9ES .O
,IMITED SCOPE OF CONDITIONS VACCINATIONS 2EFERRED TO LOCAL PHYSICIANS HOSPITALS
(OW DO WE TREAT THIS
0ROTOCOLS FROM !MERICAN !CADEMY OF &AMILY 0HYSICIANS !MERICAN !CADEMY OF 0EDIATRICS )NSTITUTE FOR #LINICAL 3YSTEM )MPROVEMENT
!RE NURSE PRACTITIONERS FOLLOWING PROTOCOLS
$IAGNOSIS AND TREATMENT ARE TRACKED THROUGH COMPANYWIDE ELECTRONIC MEDICAL RECORD SYSTEM CHARTS RANDOMLY REVIEWED BY LOCAL MEDICAL DIRECTOR
7ILL TREATMENT BE SAFE
0RESCRIPTIONS ARE CHECKED WITH ELECTRONIC DRUG INTERACTION DATABASE
(OW CAN PATIENTS BE INCLUDED IN THE QUALITY CONTINUUM
%DUCATIONAL INFORMATION IS PRINTED FOR ALL PATIENTS UPON DISCHARGE FROM THE CLINIC
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
-AGNET .URSING 3TATUS 4IME AND MONEY SPENT ACHIEVING -AGNET NURSING STATUS IS PAYING QUALITY DIVIDENDS TO HOSPITALS CAREGIVERS AND PATIENTS ALIKE THROUGH RECRUITMENT AND RETENTION OF MORE PROFESSIONAL NURSES AND BETTER HEALTHCARE OUTCOMES
"Y $EBORAH !LLBACH 0RICEWATERHOUSE#OOPERS 3HERRY $ANELLO AND 3USAN (OWELL 3T *OSEPHS#ANDLER (EALTH 3YSTEM
4
HE -AGNET 2ECOGNITION 0ROGRAM¸ DEVELOPED AND ADMINIS TERED BY THE !MERICAN .URSES !SSOCIATION !.! PROMOTES AND HONORS EXCELLENCE IN HOSPITAL NURSING SERVICE !CHIEVING -AGNET STATUS REQUIRES A HEALTHCARE ENVIRONMENT THAT ENCOURAGES AND EXPECTS NURSES TO WORK IN PARTNERSHIP WITH PHYSICIANS AND OTHER STAFF IN DELIVERING QUALITY HEALTHCARE TO PATIENTS -AGNET NURSING STATUS IS RESPECTED AS THE ONLY QUALITY MEASURE AND RECOGNITION SYSTEM RELATED SPECIlCALLY TO HOSPITAL NURSING )T CONlRMS NURSES ABILITY TO COLLABORATE CONlDENTLY WITH PHYSICIANS AND OTHER CAREGIVERS AND THEIR PARTICIPATION IN MAKING THE DECISIONS THAT GOVERN THEIR OWN RESPONSIBILITIES PRACTICES AND PROFESSIONAL DEVELOPMENT $ECADES OF RESEARCH SHOW THAT THE ORGANIZATIONAL AND MANAGEMENT CHARACTERISTICS OF -AGNET HOSPITALS ARE ASSOCIATED WITH MORE PROFESSIONAL NURSE PRACTICE ENVIRONMENTS AND BETTER PATIENT AND STAFF OUTCOMES; = .URSES SEEK -AGNET ORGANIZATIONS BECAUSE THEY lND WORK MORE SATISFYING WHERE THEIR TALENTS ARE RESPECTED AND MAKE A DIFFERENCE TO PATIENT OUTCOMES 0ATIENTS ARE BEGINNING TO RECOGNIZE THAT SUCH ORGANIZATIONS ALSO DELIVER MORE SATISFYING PATIENT EXPERIENCES
4HE /RIGIN OF -AGNETISM 4HE EARLY S SAW A NATIONWIDE SHORTAGE OF NURSES (OSPITALS AND OTHER PROVIDERS SOUGHT TO RECRUIT AND RETAIN NURSES BY A VARIETY OF METHODS 3OME FELT OFFERING LARGER SALARIES WOULD SOLVE
THE NURSING SHORTAGE 4HE 2OBERT 7OOD *OHNSON &OUNDATION DECIDED TO TAKE A LOOK AT MANY hATTRACTORSv 7HAT ATTRACTED NURSES TO THE PROFESSION 7HAT KIND OF ENVIRONMENTS ATTRACTED THEM TO PARTICULAR HEALTH SYSTEMS 7HAT MADE THEM WANT TO STAY 4HIS AND MANY SUBSEQUENT STUDIES FOUND A HIGH CORRELATION BETWEEN HOSPITALS THAT DELIVER QUALITY CARE AND THOSE THAT ATTRACT AND RETAIN NURSES (OSPITALS THAT PROMOTE AND SUPPORT THE ROLE OF PROFESSIONAL NURSING AND GIVE NURSES AUTHORITY AND AUTONOMY TO ACT IN THEIR AREAS OF EXPERTISE ALSO CREATE INTERDISCIPLINARY CARE CULTURES PATIENT CENTRIC CARE ENVIRONMENTS AND BETTER PATIENT OUTCOMES;= .URSES PREFER TO WORK IN HEALTH SYSTEMS WHERE PATIENTS RECEIVE EXCELLENT CARE AND WHERE NURSES CAN FOCUS THEIR TIME AND TALENTS ON CONTRIBUTING TO PATIENT CARE SAFETY AND SATISFACTION .URSES WANT TO PARTICIPATE IN DECISIONS REGARDING PATIENT CARE AND THEIR ROLES RESPONSIBILITIES AND PRACTICES IN DELIVERING IT 4HEY WANT TO BE RESPECTED AS ESSENTIAL TO QUALITY CARE AND GOOD PATIENT OUTCOMES 4HEY WANT TO WORK IN A PLACE WHERE THEY CAN GROW AND DEVELOP THEIR EXPERIENCE AND EXPERTISE 2ESEARCH SUGGESTS THAT PROVIDING SUCH AN ENVIRONMENT DIFFERENTIATES HOSPITALS WITH SIGNIlCANTLY LESS TURNOVER AND FEWER NURSING VACANCIES FROM LESS hMAGNETICv COMPETITORS 4HIS WAS THE GENESIS OF THE -AGNET 2ECOGNITION 0ROGRAM¸ TODAY ADMINISTERED BY THE !MERICAN .URSES #REDENTIALING #ENTER AN ARM OF THE !.! 4HE PROGRAM AIMS TO HELP HOSPITALS PROVIDE MORE REWARDING LONG TERM CAREER SATISFACTION AND OPPORTUNITIES FOR
$EBORAH !LLBACH 2. -3. #.! IS A SUBJECT MATTER EXPERT WITH 0RICEWATERHOUSE#OOPERS (EALTHCARE #ONSULTING PRACTICE AND HAS MORE THAN YEARS EXPERIENCE AS A HEALTHCARE OPERATIONS LEADER 3HE SPECIALIZES IN CARE DELIVERY DESIGN PROCESS IMPROVEMENT COST CONTAINMENT REVENUE ENHANCEMENT AND QUALITY IMPROVEMENT 3HE CAN BE REACHED AT DEBORAHPALLBACH USPWCCOM 3HERRY $ANELLO -3. 2. #.!! IS VICE PRESIDENT OF PATIENT CARE SERVICES AND THE CHIEF NURSING OFlCER AT 3T *OSEPHS #ANDLER IN 3AVANNAH 'A 3HE HOLDS MASTERS DEGREES IN BOTH NURSING AND BUSINESS 3HE HAS MORE THAN YEARS EXPERIENCE IN HEALTHCARE AND HAS HELD JOBS IN CRITICAL CARE NURSING EDUCATION ADMINISTRATION AND OPERATIONS 3HE HAS ALSO LED A NUMBER OF INITIATIVES EVALUATING THE ENVIRONMENT OF NURSING PRACTICE AND HOW IT AFFECTS EFlCIENCY AND QUALITY 3HE CAN BE REACHED AT DANELLOS SJCHSORG 3USAN (OWELL %D$ 2. !/#. IS THE DIRECTOR OF PROFESSIONAL PRACTICE AT 3T *OSEPHS#ANDLER 3HE HAS FACILITATED THE PROCESS FOR OBTAINING -AGNET DESIGNATION AND REDESIGNATION FOR THE ORGANIZATION FOR THE PAST SIX YEARS $R (OWELL HAS OVER YEARS EXPERIENCE IN NURSING PRIMARILY IN THE lELDS OF ONCOLOGY AND EDUCATION 3HE CAN BE REACHED AT HOWELLS SJCHSORG
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
L@FM D S ã M T Q RH M Fã RS@S T R
&ORCES OF -AGNETISM ;=
&ORCE 1UALITY OF .URSING ,EADERSHIP +NOWLEDGEABLE STRONG RISK TAKING NURSE LEADERS FOLLOW A WELL ARTICU LATED STRATEGIC AND VISIONARY PHILOSOPHY IN THE DAY TO DAY OPERATIONS OF THE NURSING SERVICES .URSING LEADERS AT ALL LEVELS OF THE ORGANIZATION CONVEY A STRONG SENSE OF ADVOCACY AND SUPPORT FOR THE STAFF AND FOR THE PATIENT 4HE RESULTS OF QUALITY LEADERSHIP ARE EVIDENT IN NURSING PRACTICE AT THE PATIENTS SIDE
&ORCE /RGANIZATIONAL 3TRUCTURE /RGANIZATIONAL STRUCTURES ARE GENERALLY mAT RATHER THAN VERTICAL OR HIERARCHI CAL AND DECENTRALIZED DECISION MAKING PREVAILS 4HE ORGANIZATIONAL STRUCTURE IS DYNAMIC AND RESPONSIVE TO CHANGE 3TRONG NURS ING REPRESENTATION IS EVIDENT IN THE STRUCTURE OF THE ORGANIZATIONAL COMMITTEE .URSING LEADERS SERVE AT THE EXECUTIVE LEVELS OF THE ORGANIZATION 4HE CHIEF NURSING OFlCER TYPICALLY REPORTS DIRECTLY TO THE CHIEF EXECUTIVE OFlCER 4HE ORGANIZATION HAS A FUNCTIONING AND PRODUCTIVE SYSTEM OF SHARED DECISION MAKING
&ORCE -ANAGEMENT 3TYLE (EALTHCARE ORGANIZATION AND NURSING LEADERS CREATE AN ENVIRONMENT ENCOURAGING PARTICIPATION FROM STAFF AT ALL LEVELS IN OPERATIONAL DECISIONS &EEDBACK IS VALUED AND INCORPORATED INTO FUTURE DECISIONS AND PRAC TICES .URSES SERVING IN LEADERSHIP POSITIONS ARE VISIBLE ACCESSIBLE AND COMMITTED TO COMMUNICATING EFFECTIVELY WITH STAFF
&ORCE 0ERSONNEL 0OLICIES AND 0ROGRAMS 3ALARIES AND BENElTS ARE COMPETITIVE #REATIVE AND mEXIBLE STAFlNG MODELS THAT SUPPORT A SAFE AND HEALTHY WORK ENVIRONMENT ARE USED 0ERSONNEL POLICIES ARE CREATED WITH DIRECT CARE NURSE INVOLVEMENT 3IGNIlCANT OPPORTUNITIES FOR PROFESSIONAL GROWTH EXIST IN ADMINISTRATIVE AND CLINICAL TRACKS 0ERSONNEL POLICIES AND PROGRAMS SUPPORT PROFESSIONAL NURSING PRACTICE WORKLIFE BALANCE AND THE DELIVERY OF QUALITY CARE
&ORCE 0ROFESSIONAL -ODELS OF #ARE 4HERE ARE MODELS OF CARE IE PRIMARY NURSING CASE MANAGEMENT FAM ILY CENTERED DISTRICT AND HOLISTIC THAT GIVE NURSES THE RESPONSIBILITY AND AUTHORITY FOR DIRECT PATIENT CARE AND FOR CONTINUITY OF CARE ACROSS THE CONTINUUM .URSES ARE ACCOUNTABLE FOR THEIR OWN PRACTICE AS WELL AS THE COORDINATION OF CARE 4HE MODELS TAKE INTO CONSIDERATION PATIENTS UNIQUE NEEDS AND PROVIDE SKILLED NURSES AND ADEQUATE RESOURCES TO ACCOMPLISH DESIRED OUTCOMES
&ORCE 1UALITY OF #ARE 1UALITY IS THE SYSTEMATIC DRIVING FORCE FOR NURSING AND THE ORGANIZATION .URSES SERVING IN LEADERSHIP POSITIONS ARE RESPONSIBLE FOR PROVIDING AN ENVIRONMENT THAT POSITIVELY INmUENCES PATIENT OUTCOMES 4HERE IS A PERVA SIVE PERCEPTION AMONG NURSES THAT THEY PROVIDE HIGH QUALITY CARE TO PATIENTS
&ORCE 1UALITY )MPROVEMENT 4HE ORGANIZATION HAS STRUCTURES AND PROCESSES FOR THE MEASUREMENT OF QUALITY AND PROGRAMS FOR IMPROVING THE QUALITY OF CARE AND SERVICES DELIVERED TO PATIENTS THROUGHOUT THE ORGANIZATION
&ORCE #ONSULTATION AND 2ESOURCES 4HE HEALTHCARE ORGANIZATION PROVIDES ADEQUATE RESOURCES SUPPORT AND OPPORTUNITIES FOR THE UTILIZATION OF EXPERTS PARTICULARLY ADVANCED PRACTICE NURSES 4HE ORGANIZATION ALSO PROMOTES INVOLVEMENT OF NURSES IN PROFESSIONAL ORGANIZATIONS AND AMONG PEERS IN THE COMMUNITY
&ORCE !UTONOMY .URSES ARE ENCOURAGED AND EXPECTED TO PRACTICE AUTONOMOUSLY TO ASSESS AND PROVIDE APPRO PRIATE PATIENT CARE BASED ON COMPETENCE PROFESSIONAL EXPERTISE AND KNOWLEDGE AND CONSISTENT WITH PROFESSIONAL STANDARDS )NDEPENDENT JUDGMENT IS EXPECTED TO BE EXERCISED WITHIN THE CONTEXT OF INTERDISCIPLINARY AND MULTIDISCIPLINARY APPROACHES TO PATIENT CARE
&ORCE #OMMUNITY AND THE (EALTHCARE /RGANIZATION /RGANIZATIONS THAT ARE BEST ABLE TO RECRUIT AND RETAIN NURSES INVARIABLY MAINTAIN A STRONG COMMUNITY PRESENCE #OLLABORATION IS APPARENT WITH ALL TYPES OF HEALTHCARE PROVID ERS AND OTHER COMMUNITY ORGANIZATIONS TO DEVELOP STRONG PARTNERSHIPS THAT SUPPORT IMPROVED PATIENTCLIENT OUTCOMES AND THE HEALTH OF THE COMMUNITIES THEY SERVE #ONTINUED ON THE NEXT PAGE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
L@ FM D S ã M T Q RH M Fã RS@S T R &ORCES OF -AGNETISM CONTINUED ;=
&ORCE .URSES AS 4EACHERS 0ROFESSIONAL NURSES ARE INVOLVED IN EDUCATIONAL ACTIVITIES WITHIN THE ORGANIZATION AND COMMUNITY A ROLE THAT REPORTEDLY GIVES NURSES A GREAT DEAL OF PROFESSIONAL SATISFACTION 3TAFF IN ALL POSITIONS SERVE AS FACULTY AND PRECEPTORSMENTORS FOR STUDENTS FROM A VARIETY OF ACADEMIC PROGRAMS WHO ARE WELCOMED AND SUPPORTED IN THE ORGANIZATION 4HERE IS A PATIENT EDUCATION PROGRAM THAT MEETS THE DIVERSE NEEDS OF PATIENTS IN ALL OF THE CARE SETTINGS OF THE ORGANIZATION
&ORCE )MAGE OF .URSING 4HE SERVICES PROVIDED BY NURSES ARE CHARACTERIZED AS ESSENTIAL BY OTHER MEMBERS OF THE HEALTHCARE TEAM .URSES ARE VIEWED AS INTEGRAL TO THE HEALTHCARE ORGANIZATIONS ABILITY AND MISSION TO PROVIDE PATIENT CARE .URSES EFFECTIVELY INmUENCE SYSTEMWIDE PROCESSES
&ORCE )NTERDISCIPLINARY 2ELATIONSHIPS #OLLABORATIVE WORKING RELATIONSHIPS WITHIN AND AMONG THE DISCI PLINES ARE VALUED -UTUAL RESPECT IS BASED ON THE PREMISE THAT ALL MEMBERS OF THE HEALTHCARE TEAM MAKE ESSENTIAL CONTRIBUTIONS IN THE ACHIEVEMENT OF GOOD CLINICAL OUTCOMES #ONmICT MANAGEMENT STRATEGIES ARE IN PLACE AND ARE USED EFFECTIVELY WHEN NEEDED
&ORCE 0ROFESSIONAL $EVELOPMENT 4HE HEALTHCARE ORGANIZATION VALUES AND SUPPORTS WITH ADEQUATE HUMAN AND lSCAL RESOURCES THE PROFESSIONAL GROWTH AND DEVELOPMENT OF THE STAFF 0ROGRAMS THAT PROMOTE STAFF ORIENTATION IN SERVICE EDUCATION CONTINUING AND FORMAL EDUCATION CAREER DEVELOPMENT COMPETENCY BASED CLINICAL AND LEADERSHIPMANAGEMENT DE VELOPMENT AND PROFESSIONAL CERTIlCATION ARE EVIDENT 3OURCE !MERICAN .URSES !SSOCIATION
"ETTER PATIENT OUTCOMES AND MORE SATISlED PATIENTS ARE NATURAL CONSE QUENCES OF HAVING NURSES WHO ARE MORE INVESTED IN MAKING CHANGES AND BEING ASSERTIVE ABOUT THEIR PRACTICE ENVIRON MENT !CHIEVING -AGNET STATUS IS A CONTINUOUS JOURNEY )T IS THE JOURNEY
(OSPITALS APPLY FOR -AGNET STATUS ON A VOLUNTARY BASIS AND RETAIN THEIR -AGNET STATUS FOR FOUR YEARS 3TATUS CAN BE PULLED IF QUALITY DIPS OR IF THERE ARE SERIOUS EVENTS THAT AFFECT THE ORGANIZATIONS ABILITY TO CONTINUE COMPLIANCE WITH THE &ORCES OF -AGNETISM %ACH SUBSEQUENT APPLICATION IS TREATED THE SAME AS A NEW APPLICATION WITH THE SAME RIGOROUS REQUIREMENTS FOR ON SITE VISITATIONS AND EVIDENCE OF COMPLIANCE /NLY ABOUT LESS THAN PERCENT OF ALL HOSPITALS HAVE ACHIEVED -AGNET STATUS (OWEVER THE NUMBER OF THOSE APPLYING HAS INCREASED STEADILY IN RECENT YEARS;=
THAT MAKES A STRONGER NURSING SERVICE
4HE 0ATH TO -AGNETISM NURSES AND CONSEQUENTLY BETTER FULlLL THEIR MISSIONS AS COMMUNITY HEALERS !CHIEVING -AGNET HOSPITAL RECOGNITION IS BUILT AROUND COMPLIANCE WITH A SET OF PRINCIPLES THE h &ORCES OF -AGNETISMv "Y WORKING TO COMPLY WITH THESE PRINCIPLES AND GIVING EVIDENCE THAT THE REQUIRED LEVELS OF EXCELLENCE ARE ATTAINED HOSPITALS LEARN TO MEASURE KEY PERFORMANCE INDICATORS AND KEEP ALL STAKEHOLDERS APPRISED OF THE ORGANIZATIONS PROGRESS IN MEETING THEM 4HESE KEY PERFORMANCE INDICATORS SUCH AS INCIDENCE OF PRESSURE SORES PER PATIENT DAYS AND OTHER INDUSTRY BENCHMARKS HELP TO EVALUATE THE HOSPITALS SUCCESS AT CREATING SATISFYING EXPERIENCES FOR PATIENTS AND SATISFYING CAREERS FOR NURSES PHYSICIANS AND STAFF -OREOVER THE FORCES OF MAGNETISM CAN ALSO APPLY TO NON NURSING DEPARTMENTS 3HAPING THE PHILOSOPHY OF HOW A HOSPITAL DOES BUSINESS CAN BE EQUALLY OR EVEN MORE IMPORTANT TO THE ORGANIZATION THAN A NURSING ONLY FOCUS
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
4HE HOSPITALS OF 3T *OSEPHS#ANDLER (EALTH 3YSTEM 3*#(3 TWO OF THE OLDEST COMMUNITY HOSPITALS IN THE 53 HAVE ALWAYS HAD A TRADITION OF lRST RATE NURSING SERVICE AND QUALITY PATIENT CARE 4HE NURSES WITHIN THE SYSTEM HAVE CONTINUOUSLY BEEN ACKNOWLEDGED BY THE PHYSICIANS WITH WHOM THEY WORK AS HAVING A PIVOTAL ROLE IN PROVIDING QUALITY CARE AND GOOD CLINICAL OUTCOMES 4HE NURSES AND EXECUTIVES AT 3T *OSEPHS#ANDLER MOVED RAPIDLY TO INCORPORATE THE PRINCIPLES OF NURSING EXCELLENCE THE h &ORCES OF -AGNETISM v INTO THEIR PROFESSIONAL LIVES 4HE ORGANIZATIONS APPLICATION WAS EVALUATED FOR COMPLIANCE WITH THE PRINCIPLES OF -AGNETISM AND KEY PERFORMANCE INDICATORS THAT SUPPORTED THE APPLICATION 4WO YEARS AND SEVERAL CHALLENGES LATER IN THE !.! CONFERRED -AGNET NURSING STATUS ON 3T *OSEPHS#ANDLER (EALTH 3YSTEM 4HE SYSTEM WAS RECERTIlED FOUR YEARS LATER WITH AN ON SITE VISIT AND INTERVIEWS WITH NO LESS THAN PERCENT OF THE NURSING STAFF TO VERIFY THAT
L@ FM D S ã M T Q RH M Fã RS@S T R THE ORGANIZATION hLIVEDv THE PRINCIPLES OF NURSING EXCELLENCE AND MADE THEM PART OF THE HOSPITALS ONGOING OPERATING PRACTICES (OSPITAL LEADERSHIP AND NURSES AGREE THAT ACHIEVING -AGNET STATUS WAS WORTH THE EFFORT INVOLVED IN MAKING AND SUPPORTING THE APPLICATION 2ECRUITING AND RETAINING NURSES HAS NOT BEEN A PROBLEM FOR 3*#(3 IN SPITE OF SLIGHTLY HIGHER SALARIES OFFERED BY A COMPETITOR -OST IMPORTANTLY COMPLYING WITH THE &ORCES OF -AGNETISM HAS STEERED 3*#(3 TOWARD CONTINUOUS IMPROVEMENT IN THE QUALITY OF PATIENT CARE AND THE QUALITY OF THE PROFESSIONAL LIVES OF NURSES IN THE ORGANIZATION
%XECUTIVE NURSES WHO HAVE PARTICIPATED IN THE PROCESS OF ACHIEVING -AGNET STATUS FOR THEIR HOSPITALS OFFER THIS ADVICE FOR THOSE WHO ARE CONSIDERING THE JOURNEY 5SE THE APPLICATION PROCESS AS AN OPPORTUNITY AND THE INSPIRATION FOR CHANGE 'ET BUY IN FROM KEY STAKEHOLDERS FROM ACROSS THE ORGANIZATION NOT JUST EXECUTIVE LEADERSHIP AND NURSES 6ISIT OTHER -AGNET HOSPITALS FOR ADVICE AND INSPIRATION 3HOW PHYSICIANS THE DATA n THEY VALUE EVIDENCE AND 6ALUE THE PROCESS AS IMPORTANT IT IS A CONTINUOUS JOURNEY THAT CAN STRENGTHEN THE NURSING SERVICE
%XTENDING THE 2EACH OF .URSING
4HE #HARACTER OF .URSING
!PPLYING FOR -AGNET NURSING STATUS PLACES STRINGENT DEMANDS ON A HOSPITAL WITH RIGOROUS DOCUMENTATION REQUIRED TO DEMONSTRATE THAT THOSE DEMANDS HAVE BEEN MET )NTERVIEWS WITH CHIEF NURSING EXECUTIVES ABOUT ACHIEVING -AGNET STATUS EMPHASIZE THAT IT IS A COSTLY ENDEAVOR THAT INCLUDES TIME AND RESOURCES (OWEVER THEY ALSO STATE THAT THE TIME AND EFFORT ARE VALIDATED BY THE RESULT h#OMPARE THE MONEY YOU BUDGET FOR THIS ;-AGNET= TO WHAT YOU SPEND ON RECRUITMENT EVERY PERCENTAGE POINT THAT YOU DROP YOUR TURNOVER OR RETAIN YOUR STAFF IT MORE THAN PAYS FOR WHAT WE PUT INTO -AGNETv;= )T IS LIKELY THAT NO HOSPITAL WILL BE FULLY COMPLIANT WITH THE PRINCIPLES THAT MERIT -AGNET STATUS RECOGNITION WHEN IT APPLIES 0ART OF THE PURPOSE OF THE RECOGNITION PROGRAM IS TO PUSH ORGANIZATIONS BEYOND IMPROVEMENTS IN THEIR CLINICAL AND lNANCIAL PERFORMANCE TO CONTINUOUS EFFORTS AIMED AT DEVELOPING THE TALENTS EFFECTIVENESS AND SATISFACTION OF THEIR NURSES (OSPITALS ARE ALSO ENCOURAGED TO CONDUCT RESEARCH THAT MAY HELP TO DEVELOP BETTER NURSING PRACTICES &OR MANY YEARS HOSPITALS HAVE BEEN ORGANIZED AROUND WHAT WORKED BEST FOR THE STAFF .URSING RESEARCH PROJECTS ARE NOW LOOKING AT WHAT HAPPENS WHEN THE TIMING AND ORGANIZATION OF CARE DELIVERY IS BETTER ORIENTED TO PATIENT COMFORT AND SATISFACTION &OR EXAMPLE 3T *OSEPHS#ANDLER (OSPITAL IS MEASURING PATIENT AND STAFF SATISFACTION AS A RESULT OF MORE LENIENT VISITING POLICIES IN THEIR CRITICAL CARE UNIT AND THE HOSPITAL IS LOOKING AT IMPROVEMENTS IN PATIENTS VITAL SIGNS AS A RESULT OF INSTITUTING A PERIOD OF hQUIET TIMEv EACH DAY IN THEIR PROGRESSIVE CARE UNIT 4ECHNOLOGY PLAYS A ROLE AS WELL 4OOLS SUCH AS SAFETY SYSTEMS FOR )6 MEDICATION #/ MONITORING AND BEDS DESIGNED TO REDUCE PRESSURE SORES AND FALLS HELP NURSES CONCENTRATE ON BEING CAREGIVERS RATHER THAN WATCHDOGS
4HE -AGNET 2ECOGNITION 0ROGRAM¸ CONFERS -AGNET NURSING STATUS ON HOSPITALS WHOSE PRACTICES AND PEOPLE EXEMPLIFY THE ESSENCE OF NURSING TO BE A CARING KNOWING PRESENCE AND TO HELP RESTORE PATIENTS TO THE BEST LEVEL OF FUNCTION THEY CAN ATTAIN OR TO CONTRIBUTE TO A PEACEFUL DEATH 3UCH RECOGNITION CANNOT BE ACHIEVED IN ISOLATION COLLABORATION WITH THE REST OF THE PATIENT CARE TEAM IS ESSENTIAL 7HEN COMPETENT CONlDENT NURSES ARE ABLE TO COLLABORATE AS PARTNERS WITH PHYSICIANS AND OTHER MEMBERS OF THE HEALTHCARE TEAM AND ISSUES GET ADDRESSED AT A MUCH MORE MANAGEABLE LEVEL AND IN A MUCH MORE COLLEGIAL ATMOSPHERE "ETTER PATIENT OUTCOMES AND MORE SATISlED PATIENTS ARE NATURAL CONSEQUENCES OF HAVING NURSES WHO ARE MORE INVESTED IN MAKING CHANGES AND BEING ASSERTIVE ABOUT THEIR PRACTICE ENVIRONMENT !CHIEVING -AGNET STATUS IS A CONTINUOUS JOURNEY )T IS THE JOURNEY THAT MAKES A STRONGER NURSING SERVICE %NDNOTES (AVENS $3 h#OMPARISON OF NURSING DEPARTMENTAL INFRASTRUCTURE AND OUTCOMES !.## -AGNET AND NON-AGNET #.%S REPORT v .URS %CON PP !IKEN ,( $3 (AVENS AND $- 3LOANE h4HE -AGNET NURSING SERVICES RECOGNITION PROGRAM A COMPARISON OF TWO GROUPS OF -AGNET HOSPITALS v !M * .URS P !IKEN ,( h)MPROVING 1UALITY 4HROUGH .URSING v -AY 0OLICY #HALLENGES IN -ODERN (EALTH #ARE PP h4HE -AGNET 2ECOGNITION 0ROGRAM 2ECOGNIZING %XCELLENCE IN .URSING v !PPLICATION -ANUAL PUBLISHED BY !MERICAN .URSES #REDENTIALING #ENTER 'EORGIA !VENUE 3ILVER 3PRING -$ COPYRIGHT EDITION PP WWWANAORGANCC-AGNETINDEXHTML (AVENS $3 AND -! *OHNSTON h!CHIEVING -AGNET (OSPITAL 2ECOGNITION #HIEF .URSE %XECUTIVES AND -AGNET #OORDINATORS 4ELL 4HEIR 3TORIES v $ECEMBER *OURNAL OF .URSING !DMINISTRATION PP
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
%VIDENCE "ASED $ECISION 3UPPORT &ROM 0APER TO %LECTRONIC ! GROWING BODY OF RESEARCH DEMONSTRATES THAT BOTH PAPER AND ELECTRONIC FORMS OF EVIDENCE BASED DECISION SUPPORT CAN REDUCE ERRORS OF OVERUSE UNDERUSE OR MISUSE OF CLINICAL INTERVENTIONS
"Y 'REGORY ( $ORN :YNX (EALTH
