Still an Optimist

This past week my daughter and I traveled to Washington DC.  I had business and she was on fall break, so it seemed like a good place to meet up, catch up and see some sights.

One of our rules of travel, no matter where we go, is that we do something we have never done before and that we learn a new piece of information we find particularly interesting, compelling or curious.  During this visit we saw the Martin Luther King monument, spent a day at the Newseum and took a private tour of the Woodrow Wilson House.  In addition, we just happened upon a Columbus Day event at the Library of Congress and saw the Stop the Machine protesters at the Freedom Plaza.   As is often the case, each activity evoked a conversation about history, politics and public policy.

I must admit, I was a relatively naïve activist when I was my daughters age (a college junior).  She is not.  She sees herself as a realist.  While she admires the courage and determination of the people memorialized at the different venues around town, she is not particularly optimistic that things can change for the better.  She questions the value of government, feeling that the huge bureaucracy as built can only fail. She wonders when new leaders will emerge and what events might actually get citizens to work together on issues of common good.  She is not sure that the collective voice of people without money and power can add value in creating a new vision and direction for the country.

I understand how she feels because I am often tempted to adopt the same attitude when I hear people talk about  “health care reform”. Can we really fix the health care crisis?  Can we even agree on what drives or defines the health care crisis?  Can we manage the multiple bureaucracies that seem so intent on maintaining the status quo?  Can anyone make a difference when the constraints of time and resources are so very limited?  Can a collective voice inform and influence a new course?

Through my work with the Buyers Health Care Action Group, I have had the good fortune of seeing, first hand, what a group of like-minded and motivated individuals can do when they work together.  I have seen leaders emerge with a vision for the future.  I have seen people engage in activities that precipitated significant change.  “Health care reform” again presents us with opportunities to rethink our current patterns of behavior, envision a better future and work with others to create a better way.  There is no better time than now, and no better way than together.

I hope my daughter has the same good fortune.

The power of personal connections

Bringing together public and private purchasers for more effective health care solutions

Recently, I received a phone call from one of the original founders of BHCAG who wanted to talk about something he read in the Star Tribune regarding health care reform. Since this is part of my job as president and CEO of BHCAG, this might not seem unusual or significant, but this particular conversation made me stop and think.

For starters, the person I was talking to was Fred Hamacher, who helped form BHCAG in 1988. Fred was a vice president of human resources at Dayton Hudson Corporation at the time, and he, along with others in similar positions at Honeywell, American Express, Carlson Companies, General Mills and Bemis (just to name a few) decided it was time to establish a coalition of like-minded companies that could influence and improve how health care was purchased and delivered. Fred has since retired but he stays active and interested - I would even go so far as to say, passionate - about high-value health care. Fred has been both a mentor and friend to me through the years, and any opportunity to connect with someone as visionary and influential as him is always a treat. But when that connection takes the form of a real, person-to-person conversation and not an email, all the better. Why? Because through conversations that allow for immediate reaction, disagreement or validation, transformative ideas are born and real problems are solved.

Driving more personal connections and collaboration

As I reflected on my discussion with Fred, I realized that my favorite part of working with BHCAG is the connection I get to have with people who care about the future. As sentimental as it might sound, caring and connecting are core to the BHCAG mission. All BHCAG members share their time and intelligence with one another to make the health care system work better for everyone. People who aren't passionate about this often don't invest the time in meeting with others to collaborate. I have to say, email, texting and social media truly do make daily life much easier in our time-constrained reality. But, as we have found recently, and what was affirmed in my discussion with Fred, nothing can compare to personal conversations and connections, particularly when you have a passion for something.

In January and February, BHCAG held several breakfast meetings with members to talk about health care reform, what’s important to them as employer purchasers, and what they want to see from BHCAG in the future.

We purposefully kept these groups very small and informal so each participant would have a chance to talk and listen and get to know one another. What I learned from these sessions is that our members really enjoyed being able to connect like this! I guess it seems like a luxury we can't afford ourselves because there is always too much to do and too little time to do it. Even our BHCAG programs over the years have become very focused on specific topics deemed critical to our members’ job functions so as not to "waste" people's time. Personal connection a waste of time? How did we get to such a place?

