Cutting Cost of Care While Improving Quality

“From my perspective, we all have a common purpose, and that is to return healthy and satisfied employees to work faster and more affordably.”

Robert Mecklenburg, MD

Virginia Mason believes every patient should receive the best evidence-based care every time. Toward that end, it has identified 10 conditions where standardized, evidence-based care means superb quality at the lowest cost:

• Abdominal pain
• Asthma
• Chest pain
• Depression/anxiety
• Diabetes
• Headache
• Hyperlipidemia
• Hypertension
• Acute respiratory infection
• Urinary tract infections

For purchasers

Analysis has shown that these 10 conditions also have a negative impact on companies paying for their employees’ health care. Workers suffering from these conditions miss work, which creates an economic disruption for the employer.

Virginia Mason teams led by Robert Mecklenburg, MD, the medical director at the Center for Health Care Solutions, have worked closely with a variety of companies to define what constitutes quality from an employer’s perspective. This work, which Dr. Mecklenburg has been leading for 10 years, looks at care delivery not only from the patient’s point of view, but also from the perspective of the employer paying for care. The breakthrough here is the alignment of interest — defining quality so the interests of workers and employers are met simultaneously.

“From my perspective, we all have a common purpose, and that is to return healthy and satisfied employees to work faster and more affordably,” says Dr. Mecklenburg. He and his colleagues leverage primary care teams to reliably meet five performance specifications:

• Appropriate evidence-based care
• 100 percent patient satisfaction
• Same-day access
• Rapid return to function
• Affordable price for the provider and purchaser

“The goal is to have primary care teams use a systems-based approach to clinical care for frequently seen conditions with zero defects in quality,’’ says Ingrid Gerbino, MD, a faculty member at Virginia Mason Institute. “Using the clinical value streams can help restore our patients to fully productive lives in a manner that is patient-centered, efficient and effective.”

Another way Virginia Mason provides the finest care at the most affordable price is through its warranty for knee- and hip-replacement surgeries. Near the top of every employer’s wish list is the ability to provide quality health care for their employees at an affordable price. Far too often this seems like a futuristic aspiration. But this approach at Virginia Mason has made it a reality, demonstrating to employers throughout the Puget Sound region and beyond that this goal is achievable today.

John Levesque, managing editor at Seattle Business magazine, wrote in November 2014: “Rarely does a medical institution say it will stand behind its work and not charge patients for return visits if something goes wrong.”

Levesque’s article quoted Gary S. Kaplan, MD, Virginia Mason’s chairman and chief executive officer: “Under the current reimbursement system in our country, hospitals are often paid more for surgery that does not go well than for surgery that is completely successful. We find this unacceptable and contrary to the needs of patients, employers and insurers paying the bill.”

Levesque commented that “to hear [this] being uttered by the CEO of a hospital is refreshing, rewarding and remarkable.”

For the State of Washington

The approach discussed here works well for patients and employers, and these principles have now been extended to the State of Washington through the work of the Robert Bree Collaborative. Established by the state legislature, this collaborative seeks to ensure “public and private health care stakeholders would have the opportunity to identify specific ways to improve health care quality, outcomes, and affordability.” As explained by the Bree Collaborative:

Each year, our members identify up to three health care services with high variation in the way that care is delivered, that are frequently used but do not lead to better care or patient health, or that have patient safety issues. For most topics, we form an expert workgroup to develop evidence-based recommendations.

Dr. Mecklenburg serves as chair of the work group that has developed bundled payment models and warranties for total joint replacement and lumbar fusion. The work group recently started creating a bundle/warranty for coronary artery bypass graft surgery.

“A warranty provides significant value for purchasers,” says Dr. Mecklenburg. “It means a fixed price for a transparent, standardized patient pathway and builds appropriateness standards into the bundle to avoid unnecessary surgery. Also built in is accountability for nine avoidable complications resulting in readmission to the hospital. The fixed price and warranty mean purchasers are not accountable for paying for avoidable mistakes. Virginia Mason can offer the warranty created by the Bree Collaborative because of our confidence in evidence-based, appropriate care backed up by reliable systems.”

One of the most powerful trends in health care nationwide is toward increased transparency in relation to quality and cost, and the work of the Bree Collaborative is an important step in that direction. Says Dr. Mecklenburg, “What Bree has achieved is a standard for production, purchasing and payment for the State of Washington, a standard in the public domain that is available to any provider group, purchaser or health plan, a standard created by multiple stakeholders and a multitude of contributors.”

Virginia Mason has committed to the quality standards created by the Bree Collaborative. It believes the Bree work over time will result in better, more affordable care for purchasers and patients throughout our state.

How is your organization building in standards that ensure higher quality and lower cost of services?