4HE #HALLENGE 4HE SCIENTIlC ADVANCEMENTS OF THE MEDICAL INDUSTRY SPANNING THE LAST YEARS RANGE FROM THE WIDESPREAD USE OF ANTIBIOTICS AFTER 7ORLD 7AR )) TO THE S LANDMARK TRIALS ON BETA BLOCKERS FOLLOWED BY POWERFUL ENZYME INHIBITORS IN THE S EG (-' #O! REDUCTASE INHIBITORS TO RECENT RECOMBINANT MYELOPROLIFERATIVE AGENTS %ACH STEP ALONG THIS STAGGERING PATH OF INNOVATION HAS SOUGHT TO IMPROVE THE HEALTH OF A PARTICULARLY VULNERABLE POPULATION WITH THE HOPE OF ACHIEVING WIDESPREAD POPULATION HEALTH GAINS 4O SOME EXTENT THE BIOLOGICAL INNOVATION FOCUSED APPROACH HAS ACHIEVED ITS GOAL A CHILD BORN IN WILL LIKELY LIVE BEYOND WHEREAS IN THE CHANCES OF EXCEEDING WERE SLIGHTLY LESS THAN PERCENT;= 4HE INNOVATION APPROACH HAS COME AT A SIGNIlCANT COST TO THE 5NITED 3TATES MEASURED BY GROWING HEALTH EXPENDITURES;= WITH MARGINAL GAINS IN LONGEVITY;= *UXTAPOSING THE BRILLIANT HALF CENTURY OF THERAPEUTIC INNOVATIONS ARE DATA DEMONSTRATING THE MARGINAL SPECIlCITY OF THE HEALTHCARE SYSTEM AT DELIVERING THESE INTERVENTIONS TO ELIGIBLE PATIENTS n WELL DEMONSTRATED BY THE PREVALENT UNDERUSE OF HIGHLY COST EFFECTIVE THERAPIES;= &URTHER AGGRAVATING THE EFFECTIVENESS OF THE HEALTHCARE DELIVERY SYSTEM ARE THE lNDINGS OF ERRORS OF MISUSE AND OVERUSE OCCURRING CONJOINTLY WITH ERRORS OF UNDERUSE 4HE FOREGOING POSES A CENTRAL QUESTION 7ILL AN APPROACH FOCUSED PURELY ON INNOVATION CONTINUE TO SERVE THE HEALTH OF THE 53 POPULACE DEEP INTO THIS CENTURY OR SHOULD IT BE SUPPLEMENTED WITH AN APPROACH FOCUSED ON ELIMINATING THE OVERUSE UNDERUSE AND MISUSE OF CLINICAL INTERVENTIONS 4O OPTIMIZE THE DELIVERY OF THERAPIES SUCH THAT OVERUSE UNDERUSE AND MISUSE ERRORS ARE SIGNIlCANTLY REDUCED TWO
PROBLEMS MUST BE SOLVED &IRST WE DONT KNOW WHICH CLINICAL INTERVENTIONS ARE EFFECTIVE AND SECOND CLINICIANS MAY NOT KNOW OF EFFECTIVE INTERVENTIONS RELEVANT TO THEIR PATIENT AT THE POINT OF CARE %VIDENCE BASED MEDICINE CAN BE THE FRAMEWORK THAT SOLVES THESE TWO PROBLEMS &ROM THE SEMINAL WORK PUBLISHED NEARLY A DECADE AGO;= TO RECENT ADOPTION INTO MEDICAL EDUCATION CURRICULA EVIDENCE BASED MEDICINE IS NOW THE ACCEPTED METHODOLOGY USED TO ELUCIDATE EFFECTIVE CLINICAL INTERVENTIONS FROM THE MULTITUDE OF INDIVIDUAL PEER REVIEWED CLINICAL TRIALS lNDINGS 7HEN COUPLED WITH EFFECTIVE POINT OF CARE DELIVERY STRATEGIES THE SCIENCE OF EVIDENCE BASED MEDICINE UNDERPINS THE APPROACH KNOWN AS EVIDENCE BASED DECISION SUPPORT %"$3
4HE %VIDENCE "ASED $ECISION 3UPPORT 3OLUTION %VIDENCE BASED DECISION SUPPORT CAN TAKE TWO FORMATS PAPER OR ELECTRONIC )N THE PEER REVIEWED LITERATURE THE MOST COMMONLY STUDIED FORMS OF PAPER BASED %"$3 ARE ON THE CHART REMINDERS ORDER SETS AND CLINICAL PATHWAYS 4HE DOCUMENTED EFFECT OF PAPER BASED %"$3 IS A REDUCTION IN ERRORS OF UNDERUSE 3PECIlCALLY ON THE CHART REMINDERS IMPROVE BOTH IMMUNIZATION RATES IN THE AMBULATORY SETTING;= AND COMMUNITY ACQUIRED PNEUMONIA PROCESS OF CARE MEASURES SUCH AS TIME TO ANTIBIOTICS AND INTRAVENOUS TO BY MOUTH ANTIBIOTIC SWITCH RATES;= !LSO EFFECTIVE ARE CLINICAL PATHWAYS WHICH ARE ASSOCIATED WITH IMPROVEMENTS ACROSS A BROAD RANGE OF CLINICAL CONDITIONS AND VENUES %XAMPLES OF THE ASSOCIATION BETWEEN CLINICAL PATHWAYS AND QUALITY INCLUDE IMPROVED QUALITY OF CARE MEASURES IN COMMUNITY ACQUIRED PNEUMONIA; = AND REDUCED MALPRACTICE RISK IN OBSTETRICAL CARE;=
'REGORY ( $ORN -$ -0( IS THE EXECUTIVE VICE PRESIDENT AND GENERAL MANAGER OF :YNX (EALTH A (EARST "USINESS -EDIA #OMPANY WHERE HE HAS HELPED GUIDE THE ORGANIZATION THROUGH CHANGES OF OWNERSHIP AND EXPANDED THE REACH OF :YNX SOLUTIONS FROM LESS THAN HOSPITALS TO MORE THAN (E IS ALSO A LECTURER ON QUALITY IMPROVEMENT FOR THE 5#,! #ENTER FOR (EALTH 3ERVICES -ANAGEMENT AND A FACULTY PRESENTER FOR THE (EALTHCARE )NFORMATION -ANAGEMENT 3YSTEMS 3OCIETY MEETING (E CAN BE REACHED AT GDORN ZYNXCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
DUHCDMB D A@RDCãCDB HR H N M ã RT OON Q S ã E Q N Lã O@ OD Q ã SN ã D K D B S Q N M H B 4HE EFFECTIVENESS OF CLINICAL PATHWAYS LED TO THE EVALUATION OF ORDER SETS AS THEY CAN BE CONSIDERED COMPONENTS OF CLINICAL PATHWAYS 4HE CENTRAL RESEARCH QUESTION WAS #OULD A MORE FOCUSED APPROACH BE EQUALLY EFFECTIVE AS THE PATHWAY APPROACH ON QUALITY OF CARE MEASURES )N ADDITION TO ORDER SETS TARGETED DESIGN
4HE LITERATURE EVALUATING %"$3 IN #0/% AND %-2S IS GROWING RAPIDLY AND FOCUSES PREDOMINANTLY ON REMIND ERS AS THE IMPLEMENTATION STRATEGY OTHER REASONS THAT CONTRIBUTE TO THEIR EFFECTIVENESS AS A FORM OF %"$3 ARE THEY ARE FAMILIAR TO CLINICIANS THEY ARE INTEGRATED INTO THE WORK mOW THEY ARE CONDITION AND VENUE SPECIlC AND THEY SPEED ORDER WRITING 3UPPORTING THESE OBSERVATIONS ARE RESULTS DEMONSTRATING ORDER SETS EFFECTIVENESS AT IMPROVING CLINICAL PROCESSES AND OUTCOMES WITH RECENT lNDINGS IN COMMUNITY ACQUIRED PNEUMONIA AND ACUTE CORONARY SYNDROME; =
%LECTRONIC #ONVERGENCE 4HE SUCCESS OF PAPER BASED %"$3 AT REDUCING ERRORS OF UNDERUSE HAS CREATED ENTHUSIASM FOR THE ELECTRONIC IMPLEMENTATIONS OF ORDER SETS REMINDERS AND CLINICAL PATHWAYS ! GOAL OF IMPLEMENTING ORDER SETS REMINDER AND CLINICAL PATHWAYS IN AN ELECTRONIC ENVIRONMENT SUCH AS COMPUTERIZED PHYSICIAN ORDER ENTRY #0/% OR AN ELECTRONIC MEDICAL RECORD %-2 IS TO EXPAND THE SCALE AND EFFECTIVENESS SUCH THAT %"$3 REDUCES ERRORS OF UNDERUSE IN CONJUNCTION WITH ERRORS OF MISUSE AND OVERUSE 4HE LITERATURE EVALUATING %"$3 IN #0/% AND %-2S IS GROWING RAPIDLY AND FOCUSES PREDOMINANTLY ON REMINDERS AS THE IMPLEMENTATION STRATEGY 2EMINDERS CAN BE DElNED AS A RULES GENERATED POP UP WINDOW THAT PROVIDES A SPECIlC RECOMMENDATION TO THE CLINICIAN 7HEN REVIEWING THE LITERATURE THERE ARE NUMEROUS STUDIES EVALUATING ALERTS AND REMINDERS FOCUSED ON DRUG INTERACTIONS CRITICAL LABORATORY VALUES AND PREVENTIVE HEALTH MEASURES EG MAMMOGRAPHY VACCINATIONS AND CANCER SCREENING 4HE EVIDENCE SHOWS THAT ALERTS ARE EFFECTIVE AT REDUCING DRUG TO DRUG AND DRUG TO ALLERGY INTERACTIONS n ESSENTIALLY ERRORS OF MISUSE;= 3PECIlCALLY THE EFFECTIVENESS OF ALERTS ON REDUCING ERRORS OF MIS USE HAS BEEN MEASURED AT A PERCENT RELATIVE REDUCTION;= 4HIS INITIAL WORK HAS LED TO THE WIDER IMPLEMENTATION OF ALERTS FOCUSED ON DRUG TO DRUG INTERACTIONS EG WARFARIN AND mUCONAZOLE AND DRUG TO PHYSIOLOGICAL ABNORMALITIES AS MEASURED BY A LABORATORY TEST EG DIGOXIN AND HYPOKALEMIA 7HEN TARGETED TOWARD ABNORMAL LABORATORY lNDINGS COMPUTER IZED ALERTS HAVE INCREASED INPATIENT RATES OF NORMOKALEMIA AND INCREASED SERUM POTASSIUM LEVELS AT DISCHARGE FOR PATIENTS AT RISK FOR HYPOKALEMIA;= 4HESE EARLY lNDINGS HAVE PUSHED THE lELD
OF %"$3 TO EVALUATE MORE COMPLEX ALERTS FOCUSED ON VELOCITIES OF PHYSIOLOGICAL VALUES %XAMPLES INCLUDE RISING CREATININE OR FALLING POTASSIUM LEVELS OVER A lXED PERIOD OF HOURS ! CENTRAL lNDING OF RESEARCH IN REMINDERS HAS BEEN THEIR EFFECTIVENESS ACROSS A BROAD RANGE OF IMPLEMENTATION SCENARIOS /NE LARGE SCALE META ANALYSIS COMPARED ELECTRONIC AND PAPER BASED REMINDERS AND FOUND SIMILAR EFFECT SIZES FOR EACH #OMPUTER GENERATED REMINDERS HAD AN EFFECT SIZE OF PERCENT WHEREAS THE PAPER BASED REMINDERS EFFECT SIZE WAS PERCENT %LECTRONIC REMINDERS WERE DElNED AS POP UP MESSAGES IN A COMPUTER SYSTEM AND PAPER BASED REMINDERS WERE DElNED AS PROMPTS ATTACHED TO THE FRONT OF THE CHART;= 4HIS INTERESTING lNDING IMPLIES THAT %"$3 IN THE FORM OF REMINDERS CAN BE EQUALLY EFFECTIVE WHETHER IMPLEMENTED ON PAPER OR IN SOPHISTICATED SOFTWARE APPLICATIONS
)NCREASING %LECTRONIC 2IGOR AND #OMPLEXITY 4HERE ARE NUMEROUS STUDIES EVALUATING THE EFFECT OF REMINDERS AS DElNED ABOVE ON POPULATION BASED HEALTH MEASURES ! BROAD BASED STUDY AT 6ETERANS !DMINISTRATION MEDICAL CENTERS ENROLLING MEDICAL RESIDENTS AND PHYSICIANS DEMONSTRATED STATISTICALLY SIGNIlCANT IMPROVEMENTS IN A RANGE OF QUALITY OF CARE MEASURES;= 4HIS WAS FOLLOWED BY A RANDOMIZED CONTROLLED TRIAL EVALUATING REMINDERS EFFECT ON PNEUMOCOCCAL AND INmUENZA VACCINATION RATES PROPHYLACTIC SUBCUTANEOUS HEPARIN AND ASPIRIN AT DISCHARGE;= 4HIS EARLY RANDOMIZED CONTROLLED TRIAL RAISED THE METHODOLOGICAL RIGOR BY WHICH REMINDER EFFECTIVENESS IS NOW MEASURED 4HESE lNDINGS ALSO ESTABLISHED THE REQUIREMENT THAT REMINDERS BE A COMPONENT OF ELECTRONIC MEDICAL RECORD AND COMPUTERIZED PHYSICIAN ORDER ENTRY IMPLEMENTATIONS 0USHING THE SCIENCE OF REMINDERS FURTHER REQUIRES THAT COMPLEX REMINDER SYSTEMS BE IMPLEMENTED AND EVALUATED !N EXAMPLE OF A COMPLEX REMINDER IS A DEEP VENOUS THROMBOSIS $64 PROPHYLAXIS REGIMEN THAT INCLUDES A RANGE OF INTERVENTIONS GROUPED INTO A PROTOCOL OF CARE THAT IS MESSAGED TO THE CLINICIAN IN AN ALERT WINDOW BASED ON THE PATIENTS CLINICAL PARAMETERS ! GROUNDBREAKING STUDY IN EVALUATED A $64 PROPHYLAXIS REGIMEN BY RANDOMIZING ELIGIBLE PATIENTS TO ONE OF TWO GROUPS CLINICIANS MANAGING $64 PROTOCOL ELIGIBLE PATIENTS IN ONE GROUP RECEIVED AN ALERT RECOMMENDING THE $64 PROTOCOL AND CLINICIANS MANAGING $64 PROTOCOL ELIGIBLE PATIENTS IN THE OTHER GROUP DID NOT 4HE RESULTS SHOWED REDUCTIONS IN THE RATES OF $64 AMONG PATIENTS RANDOMIZED TO DOCTORS RECEIVING THE ALERT 4HIS RESULT HAS MOVED THE lELD OF %"$3 TOWARD THE IMPLEMENTATION OF INCREASINGLY COMPLEX PROTOCOLS 4HE USE OF ORDER SETS AS AN ELECTRONIC FORM OF %"$3 IS INCREASING WITH %-2 AND #0/% SYSTEM IMPLEMENTATIONS )N THE ELECTRONIC ENVIRONMENT ORDER SETS HAVE TWO PRIMARY FOCI ACCELERATING PHYSICIAN WORK mOW AND IMPROVING QUALITY THROUGH THE REDUCTION OF ERRORS OF UNDERUSE )T IS FEASIBLE THAT
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
DUHCDMB D A@RDCãCDB HR H N M ã RT OON Q S ã E Q N Lã O@ OD Q ã SN ã D K D B S Q N M H B ORDER SETS COULD IMPACT ERRORS OF OVERUSE AND MISUSE HOWEVER THE RESULTS IN THE LITERATURE SHOW ONLY IMPROVEMENTS IN UNDERUSE ERRORS ! STUDY FOCUSED ON VACCINE ADMINISTRATION RATES SHOWED THAT ORDER SETS WERE MORE EFFECTIVE THAN REMINDERS;= &URTHER SUPPORTING ORDER SET EFFECTIVENESS A LIMITED CASE CONTROL STUDY DOCUMENTED THE IMPACT OF ORDER SETS ON QUALITY OF CARE FOR ACUTE MYOCARDIAL INFARCTION PATIENTS;= )N LIGHT OF THESE lNDINGS IT IS CLEAR THAT MORE RESEARCH SHOULD FOCUS ON THE EFFECTIVENESS OF ORDER SETS IN ADDITION TO COMPLEX REMINDERS
0USHING THE SCIENCE OF REMINDERS FURTHER REQUIRES THAT COMPLEX REMINDER SYSTEMS BE IMPLEMENTED AND EVALUATED
#ONCLUSION )N SUMMARY %"$3 CAN TAKE ON A MYRIAD OF FORMS WHICH VARY IN THEIR EFFECTIVENESS /RGANIZATIONS SEEKING TO REAP THE BENElTS OF %"$3 SHOULD lRST ASK IN WHAT ENVIRONMENT THEY INTEND TO IMPLEMENT THE DECISION SUPPORT IN PAPER OR ELECTRONIC &ROM THAT BRANCHING DECISION ORDER SETS REMINDERS OR CLINICAL PATHWAYS COULD BE IMPLEMENTED DEPENDING ON WHETHER THE GOAL IS TO REDUCE ERRORS OF UNDERUSE MISUSE OR OVERUSE -OST ENCOURAGING ARE THE NUMEROUS STUDIES UNDER WAY EVALUATING THE EFFECTIVENESS OF COMPLEX REMINDER AND ORDER SETS ON THE THREE CATEGORIES OF MEDICAL ERRORS 5LTIMATELY IT IS THIS EMERGING DATA AND THE SUMMARIZED STUDIES HEREIN THAT WILL DRIVE BROAD BASED ACCEPTANCE OF %"$3 WITHIN THE HEALTHCARE DELIVERY SYSTEM %NDNOTES HTTPWWWCDCGOVNCHSDATANVSRNVSRNVSR?PDF P HTTPWWWCMSHHSGOV.ATIONAL(EALTH%XPEND$ATADOWNLOADS HIGHLIGHTSPDF HTTPWWWCDCGOVNCHSDATANVSRNVSRNVSR?PDF P -C'LYNN % ! ET AL h4HE QUALITY OF HEALTH CARE DELIVERED TO ADULTS IN THE 5NITED 3TATES v . %NGL * -ED *UNE PP %LLRODT ' ET AL h%VIDENCE "ASED $ISEASE -ANAGEMENT v *!-! PP 3TONE %' AND 3# -ORTON - % (ULSCHER - ! -AGLIONE % ! 2OTH * - 'RIMSHAW "3 -ITTMAN , 6 2UBENSTEIN , : 2UBENSTEIN 0 ' 3HEKELLE h)NTERVENTIONS THAT )NCREASE 5SE OF !DULT )MMUNIZATION
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
AND #ANCER 3CREENING 3ERVICES ! -ETA ANALYSIS v !NN )NTERN -ED PP 'OUNDER 00 AND $ # 2HEW , ,ANDRY 4 3KLAR ' ( $ORN * 9 7ONG 3 2 7EINGARTEN h! -ULTICENTER )NTERVENTION TO )MPROVE THE #ARE OF (OSPITALIZED 0ATIENTS WITH #OMMUNITY !CQUIRED 0NEUMONIA v *#/- VOL PP -EEHAN 40 ET AL h! STATE WIDE INTERVENTION TO IMPROVE THE CARE OF HOSPITALIZED PNEUMONIA PATIENTS 4HE #ONNECTICUT 0NEUMONIA 0ATHWAY 0ROJECT v !M * -ED VOL PP 4U '3 AND 4 0 -EEHAN * - &INE 9 7ANG % 3 (OLMBOE : -OHSENIFAR 3 2 7EINGARTEN h7HICH 3TRATEGIES &ACILITATE )MPROVEMENT IN 1UALITY OF #ARE FOR %LDERLY (OSPITALIZED 0NEUMONIA 0ATIENTS v *T #OMM * 1UAL 3AF VOL PP 2ANSOM 3" AND $ - 3TUDDERT - 0 $OMBROWSKI - - -ELLO 4 ! "RENNAN h2EDUCED -EDICOLEGAL 2ISK BY #OMPLIANCE 7ITH /BSTETRIC #LINICAL 0ATHWAYS ! #ASE #ONTROL 3TUDY v /BSTET 'YNECOL VOL PP (AUCK ,$ AND , - !DLER : $ -ULLA h#LINICAL 0ATHWAY #ARE )MPROVES /UTCOMES AMONG 0ATIENTS (OSPITALIZED FOR #OMMUNITY ACQUIRED 0NEUMONIA v !NN %PIDEMIOL VOL PP /ZDAS ! ET AL h)NTEGRATING @"EST OF #ARE 0ROTOCOLS INTO #LINICIANS 7ORKmOW VIA #ARE 0ROVIDER /RDER %NTRY )MPACT ON 1UALITY OF #ARE )NDICATORS FOR !CUTE -YOCARDIAL )NFARCTION v *!-)! VOL PP "ATES $7 AND * - 4EICH * ,EE $ 3EGER ' * +UPERMAN . -A,UF $ "OYLE , ,EAPE h4HE )MPACT OF #OMPUTERIZED 0HYSICIAN /RDER %NTRY ON -EDICATION %RROR 0REVENTION v *!-)! VOL PP &ELDSTEIN !# AND $ ( 3MITH . 0ERRIN 8 9ANG 3 2 3IMON - +RALL $ & 3ITTIG $ $ITMER 2 0LATT 3 " 3OUMERAI h2EDUCING 7ARFARIN -EDICATION )NTERACTIONS !N )NTERRUPTED 4IME 3ERIES %VALUATION v !RCH )NTERN -ED VOL PP 0ALTIEL / AND , 'ORDON $ "ERG ! )SRAELI h%FFECT OF A #OMPUTERIZED !LERT ON THE -ANAGEMENT OF (YPOKALEMIA IN (OSPITALIZED 0ATIENTS v !RCH )NTERN -ED VOL PP "ALAS %! AND 3 7EINGARTEN # 4 'ARB $ "LUMENTHAL 3 ! "OREN ' $ "ROWN h)MPROVING 0REVENTIVE #ARE BY 0ROMPTING 0HYSICIANSv !RCH )NTERN -ED VOL PP $EMAKIS *' AND # "EAUCHAMP 7 , #ULL 2 $ENWOOD 3 ! %ISEN 2 ,OFGREN + .ICHOL * 7OLLISCROFT 7 ' (ENDERSON h)MPROVING 2ESIDENTS #OMPLIANCE 7ITH 3TANDARDS OF !MBULATORY #ARE 2ESULTS FROM THE 6! #OOPERATIVE 3TUDY ON #OMPUTERIZED 2EMINDERS v *!-! PP $EXTER 02 AND 3 0ERKINS * - /VERHAGE + -AHARRY 2 " +OHLER # * -C$ONALD h! #OMPUTERIZED 2EMINDER 3YSTEM TO )NCREASE THE 5SE OF 0REVENTIVE #ARE FOR (OSPITALIZED 0ATIENTS v . %NGL * -ED VOL PP $EXTER 02 AND 3 0ERKINS + -AHARRY *ONES + # * -C$ONALD h)NPATIENT #OMPUTER "ASED 3TANDING /RDERS VS 0HYSICIAN 2EMINDERS TO )NCREASE )NmUENZA AND 0NEUMOCOCCAL 6ACCINATION 2ATES v *!-! VOL PP
1UALITY AND (EALTHCARE )NFORMATION 4ECHNOLOGY 4HE EXTENT TO WHICH A HOSPITAL ADOPTS )4 WILL NOT NECESSARILY PARALLEL THE EXTENT OF CLINICAL AND OPERATIONAL IMPROVEMENT 4HE KEY IS WHETHER THE TECHNOLOGIES BEING DEPLOYED ARE REALIZING MEASURABLE RETURNS IN PERFORMANCE AND QUALITY "Y .ICK "EARD 0RICEWATERHOUSE#OOPERS
)NTRODUCING THE $IGITAL (OSPITAL (OSPITALS ARE WIDELY CRITICIZED FOR FAILING TO ADOPT INFORMATION TECHNOLOGY MORE QUICKLY AND FOR TAKING A REACTIVE POSTURE DEFERRING THE COST OF INVESTING IN TECHNOLOGIES THAT CAN IMPROVE PATIENT CARE AND EFlCIENCY #RITICS WARN THAT SOME HOSPITALS RUN THE RISK OF FALLING BEHIND MISSING OUT ON IMPORTANT STRATEGIC BENElTS 4HIS CONCEPT IS THOROUGHLY DISCUSSED IN A 0RICEWATERHOUSE#OOPERS THOUGHT LEADERSHIP PAPER h2EACTIVE TO !DAPTIVE 4RANSFORMING (OSPITALS WITH $IGITAL 4ECHNOLOGYv;= $IGITAL HOSPITALS RELY ON TECHNOLOGY AS AN INTEGRAL PART OF THEIR BUSINESS STRATEGY TO PROMOTE HIGHER QUALITY CARE THROUGH EFlCIENT USE OF INFORMATION TECHNOLOGY AND PROCESS REDESIGN 4HESE )4 INITIATIVES SURPASS ADVANCED CLINICAL SYSTEMS TO INCLUDE ADDITIONAL INTEGRATION BETWEEN INFORMATION TECHNOLOGIES AND MEDICAL TECHNOLOGIES SUCH AS PATIENT BEDS SURGICAL EQUIPMENT NURSE CALL AND COMMUNICATION SYSTEMS PAGERS AND MEDICAL IMAGING TECHNOLOGIES
"ENElTS OF THE $IGITAL (OSPITAL 0ATIENT 3AFETY %XAMPLES OF AUTOMATION BENElTS ABOUND IN THE HEALTHCARE INDUSTRY 3OME ARE DERIVED FROM SIMPLE SINGLE INSTITUTIONAL CASE STUDIES SUCH AS A RADIOLOGY DEPARTMENT THAT REDUCES TRANSCRIPTIONIST FULL TIME EQUIVALENTS THROUGH THE USE OF SPEECH RECOGNITION SOFTWARE /THERS CAN BE SEEN IN MORE ACADEMICALLY ROBUST STUDIES OF BENElTS SUCH AS FEWER PRESCRIBING ERRORS AFTER IMPLEMENTATION OF COMPUTERIZED PHYSICIAN ORDER ENTRY #0/% SYSTEMS #0/% A KEY COMPONENT OF ANY DIGITAL HEALTH STRATEGY PLAYS A SIGNIlCANT ROLE IN PATIENT SAFETY 2ESULTS FROM SEVERAL STUDIES SUCH AS MANY CITED IN THE 0RESIDENTS )NFORMATION 4ECHNOLOGY !DVISORY #OMMITTEES REPORT h2EVOLUTIONIZING (EALTHCARE THROUGH )NFORMATION 4ECHNOLOGY v;= VALIDATE THIS CLAIM #0/% IMPROVES PATIENT SAFETY BY REDUCING ORDER TRANSCRIPTION ERRORS AND BY IMPROVING LEGIBILITY OF ORDERS 4HE INTEGRATION OF #0/%
WITH DECISION SUPPORT TECHNOLOGY FURTHER ENHANCES PATIENT SAFETY BECAUSE ALERTS AND REMINDERS CAN INTERCEPT POTENTIAL ERRORS SUCH AS DOSING MISTAKES MEDICATION CONmICTS AND ALLERGIES )MPROVING THE AVAILABILITY OF PATIENT INFORMATION BY ELIMINATING PAPER CHARTS AND REPLACING THEM WITH A WIDELY AND CONTINUOUSLY AVAILABLE %-2 ALSO CONTRIBUTES TO PATIENT SAFETY !CCORDING TO THE #ENTER FOR )NFORMATION 4ECHNOLOGY ,EADERSHIP #)4, APPROXIMATELY ONE lFTH OF MEDICAL ERRORS ARE DUE TO INADEQUATE AVAILABILITY OF PATIENT INFORMATION !NOTHER IMPORTANT ELEMENT OF A DIGITAL HOSPITAL STRATEGY IS CLINICAL KNOWLEDGE MANAGEMENT )N MOST HOSPITALS TECHNOLOGY RARELY PLAYS A SIGNIlCANT ROLE IN THE DIRECT SUPPORT OF CLINICAL BEST PRACTICES 4HE SELECTION OF IDEAL INVESTIGATION STRATEGIES OR PHARMACOLOGICAL REMEDIES TYPICALLY RELIES EXCLUSIVELY ON PROFESSIONAL JUDGMENT 4ECHNOLOGY CAN HELP PHYSICIANS MAKE THE RIGHT DECISIONS 2ECENT HEALTHCARE AUTOMATION HAS FOCUSED ON PATIENT SAFETY THROUGH THE AVOIDANCE OF ERRORS OF COMMISSION PRESCRIBING ERRORS BEING THE MOST SIGNIlCANT EXAMPLE (OWEVER EVIDENCE INDICATES THAT ERRORS OF OMISSION ARE MUCH MORE FREQUENT AND MORE DIFlCULT TO IDENTIFY %RRORS OF OMISSION MIGHT INCLUDE MISSING VACCINATION OPPORTUNITIES OR FAILING TO FOLLOW SPECIlC THERAPEUTIC RECOMMENDATIONS BASED ON CLINICAL PRACTICE GUIDELINES /NLY THROUGH THE USE OF ADVANCED CLINICAL DECISION SUPPORT WILL MANY ERRORS OF OMISSION BE ADDRESSED FOR THE lRST TIME )NFORMATION SYSTEMS ARE REQUIRED TO SUPPORT SUCH IMPROVEMENTS BUT DO NOT GUARANTEE THEM )NCREASED AUTOMATION MUST BE ACCOMPANIED BY ORGANIZATIONAL CHANGE SUCH AS THE FORMATION OF A MEDICAL INFORMATICS BOARD TO EVALUATE NEW PROPOSED CARE MANAGEMENT PROTOCOLS
/PERATIONAL %FlCIENCY (EALTHCARE AUTOMATION ENABLES ORGANIZATIONS TO REALIZE SIGNIlCANT OPERATIONAL EFlCIENCIES !CCORDING TO THE #)4, APPROXIMATELY PERCENT OF THE MORE THAN BILLION POINT TO POINT HEALTHCARE COMMUNICATIONS THAT OCCUR IN THE 5NITED 3TATES EACH YEAR ARE
.ICK "EARD -$ -3 IS A DIRECTOR IN THE 0RICEWATERHOUSE#OOPERS 'LOBAL 4ECHNOLOGY #ENTRE WHERE HE DIRECTS HEALTHCARE RESEARCH (E IS A PHYSICIAN WITH YEARS EXPERIENCE IN HEALTHCARE AND HEALTH )4 SPANNING SEVERAL COUNTRIES (E HAS SERVED AS A #)/ AND AS AN EXECUTIVE IN A LEADING HEALTHCARE SOFTWARE COMPANY AND IS A FREQUENT LECTURER AND SPEAKER AT VARIOUS UNIVERSITIES AND CONFERENCES (E CAN BE REACHED AT NICOLASBEARD USPWCCOM
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