So, stay tuned. I am pretty sure we will be having more breakfasts with members in the months ahead.

Validation of BHCAG’s guiding principles and initiatives

What was also really important from my conversation with Fred was the reinforcement that the current concepts that are driving health care reform and making headlines today are the very same concepts on which BHCAG was founded and that we have been pursuing through our programming and initiatives for more than 20 years. Here are a few examples of how early BHCAG initiatives align with current health reform hot buttons:

• The call for increased oversight of, and accountability for health plans - BHCAG created the eValue8 survey as part of our effort to generate public reporting by health plans that is relevant to what purchasers want and need to know when making a health plan selection.


• The push toward accountable care organizations (ACO) - BHCAG developed what can be considered Minnesota’s first ACO with Choice Plus in the ‘90s. Choice Plus was the first program of its kind in the nation and BHCAG continues to provide counsel to organizations interested in advancing this type of initiative.


• The demand for improved patient safety - BHCAG was one of the founding members of the Leapfrog Group in 2000, and we continue to serve as the regional rollout coordinator for that organization’s annual survey of hospital patient safety outcomes.


• The need for improved patient outcomes - The Minnesota Bridges to Excellence program is managed by BHCAG. Launched in 2005, this program has contributed to an improvement in the delivery of optimal care for patients with diabetes, depression and vascular disease and is considered a national model for provider pay-for-performance programs.


• The need for purchasing principles - BHCAG was a founding member of the Smart Buy Alliance in 2004. The goal of the Smart Buy Alliance was to establish best practice purchasing principles for employer purchasers, and in turn to drive efficiency and improvements in care delivery.

What does this all mean to BHCAG as an organization? Well, for starters, it underscores that there is a market need for BHCAG and it demonstrates that what we do and provide is essential to changing health care in Minnesota. The fact that BHCAG initiatives and guiding principles are being validated at the legislative level means that we’re on the right track and that we can’t let up. The response that we’re hearing from members in our monthly breakfast meetings tells me that we must continue our commitment to these principles and to fostering conversations and collaboration among a wide variety of health care purchasers and stakeholders.

In the spirit of collaboration,

Carolyn Pare

President and CEO

Bringing it all together

Connecting public and private purchasers for more effective health care solutions

Aristotle knew what he was talking about when he penned the phrase, “The whole is greater than the sum of its parts.” In many aspects of life and business, we’ve learned that greater outcomes can be achieved when a group of people-or organizations-work together toward a common goal, with agreed upon parameters and metrics.

In health care, this sentiment has been proven time and time again. And it’s now more important than ever.

If we look historically at health care initiatives that failed when undertaken by an individual organization or entity, yet flourished as a collaborative effort with the proper industry expertise and guidance, it doesn’t take long to realize that we all benefit from a collaborative approach to health care. Minnesota is fortunate to have the type of business and health care environment that fosters and accepts collaboration as a key element of innovation. Consider the following examples:

• Payment reform-When BHCAG established the ChoicePlus product in 1992, it was with the intent to foster greater consumer choice, increased competition among providers, and improved quality. By uniting the interests of employers, health care providers, and individual consumers, we were able to develop a product that helped people make informed choices about where and how to spend their health care dollars. This initiative was so successful that the State of Minnesota adopted it as the model for its employee health plan. In addition, ChoicePlus was spun off and is now offered by one of the state’s leading health plans as part of their product portfolio. But the success of this initiative extends beyond of the borders of Minnesota, as tiered programs like ChoicePlus have become the foundation for consumer-directed health plans across the country.
• Patient outcomes-Minnesota Bridges to Excellence unites the clinical practices of physicians, the need to improve outcomes for patients with chronic conditions, and the broader public need for transparency around performance data. Providers who participate in Bridges to Excellence are helping to ensure that more Minnesotans receive optimal care for these conditions. Bridges to Excellence served as the basis for the Quality Care and Rewarding Excellence program launched by the State of Minnesota, as well as the public reporting structure adopted by the State.
• Patient safety-Patient safety should never be thought of as yesterday’s news. As one of the founding members of the Leapfrog Group, BHCAG has successfully worked with health care providers, employers, and legislative leaders to increase the public reporting of patient safety data and to educate consumers and employer purchasers on how to use this information when purchasing health care services.
• Health care data transparency and reporting-In all aspects of programming, BHCAG pushes for greater data transparency. For example, we bring together health care providers and legislative leaders to promote public reporting of outcomes and safety data. We convene employer purchasers, health plans and providers to address more cost-effective methods of reimbursing for care. And, we unite employer purchasers and health plans in an effort to promote health care consumerism through public reporting.

