Article

How A Regional Collaborative Of Hospitals And Physicians In Michigan Cut Costs And Improved The Quality Of Care

BlueCross and Blue Shield of Michigan, Detroit, Michigan, USA.
Health Affairs (Impact Factor: 4.64). 04/2011; 30(4):636-45. DOI: 10.1377/hlthaff.2010.0526
Source: PubMed

ABSTRACT There is evidence that collaborations between hospitals and physicians in particular regions of the country have led to improvements in the quality of care. Even so, there have not been many of these collaborations. We review one, the Michigan regional collaborative improvement program, which was paid for by a large private insurer, has yielded improvements for a range of clinical conditions, and has reduced costs in several important areas. In general and vascular surgery alone, complications from surgery dropped almost 2.6 percent among participating Michigan hospitals-a change that translates into 2,500 fewer Michigan patients with surgical complications each year. Estimated annual savings from this one collaborative are approximately $20 million, far exceeding the cost of administering the program. Regional collaborative improvement programs should become increasingly attractive to hospitals and physicians, as well as to national policy makers, as they seek to improve health care quality and reduce costs.

Download full-text

Full-text

Available from: Mauro Moscucci, Jul 06, 2015
1 Follower
 · 
165 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pay for performance (P4P) has become a leading initiative for improving the quality of care in numerous countries around the world, most notably the United States and United Kingdom. However, the scientific evidence regarding the effectiveness of P4P for improving quality is quite thin. Applying a social capital perspective to the US experience with P4P, this article offers a conceptual analysis of the relationship between payers and providers relative to the prospect for improving the effectiveness of P4P as applied to quality of care. From this perspective, a key barrier to improving the effectiveness of P4P has been that payers and providers have not worked cooperatively in the design and implementation of these financial incentive programs. However, recent developments in the US health care system, namely, the formation of quality improvement collaboratives and global payment arrangements, are helping to redefine relationships between payers and providers that support innovative payment arrangements. These relationships are being redefined in ways that are in accordance with social capital concepts such as trust, commitment, and shared purpose. As such, the US experience offers lessons for improving the effectiveness of P4P in any context in which better cooperation between payers and providers is needed.
    Quality management in health care 22(3):187-198. DOI:10.1097/QMH.0b013e31829a6af3
  • Progress in Pediatric Cardiology 12/2011; DOI:10.1016/j.ppedcard.2011.10.003
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Payers, policy makers, and professional organizations have launched a variety of initiatives aimed at improving hospital quality with inpatient surgery. Despite their obvious benefits for patients, the likely impact of these efforts on health care costs is uncertain. In this context, we examined relationships between hospital outcomes and expenditures in the US Medicare population. Using the 100% national claims files, we identified all US hospitals performing coronary artery bypass graft, total hip replacement, abdominal aortic aneurysm repair, or colectomy procedures between 2005 and 2007. For each procedure, we ranked hospitals by their risk- and reliability-adjusted outcomes (complication and mortality rates, respectively) and sorted them into quintiles. We then examined relationships between hospital outcomes and risk-adjusted, 30-day episode payments. There was a strong, positive correlation between hospital complication rates and episode payments for all procedures. With coronary artery bypass graft, for example, hospitals in the highest complication quintile had average payments that were $5353 per patient higher than at hospitals in the lowest quintile ($46,024 vs $40,671, P < 0.001). Payments to hospitals with high complication rates were also higher for colectomy ($2719 per patient), abdominal aortic aneurysm repair ($5279), and hip replacement ($2436). Higher episode payments at lower-quality hospitals were attributable in large part to higher payments for the index hospitalization, although 30-day readmissions, physician services, and postdischarge ancillary care also contributed. Despite the strong association between hospital complication rates and payments, hospital mortality was not associated with expenditures. Medicare payments around episodes of inpatient surgery are substantially higher at hospitals with high complications. These findings suggest that local, regional, and national efforts aimed at improving surgical quality may ultimately reduce costs and improve outcomes.
    Annals of surgery 12/2011; 255(1):1-5. DOI:10.1097/SLA.0b013e3182402c17 · 7.19 Impact Factor