P T@KHSX ã@MCãGD@ KS G B @ Q D ã H M E N Q L@S H N M ã S D B G M N KN FX CONDUCTED BY FAX PAPER MAIL OR PHONE ! DIGITAL HOSPITAL ADOPTS DIRECT INFORMATION INTERCHANGE THROUGH INTEROPERABLE INFORMATION TECHNOLOGY FOR MANY OF ITS TRANSACTIONS MAKING COMMUNICATION LESS EXPENSIVE FASTER AND MORE ACCURATE 3EVERAL STUDIES INCLUDING THE )NSTITUTE OF -EDICINES h4HE #OMPUTER "ASED 0ATIENT 2ECORD !N %SSENTIAL 4ECHNOLOGY FOR (EALTHCARE v;= HAVE DOCUMENTED THE AMOUNT OF STAFF TIME SPENT LOOKING FOR CLINICAL INFORMATION %FFECTIVE DEPLOYMENT OF %-2S DRAMATICALLY IMPROVES THIS SITUATION #ASE REVIEWS MAY BE UNDERTAKEN WITHOUT EXTENSIVE MANUAL SEARCHING .URSING HANDOVERS MAY BE SHORTENED SIGNIlCANTLY 3CHEDULING SYSTEMS ENABLE REDUCTIONS IN WAIT TIMES FOR PATIENTS AND STAFF ALIKE .EXT STEPS IN PROCESSES CAN BE SCHEDULED AUTOMATICALLY AND WHEN A TEST MUST BE CANCELED ASSOCIATED ORDERS CAN ALSO BE AUTOMATICALLY CANCELED
/THER "ENElTS 4ECHNOLOGY INVESTMENT CAN ALSO INCREASE PATIENT SATISFACTION )F PATIENT RECORDS ARE ELECTRONIC HEALTHCARE CAREGIVERS ARE LESS LIKELY TO ASK THE SAME QUESTIONS REPEATEDLY 0ATIENTS REPORT A REASSURING SENSE THAT PHYSICIANS AND NURSES KNOW MORE ABOUT THEIR CASES WHEN ALL THEIR INFORMATION CAN BE ACCESSED FROM ONE SOURCE /RGANIZATIONS CAN ALSO GAIN A COMPETITIVE ADVANTAGE THROUGH TECHNOLOGY 0HYSICIANS AND NURSES ARE INCREASINGLY ATTRACTED TO THE EFlCIENT OPERATIONAL ENVIRONMENT THAT AUTOMATION CAN OFFER $IGITAL HOSPITALS ALSO ENJOY MORE EFFECTIVE REIMBURSEMENT
MANAGEMENT THROUGH ONLINE ELIGIBILITY CHECKING PRIOR TO PROVIDING TREATMENT #LINICALLY DRIVEN REVENUE CYCLE MANAGEMENT REDUCES CHARGE ENTRY EFFORTS AND ENABLES BILLING TO BECOME MORE OF A BY PRODUCT OF THE CLINICAL PROCESS #HARGE CAPTURE BECOMES MORE RAPID AND ACCURATE WHICH CAN REDUCE THE AMOUNT OF REWORK THAT OFTEN PLAGUES BILLING FUNCTIONS
-EASURING THE "ENElTS OF THE $IGITAL (OSPITAL 4O FURTHER EXPLORE THE BENElTS OF DIGITAL HOSPITALS 0RICEWATERHOUSE#OOPERS TEAMED WITH ()-33 !NALYTICS A WHOLLY OWNED SUBSIDIARY OF THE (EALTHCARE )NFORMATION AND -ANAGEMENT 3YSTEMS 3OCIETY TO REVIEW OPERATIONAL lNANCIAL AND QUALITY METRICS OF A STUDY GROUP OF DIGITALLY ADVANCED HOSPITALS (OSPITALS IN THE GROUP WERE SELECTED ON THE BASIS OF THEIR REPUTATIONS IN THE INDUSTRY FOR IMPLEMENTING CLINICAL INFORMATION SYSTEMS 4HE RESULTS AND EVIDENCE OF THIS RESEARCH WERE EXPLORED AND DISCUSSED IN DETAIL IN THE PAPER h2EACTIVE TO !DAPTIVEv %XHIBIT PROVIDES AN OVERVIEW OF PERCEIVED DIGITAL HOSPITAL BENElTS DERIVED FROM THIS RESEARCH &OR THE RESEARCH PROJECT DIFFERENT APPLICATIONS IN THE ()-33 !NALYTICS $ATABASE3- WERE CATEGORIZED INTO THREE APPLICATION TYPES ADMINISTRATIVE BACK OFlCE AND CLINICAL 4HE CLINICAL CATEGORY WAS FURTHER BROKEN DOWN INTO CLINICAL AND ADVANCED CLINICAL 4HE SAMPLE GROUP WAS SIGNIlCANTLY MORE DIGITAL THAN THE FULL
%XHIBIT "ENElTS OF THE $IGITAL (OSPITAL #ONCEPT
0ATIENT SAFETY /PERATIONAL EFlCIENCY 2EIMBURSEMENT MANAGEMENT REVENUE CYCLE #ONSUMER IMPACT PATIENT SATISFACTION 0HYSICIAN RECRUITMENT AND RETENTION "EST USE OF CAPITAL RESOURCES #OMPETITIVE ADVANTAGE 2EGULATORY COMPLIANCE 2EVENUE GROWTH 3TAFF RECRUITMENT AND RETENTION
¹ 0RICEWATERHOUSE#OOPERS ,,0 !LL 2IGHTS 2ESERVED
7HEN ASKED TO RATE THE MOST COMPELLING BENElTS OF DIGITIZATION FOR A HEALTHCARE DELIVERY ORGANIZATION ON A SCALE OF TO WITH HAVING THE GREATEST IMPACT MORE THAN DOZEN HOSPITAL EXECUTIVES HEALTHCARE )4 VENDORS AND OTHER INDUSTRY EXPERTS CITED IMPROVEMENTS IN PATIENT SAFETY AS THE MOST LIKELY BENElT 2ESPONDENTS ALSO LOOK TO THE DIGITAL HOSPITAL TO PROVIDE GAINS IN OPERATIONAL EFlCIENCY
5!, 49 - # ( ! 0 4 % 2 1 5! ,)4 9 #/. 5 . $2 5
P T@KHSX ã@MCãGD@ KS G B @ Q D ã H M E N Q L@S H N M ã S D B G M N KN FX SET OF HOSPITALS IN THE ()-33 !NALYTICS %XHIBIT !VERAGE ,ENGTH OF 3TAY FOR $IGITALLY !DVANCED (OSPITALS $ATABASE 4HE DIGITALLY ADVANCED SAMPLE #OMPARED 7ITH !LL (OSPITALS GROUP SHOWED PERCENT IMPLEMENTATION !,/3 FOR OF GENERAL CLINICAL APPLICATIONS DIGITALLY !,/3 FOR ALL PERCENT IMPLEMENTATION OF ADVANCED 9EAR CHANGE CHANGE ADVANCED HOSPITALS
CLINICAL APPLICATIONS AND PERCENT HOSPITALS OVERALL !T THE SAME TIME THE AVERAGE IMPLEMENTATION LEVELS FOR ALL HOSPITALS IN THE DATABASE WERE PERCENT GENERAL
CLINICALS PERCENT ADVANCED CLINICALS
AND PERCENT OVERALL
4HE DATA ALSO SHOWED THAT THE DIGITALLY ADVANCED HOSPITALS TENDED TO
SHARE CHARACTERISTICS SUCH AS THE FACT 3OURCE !(! (OSPITAL 3TATISTICS
)NCLUDES ALL NONFEDERAL SHORT TERM GENERAL AND THAT MANY WERE ACADEMIC HOSPITALS %DITION 3OLUCIENT OTHER SPECIALTY HOSPITALS SURVEYED BY THE !(! 4HIS IS NOT SURPRISING SUCH HOSPITALS TEND TO BE LARGER THAN AVERAGE AND THE INDICATOR OF EFlCIENCY %XHIBIT USES DATA FROM 3OLUCIENT AND THE MOST MEDICALLY ADVANCED &URTHER LARGER HOSPITALS IN GENERAL !MERICAN (OSPITAL !SSOCIATION !(! TO COMPARE THE DIGITALLY AND HEALTHCARE SYSTEMS IN PARTICULAR ARE MORE LIKELY TO BE DIGITAL ADVANCED GROUP WITH ALL HOSPITALS .OT ONLY CAN SUCH ORGANIZATIONS REALIZE ECONOMIES OF SCALE BUT /VERALL THE DIGITALLY ADVANCED HOSPITALS ALSO REPORTED A HOSPITALS WITH MULTIPLE FACILITIES ARE ALSO GENERALLY ACCUSTOMED GREATER INCREASE IN REVENUES THAN ALL HOSPITALS SEE %XHIBIT TO ELECTRONIC COMMUNICATION AND COLLABORATION 4HE DATA ALSO )N ADDITION TO THE COST IMPACT OF DIGITAL TECHNOLOGY INVESTMENTS REVEALED THAT DIGITALLY ADVANCED HOSPITALS EXIST NATIONWIDE AND MOST ORGANIZATIONS SEEK QUALITY IMPROVEMENTS -EASURING CLINICAL ARE NOT LIMITED TO HIGH TECHNOLOGY REGIONS QUALITY USUALLY INVOLVES ASSESSMENT OF PROCESS MEASURES -OST 0RICEWATERHOUSE#OOPERS UNDERTOOK ADDITIONAL COMPARATIVE QUALITY METRICS REFER TO PROCESSES THAT ARE THOUGHT TO LEAD TO ANALYSES OF OPERATIONAL lNANCIAL AND QUALITY METRICS OF THE QUALITY &OR EXAMPLE THE #-3 HAS ASKED HOSPITALS TO REPORT ON STUDY GROUP OF HOSPITALS 4HE PERFORMANCE OF THE GROUP OF MEASURES THAT PERTAIN TO HOSPITAL CARE FOR THREE CONDITIONS DIGITALLY ADVANCED HOSPITALS WAS COMPARED TO NATIONAL AVERAGES HEART ATTACK HEART FAILURE AND PNEUMONIA 7HEN THE GROUP OF USING MEDICAL DATA FROM THE #ENTERS FOR -EDICARE -EDICAID DIGITALLY ADVANCED HOSPITALS WAS MEASURED AGAINST ALL HOSPITALS 3ERVICES #-3 (OSPITAL 1UALITY !LLIANCE h)MPROVING #ARE THAT HAD REPORTED ON THE INDICATORS THE DIGITALLY ADVANCED THROUGH )NFORMATIONv AND lNANCIAL DATA OBTAINED FROM 3OLUCIENT HOSPITALS RANKED HIGHER ON SEVEN OF THE INDICATORS FOR THE DIGITALLY ADVANCED HOSPITALS AND IN AGGREGATE 4HE DIGITALLY ADVANCED GROUP OF HOSPITALS SAW GREATER DROPS IN AVERAGE LENGTH OF STAY A MEASUREMENT GENERALLY REGARDED AS AN
-AKING THE "USINESS #ASE
%XHIBIT #HANGE IN /PERATING 2EVENUE FOR $IGITALLY !DVANCED (OSPITALS #OMPARED 7ITH !LL (OSPITALS 9EAR
$IGITALLY ADVANCED HOSPITALS
!LL HOSPITALS
#UMULATIVE INCREASE
)NCLUDES ALL NONFEDERAL SHORT TERM GENERAL AND OTHER SPECIALTY HOSPITALS SURVEYED BY THE !(!
3OURCE !(! (OSPITAL 3TATISTICS %DITION 3OLUCIENT
4HESE RESULTS SUGGEST A POTENTIALLY POSITIVE RELATIONSHIP BETWEEN INFORMATION TECHNOLOGY INVESTMENT AND THE BENElTS OF INTEGRATION HOWEVER THEY DO NOT NECESSARILY REACH STATISTICAL SIGNIlCANCE 4HE PERCEIVED WEAKNESS IN AVAILABLE EVIDENCE FOR STRONG CAUSAL LINKS BETWEEN )4 INVESTMENT AND SUBSEQUENT BENElTS IS ONE REASON IT CAN BE DIFlCULT FOR HEALTHCARE ORGANIZATIONS TO MAKE A PERSUASIVE CASE FOR INCREASED TECHNOLOGY SPENDING 4O JUSTIFY CAPITAL EXPENDITURES MOST HOSPITAL BOARDS FOR EXAMPLE SEEK PROOF OF A lNANCIAL RETURN ON INVESTMENT 4HE MAJORITY OF EMPIRICAL EVIDENCE TO DATE COMES FROM CASE STUDIES AND EXPERT OPINION RATHER THAN QUANTITATIVE CONTROLLED STATISTICALLY SIGNIlCANT RESEARCH !LTHOUGH THE RESULTS OF THE 0RICEWATERHOUSE#OOPERS RESEARCH CITED ABOVE WERE CULLED FROM YEARS OF DATA THE STATISTICAL TECHNIQUES USED WERE LARGELY BASED ON CROSS SECTIONAL STUDIES WHICH ALTHOUGH INTERESTING MADE IT IMPOSSIBLE TO CONCLUDE A CAUSAL RELATIONSHIP FROM THESE DATA $IFFERENT TECHNIQUES AND LARGER DATA SETS ARE REQUIRED TO ENABLE A MORE RIGOROUS ECONOMIC ANALYSIS
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
P T@KHSX ã@MCãGD@ KS G B @ Q D ã H M E N Q L@S H N M ã S D B G M N KN FX
%MERGING %VIDENCE 0RICEWATERHOUSE#OOPERS HAS BEEN COLLABORATING WITH RESEARCHERS AT A LEADING BUSINESS SCHOOL;= TO EXPLORE THE RELATIONSHIP BETWEEN HEALTHCARE )4 INVESTMENT AND BUSINESS PERFORMANCE 4HE RESEARCH STUDY IS DESIGNED TO PROVIDE A STATISTICALLY RIGOROUS ANALYSIS OF BENElTS ASSOCIATED WITH HEALTHCARE INFORMATION TECHNOLOGY AND EVENTUALLY TO ENABLE COMPARISONS BETWEEN THE PERFORMANCE OF INDIVIDUAL INSTITUTIONS AND PEERS AT THE SAME LEVEL OF )4 ADOPTION
$ATA 3OURCES 4HE STUDY RELIED ON SEVERAL DATA SOURCES ( )-33 !NALYTICS $ATABASE DERIVED FROM $ORENFEST )($3 $ATABASE» WHICH MAINTAINS INFORMATION ON )4 APPLICATIONS IN MORE THAN HOSPITALS THROUGHOUT THE 53 !MERICAN (OSPITAL !SSOCIATIONS ANNUAL SURVEY DATABASE PROVIDING A WIDE RANGE OF HOSPITAL INFORMATION 3OLUCIENT 0ROVIDER6IEW WHICH PROVIDES A SOURCE OF -EDICARE DATA ON REVENUES COSTS AND PROlTS FROM OVER HOSPITALS FROM TO AND 3ELECT 1UALITY #ARE¸ FROM 7EB-$ WHICH PROVIDES HOSPITAL QUALITY DATA ON READMISSIONS COMPLICATIONS AND OTHER METRICS )N ADDITION TO LOOKING FOR EMPIRICAL EVIDENCE OF CAUSAL LINKS BETWEEN INFORMATION TECHNOLOGY ADOPTION AND BUSINESS PERFORMANCE THE RESEARCH ALSO SEEKS TO ENABLE INDIVIDUAL HOSPITALS TO GAIN FRESH INSIGHTS INTO THEIR OWN PERFORMANCE
3TATISTICAL -ETHODS !DVANCED STATISTICAL TECHNIQUES COMMONLY USED IN ECONOMIC RESEARCH ARE EMPLOYED TO HELP RESEARCHERS IDENTIFY THE RELATIVE CONTRIBUTIONS )4 HAS TO HOSPITAL EFlCIENCY AND OTHER PERFORMANCE MEASURES )NDIVIDUAL HOSPITALS ARE THEN COMPARED AGAINST NATIONAL AVERAGES FOR SIMILAR INSTITUTIONS WITH RESPECT TO THEIR LEVEL OF AUTOMATION
!NALYZING (OSPITAL 0ERFORMANCE 4HE RESEARCH EXPLORES RELATIONSHIPS BETWEEN AN ORGANIZATIONS POSITION ON THE )4 ADOPTION SCALE AND ITS CLINICAL AND BUSINESS PERFORMANCE !DVANCED STATISTICAL TECHNIQUES ARE EMPLOYED TO ANALYZE FOUR DIFFERENT AREAS OF HOSPITAL PERFORMANCE !S SUMMARIZED IN %XHIBIT THE STUDY EXAMINED MORTALITY RATES IN HOSPITALS WITH LOW VERSUS HIGH COSTS AND THOSE WITH LOW VERSUS HIGH )4 CAPITAL (OSPITALS WITH HIGHER COSTS TENDED TO HAVE LOWER MORTALITY RATES AND HOSPITALS IN THE hHIGH )4 USAGEv CATEGORY ALSO HAD LOWER MORTALITY RATES 4HE DIFFERENCES IN MORTALITY BETWEEN THE LOW )4 AND HIGH )4 GROUPS WITH ABOVE AVERAGE HOSPITAL COSTS IS STATISTICALLY SIGNIlCANT 4HIS RELATIONSHIP IS SUGGESTIVE OF A POSITIVE ASSOCIATION BETWEEN )4 INVESTMENT AND QUALITY OF CARE AND WARRANTS DEEPER INVESTIGATION
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
USING MORE PRECISE AND ACCEPTED DElNITIONS OF QUALITY 4HE FULL RESULTS OF THE STUDY WILL BE PUBLISHED UPON COMPLETION
7HAT 4HIS -EANS FOR (OSPITALS 4ODAY (OSPITALS THAT PROMOTE TECHNOLOGY AS AN INTEGRAL BUSINESS STRATEGY HAVE A COMPETITIVE ADVANTAGE 4HEY WILL ENJOY THE BENElTS OF AUTOMATION INCLUDING INCREASED PATIENT SAFETY AND OPERATIONAL EFlCIENCY %ARLY TECHNOLOGY ADOPTERS WILL ALSO REAP THE BENElTS OF INCREASED PATIENT SATISFACTION IMPROVED EMPLOYEE RETENTION AND MORE EFFECTIVE REIMBURSEMENT MANAGEMENT !LTHOUGH CASE STUDIES AND QUALITATIVE DATA HAVE BEEN IMPORTANT TO DATE NEW STATISTICAL TECHNIQUES ARE BEING EMPLOYED TO PROVIDE BETTER MORE DElNITIVE EVIDENCE OF THE RELATIONSHIP BETWEEN HEALTHCARE )4 INVESTMENT AND BUSINESS PERFORMANCE 4HIS WILL HELP HEALTHCARE ORGANIZATIONS BUILD A MUCH STRONGER BUSINESS CASE FOR THE )4 INVESTMENTS THEY NEED TO MAKE IN THE FUTURE 4HE RESEARCH WILL ALSO ENABLE THE USE OF A NOVEL BENCHMARKING TECHNIQUE ENABLING HOSPITALS TO IDENTIFY HOW WELL THEY ARE ACTUALLY USING THEIR TECHNOLOGY TO DRIVE MEASURABLE BUSINESS RESULTS %NDNOTES h2EACTIVE TO !DAPTIVE 4RANSFORMING (OSPITALS WITH $IGITAL 4ECHNOLOGY v -ARCH 'LOBAL 4ECHNOLOGY #ENTRE 0RICEWATERHOUSE#OOPERS ,,0 HTTPPWCCOMUSENGABOUTINDHEALTHCAREPUBDHHTML h2EVOLUTIONIZING (EALTHCARE 4HROUGH )NFORMATION 4ECHNOLOGY v *UNE 0RESIDENTS )NFORMATION 4ECHNOLOGY !DVISORY #OMMITTEE HTTP WWWNITRDGOVPITACREPORTS?HIT?REPORTPDF $ICK 2 3 AND % " 3TEEN % % $ETMER h4HE #OMPUTER "ASED 0ATIENT 2ECORD !N %SSENTIAL 4ECHNOLOGY FOR (EALTHCARE v *ANUARY )NSTITUTE OF -EDICINE 2ESEARCH COLLABORATION BETWEEN 0W# AND 0ROFESSOR ,ORIN (ITT AND -ICHAEL (OUSMAN OF THE $EPARTMENT OF /PERATIONS AND )NFORMATION -ANAGEMENT 4HE 7HARTON 3CHOOL 5NIVERSITY OF 0ENNSYLVANIA AND 0RICEWATERHOUSE#OOPERS
%XHIBIT (OSPITAL -ORTALITY 2ATES BY )4 )NVESTMENT AND /PERATING #OSTS ,OW )4 BOTTOM
(IGH )4 TOP
(IGH #OST TOP
,OW #OST BOTTOM
.ATIONAL !VERAGE 2ATE FOR 0OPULATION OF (OSPITALS IN OUR 3TUDY
3OURCE h4HE %FFECTS OF )4 )NVESTMENTS ON (OSPITAL #OST AND 1UALITY v 0W# WHITE PAPER
4HE 2OLE OF 2()/S AND /THER #OLLABORATIVES IN 1UALITY &RAGMENTED PATIENT DATA REPRESENTS A SIGNIlCANT CHALLENGE TO THE HEALTHCARE INDUSTRY 7ITHOUT A UNIFYING STRUCTURE CENTRAL GOVERNING BODY OR CONNECTED REPOSITORY THESE DISPARATE DATA MAY RESULT IN FRAGMENTED PATIENT CARE "Y "RUCE (ENDERSON 0RICEWATERHOUSE#OOPERS
-
ANY HOSPITALS AND PHYSICIAN OFlCES KEEP PATIENT INFOR MATION PRESCRIPTION RECORDS AND LAB RESULTS IN PAPER DOCUMENTS OR IN SEPARATE COMPUTER SYSTEMS "ECAUSE CLINICAL INFORMATION IS NOT INTEGRATED INTO ONE COMPREHENSIVE SOURCE IT CANNOT BE EASILY ACCESSED BY CAREGIVERS AT THE POINT OF CARE DELIVERY %LIMINATING PAPER RECORDS AND STORING ALL DATA IN INTEGRATED COMPUTER DATABASES WHERE IT CAN BE QUICKLY AND EASILY RETRIEVED WILL BE VITAL TO THE CONTINUING EVOLUTION AND IMPROVEMENT OF HEALTHCARE 2EGIONAL HEALTH INFORMATION ORGANIZATIONS 2()/S OFFER ONE VIABLE OPTION TO CREATE AND MANAGE SUCH DATABASES
(OW $O 2()/S 7ORK 2()/S FUNCTION AS REGIONAL CONDUITS TO COLLECT AND DISSEMINATE MEDICAL INFORMATION 4HEY ESTABLISH STRUCTURES POLICIES AND GOVERNANCE THAT DICTATE HOW HEALTHCARE DATA ARE USED AND SHARED WHICH PROVIDERS SHARE WHAT INFORMATION AND IN MANY CASES THE PRECISE BUSINESS MODEL THAT THE 2()/ FOLLOWS 4HE 2()/ hTOUCHESv PATIENT PRESCRIPTION AND LAB INFORMATION BENCHMARKS IT AND DISTRIBUTES IT TO IMPROVE NOT ONLY ACCESS TO HEALTHCARE DATA BUT THE PROCESS OF CARE ITSELF 2()/S OFFER SEVERAL KEY ADVANTAGES OVER THE CURRENT METHODS OF HEALTHCARE DATA COLLECTION STORAGE AND RETRIEVAL "ETTER QUALITY CARE n 7HEN CAREGIVERS CAN EASILY ACCESS ACCURATE INTEGRATED PATIENT MEDICATION AND LAB DATA THEY CAN MAKE CLINICAL DECISIONS BASED ON A COMPLETE PICTURE OF THE PATIENTS MEDICAL HISTORY 2EDUCED COSTS n !CCESS TO ACCURATE CURRENT RECORDS CAN DRASTICALLY REDUCE THE NUMBER OF REDUNDANT DIAGNOSTIC TESTS PERFORMED AND CLINICAL ERRORS MADE #ONSERVATIVE ESTIMATES PLACE SAVINGS FROM INTEGRATION OF DATA AT TO PERCENT;= SOME INDUSTRY EXPERTS CLAIM THOSE PERCENTAGES WILL BE MUCH HIGHER (EIGHTENED KNOWLEDGE TRANSFER n 7HEN CAREGIVERS
RECEIVE TIMELY COMPREHENSIVE INFORMATION THEY NOT ONLY USE IT THEY ADD TO IT AND IMPROVE UPON IT !S THE KNOWLEDGE IS TRANSFERRED IT GROWS EXPONENTIALLY 4HIS GROWTH OF KNOWLEDGE IMPROVES OUR UNDERSTANDING OF THE CAREGIVING PROCESS
(URRICANE +ATRINA 2EVEALS THE .EED FOR 4ECHNOLOGY "EFORE THE HURRICANE SEASON OF MOST HEALTHCARE PROVIDERS IN ,OUISIANA STORED PATIENT RECORDS ON PAPER /NLY ABOUT PERCENT OF PHYSICIANS IN THE STATE USED ELECTRONIC MEDICAL RECORDS OR SHARED DATA ELECTRONICALLY;= 7HEN +ATRINA DEVASTATED THE REGION DESTROYING COUNTLESS MEDICAL RECORDS IN THE PROCESS THE NEED FOR TECHNOLOGY IN THE REGIONS HEALTHCARE SYSTEM WAS PAINFULLY REVEALED ,OUISIANA RESPONDED /NE MONTH AFTER THE HURRICANE THE +ATRINA(EALTH3- PROGRAM A COLLABORATION AMONG PRIVATE BUSINESSES A NATIONAL FOUNDATION HEALTHCARE ORGANIZATIONS AND FEDERAL STATE AND LOCAL GOVERNMENTS MADE EVACUEES PRESCRIPTION HISTORIES AVAILABLE TO AUTHORIZED CAREGIVERS ONLINE VIA WWWKATRINAHEALTHORG (AVING THESE DATA HELPED CAREGIVERS GIVE THE RIGHT MEDICATIONS TO EVACUEES AVOIDING THE RISKS OF ADVERSE DRUG REACTIONS ,OUISIANA IS REBUILDING ITS HEALTHCARE SYSTEM WITH A COMPLETE TECHNOLOGY INFRASTRUCTURE THAT WILL SUPPORT DELIVERY OF CARE ! COLLABORATIVE WITH MULTIPLE STAKEHOLDERS HAS BEEN FORMED AND IS BASING ITS WORK ON THE SIX )NSTITUTE OF -EDICINE QUALITY PRINCIPLES )N ITS GUIDING PRINCIPLES THE COLLABORATIVE RECOGNIZED THAT )4 IS PART OF THE FOUNDATION FOR A QUALITY REDESIGNED HEALTHCARE SYSTEM AND IMPORTANT FOR VALUE BASED PERFORMANCE ,OUISIANA HAS A CONTRACT WITH THE $EPARTMENT OF (EALTH AND (UMAN 3ERVICES /FlCE OF THE .ATIONAL #OORDINATOR TO DEVELOP A HEALTH INFORMATION EXCHANGE THAT WILL BE THE HIGHWAY TO SHARE INFORMATION ACROSS
"RUCE (ENDERSON -(! -"! IS A SENIOR EXECUTIVE WITH YEARS EXPERIENCE IN LEADING GROWING AND ADVISING HEALTHCARE SYSTEMS ACADEMIC MEDICAL CENTERS MANAGED CARE ORGANIZATIONS LARGE MULTI SPECIALTY GROUP PRACTICES AND DIVERSIlED HEALTHCARE BUSINESSES (E IS SKILLED IN BUSINESS AND )4 STRATEGY AND TRANSFORMATION CUSTOMER MANAGEMENT AND TECHNOLOGY ENABLERS TO IMPROVE QUALITY BUILD COMPETITIVE ADVANTAGE AND ACHIEVE lNANCIAL SUCCESS (E IS KNOWLEDGEABLE ABOUT THE -EDICARE -ODERNIZATION !CT AND THE .ATIONAL (EALTH )NFORMATION )NFRASTRUCTURE (E IS AN EXECUTIVE LEADER OF 0RICEWATERHOUSE#OOPERS $IGITAL (EALTH #OMMUNITY PRACTICE (E CAN BE REACHED AT BRUCEAHENDERSON USPWCCOM
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
SGDãQNKDãN Eã1'(.Rã @ M C ã NS G D Q ã B N KK@ A N Q @S H U D Rã H M ã P T @ KH S X PROVIDERS /THER ONGOING PROGRAMS INCLUDE INSTALLING ELECTRONIC HEALTH RECORDS IN RURAL AREA EMERGENCY ROOMS )N ADDITION A 2OBERT 7OOD *OHNSON &OUNDATION GRANT IS PAYING FOR ELECTRONIC MEDICAL RECORDS IN DIFFERENT SAFETY NET SITES h4HIS NATURAL DISASTER HAS UNDERSCORED THE CRITICAL NEED FOR REAL TIME ACCESS TO THE MOST UP TO DATE MEDICATION HISTORY INFORMATION AT THE POINT OF CARE REGARDLESS OF WHERE INDIVIDUALS ARE BEING TREATED v SAID $AVID -C,EAN #%/ OF ONE OF THE SPONSORING COMPANIES OF +ATRINA(EALTH;=
@4HE SPIRIT OF COOPERATION AMONG HEALTHCARE STAKEHOLDERS IS MUCH HIGHER THAN ITS EVER BEEN IN OUR HIS TORY 7ERE SEEING PEOPLE WHO WERE HISTORICALLY COMPETITORS SIT DOWN AT THE TABLE TOGETHER TO FIGURE THINGS OUT 4HEY ARE ALL WORKING TOGETHER AND EXCITED ABOUT THE SAME PROJECT AND WANTING TO SHARE INFORMATION 7ITH THE HEALTH INFORMATION EXCHANGE n WE DID IN THREE MONTHS WHAT WOULD NORMALLY TAKE THREE TO FIVE YEARS IN ANY OTHER TIME IN OUR HISTORY )TS THE MOST AMAZ ING THING )VE EVER SEEN )VE TRULY SEEN SOME OF THE BEST OF HUMAN NATURE n 2OXANE 4OWNSEND -$ -EDICAID MEDICAL DIRECTOR FOR ,OUISIANA ,OUISIANA IS ATTEMPTING TO REBUILD ITS ENTIRE SYSTEM SO THAT ALL PAYERS ADOPT THE SAME PRINCIPLES PERFORMANCE MEASURES AND REIMBURSEMENT MECHANISMS !CCORDING TO ,OUISIANA -EDICAID MEDICAL DIRECTOR 2OXANE 4OWNSEND -$ h!S WE LOOK AT HOW WE WANT TO MOVE FORWARD IN ,OUISIANA WE REALIZE THAT UNLESS WE HAVE A SYSTEM OF CARE THAT GOES ACROSS THE BOARD WERE PROBABLY NOT GOING TO BE ABLE TO MAKE SIGNIlCANT CHANGES IN OUR QUALITY OR OUTCOMESv "ECAUSE OF THE URGENCY CREATED BY THE HURRICANE ,OUISIANA ESSENTIALLY HAS A BLANK SLATE TO FORM A COMPREHENSIVE SYSTEM WITH ALIGNED INCENTIVES 4OWNSEND ADDS h7ERE DOING THINGS NOW TO MAKE SURE THAT PATIENTS GET TAKEN CARE OF "UT WE DONT WANT THE SYSTEMS IN PLACE NOW TO BECOME THE @NEW NORMAL AND PERPETUATE 3OME OF THESE NEW SYSTEMS MAY GIVE EVEN WORSE OUTCOMES THAN WHAT WE HAD BEFORE 7ERE HOPING THAT COLLABORATIVE APPROACHES THAT WEVE DEVELOPED FOR THE SHORT TERM WILL lT INTO OUR LONG TERM PLANNING PRINCIPLESv
