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

Patient safety requires vigilance

Infections in surgery centers show need for ongoing focus on patient safety and quality

You’ve heard the reports of misdiagnoses, botched surgeries, and now, a report from the Centers for Disease Control and Prevention that shows a serious problem with infection control in same-day surgery centers across the country.

The report, which was conducted by the Centers for Disease Control and Prevention and published first in the Journal of the American Medical Association and last week in the Washington Post, reflected unsafe practices that were observed in same-day surgery centers in Maryland, North Carolina and Oklahoma. The safety lapses were very basic, from failure to wash hands or wear gloves, to reusing devices meant for one patient on multiple patients. At the end of the day, 67 percent of the centers in the study had at least one lapse in infection control and 57 percent were cited for deficiencies.

While it is not known whether the safety lapses identified in this study led to infections in patients, we do know that infections in the surgical and hospital settings are a very real, very serious matter. In March 2010, the Leapfrog Group (of which BHCAG is a founding member) released a report on central-line associated blood stream infections, or CLABSIs, which cause at least 30 percent of the estimated 99,000 hospital-infection related deaths in the United States and account for billions of dollars in avoidable health care costs every year.

The Leapfrog report, which targeted 926 hospitals in Minnesota and across the country, was significant not only because of what it revealed about the CLABSI rates in hospitals. It was significant because it demonstrated the real-life value that comes from public reporting of performance data by health care providers. In this case, the public learned of the serious health problems a central-line infection can present and whether their hospital was up to par in preventing them.

However, many hospitals, including six in Minnesota chose not to respond to requests for data regarding their CLABSI rates. This failure to publicly report performance data robs individual health care consumers and health care purchasers of their ability to make informed decisions about where they receive care. It also stunts efforts to transform the health care reimbursement system from one that rewards for quantity of services performed to one that rewards for quality outcomes achieved.

And that’s where the commonality lies between the CDC study and the Leapfrog report. Both examples shine a light on the need for greater patient safety measures in health care facilities. BHCAG and its member organizations believe that patient safety is not a topic that should be pulled off the shelf and paraded around once a year. Patient safety should always be front and center in the health care reform debate.

It is equally important to remember that the key to improving patient safety is public reporting of data, such as shown in these studies. Whether data is voluntarily submitted through programs like BHCAG’s Minnesota Bridges to Excellence initiative, Minnesota Community Measurement, or through reports such as those mentioned here; business leaders, the health care community, and political leaders need to work together to generate greater momentum and compliance for public reporting among health care providers. And, since we’re talking about public reporting, let’s not forget to recognize those health care providers that have been leaders in this area and that have, as a result, realized notable improvements in care delivery and patient outcomes.

Look for more on the topic of rewards for improving care delivery and patient outcomes later this month as we celebrate the fifth anniversary of the Bridges to Excellence program.

In the spirit of collaboration,

Caroyln Pare
President and CEO
The Buyers Health Care Action Group

Closing the quality gap

Patient safety must remain a key component of value-based purchasing

Addressing gaps in the quality of care and outcomes for Minnesota’s hospitals is an issue that BHCAG has been involved in for many years. Since first lending our support to the Minnesota Alliance for Patient Safety in 2000, BHCAG has continued to advocate for transparency at the hospital level by collaborating with employers and other health care organizations to establish The Leapfrog Group (also in 2000). And later, in 2003, BHCAG joined forces with the Minnesota Department of Health to introduce the state’s first adverse events report.

These initiatives have contributed to community and statewide improvements in outcomes and pushed Minnesota to the forefront of public reporting in health care in very meaningful ways:

• BHCAG was a founding member of The Leapfrog Group, collaborating with employers and health care organizations to address a report on medical errors by the Institute of Medicine. The Leapfrog survey, which focuses on specific safety measures that hospitals can take to avoid some of the most common medical errors, is now completed by hospitals in 31 regions of the United States. In addition, this initiative has prompted many hospitals to respond with their own quality initiatives. The Leapfrog survey provides consumers with information about specific steps that hospitals in their community are taking to improve quality and to avoid common medical mistakes.
• The Minnesota Alliance for Patient Safety (MAPS) is a partnership between the Minnesota Hospital Association, the Minnesota Medical Association, the Minnesota Department of Health and organizations, like BHCAG, that are committed to improving patient safety. MAPS strives to promote optimum patient safety through collaborative and supportive efforts among all participants of the health care system in Minnesota. Among other things, MAPS offers awareness campaigns for hospital employees, pilot programs, and tools to assist staff in their quality improvement efforts. BHCAG representatives serve on the MAPS steering committee, which guides the ongoing strategy and direction for this organization.
• Minnesota was the first state to adopt by legislative action all 27 (now 28) of the National Quality Forum’s adverse events. This requires Minnesota hospitals to develop an action plan for improving their performance and holds them accountable for regular reporting of outcomes to the public. BHCAG was instrumental in establishing the adverse events report in Minnesota by providing funding for the development of the reporting protocol. BHCAG also facilitated ongoing discussions with hospitals and health plans to identify ways to improve outcomes and reshape the reimbursement system. By targeting deadly, and avoidable, medical mistakes the adverse events report keeps consumers informed about the performance of providers in their community. This supports individual decision making and gives hospitals an extra incentive to improve.

But there is still much room for improvement. A recent article in the Star Tribune drove this point home by citing the gaps in quality that can exist between hospitals that are part of the same hospital system, much less across different care systems.

