Under the tab of “why didn’t we think of that” comes news that Dartmouth College is establishing the “Dartmouth Center for Health Care Delivery Science.”  The center’s basic mission is to show how health care can be improved without increasing costs and how costs can be lowered without impacting quality. 

Dartmouth is a natural for this sort of endeavor primarily because it is home to the Dartmouth Institute for Health Policy and the Dartmouth Atlas of Health Care, which have been studying variation in health care delivery and spending for a couple of decades.  But while the Atlas gives Dartmouth the data, the college’s home state, New Hampshire, isn’t exactly a shining example of health care value. 

At more than $7,800 per Medicare recipient per year, New Hampshire spends nearly 20 percent more than Iowa ($6,686).  Of course, that’s not nearly as bad as nearby Massachusetts ($9,568) or New York ($9,995), both of which should provide convenient laboratories for what not to do for value-based health care delivery. 

This is worth noting because of something Dartmouth’s president, Jim Yong Kim, mentioned when the center was announced over the weekend.  According to Associated Press coverage of the story, Kim and state leaders have “discussed using the center to make New Hampshire a model for innovative health care.” 

This brings one thought immediately to mind: Why not Iowa? 

Obviously, Dartmouth has every right and reason to focus on its home state.  But this deserves serious consideration in Iowa, where IHA has made “value” a health care watchword.  Certainly, the tools and the people are there. The Iowa Healthcare Collaborative has united hospital and physician interests under the value flag and, like the Dartmouth Atlas, has become a vast data collector.  

The University of Iowa (UI) and Des Moines University both offer excellent schools of health care administration and medicine with easy access to not only urban medical centers but also nearby rural referral centers and Critical Access Hospitals, many of which are on the cutting edge of innovative health care delivery models.  The schools of engineering at UI and Iowa State, along with major businesses (including hospitals) that have adopted ideas like Lean and the Toyota model of process improvement, offer expertise and laboratories for systems analysis. 

What Iowa doesn’t have is seed money, like the $35 million that was anonymously donated to fund the Dartmouth center.  Perhaps if we can broaden our state leaders’ views on what drives a healthy economy (hint: it’s more than wind turbines and gambling halls) and quality of life (more than good schools and smooth roads) to realize the impact of high-value health care, some investment capital might emerge.

Leave a Comment

The White House has released rules concerning the provision in the health care reform law that allows young adults to stay covered under their parents’ insurance up to age 26. The U.S. Department of Health and Human Services has estimated this proposal would expand access to 1.2 million young adults across the country.

The rules do not go into effect until September 23, although several insurance companies across the nation, including Wellmark Blue Cross and Blue Shield of Iowa, have elected to implement the policy earlier.

Trends show that patients in the young adult age group are less likely to have insurance, which places burdens on hospitals in areas with high volumes of young adults. Mike Tretina, CFO at Mary Greeley Medical Center in Ames, home to Iowa State University, says that the hospital has budgeted $670,000 in uncompensated care to offset the cost of treating students or other young adults who do not have insurance.

Tretina hopes that the new provision will help to encourage parents to add their children to their coverage to reduce the number of young adults who are uninsured, and thereby reduce uncompensated care costs for hospitals.

Since 2008, Iowa law has allowed young adults up to age 25 to stay on their parents coverage.  The new federal provision adds an additional year, but it’s up to parents and young adults to take advantage of these benefits.

Nationwide, according to a White House fact sheet, estimates show that young adults comprise the largest percentage of uninsured of any age group, with an estimated 1 out of every 5 uninsured American falling in this age group.

Leave a Comment

The 2009-2010 flu season is coming to a close.  Except for localized cases in the Southeast, Maine and Hawaii, current H1N1 flu information from the Centers for Disease Control and Prevention indicates sporadic activity in most of the U.S. and no activity in Iowa and most of the Upper Midwest. 