BHCAG has played a pivotal role in all of these initiatives-and in driving health care reform at a higher level. How? By uniting a broad spectrum of audiences-including public and private purchasers of health care, the medical community and political leaders-and connecting those individual interests to form a common goal.

To use a health care metaphor, BHCAG, like the connective tissue in our bodies, brings all the important players and functional areas in the health care and business community together to make health care work better. Because of BHCAG, and other employer collaboratives across the country, Minnesota has seen positive change in many aspects of health care.

As we look at the year ahead and the current state of health care reform, not to mention the still-slow-to-respond economy, purchasers will need to challenge conventional thinking and commit to working together to find solutions for some very complex issues. Changing a system that has been in place for decades and that is mired in broken processes that impact so many aspects of our economy will not be easy.

But, I have no doubt that if solutions are to come from anywhere, they will come from Minnesota. I look forward to working with BHCAG member organizations, the health care community, business leaders and political leaders in Minnesota and in Washington to meet health care reform challenges head on, and to demonstrate, once again, why Minnesota is a leader in health care and business innovation.

In the spirit of collaboration,

Carolyn Pare

President and CEO

Three Minnesota hospitals receive Top Hospital Award

All Minnesota hospitals should make this same commitment to patient safety

There is good news and bad news when it comes to patient safety in hospitals. The good news: Since the Institute of Medicine, (IOM) released its report in 1999 that detailed the cause of 100,000 needless deaths in hospitals due to medical mistakes, hospitals have made improvements in public reporting of outcomes and implementing quality improvement practices. The bad news: We still have a long way to go and in some cases, we have lost ground.

One form of public reporting that occurs in Minnesota hospitals is the reporting of "never events." Never events are 27 things that should never happen when you’re in the hospital. The list includes things like surgery being performed on the wrong body part, death associated with contaminated drugs, an infant who is discharged to the wrong person, and patient falls. Never events are puplicly reported annually at the state level in a report from the Minnesota Department of Health as “adverse events.” While this information is critically important to improving the quality of care in hospitals, it takes a retrospective look at what has gone wrong. Although it’s important to learn from mistakes so they are never repeated, more information should be provided to individual health care consumers so they can understand what hospitals are doing right, based on what is important to them, as patients.

In 2000, the Leapfrog Group was established by health care purchasers in an effort to use available evidence to help real people understand what is actually being done by hospitals to prevent mistakes before they happen. With the assistance of purchaser organizations like the Buyers Health Care Action Group (BHCAG), Leapfrog conducts an annual survey of hospital patient safety procedures and outcomes, with a focus on what hospitals are doing right. Twelve hundred hospitals across the country complete the survey and their results can be found at www.leapfroggroup.org. Unlike other hospital quality and safety reports, the Leapfrog Group reports on processes and outcomes that matter to a broad spectrum of the general public and delivers that information in a way that real people can understand. Hospitals complete many different surveys each year, some required by regulatory bodies, some required by health plans, some required by accrediting agencies. However, the Leapfrog survey is the only purchaser developed and requested survey.

Minnesota hospitals have historically scored very well on the Leapfrog survey, and 2010 is no exception. This year, three Minnesota hospitals were recognized with the Leapfrog Group’s Top Hospital Award. Those hospitals are: Children’s Hospitals and Clinics-St. Paul, Children’s Hospitals and Clinics-Minneapolis, and Mayo Clinic Rochester-St. Mary’s. Less than 6 percent of all hospitals that report to Leapfrog receive Top Hospital status.

Children’s Hospitals and Mayo Clinic stand apart from other hospitals because they have been able to successfully make patient safety and reporting a regular part of their workflow and to balance the investment of resources that reporting often requires with their responsibility to care for patients.

All hospitals across the state should take note of the commitment and approach shown by Children’s Hospitals and the Mayo Clinic to re-engage with reporting tools like the Leapfrog Survey and dedicate resources to re-energizing their reporting efforts.

