What health reform looks like in the real world, right now

Susan DeVore, the CEO of the Premier healthcare alliance, writes about the lessons health reformers can learn from its efforts to drive quality improvement and costs savings in hospitals.

A year ago, 157 hospitals in the Premier healthcare alliance set out to see if they could deliver better care to save lives, while simultaneously saving money.

As it turns out, they can. And there is a lesson from this effort for Congress as it struggles to find practical solutions to improve health care quality and control spending. Cutting costs while improving care is the holy grail of healthcare reform. If we can bend the curve of healthcare costs, we stop the system from careening toward insolvency and make coverage more affordable.

Premier, an alliance of 2,200 not for profit hospitals, created QUEST (for “Quality, Efficiency, Safety and Transparency), in partnership with the Institute for Healthcare Improvement, to find ways to holistically improve healthcare. To participate, hospitals joining the collaborative agreed to transparently share data and results with one another; adopt tough measures; and then observe and implement new ways of providing care to enhance quality.

This wasn’t some academic study. We pulled performance statistics on deaths, costs and effective care. We then figured out what is driving deaths, errors and excessive costs, devising the best ways to prevent them and setting aggressive improvement goals. After just one year, we estimate QUEST saved 8,043 lives, or 14 percent fewer deaths than expected. At the same time, hospitals also saved $577 million, or $343 per patient discharge.

This was real hospitals using real measures to learn what gets the best results, which in addition to the depth and breadth of the study makes it relatively unusual. At the end of our first year, we achieved the best kind of result in our profession – lives saved. And as an added benefit, we learned how to shave costs while also improving the quality of care.

We could have waited for Congress to first pass reform before acting, but we didn’t because we know there are things hospitals and doctors can do right now to fix some of our biggest problems. Given the fact that healthcare costs us more than $2.3 trillion a year, more than any other country, and our quality is worse than most industrialized nations, we didn’t believe patients could afford to wait for reform.

In many cases, we’re talking about implementing systems and protocols to make sure we provide focused interventions that drive high-quality care. So, for instance, heart-attack victims get aspirin and a beta blocker as soon as they arrive at the hospital; an organized rapid response team is on standby; heart monitors are used appropriately; and clear medical instructions are given at discharge so they don’t wind up back in the hospital.

These are workable solutions built on a foundation of transparency and collaboration that hospitals can start adopting right away. We estimate that if all the nation’s 5,000 hospitals had made the same level of improvements, we would have saved 52,000 additional lives last year – or, the entire population of a small city.

It is important to bear in mind that this was a voluntary effort. There weren’t any financial incentives for our hospitals to get involved; in fact, there were good reasons not to. But they did it because it was the right thing to do. This is why Congress needs to enact payment and delivery system reforms such as value-based purchasing to properly align the incentives and reward hospitals for better outcomes.

In doing so, perhaps the other 4,800 hospitals in American will join us, and together we can take a huge step on the road to transforming our healthcare system.