Health Affairs

Two Studies Focus On Delivering Quality Care, Reducing Costs, And Reaching Underserved Rural Populations

Bethesda, MD -- The Affordable Care Act of 2010 is expected to extend health coverage to some thirty-two million previously uninsured Americans. Two of the many challenges faced by both the private sector and the government are getting a handle on rapidly rising medical costs and providing care to the many new enrollees with chronic illnesses who are living in medically underserved areas. Health Affairs is releasing two studies today as Web Firsts, which describe programs tackling these issues.

How Intermountain Trimmed Health Care Costs Through Robust Quality Improvement Efforts
By Brent C. James and Lucy A. Savitz
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2011.0358

 

James is the chief quality officer and Savitz is director of research and education at the Institute for Health Care Delivery Research, Intermountain Healthcare in Salt Lake City.

 

Intermountain Healthcare is an integrated delivery system based in Utah and Idaho that provides more than half of all health care in that region. It has been identified as a low-cost, high-quality provider and has made demonstrated improvements in clinical quality that have lowered the cost of care delivery. By adopting the process management techniques of W. Edwards Deming and focusing on the processes of care delivery, Intermountain has learned to streamline its operations. While checklists, order sheets, and clinical flowcharts are routinely used, clinicians are comfortable modifying these guidelines when an individual patient’s particular needs warrant it. To make its system function smoothly, Intermountain identified 1,400 unique inpatient and outpatient work processes, and discovered that 104 of these accounted for 95 percent of its care delivery. It then built evidence-based best practice guidelines, outcomes tracking data systems, and management structure around high-priority clinical processes. For example, Intermountain estimates its labor induction protocol is able to reduce costs in its Utah centers by $50 million per year. Based on Intermountain’s experience, the authors predict that organized care delivery groups will ultimately succeed in “bending the cost curve” if “[r]esearchers...partner with practitioners to evaluate and demonstrate innovative financial alignment models...that can provide ‘the best clinical result at the lowest necessary cost.’”

Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care
By Sanjeev Arora, Summers Kalishman, Denise Dion, Dara Som, Karla Thornton, Arthur Bankhurst, Jeanne Boyle, Michelle Harkins, Kathleen Moseley, Glen Murata, Miriam Komaramy, Joanna Katzman, Kathleen Colleran, Paulina Deming, and Sean Yutzy

Financial support was provided by the Robert Wood Johnson Foundation, the Agency for Healthcare Research and Quality, and the New Mexico State Legislature.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2011.0278

 

Arora, Dion, Som, Thornton, Boyle, Moseley, Komaramy are with Project ECHO at the University of New Mexico (UNM) School of Medicine in Albuquerque; Kalishman, Bankhurst, Harkins, Katzman, Colleran, Deming, and Yutzy are also affiliated with UNM; Murata is chief of the Epidemiology Section at the New Mexico Veterans Affairs Health Care System.

 

Project ECHO (Extension for Community Healthcare Outcomes) is an innovative new model of health care education and delivery in New Mexico. It uses state-of-the-art telehealth technology and care-based learning, enabling specialists at the University of New Mexico Health Sciences Center in Albuquerque to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with a host of chronic diseases. The program was originally developed for combating hepatitis C.

Primary care physicians in rural areas receive specific training to make the program a success. They travel to the University of New Mexico’s School of Medicine in Albuquerque for orientation and to learn the treatment protocol as well as the communications technology and cased-based presentation format for the weekly two-hour telemedicine clinics that lie ahead. The clinics, lead by the Albuquerque-based specialists, serve to review and discuss the rural patients’ needs with the primary care provider teams. The teams typically include physicians, nurses, and physician assistants and are organized into a disease-specific learning network.

Encouraged by the success dealing with hepatitis C, Project ECHO has expanded to address asthma, chronic pain, diabetes, and cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, pediatric obesity, rheumatology, substance abuse disorders, and mental illness. As of March 2011, 298 ECHO teams across New Mexico were delivering specialty care for these various conditions. Project ECHO is a cost-effective care model for others to replicate. “It creates partnerships between primary care providers in rural and underserved areas and specialty care providers at academic medical centers that allow for the sharing of new knowledge in real time,” say the authors. “These partnerships exponentially boost the health care system’s ability to deliver specialty care to people who otherwise would lack access…[and] uses technology and existing resources to magnify the capacities of the health care workforce, build a bridge across health care settings, and truly provide health care without walls.”

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at www.healthaffairs.org. You can also find the journal on Facebook and Twitter and download Narrative Matters on iTunes. Address inquiries to Sue Ducat at (301) 841-9962 or sducat@projecthope.org