Why? Because aside from these three top-performing hospitals, fewer Minnesota hospitals are participating in voluntary patient safety reporting efforts like the Leapfrog survey. In fact, participation by Minnesota hospitals in this survey has decreased over the past 10 years. In 2010, just 22 of the 136 Minnesota hospitals completed the survey. And although Minnesota hospitals are making progress against many patient safety measures, overall scores are declining in key areas like heart attack and pneumonia.

The exception to that trend is Children’s Hospitals and Mayo Clinic. At Children’s Hospitals, patient safety initiatives have helped the hospital achieve one of the lowest rates of hospital-acquired infections in the nation, and their use of electronic medical records has helped further reduce patient complications and to improve patient care.

Mayo Clinic’s receipt the Top Hospital ranking is due largely to that organization’s continued efforts to develop evidence-based improvements and to adopt cutting edge, high standards of patient care across the organization. For example, every employee⎯from office staff, care providers, all the way up to the CEO⎯are encouraged to participate in the Mayo Quality Fellows Program or take individual and team courses at Mayo's Quality Academy to improve quality, safety and efficiency in their work area.

From the purchaser perspective, the Leapfrog survey is the most comprehensive survey of hospital patient safety. The survey reports on three key areas that are important to health care consumers: 1) how patients fare in a particular hospital, 2) the resources that hospital uses to care for patients, and 3) hospital management practices that promote safety. When it comes to investing in reporting that consumers can actually use, the Leapfrog Survey effectively connects hospital performance with consumer information needs.

With all the negative and conflicting reports on the state of patient safety across the country, Minnesotans should be proud that they have three top-performing hospitals in their midst. Not only have these hospitals made a long-term commitment to improving patient safety, but equally important, they have committed to publicly reporting on their processes and outcomes based on what the purchasers want. Without this information, individuals cannot make informed decisions about where they receive care based on understandable and useful information.

Patient safety is not a competition, but rather something that every hospital should strive to achieve. Not only is improving patient safety essential for improved health outcomes, but it also addresses the overall problem of ever-increasing health care costs. The health care industry cannot expect purchasers⎯whether individuals or employer purchasers⎯to continue to foot the bill for care that is inefficient and of poor quality.

As health care reform initiatives are implemented in the coming years, employers and individual consumers will be driven to make purchase decisions based on factors other than cost. Patient safety outcomes are likely to be at the top of that list. As employer purchasers, health care decision makers and industry leaders, we need to work together to increase participation in the Leapfrog survey by Minnesota hospitals, because it is this level of public reporting that will truly make a difference in improving patient safety for all Minnesotans.

In the spirit of collaboration,

Carolyn Pare

President & CEO

Buyers Health Care Action Group

Patient Safety: What will it take to move the needle?

The answer is in transparency, public reporting and collaboration.

During a recent Community Dialogue sponsored by the Buyers Health Care Action Group (BHCAG), four health care industry leaders discussed patient safety, including:

• Where we're at with efforts to improve patient safety.
• How Minnesota compares to national patient safety outcomes.
• What is needed to truly move the needle on this important issue.

Guest speakers included Leah Binder, CEO of The Leapfrog Group; Jennifer Lundblad, CEO of Stratis Health; Lawrence Massa, president of the Minnesota Hospital Association; and Dr. Phil Kibort, vice president of medical affairs and chief medical officer at Children’s Hospital. Between these four leaders, there exists a wealth of knowledge and experience in the area of patient safety. So, what did these thought leaders have to say on the subject? In short:

• We can't expect employers to continue paying for health care that is inefficient and of poor quality.
• In order for public reporting to work, the data must be meaningful to consumers and individuals must actively use the data that hospitals are reporting to decide where to receive care.
• Collaboration and communication are necessary if reporting efforts are to be successful.
• Patient safety is not a competition, but rather something that every hospital should achieve.
• Data reporting is essential to demonstrate the quality of care provided to patients.

