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  • 25th National Forum: Changing the World by Improving Health and Health Care
    Nov 21 2013 The following is part of a series of guest posts celebrating the 25th Anniversary of the IHI National Forum Eugene Nelson DSc MPH is Professor of Community Family Medicine at The Dartmouth Institute TDI Director of the Population Health Measurement Program TDI and Director of Population Health and Measurement at Dartmouth Hitchcock Medical Center Nelson is also a member of the small group of pioneers who began meeting in the late 1980s and whose collaboration and ideas led directly to the birth of IHI Looking back to the birth of IHI and the first National Forum 25 years ago we recognized that quality of care was not nearly good enough We believed that to enable health systems to improve quality we needed to start a movement to bring modern improvement science into health care and to popularize quality improvement principles and methods as a better way to build a better system to better serve patients The first National Forum was a big event at the time with more than 300 people in attendance Little did we know that a few decades later thousands of people would participate IHI has great leaders Maureen Bisognano Jeff Selberg Derek Feeley Don Goldmann and many others and an incredible staff IHI leaders and staff and faculty all continue to be inspired by Don Berwick the first president of IHI and Paul Batalden the first Board Chair of IHI and longest serving Board member The National Forum has become a gathering place for the old guard and a meeting place for the vanguard It s a place for people who are committed to improving health and health care for patients and for populations It s a place for people who are demonstrating new ways to both improve and to innovate It s a place for people who have embraced the Triple Aim better health better care and lower costs And the Forum has become both an international event and a virtual learning festival allowing people from all over the planet to take part without even leaving their hometowns Looking to the future I hope that IHI can continue to advance health care delivery science and population health so that more people in more places can enjoy better health and live better lives I hope that IHI can continue to find innovative ways to measurably improve the outcomes and value of health care for patients and populations I hope that IHI can continue to improve the work life of the health care professionals who have elected to devote their lives to taking care of people who need help and health care And I hope that IHI will spark even more improvement and even more innovation in every corner of the world Gene Nelson Tags Leadership National Forum Triple Aim Population Health Individual Care and Cost Control Optimization 25th Forum Anniversary innovation Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=36 (2016-02-01)
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  • The Big Barrier to High-Value Health Care: Destructive Self-Interest
    something truly new Each small success however is helping to build a foundation for a system that will focus on the people who should matter the most workers and their families One of the best kept secrets in the United States is that workers pay almost all of the costs of their health care They do so through employee contributions to premiums out of pocket payments for services a shift of compensation dollars from wages to benefits and state and federal taxes such as the payroll tax that supports Medicare But instead of serving workers best interests by trying to give them the best care at the lowest cost insurers providers employers and unions act like adversaries Insurers leverage their purchasing power to exact discounts from providers and their administrative power to reduce benefits Dominant providers leverage their market position to raise prices independently of cost or quality Employers leverage their power in labor markets where workers have limited job options to extract higher deductibles and out of pocket payments from employees Unions which now represent a tiny share of American workers resist to the extent they can The numbers spell out the sorry result On average family premiums and out of pocket costs are about 40 of median household income and even more if the payroll tax for Medicare is included Meanwhile health care outcomes for the population as a whole are improving at a rate far slower than premiums are increasing This continuing transfer from wages to health care does not reflect better value for money To get on to the pathway to lower total costs with better outcomes like the parties involved in the mid Atlantic region are trying to do players in other regions must understand that they are in a common system with a common pool of limited resources and that separate zero sum strategies are destructive With that in mind they must seek four changes 1 Establish Common Goals The goals should reflect the Triple Aim articulated by the Institute for Healthcare Improvement again better care for individuals better health for populations and a lower per capita cost Each should be measured reported transparently and tracked over time The metrics of per capita cost should include health care premiums paid directly by the wage earner and indirectly by the employer from the compensation pool as well as payroll taxes to support Medicare Goals should include a mutually agreed distribution of the risks and benefits of cost reduction among all actors 2 Build Trust Among the Actors Lack of transparency stifles competition based on real value and encourages leveraging strategies Shared measurement systems and unprecedented and complete transparency about costs and outcomes will help build trust among former adversaries Key to trust is an agreement in advance on consequences when cost and outcome goals are not met This is hard work and failure will happen therefore it is essential to test ideas on a small scale and increase the scope of the system change as

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=34 (2016-02-01)
