Louisiana Health Care Quality Forum

 

Dr. Edwards Demming, the father of manufacturing quality once said that all systems produce exactly the results that they were designed to produce. In To Err is Human: Building a Safer Health System, the Institute of Medicine noted, “The problem is not bad people in health care - it is that good people are working in bad systems (my highlight) that need to be made safer.” (Institute of Medicine; Nov 1999). And yet we continue to plod along in the same flawed system year after year.

I recently heard a very interesting analogy applied: It’s as if an arsonist were on the loose setting fires all around. But our typical response is to hire more firefighters and buy more fire trucks to fight the fires; then to cut the wages and services because of all we’ve spent on the new personnel and equipment; and arsonist continues to set fires! Wouldn’t it make more sense to, instead, catch the arsonist???

Our current healthcare system is woefully misaligned to provide meaningful, quality care in the 21^st century. Let me explain. In 1965 when Medicare was created, the leading causes of death among the elderly population in the US were acute cardiovascular events and infectious diseases. And Medicare was an important and effective tool in changing that. However, in 2010 the leading causes of death in this same population are complications of chronic diseases, primarily cardiovascular diseases and cancer. Many of these are preventable, curable if detected early, and manageable. Indeed, the chronic diseases that cause the most morbidity and mortality – hypertension, diabetes, dyslipidemias, etc. – can be managed to prevent complications and improve quality of life. So we live in a 1965 “treat and cure” system, while we need a 2010 “prevent and manage” system.

Up to this point, the entire healthcare debate has focused on cutting costs in a “treat and cure” system that only sometimes provides what we have defined as quality care – remember the six characteristics of quality: Safety, effectiveness, efficiency, equitability, timeliness and patient-centeredness. When data from across the world has proven that “cost” of care and “quality” of care aren’t necessarily related.

Drs. Fisher and Wennberg at the Dartmouth Institute have provided us with documentation of this phenomena: that there are remarkable variations in “cost” of care that are inexplicable, unwarranted, and that don’t align with quality outcomes. As they have stated, “Huge inefficiencies in the U.S. health care system are hamstringing the nation's ability to expand access to care.”(Dartmouth Atlas Project, 2009). In another publication they note, “To succeed, health care reform must slow spending growth while improving quality.” (Health Affairs  27 January 2009).

In order to build better systems of care that are realigning priorities, and that provide quality outcomes while impacting these “huge inefficiencies, “we have only to look around the nation. The Patient-Centered Primary Care Collaborative,  a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, physicians and many others who have joined together to develop and advance the patient centered medical home. Now with well over 500 members, PCPCC believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system.  At the Collaborative’s web site, http://www.pcpcc.net/ several current pilot projects are highlighted from around the nation. Remarkable success has been achieved by re-aligning models of care – systems, if you will – to produce quality outcomes. And guess what else has happened, even in the early going: they have lowered costs!

 

Health systems are experimenting with new models of alignment as well. Virginia Mason Medical Center in Seattle has won quality and efficiency awards with its work in creating a patient-centered model of care that puts patients’ needs first. Geisinger Clinic in Pennsylvania has published widely its experience with new, efficient models of care that are founded on the principles of quality. And one large employer, Perdue Farms, the US’ largest chicken processor has published amazing results with its patient-centered medical home project at its plants across the country. In fact, utilizing a patient-centered medical home approach to care for their 20,000 employees and dependents, Perdue Farms outcomes based on evidence-based guidelines for blood pressure, diabetes management, etc. are among the top decile, and average annual healthcare expenditures have increased by less than 0.6% per year over the past 6 years!

 

Indeed, in our present political quandary change in healthcare will – must! – come from the businesses and communities that make up this country; rather than from a government that is too bureaucratic to change.

 

The Louisiana Health Care Quality Forum is dedicated to the mission of working collaboratively with all of our stakeholders – patients, families, physicians, nurses, hospitals, health plans, employers and government – to design systems that work to improve quality outcomes for the people of Louisiana. We are active members in the Patient Centered Primary Care Collaborative. We have been designated by the Agency for Healthcare Research and Quality (AHRQ) as one of the original 14 Chartered Value Exchanges, a multi-stakeholder collaborative that has taken clear action in its community to convene community purchasers, health plans, providers, and consumers to advance the four cornerstones of Value-Driven Health Care.  Working together with all, we will make healthcare in Louisiana better.

By:
Michael Fleming, MD
President, LHCQF Board of Directors

Quality Correspondent
Healthcare Journal of Baton Rouge