Health Affairs: System-wide quality definition can lead to improved outcomes
A multispecialty group practice, hospital, employers and health plans can define “quality” and align performance and payment along common goals, according to an article published in the September edition of Health Affairs.
Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to facilitate development of standardized approaches to care of patients with common conditions, C. Craig Blackmore, MD, MPH, scientific director for the Center for HealthCare Solutions at Virginia Mason, and colleagues wrote. The authors described their collaborative approach and illuminated on some of its benefits.
Virginia Mason Medical Center is an integrated, nonprofit healthcare delivery system in Seattle with approximately 450 salaried physicians, an acute care hospital, outpatient clinics and residency programs. “What began as an invitation to employers and their health plans to meet with Virginia Mason providers became what we now call ‘marketplace collaborative,’” the authors wrote. “This collaborative approach required a level of transparency and communication that would not have been needed in a strictly internal initiative. However, the benefits of direct contact with the consumers of our services are now considered to be an integral part of our ongoing initiative to improve healthcare quality.”
The overall collaborative effort was to improve the quality of care. Thus, the initial task of the first collaborative was to define the term. In the end, the collaborative defined “quality” based on domains summarized as “better, faster and more affordable,” the authors elaborated.
Better care meant standardized processes constructed from the best available evidence on effective medical treatments.
Faster care meant a rapid return to function. “Patients needed to get through the care process, including diagnosis and treatment, swiftly—enabling a return to normal activity in the shortest possible time,” the authors wrote.
Quality meant a fair price—one that was affordable to the buyer while also compensating the seller fairly. “Overall, application of our definition of quality should have resulted in a decrease in the cost of care by eliminating unnecessary care and reducing costs associated with delays in treatment.”
After the term was defined, the collaborative and all subsequent ones consistently followed several steps. First, the collaboratives identified areas of major cost and outcome concern to the employer, thereby determining the specific clinical condition that would be the focus for that collaborative’s initiatives.
“Second, the collaboratives developed optimal care pathways—known as clinical value streams and described below—for patients with the target conditions,” Blackmore and colleagues wrote. “The third step was to measure and report quality results and costs, and to ensure that the resulting reports would be available in their entirety to all stakeholders.”
Finally, the collaboratives worked to ensure that incentives within the healthcare system were aligned to reward providers for meeting the specific, agreed-upon quality targets, rather than simply for more quantity of care.
The initial collaborative focused on low back pain. "We have subsequently hosted multiple additional collaboratives on conditions including headache, breast complaints, and large joint pain," the authors said.
According to the authors, these efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients and providers. “We have achieved 91 percent patient satisfaction, decreased use of advanced imaging by 23 percent, and provided same-day appointments in 95 percent of cases,” the authors reported.
Fundamental to the success is the development of standardized clinical pathways. Virginia Mason’s clinical value stream, through which the patient with a priority clinical condition would receive the same care, shows evidence-based care is at the core of the value streams, which are derived by providers representing relevant specialties.
According to the article, Virginia Mason experienced reductions in rates of use of advanced imaging strategies following implementation of the corresponding value streams for uncomplicated headache, uncomplicated low back pain and acute sinusitis. “For example, the MRI rate for headache decreased 23.2 percent; the lumbar MRI rate decreased by 23.4 percent; and the sinus CT rate decreased by 26.8 percent.
“Through the collaborative process, we have developed and implemented evidence-based care pathways with a corresponding decrease in unnecessary care and costs, and with high patient satisfaction and rapid access,” the authors concluded. “We expect ongoing development of additional care pathways in the future.”
Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to facilitate development of standardized approaches to care of patients with common conditions, C. Craig Blackmore, MD, MPH, scientific director for the Center for HealthCare Solutions at Virginia Mason, and colleagues wrote. The authors described their collaborative approach and illuminated on some of its benefits.
Virginia Mason Medical Center is an integrated, nonprofit healthcare delivery system in Seattle with approximately 450 salaried physicians, an acute care hospital, outpatient clinics and residency programs. “What began as an invitation to employers and their health plans to meet with Virginia Mason providers became what we now call ‘marketplace collaborative,’” the authors wrote. “This collaborative approach required a level of transparency and communication that would not have been needed in a strictly internal initiative. However, the benefits of direct contact with the consumers of our services are now considered to be an integral part of our ongoing initiative to improve healthcare quality.”
The overall collaborative effort was to improve the quality of care. Thus, the initial task of the first collaborative was to define the term. In the end, the collaborative defined “quality” based on domains summarized as “better, faster and more affordable,” the authors elaborated.
Better care meant standardized processes constructed from the best available evidence on effective medical treatments.
Faster care meant a rapid return to function. “Patients needed to get through the care process, including diagnosis and treatment, swiftly—enabling a return to normal activity in the shortest possible time,” the authors wrote.
Quality meant a fair price—one that was affordable to the buyer while also compensating the seller fairly. “Overall, application of our definition of quality should have resulted in a decrease in the cost of care by eliminating unnecessary care and reducing costs associated with delays in treatment.”
After the term was defined, the collaborative and all subsequent ones consistently followed several steps. First, the collaboratives identified areas of major cost and outcome concern to the employer, thereby determining the specific clinical condition that would be the focus for that collaborative’s initiatives.
“Second, the collaboratives developed optimal care pathways—known as clinical value streams and described below—for patients with the target conditions,” Blackmore and colleagues wrote. “The third step was to measure and report quality results and costs, and to ensure that the resulting reports would be available in their entirety to all stakeholders.”
Finally, the collaboratives worked to ensure that incentives within the healthcare system were aligned to reward providers for meeting the specific, agreed-upon quality targets, rather than simply for more quantity of care.
The initial collaborative focused on low back pain. "We have subsequently hosted multiple additional collaboratives on conditions including headache, breast complaints, and large joint pain," the authors said.
According to the authors, these efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients and providers. “We have achieved 91 percent patient satisfaction, decreased use of advanced imaging by 23 percent, and provided same-day appointments in 95 percent of cases,” the authors reported.
Fundamental to the success is the development of standardized clinical pathways. Virginia Mason’s clinical value stream, through which the patient with a priority clinical condition would receive the same care, shows evidence-based care is at the core of the value streams, which are derived by providers representing relevant specialties.
According to the article, Virginia Mason experienced reductions in rates of use of advanced imaging strategies following implementation of the corresponding value streams for uncomplicated headache, uncomplicated low back pain and acute sinusitis. “For example, the MRI rate for headache decreased 23.2 percent; the lumbar MRI rate decreased by 23.4 percent; and the sinus CT rate decreased by 26.8 percent.
“Through the collaborative process, we have developed and implemented evidence-based care pathways with a corresponding decrease in unnecessary care and costs, and with high patient satisfaction and rapid access,” the authors concluded. “We expect ongoing development of additional care pathways in the future.”