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  • Constraints on Health Care Budgets Can Drive Quality
    has been a marked reduction in the use of emergency beds for patients over 75 That said many of the strategies put in place are still in their early stages and their results in terms of patient outcomes won t be clear for some time Nonetheless it s not too early to declare that NHS Scotland has made significant progress in creating the foundations for achieving the Triple Aim The Affordable Care Act and the emergence of accountable care organizations ACOs provide an opportunity to rethink not just how U S systems are organized for care but also how to forge new relationships and partnerships between clinical groups between clinicians and patients and among communities and populations The possibilities opened up by these changes are profound But in order to optimize their potential health care systems need to change their perspective from focusing on volume provide as much care as possible to focusing on value provide the highest quality care possible Changes in payment models may reinforce these changes The traditional fee for service model prevalent in the United States has driven health care policy and practice placing a stronger emphasis on volume of care than on quality If some of the early proponents of accountable care are correct that the Affordable Care Act will lead to a transition in payment models from fee for service through bundled payments and towards fixed budgets then U S health care would do well to benefit from the lessons already learned in countries where these constraints have been the norm Here s what we learned in Scotland In an environment where generating revenue by increasing the volume of hospital care is not an option success requires doing the following things well Balance Investments in Population Health and Treatment The challenges facing health care demographic change multiple morbidities obesity etc are such that unless systems invest in improving population health to reduce demand for sick care they risk being overwhelmed A fixed budget forces you to invest in wellness Investments we made in Scotland include national programs to improve behavioral health and early detection of cancer and targeted programs to reduce disparities in the prevalence of heart disease Work with Outside Partners on the Social Determinants of Health Once you prioritize wellness you are forced to think beyond the 20 that health care contributes to improving people s health and address the behavioral social and environmental issues that make up most of the other 80 Members of the health care sector need to stop thinking that they can do all of this heroically on their own Instead they should start thinking about being a better partner in communities and working with schools voluntary groups housing authorities faith based groups and other community activities to promote wellness Earlier this year we launched the Early Years Collaborative which aims to give all Scottish children the best start in life Already the collaborative has pulled together health care workers social care workers the police and education professionals

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=32 (2016-02-01)
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  • Did You Miss the Bus? Achieve the Triple Aim On the Road
    Bennet the Family Van s executive director got down to the nitty gritty of what designing a mobile health van and putting it on the road actually entails Dr Anthony Vavasis drove us through the streets of New York City to explain the critical support his health center s mobile health clinic offers to LGBT youth Dr Leo Lacayo who co founded the Health Hut in Louisiana gave listeners a sense of how vital mobile health clinics are to communities in rural areas and wide open spaces where residents often live far apart Finally IHI s Ninon Lewis who works with Triple Aim initiatives across the country offered her thoughts on where these innovative clinics fit in the path toward the IHI Triple Aim And listeners contributed too In Norwalk Connecticut Eva Beau s Medical Mobile Unit is making a huge impact in public housing units and at a homeless shelter after only 9 months Janet Cuddigan s Mobile Nurse Managed Clinic in Nebraska is providing comprehensive geriatric assessments to older adults through the University of Nebraska Medical Center In Northeast Indiana mobile mammography has been an asset to the community for eight years now Our 9 12 WIHI also featured great questions from our listeners Here s a sample Khin Kyemon asked Is there an interest in being connected to a hospital or community health center Are you interested in pursuing insurance reimbursement for your services Mistie asked What is your approach in addressing the various degrees of patient activation and engagement to get patients to begin changing their diet and exercise Carol asked What standard benchmarks are being measured to demonstrate improvement in operations and outreach over time We are trying to capture health improvement with recurring patient visits but are interested in understanding what other scorecard measures can be valuable to the mobile health clinic Jodi asked With the cost of healthcare rising even for those who are insured how do you attempt to prevent abuse of this service This is just a quick glance at what our listeners have to say and wonder about with mobile health clinics You can find the archived audio transcript of the complete CHAT and related resources here at IHI org Up next on WIHI we ll take a look at the work in progress that is patient and family centered care and how patient engagement impacts outcomes safety and quality of care What Recognizing Person and Family Centered Care Always Events at IHI When Thursday September 26 2013 at 2 00 EST Tags WIHI Triple Aim Population Health Individual Care and Cost Control Optimization Patient and Family Centered Care Mobile Health Map health clinics Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=57 (2016-02-01)
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  • From Universal Coverage to Universal Quality