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
#URRENT %XAMPLES OF %FFECTIVE (EALTH )NFORMATION %XCHANGE 4HE FOLLOWING EXAMPLES ILLUSTRATE THE BENElTS OF EFFECTIVE TECHNOLOGY AND KNOWLEDGE TRANSFER IN THE DELIVERY OF HEALTHCARE 4HEY REPRESENT DIFFERENT APPROACHES ALL WITH THE SAME GOAL IMPLEMENTATION AND USE OF AN )4 INFRASTRUCTURE AND INTEGRATED DATA TO IMPROVE ACCESS TO MEDICAL DATA AND QUALITY OF CARE
5NITED +INGDOM 4HE LARGEST HEALTHCARE ORGANIZATION IN %UROPE THE 5NITED +INGDOMS .ATIONAL (EALTH 3ERVICE .(3 HAS STARTED ITS .ATIONAL 0ROGRAMME FOR )4 "Y CREATING AN )4 INFRASTRUCTURE THIS PROGRAM IS EXPECTED TO IMPROVE PATIENT CARE AND SERVICES /VER THE NEXT DECADE THE .ATIONAL 0ROGRAMME FOR )4 WILL TRANSFORM CARE BY CONNECTING MORE THAN GENERAL PRACTITIONERS AND NEARLY HOSPITALS )T WILL ALSO GIVE PATIENTS TOTAL ACCESS TO THEIR PERSONAL HEALTHCARE INFORMATION +EY ELEMENTS OF THE .ATIONAL 0ROGRAMME 4HE .(3 #ARE 2ECORDS 3ERVICE IMPROVES THE SHARING OF PATIENT RECORDS ACROSS THE ENTIRE ORGANIZATION 4HE )4 SYSTEM ELECTRONICALLY TRANSMITS PRESCRIPTION INFORMATION AND LETS PRIMARY CARE STAFF QUICKLY AND EASILY SCHEDULE PATIENT APPOINTMENTS AND !DAPTABILITY n THE SYSTEM CAN BE UPGRADED AND IMPROVED TO MEET THE FUTURE NEEDS OF THE .(3
!USTRALIA (EALTH#ONNECT AN ELECTRONIC NETWORK FOR HEALTHCARE DATA IMPROVES THE FLOW OF INFORMATION ACROSS THE !USTRALIAN HEALTHCARE SECTOR 4HE NETWORK ENABLES THE AUTOMATED COLLECTION STORAGE AND EXCHANGE OF CONSUMER HEALTH INFORMATION THROUGH A SECURE NETWORK THAT MEETS STRICT PRIVACY STANDARDS (EALTH#ONNECT GIVES DOCTORS AND OTHER HEALTH PROFESSIONALS QUICK AND SECURE ACCESS TO VITAL MEDICAL INFORMATION 7ORK ON A PHASED NATIONAL IMPLEMENTATION OF (EALTH#ONNECT HAS BEGUN IN CONCERT WITH STATES TERRITORIES AND HEALTHCARE PROVIDER GROUPS 4HE NETWORK WILL BE IMPLEMENTED ON A STATE BY STATE BASIS PARTICIPATION IS VOLUNTARY 5SING (EALTH#ONNECT PATIENT INFORMATION IS COLLECTED AT A POINT OF CARE THEN DOCUMENTED AND STORED IN THE NETWORK 7ITH THE PATIENTS CONSENT THE DATA MAY BE RETRIEVED BY OR EXCHANGED AMONG HEALTHCARE PROVIDERS (EALTH#ONNECT IS EXPECTED TO DELIVER THESE BENElTS 1UICK ACCESS TO COMPREHENSIVE ACCURATE PATIENT INFORMATION ,ESS DUPLICATION OF SERVICES -ORE TIME AVAILABLE FOR DIRECT PATIENT CARE 'REATER PORTABILITY OF HEALTH RECORDS FOR MOBILE HEALTHCARE PROVIDERS -ORE ACTIVE CONSUMER PARTICIPATION IN DECISIONS ABOUT THEIR HEALTHCARE AND )MPROVED DIAGNOSES AND HIGHER QUALITY CARE THROUGH BETTER QUALITY OF INFORMATION EXCHANGE AMONG HEALTHCARE PROVIDERS
SGDãQNKDãN Eã1'(.Rã @ M C ã NS G D Q ã B N KK@ A N Q @S H U D Rã H M ã P T @ KH S X
#ALIFORNIA
.EW 9ORK
#AL2()/ BEGAN IN *ANUARY AS A PROJECT OF THE (EALTH 4ECHNOLOGY #ENTER TO SUPPORT 2()/ EFFORTS THROUGHOUT THE STATES RURAL AND URBAN AREAS #AL2()/ HAS THREE MAIN GOALS #ATALOG EXISTING 2()/S IN #ALIFORNIA 3UPPORT NEW AND EXISTING 2()/S BY FUNCTIONING AS A CLEARINGHOUSE FOR BEST PRACTICES AND 0ROVIDE A NEUTRAL ENVIRONMENT FOR DISCUSSION AMONG STAKEHOLDERS AND THE DEVELOPMENT OF NEW 2()/ PROJECTS
4ACONIC (EALTH )NFORMATION .ETWORK AND #OMMUNITY IS A MULTI STAKEHOLDER COMMUNITYWIDE DATA EXCHANGE AMONG PHYSICIANS HOSPITALS REFERENCE LABORATORIES PHARMACIES PAYERS EMPLOYERS AND CONSUMERS IN THE (UDSON 6ALLEY REGION OF .EW 9ORK STATE )T PROVIDES CLINICAL INSURANCE AND DEMOGRAPHIC INFORMATION FOR MORE THAN PATIENTS VIA A SECURE )NTERNET INFRASTRUCTURE DESIGNED FOR DATA EXCHANGE
!PPALACHIA
3UMMARY
3OME INDUSTRY OBSERVERS HAVE SAID THAT INFORMATION TECHNOLOGY HOLDS THE PROMISE OF REDUCING HEALTHCARE DISPARITIES FOR THOSE LIVING IN RURAL COMMUNITIES "ASED IN RURAL CENTRAL !PPALACHIA #ARE3PARK IS BUILDING A SECURE )4 NETWORK THAT ENABLES A VARIETY OF HEALTHCARE PROVIDERS n PHARMACIES LABORATORIES IMAGING CENTERS AND PUBLIC HEALTH DEPARTMENTS n TO COMMUNICATE ELECTRONICALLY #ARE3PARK IS SUPPORTED BY MANY EMPLOYERS HEALTHCARE PROVIDERS HEALTHCARE PAYERS AND ACADEMIC CENTERS IN THE REGION
/HIO )NITIALLY FUNDED BY LOCAL HEALTH SYSTEMS AND INSURERS (EALTH"RIDGE STARTED IN AS A COMMUNITYWIDE COMPUTER PORTAL FOR PHYSICIANS IN THE GREATER #INCINNATI AREA 4HE SERVICE ALLOWS MEDICAL DATA TO BE EXCHANGED EVEN IF A PROVIDER DOES NOT HAVE AN ELECTRONIC MEDICAL RECORD SYSTEM (EALTH"RIDGE OFFERS CLINICAL MESSAGING FUNCTIONALITY AND PUBLIC HEALTH AND PHYSICIAN ALERTS AND IS IMPLEMENTING ELECTRONIC ORDER ENTRY IN AMBULATORY OFlCES 0ARTICIPANTS IN THIS 2()/ ATTEST TO IMPROVEMENTS IN EFlCIENCY AND PATIENT SAFETY AND A REDUCTION IN OPERATING EXPENSES /NE OF (EALTH"RIDGES DElNING CHARACTERISTICS IS ITS SUCCESS IN ACHIEVING COLLABORATION ACROSS STATE LINES
-ASSACHUSETTS -ASSACHUSETTS 3IMPLIFYING (EALTHCARE !MONG 2EGIONAL %NTITIES 3(!2% IS A COLLABORATIVE PROGRAM OF THE -ASSACHUSETTS (EALTH $ATA #ONSORTIUM -ASSACHUSETTS 3(!2% AIMS TO PROMOTE THE INTERORGANIZATIONAL EXCHANGE OF HEALTHCARE DATA VIA INFORMATION TECHNOLOGY STANDARDS AND SIMPLIlED ADMINISTRATION TO MAKE ACCURATE CLINICAL HEALTH INFORMATION AVAILABLE EFlCIENTLY COST EFFECTIVELY AND SAFELY -ASSACHUSETTS 3(!2% INTENDS TO IMPROVE COMMUNITY CONNECTIVITY THROUGH THE SHARING OF HEALTHCARE DATA AMONG PATIENTS DOCTORS HOSPITALS GOVERNMENT AGENCIES INSURERS (-/S AND OTHER PARTICIPANTS IN THE HEALTHCARE SYSTEM
0ACIlC .ORTHWEST 0EACE(EALTH IS AN INTEGRATED DELIVERY NETWORK THAT PROVIDES TECHNOLOGY SERVICES AND ACCESS TO ITS COMPREHENSIVE COMMUNITY HEALTH RECORD #(2 OF ABOUT MILLION PATIENTS 3MALLER RURAL CLINICS AND PHYSICIANS WITHOUT THE RESOURCES FOR EXPENSIVE )4 INVESTMENTS CAN SECURELY ACCESS THE NETWORK FOR A MODEST FEE 3INCE THE PROGRAM BEGAN INDEPENDENT PRACTICES USE ITS SERVICES AND MORE THAN AUTHORIZED CLINICIANS HAVE FULL ACCESS TO THE #(2 TO SUPPORT PATIENT CARE
3UCCESSFUL 2()/S WILL LIKELY BE BEST INITIATED AT THE GRASS ROOTS LEVEL BY HOSPITALS MEDICAL SOCIETIES OR INSURANCE PAYERS WHO SEE THEIR BENEFITS )N SOME CASES A STATE BECOMES THE CONVENING BODY FOR THE LOCAL ORGANIZATIONS ! CRITICAL SUCCESS FACTOR IS TO INCLUDE ALL KEY STAKEHOLDERS FROM THE START ,ONG TERM 2()/S MUST BE SELF SUSTAINING BUT THEY NEED INITIAL FUNDING TO START BUILDING THE )4 INFRASTRUCTURE 7HEN EDUCATED ABOUT THE VALUE OF THE 2()/ STATE AND FEDERAL GOVERNMENTS OFTEN PROVIDE FUNDING 0ROVIDERS CAN MOVE FORWARD WITH THEIR OWN h2()/ ACTIVATION PLANv BY FOLLOWING THESE GUIDELINES $ElNE THE GEOGRAPHICAL BOUNDARIES FOR THE 2()/ n THESE COULD BE A CITY A STATE OR SEVERAL REGIONS IN A STATE %DUCATE ALL POTENTIAL STAKEHOLDERS ABOUT THE IMPORTANCE OF THE 2()/ TO HEALTHCARE IN THE REGION 7ORK TO UNDERSTAND THE SPECIlC HEALTHCARE NEEDS AND PRIORITIES OF THE REGION (OW DOES IT NEED TO IMPROVE QUALITY 7HERE DOES IT NEED TO REDUCE COSTS 4O ESTABLISH A SENSE OF OWNERSHIP INVOLVE ALL STAKEHOLDERS AND MAKE SURE THEY ARE REPRESENTED WHEN POLICY DECISIONS ARE MADE #REATE IMPLEMENTATION AND lNANCIAL PLANS TO COVER OPERATING COSTS OF THE 2()/ 4O LEVERAGE EXISTING RESOURCES REVIEW THE EXISTING )4 INFRASTRUCTURE AND THE CURRENT STATE OF CONNECTIVITY 3ECURE AGREEMENT FROM ALL STAKEHOLDERS ON OBJECTIVES FOR THE 2()/ AND 4RY TO INVOLVE STATE AND FEDERAL AGENCIES IN ESTABLISHING STANDARDS AND CERTIlCATIONS AND PROVIDING INITIAL FUNDING 7ALK BEFORE RUNNING $O NOT TAKE ON TOO MUCH ACTIVITY OR EXPENSE IN THE BEGINNING &IRST LEARN HOW THE MECHANISM OF SHARING INFORMATION WORKS AND LATER TAKE ON ADDITIONAL ANALYTICAL AND PUBLIC HEALTH RESPONSIBILITIES %NDNOTES 0AN % ET AL h4HE 6ALUE OF (EALTHCARE )NFORMATION %XCHANGE AND )NTEROPERABILITY v #HICAGO (EALTH )NFORMATION -ANAGEMENT AND 3YSTEMS 3OCIETY h2EPORT ON ,OUISIANA (EALTHCARE $ELIVERY AND &INANCING 3YSTEM v REPORT TO THE ,OUISIANA 2ECOVERY !UTHORITY 3UPPORT &OUNDATION !PRIL 0RICEWATERHOUSE#OOPERS P HTTPWWWKATRINAHEALTHORGPRESSHTML
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
/VERVIEW OF 0HARMA AND ,IFE 3CIENCE 1UALITY )SSUES "Y BLENDING ITS TALENT FOR INNOVATION WITH A FOCUS ON @QUALITY BY DESIGN THE PHARMACEUTICAL INDUSTRY CAN DRIVE GROWTH AND REGAIN ITS ROLE AS A HEALTHCARE QUALITY LEADER
"Y !NTHONY , &ARINO 0RICEWATERHOUSE#OOPERS
&
OR MANY YEARS THE PHARMACEUTICAL INDUSTRY MAINTAINED A REPUTATION AS A LEADER IN THE IMPROVEMENT OF HEALTHCARE 4HE INDUSTRY CONSISTENTLY USED REMARKABLE INNOVATION TO CREATE NEW IMPROVED DRUGS THAT HELPED PATIENTS AND DROVE BUSINESS GROWTH AND PROlTS "UT TIMES HAVE CHANGED 4HE INDUSTRYS REPUTATION HAS SAGGED .UMEROUS ISSUES ARE AT THE HEART OF THIS DECLINE A STRING OF RECENT WELL PUBLICIZED PRODUCT WITHDRAWALS A SLOWDOWN IN THE INTRODUCTION OF NEW PRODUCTS RISING DRUG COSTS AND CONTROVERSY ABOUT DIRECT TO CONSUMER ADVERTISING -ANY CONSUMERS BELIEVE THAT DRUG COMPANIES HAVE STRAYED FROM THEIR ORIGINAL VISION OF HELPING PEOPLE BECOME HEALTHIER AND ARE MORE INTERESTED IN SATISFYING THEIR BUSINESS STAKEHOLDERS;= 4O REGAIN THE PUBLICS TRUST PHARMACEUTICAL COMPANIES MUST DEMONSTRATE THAT THEY HAVE REFOCUSED ON THE PATIENT 4O ACCOMPLISH THIS COMPANIES MUST USE A BUSINESS MODEL THAT COMBINES IMPROVEMENT IN OPERATIONS WITH A FOCUS ON INTEGRITY ETHICS AND VALUES AS ELEMENTS OF SUCCESS 4HE ISSUES OF GOVERNANCE RISK AND COMPLIANCE ALSO MUST PLAY IMPORTANT ROLES BEGINNING WITH RESEARCH AND DEVELOPMENT AND EXTENDING THROUGH MANUFACTURING AND SALES
%NSURE 1UALITY IN #LINICAL 4RIALS 0ROCESS )N TERMS OF DRUG DEVELOPMENT LIFE SCIENCES COMPANIES NEED TO ENSURE THAT CLINICAL TRIAL OUTCOMES ARE REPORTED ACCURATELY AND COMPLETELY BY COLLABORATING CLOSELY WITH HEALTHCARE WORKERS AND PATIENT GROUPS TO UNDERSTAND THE BEST MEANS OF CHANNELING CLINICAL TRIAL RESULTS 0OST MARKET PHARMACOVIGILANCE RISK MANAGEMENT PROTOCOLS NEED TO BE DESIGNED TO ACTIVELY INVESTIGATE AND ADDRESS ADVERSE DRUG EVENTS )N ADDITION THEY SHOULD FOCUS ON IMPROVING DEVELOPMENT PROCESSES THAT WILL HELP DRIVE GREATER PRODUCTIVITY AND HIGHER QUALITY DATA 4HIS SHOULD ENSURE THAT
DATA IS CONSISTENTLY PREPARED AND OF AN ACCEPTABLE MINIMUM QUALITY LEVEL REGARDLESS OF COUNTRY OF ORIGIN 0OST MARKET SAFETY PROCESSES AND TOOLS WERE DESIGNED IN AN EARLIER ERA AND IT IS DIFlCULT TO ADAPT THEM TO THE REQUIREMENTS OF THE CURRENT SAFETY ENVIRONMENT
)MPROVE THE -ANUFACTURING 0ROCESS )N GENERAL MANUFACTURING TECHNIQUES HAVE NOT KEPT UP WITH ADVANCES IN SCIENCE AND TECHNOLOGY 5NTIL RECENTLY THE ECONOMIC CLIMATE DID NOT DEMAND THAT THEY DO SO PRODUCT COMPLEXITY DID NOT REQUIRE IT AND THE REGULATORY FRAMEWORK ACTIVELY DISCOURAGED IT "UT THAT HAS ALL CHANGED )MPROVEMENTS TO THE DRUG MANUFACTURING PROCESS CAN RAISE THE LEVEL OF PRODUCT QUALITY )N 3EPTEMBER 4HE 7ALL 3TREET *OURNAL MADE A CONNECTION BETWEEN THE RISE IN PRODUCT RECALLS AND QUALITY PROBLEMS 4HE PUBLICATION NOTED THAT IN SPITE OF lNES OF MORE THAN MILLION FOR MANUFACTURING FAILURES PHARMA COMPANIES ARE NOT MAINTAINING ACCEPTABLE STANDARDS OF PRODUCT QUALITY;= 4HE lVE POINTS BELOW SUMMARIZE THE 53 &OOD AND $RUG !DMINISTRATIONS VISION FOR PHARMACEUTICAL DEVELOPMENT AND MANUFACTURING IN THE ST CENTURY 4HESE POINTS FOCUS ON hQUALITY BY DESIGN v SCIENTIlC MANUFACTURING AND RISK BASED REGULATORY OVERSIGHT $ESIGNING EFFECTIVE EFlCIENT MANUFACTURING PROCESSES TO ACHIEVE AND ENSURE PRODUCT QUALITY AND PERFORMANCE %STABLISHING PRODUCT SPECIlCATIONS BASED ON A MECHANISTIC UNDERSTANDING OF HOW FORMULATION AND PROCESS FACTORS IMPACT PRODUCT PERFORMANCE #ONTINUOUS hREAL TIMEv ASSURANCE OF QUALITY %STABLISHING REGULATORY POLICIES AND PROCEDURES THAT RECOGNIZE THE LEVEL OF SCIENTIlC KNOWLEDGE REQUIRED TO SUPPORT PRODUCT APPLICATIONS PROCESS VALIDATION AND PROCESS CAPABILITY AND
!NTHONY , &ARINO IS A PARTNER AND LEADER OF 0RICEWATERHOUSE#OOPERS 53 ,IFE 3CIENCES PRACTICE FOCUSED ON HELPING COMPANIES ADDRESS A BROAD RANGE OF STRATEGIC lNANCIAL AND OPERATIONAL ISSUES (E HAS OVER YEARS OF EXPERIENCE AND HAS AN IN DEPTH UNDERSTANDING OF PHARMACEUTICAL AND HEALTHCARE PRODUCTS DISTRIBUTION SALES AND MARKETING AND PRICING STRUCTURES (E CAN BE REACHED AT ANTHONYLFARINO USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
NUDQ UHDVãNEãOG@QL@ ã @ M C ã KH E D ã RB H D M B D ã P T @ KH S Xã H RRT D R 2EGULATORY SCRUTINY THAT IS RISK BASED AND RELATES TO THE SCIENTIlC UNDERSTANDING OF HOW FORMULATION AND MANUFACTURING PROCESSES AFFECT PRODUCT QUALITY AND PERFORMANCE IMPLEMENTING PROCESS CONTROL STRATEGIES TO PREVENT OR MITIGATE THE RISK OF PRODUCING A PRODUCT OF POOR QUALITY;= !CHIEVING THE &$!S VISION WILL PROBABLY REQUIRE SIGNIlCANT INVESTMENTS BY PHARMACEUTICAL COMPANIES BUT THE INVESTMENT COULD BE WELL WORTH IT 4HE &$! WANTS TO ACCELERATE THE RATE OF CHANGE BY PUBLISHING EXTENSIVE GUIDELINES AND FACILITATING THE ADOPTION OF CHANGE BY CREATING hSAFE HARBORSv FOR COMPANIES THAT MAKE THE CHANGES;=
@1UALITY IN THE 53 IS AT ITS BEST HIGHLY UNEVEN !T TIMES IT IS THE BEST IN THE WORLD SOMETIMES IT IS POOR AND SOMETIMES IT IS IN BETWEEN AND SHOULD BE BETTER ESPECIALLY GIVEN WHAT WE SPEND n (ELEN $ARLING PRESIDENT OF THE .ATIONAL "USINESS 'ROUP ON (EALTH
,EVERAGE #ONNECTIVITY FOR %XCHANGE OF 1UALITY $ATA (EALTHCARE EXPERTS POLICY MAKERS AND PAYERS CONSIDER HEALTH INFORMATION TECHNOLOGY ()4 SUCH AS ELECTRONIC HEALTH RECORDS AND COMPUTERIZED PROVIDER ORDER ENTRY TO BE CRITICAL FOR THE TRANSFORMATION OF THE HEALTHCARE INDUSTRY )NFORMATION MANAGEMENT IS FUNDAMENTAL TO HEALTHCARE DELIVERY "ECAUSE OF THE FRAGMENTED NATURE OF HEALTHCARE THE HIGH VOLUME OF TRANSACTIONS IN THE HEALTHCARE SYSTEM THE CONSTANT INTEGRATION OF NEW SCIENTIlC EVIDENCE INTO PRACTICE AND OTHER COMPLEX INFORMATION MANAGEMENT ACTIVITIES PAPER BASED INFORMATION MANAGEMENT CLEARLY CANNOT KEEP UP WITH THE DEMAND FOR ACCESS TO ACCURATE TIMELY COMPLETE PATIENT INFORMATION;= )F SYSTEMS ARE STANDARDIZED AND NETWORKED THEY CAN TRANSMIT VITAL HEALTH INFORMATION TO PROVIDERS PATIENTS AND INSURERS #REATING AND MAINTAINING THESE SYSTEMS REQUIRES SUBSTANTIAL EFFORT BUT THE BENElTS CAN INCLUDE DRAMATIC COST SAVINGS GREATLY INCREASED SAFETY AND IMPORTANT HEALTH BENElTS 3AVINGS FROM INCREASED EFlCIENCY n )F MOST HOSPITALS AND DOCTORS OFlCES ADOPTED ()4 THE POTENTIAL EFlCIENCY SAVINGS FOR BOTH INPATIENT AND OUTPATIENT CARE COULD AVERAGE MORE THAN BILLION PER YEAR;= 4HE LARGEST SAVINGS COME FROM REDUCED HOSPITAL STAYS REDUCED ADMINISTRATIVE TIME FOR NURSES AND MORE EFlCIENT USE OF DRUGS )NCREASED SAFETY n #OMPUTERIZED PHYSICIAN ORDER ENTRY SYSTEMS FOR MEDICATIONS GENERATE ALERTS AND REMINDERS THAT PROVIDE IMMEDIATE INFORMATION TO PHYSICIANS &OR EXAMPLE THIS TYPE OF SYSTEM WARNS PHYSICIANS ABOUT POTENTIAL ADVERSE
REACTIONS FROM A PATIENTS MEDICATIONS )F ALL HOSPITALS HAD AN ()4 SYSTEM THAT INCLUDED COMPUTERIZED PHYSICIAN ORDER ENTRY SOME HAVE ESTIMATED THAT ABOUT ADVERSE DRUG EVENTS COULD BE ELIMINATED EACH YEAR FOR ANNUAL SAVINGS OF ABOUT BILLION;= (EALTH BENElTS n ()4 CAN SCAN PATIENT RECORDS FOR RISK FACTORS AND RECOMMEND APPROPRIATE SERVICES SUCH AS VACCINATIONS AND SCREENINGS )F lVE PREVENTIVE SERVICES FOR PNEUMONIA n TWO TYPES OF VACCINATIONS AND THREE TYPES OF SCREENINGS n WERE INCREASED AT A TOTAL COST OF MILLION EACH YEAR SOME HAVE ESTIMATED THAT BETWEEN AND DEATHS FROM THE DISEASE COULD BE ELIMINATED ANNUALLY IN THE 53;= &OR AN ELECTRONIC HEALTH RECORD TO RAISE LEVELS OF PATIENT CARE AND SAFETY RECORDS MUST BE EASILY ACCESSED BY CAREGIVERS AND THEY MUST CONTAIN EXTENSIVE MEDICAL HISTORIES n INCLUDING PROGRESS NOTES TEST RESULTS 8 RAY IMAGES MEDICATIONS FUTURE APPOINTMENTS AND DEMOGRAPHIC DATA n THAT ENCOMPASS ALL MEDICAL ENCOUNTERS FOR EVERY PATIENT 4HE MOST COMPELLING REASON TO OFFER AN ELECTRONIC HEALTH RECORD IS THAT IT ALLOWS HEALTHCARE PROVIDERS TO OFFER SAFER AND MORE CONSISTENT CARE TO ALL PATIENTS
2ECONlGURE THE 3ALES 0ROCESS !ROUND %DUCATION /VER THE PAST TWO DECADES THE NATURE OF THE DOCTOR PATIENT RELATIONSHIP HAS CHANGED IRREVERSIBLY 4ODAYS PATIENTS WANT MORE MEDICAL INFORMATION AND THEY WANT TO ACTIVELY PARTICIPATE IN DECISIONS THAT AFFECT THEIR HEALTH $IRECT TO CONSUMER PROMOTION WHICH IN ITS EARLY STAGES DOESNT INVOLVE PRIMARY CARE DOCTORS AND OTHER PHYSICIANS ADDRESSES THIS TREND /PINIONS ARE MIXED ABOUT THIS TYPE OF PROMOTION ! SURVEY OF TELEVISION VIEWERS WHO WATCHED ADVERTISEMENTS FOR PHARMACEUTICALS FOUND THAT PERCENT LEARNED LITTLE OR NOTHING MORE ABOUT THE HEALTH CONDITION REQUIRING TREATMENT FROM THE AD )N ADDITION PERCENT SAID THAT THEY KNEW LITTLE OR NOTHING MORE ABOUT THE DRUG AFTER VIEWING THE ADVERTISEMENT;= 4HE EFFECT OF CONSUMER DRIVEN HEALTH PLANS COMBINED WITH CHANGES IN THE COMPLEXITY OF PRODUCTS AND THE DISEASE STATES THEY ARE DESIGNED TO TREAT WILL HAVE A TREMENDOUS IMPACT ON TODAYS PHARMACEUTICAL SALES AND MARKETING MODEL 4HE DEMAND FOR INFORMATION FROM PHYSICIANS PAYERS CONSUMERS AND OTHER STAKEHOLDERS WILL INCREASE DRAMATICALLY 4ECHNOLOGY WILL CONTINUE TO OFFER NEW WAYS TO REACH THESE STAKEHOLDERS !T THE SAME TIME THIS SHIFT HAS TREMENDOUS IMPLICATIONS FOR HOW TODAYS SALES ORGANIZATIONS ARE STRUCTURED AND THE METHODS THEY USE TO REACH THEIR TARGETED AUDIENCE !LSO CONSUMERS WILL BE PAYING MORE OUT OF POCKET FOR DRUGS IN THE FUTURE (EALTH PLANS GOVERNMENT AND EMPLOYERS NEED TO DEVELOP COST SHARING BENElT DESIGNS THAT ENCOURAGE PATIENTS TO TAKE THE DRUGS THEY NEED AND AVOID COSTLY HOSPITALIZATIONS )N ADDITION DEMAND FOR INFORMATION ON EFFECTIVENESS OF PRODUCTS WILL INCREASE AS PAYERS INCLUDING THE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
NUDQ UHDVãNEãOG@QL@ ã @ M C ã KH E D ã RB H D M B D ã P T @ KH S Xã H RRT D R GOVERNMENT CONSUMERS AND PHYSICIANS STRIVE TO UNDERSTAND THE MOST EFFECTIVE COURSE OF TREATMENT
@4HE ACKNOWLEDGMENT THAT WE NEED TO PUSH FORWARD ON MULTIPLE FRONTS TO REMOVE BARRIERS TO IMPROVING PATIENT SAFETY IS A FUNDAMENTAL MESSAGE $ENNIS 3 /,EARY -$ PRESIDENT OF THE *OINT #OMMISSION ON !CCREDITATION OF (EALTHCARE /RGANIZATIONS