Evaluation is underway and official reports will be published in the coming months, but one conclusion is obvious: the flu season was expected to be much worse than it actually turned out to be. 

Why? 

While the official and scientific response to that question is in the works, an interesting bit of data was provided by a recent post on the Gallup Web site.  Since September 2009, Gallup has randomly called 1,000 Americans a day and asked them, “Were you sick with the flu yesterday?”. 

For seven of the eight months between September and April, the percentage of people who self-reported flu symptoms was lower in 2009-2010 than during the 2008-2009 flu season.  The same was true for people who were asked if they had a cold the previous days.

So, surprisingly, on any given day fewer people were sick this flu season compared to that last one.  The reasons are complicated and, as noted, being figured out.

But at least partial credit for this decline goes to efforts to inform and educate the public about the flu, how to prevent its spread and, of course, constantly pushing people to get vaccinated, Gallup concluded.  People washed their hands, sneezed into their elbows, stayed home when they were sick and went out of their way to get their shots.  And they reminded their families and friends to do the same.

Hospitals played an important role in all of this.  Hospitals were not only a source of vaccine, but also a source of expert information that was disseminated to the community through a large corps of knowledgeable, trusted health care professionals. 

In most communities, no other entity – public or private – could have fulfilled the mission that hospitals did during the 2009-2010 flu season. 

Hospitals also increased their credibility in this potential crisis by setting the example – by diligently enforcing hygiene policies and pressing employees to get vaccinated.  This is why, nationwide, hospital employees had higher vaccination rates than all other health care workers – nearly 75 percent, versus about 50 percent for all other workers.  Hospitals that required vaccination had a 97 percent rate. 

Final results are still being tabulated, but expect Iowa hospitals to fall somewhere between 80 and 90 percent for their employee vaccination rates.  Not a bad result, but you can count on hospital leaders to be pushing their staffs to do better.

Leave a Comment

It’s official: Health care reform guru Donald Berwick has been formally announced by President Obama as his nominee to head the Centers for Medicare & Medicaid Services (CMS).  The first sentence of the president’s two-sentence statement about Berwick succinctly addresses why he was chosen: “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost.” 

Bringing real value to government-supported health care will be Dr. Berwick’s foremost challenge.  And with health care reform set to trim billions of dollars from the Medicare program while adding millions of new enrollees to Medicaid, it is a formidable challenge, indeed. 

But Dr. Berwick has two things going for him.  First, he knows what he is talking about.  His work and leadership at the Institute for Healthcare Improvement (IHI), which he cofounded nearly 20 years ago, has led to changes in the way hospitals provide health care that have saved lives, lowered costs and improved quality.  IHI’s current initiative, it’s “Improvement Map,” is perhaps its most ambitious.  

The Improvement Map is an interactive, Web-based tool designed to bring together the best knowledge available on key process improvements that lead to exceptional patient care. It offers clear guidance through the often confusing health care landscape, helping hospitals set change agendas, establish priorities, organize work and optimize resources.  The Improvement Map is also a testament to IHI’s dedication to shared learning, which it established from its beginning through collaboratives, learning networks and mentor hospitals (among these are Mercy Medical Center and St. Luke’s Hospital in Cedar Rapids, University of Iowa Hospitals and Clinics in Iowa City and Buena Vista Regional Medical Center in Storm Lake). 

But leaders succeed only when they energize followers, and that is Dr. Berwick’s other strength.  Throughout the medical world, Dr. Berwick is highly respected not only for his ideas but for his ability to bring key players to the table and keep them there.  Time and again, Dr. Berwick has been described as “a visionary.”  Hospital leaders in Iowa continue to be pleased about his nomination: 

“I was very excited to hear of the nomination of Dr. Don Berwick as the administrator for CMS,” said Jim FitzPatrick, CEO at Mercy Medical Center-North Iowa in Mason City.  “Dr. Berwick has spent his career on a quest for improving quality in the nation’s health care system.  His passion for improving processes for our patients and keeping focus on the ‘big dot’ issues to eliminate defects in care makes him the perfect leader for CMS. 