Where we're at with efforts to improve patient safety

Our guest speakers agreed that, by and large, the health care industry has improved since the original Institute of Medicine report in 1999 that illustrated the impact to patients of poor patient safety efforts. Yet, we still have a long way to go. All hospitals need to make patient safety and public reporting a regular part of their workflow. Organizations like BHCAG and The Leapfrog Group continue to work with hospitals to make balancing the investment of resources that reporting often requires with the organization’s responsibility to care for patients.

How Minnesota compares to national outcomes

As for Minnesota, hospitals locally continue to score better than those in other states; however, our health care ranking is declining and we don’t see much improvement against the national average in many publicly reported measures. Minnesota hospitals need to re-engage with reporting tools like the Leapfrog Survey and re-energize their reporting efforts. The Leapfrog Survey reports on three key areas that are important to consumers: how patients fare in a particular hospital, the resources that hospital uses to care for patients, and hospital management practices that promote safety. When it comes to investing in reporting that consumers can actually use, the Leapfrog Survey effectively connects hospital performance with consumer information needs.

What will it take to move the needle?

At the risk of repeating myself, three things need to happen in order for patient safety to continue to improve:

1. All hospitals need to make patient safety a priority and commit to this effort on an ongoing basis.
2. Hospitals need to commit to publicly reporting the outcomes that are important to purchasers and consumers and to working with organizations like BHCAG and The Leapfrog Group to report their patient safety efforts.
3. We all need to work together to educate consumers about how to use public data to make decisions when receiving care and why this is such an important step in the process.

We all play a part in making our health care system safe. And, as the focus on health care costs and outcomes continues to intensify, now is the time to work together to create long-lasting improvements.

In the spirit of collaboration,

Carolyn Pare

President & CEO

Buyers Health Care Action Group

Strength in numbers

Coalitions connect local health care needs and strengths with national agenda to create change

When someone has a problem, often the first thing they do is find other people who are in a similar situation. Why? For one thing, finding a solution to a complicated situation is easier when you have more people to lend their expertise and perspective. Two heads are better than one, right? But, joining forces with others also gives you more leverage and a greater ability to influence key decision makers and leaders who might be more inclined to listen to a group of consumers versus a single person.

Such is the case with health care.

In health care, that strength in numbers comes in the form of coalitions like the Buyers Health Care Action Group (BHCAG) and the National Business Coalition on Health (NBCH).

Coalitions exist to unite like-minded groups of people and organizations together under a common goal and to enable them to work together to create change.

In my new role as board chair for the NBCH and through the work that BHCAG is committed to, I’ve seen how influential a group of like-minded organizations can be. But what makes these organizations work is the balance of national and regional influence and perspective they offer.

You’ve heard me say many times that all health care is local, and I believe this truth will hold even as health care reform is enacted in the coming years. How then, you might wonder, does a national organization like NBCH figure into the equation if health care is, at its heart, local?

The answer is simple and clear. The NBCH provides the national perspective and presence in Washington that regional coalitions often can’t fund. The NBCH also provides support services for local coalitions to help them implement reform at the local level. The 60 member coalitions and more than 7,000 employer organizations across the country - including BHCAG members and employer organizations - benefit from the efforts and influence of the NBCH in several ways, including:

• The ability to use NBCH as our collective voice to policy makers in Washington and as a source for information on national health care reform
• Access to research on health care trends, best practices, and employer response to reform
• Partnership and participation in national programs that drive marketplace change, like eValue8, Bridges to Excellence and the Leapfrog survey
• The opportunity to learn from the experience of other markets and coalitions and to share best practices with business leaders through activities like the College for Value Based Purchasing
• Access to events like the Health and Productivity Forum and the National Leadership Council, which address trends in health management and health reform and provide opportunity for both learning and dialog with your peers
• Opportunities to participate in the national, as well as local, legislative process through work groups and task forces as a NBCH and BCHAG member

The guiding principles that have made BHCAG a driving force in health reform and that have made Minnesota a leader in health care for decades are still relevant in the current economy:

• Pay for quality
• Abide by common standards and measures
• Share data publicly
• Use technology to reduce costs and engage the consumer

These principles also align directly with the purchasing principles for which BHCAG advocates and that made the Smart Buy Alliance a successful early model of an accountable care organization. You will see BHCAG and the NBCH continue to advocate for these principles as we collectively pursue payment reform:

• Buy from the best
• Work toward common standards
• Engage the consumer
• Push for health information technology

NBCH member coalitions, like BHCAG, are an integral part of health reform in their own communities and home states, but they are also closely connected to the national work that the NBCH leads. This combination of national presence and local support is unique to the NBCH and differentiates the coalition from other national organizations that merely disseminate information to employer groups, but that do not provide the ongoing support to affect local change.