Understanding and eliminating these gaps will become even more important in the coming months and years as the new Patient Protection and Affordable Care Act is implemented. The legislation’s focus on increased public reporting will put more emphasis on reporting by all hospitals and will shift the focus for comparing facilities to a value-based purchasing approach.

What to expect from BHCAG

As the details become known for how the new health care legislation will be enacted, BHCAG will continue to bring together employers, health plans and health care providers to push for widespread compliance with patient safety and reporting initiatives like Leapfrog and the adverse events report. More specifically, we will advocate for a universal and standardized reporting format that is meaningful and useful to employers and individual health care consumers. Meanwhile, we will continue our involvement in Aligning Forces for Quality (AF4Q) a grant from the Robert Wood Johnson Foundation that aims to align provider performance, public reporting and quality improvement.

If you are looking for a way to become more involved in patient safety and public reporting, please contact me. And watch for an upcoming BHCAG Community Dialogue session on this topic.

Remember that, together, our collective voice can have a profound influence on the future health care marketplace.

In the spirit of healthy change,

Carolyn Pare
President & CEO

Curing health care calls for transparency and collaboration

Most people wouldn’t buy a car or even a pair of shoes without knowing the price and how the product compares to other, similar products. Yet, when it comes to health care, people make decisions for themselves and their family members every day without fully understanding the implications of those decisions.

Consider the employee who enrolls in an employer-sponsored health plan without understanding what their cost-sharing responsibility will be. Or the patient newly diagnosed with diabetes who does not ask their primary care physician about the diabetes program and outcomes at his or her clinic. And furthermore, the individual who is managing their personal health care needs along with those of their children and aging parents. In any and all of these situations, people are making important decisions based on incomplete data about themselves and their physicians.

With health care, as in many other areas of life, information equals knowledge, and knowledge equals power. Access to information ultimately comes from greater transparency, or sharing of data by health plans and health care providers. In our work at the Buyers Health Care Action Group (BHCAG), we participate in and observe health care reform on both a regional and national level, and are reminded at every turn of the need for greater transparency in all things related to health care.

We believe that in order for real change to occur, the general public and the business community need to have a voice in the debate, and they need access to information and data that can influence the decisions they make about how they purchase health care coverage and services. These essential conversations cannot happen behind closed doors.

Minnesota has historically been at the forefront of change in health care, thanks to the innovative spirit of the health care community, the collaborative nature of our employer base, and the expertise of the medical community. Minnesota has already made great strides in data transparency and serves as a model for national change in many areas. However, we need to continue to work together and push to make more meaningful data available to employers and individual purchasers. The availability and understanding of health care data will contribute to positive health care reform in several key categories, including:

• Improving quality of care and outcomes. Current health care reform calls for improved outcomes and emphasizes pay-for-performance programs and value-based benefit design as a way to reign in spending and create a more sustainable reimbursement system. The Minnesota Bridges to Excellence program, implemented in 2006, was one of the nation’s first employer-led, pay-for-performance programs designed to improve and report on outcomes, at both the clinic and medical system level, for people with diabetes, heart and vascular disease, and depression. By pushing for direct data reporting at the clinic level rather than the system level, health care consumers gain a better understanding of the quality of care and outcomes delivered by individual clinics in different communities.
  
  By accelerating the use of direct data reporting at the clinic level, BHCAG has encouraged greater use of transparency tools across the entire community. In addition, the Bridges to Excellence program has been a driving force behind a shift from process reporting by health care providers to performance reporting. In other words, reporting on the outcomes of the procedures or care that is delivered instead of merely whether something was or was not done.
  
  
• Patient safety. Closely related to the issue of quality is patient safety. BHCAG worked closely with Minnesota employers to help pass legislation in 2003 that required Minnesota hospitals to report on adverse events or medical mistakes, as identified by the National Quality Forum. As a result, Minnesota was the first state to adopt all of the National Quality Forum’s 27 adverse events by legislative action. The push for reporting of outcomes continues through Aligning Forces for Quality (AF4Q), a grant from the Robert Wood Johnson Foundation. AF4Q grants were awarded in 14 communities, including the metro area, with the common goal of aligning provider performance, public reporting and quality improvement.
  
  BHCAG is actively involved in AF4Q and efforts to increase use of the Minnesota Community Measurement Web site as a common source for data. In addition, we are part of a workgroup that has developed http://www.theD5.org, a web site for people with diabetes to help them understand the common diabetes measurements, why they’re important and how local clinics perform against these measures.
  
  
• Health plan performance and accountability. Health plans are at the center of the health care debate, as businesses and individuals are reeling from year after year premium increases and millions of Americans remain uninsured. We have worked steadily with employers and health plans as a founding member of eValue8, a health plan survey tool, to make public information about health plan cost, quality and performance in eight key areas.
  
  
• Personal health information. Giving individual patients access to and control of their own health information, including medical history, test results, coverage limitations and financial information, is key to creating more informed and engaged health care consumers. And, it could be a critical component to how people experience health care in the future. BHCAG believes that personal health information should belong to the individual and should not be tethered to a health plan or provider system. To this end, we continue to advocate for businesses and health care companies to adopt myHealthfolio, a Web-based public health record that is owned by the individual, regardless of where they receive care or who their insurance carrier is.

In the coming months, we will continue to advocate for increased transparency and meaningful change in the availability of data and how employers and individual consumers access health care information. I encourage you to share your thoughts and comments with me via this blog. A healthy dialog is a first step to creating change in the marketplace.

In the spirit of healthy change,

Carolyn Pare

President & CEO