“Dr. Berwick’s appointment to CMS would be very positive for the health care industry,” said Eric Lothe, administrator at Iowa Lutheran Hospital in Des Moines.  “He has a long history of setting transformational goals for health care quality and then achieving great results.  Dr. Berwick would continue the focused work of IHI to help physicians and hospitals improve quality, reduce errors and eliminate adverse events.” 

The real question is, can Dr. Berwick’s ability to unite diverse interests come through in a U.S. Senate that remains bitterly divided over health care reform?  Can he show that not only can Medicare and Medicaid lead the way in improving care, but they can do it at less cost?  And can he hold his ground should talk of “rationing” and perhaps even “death panels” rear its ugly head? 

Answers should come fairly quickly, as Dr. Berwick’s first stop will be in front of the Senate Finance Committee and its ranking Republican, Iowa’s own Chuck Grassley.

Leave a Comment

One of the great minds and motivators behind the national movement to improve health care quality is slated to become the next administrator of the federal Centers for Medicare & Medicaid Services (CMS).  In anticipation of his nomination by President Obama (not yet official, but confirmed to multiple major media outlets by administration officials), Iowa hospital leaders are pleased with the thought of Dr. Donald Berwick running these important programs. 

They should be.  Much of what is right about Iowa health care – low-cost, high-quality, patient-centered and primary-care based – is what Dr. Berwick would like to see happening in the rest of the country.  If Dr. Berwick is confirmed to the post (something that probably won’t happen quickly, given the tumult surrounding the recently passed health care reform legislation), it wouldn’t be surprising to hear him talking about Iowa early on and often. 

As many Iowa health care providers know, Dr. Berwick runs the Institute for Healthcare Improvement (IHI), which focuses on “cultivating promising concepts for improving patient care and turning those ideas into action.”  One of IHI’s recent initiatives was “How Do They Do That?,” which provided regional case studies of high-value care.  

Out of hundreds of hospital referral regions (HRRs) around the country, 70 met IHI’s selection criteria.  With all eight of its HRRs meeting the criteria, only one other state had more representation than Iowa among the final 70 (California, which has two dozen HRRs, had nine that met the criteria).  One of the 10 HRRs selected to share their How Do They Do That? story was Cedar Rapids, and the CEOs of both of the city’s hospitals are excited about the prospect of Dr. Berwick leading CMS. 

“The selection of Dr. Berwick by President Obama to lead CMS is an inspired choice, particularly at a time of unprecedented rethinking of health care in our nation,” said Tim Charles, CEO at Mercy Medical Center-Cedar Rapids. “In 2003, our hospital joined with IHI because of Dr. Berwick’s commitment to the triple aims of improving patient experience, per capita cost and population health. I am certain these principles will act as his ‘true north’ as he guides CMS. 

“I have come to know Dr. Berwick more personally this past year and respect his commitment to our health care system. His identification of Cedar Rapids as a model suggests he would bring to his new role the recognition that our community is well down the road to achieving both its potential and promise as a provider of high-quality, low-cost care. We look forward to working with him.”

 “CMS could not be in more capable hands if Dr. Berwick is appointed its director,” said Ted Townsend, St. Luke’s Hospital president and CEO.  “I had the privilege of getting to know Don on a personal level after he invited a contingent of health care leaders from Cedar Rapids to IHI’s National Conference last year to talk about how Cedar Rapids provides high-quality, low-cost care.  Additionally, in his role at IHI, Don has worked with St. Luke’s and countless of other hospitals across the county to reduce errors, waste and preventable deaths. He is the perfect person to engage hospitals, doctors and health care providers to constantly strive to provide high-quality, low-cost and safe care.” 

Other hospital leaders have also spoken up in support of Dr. Berwick. IHA will share their thoughts in an upcoming post.

Leave a Comment