As the implementation of the health care reform legislation becomes a reality, our ability to unite against a common cause and with a singular focus will produce better quality, more efficiently delivered health care for all Americans. If you are interested in becoming more actively involved in health reform through BHCAG locally or nationally through the NBCH, please contact me and I will answer any questions you might have.

In the spirit of collaboration,

Carolyn Pare

President and CEO

Buyers Health Care Action Group

Reaping rewards for optimal care

Minnesota Bridges to Excellence drives improved care and outcomes for patients

Public reporting of performance data by health care providers has produced startling findings, such as the recent study on safety lapses in same-day surgery centers and the annual Department of Health report on “never events.” But, that same data has also revealed more promising news for patients and the health care industry⎯like the Minnesota Bridges to Excellence results.

Minnesota Bridges to Excellence is a BHCAG program that provides financial rewards for clinics that meet or exceed optimal care measures for patients with diabetes, vascular disease and depression. This year, as we celebrate the 5^th anniversary of Minnesota Bridges to Excellence, we acknowledge the commitment these health care providers have made to data reporting and improving patient care, and we applaud them for their efforts.

Tonight, BHCAG will host a recognition event to pay tribute to 39 medical groups and 124 clinics from various parts of the state who have qualified for “achievement” (meeting or exceeding optimal care guidelines) or “improvement” (did not meet optimal care goals, but showed improvement of 10 percent or more over last year) through the Bridges to Excellence program. We look forward to recognizing their efforts and successes and hope that you will join us for the event.

I’m very pleased and encouraged to report that the number of clinics that qualified for rewards has more than doubled since 2009.

This means that more people who are living with these chronic conditions are receiving better care. As for clinical outcomes, physicians point to a decrease in the number of referrals being processed as a sign that improved care delivery is having a real-life impact on patients. To quote Dr. Kenneth Ripp of the Raiter Clinic in Cloquet, Minn.:

“Prevention is the unsung hero in health care. It’s the heart attack that never happened because a patient’s condition is being appropriately managed. In the end, we know our efforts are making a difference if we’re sending fewer patients to specialists to treat heart attacks and other medical emergencies.”

In addition to an increase in the number of clinics that qualified for rewards, I was also encouraged that more clinics outside of the Twin Cities metro area qualified for rewards this year.

Geography can complicate quality improvement efforts for clinic systems in greater Minnesota, as they attempt to bring disparate clinics together under a unified, systematic quality improvement program. The fact that more clinics in greater Minnesota qualified for Minnesota Bridges to Excellence rewards shows a high level of commitment to their patients and innovation on the part of these clinics.

“Because we’re small, we can do quality in a different way,” said Dr. Ripp. “We can do things on a much more personal level and incent physicians on a personal basis. We’ve found that a little incentive can go a long way to getting people’s attention.”

The value that programs like Minnesota Bridges to Excellence brings to the table is not so much in the financial reward, but in the focus that it lends to quality improvement efforts. Physicians and Minnesota Bridges to Excellence reward winners tell us that the program helped them focus their efforts and got everyone at various clinic locations singing the same song.

“It’s difficult for a mid-level practice to do 14 different quality initiatives really well,” said Dr. Tim Hernandez, Family HealthServices, White Bear Lake, Minn. “Having key initiatives that everyone supports and is aligned with is a huge help to us. And getting public recognition for developing the infrastructure and tools needed to measure outcomes provides valuable reinforcement to our staff.”

While these most recent Minnesota Bridges to Excellence results are encouraging, there is still much progress to be made in the area of care delivery. But the efforts of this year’s winners set a prime example of the dedication and innovation that is needed to improve care and to put the focus in health care on quality instead of quantity. This level of collaboration and leadership is essential to the success of individual clinics and the health care marketplace as a whole.

In the spirit of collaboration,

Carolyn Pare

President and CEO

Buyers Health Care Action Group