3ECURE THE 3UPPLY #HAIN &INALLY PHARMACEUTICAL COMPANIES MUST ENSURE THE QUALITY AND PURITY OF THE PRODUCTS THEY PRODUCE BY SECURING THE SUPPLY CHAIN )MPROVING A COMPANYS SUPPLY CHAIN PROCESSES TO PREVENT INAPPROPRIATE ACCESS THAT RESULTS IN COUNTERFEIT ADULTERATED OR DAMAGED PRODUCTS COMING TO MARKET WILL PROTECT THE COMPANYS REPUTATION AND MOST IMPORTANTLY PROTECT ITS CUSTOMERS FROM HARM ! PHARMACEUTICAL PRODUCT MOVING THROUGH THE COMPLEX PIPELINE FROM 2$ TO PRODUCTION TO MARKETING PASSES THROUGH MANY CHANNELS BEFORE IT REACHES THE PATIENT $RUG SHORTAGES AND SECONDARY DISTRIBUTION CHANNELS ALL PRESENT DIFlCULT CHALLENGES IN ENSURING THE SAFETY OF PRODUCTS 3HORTAGES OF CRITICAL MEDICATIONS FORCE PROVIDERS TO lND ALTERNATIVE PRODUCTS EXPEND MORE RESOURCES AND INCREASE THE COMPLEXITY OF PROVIDING PATIENT CARE;= 4HREE FACTORS HAVE INCREASED THE AMOUNT OF COUNTERFEIT DRUGS &IRST COMPUTER TECHNOLOGY FOR FORGING LABELS IS MORE SOPHISTICATED n IT IS NOW POSSIBLE TO REPRODUCE ANY LABEL ON ANY MEDICATION 3ECOND MANY SMALL WHOLESALERS ARE NOW BUYING AND SELLING MEDICATIONS 4HESE WHOLESALERS CREATE AN ACTIVE SECONDARY MARKET &INALLY THE HIGHER COST OF DRUG THERAPIES CREATES MORE POTENTIAL FOR HIGH PROlTS FOR FORGERS AND THOSE WHO SELL IMPURE OR ADULTERATED DRUGS;= 4HE 7ORLD (EALTH /RGANIZATION ESTIMATES THAT BETWEEN AND PERCENT OF THE WORLDWIDE TRADE IN PHARMACEUTICALS IS COUNTERFEIT -ANY INDUSTRY EXPERTS BELIEVE THIS IS A CONSERVATIVE ESTIMATE %VEN THOUGH THE OVERWHELMING MAJORITY OF DRUGS SOLD IN THE 53 ARE SAFE THE BILLION PER YEAR PHARMACEUTICAL MARKET IS AN ATTRACTIVE TARGET FOR COUNTERFEITERS;= ,AWS THAT DONT ASSIGN SUPPLY CHAINWIDE ACCOUNTABILITY TO ANY SINGLE AUTHORITY HINDER FEDERAL EFFORTS TO DEAL WITH COUNTERFEIT PRODUCTS 2EIMPORTATION OF DRUGS AND THE ADVENT OF )NTERNET PHARMACIES MAKE COUNTERFEITING DIFlCULT TO PREVENT
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
4HE KEYS TO INCREASING THE SECURITY OF PHARMACEUTICAL PRODUCTS ARE CONSISTENT AND EFFECTIVE REGULATORY STANDARDS CONSISTENT AND EFFECTIVE DILIGENCE BY PURCHASERS WHEN CHOOSING PRIMARY AND SECONDARY SUPPLIERS AND MORE ROBUST TRACKING OF PRODUCT ENABLED BY TECHNOLOGY 2EGULATIONS AND THE TECHNOLOGY USED TO ENFORCE THEM SHOULD SUPPORT AN ELECTRONIC PRODUCT hPEDIGREEv THAT WILL ADDRESS MANY CONCERNS ABOUT SECURITY BY VERIFYING THE AUTHENTICITY OF EVERY DRUG SOLD;=
#ONCLUSION #OMPANIES THAT QUANTIFY THEIR QUALITY AND COMPLIANCE RISKS AND PLAN STRATEGIC ACTIONS TO MITIGATE THOSE RISKS WHILE BUILDING A FOUNDATION FOR hQUALITY BY DESIGNv AND SCIENTIlC MANUFACTURING WILL LIKELY BE REWARDED WITH BUSINESS CERTAINTY OPERATIONAL EFlCIENCIES REDUCED REGULATORY BURDENS AND THE FREEDOM FOR REAL PROCESS AND PRODUCT INNOVATION;= "Y SECURING THE SUPPLY CHAIN IMPROVING THE MANUFACTURING PROCESS ENHANCING CONNECTIVITY THROUGH TECHNOLOGY AND FOCUSING SALES ORGANIZATIONS ON EDUCATING CONSUMERS THE PHARMACEUTICAL INDUSTRY CAN MAKE STRIDES TOWARD ITS FORMER STATUS AS AN INDUSTRY THAT USES IMPRESSIVE DOSES OF VISION COMPASSION AND EXPERTISE TO IMPROVE THE LIVES OF PATIENTS %NDNOTES h2ECAPTURING THE 6ISION v 0RICEWATERHOUSE#OOPERS P !BBOUD , AND 3 (ENSLEY h.EW 0RESCRIPTION FOR $RUG -AKERS 5PDATE THE 0LANTS v 3EPTEMBER 4HE 7ALL 3TREET *OURNAL h4HE -ETAMORPHOSIS OF -ANUFACTURING v )"- EXECUTIVE BRIEF P )BID (EALTH )NFORMATION 4ECHNOLOGY 2AND #ORPORATION P )BID )BID )BID h$IRECT TO #ONSUMER !DVERTISING n %DUCATION OR %MOTION 0ROMOTION v .EW %NGLAND *OURNAL OF -EDICINE P h)NTEGRITY OF THE 0HARMACEUTICAL 3UPPLY #HAIN 0RODUCT 3OURCING FOR 0ATIENT 3AFETY v (EALTH )NDUSTRY 'ROUP 0URCHASING !SSOCIATION P h3ECURING THE 0HARMACEUTICAL 3UPPLY #HAIN v !UTO )$ #ENTER P h)NTEGRITY OF THE 0HARMACEUTICAL 3UPPLY #HAIN 0RODUCT 3OURCING FOR 0ATIENT 3AFETY v (EALTH )NDUSTRY 'ROUP 0URCHASING !SSOCIATION P h%LECTRONIC $RUG 0EDIGREE h% 0EDIGREEv #ONSIDERATIONS IN #HOOSING A 0ARTNER FOR THE $RUG 0EDIGREE 2ACE v 6ERI3IGN )NC P h4HE -ETAMORPHOSIS OF -ANUFACTURING v )"- EXECUTIVE BRIEF P
&ROM 2ESEARCH TO 1UALITY 4RANSLATING #LINICAL ,AB 2ESULTS )NTO 0ATIENT #ARE 3EQUENCING OF THE HUMAN GENOME WILL ENABLE THE SHIFT FROM SYMPTOM BASED TREATMENT TO PERSONALIZED MEDICINE n A PRECURSOR TO REDUCED ADVERSE DRUG REACTIONS AND IMPROVED EFFECTIVENESS OF TREATMENT "Y 7ILLIAM - $RACOS -ICHAEL 2 'LICK 'ERRY -C$OUGALL AND "ARBARA 7ALSH 0RICEWATERHOUSE#OOPERS
3
INCE THE LATTER HALF OF THE TH CENTURY ADVANCES IN BIOMEDICAL RESEARCH HAVE LARGELY BEEN SUPPORTED THROUGH ALLOCATIONS OF SMALL TO MIDSIZE RESEARCH GRANTS TO ACADEMIC SCIENTISTS 2ESEARCH HAS BEEN CONDUCTED WITH A FOCUS ON DISCOVERY AND SCHOLARLY KNOWLEDGE &OR COMMERCIAL ENTITIES SUCH AS LARGE PHARMACEUTICAL COMPANIES DRUG DISCOVERY TECHNIQUES WERE BASED ON SYSTEMATIC SEARCHES FOR COMPOUNDS THAT COULD TREAT DISEASES "OTH OF THESE METHODS REPRESENTED LIMITED EFFORTS TO TRANSLATE BASIC DISCOVERY TO CLINICAL APPLICATION STEMMING BOTH FROM RELATIVE MYOPIA OF THEIR MISSIONS AND THE INABILITY TO UNDERSTAND DISEASE AT THE GENOMIC LEVEL 7HILE THESE APPROACHES HAVE LED TO MEDICAL ADVANCES OVER THE PAST DECADES THE STATUS QUO WILL PROVE TOO LIMITED TO DRIVE FUTURE DISCOVERY 4HE FUTURE OF MEDICINE LIES IN TRANSLATIONAL RESEARCH EFFORTS ENABLED BY THE APPLICATION OF TECHNOLOGIES TO UNDERSTAND THE GENOMIC BASIS OF DISEASE "ASED ON THE COMPLETED SEQUENCING OF THE HUMAN GENOME THE ST CENTURY HAS RESULTED IN THE DAWN OF TRANSLATIONAL RESEARCH AND A NEW ERA OF PROSPECTIVE AND PERSONALIZED MEDICINE 4RANSLATIONAL RESEARCH IS THE PROCESS OF TRANSLATING BASIC SCIENTIlC DISCOVERIES INTO CLINICAL APPLICATIONS SUCH AS NEW DIAGNOSTICS AND TREATMENTS #LINICAL PRACTICE IS SHIFTING FROM TREATMENT BASED ON SYMPTOMS TO TREATMENT BASED ON EACH PERSONS UNIQUE GENETIC MAKEUP n IN OTHER WORDS PERSONALIZED MEDICINE 4RANSLATIONAL RESEARCH HELPS TO SPEED DEVELOPMENTS OF NEW TREATMENTS FROM THE hBENCH TO BEDSIDEv )T ATTEMPTS TO REDUCE
THE TIME IT TAKES BETWEEN DISCOVERY OF A FAULTY GENE OR PROTEIN IMPLICATED IN A CANCER AND DEVELOPMENT OF A NEW DIAGNOSTIC TECHNIQUE OR DRUG THAT EITHER ARRESTS OR CORRECTS THE GENE OR PROTEINS MALFUNCTION IN THE PATIENT 4HIS RESEARCH MAKES POSSIBLE A PHARMACOGENIC COURSE OF TREATMENT THAT IS PERSONALIZED TO THE INDIVIDUAL PATIENT;= 4HERAPIES RESULTING FROM TRANSLATIONAL RESEARCH LEAP BEYOND TRADITIONAL DRUG THERAPIES WHICH CANNOT DIFFERENTIATE ONE TYPE OF PATIENT FROM ANOTHER &OR EXAMPLE IN PATIENTS CALLED HIGH RESPONDERS TRADITIONAL DRUG THERAPIES HAVE A HIGH EFlCACY )N POOR RESPONDERS DRUGS SHOW INCOMPLETE EFlCACY AND NONRESPONDERS DEMONSTRATE NO RESPONSE TO DRUGS AND MAY HAVE A HIGH RISK OF ADVERSE DRUG REACTIONS !$2S )NDIVIDUALS CALLED hPOOR METABOLIZERSv CANNOT CLEAR DRUGS FROM THEIR BODIES EFFECTIVELY AND FACE HIGH RISKS OF TOXICITY AND OTHER !$2S;= ! PHARMACOGENIC APPROACH MATCHES AN INDIVIDUAL PATIENT WITH DRUGS THAT ARE MORE LIKELY TO BE SAFE AND EFFECTIVE BASED ON THEIR GENETIC MAKEUP )MPROVING THE SAFETY AND EFlCACY OF TREATMENTS RAISES INCREASINGLY IMPORTANT QUALITY CONCERNS 4ODAY NEARLY MILLION OF THE APPROXIMATELY BILLION PRESCRIPTIONS WRITTEN ANNUALLY IN THE 53 ARE INAPPROPRIATE OR INEFFECTIVE -OST OF THESE PRESCRIBING ERRORS ARE MINOR BUT MANY STUDIES HAVE SHOWN AN INCREASE IN !$2S IN PATIENTS !CCORDING TO THE 53 &OOD AND $RUG !DMINISTRATION MORE THAN 53 PATIENTS DIE EACH YEAR FROM !$2S;=
7ILLIAM - $RACOS -"! IS A DIRECTOR WITHIN 0RICEWATERHOUSE#OOPERS ,IFE 3CIENCES !DVISORY PRACTICE MAINTAINING OVER YEARS OF HIGHER EDUCATION AND ACADEMIC MEDICINE EXPERIENCE (IS EXPERTISE INCLUDES STRATEGIC BUSINESS PLANNING OPERATIONAL IMPLEMENTATION AND IMPROVEMENT AND lNANCIAL ANALYSIS FOR RESEARCH HEALTHCARE AND HIGHER EDUCATION ORGANIZATIONS (E CAN BE REACHED AT BILLDRACOS USPWCCOM -ICHAEL 2 'LICK IS A MANAGER WITH 0RICEWATERHOUSE#OOPERS (EALTH )NDUSTRIES PRACTICE (E FOCUSES ON HOSPITAL CLINICAL SERVICE LINE STRATEGY DEVELOPMENT WITH SIGNIlCANT FOCUS ON DEVELOPING ALIGNMENT MODELS AMONG HOSPITALS AND PHYSICIANS TO ENHANCE CLINICAL SERVICES (E CAN BE REACHED AT MICHAELRGLICK USPWCCOM 'ERRY -C$OUGALL IS THE PARTNER IN CHARGE OF 0RICEWATERHOUSE#OOPERS (EALTH 3CIENCES PRACTICE (E HAS BEEN ASSISTING RESEARCH ORGANIZATIONS WITH THEIR STRATEGIC AND OPERATIONAL ISSUES FOR MORE THAN YEARS AND FOCUSES ON THE DEVELOPMENT OF RESEARCH ORGANIZATIONS THROUGH PUBLIC PRIVATE PARTNERSHIPS (E CAN BE REACHED AT GERALDJMCDOUGALL USPWCCOM "ARBARA 7ALSH IS A MANAGING DIRECTOR IN 0RICEWATERHOUSE#OOPERS (EALTH 3CIENCES GROUP 3HE HAS MORE THAN YEARS OF EXPERIENCE IN ACADEMIC AND RESEARCH ORGANIZATIONS AND ISSUES 3HE CAN BE REACHED AT BARBARAEWALSH USPWCCOM
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
EQNLãQDRD@QBGãSN ãP T@KHSX ãSQ@M RK @S H M Fã B KH M H B @ Kã K @ A ã Q D RT K S Rã H M SN ã O@S H D M S ã B @ Q D
@4HE PRIMARY FOCUS OF 4'ENS RESEARCH CAN BE SUMMED UP IN FOUR WORDS EARLIER DIAGNOSIS SMARTER TREATMENTS /UR GOAL IS TO MAKE MEDICINE NOT ONLY MORE EFFECTIVE BUT ALSO MORE PERSONALIZED )TS A TRANSITION POINT BOTH FOR DRUG DEVELOPMENT AND CLINICAL IMPLEMEN TATION *EFF 4RENT 0H$ PRESIDENT AND SCIENTIFIC DIRECTOR OF 4'EN
4HE "EGINNINGS OF 'ENOMIC AND 4RANSLATIONAL -EDICINE 0RIOR TO THE TH CENTURY BIOMEDICAL SCIENCE COULD BE CHARACTERIZED AS hSYMPTOMATOLOGIC MEDICINE v AS ILLNESSES WERE IDENTIlED AND TREATED BASED UPON EXTERNAL SYMPTOMS AND DISEASE MANIFESTATION WITH LITTLE UNDERSTANDING OF THE UNDERLYING CAUSE OF THE DISEASE FOR EXAMPLE TREATMENTS FOCUSED ON ADDRESSING PHYSIOLOGICAL EFFECTS OF ILLNESS AND PHYSICIANS DIAGNOSED BASED ON SYMPTOMS SUCH AS hTHE PATIENT SUFFERED FROM A COUGHv $ISCOVERIES IN THE TH CENTURY ALLOWED FOR A BETTER UNDERS TANDING OF THE UNDERLYING CAUSES OF MANY DISEASES PARTICULARLY THOSE DRIVEN BY PATHOGENS SUCH AS VIRUSES AND BACTERIA 4REATMENTS FOR DISEASE BASED ON AN UNDERSTANDING OF HUMAN AND PATHOGENIC BIOLOGY COULD BE DESCRIBED AS hREACTIVE MEDICINE v WITH TREATMENTS APPLIED ONCE SYMPTOMS HAVE MANIFESTED 4HERAPIES SUCH AS PENICILLIN WERE OFTEN DEVELOPED BY HAPPENSTANCE OR THROUGH RANDOM APPLICATION OF COMPOUNDS SUCH AS HIGH THROUGHPUT CHEMISTRY AGAINST A DISEASE 4RANSLATIONAL MEDICINE IN WHICH CUTTING EDGE TECHNOLOGIES SUCH AS GENOMICS PROTEOMICS AND SYSTEMS BIOLOGY ARE APPLIED TO UNDERSTAND BIOLOGY AND DISEASE IS ANTICIPATED TO BE THE MEDICINE OF THE ST CENTURY 4RANSLATIONAL MEDICINE AIMS TO UNDERSTAND THE GENETIC ORIGINS OF DISEASE AND THEN TRANSLATE THAT KNOWLEDGE INTO THERAPEUTICS BASED ON AN INDIVIDUALS GENETIC PROlLE 'ENOMIC MEDICINE BEGAN IN WHEN AFTER A YEAR QUEST THE 53 (UMAN 'ENOME 0ROJECT REACHED ITS MIRACULOUS GOAL OF IDENTIFYING THE TO GENES AND BILLION CHEMICAL BASE PAIRS THAT MAKE UP HUMAN $.!;= 4HIS LANDMARK ACHIEVEMENT SIGNALED A PARADIGM SHIFT IN MEDICINE FOR THE ST CENTURY AND LED TO A NUMBER OF IMPORTANT MEDICAL ADVANCES &OR EXAMPLE WE NOW SEE WIDESPREAD GENETIC TESTING THAT IDENTIlES PEOPLE AT RISK FOR PREVENTABLE CHRONIC CONDITIONS OR DEVASTATING DISEASES /VER GENETIC TESTS ARE NOW AVAILABLE )N THE FUTURE THERE WILL BE SIX TIMES THE NUMBER OF GENE BASED DRUGS ON THE MARKET THAN THERE ARE NOW (OWEVER IT IS LIKELY THAT THESE DRUGS WILL NOT BE AVAILABLE TO PATIENTS UNTIL ;=
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
0HARMACOGENICS IN $RUG $EVELOPMENT /NE IMMEDIATE APPLICATION OF PHARMACOGENICS OCCURS DURING THE DRUG DEVELOPMENT PROCESS 5SING TRANSLATIONAL RESEARCH lNDINGS EARLY IN THE DRUG DEVELOPMENT PROCESS TO IMPROVE A DRUGS PERFORMANCE GREATLY REDUCES OR ELIMINATES PRODUCT FAILURES LATER IN THE PROCESS WHEN COSTS ARE MUCH HIGHER 4RIALS ARE EVALUATING THE EXPENSES RELATIVE TO THE INCREMENTAL SURVIVAL ADVANTAGE TO DETERMINE WHETHER THESE NEW THERAPIES RESULT IN A NET COST BENElT )N ADDITION PHARMACOGENICS BASED TRIALS STRATIFY CLINICAL TRIAL PARTICIPANTS TO INCLUDE THOSE WHO ARE MOST LIKELY TO BENElT FROM THE DRUG AND EXCLUDE THOSE WHO PROBABLY WILL NOT 3TRATIlCATION ENABLES THESE TRIALS TO ACHIEVE MORE SPECIlC RESULTS WITH SMALLER NUMBERS OF PATIENTS FURTHER REDUCING 2$ COSTS -ORE IMPORTANTLY FOR TRIAL PARTICIPANTS AND INTERNAL REVIEW BOARDS STRATIlCATION BASED ON CORRECT BIOMARKERS MAY REDUCE OR ELIMINATE ADVERSE EVENTS;=
#LINICAL )MPROVEMENTS )N A CLINICAL SETTING PHARMACOGENICS HELPS PHYSICIANS BETTER DElNE PATIENTS LONG TERM HEALTH RISKS MORE PRECISELY DIAGNOSE THE STAGE OF A PATIENTS ILLNESS AND MORE ACCURATELY PREDICT A PATIENTS RESPONSIVENESS TO SPECIlC DRUGS OR THE LIKELIHOOD OF ADVERSE EVENTS;= #ERTAIN PATIENT GROUPS SUCH AS END STAGE RELAPSED CANCER PATIENTS COULD ESPECIALLY BENElT FROM GENOMIC MEDICINE 4HESE PATIENTS HAVE RECEIVED MULTIPLE ROUNDS OF THERAPY AND WHILE THEY HAVE PROGRESSED ON ALL OF THE STANDARD AGENTS THEY HAVE FAILED ON SECOND AND THIRD ROUND TREATMENTS "ECAUSE EFlCACY AND SIDE EFFECTS OF THE NEW APPROACHES ARE UNKNOWN THEY ARE NOT APPROPRIATE FRONT LINE TREATMENT WITH EARLY STAGE CANCER PATIENTS FOR WHOM THERE ARE EXISTING EFFECTIVE TREATMENTS EVEN IF THOSE TREATMENTS ONLY HELP A SMALL SUBSET 4HEY MUST lRST BE RESEARCHED AND TESTED ON END STAGE PATIENTS 7HEN THESE PATIENTS ARE TREATED USING A PHARMACOGENIC APPROACH AND THEIR MOLECULAR TARGETS ARE FOUND AN EXISTING APPROVED AGENT IS MATCHED WITH THE PATIENTS CANCER -ATCHING THAT AGENT TO THE MOLECULAR CONSTRUCTION OF A PATIENTS TUMOR IMPROVES THE CHANCE OF INCREASING THAT PATIENTS LENGTH OF SURVIVAL AND WELLNESS 4HIS APPROACH HAS ALREADY ACHIEVED SOME REMARKABLE RESULTS;=
4HE 4RANSLATIONAL 'ENOMICS 2ESEARCH )NSTITUTE 4HE 4RANSLATIONAL 'ENOMICS 2ESEARCH )NSTITUTE 4'EN IS A NONPROlT C ORGANIZATION FOCUSED ON DEVELOPING EARLIER DIAGNOSTICS AND SMARTER TREATMENTS FOR CANCER NEUROLOGICAL DISORDERS DIABETES AND OTHER COMPLEX DISEASES 4'ENS RESEARCH IS BASED ON PERSONALIZED MEDICINE 7ITH AN ANNUAL BUDGET OF MORE THAN MILLION THE INSTITUTE IS NEARING
EQNLãQDRD@QBGãSN ãP T@KHSX ãSQ@M RK @S H M Fã B KH M H B @ Kã K @ A ã Q D RT K S Rã H M SN ã O@S H D M S ã B @ Q D !N %XAMPLE OF 4'ENS 2ESULTS 4'ENS STRATEGY OF APPLYING GENOMIC TECHNOLOGIES TO DEVELOP PERSONALIZED THERAPIES FOR PATIENTS HAS VERY REAL RESULTS 4'EN SCIENTIST $R -ICHAEL "ERENS PARTNERING WITH PHYSICIANS AT 0HOENIX #HILDRENS (OSPITAL HELPED A YEAR OLD GIRL WITH GLIOBLASTOMA BRAIN TUMOR WHO HAD FAILED RADIATION THERAPY AND lRST LINE CHEMOTHERAPY AND HAD BEEN GIVEN ONLY SIX MONTHS TO LIVE 4'EN SCIENTISTS TESTED THE GENOMIC PROlLE OF HER TUMOR AGAINST KNOWN EFFECTIVE CHEMOTHERAPIES lNDING A POTENTIAL MATCH 4HE TEEN WAS SUCCESSFULLY TREATED RESULTING IN REMISSION OF THE ORIGINAL TUMOR
EMPLOYEES THE MAJORITY OF WHOM ARE SCIENTISTS WORKING IN HIGHLY COLLABORATIVE TEAMS ,OCATED IN 0HOENIX 4'ENS LABS ARE STAFFED WITH CROSS FUNCTIONAL TEAMS OF ENGINEERS GENETICISTS CLINICIANS BIOLOGISTS AND COMPUTER EXPERTS 4HIS INFRASTRUCTURE IS COMBINED WITH SCIENTIlC TECHNOLOGIES AND PROGRAMS ACADEMIC AND CORPORATE PARTNERSHIPS AND ENTERPRISE EFFORTS 4HE ORGANIZATION GAINS LARGE SCALE ACCESS TO EXPERTISE AND TECHNOLOGY BY PARTNERING WITH ACADEMIA GOVERNMENT AGENCIES AND CLINICAL AND CORPORATE ENTITIES IN !RIZONA AND AROUND THE WORLD "Y COLLABORATING WITH ITS CLINICAL PARTNERS 4'EN ESTABLISHES LINKS TO PATIENTS AND HEALTHCARE PROVIDERS WHO CAN BENElT FROM THE ORGANIZATIONS RESEARCH 4'ENS GOAL IS TO EMPLOY WORLD CLASS SCIENTIlC EXPERTISE AND NOVEL RESEARCH PROGRAMS TO ACCELERATE THE TRANSLATIONAL PROCESS SO GENOMIC RESEARCH DISCOVERIES CAN QUICKLY BENElT PATIENTS 4HESE hACCELERATORSv ARE DESIGNED TO QUICKLY DEVELOP THERAPEUTICS PROGNOSTICS AND DIAGNOSTICS TO DELIVER THESE DISCOVERIES TO PATIENTS AS QUICKLY AS POSSIBLE 4'ENS RESEARCH DIVISIONS ARE DESIGNED TO FOSTER A WIDE RANGE OF GENETIC DISCOVERIES 4'EN IS PARTNERING WITH PAYERS AND COMMUNITY LEADERS TO SUPERSEDE TRADITIONAL TRIAL AND ERROR BASED MEDICINE 4HE INSTI TUTE IS FOCUSED ON ESTABLISHING GENOMIC BASED TESTING CENTERS LINKED TO COMMUNITY CENTERS THEN SENDING THE INFORMATION TO PHYSICIANS TO HELP THEM TREAT THEIR PATIENTS 4'EN VIEWS THE PARTICIPATION OF COMMUNITY CENTERS AS VITAL BECAUSE ONLY ABOUT PERCENT OF CANCER PATIENTS IN THE 5NITED 3TATES ARE SEEN AT THE MAJOR COMPREHENSIVE CANCER CENTERS %IGHT PERCENT RECEIVE THEIR CANCER CARE AT COMMUNITY BASED HOSPITALS;=
3IX 'UIDELINES FOR 3UCCESS 7HEN ESTABLISHING ITS RESEARCH PROGRAM IN 0HOENIX 4'EN FOCUSED ON THE FOLLOWING GUIDELINES 2ECOGNIZE AND LEVERAGE LOCAL ADVANTAGES %VERY LOCATION HAS ITS OWN ADVANTAGES SUCH AS QUALITY OF LIFE LOW COSTS AND OR ACCESS TO A POOL OF QUALIlED EMPLOYEES 4HESE ADVANTAGES NEED TO BE IDENTIlED MARKETED AND ACQUIRED
,EADERSHIP FROM THE TOP IS KEY )N !RIZONA HAVING THE STATE AND CITYS CHIEF EXECUTIVES PERSONALLY DRIVE THE PROJECT CUT RED TAPE AND ENSURED THAT POTENTIAL SUPPORTERS PAID ATTENTION %FFECTIVE LEADERSHIP ALSO HELPED TO FACILITATE RECRUITMENT OF SCIENTISTS AND EXECUTIVES "UILD PARTNERSHIPS 'OVERNMENT BUSINESS ACADEMIC AND NONPROlT GROUPS ALL MUST JOIN TOGETHER TO ENSURE A BROAD BASE OF SUPPORT THAT TRANSCENDS ANY SINGLE GROUPS NARROW INTERESTS 4HE 4'EN BOARD WAS STRUCTURED TO HELP FOSTER THESE PARTNERSHIPS GOING FORWARD 3ECURE SUPPORT AND FUNDING FROM MULTIPLE SOURCES $IVERSE FUNDING FROM THE PUBLIC AND PRIVATE SECTORS PROVIDES STABILITY AND BROAD STAKEHOLDER INVOLVEMENT !CCURATELY IDENTIFYING FUNDING REQUIREMENTS AS WELL AS REALISTICALLY IDENTIFYING WHERE AND WHEN FUNDS WILL BECOME AVAILABLE CAN HELP STABILIZE THE INITIATIVE QUICKLY %STABLISH AN ADMINISTRATIVE INFRASTRUCTURE QUICKLY %NSURING THAT THE ADMINISTRATIVE SUPPORT ELEMENTS ARE IN PLACE INCREASES EFlCIENCY AND ENABLES RESEARCHERS TO FOCUS ON WHAT THEY DO BEST DEVELOP DISCOVERIES AND SOLUTIONS 4RANSLATIONAL RESEARCH GENERATES TREMENDOUS BENElTS 4HE NEXUS BETWEEN BASIC RESEARCH AND ITS COMMERCIAL APPLICATIONS IS TOO OFTEN NEGLECTED YET IT CAN ATTRACT PLAYERS ON BOTH SIDES CREATING A TRUE HUB OF SCIENTIlC AND BUSINESS ACTIVITY;=
4HE &UTURE OF 0HARMACOGENICS $ESPITE THE ENORMOUS POTENTIAL OF PHARMACOGENICS MANY CHALLENGES REMAIN BEFORE THESE DRUGS CAN BE IMPORTANT TREATMENTS IN THE PHYSICIANS ARMAMENTARIUM )N ADDITION TO THE lNANCIAL TECHNOLOGICAL AND OPERATIONAL HURDLES PHARMACOGENICS POSES NUMEROUS DILEMMAS INCLUDING PRIVACY AND ETHICAL ISSUES AROUND THE COLLECTION OF $.! SAMPLES IMPENDING INTELLECTUAL PROPERTY BATTLES AND THE NEED FOR NEW REGULATORY AND REIMBURSEMENT POLICIES $ISCUSSIONS ON ALL OF THESE TOPICS HAVE BEGUN WITH THE ANTICIPATION THAT THESE PROBLEMS WILL BE RESOLVED AS PROVEN PRODUCTS ENTER THE MARKET;= %NDNOTES )NTERVIEW WITH *EFFREY - 4RENT 0H$ -AY PRESIDENT AND SCIENTIlC DIRECTOR 4RANSLATIONAL 'ENOMICS 2ESEARCH )NSTITUTE h0ERSONALIZED -EDICINE 4HE %MERGING 0HARMACOGENOMICS 2EVO LUTION v 0RICEWATERHOUSE#OOPERS P )BID 53 $EPARTMENT OF %NERGY (UMAN 'ENOME 0ROJECT HTTPWWWORNL GOVSCITECHRESOURCES(UMAN?'ENOMEPROJECTABOUTSHTML )BID h0ERSONALIZED -EDICINE 4HE %MERGING 0HARMACOGENOMICS 2EVOLUTION v 0RICEWATERHOUSE#OOPERS P )BID P h4'EN 4RANSLATIONAL 2ESEARCH )NSTITUTE ! #ASE 3TUDY v 0RICEWATERHOUSE#OOPERS P h0ERSONALIZED -EDICINE 4HE %MERGING 0HARMACOGENOMICS 2EVOLUTION v 0RICEWATERHOUSE#OOPERS P
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
$RUG 3AFETY AND 0HARMACOVIGILANCE )MPROVING DRUG SAFETY AND EFFECTIVENESS WILL INCLUDE INTEGRATION OF DATA ANALYSIS AND COMMUNICATION THROUGHOUT THE DRUG LIFE CYCLE AND REQUIRE COLLABORATION FROM ALL PARTICIPANTS IN THE HEALTHCARE DELIVERY PROCESS
"Y +ATE -ALONEY AND -ICHAEL -ENTESANA 0RICEWATERHOUSE#OOPERS
!
