While the nation has been focused on the recent Supreme Court ruling on the Affordable Care Act, innovations in hospitals and physician practices far from Capitol Hill have been triggering an historic transformation of our health care system. Propelled by a mix of urgency and vision, innovators at hospitals, physician groups and companies are remaking American health care by demonstrating that more effective and affordable care is achievable quite apart from statutory changes in Washington.
These organizations are working to achieve the Triple Aim: improve the health of the population; enhance the patient experience of care (including quality, access, and reliability); and reduce, or at least control, the per capita cost of care. This approach, developed by the Institute for Healthcare Improvement, is a sharp break with the traditional focus on single encounters with patients within the strict walls of health care delivery, typically addressing only the most immediate problems.
The Triple Aim has providers focus instead on each patient’s overall health care experience while simultaneously managing the health of populations of patients, especially those with debilitating and expensive chronic conditions. Doctors and hospitals in pursuit of the Triple Aim acknowledge their profound responsibility as stewards of our finite national resources.
These innovators recognize that health care consumes 17.9 percent of GDP, and that, as a result, other societal needs, especially education and social services, have been forced to make do with much less.
To really understand the transformative power of the innovations we’ve seen firsthand, consider one example at HealthPartners in Minnesota. Their Optimal Diabetes Measure recognizes that patients with diabetes will be much healthier if they meet the five items within the optimal measure: no smoking, regular aspirin use, and control of blood sugars, cholesterol and blood pressure.
This standard is so tough to meet that when HealthPartners leaders initiated the measure back in 2003, a mere 1.8 percent of HealthPartners patients with diabetes met all five measures. Through years of innovation in how primary care is delivered, HealthPartners has reached a point where 43 percent of patients with diabetes meet the standard. And in some patient panels clinical teams have pushed that up over 60 percent.
And the impact of this work on cost? At HealthPartners the cost for patients with well-managed diabetes is about $1,500 per year. For patients whose diabetes is poorly managed – about $20,000 per year. Consider the national implications of the HealthPartners work in light of the fact that three-quarters of the $2.75 trillion spent annually by the U.S. goes to treating chronic conditions.
Atul Gawande, surgeon and author, has observed that despite all the challenges in health care “there is hope. . . We can look to the top performers—the positive deviants—to understand how to provide what society most needs: better care at lower cost.”
In the midst of the health care turbulence roiling America, we can look to the “positive deviants” to find innovations with the collective power to transform our health care system. We hear constantly of the urgent need for change in foundational areas of health care, as though these problems were awaiting solutions. But the reality is that on the front lines of care innovators – such as those at HealthPartners – are demonstrating workable solutions to some of the nation’s most difficult health care challenges:
Shift the payment system away from wasteful fee-for-service to global payments that incent quality and reduce waste? It is a reality at Atrius Health and a dozen other provider organizations in Massachusetts, where a Harvard Medical School study found that after just one year the new approach resulted in better quality care and slightly lower medical spending.
Harness the purchasing power of major corporations to buy high-quality evidence-based care while reducing waste and cutting costs? It is happening at Virginia Mason Medical Center and Intel in Portland, Oregon, where a new approach to treating common back pain resulted in cost savings of 10-30 percent, same-day access and patient satisfaction at 98 percent, and the use of evidence-based medicine at 96 percent.
Shift effective primary care out of the clinic and into the workplace to improve a wide variety of health conditions and reduce the cost of care? It is a reality at Bellin Health in Green Bay, Wisconsin, which has worked with hundreds of companies to locate caregivers at the jobsite. A Commonwealth Fund study of nine companies using Bellin’s services reported health care costs 21 percent below the national average.
Spread a patient- and family-centered care methodology that measurably improves patient-centeredness and improves outcomes? It’s happening at UPMC in Pittsburgh, starting in orthopedics and now in dozens of other medical departments.
· Reduce emergency department use by 40 percent and hospital admissions by 30 percent by providing high quality primary care to Medicaid patients? It is a reality at several clinics that contract with CareOregon.
Take on a number of these challenges simultaneously? Kaiser Permanente in California and elsewhere is doing so through its internal drive to spread innovation quickly across multiple sites, affecting and improving the care of millions of patients.
Solutions to most of the major challenges in American health care are out there hiding in plain sight. We need to do a better job of identifying, celebrating and spreading this important work.
Maureen Bisognano, CEO of the Institute for Healthcare Improvement, and Charles Kenney are the authors of Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs (Jossey-Bass, 2012).