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Balancing act
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Health care systems search for right prescription to keep costs down and quality up
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By MaryBeth Matzek, March, 2010
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While Congress debates the future of health care, providers are walking a fine line as they strive to improve the quality of care being delivered to patients while also making sure costs don’t get too high. In Northeast Wisconsin, health providers are looking at different ways to deliver care to patients, embracing lean business practices and focusing on preventative care as they search for the right mix.
Affinity Medical Group, which is part of the Menasha-based Affinity Health System, rolled out its medical home model more than a year ago as a way to provide not only better care to patients, but also keep costs down, says Tim Loch, chief operating officer for Affinity Medical Group.
In the medical home model, which will spread to all Affinity clinics this fall, each patient is assigned a team of providers, including physicians, nurse practitioners, nurse specialists, health care associates and patient service representatives to supervise their care. Other specialists, such as those focused on behavior health or obstetrics, may also be a part of the patient’s team of providers depending on individual needs. The team all works together to provide the best care possible to patients, Loch says.
Since Affinity is part of Network Health Plan, it has been able to track how the change in care being delivered affects overall costs, Loch says. “We have clearly seen that the quality of care being delivered has improved while the overall cost for that patient’s care has declined,” he says. “It’s amazing how quickly we have seen the improvements.”
The biggest improvements have come among patients with chronic diseases. Loch says the latest metrics from the clinic in Kaukauna, which implemented the medical home model last year, show the percent of diabetic patients with LDL (bad cholesterol) lower than 100 has increased 43 percent over a nine-month period.
At the same time, there has also been a shift to outpatient care provided by a primary care provider rather than a specialist. That all translates into lower overall costs, Loch says.
Focusing on preventive and personalized care is essential to improving quality at Bellin Health, says Dr. Chris Wilson, chief medical officer for the Green Bay-based health system.
“We have 35 clinics and for us, the focus of primary care is to have a relationship built between the patient and provider so we can be an effective resource as well as offer referrals,” he says. “Getting patients involved and having them take better care of themselves by having regular screenings done is also part of the equation.”
Bellin also seeks to thoroughly coordinate care for patients with chronic diseases or complicated medical histories to make sure medications and conditions are being properly managed, Wilson says. “It can get complicated if you are on multiple medications. It’s all about embracing a new way of providing care and using technology and electronic medication records to our advantage,” he says.
Bellin is one of 27 health systems belonging to the Wisconsin Collaborative for Healthcare Quality (WCHQ), which compares health organizations on a variety of quality measures.
“We find that to be a valuable resource and a great way to see where we’re at compared to other organizations and how care is delivered,” Wilson says.
Appleton-based ThedaCare is also a WCHQ member and compares its results in such measures as diabetes and heart care. Besides focusing on key quality measures, ThedaCare also keeps a close eye on cost, says Dr. Dean Gruner, ThedaCare’s president and chief executive officer.
While Wisconsin hospitals raised their rates an average of 5.73 percent in the past year, ThedaCare kept its cost increases at just 2 percent through its “lean” business practices adapted to a health care setting.
Since 2003 when ThedaCare adapted its lean principles, it has redesigned how it delivers care to patients in hospital and clinical settings through hundreds of rapid improvement events where management, staff, doctors and patients join together as a team to look at a process to cut out waste and find efficiencies.
“The old mindset was that to improve quality, you had to raise costs. By using lean, we have found you can improve safety, quality, employee and customer satisfaction while improving your financial results, which means lower costs to patients,” Gruner says.
Gruner points to a team that came together to study ways to improve the speed and flow of heart attack patients through the hospital. As a result, ThedaCare now ranks among the top 2 percent of health facilities across the country for its fast “door-to-balloon” time – the time it takes to get heart attack patients from their arrival in the emergency department to clearing the blockage in the catheterization lab.
“By focusing on quality, we are merging the science of medicine with the best redesign methods, which results in lower costs,” he says. “We go into a situation and say what’s the best way to deliver care and we start from there and redesigned how it’s all done. We’re constantly looking to make things better. It’s definitely a journey.”
And it’s one other health care systems are also on. “Improving care while keeping costs down won’t be done tomorrow,” says Affinity’s Loch. “It’s never really complete, you’re always improving.”
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