T A #LINICAL 2ESEARCH %DUCATIONAL #ONFERENCE 3COTT 'OTTLIEB -$ THE &$!S DEPUTY COMMISSIONER FOR MEDICAL AND SCIENTIlC AFFAIRS COMMENTED THAT h%VEN WHILE WE HAVE POURED BILLIONS INTO THE SCIENCE OF DISCOVERING NEW DRUGS WE HAVE INVESTED COMPARATIVELY LITTLE IN THE SCIENCE OF HOW WE GO ABOUT ACTUALLY TESTING AND EVALUATING THOSE DRUGS FOR SAFETY AND EFFECTIVENESSv;= 4HE &$! REPORTS AN ALARMING INCREASE IN THE NUMBER OF ADVERSE EVENTS FROM PRESCRIPTION DRUGS n AN AVERAGE OF PERCENT EVERY YEAR SINCE ;= 4HIS INCREASE AND A SERIES OF WELL PUBLICIZED DRUG WITHDRAWALS HAVE MADE DRUG SAFETY A TOP PRIORITY AT PHARMACEUTICAL AND BIOTECHNOLOGY COMPANIES #OMPANIES CAN NO LONGER JUST COMPLY WITH REGULATIONS THEY MUST TAKE A PROACTIVE APPROACH TO DRUG SAFETY TO PROTECT CONSUMERS AND PROTECT THEIR BOTTOM LINE !T THE HEART OF THIS NEW APPROACH IS A PHARMACOVIGILANCE PLAN THAT STARTS IN PREMARKET CLINICAL TRIALS AND CONTINUES THROUGHOUT THE DRUG LIFE CYCLE TO CONTINUALLY MONITOR FOR SIGNALS THAT MAY INDICATE A RISK
4RANSITION FOR )MPROVEMENT $ATABASES -ANY LARGE CLINICAL TRIALS STILL USE SLOW OUTDATED DATA COLLECTION AND MANAGEMENT TECHNIQUES INCLUDING HANDWRITTEN CASE REPORT FORMS AND MANUAL DATA ENTRY ! PAPER DRIVEN DATA MANAGEMENT SYSTEM CREATES A DELAY BETWEEN THE TIME A STUDY IS PERFORMED AND THE TIME RESEARCHERS RECEIVE THE DATA FOR REVIEW "ECAUSE
OF THIS DELAY AN OPPORTUNITY TO MAKE CLINICAL TRIALS SAFER AND MORE EFFECTIVE CAN BE MISSED )N RESPONSE SOME COMPANIES ARE ESTABLISHING DATABASES THAT INTEGRATE CLINICAL TRIAL AND POST MARKETING DATA TO IDENTIFY AND ADDRESS SAFETY PROBLEMS MORE QUICKLY (OWEVER FOR SOME COMPANIES THE COST OF SUCH DATABASES IS PROHIBITIVE )N /CTOBER THE &$! ANNOUNCED THAT ITS #ENTER FOR $RUG %VALUATION AND 2ESEARCH AWARDED FOUR CONTRACTS THAT GIVE THE &$! ACCESS TO DATABASES THAT HELP THE AGENCY EVALUATE THE SAFETY OF NEW DRUGS FASTER AND MORE EFFECTIVELY 4HE DATABASES CONTAIN MEDICAL CLAIMS FROM HEALTHCARE DELIVERY AND OUTPATIENT PRESCRIPTION DRUG USE THAT CAN BE USED TO STUDY MANY DRUGS AND THEIR ADVERSE EFFECTS 4HE DATABASES ALSO HELP THE &$! QUICKLY UNCOVER RARE SIDE EFFECTS THAT BECOME EVIDENT ONLY AFTER DRUGS ARE APPROVED AND GIVEN TO THOUSANDS OR EVEN MILLIONS OF PATIENTS
2ISK-!0 4HE 2ISK -INIMIZATION !CTION 0LAN 2ISK-!0 IS DElNED BY THE &$! AS A hSTRATEGIC SAFETY PROGRAM DESIGNED TO MEET SPECIlC GOALS AND OBJECTIVES IN MINIMIZING KNOWN RISKS OF A PRODUCT WHILE PRESERVING ITS BENElTSv;= ! 2ISK-!0 IS USED FOR DRUGS ASSOCIATED WITH AN UNUSUALLY HIGH LEVEL OF RISK THAT EMERGES BEFORE OR AFTER THE DRUG IS MARKETED 4HE 2ISK-!0 LISTS THE ACTIVITIES THAT A COMPANY WILL PERFORM SUCH AS EDUCATING PHYSICIANS ABOUT THE RISKS OF USING CERTAIN DRUGS AND CREATING MATERIALS FOR PHYSICIANS TO GIVE TO PATIENTS WHEN THEY PRESCRIBE DRUGS THAT ARE KNOWN TO BE HIGHER RISK
+ATE -ALONEY 2. -3 #0(1 IS A MANAGER IN 0RICEWATERHOUSE#OOPERS 'LOBAL 0HARMACEUTICAL AND (EALTH 3CIENCES PRACTICE 3HE HELPS TO LEAD THE lRMS EFFORTS TO PROVIDE PHARMACEUTICAL BIOTECH AND MEDICAL DEVICE CLIENTS WITH GUIDANCE AND DIRECTION ON &$! REGULATIONS )#( GUIDELINES AND THE %5 DIRECTIVE COMPLIANCE RELATING TO CLINICAL TRIALS BOTH NATIONALLY AND INTERNATIONALLY 3HE ALSO LEADS THE CLINICAL PORTION OF ENTERPRISE RISK MANAGEMENT PROJECTS 3HE IS A 3IX 3IGMA 'REEN "ELT WITH OVER YEARS OF NURSING #1) RISK MANAGEMENT BUSINESS DEVELOPMENT TRAINING AND CLINICAL TRIAL EXPERIENCE IN THE HOSPITAL PHARMACEUTICAL AND )4 SECTORS 3HE CAN BE REACHED AT KATENMALONEY USPWCCOM -ICHAEL -ENTESANA LEADS THE 53 0HARMACEUTICAL AND ,IFE 3CIENCE 2$ !DVISORY PRACTICE FOR 0RICEWATERHOUSE#OOPERS (E HAS OVER YEARS OF EXPERIENCE ASSISTING ORGANIZATIONS TO IMPROVE BUSINESS PERFORMANCE BY ACHIEVING TRANSFORMATIONAL CHANGE THROUGH OPERATIONS IMPROVEMENT (IS AREAS OF SPECIALIZATION INCLUDE SENIOR MANAGEMENT DECISION SUPPORT DEMAND MANAGEMENT PORTFOLIO VISUALIZATION OPERATIONAL PLANNING AND OPERATIONAL STRATEGY DEVELOPMENT ORGANIZATION DESIGN AND PROCESS IMPROVEMENT RE ENGINEERING (E CAN BE REACHED AT MICHAELMENTESANA USPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
CQ TFãR@ED S Xã @ M C ã OG @ Q L@ B N U H FH K@ M B D
@7E WANT TO SEE QUALITY TREATED AS A CRISIS A .O PRIORITY A SAFETY CULTURE FOR ALL HEALTH ORGANIZATIONS AT THE HIGHEST LEVEL n (ELEN $ARLING PRESIDENT OF THE .ATIONAL "USINESS 'ROUP ON (EALTH 0ACKAGE )NSERTS 0HYSICIANS STRIVE TO STAY INFORMED ABOUT NEW DRUGS ON THE MARKET SO THEY CAN PRESCRIBE THE RIGHT ONES FOR THEIR PATIENTS "UT INDUSTRY CRITICS BELIEVE THAT ALL TOO OFTEN PHYSICIANS DONT HAVE TIME TO REVIEW THE MOUNTAINS OF INFORMATION THEY RECEIVE ABOUT A MULTITUDE OF DRUGS !S A RESULT THEY MAY PRESCRIBE A DRUG BASED ON PATIENT DEMAND REGARDLESS OF WHETHER THAT DRUG IS THE BEST THERAPY FOR A GIVEN PATIENT -ICHAEL ,EAVITT SECRETARY OF 53 (EALTH AND (UMAN 3ERVICES CLAIMS THAT IMPROVEMENTS TO PACKAGE INSERTS n THE PRINTED INFORMATION INSIDE PRESCRIPTION DRUG PACKAGING n CAN MAKE A BIG DIFFERENCE h0ROVIDING HEALTHCARE PROFESSIONALS AND PATIENTS WITH CLEAR AND CONCISE INFORMATION ABOUT PRESCRIPTIONS WILL HELP ENSURE SAFE AND OPTIMAL USE OF DRUGS WHICH TRANSLATES INTO BETTER HEALTH OUTCOMES FOR PATIENTS AND MORE EFlCIENT DELIVERY OF HEALTHCARE "Y IMPROVING THE PACKAGE INSERT TO MAKE IT MORE USEFUL FOR HEALTHCARE PROVIDERS IN THEIR DAY TO DAY CLINICAL PRACTICE WE ARE MAKING IT EASIER FOR THEM TO EXPLAIN THE BENElTS AND RISKS OF MEDICATIONS FOR THEIR PATIENTSv;= 4HE &$! AGREES 4O REDUCE THE RISKS OF MEDICATION ERRORS THE AGENCY RECENTLY MADE MAJOR REVISIONS TO THE FORMAT OF DRUG PACKAGE INSERTS 4HE REVISIONS TO THE INSERTS n THE lRST IN YEARS n ARE INTENDED TO GIVE HEALTHCARE PROVIDERS CLEARER MORE CONCISE PRESCRIBING INFORMATION 4HE NEWLY DESIGNED INSERT WILL BE PRINTED IN AN EASY TO READ FORMAT THAT DRAWS THE ATTENTION OF PHYSICIANS AND PATIENTS TO THE MOST IMPORTANT DRUG INFORMATION 4HE INSERTS ALSO INCLUDE A SECTION WITH INFORMATION ON PATIENT COUNSELING THAT EMPHASIZES THE IMPORTANCE OF COMMUNICATION BETWEEN HEALTHCARE PROFESSIONALS AND PATIENTS
0ROBLEMS 7ITH 0OST -ARKETING 3TUDIES )N PREMARKET CLINICAL TRIALS THE &$! CONDUCTS MORE EVALUATIONS FOR SAFETY THAN EVER BEFORE (OWEVER NO AMOUNT OF PREMARKET STUDY CAN PAINT THE TOTAL PICTURE OF THE EFFECTIVENESS OF AND RISKS ASSOCIATED WITH A DRUG #LINICAL TRIALS ARE CONDUCTED WITHIN CONTROLLED CONDITIONS !LL TRIAL SUBJECTS ARE GIVEN PRECISE DOSES ON A REGIMENTED SCHEDULE AND MONITORED CLOSELY FOR ANY SIGNS OF DRUG REACTION POSITIVE OR NEGATIVE "UT OVER TIME A DRUG THAT IS SAFE AND EFFECTIVE IN A CLINICAL TRIAL MAY POSE SAFETY RISKS IN A BROADER POPULATION IN UNCONTROLLED CONDITIONS
"ECAUSE THERE ARE NO SYSTEMATIC PLANS FOR POST MARKET RESEARCH SUFlCIENT INFORMATION IS OFTEN UNAVAILABLE ON A NUMBER OF TOPICS SUCH AS THE FREQUENCY OF ADVERSE EVENTS OF MARKETED DRUGS THE EFFECTS OF LONG TERM DRUG EXPOSURE AND THE EFFECTS OF A DRUG IN SPECIAL POPULATIONS;= )N THE POST MARKETING ENVIRONMENT PHARMACEUTICAL COMPANIES CANNOT CONTROL A NUMBER OF BEHAVIORS THAT CAN LEAD TO ADVERSE EVENTS 0HYSICIANS MAY PRESCRIBE A DOSAGE THAT IS NOT RECOMMENDED BECAUSE HE OR SHE IS UNAWARE OF THE RISKS OF DOING SO 0HYSICIANS MAY PRESCRIBE A DRUG FOR NONAPPROVED USES 0ATIENTS MAY NOT COMPLY WITH THE PRESCRIBED DOSING REGIMEN 0ATIENTS MAY BE USING OTHER PRESCRIPTION DRUGS OR OVER THE COUNTER PRODUCTS THAT WERE NEVER TESTED FOR INTERACTION WITH THE PRESCRIBED DRUG AND 0ATIENTS FROM VARIOUS ETHNIC ANDOR RACIAL GROUPS MAY NOT HAVE BEEN INCLUDED IN PREMARKET CLINICAL STUDIES AND THEREFORE MAY BE AT INCREASED RISK 4HESE ARE JUST A FEW REASONS WHY POST MARKET STUDIES ARE EXTREMELY IMPORTANT !DVERSE DRUG EFFECTS THAT ARE NOT DETECTED IN PREMARKETING TRIALS ARE OFTEN FOUND THROUGH POST MARKETING TRIALS SPONTANEOUS REPORTING OF ADVERSE EVENTS OR OBSERVATIONAL STUDIES OF WIDESPREAD USE OF THE PRODUCT /NE IMPORTANT QUESTION IS WHO IS GOING TO PAY FOR THESE STUDIES 4HE LACK OF INFORMATION AVAILABLE ABOUT THE PATIENTS USING A DRUG LIMITS THE EFFECTIVENESS OF POST MARKET STUDIES /NCE A DRUG IS MARKETED THERE IS NO RELIABLE SOURCE OF INFORMATION ON THE POPULATION THAT HAS BEEN PRESCRIBED THE DRUG AND HOW TO CONTACT THEM TO GET FOLLOW UP INFORMATION 4HE (EALTH )NSURANCE 0ORTABILITY AND !CCOUNTABILITY !CT PRIVACY REGULATIONS HAVE MADE IT EVEN MORE DIFlCULT FOR PHARMACEUTICAL COMPANIES TO GET ADVERSE EVENT INFORMATION ABOUT PATIENTS FROM PHYSICIANS OR HOSPITALS 3UCH INFORMATION IS CRITICAL FOR MEANINGFUL POST MARKETING STUDIES -ED7ATCH THE &$!S SAFETY INFORMATION AND ADVERSE EVENT REPORTING PROGRAM PROVIDES CLINICAL INFORMATION ABOUT SAFETY ISSUES WITH MEDICAL PRODUCTS INCLUDING PRESCRIPTION AND OVER THE COUNTER DRUGS -ED7ATCH ALLOWS HEALTHCARE PROFESSIONALS AND CONSUMERS TO REPORT SERIOUS PROBLEMS THAT THEY SUSPECT ARE ASSOCIATED WITH THE DRUGS AND MEDICAL DEVICES THEY PRESCRIBE DISPENSE OR USE 2EPORTING CAN BE DONE ONLINE BY PHONE OR BY SUBMITTING A -ED7ATCH FORM 7HILE IT OFFERS A VALUABLE SERVICE THE -ED7ATCH FORM FOR REPORTING ADVERSE DRUG EFFECTS IS A VOLUNTARY FORM AND MOST PHYSICIANS DONT lND THE TIME TO lLL OUT THE DETAILED REPORTS "ECAUSE CLINICAL TRIALS DO NOT IDENTIFY ALL OF THE SEVERE TOXICITY IN PATIENT POPULATIONS WHO ARE NOT INCLUDED IN STUDY GROUPS AND -ED7ATCH REPORTS LACK ADEQUATE DETAIL TO DETERMINE CAUSALITY SOME HAVE CALLED FOR A NEW POST MARKETING SAFETY SURVEILLANCE SYSTEM;= $ATA ON SAFETY AND EFFECTIVENESS WHICH ARE KEY ELEMENTS CAPTURED IN PREMARKET CLINICAL TRIAL PHASES ALSO NEED TO BE LINKED
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
CQ TFãR@ED S Xã @ M C ã OG @ Q L@ B N U H FH K@ M B D WITH POST MARKET DATA TO CREATE A hCONTINUUMv OF INFORMATION THAT MAY EXPOUND ON THE MORE ELUSIVE SAFETY SIGNALS THAT APPEAR RANDOMLY OVER TIME
@7E CANNOT SOLVE TODAYS PROBLEMS WITH A TH CENTURY SOLUTION 7E NEED A PATIENT CENTERED APPROACH THAT WILL DELIVER hINDUSTRIAL STRENGTHv RATHER THAN hCRAFTSMANv LEVEL QUALITY -ARGARET % /+ANE PRESIDENT .ATIONAL #OMMITTEE FOR 1UALITY
THAT EFFORT STANDARDIZING PHARMACOVIGILANCE OPERATIONAL AND DATA MANAGEMENT ACTIVITIES WITHIN THE SAFETY ORGANIZATION AND AROUND CROSS FUNCTIONAL SAFETY TOUCH POINTS TO IMPROVE MONITORING PRACTICES MAY BE BENElCIAL ! HOLISTIC FOUNDATION FOR PHARMACOVIGILANCE SHOULD ALSO BE SUPPORTED BY RISK MANAGEMENT AND INFORMATION TECHNOLOGY 2EGULATORS n 4HE FEDERAL GOVERNMENT SHOULD CONSIDER ALLOCATING FUNDING FOR hCUTTING EDGEv TECHNOLOGY TO COLLECT DATA EFlCIENTLY REVOLUTIONIZE DATA MINING MANAGE THE BURDEN OF DRUG SAFETY WARNING SIGNALS AND ENHANCE DATA ANALYSIS STRATEGIES TO PROMOTE POSITIVE INTERVENTION RATHER THAN REACTION TO DRUG SAFETY PROBLEMS 7ITH BETTER DETECTION SYSTEMS IN PLACE REGULATORS SHOULD BE ABLE TO MONITOR EVENTS WITH A SPECIlC NEW DRUG OR CLASS OF DRUGS THAT MAY INDICATE POTENTIAL SERIOUS ADVERSE EVENTS IF NOT ADDRESSED PROMPTLY
!SSURANCE .#1!
