Richard Norling, chief executive officer at Premier, the purchasing group for more than 1,800 hospitals across the country, is out to make the alliance a heavyweight in clinical quality improvement.
In a recent telephone interview, Norling talked about his unfolding plans to make Premier synonymous with clinical excellence.
"The mark I'm trying to leave on Premier is all about clinical process improvement," Norling says. "We're in a position to be a catalyst. We have the opportunity and the obligation to stimulate change."
For years, Premier has been a serious, if somewhat quiet, player in clinical quality. The San Diego-based alliance has offered fee-for-service consulting out of its Charlotte, N.C., office, where it also manages a database drawn from the records of member hospitals. Premier says the database is the largest of its kind.
But during the next four years, Premier plans to do much more. The alliance, Norling says, will invest $50 million dollars to build a brainier and brawnier clinical data warehouse that will serve as the foundation for broad disease-management-based initiatives that aim to improve quality of care while reducing cost at member hospitals. The goal: Put participating institutions in the top quartile of clinical performance.
Early this year, Premier's board of directors approved the strategy and authorized the multimillion-dollar investment, which will cover the considerable cost of data collection with a portion of the administrative fees reaped from Premier's $10 billion group purchasing programs.
The quality expansion at Premier should come as no surprise to those who've followed Norling's career. Norling is a quality junkie. As president and CEO at Fairview Hospital and Healthcare Services, Minneapolis, he relentlessly applied total quality management approaches to the delivery of healthcare.
Beyond Premier, Norling sits on the boards of the Institute for Healthcare Improvement and the Malcolm Baldrige Foundation, which administers the top prize for business quality in the U.S.
"We're putting our money where are mouths are," Norling declares.
At first blush, the obvious question is why Premier, or any group purchasing organization for that matter, should be the outfit to aid hospitals with the nuts and bolts of delivering care.
"Hospitals brought us together to aggregate purchasing volume, and most recognize that aggregation is the core competency, not purchasing," says Chip Caldwell, senior vice president of performance services at Premier. "Now we're aggregating information and knowledge."
So Premier will pull together data on clinical practices, costs and, yes, products used at participating hospitals, as it has historically pooled buying power, to figure out what works best.
"This is a natural evolution of any hospital alliance," says Andrew Balas, M.D., director at the Center for Health Care Quality at the University of Missouri at Columbia. Balas believes that Premier's "serious" investment in building its database is crucial. "Most quality improvement efforts are frustrated by a lack of data," he explains. "The usual billing data that most people collect don't provide an adequate foundation for addressing quality."
To ensure that the database delivers, Premier has set its sights high and is spending plenty of money to process the data so that information from all the institutions is directly comparable.
"It's a huge undertaking," Premier's Caldwell says.
Somewhat optimistically, Caldwell predicts the biggest challenges will stem from the program's popularity managing the onslaught of data and the demand for specialized analysis.
Basic quality reports will be free to members, and more sophisticated analyses will be available for a fee. "We're anticipating being deluged with requests, then demands and then insults," he jokes.
In the first test of the approach, Premier is bringing the new data to bear on cardiovascular diseases. Representatives from about 100 institutions convened in January to begin work on the project, and a follow-up meeting is scheduled later this month to review preliminary findings.
To drill deeper into clinical outcomes, Premier is partnering with professional medical societies to get access to their scientific data on care.
On the cardiovascular project, for instance, the Society for Thoracic Surgery is sharing its detailed database on clinical experience with Premier. The organizations can match information down to individual patients, Caldwell says, and can tease out links between detailed clinical measures such as cardiac ejection fraction, a key indicator of heart health, with various interventions performed during an episode of care. Neither organization, he says, could make that match alone.
A similar push in orthopedic care was started in April, and Caldwell says Premier plans to roll out new initiatives about every four months.