A Portland, Oregon-based healthcare collaboration involving an insurer, a Seattle hospital system and an information technology company has reduced treatment costs, improved patient satisfaction and eliminated thousands of hours' worth of wasted work, according to a case study published in the Harvard Business Review.
The Healthcare Marketplace Collaborative (HMC) began in 2009 when Intel faced healthcare costs projected to reach $1 billion by 2012. After limited success with initiatives such as wellness programs and on-site clinics, the company created a pilot program with Virginia Mason Medical Center and insurer Cigna that implemented new clinical processes for six common medical conditions: lower back pain, headaches, upper respiratory illness, breast problems, diabetes, and shoulder, knee and hip pain.
The collaborative encouraged area providers to implement best practices for the conditions, tailored to the individual hospital or system. Virginia Mason assisted in developing the best practices. Over the course of five years, direct treatment costs for lower back pain fell 23.5 percent, while costs for headaches dropped 49 percent and costs for shoulder, knee and hip pain declined 37.7 percent, according to the HBR report. The pilot's success was the result of several characteristics, including:
Clearly establishing each player's contribution: The pilot involved input from Intel, which contributed its customer base; Cigna, Intel's insurance provider, which supplied claims data; providers Providence Health & Services, a multi-state system headquartered in Renton, Washington, and Tuality Healthcare, an independent hospital in Portland, which brought increased access and, due to their different sizes, diverse healthcare perspectives; and physician leaders, represented by study co-author Robert Mecklenburg, M.D., of Virginia Mason, who helped guide the other participants and acted as an adviser.
Flexibility: The broad variation between operations at individual healthcare providers means initiatives such as HMC cannot be one-size-fits-all; with this in mind, HMC gave Providence and Tuality leeway to decide if and how to adopt each process.
Priorities based on importance and difficulty: Intel analyzed Cigna claims data to identify the six conditions that would yield the most return on investment. The collaborative used four factors to identify these conditions: impact and expense for patients; amount of risk and complication; ease of standardization; and overall gain for the health system.
Simple, easy-to-understand goals and metrics: For example, HMC set up measures for faster care that used a measure that combined same-day access and how quickly patients returned to function; better care, measured by a combination of patient satisfaction and whether patients received evidence-based care; and more affordable care, measured by total cost to employer and patient while also incorporating the return-to-function measure. Affordability was particularly important, as the collaborative's goal was to actively reduce prices rather than slow the rate of growth.
To learn more:
- here's the study abstract (subscription or registration may be required)