Working together

The adoption of healthcare reform has created an environment that encourages insurers, health plans, hospitals and clinicians to seek common ground on cost and quality. More so than ever before, stakeholders who typically sit at opposite ends of the bargaining table are collaborating.

Hamman says providers vary significantly in their appetite for the infrastructure changes that will realign accountability. Insurers will need to accommodate providers' various levels of ability and meet them where they're at, he says, adding that BCBSIL is currently developing its shared savings model.

Information sharing is paramount to clinical quality improvement. In the past, payers and providers didn't have an efficient way to share data, but connectivity is progressing rapidly to allow for comprehensive patient/member records.

"Health plans should look at this as a chance to improve client health and save money," Dr. Harper says. "Health plans should consider different reimbursement models that will reward coordination of care."

ONE PROJECT AT A TIME

One of the first clinical improvement projects taken on by the Keystone Center for Patient Safety & Quality saved more than 1,830 lives, $300 million and 140,700 excess inpatient days between March 2004 and March 2010.

Created by the Michigan Health & Hospital Assn. (MHA), the not-for-profit organization brought hospitals together to implement evidence-based best practices to combat central line-associated bloodstream infections in the intensive care units. To reduce infections, the MHA Keystone Center worked with vendors to create a central-line kit that contained all of the clinical supplies needed to safely place a central line according to best practices.

For example, two components of the central line kits are a full-body sterile drape and chlorhexidine to clean the site. Prior to the creation of the full kit, staff might have only had one of those items at hand, or a smaller sterile drape that only covered the incision area.

"Before the vendors began to package line kits this way, staff had to go to different places to get materials," says Sam Watson, senior vice president for patient safety and quality of MHA and executive director of the MHA Keystone Center. "It lowered the risk of infection by having everything in the kit ready to go."

The project highlights how measurable improvement of clinical outcomes can be achieved when resources are dedicated to a specific goal. Watson says the center's initial project in the intensive care units at the participating hospitals laid the groundwork for other infection-prevention objectives in surgery, obstetrics, emergency departments and other areas.

"Underlying all of this work, we also address the culture within the unit," Watson says. "That's important, because if you just change the kit or the checklist, it's not sustainable without changing the behaviors to get those things done. It's a very important part of this work that allows it to continue to be successful."

Last year, Blue Cross Blue Shield of Michigan (BCBSM) announced an expansion of its ongoing commitment with a $6 million, five-year investment in the MHA Keystone Center. This investment from BCBSM was the second of its kind to MHA Keystone Center in less than four years.