A collaborative effort

Six hospitals and health systems and the Dartmouth Institute for Health Policy and Clinical Practice are hoping to quicken the pace of healthcare quality improvement for the country with the formation of a quality collaborative effort unveiled last week.

The group plans to systematically determine best care practices for some common and expensive conditions, and then share that information with the rest of the country in a way that’s faster than it’s been historically done. “The goal of the collaboration is to understand quality and understand cost,” said Patricia Gabow, CEO of Denver Health, an integrated public system that is participating. “It represents a new way to rapidly define best practices for high quality care,” Gabow said.

Also participating in the collaborative effort are: Cleveland Clinic; Dartmouth-Hitchcock Medical Center, Lebanon, N.H.; Geisinger Health System, Danville, Pa.; Intermountain Healthcare, Salt Lake City; and Mayo Clinic, Rochester, Minn.

To arrive at their ambitious goals, the participants intend to swap data on outcomes, quality and costs, a level of sharing that could raise antitrust concerns if the organizations are viewed as competitors fixing prices. “We’re keeping an eye very much on antitrust principles to make sure we’re well within those guidelines,” said Dartmouth-Hitchcock spokesman Rick Adams . He added that the group’s members see the endeavor as pro-competitive because patients ultimately will benefit from “a much richer data set than any of us individually could come up with.”

First on the as-yet unnamed group’s to-do list is an analysis of incidents of total knee replacement surgery, which was chosen for its high frequency and high range of costs, as were the other procedures. The group says that there are more than 300,000 such procedures performed each year at costs that range on average from $16,000 to $24,000 each.

Total knee replacement is a good candidate to be included in future federal bundled payment programs, and this information could inform that effort, said James Weinstein, a physician who is director of the Dartmouth Institute. Weinstein was a key player in the formation of the group, which has its roots in a collaboration between Dartmouth, Intermountain and Mayo that began 12 years ago, participants said.

The idea is to publicly provide a set of standards of care for use by any interested parties, including the CMS, private insurers and employers, Weinstein said.

Early next year, the group will analyze best practices in care for diabetes and heart failure. Rounding out the list of other procedures to be analyzed are: asthma, depression, labor and delivery, spine surgery and weight-loss surgery.

The backers of the group believe that swift action is needed given the changes occurring under health reform, and clinicians are in the best position to promote that action. “We believe that true healthcare reform will come out of the front lines,” said Brent James, chief quality officer at Intermountain Healthcare and executive director of the Intermountain Institute for Health Care Delivery Research.

The six members alone serve an estimated patient population of 10 million people. The members of the initial group were chosen for their diversity in terms of location, the types of patients they serve and payers of the care, participants said. For example, Denver Health serves a large number of Medicaid patients in an urban setting, while others deal more with private insurers and Medicare, some in more suburban or rural facilities. About 30 more providers are seeking to join the group, and expansion is planned. By starting with six large participants and eventually including other sites, the collaborative effort can create momentum to apply some of these best practices nationally, said Robert Stroebel, chairman of Mayo Clinic’s division of primary-care internal medicine.

Getting broad participation to work given the variety of providers out there may prove challenging at points, said one quality expert, Janet Corrigan, president and CEO of the standards-setting National Quality Forum. Nevertheless, she said she welcomes the effort. “This is very much what we need to be doing at this time,” Corrigan said. The group’s focus on analyzing an entire episode of care is important, as is the participants’ experience with health information technology, she said.

One question mark is how the participants will split the tab for their collective work. A spokesman for Dartmouth said that remains under discussion.