HPCI News

HPCI News is distributed to members and over 400 other Iowa leaders in business, industry, health care professionals, health plans, labor, consumer groups, public policy makers and government, news media, and others.

In This Issue: June/July, 2006

First Iowa Consumers’ Health Guide Available this Month

The first in a series of Iowa Consumers’ Health Guides will be published and available this month through the Iowa Health Buyers Alliance. HPCI and the Alliance have identified education, empowerment, and engagement of consumers and patients as high priorities. We recognize that public reporting and transparency of health service providers, health plan and vendor performance, price and other information is essential. Transparency has proven to be an important catalyst for change and improvement in health care. It is also essential for consumers and patients. The organizations support easy access to relevant performance and cost information of health providers, plans and other vendors for patients, consumers and other customers of health services.

Guide #1: Consumers’ Health Reference Guide, Version 1.0.
This Guide will be available this month. It emphasizes the importance of quality, patient safety and transparency. It will also focus on prevention, maintaining wellness and a healthy lifestyle. Other learning chapters include: dealing with illness, quality of care, handling disputes, types of health plans, and health literacy resources and programs. The Guide will also include links to numerous web sites, and a glossary of terms and organizations.

Guide #2: Hospital Quality Performance Report for Greater Iowa, Version 1.0.
This Guide will be published later this year. It focuses on hospital performance measurement and results for hospitals in the greater Iowa area. Hospital specific information will be included for Iowa hospitals and hospitals in the surrounding market areas of Omaha, Sioux Falls, southern Minnesota, south-western Wisconsin and western Illinois.

Guide #3: Heart Health Guide, Version 1.0.
To be published in early 2007, it will combine information resources on heart health with performance measurement and results for numerous hospitals and centers of excellence in the greater Iowa market area.

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“Saving 37 Miles"

HPCI continues to feature successes using Lean in the health care sector. The following article appeared in the St. Luke’s Hospital newsletter describing successes in reducing the number of steps in their Women and Children’s Center. St. Luke’s is located in Cedar Rapids.

Recently, a Lean activity was held in the Center for Women’s and Children’s Health that focused on the admission and triage area for expectant mothers. As we reviewed the area, we saw several opportunities for efficiency, the most notable being the physical arrangement of the rooms and equipment required to triage a patient. By tracking the steps of triage nurses, we discovered that by moving a few things around and changing the usage of a couple rooms would help considerably. But even the people directly involved in this process were surprised at what we found. We measured the steps that nurses took to complete the task before and after the changes, and noted that the travel distance to serve one patient was reduced by an average of 380 feet. But if you multiply that number by the average number of patients the CWCH serves every month – which is about 525 – we found that the nurses, using this new process, would have to walk 37 miles less. That’s right, 37 MILES. A great job by the CWCH Lean team, and an example of how Lean can help make life better for the associates, which will help us serve our patients better.

Congratulations to all involved at St. Luke’s. Keep up the good work!

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Iowa Health Care Collaborative Steps-up with Bold Agenda

The Iowa Health Care Collaborative (IHC) has established an important and bold work program. It is based upon “A new era of transparency and accountability". Congratulations to all involved in this effort. HPCI is actively supporting the IHC effort.

Under its vision, “An Iowa culture of continuous improvement and quality, patient safety and value", the IHC has identified specific goals:

  1. Improve clinical outcomes
  2. Save lives and
  3. Reduce cost

The Collaborative focuses on: aligning Iowa hospitals and physicians on quality and patient safety, supporting responsible public reporting, engaging physicians for clinical improvement, and raising the standard of care in Iowa.

The IHC 2006 work plan includes four initiatives:

  1. Public reporting: the first annual IHC Iowa Report is available on their web sitewww.ihconline.org The second annual report will be issued later this year. It will expand reporting to include adverse outcomes reporting, clinical outcomes measures and effects and reporting.
  2. Patient safety: pursuing National Quality Forum’s Safe Practices and statewide initiatives promoting Iowa’s solutions for Iowa problems.
  3. Clinical initiatives: participating in the Institute for Health Improvement 100,000 lives campaign to reduce ventilator associated pneumonia, central line infections, promoting rapid response teams, heart attack, adverse drug events, and surgical infections. IHC also is conducting an anti-quagulation initiative.
  4. Improving care delivery: initiatives include health information technology, ambulatory care measures, chronic care, physical engagement, Lean and Toyota Production Model, and IHC clearing house-- a resource for hospitals to share best practice.

