As policymakers continue to attempt to assemble a healthcare reform package, another group of providers is moving forward with its own plans to restructure payment policies and improve patient care.
Twin Cities providers try their own reform plan
Two systems based in Minneapolis, HealthPartners and Allina Hospitals & Clinics, last week announced a collaboration in the northwest area of the Twin Cities market through which they will implement payment agreements, care coordination and information-sharing. The goal is to reduce per capita spending on each patient while boosting outcomes and the patient experience, according to the organizations. About 120 providers from 11-hospital Allina's Mercy Hospital in suburban Coon Rapids, Minn., and four of its clinics, along with 40 providers from four HealthPartners clinics, will participate in the seven-year program.
Similar partnerships are cropping up among hospitals and insurers in Massachusetts, and a pilot project with the Dartmouth Institute for Health Policy and Clinical Practice, the Brookings Institution's Engelberg Center for Health Care Reform and health systems in several states also explores payment and quality restructuring.
The Minnesota collaboration's three areas of focus include payment structures, electronic health information and care coordination. Using the medical home concept to coordinate care is one way to help improve outcomes for patients with chronic illnesses, said Tom O'Connor, president of 264-bed Mercy Hospital. By sharing information and communicating across settings, “We should be able to target where the opportunities are.”
The collaboration—affecting about 170,000 patients in the Twin Cities metro area—is based on Triple Aim, a strategic initiative created by the Institute for Healthcare Improvement, or IHI. HealthPartners has been a Triple Aim participant for the past couple of years and believes the approach works, said Babette Apland, senior vice president of health and care management at HealthPartners, a two-hospital system that also offers insurance plans. The initiative encourages healthcare providers to focus simultaneously on three objectives: reducing costs, enhancing individual care and improving population health.
By focusing on all three, providers are able to find new approaches and redesign care that targets all goals, not “one goal at the expense of the others,” Apland said.
Since implementing the initiative two years ago, HealthPartners has been able to optimize care for its patients with diabetes, she said. There has been a focus on ensuring patients are maintaining healthy diet and exercise programs while complying with medication and doctors visits and monitoring their blood sugar levels. Since that program has started, the organization has seen a reduction in diabetes-related conditions, such as eye complications, she said. “And that translates into saved medical costs.”
Cost reduction has been a theme of healthcare reform, as officials point to increased spending in fee-for-service payment models they say are no longer sustainable. A major component of reducing total cost-per-patient includes changing that fee structure, and the collaboration will explore payment agreements that provide incentives for quality outcomes, Apland said.
For example, the collaboration hopes to conduct activities that prevent complications, hospitalizations and readmissions—the types of services that can add up. “We will in turn decrease the need for medical services and therefore decrease those costs,” she said. At the same time, patients are satisfied because they are healthier. “The outcome, of course, is a lower total cost index.”
That goal echoes a similar plan under way in Massachusetts to enact a global payment system in which providers receive a fee per person, based on agreed-upon factors, including quality measures. While providers and insurers in the state are partnering to establish global payment contracts, some in the state are more cautious about how well the plan would work (July 27, p. 6).
This month, physicians in Massachusetts said the race to global payments should be slowed. Doctors support the need for more coordinated care, but restructuring the entire payment system without first testing the model could have “unpredictable effects,” said Mario Motta, a cardiologist who is president of the Massachusetts Medical Society, while testifying last week before the state Legislature. Global payments can work for certain physicians, particularly large groups that are capable of spreading out the risk among many practitioners. Doctors “are not insurance companies,” he said.
But Triple Aim itself does not require significant changes to payment structures to make the goals work, according to the IHI.
“People have the tendency to translate this into payment structures,” but “the idea of reducing per capita costs of care does not necessarily” mean an overhaul, said Carol Beasley, director of strategic projects at the quality organization.
The initiative is meant to be innovative, she said. “We're in a world where we don't have a nice clear recipe book.” There are 65 sites in Canada, Europe and the U.S., now participating in the 3-year-old Triple Aim program.
What the IHI really hopes the initiative accomplishes is educating members of the industry, Beasley added.
The current discussion on healthcare reform seems too focused on cost, and what the IHI initiative demonstrates is that it's possible to make progress in several areas at the same time. “I'm not sure that learning is apparent to everyone yet.”
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