    I loved most about the building was its symbolic message Walking through the main entrance you have two options on one side is a wing focused on clinical care and on the other a wing devoted to prevention and public health Nearly nine decades ago the building s designers recognized the importance and connection of both clinical care and overall wellness The message the design conveys is clear we ve got to do both well As I toured the Ministry of Health building I couldn t help but wonder what the health of populations in Mexico and elsewhere would look like today if the holistic vision embodied by the architecture had taken hold and become rooted in our cultures Unfortunately throughout most of the world today too many resources go to sick care rather than prevention and wellness Tens of millions of men and women around the globe have fallen into lifestyles and habits that lead to poor health and disease While in Mexico City news came that Mexico has overtaken the United States in the incidence of obesity These challenges are becoming increasingly common highlighting the need for information sharing and two way learning At the same time I was impressed by much of the work being done in Mexico and throughout Latin America to improve health I spoke to more than 500 delegates thousands more attended virtually at the Latin American Summit which was convened jointly by Mexico s Ministry of Health the National Academy of Medicine of Mexico and IHI I was privileged to share some of IHI s latest thinking on the importance of a broader understanding of care and health and was able to hear about so much inspiring work being done around the globe One of the most encouraging signs coming out of this Summit was the remarkable progress many Latin American nations have made toward universal health coverage The World Bank noted this impressive trend in a February article pointing out that Latin American countries are currently leading the charge in the direction of universal coverage In Mexico for example Seguro Popular popular health insurance has achieved universal coverage in less than 10 years with more than 50 million previously uninsured citizens now covered an amazing achievement Now the challenge for Mexico as for so many countries is to strive toward realizing the vision represented by the powerful symbolism in their health ministry building integrate great clinical care with a broader and deeper understanding of health prevention and wellness to move from universal coverage to universal quality Maureen Bisognano Tags Leadership public health and leadership Prevention and Wellness Latin America Triple Aim Population Health Individual Care and Cost Control Optimization Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by David Dhanraj 8 7 2013 2 36 25 PM The data from World Bank is bittersweet for me I m encouraged by how universal

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=26 (2016-02-01)
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  • Overuse and Underuse: Consider Colonoscopy
    also does not guarantee prompt appropriate referral and follow up even when doctor and patient agree that screening is indicated The gap between evidence and practice remains large Another issue is that both doctors and patients tend to equate screening with the more extensive and invasive colonoscopy procedure even though there is scant evidence that it is superior to FOBT and flexible sigmoidoscopy not surprisingly most patients end up getting the more expensive and invasive procedure as the default test Some doctors have built a profitable business around colonoscopy which often is performed in special ambulatory procedure centers Procedures such as colonoscopy seem to defy usual economic principles excess capacity and availability of these tests has not yet lead to meaningful competition on price Moreover as pointed out by Rosenthal in the New York Times article many patients such as those over 75 for whom routine colon cancer screening is not recommended are being sedated and scoped Since this procedure is not without risk especially in the elderly dehydration and renal injury perforation of the intestine we are spending money on procedures that are not evidence based are costly and may be harmful So the first question that doctors and patients should be asking is should we perform colon cancer screening and is it necessary and appropriate for this particular individual For elderly patients the answer may be no For patients who do need screening the age for starting screening and frequency of screening will depend on several factors most importantly family history and whether or not the patient has had polyps in the past The next question should be which screening procedure is best for the individual patient informed by patient preferences and circumstances For a patient living in a remote rural area a patient without support to get to and from a procedure center or a patient who cannot or will not perform the required prep for a colonoscopy or sigmoidoscopy FOBT may be the best option When providers and patients do elect to choose colonoscopy the importance of a thorough prep must be discussed An inadequate prep can lead to an aborted procedure or worse a colonoscopy in which the operator cannot visualize the entire colon adequately Often not enough time is allocated for a detailed discussion of that is involved and how to optimize the prep and minimize risk This sort of informed engaged provider patient dialogue is far too rare and is a case in point for why the ABIM Foundation s Choosing Wisely campaign is so necessary The initiative involving over 20 specialty groups encourages doctors and patients to rigorously examine options in order to avoid tests and procedures that are unnecessary and even potentially harmful The campaign is especially powerful because the tests and treatments that are being targeted have been chosen by the professional societies themselves The recommendations are credible and evidence based ABIM clearly advocates not just for avoiding overuse but for providing evidence based care for those who need it

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=24 (2016-02-01)