HPCI will be encouraging, supporting, and reporting on these good and important efforts. It is our hope and expectation that more hospital and provider specific information will be forthcoming. See article below entitled “HPCI Supports Rapid Adoption of Nationally Standardized Comparable Measures". Stay tuned.

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HPCI Supports Rapid Adoption of Nationally Standardized Comparable Measures

The pace and scope of performance measurement development, endorsement, and implementation frequently does not recognize the urgency felt by consumers and purchasers who are making health care decisions with little or no information. Improving the quality of our health care requires the rapid adoption of nationally standardized comparable measures about the clinical quality, patient experience, efficiency, and equity of care delivered by hospitals, physicians and treatment options. A performance “dashboard" would allow:

  1. Consumers to make informed decisions about their health care
  2. Purchasers and insurers to make value-based contracting decisions and use differential payments as incentives; and
  3. Providers’ improvement efforts to be supported with better information.

As a member of the Consumer-Purchaser Disclosure Project, HPCI is supporting that all measurement development should be guided by the following considerations:

  1. Reasonable scientific acceptability: Measures must be scientifically sound, (i.e., precisely specified, sufficiently reliable, valid, risk adjusted, and reflect current evidence base). Consumers and purchasers want sound science because they do not want to be misled, but do not want the pursuit of perfection to delay the availability of good and useful information.
  2. Feasibility: Wide-spread adoption of performance measures and rapid reporting necessitates that measures are constructed and specified so that the data needed is currently available or can be collected with limited reporting burden. For the immediate future, this means collection of the data via currently existing payer-based electronic databases. If additional data collection effort is required, the measure should substantially improve upon those collectible via existing payer-based electronic databases and a credible and rapid path should be articulated by which the data will actually be collected.
  3. Relevance to consumers & purchasers (important and actionable): Development of performance measures that are intended to produce comparative information and inform provider selection and payment should be driven by the needs of consumers and purchasers. The needs of providers for information to support improvement efforts are important considerations that should also inform priorities for measure development.
  4. Reflect continuum of care/care coordination from patient perspective: Measures should reflect both conditions and procedures addressed by a particular provider, but as importantly, the continuum of care across providers. Measures developed for either particular specialties or conditions should specifically reflect the measurement concepts of being comprehensive, longitudinal, multi-level (individual, population-based and systems), and shared accountability.

The Consumer-Purchaser Disclosure Project is a group of leading employer, consumer, and labor organizations working toward a common goal to ensure that all Americans have access to publicly reported health care performance information. Their shared vision is that Americans will be able to select hospitals, physicians, and treatments based on nationally standardized measures for clinical quality, consumer experience, equity, and efficiency.

Members of the Project include numerous fortune 500 companies, the Business Roundtable, ERISA Industry Committee, U.S. Chamber of Commerce, AARP, AFL-CIO, International Association of Machinists and Aerospace Workers, The Leapfrog Group, National Association of Manufacturers, National Partnership for Women and Families, National Coalition for Cancer Survivorship, March of Dimes, American Hospice Foundation, American Benefits Council, National Small Business Association, and many others. More information can be found atwww.healthcaredisclosure.org

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Supply Chain Management Meets Employee Health Management

The Employer Health Management News published a three-part series on supply chain management meeting employee health management. This series was based upon work described earlier in the Harvard Business Review. The series describes the alignment challenge in the current health care supply chain and what needs to be done to fix this alignment from the point of view of the various stakeholders, i.e., employers/sponsors of the customer, suppliers (e.g.: physicians, hospitals, pharmaceutical manufacturers, disease management firms), intermediaries (e.g.: plans and PBM's), and others.

Three key take-away's:

  1. Alignment of supply chain participants can be thwarted by information and incentive-related problems. Gaining alignment requires not only dealing with these issues, but also addressing the gap of trust that often stands between supply chain owners and potential partners.
  2. Employers/sponsors must establish a mission for their supply chain. Other supply chain stakeholders have need to adapt their mindset and business models to establish their value-adding role in the supply chain.
  3. As Supply Chain Management principles are applied in the health market, stakeholders that fail to deliver value will be increasingly squeezed out.

Consistent with this Employer Health Management News feature, HPCI has developed a demonstration project entitled “Bridging Health Care and the Customer - - Connect and Resonate". In the introduction, HPCI points out that Lean enterprise has great potential to significantly improve productivity in health care as it has in other sectors such as manufacturing. It drives-out costs while improving quality. Focusing on the customer is essential in implying Lean. Becoming focused is also a great benefit of Lean.