! 0RESCRIPTION FOR THE &UTURE !LTHOUGH THE PHARMACEUTICAL AND BIOTECHNOLOGY INDUSTRIES WILL LOGICALLY LEAD THE WAY ON PHARMACOVIGILANCE IT IS NOT THEIR SOLE RESPONSIBILITY !LL PARTICIPANTS IN THE HEALTHCARE DELIVERY PROCESS n PATIENTS PHYSICIANS HOSPITAL PERSONNEL INSURERS DRUG MANUFACTURERS PHARMACISTS GOVERNMENT REGULATORS n MUST PLAY A ROLE IN PHARMACOVIGILANCE 0HYSICIANS n 4HE MEDICAL COMMUNITYS GENERAL LACK OF FAMILIARITY WITH THE ADVERSE EVENT REPORTING PROCESS IS A SIGNIlCANT HURDLE TO PHARMACOVIGILANCE EFFORTS 0HYSICIANS NEED TO BE EDUCATED ON HOW TO REPORT ADVERSE DRUG EVENTS AND BE INCENTIVIZED TO DO SO 0HARMACISTS n 4HE AMOUNT OF TRUST THAT PATIENTS PUT IN THEIR PHARMACISTS IN ADVISING THEM ON DRUG ISSUES BECAME VERY CLEAR WITH THE INTRODUCTION OF THE -EDICARE DRUG BENElT 3URVEYS SHOWED THAT SENIORS HEAVILY RELIED ON PHARMACISTS FOR ADVICE IN SELECTING A DRUG PLAN 0HARMACISTS CAN PLAY A KEY ROLE IN EDUCATING PATIENTS ABOUT DRUG RISKS AND SYMPTOMS OF WHICH TO BE AWARE $RUG MANUFACTURERS n &OR MANY COMPANIES PHARMACO VIGILANCE PROGRAMS HAVE BEEN REACTIVE RATHER THAN PROACTIVE #OMPANIES MUST DEVELOP A FRAMEWORK TO COLLECT AND ANALYZE DATA CAPTURED THROUGHOUT THE LIFE CYCLE OF A DRUG INCLUDING CLINICAL TRIAL RESEARCH AND POST MARKET INFORMATION !S PART OF
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
3UMMARY 0ROACTIVE hSAFETY SIGNALv MONITORING THROUGH THE CONTINUUM FROM CLINICAL TRIALS TO POST MARKETING AND LONG TERM SAFETY SURVEILLANCE MAY HELP PHARMACEUTICAL COMPANIES AVOID CRISIS SITUATIONS MINIMIZE THE RISK OF COSTLY STUDY SETBACKS BUSINESS INTERRUPTIONS PRODUCT WITHDRAWALS LITIGATION EXPENSES AND TARNISHED COMPANY REPUTATIONS -ORE IMPORTANTLY IT WILL IMPROVE DRUG SAFETY FOR PATIENTS (OWEVER FOR THAT TYPE OF INCLUSIVE MONITORING TO HAPPEN ALL STAKEHOLDERS NEED TO BE PROACTIVELY INVOLVED IN DRUG SAFETY %NDNOTES 3PEECH BEFORE #LINICAL 2ESEARCH %DUCATIONAL #ONFERENCE .ORTHWESTERN 5NIVERSITY -EDICAL #ENTER #HICAGO -AY REMARKS BY 3COTT 'OTTLIEB -$ DEPUTY COMMISSIONER FOR MEDICAL AND SCIENTIlC AFFAIRS HTTPWWWFDAGOVOCSPEECHESNORTHWESTERNHTML h)MPROVING 0UBLIC (EALTH 4HROUGH (UMAN $RUGS v #$%2 2EPORT TO THE .ATION !UGUST #ENTER FOR $RUG %VALUATION AND 2ESEARCH ACCESSED AT HTTPWWWFDAGOVCDERREPORTSRTNRTN HTM !PRIL h0HARMACOVIGILANCE ! .EW %RA IN $RUG 3AFETY v WWWDATAMONITOR COM $!MORE . h.EW 0ACKAGE )NSERTS !RE #LEARER v -ARCH -ED !D .EWS P 2AY 7 ! AND # - 3TEIN h2EFORM OF $RUG 2EGULATION n "EYOND AN )NDEPENDENT $RUG 3AFETY "OARD v .EW %NGLAND *OURNAL OF -EDICINE PP h0HARMACOVIGILANCE ! .EW %RA IN $RUG 3AFETY v WWWDATAMONITOR COM
"RIDGING #ARE AND 2ESEARCH 4HROUGH (EALTH )NFORMATION 4ECHNOLOGY #ONVERGENCE OF CLINICAL CARE AND CLINICAL RESEARCH ELECTRONIC INFORMATION SYSTEMS COULD BETTER SUPPORT CLINICAL RESEARCH ENABLE MORE EFlCIENT DRUG DEVELOPMENT AND OFFER SIGNIlCANT lNANCIAL BENElTS TO RESEARCHERS AND SPONSORS "Y .ICK "EARD 0RICEWATERHOUSE#OOPERS
#
LINICAL RESEARCH IS CENTRAL TO THE MISSION OF PHARMACEUTICAL COMPANIES AND MEDICAL RESEARCH CENTERS &OR BOTH TYPES OF ORGANIZATIONS CLINICAL TRIALS ARE INFORMATION INTENSIVE AND THE ASSOCIATED PROCESSES CAN BE CUMBERSOME 0HARMACEUTICAL COMPANIES AND HEALTHCARE PROVIDERS HAVE DESIGNED DIFFERENT APPROACHES TO COLLECTING PATIENT DATA ELECTRONICALLY 4HESE SYSTEMS ADDRESS THE PRIMACY OF DIRECT PATIENT CARE IN THE MISSION OF THE MEDICAL CARE CENTER AND THE RESEARCH AND COMMERCIALIZATION GOALS OF PHARMACEUTICAL COMPANIES 9ET IF THE SECTORS DEVELOPED MUTUALLY EFFECTIVE ELECTRONIC DATA SYSTEMS THEY COULD WORK MORE SYNERGISTICALLY FOR ADDED EFlCIENCIES PROlTS AND SATISFACTORY OUTCOMES IN CLINICAL RESEARCH
#LINICAL 4RIALS 2EGARDLESS OF WHETHER PATIENTS ARE PARTICIPATING IN A CLINICAL TRIAL OR IN CLINICAL CARE INDIVIDUALS GENERALLY EXPERIENCE SIMILAR INTERCHANGES WITH CLINICIANS 4HEY ARE ASKED ABOUT THEIR PROBLEMS THEIR HEALTH AND ANY SYMPTOMS THEIR VITAL STATISTICS ARE TAKEN TESTS MAY BE UNDERTAKEN AND SOMETIMES THEY ARE GIVEN A COURSE OF THERAPY 4HERE IS A SIGNIlCANT OVERLAP IN THE DATA COLLECTED IN BOTH SITUATIONS IE GENDER AGE WEIGHT BLOOD PRESSURE ETC DEPENDING ON THE PATIENTS CONDITION )N A TRIAL SPECIlC DATA MAY BE REQUIRED BEYOND THAT NORMALLY GATHERED 4HE PARTICULARS MAY VARY WIDELY BECAUSE THE OBJECTIVES DO )N CLINICAL CARE THE PRIMARY GOAL IS THE TREATMENT OF THE PATIENTS UNDERLYING PROBLEM AND IDEALLY TO MAKE THE PATIENT FEEL BETTER 0HYSICIANS PRESCRIBE THE THERAPY OR MEDICATIONS THEY BELIEVE WILL DELIVER THE MOST OPTIMAL RESULTS 4HERAPIES ARE OFTEN ADMINISTERED BY THE PATIENTS OR THEIR CARETAKERS WHO MAY OR MAY NOT DISPENSE THE PRESCRIBED AMOUNT AT THE DESIGNATED INTERVALS )NFORMATION ENTERED INTO THE MEDICAL RECORD MAY INCLUDE PRECISE DATA POINTS SUCH AS BLOOD PRESSURES OR BLOOD TEST RESULTS ALONG WITH PHYSICIANS OBSERVATIONS AND PATIENTS DESCRIPTIONS OF THEIR SYMPTOMS REACTIONS OR RESULTS WHICH MAY BE MORE SUBJECTIVE
4HE GOAL OF CLINICAL RESEARCH IS TO GENERATE STATISTICALLY SIGNIlCANT EVIDENCE THAT A THERAPY YIELDS SUITABLE BENElTS 3UCH RESEARCH TAKES SEVERAL FORMS INCLUDING PHARMACEUTICAL COMPANY SPONSORED STUDIES WITH PROSPECTIVELY DElNED END POINTS THAT FORM THE BASIS FOR DRUG APPROVAL )NVESTIGATOR INSTIGATED STUDIES MAY COMPARE THERAPIES OR EXPLORE THE EFlCACY OF A PRODUCT IN AN OFF LABEL USE )NCLUSION AND EXCLUSION CRITERIA ENSURE THAT THE SUBJECTS ARE SIMILAR TO ONE ANOTHER IN KEY WAYS )N ALMOST ALL CASES PATIENTS ARE ASSIGNED RANDOMLY TO RECEIVE ONE THERAPY OR THE OTHER AND USUALLY NEITHER THE PATIENT NOR THE RESEARCHERS KNOW WHICH THEY ARE RECEIVING 4O GENERATE VALID SCIENTIlC EVIDENCE OF EFlCACY SUCH STUDIES MUST COMPARE SPECIlC DATA POINTS TAKEN FROM EVERY SUBJECT IN THE SAME WAY
4HE 6ISION )T WILL TAKE SIGNIlCANT INVESTMENTS OF TIME FUNDING AND COMMITMENT TO BUILD AN ELECTRONIC MEDICAL RECORD %-2 SYSTEM THAT ALSO SERVES ALL CLINICAL RESEARCH NEEDS !S A STEP TOWARD THAT LONG TERM VISION ONE MODEL FOR MAKING THE TWO DATA COLLECTION APPROACHES INTEROPERABLE IS EMERGING -ULTIPLE ORGANIZATIONS AND VENDORS ARE WORKING ON AN APPROACH TO ENABLE CLINICAL TRIAL DATA COLLECTION PROGRAMS TO BE hPLUGGED INv TO THE %-2 )N THIS SCENARIO DRUG SPONSORS CONTRACTING WITH A HEALTHCARE PROVIDER TO CONDUCT A CLINICAL TRIAL WOULD PROVIDE THE STUDY PROTOCOL AND INCLUSION CRITERIA IN A FORMAT THAT COULD BE PIGGYBACKED ONTO THE %-2 7HEN PATIENTS CHECKED IN AT THEIR HEALTHCARE PROVIDER THE %-2 SYSTEM WOULD SCAN THEIR lLES AND THOSE WHO MET THE STUDY CRITERIA WOULD BE mAGGED FOR POSSIBLE INCLUSION IN THE TRIAL 3PECIlC CONSENT FORMS AND OTHER PAPERWORK WOULD BE CUED TO PRINT /NCE ENROLLED THE PATIENTS lLES WOULD AUTOMATICALLY DISPLAY THE TREATMENT PROTOCOL TO BE FOLLOWED AND THE CASE REPORT FORM TO BE COMPLETED 4HE BENElTS OF ALIGNING CLINICAL CARE AND RESEARCH RECORD KEEPING ARE SIGNIlCANT &OR THE OVERALL HEALTHCARE SYSTEM COMPATIBLE %-2S
.ICK "EARD -$ -3 IS A DIRECTOR IN THE 0RICEWATERHOUSE#OOPERS 'LOBAL 4ECHNOLOGY #ENTRE WHERE HE DIRECTS HEALTHCARE RESEARCH (E IS A PHYSICIAN WITH YEARS EXPERIENCE IN HEALTHCARE AND HEALTH )4 SPANNING SEVERAL COUNTRIES (E HAS SERVED AS A #)/ AND AS AN EXECUTIVE IN A LEADING HEALTHCARE SOFTWARE COMPANY AND IS A FREQUENT LECTURER AND SPEAKER AT VARIOUS UNIVERSITIES AND CONFERENCES (E CAN BE REACHED AT NICOLASBEARD USPWCCOM
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
AQ HCFHMFãB @QDã@MCãQDRD@QB G ã S G Q N T FG ã G D @ KS G ã H M E N Q L@S H N M ã S D B G M N KN FX AND ELECTRONIC DATA CAPTURE %$# PROGRAMS WOULD GENERATE DATA THAT COULD BE CROSS REFERENCED AND MINED TO IDENTIFY AND SUPPORT A WIDE VARIETY OF RESEARCH SAFETY EPIDEMIOLOGIC AND OTHER MISSIONS FOR BOTH THE CLINICIAN AND THE RESEARCHER &OR ACADEMIC MEDICAL CENTERS !-#S AND OTHER HEALTHCARE PROVIDERS THE EFlCIENCIES INHERENT IN USING THEIR OWN %-2S AND EVERYDAY OPERATING PROCEDURES IN THE CONDUCT OF CLINICAL TRIALS AND OTHER CLINICAL RESEARCH PROJECTS WOULD SAVE STAFF TIME REDUCE THE TRAINING REQUIRED FOR EACH SEPARATE TRIAL AND MAKE THE INSTITUTIONS MORE EFFECTIVE AND MARKETABLE AS TRIAL INVESTIGATORS &OR HEALTHCARE PROVIDERS WHICH FACE COST AND REIMBURSEMENT PRESSURES SUCH ADDED EFlCIENCIES ARE VITAL #ONDUCTING CLINICAL TRIALS CAN GENERATE REVENUES AND HELP FULlLL THE RESEARCH ORGANIZATIONS MISSION WHILE RAISING ITS PROlLE WITHIN THE MEDICAL AND SCIENTIlC COMMUNITIES &URTHER STREAMLINED AND COMPATIBLE DATA COLLECTION SYSTEMS WOULD HELP ENSURE COMPLIANCE WITH THE (EALTH )NSURANCE 0ORTABILITY AND !CCOUNTABILITY !CT )NSTITUTIONAL 2EVIEW "OARD REQUIREMENTS INTERNAL OPERATING PROCEDURES AND OTHER GUIDANCE
@7E HAVE A CULTURE IN HEALTHCARE OF NOT LOOKING AT OURSELVES AS A DATA DRIVEN BUSINESS EXCEPT FOR lNANCIAL DATA 7E DONT HAVE A LOGISTICAL CLINICAL OR EPI DEMIOLOGICAL NATIONAL DATABASE n #HRISTINE + #ASSEL PRESIDENT AND #%/ !MERICAN "OARD OF )NTERNAL -EDICINE 0HARMACEUTICAL AND LIFE SCIENCES COMPANIES ALSO WOULD BENElT FROM COMPATIBLE %-2%$# PROGRAMS "Y CONNECTING CLINICAL DATA CAPTURE WITH THE INVESTIGATORS MEDICAL PRACTICE THE COMPANIES AND THEIR INVESTIGATORS COULD MORE EASILY IDENTIFY POTENTIAL TRIAL PARTICIPANTS *UST KNOWING WITH WHICH PATIENTS TO DISCUSS POSSIBLE TRIAL PARTICIPATION IS A SUBSTANTIAL STEP TOWARD COMPLETING ENROLLMENT ! STUDY OF NEARLY CANCER PATIENTS FOUND THAT EIGHT OUT OF EVERY PATIENTS WERE UNAWARE OF THE OPTION TO PARTICIPATE IN CLINICAL TRIALS /F THOSE PERCENT SAID THAT IF THEY HAD KNOWN ABOUT CLINICAL TRIALS THEY WOULD HAVE BEEN SOMEWHAT OR VERY RECEPTIVE TO PARTICIPATE;= 5SING THE %-2 TO COLLECT CLINICAL TRIAL DATA WOULD BE BENElCIAL IN MAKING POTENTIAL SUBJECT SCREENING MORE EFlCIENT AND COMPREHENSIVE &URTHER PARTICIPATION IN THE CLINICAL TRIAL WOULD MIRROR SUBJECTS REGULAR CARE MAKING IT MORE LIKELY THAT THEY WOULD COMPLETE THE STUDY 4HE DROPOUT RATE OF CLINICAL TRIAL PATIENTS IS ESTIMATED TO AVERAGE ABOUT PERCENT PER TRIAL;= !LTHOUGH REASONS FOR PATIENTS WITHDRAWING FROM STUDIES INCLUDE DEATH ADVERSE REACTIONS UNPLEASANT STUDY PROCEDURES LACK OF IMPROVEMENT EARLY RECOVERY AND OTHER FACTORS RELATED OR UNRELATED TO TRIAL PROCEDURE AND TREATMENTS ;= EFFORTS TO MAKE THE TESTING ROUTINE WOULD BE BENElCIAL "Y MAKING THE
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
CLINICAL TRIALS LESS DISRUPTIVE DRUG SPONSORS WOULD SEE HIGHER PARTICIPATION AND REPEAT RATES AMONG PATIENTS AND INVESTIGATORS -ANY INVESTIGATORS PARTICIPATE IN ONE CLINICAL TRIAL AND ELECT NOT TO REPEAT THE EXPERIENCE;= 4RIAL SPONSORS ALSO MAY REALIZE MONETARY SAVINGS OF NO LONGER PROVIDING COMPUTERS AND RELATED HARDWARE TO INVESTIGATIVE SITES FOR EACH TRIAL !DDING SOFTWARE CAPABILITIES THAT PROVIDE EXTENSIONS TO THE %-2 AND AVOIDING DUPLICATING SIGNIlCANT ELEMENTS OF INFORMATION CAPTURE WOULD NOT BE WITHOUT COST BUT THE OVERALL COSTS SHOULD BE LOWER 4HE EFlCIENCIES ALSO TRANSLATE INTO QUICKER ASSEMBLY AND EVALUATION OF DATA SUBMITTALS TO REGULATORS FOR MARKET APPROVAL OF NEW PHARMACEUTICALS OR NEW USES FOR EXISTING PRODUCTS %LECTRONIC CAPTURE OF CLINICAL RESEARCH DATA BUILDS IN QUALITY CONTROL MECHANISMS &OR EXAMPLE lELDS IN THE SYSTEM CAN BE SET UP TO EXPECT CERTAIN DATA RANGES WHEN OUTLYING DATA IS ENTERED THE COMPUTER QUERIES IMMEDIATELY 4HIS CONTRASTS THE NONAUTOMATED SYSTEMS IN WHICH TRIAL MONITORS ARE CHARGED WITH lNDING SUCH MISTAKES AND INITIATING QUERIES TO DETERMINE THE ACTUAL VALUES 3UCH FOLLOW UP IS TIME CONSUMING AND CAN BE COSTLY %STIMATES RANGE FROM TO PER QUERY;= !S IMPORTANT TO TRIAL SPONSORS WOULD BE THE REAL TIME TRACKING OF TRIAL ENROLLMENT AND THE EARLIER IDENTIlCATION OF UNEXPECTED SIDE EFFECTS OR FAILURES OF CANDIDATE PRODUCTS "EYOND DIVERTING FUNDS TO MORE PROMISING PROJECTS EARLY TERMINATION OF UNSUCCESSFUL TESTING ADDS A LAYER OF SAFETY TO THE CLINICAL TRIAL PROCESS WHILE ENHANCING THE AVAILABLE SCIENTIlC KNOWLEDGE FOR DRUG DEVELOPERS AND MEDICAL RESEARCHERS 4HE QUALITY ADVANTAGES FOR PATIENTS AND RESEARCH SUBJECTS WILL COME VIA LESS DISRUPTIVE AND SAFER CLINICAL TRIAL PARTICIPATION AND IN THE LONGER TERM WITH BETTER AND SAFER PRODUCTS MORE COMPREHENSIVE SAFETY MONITORING AND MORE RELIABLE OUTCOME COMPARISONS
4HE #HALLENGE (EALTHCARE PROVIDERS AND MEDICAL RESEARCHERS AND THE SEPARATE SOFTWARE INDUSTRIES SERVING THEM HAVE DEVELOPED QUITE DIFFERENT SYSTEMS TO MEET THEIR RESPECTIVE NEEDS 4HE MAJORITY OF HEALTHCARE PROVIDERS HAVE IMPLEMENTED SYSTEMS TO SUPPORT BASIC ADMINISTRATIVE AND BILLING PROCESSES 4HOSE THAT HAVE ELECTRONIC MEDICAL RECORDS ESTIMATED TO BE TO PERCENT ;= IMPLEMENTED THEM PRIMARILY TO FACILITATE CLINICAL CARE 4HE USER INTERFACES THEY OFFER AND THE STANDARDS AND CODING SYSTEMS THEY SUPPORT ARE RARELY SELECTED WITH CLINICAL RESEARCH IN MIND %VEN IN HEALTHCARE PROVIDERS AND !-#S WHERE RESEARCH IS A KEY MISSION THE ABILITY OF THE %-2 TO TRULY SUPPORT RESEARCH DATA COLLECTION IS NOT ALWAYS TAKEN INTO ACCOUNT AT ITS PURCHASE !MONG PHARMACEUTICAL COMPANIES THE LEVEL OF INTEREST IN IMPLEMENTING %$# SYSTEMS IS HIGH AND A NUMBER ARE REPORTEDLY REALIZING UP TO AN PERCENT COST REDUCTION IN CLINICAL TRIAL COSTS WHEN USING %$# INSTEAD OF PAPER REPORTING ! SAVINGS OF TO PERCENT IS REALIZED THROUGH CUTS TO THE TRADITIONAL MONITORING AND DOUBLE DATA ENTRY FUNCTIONS ALONE;=
AQ HCFHMFãB @QDã@MCãQDRD@QB G ã S G Q N T FG ã G D @ KS G ã H M E N Q L@S H N M ã S D B G M N KN FX -OST TRIAL SPONSORS WHO HAVE CREATED %$# SYSTEMS HAVE DESIGNED SYSTEMS PROPRIETARY TO THEIR ORGANIZATIONS %VERY TRIAL MAY HAVE AN %$# SYSTEM CUSTOMIZED FOR ITS PARTICULAR PROTOCOL AND DATA REQUIREMENTS 4HESE TAILORED SYSTEMS SERVE IN PART TO HELP PROTECT THE COMPANYS INTELLECTUAL PROPERTY AND ITS HIGHLY SENSITIVE AND VALUABLE CLINICAL TRIAL DATA 4HUS CONVERGED DATA APPROACHES WILL HAVE TO INCLUDE ROBUST SECURITY FOR CLINICAL TRIAL DATA WITHIN THE %-2 !NOTHER CHALLENGE FOR CLINICAL TRIAL SPONSORS IN THIS ARENA IS THAT THE RATE OF %-2 UPTAKE VARIES WIDELY AMONG DIFFERENT COUNTRIES #LINICAL TRIALS ARE FREQUENTLY INTERNATIONAL UNDERTAKINGS AND SLOW UPTAKE OF %-2S IN KEY MARKETS COULD SLOW THE PHARMACEUTICAL INDUSTRYS ADOPTION OF INTEROPERABLE SYSTEMS SINCE THE BENElTS ASSOCIATED WITH CONVERGENCE OF %-2 AND %$# SYSTEMS MAY BE DILUTED IF ONLY PART OF A MULTINATIONAL TRIAL CAN BE ACCELERATED
4HE $RIVERS $ESPITE THE CHALLENGES AND THE DISPARATE NEEDS AND DIFFERENT ADOPTION RATES FOR CONVERGENCE AMONG PHARMACEUTICAL COMPANIES AND HEALTHCARE PROVIDERS PROGRESS IS BEING MADE &IRST ALL OF THE PLAYERS HAVE lNANCIAL INCENTIVES TO STREAMLINE AND OPTIMIZE THEIR DATA COLLECTION SYSTEMS &OR INVESTIGATORS SPONSORED CLINICAL TRIALS PROVIDE ESSENTIAL REVENUE AND INDEPENDENT STUDIES YIELD AUTHORITY AND PRESTIGE THAT SUPPORTS THEIR RESEARCH MISSIONS 4HE PHARMACEUTICAL INDUSTRY IS UNDER PRESSURE FROM ITS INVESTORS REGULATORS AND CUSTOMERS TO DEVELOP MORE AND BETTER DRUGS AND TO ENSURE PRODUCT SAFETY !CCESSIBLE USABLE AND hMINE ABLEv DATA PLAY A KEY ROLE TOWARD THOSE GOALS #ONVERGENCE OF REQUIREMENTS AND TECHNOLOGY TO SUPPORT THEM COULD OCCUR AS PART OF THE CONTINUING CONSOLIDATION OF THE HEALTHCARE INFORMATION TECHNOLOGY INDUSTRY !LTERNATIVELY INTEROPERABLE DATA SYSTEMS MAY RESULT FROM EMERGING TECHNOLOGY DEVELOPMENTS SUCH AS SERVICES ORIENTED ARCHITECTURES WHICH FACILITATE SIGNIlCANT IMPROVEMENTS IN HOW INFORMATION SYSTEMS CAN FUNCTION IN CONCERT 3UCH DEVELOPMENTS COULD ALSO DELIVER NEW EFlCIENCIES AND OPEN NEW MARKETS FOR ANCILLARY PLAYERS IN THE MEDICAL RESEARCH ARENA 4HESE INCLUDE SOFTWARE DEVELOPERS CURRENTLY CATERING TO SPONSORS OF CLINICAL TRIALS OR TO HEALTHCARE PROVIDERS 7HILE PILOT STUDIES AND DEVELOPMENT PROGRAMS HAVE BEEN ANNOUNCED CURRENTLY NO COMPANY TRULY BRIDGES THE NEEDS OF RESEARCHERS AND CLINICIANS IN AN INTEGRATED SOLUTION !S HEALTHCARE PROVIDERS AND MEDICAL RESEARCHERS CONCENTRATE ON MEETING THEIR IMMEDIATE RESPONSIBILITIES A NUMBER OF ORGANIZATIONS ARE WORKING TOWARD MAKING THE SHARING OF ELECTRONIC MEDICAL DATA REGARDLESS OF SOURCE POSSIBLE !MONG THEM ARE TWO IMPORTANT STANDARDS BODIES (EALTH ,EVEL 3EVEN AN )NTERNATIONAL /RGANIZATION FOR 3TANDARDIZATION WHICH STUDIES STANDARDS FOR HEALTHCARE DATA MANAGEMENT AND THE #LINICAL $ATA )NTERCHANGE 3TANDARDS #ONSORTIUM A USER AND VENDOR GROUP;=
"OTH GROUPS ARE FOCUSED ON ESTABLISHING THE FOUNDATIONS ON WHICH INTEROPERABLE DATA SYSTEMS WILL RUN;=
.EAR 4ERM 3TEPS 4HE COMPONENTS OF INTEROPERABLE MEDICAL CARE AND RESEARCH DATA ARE IN PLACE AND SLOWLY GAINING MOMENTUM 4HE FULCRUM TO BE LEVERAGED IS THE POINT OF HEALTHCARE DELIVERY THE ACADEMIC MEDICAL CENTERS HOSPITALS AND LARGE PHYSICIAN PRACTICES THAT CONDUCT RESEARCH AS WELL AS TREAT PATIENTS !S THESE ORGANIZATIONS IMPLEMENT MORE ADVANCED CLINICAL SYSTEMS THEY SHOULD SEIZE THE OPPORTUNITY AND DEMAND RESEARCH SUPPORT FUNCTIONS IN THE PRODUCTS THEY DEPLOY 4HEY SHOULD INSIST THAT SOFTWARE VENDORS INCORPORATE RESEARCH COMPONENTS THAT WILL FOR EXAMPLE AUTOMATICALLY IDENTIFY TRIAL SUBJECTS AND MEET THE STRINGENT INFORMATION MANAGEMENT REQUIREMENTS OF CLINICAL TRIALS )NVESTIGATORS SHOULD BEGIN NEGOTIATING USE OF THEIR %-2S IN SPONSORED TRIALS "RIDGING THE TECHNICAL PROCEDURAL AND OPERATIONAL DIVISIONS BETWEEN CLINICAL RESEARCH AND CLINICAL CARE RECORD KEEPING COULD YIELD SIGNIlCANT EFlCIENCIES AND lNANCIAL BENElTS IN DRUG DEVELOPMENT AND OTHER CLINICAL RESEARCH !S !-#S AND OTHER HEALTHCARE PROVIDERS DEPLOY ELECTRONIC INFORMATION SYSTEMS THEY WOULD BENElT BY lNDING WAYS FOR THOSE SYSTEMS TO ACCOMMODATE BOTH CLINICAL CARE AND CLINICAL RESEARCH DATA %NDNOTES h$OCTORS 0ATIENTS &ACE $IFFERENT "ARRIERS TO #LINICAL 4RIALS v .ATIONAL #ANCER )NSTITUTE POSTED !PRIL REVIEWED BY .#) *ANUARY HTTP WWWCANCERGOVCLINICALTRIALSDEVELOPMENTSDOCTORS BARRIERS (YNES 4 h,ETS "RING THE 4RIAL TO THE 3UBJECTv !PPLIED #LINICAL 4RIALS *ULY ACCESSED AT HTTPWWWACTMAGAZINECOMAPPLIEDCLINICALTRIALSARTICLEARTICLE$ETAIL JSP ID 3HIH 7 * h0ROBLEMS IN $EALING WITH -ISSING $ATA AND )NFORMATIVE #ENSORING IN #LINICAL 4RIALS v #URR #ONTROL 4RIALS #ARDIOVASC -ED P 5EHLING - h(OVDE 2EPORT 7HEN )T 0AYS TO /UTSOURCE THE /UTSOURCERSv .OVEMBER ")/ )4 7ORLDE#LINIQUA ACCESSED AT HTTPWWWBIO ITWORLDCOMARCHIVEECLINICAHTML %LLIS , $ h!CHIEVING #OST 3AVINGS 5SING %$# %FFECTIVELY v 2ESEARCH $YNAMICS #ONSULTING 'ROUP ,TD .OVEMBER ACCESSED AT HTTPWWWCLICKlNDCOM2$#' PERCENT%$# PERCENTPAPER PERCENT#,)#+&).$ PERCENT PERCENT&).!,PDF AND 0HASE&ORWARD h0'0S 0ROGRESSIVE E#LINICAL )NTEGRATION v ADAPTED FROM 0ROCTER 'AMBLE 0HARMACEUTICALS "EST 0RACTICES ENTRY TO "IO )4 7ORLD -ARCH ACCESSED AT HTTPWWWPHASEFORWARDCOMNEWSMEDIA HTM &ONKYCH + AND 4AYLOR 2 h4HE 3TATE AND 0ATTERN OF (EALTH )NFORMATION 4ECHNOLOGY !DOPTION v 2!.$ (EALTH -ULLIN 2 h$RUG &IRMS 'OVERNMENT 3EEK )4 3TANDARDS FOR #LINICAL $ATA v #HEMICAL %NGINEERING .EWS &EBRUARY ACCESSED AT HTTPPUBSACSORGCENCOVERSTORYPHARMAHTML 3TAKEHOLDER COMPENDIUM FOR 5NIVERSITY OF 0ITTSBURGH #ANCER #ENTER CA")' #4-3 n $EVELOPER STATEMENT OF WORK 50#) #4-3 STAKEHOLDER COMPENDIUM $ECEMBER VOL ACCESSED AT CABIGCVSNCI NIHGOVVIEWCVSVIEWCVSCGISTRUCTUREDPROTOCAL
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
)MPORTANT .EXT 3TEPS FOR !CHIEVING THE 6ISION 4HE FUTURE OF 53 HEALTHCARE WILL BE DETERMINED BY OUR NATIONAL APPROACH TO INSURANCE COVERAGE QUALITY STANDARDS PRACTITIONER EDUCATION PATIENT ACTIVATION AND THE lNANCING OF QUALITY INFRASTRUCTURE "Y 3TEPHEN # 3CHOENBAUM +AREN $AVIS AND !NNE -ARIE * !UDET
(