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  • The Future of Successful Health Care
    of care for Bellin employees but also measurably improved their health status And they didn t stop there They took their program to improve employee health while reducing costs to scores of other companies in their area And in virtually every case the Bellin team has both improved the measurable quality of health for employees and cut costs for the employer I love keeping up with what the folks we wrote about in our book are doing now and when I checked in with Bellin recently I was not surprised to learn that they have taken even greater steps forward George Pete Randy and their colleagues have worked hard during the past several years to reduce the number of the most expensive medical cases among their employee population Randy explains that they focused on cases where the care s cost exceeded 50 000 In 2012 alone Bellin reduced the number of these expensive cases by 24 percent even as the number of employees they covered increased from 4 289 to 4 523 How has this worked Randy explained We started this work three and a half years ago We provide incentives to employees to fill out a health risk evaluation and we also provide incentives for our employees to get all the age and gender screenings that are appropriate for them In 2012 71 percent got all the screenings There is no magic to this work Randy says only good planning providing the right incentives and persistence We did it through our value based primary care where we have created free physician visits and labs for anyone who has one or more of six specific conditions obesity smoking cardio vascular disease diabetes hypertension or elevated cholesterol We ve removed the barriers to getting engaged with your primary care physician And our expense for the large cases went down from a total of 4 5 million a year to 3 4 million a year There are fewer cases and we are spending less on each case Randy points to an individual Bellin employee Karen Johnson who perfectly embodies the success of the Bellin program Watch this video it s amazing So I took these lessons from Bellin back home to IHI As we bid out our own employee health insurance plan to vendors this year we used the Triple Aim as the bid spec and we had amazing conversations with insurers who we can collaborate with to accomplish the Triple Aim for the entire IHI staff We offered health risk appraisals for all of our staff and their families To date over half of our employees have completed the assessments I was first in line The good news for us is that our organizational health score was high but we are still working hard to make IHI the healthiest workplace around My hope is that we will produce a bunch of stories like Karen s here at IHI This kind of improvement this kind of change is the future of successful

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=20 (2016-02-01)
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  • The Power of Optimal Measures
    power of an inspiring vision and incredible execution Charlie Kenney and I devoted a chapter of the book we wrote Pursuing The Triple Aim to the inspiring results achieved at HealthPartners Mary Brainerd CEO HealthPartners Our book came out last year and I thought it would be interesting to check back in with Mary and others we wrote about to see how things are going I was not surprised to discover that HealthPartners and the other organizations we wrote about in the book are making significant new progress They all demonstrate a relentless pace of innovation and improvement and seem to get their energy from a promise to patients that keeps them from enjoying their progress and resting on their laurels even for a minute Particularly exciting is HealthPartners consistently groundbreaking work on population care for patients with chronic conditions The HP Optimal Diabetes Measure is one of the most challenging diabetes care standards anywhere The measure includes five elements Hemoglobin A1c 6 9 LDL low density lipoprotein 99 Blood pressure below 129 79 Non tobacco user Daily aspirin user What makes the optimal measure so challenging is that a patient must meet all five elements to achieve the standard When they kicked off this new measure in 2004 Mary and her team found that just 5 percent of patients met the standard But by late 2012 through excellent teamwork an essential element of the HealthPartners approach that number had climbed to 42 percent And in some patient panels more than 60 percent of patients with diabetes meet the optimal measure Over the past several years HealthPartners has continued to innovate and one of their latest contributions is an optimal measure for patients with asthma Like the optimal diabetes measure the optimal asthma measure is all or none Here s how Beth Waterman HealthPartners Chief Improvement Officer below describes the measure Beth Waterman Chief Improvement Officer HealthPartners To meet the criteria for optimal asthma control patients must meet all of the following First have a complete Asthma Control test in the past twelve months with the most recent score equal to or less than 20 Second have a low risk of exacerbation as measured by the total number of emergency department and or hospitalizations due to asthma in the last 12 months must have less than 2 to meet the measure and Third have a current asthma management plan Here are the amazing results so far Just a year ago a mere 0 4 percent of patients in the HealthPartners Medical Group met the measure As of January 2013 40 7 percent of asthma patients met the measure There are so many important lessons to take away from this work The courage to tackle something the organization is not doing well Fostering and institutionalizing transparency throughout the organization that generates healthy competition and drives improvement and The three most important drivers of improvement are teamwork teamwork and teamwork More to come from HealthPartners and others Maureen Bisognano Tags Leadership Triple

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=16 (2016-02-01)
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