The goal of this HPCI project is to improve the working relationship between health providers and their customers using Lean enterprise. For more information, contact the HPCI office.

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Designing Benefits with Evidence in Mind

There is growing interest in more explicit approaches to benefit language that better integrate medical evidence, encourage its use, reward improvement in the quality of evidence, and provide more precision for decision makers. These developments give credibility to a movement in which the demand side of the health care equation is becoming ever more explicit about exactly what it expects for the enormous sums it is transferring to the supply side of the health care system.

The better use of evidence in coverage design can reduce the use of marginal services and control some the variation in utilization among providers.

Consumer-driven plans use various strategies to offer patients more and better information. They need to do so, since evidence consistently shows cost sharing is indiscriminate in its effects, reducing utilization of valuable services that improve health as much as it reduces ineffective services. Without more transparency, consumers may conclude that these efforts to provide patients with better information are incomplete or biased.

The state of Oregon has developed a language of benefit design that is organized around combinations of conditions and treatments that use medical evidence in determining covered conditions and approved treatments. Health plans currently administering the Oregon Health Plan benefit have been profitable over the course of multiple changes in the plan.

More information is available through HPCI

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Second Annual Incentives and Rewards Workshop

The Leapfrog Group, founded by the Business Roundtable, and the National Business Coalition on Health are holding their second annual incentives and reward workshop in Chicago on July 19 – 20. Mark McClellan, MD, Director for the Centers for Medicare and Medicaid Services will be the keynote speaker.

Emphasis will be placed on how to structure benefit design to steer patients to high value providers and alter payment schemes to reward those providers. The first ever “driving value in health care" rewards will be presented at the workshop recognizing leadership in incentives and rewards.

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Janet Corrigan Selected to Head Reconstituted National Quality Forum (NQF)

Janet Corrigan, the keynote speaker at HPCI’s November, 2002 Statewide Conference, was recently appointed CEO and President of the NQF. The announcement completes a merger of two national health care quality organizations, the National Quality Forum and the National Committee on Quality Health Care. Corrigan was formerly CEO and President of NCQHC. Prior to that, Janet worked for the Institute of Medicine, Committee on Quality of Health Care in America. While there she was instrumental in publishing the landmark report, Crossing the Quality Chasm, a New Health System for the 21st Century. The NQF’s mission is to dramatically improve quality of care.

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Iowa Health Buyers Alliance Establishes Web Site

The Iowa Health Buyers Alliance (IHBA) recently established its web site, www.ihbaonline.org

The Alliance is an association of health purchasers who have come together to identify, evaluate, recommend and provide access to cost-effective high performance policies, practices, providers, and products for its members. HPCI is a co-founder of the IHBA.

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HPCI Priorities for 2006/2007

  1. Conduct and support projects to increase transparency of health information on cost, quality and patient safety. Meaningful comparative performance information assists purchasers and consumers with wise decision making. Transparency has also proven to be an important catalyst for needed change and improvement in health care.
    • Work with the Iowa Healthcare Collaborative.
    • Leverage and support national resources such as the Consumer-Purchaser Disclosure Project, the National Quality Forum, the Business Roundtable founded Leapfrog Group, Agency for Health Care Research and Quality (AHRQ), CMS and the eValue8 health plan/provider system evaluation tool.
  2. Empower, Inform and Engage Consumers and Patients (“Consumerism")
    • Publish and distribute the Consumers’ Health Guide series for Greater Iowa.
    • Research and report on plan design changes including health savings accounts (HSA's).
    • Peruse holistic approach to wellness and health literacy.
  3. Engage and support Lean enterprise efforts to drive out cost and improve quality
    • Recognize and encourage Lean transformation in Iowa’s health industry.
    • Describe, communicate and encourage the adoption of Lean enterprise and supply-chain management methods for managing employee health and productivity.
    • Seek partners and resources to conduct the Bridging Demonstration Project: Bridging Health Care and the Customer---Connect and Resonate.
  4. Carry-out education, research and communications
    • Publish HPCI News 6 times per year with distribution to over 500 Iowa leaders.
    • Hold state-wide Health Buyers Conference
    • Partner with groups for greater impact, i.e. the Iowa Health Buyers Alliance, the Iowa Healthcare Collaborative, and the Iowa Coalition for Innovation and Growth.
    • Conduct research on key health issues at the state and local levels.
    • Communications with the news media.
  5. Serve as a resource to HPCI members/investors.

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