Hospital alliance VHA would like to market its members as high-quality healthcare providers, figuring purchasers would pay a little more for better care. But before they buy anything, purchasers want to see proof of quality.
In response, VHA has organized an alliance of purchasers and providers to develop measures of clinical and customer-service quality. The group will meet in Dallas Oct. 13 to begin work on standards for VHA's 1,650 community-owned hospital and physician group members.
Purchasers in the group -- including American Airlines, the Blue Cross and Blue Shield Association, Digital Equipment Corp. and General Electric Co. -- were chosen for their national prominence and healthcare benefits expertise.
Providers on the panel include VHA members Baylor Health Care System of Dallas, University of Pennsylvania Health System of Philadelphia, Allina Health System of Minneapolis and Indianapolis-based Community Hospitals of Indiana.
By the end of 1999, VHA hopes to sign on other provider groups to participate.
"What we want to do is come up with some performance indicators that our members can use to demonstrate the quality of the services they provide," says Ken Smithson, M.D., VHA's vice president of clinical and customer-service quality. "They would be less concerned about how (their) hospital stacks up across the country than across town.
"To be relevant to large purchasers, the more organizations we can engage to do this, the better," Smithson says.
Establishing a link between providers and purchasers is part of VHA's switch from marketing based on cost-containment ability to a "quality and service strategy," says Stuart Baker, M.D., the alliance's executive vice president for clinical affairs.
VHA, which represents 24% of the nation's community-owned hospitals, isn't the first to discover "healthcare quality." The term has become an industry buzzword as consumers dig for more information on providers' clinical and customer-service skills. Consumer interest has prompted popular magazines and groups like J.D. Power & Associates to begin rating hospital performance.
There already have been plenty of efforts to measure clinical outcomes. Oryx, the Joint Commission on Accreditation of Healthcare Organizations' long-awaited effort, started July 1. An alliance of purchasers formed the Foundation for Accountability in 1996 to gather health plan quality data -- the same sort of information the National Committee for Quality Assurance draws on for its Health Plan Employer Data and Information Set, or HEDIS, survey.
However, major purchasers express frustration to VHA over the lack of easy-to-analyze data that cover both clinical and customer-service quality.
Because they don't have that information, they say they end up buying the lowest-cost care.
"We maybe have the frame, but we don't have the picture," Smithson says. "What the purchasers have told us is they would like to see something on one piece of paper they could look at to evaluate the quality of the provider."
VHA had its first skull session with purchasers in August 1997 in Santa Fe, N.M.
"We've spent almost a year now trying to get providers and major purchasers to be able to talk to and understand each other," Smithson says. "It turns out there's a huge communication barrier between the two.
"Providers don't really understand the environment, the business that major purchasers are in. Major purchasers have lost communication with providers because they've been so used to working through health plans. As a result, physicians and hospitals have lost the high ground in establishing quality."
VHA plans to issue its own quality standards to the purchaser-provider group at the Oct. 13 meeting. Then the group plans to take VHA's rough draft and create quality indicators that will be brought to major professional organizations for their input.
Participating purchasers and providers have agreed they will accept the standards that are developed, although they haven't signed any contracts, Baker says.
The goal is to make healthcare less of a "commodity buy," Smithson says.