May 19th, 2011
The Affordable Care Act of 2010 is expected to extend health coverage to some thirty-two million previously uninsured Americans. Two of the many challenges faced by both the private sector and the government are getting a handle on rapidly rising medical costs and providing care to the many new enrollees with chronic illnesses who are living in medically underserved areas. Health Affairs today released two Web First articles which describe programs tackling these issues.
Intermountain Healthcare: Trimming Costs Through Quality Improvement Efforts
Intermountain Healthcare is an integrated delivery system based in Utah and Idaho that provides more than half of all health care in that region. It has been identified as a low-cost, high-quality provider and has made demonstrated improvements in clinical quality that have lowered the cost of care delivery. By adopting the process management techniques of W. Edwards Deming and focusing on the processes of care delivery, Intermountain has learned to streamline its operations. While checklists, order sheets, and clinical flowcharts are routinely used, clinicians are comfortable modifying these guidelines when an individual patient’s particular needs warrant it, write Brent James and Lucy Savitz of the Institute for Health Care Delivery Research, Intermountain Healthcare, in Salt Lake City.
To make its system function smoothly, Intermountain identified 1,400 unique inpatient and outpatient work processes and discovered that 104 of these accounted for 95 percent of its care delivery. It then built evidence-based best-practice guidelines, outcomes tracking data systems, and management structure around high-priority clinical processes. For example, Intermountain estimates its labor induction protocol is able to reduce costs in its Utah centers by $50 million per year.
Project ECHO: Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians
Project ECHO (Extension for Community Healthcare Outcomes) is an innovative new model of health care education and delivery in New Mexico. It uses state-of-the-art telehealth technology and care-based learning, enabling specialists at the University of New Mexico Health Sciences Center in Albuquerque to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with a host of chronic diseases. The program was originally developed for combating hepatitis C, report Sanjeev Arora of Project Echo and coauthors.
Primary care physicians in rural areas receive specific training to make the program a success. They travel to the University of New Mexico’s School of Medicine in Albuquerque for orientation and to learn the treatment protocol as well as the communications technology and cased-based presentation format for the weekly two-hour telemedicine clinics that lie ahead. The clinics, lead by the Albuquerque-based specialists, serve to review and discuss the rural patients’ needs with the primary care provider teams. The teams typically include physicians, nurses, and physician assistants and are organized into a disease-specific learning network.
Encouraged by its success dealing with hepatitis C, Project ECHO has expanded to address asthma, chronic pain, diabetes, and cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, pediatric obesity, rheumatology, substance abuse disorders, and mental illness. As of March 2011, 298 ECHO teams across New Mexico were delivering specialty care for these various conditions.