EALTHCARE FOR !MERICANS CAN BE SIGNIlCANTLY BETTER IN THE FUTURE THAN IT HAS BEEN IN THE PAST ! NUMBER OF INDIVIDUALS AND ORGANIZATIONS ARE RESPONDING TO THE CHALLENGE OF ENVISIONING A HEALTH SYSTEM WORTHY OF THE TWENTY lRST CENTURY 7HILE THERE IS A MAJOR LEAP FROM IDEAS TO ACTION THERE ARE PROMISING SIGNS ON THE HORIZON )N 4HE #OMMONWEALTH &UND PUBLISHED h! 6ISION FOR !MERICAN (EALTH #AREv )TS COMPONENTS INCLUDED AUTOMATIC AND AFFORDABLE HEALTH INSURANCE COVERAGE FOR ALL ACCESS TO HEALTHCARE FOR ALL PATIENT RESPONSIVE HEALTHCARE INFORMATION DRIVEN HEALTHCARE INCLUDING CARE THAT IS BASED ON SCIENTIlC EVIDENCE AND SUPPORTED BY CLINICAL INFORMATION SYSTEMS AND A COMMITMENT BY EACH PROVIDER OF HEALTHCARE AND PROVIDER ORGANIZATION TO CONTINUOUS IMPROVEMENT OF CARE AND TO BETTERMENT OF HEALTH OUTCOMES;= 3INCE THEN TWO COMPONENTS OF THE VISION HAVE BEEN ADDED n HAVING A SATISlED HEALTHCARE WORKFORCE AND A WILLINGNESS TO LEARN FROM AND SHARE LESSONS WITH OTHER COUNTRIES SO THAT !MERICAN HEALTHCARE CAN CROSS THE QUALITY CHASM !LTHOUGH THE 5NITED 3TATES IS FAR FROM ACHIEVING THIS VISION WE BELIEVE IT IS POSSIBLE TO ACHIEVE &OR EACH COMPONENT WE HAVE NOT ONLY POINTED OUT THE CURRENT PROBLEMS BUT ALSO EXAMPLES OF POSITIVE WORK OR POSSIBILITIES FOR CHANGE 4HERE ARE A RELATIVE HANDFUL OF CHANGES THAT MUST OCCUR IF THE VISION IS TO BE ACHIEVED PARTICULARLY BY 4HESE INCLUDE A MORE PROACTIVE STANCE TO HEALTH INSURANCE COVERAGE BY THE FEDERAL GOVERNMENT OR FAILING THAT BY MORE STATE GOVERNMENTS A MORE PROACTIVE STANCE TO IMPROVEMENT OF QUALITY OF CARE BY THE FEDERAL GOVERNMENT SERIOUS CHANGES IN THE EDUCATION OF ALL HEALTH PROFESSIONALS ACTIVATION OF PATIENTS TO UNDERSTAND THAT THEY CAN RECEIVE AND MUST DEMAND CONSIDERABLY BETTER CARE n CARE THAT IS SAFER MORE EFFECTIVE MORE EFlCIENT MORE TIMELY MORE EQUITABLE AND BETTER DESIGNED AROUND THE NEEDS OF CONSUMERS NOT PROVIDERS AND ALL PAYER COALITIONS ARE NEEDED TO SUPPORT THE lNANCING OF QUALITY IMPROVEMENT ACTIVITIES AT LEAST IN THE SHORT RUN ! MORE PROACTIVE STANCE TO HEALTH INSURANCE COVERAGE BY THE FEDERAL GOVERNMENT OR FAILING THAT BY MORE STATE GOVERNMENTS IS THE ONLY WAY ALL !MERICANS WILL HAVE INSURANCE COVERAGE 4HERE ARE NOW SEVERAL STATES WITH RELATIVELY LOW RATES OF UNINSURANCE OWING TO VARIOUS TYPES OF STATE SPECIlC LEGISLATION 3TATES OFFER AN IMPORTANT OPPORTUNITY
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
TO EXPERIMENT WITH DIFFERENT APPROACHES TO COVERING THE ENTIRE POPULATION AND GATHER DATA ON THE PLUSES AND MINUSES OF THESE VARIOUS APPROACHES !S PREVIOUSLY INDICATED WE BELIEVE THERE IS ALREADY SUFlCIENT INFORMATION TO DESIGN FEDERAL LEGISLATION THAT WOULD EITHER GUARANTEE COVERAGE FOR ALL !MERICANS OR WOULD REQUIRE ALL STATES TO DEVELOP APPROPRIATE STATE SPECIlC APPROACHES -ISSING AT THIS WRITING IS A MANDATE FROM THE !MERICAN PEOPLE TO EMBOLDEN #ONGRESS TO ENACT AND THE PRESIDENT TO SIGN SUCH LEGISLATION ! MORE PROACTIVE STANCE TO IMPROVEMENT OF QUALITY OF CARE BY THE FEDERAL GOVERNMENT IS ESSENTIAL TO PUT SOME ORDER INTO THE CHAOS OF THE !MERICAN HEALTHCARE SYSTEM OR hNONSYSTEMv AS SOME CONSIDER IT TO BE 4HERE ARE MANY THINGS THAT THE FEDERAL GOVERNMENT COULD AND MUST DO n AND SOME ARE BEGINNING TO BE DONE 7E BELIEVE THESE INCLUDE DEVELOPING A DEDICATED FEDERAL AGENCY FOR SETTING OF NATIONAL PRIORITIES FOR IMPROVEMENT DEVELOPMENT OR RATIlCATION OF CLINICAL GUIDELINES PERFORMANCE MEASURES AND STANDARDS OF CARE LEADING INITIATIVES FOR PUBLIC REPORTING OF PERFORMANCE FURTHER SUPPORT FOR THE DEVELOPMENT AND ADOPTION OF CLINICAL INFORMATION TECHNOLOGY DEVELOPING THE CAPABILITY TO PROVIDE TECHNICAL ASSISTANCE IN QUALITY IMPROVEMENT TO ALL PARTS OF THE HEALTHCARE SYSTEM HEADING THE EFFORT TO ALIGN INCENTIVES SO THAT QUALITY IMPROVEMENT IS STIMULATED AND REWARDED AND FUNDING KEY DEMONSTRATION PROJECTS THAT EXPLORE NEW WAYS OF COORDINATING CARE AND PAYING FOR IMPROVED CARE;= 3ERIOUS CHANGES IN THE EDUCATION OF ALL HEALTH PROFESSIONALS ARE ESSENTIAL BUT THIS WILL REQUIRE A CHANGE IN ACADEMIAS APPROACH TO QUALITY IMPROVEMENT *UST AS IN THE LATE NINETEENTH CENTURY WITH THE OPENING OF *OHNS (OPKINS MEDICAL SCHOOL MEDICAL EDUCATION BEGAN TO BE MORE SCIENTIlC A PROCESS THAT ACCELERATED IN THE EARLY TWENTIETH CENTURY THANKS TO THE &LEXNER 2EPORT THAT HIGHLIGHTED THE POOR SCIENTIlC QUALITY OF MOST SCHOOLS NOW MEDICAL EDUCATION AND THE EDUCATION OF OTHER HEALTH PROFESSIONALS MUST BECOME ORIENTED TO PUTTING THE PATIENTPERSON AND HIS HER HEALTH AND NOT THE SCIENTIlC ASPECTS OF DISEASE AT THE CENTER OF THE UNIVERSE !CADEMIC HEALTH CENTERS MUST BECOME LEADERS IN PATIENT CENTERED CARE AND QUALITY IMPROVEMENT 4HE !#'-%S COMPETENCIES SEEM TO BE THE CATALYST FOR THIS
HLONQ S@MSãMDWS ã RS D ORã E N Q ã @ B G H D U H M Fã S G D ã U H RH N M CHANGE AND COULD SERVE AS THE TWENTY lRST CENTURY EQUIVALENT OF THE &LEXNER 2EPORT !CTIVATION OF PATIENTS TO UNDERSTAND THAT THEY CAN RECEIVE AND MUST DEMAND CONSIDERABLY BETTER CARE n CARE THAT IS SAFER MORE EFFECTIVE MORE EFlCIENT MORE TIMELY MORE EQUITABLE AND BETTER DESIGNED AROUND THE NEEDS OF CONSUMERS NOT PROVIDERS 4HIS IS EASIER SAID THAN DONE &OR THE MOST PART CONSUMERSPATIENTS ARE NOT ORGANIZED AS A LOBBY IN THE 5NITED 3TATES AND UNFORTUNATELY HAVE DEPENDED ON THE CHAOTIC HEALTHCARE SYSTEM TO GIVE THEM hTHE BEST CARE IN THE WORLDv 0UBLIC CONCERN ABOUT QUALITY OF CARE IN THE 5NITED +INGDOM HAS LED TO THE PUBLICS WILLINGNESS INDEED DEMAND TO EXPEND MORE NATIONAL RESOURCES ON HEALTH 4HIS IS ANOTHER LESSON FROM ABROAD THAT THE 5NITED 3TATES COULD PROlT FROM IMPORTING 0UBLIC ACTIVATION IS LIKELY TO COME IN RESPONSE TO PROBLEMS HIGHLIGHTED IN THE MEDIA OR BY POLITICIANS WHO ARE LEADERS NOT MERE REACTORS 4HE MORE INFORMATION THE PUBLIC RECEIVES THE MORE LIKELY CONSUMERS WILL BECOME ACTIVISTS !CCORDINGLY WE STRONGLY FAVOR PUBLIC REPORTING OF INFORMATION ABOUT QUALITY OF CARE !LL PAYER COALITIONS ARE NEEDED TO SUPPORT THE lNANCING OF QUALITY IMPROVEMENT ACTIVITIES AT LEAST IN THE SHORT RUN 5LTIMATELY ALL QUALITY IMPROVEMENT ACTIVITIES SHOULD EITHER BENElT PROVIDERS BY BEING MORE EFlCIENT OR YIELDING PERFORMANCE BASED PAYMENTS OR BENElT SOCIETY AS A WHOLE BY CREATING A HEALTHIER MORE PRODUCTIVE COUNTRY )NITIALLY ADOPTION
OF INFORMATION TECHNOLOGY AND TRAINING THE WORKFORCE IN QUALITY IMPROVEMENT METHODS ARE LIKELY TO BE SEEN AS NET EXPENDITURES BY THOSE WHO MUST INVEST IN AND IMPLEMENT THEM 4HE FEDERAL GOVERNMENT AS THE SINGLE LARGEST PAYER FOR HEALTHCARE IN THE 5NITED 3TATES CAN TAKE THE LEAD BUT IDEALLY WOULD BRING TOGETHER ALL PAYERS SO THAT THERE IS BROAD BASED lNANCIAL SUPPORT FOR CREATING RAPID CHANGE IN THE HEALTHCARE DELIVERY SYSTEM 4HE hPERFECT STORMv IS KNOWN TO HAPPEN AND CAUSE UNSPEAKABLE DISASTERS 7E BELIEVE THE TIME IS RIPE FOR THE hPERFECT OPPORTUNITYv )T IS APPROPRIATE TO BE HOPEFUL THAT WE ARE REACHING A TIPPING POINT -AJOR PROGRESS IN THE lVE AREAS OUTLINED WOULD ALLOW THE VISION TO BE ACHIEVED 4HIS WOULD PRODUCE A VASTLY IMPROVED HEALTHCARE SYSTEM FOR ALL !MERICANS AND A HEALTHIER AND MORE PRODUCTIVE COUNTRY 4HIS PAPER WAS EXCERPTED FROM 3TEPHEN # 3CHOENBAUM +AREN $AVIS !NNE -ARIE * !UDETS h6ISIONS OF THE &UTURE v IN $AVID " .ASH AND .EIL * 'OLDFARBS 4HE 1UALITY 3OLUTION *ONES AND "ARTLETT 0UBLISHERS 3UDBURY -ASS WWWJBPUBCOM 2EPRINTED WITH PERMISSION %NDNOTES $AVIS + AND # 3CHOEN 3# 3CHOENBAUM h! 6ISION FOR !MERICAN (EALTH #ARE v !RCHIVES OF )NTERNAL -EDICINE PP 3CHOENBAUM 3# AND ! - !UDET + $AVIS h/BTAINING 'REATER 6ALUE FROM (EALTHCARE 4HE 2OLES OF THE 53 'OVERNMENT (EALTH !FFAIRS PP
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
,OOKING "ACK -OVING &ORWARD 2EmECTIONS ON THE 1UALITY #ONUNDRUM BY 0ROFESSORS $ON "ERWICK )NSTITUTE FOR (EALTHCARE )MPROVEMENT 2ICHARD 'ROL 2ADBOUD 5NIVERSITY .IJMEGEN !CHIEVING LONG TERM IMPROVEMENTS IN QUALITY HEALTHCARE WILL REQUIRE COMMITMENT TO PRIMARY CARE CONSISTENT POLICY IMPLEMENTATION AND AN UNWAVERING FOCUS ON THE PATIENT
"Y 4IM 7ILSON 0RICEWATERHOUSE#OOPERS
(
OSPITALS PHYSICIANS HEALTH PLANS PHARMACEUTICAL MANUFACTURERS EMPLOYERS GOVERNMENTS AND PATIENTS ALL WANT QUALITY 9ET AS ADDRESSED THROUGHOUT THIS BOOK ACHIEVING QUALITY REQUIRES CHANGES IN THE WAY HEALTH SERVICES AND TREATMENTS ARE DEVELOPED PROVIDED MEASURED AND lNANCED #HANGE IS DIFlCULT (OWEVER IT IS MADE EASIER WHEN LEADERS ARE WILLING TO PUSH THE ENVELOPE EXPOSE THE MYTHS AND OFFER PRACTICAL SOLUTIONS 4WO SUCH LEADERS ARE AN !MERICAN PHYSICIAN $ONALD "ERWICK -$ AND A $UTCH RESEARCHER 2ICHARD 'ROL 0H$ "OTH HAVE ACHIEVED INTERNATIONAL STATURE AS STATESMEN FOR QUALITY SEE SIDEBAR )N THE FACE OF DEPRESSING STATISTICS ABOUT MEDICAL ERRORS AND THE LACK OF APPROPRIATE CARE "ERWICK AND 'ROL HAVE BEEN LUMINARIES ADVOCATING A RESEARCH BASED APPROACH TO SOLUTIONS 4HEIR IDEAS ARE OFTEN REVOLUTIONARY &OR THIS lNAL CHAPTER WE TALKED WITH THEM EXAMINED THEIR WORK AND ANALYZED HOW THE INDUSTRY CAN LEARN FROM THEM TODAY 4HROUGHOUT THE CONVERSATIONS EACH HAD AN OVERARCHING COMMENT "ERWICK SPOKE OF THE NEED FOR THE INDUSTRY TO REMEMBER THAT BEHIND EVERY QUALITY PROBLEM IS A HUMAN TALE (EALTHCARE IS A PEOPLE BUSINESS INVOLVING AND AFFECTING THOSE WHO RECEIVE AND DELIVER CARE 'ROL ON THE OTHER HAND ADVOCATED A NEED FOR CONSISTENCY )MPROVEMENT IN HEALTHCARE CAN ONLY BE ACHIEVED THROUGH STEP BY STEP CONSISTENT APPROACHES AND POLICIES 0OLICY MAKERS NEED TO GUARANTEE CONSISTENCY IN POLICIES BUDGETS AND LEADERSHIP
)NVEST IN 0RIMARY #ARE "ERWICK HAS FREQUENTLY MENTIONED THAT THE lDELITY OF THE COST QUALITY LINK IS QUESTIONABLE 4HE GROUNDBREAKING WORK OF 3IR "RIAN
*ARMAN PROFESSOR EMERITUS OF PRIMARY HEALTHCARE AT )MPERIAL #OLLEGE 3CHOOL OF -EDICINE IN ,ONDON AND )() SENIOR FELLOW HAS SHOWN THAT LINKS BETWEEN COSTS AND STANDARDIZED MORTALITY RATES IN HOSPITALS IN THE 53 AND 5+ ARE VARIABLE;= (EALTH SYSTEMS AROUND THE WORLD ABSORB LARGER PROPORTIONS OF NATIONAL WEALTH AND WHILE THERE ARE IMPROVEMENTS THE GAPS IN QUALITY SEEM TO PERSIST -ORE MONEY THEREFORE DOES NOT APPEAR TO BE THE ANSWER 'ROL NOTES THAT RESEARCH HAS REPEATEDLY SHOWN THAT PRIMARY CARE ORIENTED SYSTEMS HAVE FAR BETTER HEALTH OUTCOMES LOWER MORTALITY RATES AND HIGHER SATISFACTION AMONG CONSUMERS n ALL FOR $ONALD "ERWICK -$ IS PRESIDENT AND CHIEF EXECUTIVE OFlCER OF THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT )() )() IS A NOT FOR PROlT ORGANIZATION LEADING THE IMPROVEMENT OF HEALTHCARE THROUGHOUT THE WORLD )N "ERWICK RANKED THIRD ON -ODERN (EALTHCARES LIST OF -OST 0OWERFUL 0EOPLE IN (EALTHCARE "ERWICK IS CLINICAL PROFESSOR OF PEDIATRICS AND HEALTHCARE POLICY AT THE (ARVARD -EDICAL 3CHOOL AND PROFESSOR OF (EALTH 0OLICY AND -ANAGEMENT AT THE (ARVARD 3CHOOL OF 0UBLIC (EALTH 2ICHARD 'ROL 0H$ CHAIRS THE DEPARTMENT OF 1UALITY OF #ARE AT THE 2ADBOUD 5NIVERSITY .IJMEGEN IN THE .ETHERLANDS AND HOLDS A PERSONAL CHAIR AT -AASTRICHT 5NIVERSITY (E IS DIRECTOR OF THE 7/+ #ENTRE FOR 1UALITY OF #ARE 2ESEARCH ONE OF THE LEADING RESEARCH AND DEVELOPMENT CENTERS ON QUALITY OF HEALTHCARE IN THE WORLD AND IS ACTING DIRECTOR OF THE .IJMEGEN #ENTRE FOR %VIDENCE "ASED 0RACTICE
4IM 7ILSON -$ IS A FAMILY DOCTOR IN THE 5+ !FTER WORKING AT THE HIGHEST LEVEL IN GOVERNMENT HE MOVED TO 0RICEWATERHOUSE#OOPERS WHERE HE IS SENIOR ADVISOR ON CLINICAL PERFORMANCE IMPROVEMENT (E HAS PUBLISHED EXTENSIVELY ON THE SUBJECTS OF QUALITY AND SAFETY (E CAN BE REACHED AT TIMWILSON UKPWCCOM
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
KNN JHMFãA@B J ãLNUHMFãENQ V@ Q C ã Q D E KD B S H N M Rã N M ã S G D ã P T @ K H S Xã B N M T M C Q T L LOWER COST 4HESE STUDIES CARRY AN IMPORTANT MESSAGE )NVESTING IN A WORKFORCE OF WELL TRAINED FAMILY MEDICINE SPECIALISTS AND NURSES SETTING UP INTEGRATED PRIMARY SECONDARY CARE PROGRAMS FOR CHRONIC CARE INCREASING THE NUMBERS OF NURSES TAKING RESPONSIBILITY FOR SURVEILLANCE AND EDUCATINGCOUNSELING PATIENTS WITH LONG TERM CONDITIONS MIGHT REAP DIVIDENDS 3UCH AN APPROACH IS BEING TAKEN IN THE REFORMS OF THE $UTCH SYSTEM WHICH HAS MOVED TOWARD INTEGRATED MULTIDISCIPLINARY PRIMARY CARE CENTERS )N ADDITION PRIMARY CARE COOPERATIVES HAVE BEEN FORMED TO PROVIDE AFTER HOURS AND EMERGENCY CARE;=
"EWARE OF 0OPULAR 4RENDS 4HAT -AY .OT )MPROVE 1UALITY "ERWICK IDENTIlES WHAT HE SEES AS lVE hCANONSv OF CURRENT HEALTH POLICY n POWERFUL TRENDS THAT ARE DRIVING HEALTH SYSTEM CHANGES TODAY h$ISAGREE WITH THEM AT YOUR PERIL v HE NOTES 4HEY ARE THE USE OF MARKETS AND COMPETITION INCREASING PATIENT CHOICE PUBLIC DISCLOSURE OF INFORMATION SHIFT OF AN INCREASING BURDEN OF lNANCIAL RESPONSIBILITY TO THE PATIENT AND USE OF PAY FOR PERFORMANCE CONTRACTS (OWEVER "ERWICK SUSPECTS THAT NONE OF THESE OFFER AN ANSWER "ECAUSE HUMAN INTERACTION LIES AT THE HEART OF HEALTHCARE MANY OF THESE POLICIES COULD CAUSE HARM BY DISTORTING PRIORITIES STRIPPING OUT SOME OF THE MOST HUMANE ASPECTS OF HEALTHCARE AND ENCOURAGING PERVERSE BEHAVIORS AMONGST CAREGIVERS (EALTHCARE PROVIDERS AND PAYERS SHOULD CONSIDER THE INTRINSIC MOTIVATION BEHIND THESE TRENDS PARTICULARLY IN AN UNREFORMED HEALTHCARE SYSTEM LIKE THAT OF THE 53 !T BEST THESE POLICIES MAY ACT AS A DISTRACTION TO THE URGENT NEED FOR REFORM AT WORST AS A BARRIER &OR EXAMPLE "ERWICK NOTED THAT THE .ATIONAL (EALTH 3ERVICES .(3 PAY FOR PERFORMANCE CONTRACT IN THE 5+ HAS COST MORE THAN ANTICIPATED AND CREATED A NUMBER OF PROBLEMS SUCH AS THE LOSS OF CONTINUITY OF CARE WITH DISRUPTIONS TO EMERGENCY SERVICES -ORE DETAILS ABOUT THIS CONTRACT ARE MENTIONED IN THE PAPER h4HE 0AY FOR 0ERFORMANCE ,ANDSCAPEv IN THIS BOOK (E ALSO POINTS OUT THAT MARKET DRIVEN SYSTEMS OFTEN LACK THE DISCIPLINE OF lXED BUDGETS 4HEREFORE THEY DO NOT HAVE THE SAME URGENCY TO ADOPT INNOVATIONS THAT lNANCIAL CONTROL BRINGS 3IMILAR CONCLUSIONS CAN BE DRAWN FROM OTHER CANONS IN HEALTHCARE IMPROVEMENT FROM PAST DECADES 4HOSE CANONS HAVE INCLUDED EVIDENCE BASED MEDICINE CHART AUDITS CLINICAL GOVERNANCE CAPITATED BUDGETS FOR GENERAL PRACTITIONERS CONTINUING PROFESSIONAL DEVELOPMENT TOTAL QUALITY MANAGEMENT AND BUSINESS PROCESS REDESIGN ORGANIZATIONAL LEARNING AND DEVELOPMENT PATIENT EMPOWERMENT AND hBREAKTHROUGHv COLLABORATIVES !LL HAVE RAISED HIGH EXPECTATIONS JUST AS PUBLIC REPORTING AND PAY FOR PERFORMANCE ARE CURRENTLY DOING AND THEIR DEFENDERS HAVE CLAIMED THAT THEY ARE ABLE TO BRING SUBSTANTIAL
IMPROVEMENTS IN CARE (OWEVER THERE IS VERY LITTLE EVIDENCE OF SUBSTANTIAL AND SUSTAINED IMPACT ON PATIENT CARE AND OUTCOMES 3OME VERY INTERESTING APPROACHES HAVE NOT BEEN EVALUATED PROPERLY OTHERS HAVE NOT DEMONSTRATED MUCH BENElT
,EARN &ROM %MERGING -ODELS "ERWICK AND 'ROL CITE FOUR MAJOR INITIATIVES TO ILLUSTRATE QUALITY IMPROVEMENT WORK . (3 IN THE 5+ HAS TAKEN A TOP DOWN APPROACH THROUGH A MIX OF PUSH IE INCENTIVES REGULATION INSPECTION AND TARGETS AND SUPPORT IE THE -ODERNIZATION !GENCY ;NOW THE .(3 )NSTITUTE FOR )MPROVEMENT AND )NNOVATION= THE .ATIONAL 0ATIENT 3AFETY !GENCY ;.03!= AND AN ENORMOUS INCREASE IN RESOURCES "ERWICK DESCRIBES .(3 EFFORTS AS hONE OF THE LARGEST SYSTEMATIC QUALITY IMPROVEMENT PROJECTS IN THE WORLDv &OR EXAMPLE THE NEW CONTRACT WITH GENERAL PRACTITIONERS PAYS BONUSES TO THOSE WHO MONITOR CHRONIC CONDITIONS (EALTHCARE PROFESSIONALS ARE BEING REWARDED FOR SYSTEMATICALLY APPLYING THE CARE THAT THEY BELIEVE IS RIGHT EXTRINSIC lNANCIAL REWARDS CAN MATCH THE INTERNAL MOTIVATIONS OF PROFESSIONALS #-30REMIER (OSPITAL 1UALITY )NCENTIVE $EMONSTRATION IN THE 53 IS USING A SERIES OF ORGANIZATIONAL LEVEL lNANCIAL INCENTIVES TO IMPROVE CARE PROVIDED BY HOSPITALS BY REWARDING HOSPITALS IN THE TOP TWO DECILES FOR PERFORMANCE AS JUDGED BY A SERIES OF QUALITY METRICS WITH OR PERCENT EXTRA REVENUE DEPENDING ON WHETHER THEY FALL WITHIN THE TOP TH OR TH DECILE RESPECTIVELY )N THE THIRD YEAR HOSPITALS THAT CONTINUE TO PERFORM AT THE LOWEST DECILE BASED ON THE PERFORMANCE RATINGS MEASURED IN THE lRST YEAR OF THE PROJECT ARE PENALIZED 4HEREFORE HOSPITALS CAN AVOID PENALIZATION THROUGH MAKING IMPROVEMENTS 4HE )-0!#4 0ROGRAMME IS )()S MEMBERSHIP NETWORK COMPOSED OF OPTIMISTIC AND ENTERPRISING ORGANIZATIONS AND INDIVIDUALS COMMITTED TO BUILDING A BETTER FUTURE FOR HEALTHCARE )T WAS FOUNDED ON THE SIMPLE BELIEF THAT IT IS EXPONENTIALLY EASIER TO IMPROVE TOGETHER THAN IT IS ALONE 4HE COLLECTIVE KNOWLEDGE OF )-0!#4 MEMBERS COUPLED WITH )()S IMPROVEMENT EXPERTISE AND GUIDANCE GIVES )-0!#4 ORGANIZATIONS A POTENT FRAMEWORK FOR TAKING ACTION AND A POWERFUL LEVER FOR ACHIEVING SUSTAINING AND SPREADING BREAKTHROUGH IMPROVEMENTS 4HE )()S K ,IVES #AMPAIGN HAS USED A SOCIAL MOVEMENT TECHNIQUE TO SAVE LIVES THAT WOULD HAVE OTHERWISE BEEN LOST BY ENGAGING HOSPITALS ACROSS THE 53 4HE CAMPAIGN BUILDS ON THE VIRTUES OF COOPERATION AND SHARING ENCOURAGING THROUGH THE USE OF THE ACCELERATORS IDENTIlED BY )() AND ESPECIALLY APPEALS TO THE INTERNAL MOTIVATION OF CAREGIVERS TO IMPROVE THE CARE THEY PROVIDE 4HE AIM IS TO FOCUS ON KEY PROVEN INTERVENTIONS LIKE RAPID RESPONSE TEAMS IN HOSPITALS AND REDUCING VENTILATOR ACQUIRED PNEUMONIA IN THE PARTICIPATING HOSPITALS !LREADY SOME HOSPITALS HAVE COMPLETELY ELIMINATED VENTILATOR ACQUIRED PNEUMONIA 4HE
# ( ! 0 4 % 2 1 5! , ) 4 9 # / . 5 . $ 2 5 -
KNN JHMFãA@B J ãLNUHMFãENQ V@ Q C ã Q D E KD B S H N M Rã N M ã S G D ã P T @ K H S Xã B N M T M C Q T L RESULTS ARE IMPRESSIVE !LTHOUGH THE TARGET MAY NOT BE REACHED PROJECTIONS SUGGEST OVER LIVES COULD BE SAVED BY THE END OF THE CAMPAIGN n A STADIUMFUL OF PEOPLE
)DENTIFY THE )NTEGRATORS 4HE NEED FOR INTEGRATION IS CRUCIAL FOR QUALITY IN PATIENT CARE BUT OFTEN NO ONE OR NO ORGANIZATION TAKES ON THE ROLE OF INTEGRATOR "ERWICK POINTS TO TWO INTEGRATORS THAT ARE WORKING WELL *ÚNKÚPING #OUNTY #OUNCIL IN 3WEDEN AND "URNLEY 0ENDLE 2OSSENDALE 0RIMARY #ARE 4RUST IN THE 5+ "OTH ARE RESPONSIBLE FOR A POPULATION IN A GEOGRAPHICAL AREA )N ADDITION BOTH HAVE DEMONSTRATED EXCELLENCE THROUGH A SERIES OF PERFORMANCE METRICS FOR THE 3WEDISH GROUP AND THROUGH WORKING ACROSS MANY AGENCIES TO DELIVER CARE TO A DEPRIVED POPULATION IN THE %NGLISH CASE 'ROL NOTED THAT THE *ÚNKÚPING PROGRAM WAS PARTICULARLY SUCCESSFUL BECAUSE OF ITS COMPREHENSIVENESS IN ADDRESSING MUTUALLY RELATED ACTIVITIES AND INITIATIVES AT ALL LEVELS 4HE PROGRAM ALSO HAS A LEVEL OF CONSISTENCY IT WAS CREATED OVER MANY YEARS TO GAIN CONSENSUS AND ACCEPTANCE )NTEGRATORS USE DIFFERENT APPROACHES TO QUALITY IMPROVEMENT IN HEALTHCARE AND BUILD BRIDGES AMONG THEM 4HE CHALLENGE OF CHANGE IN HEALTHCARE IS TOO LARGE AND TOO COMPLEX TO BE LEFT TO ONE APPROACH 'ROL HAS POINTED OUT THE IMPORTANCE OF SETTING UP CONSISTENT COMPREHENSIVE QUALITY IMPROVEMENT SYSTEMS IN WHICH DIFFERENT APPROACHES ARE UTILIZED 4HESE CAN INCLUDE EVIDENCE BASED GUIDELINES PERFORMANCE INDICATORS EDUCATION AND SUPPORT TO PROFESSIONALS FEEDBACK AND REPORTING IMPROVING TEAMWORK AND COLLABORATION REDESIGN OF PROCESSES COLLABORATIVE WORK AND LEARNING FROM OTHER TEAMS AND PRACTICES INTEGRATED CARE MODELS AND INCENTIVES !UTHORITIES POLICY MAKERS AND MANAGERS AT DIFFERENT LEVELS OF HEALTHCARE NEED TO TAKE THE LEAD IN DEMANDING FACILITATING AND SUPPORTING SUCH SYSTEMS BUT THEY ARE PREFERABLY CONDUCTED BY THOSE WHO ARE DIRECTLY RESPONSIBLE FOR CARE PROVISION )N TERMS OF SETTING UP AN INTEGRATED SYSTEM AROUND QUALITY "ERWICK AND )() HAVE POINTED TO THE APPROACHES DEVELOPED BY THE *APANESE QUALITY EXPERT .ORIAKI +ANO +ANO WHO IS KNOWN FOR THE STUDY OF PRIORITIZING CUSTOMER QUALITY ISSUES HAS SUGGESTED THAT HEALTHCARE ORGANIZATIONS VIEW QUALITY THROUGH THESE THREE LENSES;=
1 5!, ) 49 # / . 5 . $ 2 5 - # ( ! 0 4 % 2
%LIMINATING QUALITY PROBLEMS THAT ARISE BECAUSE THE EXPECTATIONS OF CONSUMERS ARE NOT MET 2EDUCING COSTS SIGNIlCANTLY WHILE MAINTAINING OR IMPROVING QUALITY AND %XPANDING THE EXPECTATIONS OF CONSUMERS BY PROVIDING PRODUCTS AND SERVICES THAT THEY PERCEIVE AS UNUSUALLY HIGH IN VALUE +ANOS IDEAS PROVIDE THE BASIS FOR AN INTEGRATED SYSTEM OF IMPROVING THE VALUE OF HEALTHCARE AND UNDERSTANDING THE RELATIONSHIP BETWEEN THE QUALITY AND COST OF CARE
-OVE "EYOND 2ESEARCH TO &OCUS ON !CCELERATING #HANGE 4HE KEY TO QUALITY IMPROVEMENT IS IN HOW TO ENCOURAGE THOSE AREAS OF GOOD PRACTICE TO BE SUSTAINED AND SPREAD ACROSS WHOLE HEALTH SYSTEMS )() HAS IDENTIlED EIGHT KEY ACCELERATORS %STABLISH BOLD AIMS -EASURE THOSE AIMS 5SE THE APPROACH OF hALL TEACH ALL LEARNv $O IMPROVEMENT AT A LOCAL LEVEL BUILD THE SKILLS LOCALLY ,EVERAGE INTRINSIC MOTIVATION AS THE MOST POWERFUL INCENTIVE 5SE A SYSTEMATIC APPROACH TOWARD SPREAD !LWAYS LISTEN TO THE VOICE OF THE PATIENT AND ,EADERSHIP LEADERSHIP LEADERSHIP )N SUMMARY NO SYSTEM HAS IT PERFECTLY RIGHT 7HAT IS CLEAR IS THAT EXTRINSIC INCENTIVES AND INTRINSIC MOTIVATION DO NEED TO BE ALIGNED BOTH FROM THE PATIENTS AND CAREGIVERS PERSPECTIVES &URTHER IT IS THE SYSTEMATIC AND CONSISTENT APPLICATION OF POLICIES OVER A BROAD RANGE OF METHODS n AND AT ALL LEVELS IN HEALTHCARE SYSTEMS n THAT IS LIKELY TO HAVE AN IMPACT %NDNOTES h2EDUCING (OSPITAL -ORTALITY 2ATES v )NSTITUTE FOR (EALTHCARE )MPROVEMENT ACCESSED AT WWWIHIORG)()0ROGRAMS#OLLABORATIVE,EARNING2EDUCING (OSPITAL-ORTALITY2ATESHTM 'ROL 2 h1UALITY $EVELOPMENT IN (EALTHCARE IN THE .ETHERLANDS v -ARCH 4HE #OMMONWEALTH &UND #ENTRE FOR 1UALITY OF #ARE 2ESEARCH 2ADBOUD 5NIVERSITY .IJMEGEN -EDICAL #ENTRE ACCESSED AT WWWCMWF ORG0UBLICATIONSPUBLICATIONS?SHOWHTM DOC?ID .OLAN 4 AND -AUREEN "ISOGNANO h&INDING THE "ALANCE BETWEEN 1UALITY AND #OST v (&- *OURNAL !PRIL ACCESSED AT WWWIHOORG.2 RDONLYRES"#$"$ %! " "%!%$? PDF
Related Documents
The Q Conundrum
May 2020 6
Wall Street's Commodity Conundrum
April 2020 4
Q
June 2020 12
Q
October 2019 46
Q
April 2020 6