Dr. Jack Cox
Senior Vice President, Chief Medical Officer
St. Joseph Health, Irvine
First of all, healthcare quality and reductions in the cost of care aren’t mutually exclusive. In fact, as we improve quality, we usually become more efficient, and that means better, more affordable and accessible healthcare for those we serve.
Our healthcare system has really taken a stand to increase quality and ensure affordability. Recently, Providence Health & Services and St. Joseph Health came together to form Providence St. Joseph Health, a move that will allow some of the best minds in healthcare to collaborate on many clinical and operational best practices.
Over the past several months, our St. Joseph Hoag Health teams in Orange County have also been working very closely to determine best practices in select medical specialties. They have been examining data to determine the procedures and practices that ensure best outcomes across our network. We are also looking at ways to keep patients healthier, altogether avoiding hospitalization. Our wellness programs and centers are great examples of keeping health costs down and improving quality of life by offering preventive and health-enhancing services for individuals and employers.
On another front, we’re getting smarter about some of the issues that have driven up the cost of care and been impediments to quality, such as sepsis. At St. Joseph Hoag Health, our clinicians developed a sepsis screening tool to more accurately determine the presence of the condition at an earlier stage. We can thereby get vital treatment started sooner. We also have set evidence-based standards for detection and care. And dedicated sepsis nurses respond to “code sepsis” calls, coordinate services and follow patients through treatment. These are not just cost-reducing practices, they are often life-saving.
Yes, for some health systems, value-based payments for healthcare have proved incentives to help keep quality high. However, that is not our organization’s primary reason for keeping our eye on quality and affordability. It’s just part of good medicine—our focus for close to 100 years here in Orange County.
Mark Costa
Executive Director, Orange County service area
Kaiser Permanente, Anaheim and Irvine
For more than 71 years, Kaiser Permanente has been committed to delivering the highest quality care at the most affordable cost to our members. In fact, one of our largest membership populations within the entire health system falls within the Medicare, Medi-Cal or dual (meaning they are covered by both) populations. And as such, we plan for any fluctuation in reimbursement rates.
Given our history, we have the ability to continue to provide world-class care to our members and patients through the transformation of care delivery. We accomplish this through integrated video visits, telephone appointments and KP Now [Kaiser’s telemedicine service for patients with less severe illnesses], to name a few. It has and will continue to lead to lower utilization rates and costs to both the organization and to our membership.
One advantage that we have is our integrated model of medicine. We have seen the recent trend of health systems partnering with physician groups in an effort to replicate the Kaiser Permanente model. Through our experience, health outcomes show that the integrated model leads to advantages, such as increased quality, while driving costs of care down for patients.
Many of the newer models are still working to align both incentives and care delivery in the hope of increasing quality and cost containment. This simply cannot be done overnight, and it is not to say that there is less pressure on us, per se. It is important to note that all healthcare providers face pressure when the trust of an individual’s health is placed upon them. Kaiser Permanente has studied and developed protocols for our members, ensuring quality outcomes. These decisions are based on what is best for the patient, not on incentives in a fee-for-service system. For decades, this has been our mission, and every year we have some of the highest quality outcomes in the nation. We believe that evidence-based medicine and an integrated system leads to great care at an affordable price.
Dr. Howard Federoff
Vice Chancellor of Health Affairs
University of California-Irvine
Chief Executive
UC Irvine Health
UC Irvine Health is dedicated to preserving and improving the quality of care for its patients, despite flat or declining reimbursements. We believe data-directed improvements are among the best ways to accomplish this. In recent years, we have revamped our approach to analyzing patient outcomes data and scrutinized how to better use resources. These data, together with reviews of the scientific literature and the application of innovations developed by our own staff and faculty, show how we can most efficiently and effectively safeguard our patients.
UC Irvine Health is a national leader in developing the perioperative surgical home. [In such homes], care before, during and after surgery is analyzed and coordinated to a degree rarely seen in most hospitals. This model shows immense promise to improve quality of care and safety while reducing costs. A recent paper by UC Irvine Health anesthesiologists published in the journal Anesthesia & Analgesia reported reduced complications, length of stay and readmission rates for patients undergoing joint replacement surgery at UC Irvine Medical Center.
UC Irvine Health is confronting the healthcare-associated infections that are a seemingly intractable presence in many hospitals. However, central line infections and the spread of MRSA and clostridium difficile are usually preventable. Our team has developed strategies to predict and thereby to avert infections at venous catheter insertion sites, such as central lines, as well as improve the antibiotic stewardship that is a key to controlling the C. diff bacteria.
Combined with our attention to overall patient experience, UC Irvine Health uses these strategies and others to elevate patient safety and the quality of care we deliver.
How do we know these efforts are working? In addition to measuring improvements among our patient population, UC Irvine Health benchmarks its performance against more than 160 academic medical centers in the University HealthSystem Consortium. Our ratings have annually improved from 79th among the nation’s academic centers in 2012 to 22nd last year. The distinguished Leapfrog group ranks UC Irvine Health in the top 98 hospitals in the country. Unlike some other hospital comparison ratings, UHC and Leapfrog analyze real-time clinical data to measure and rate quality care.
This is good news for our patients and our colleagues in community hospitals that adopt best practices developed in the fulfillment of our mission to “Discover. Teach. Heal.”
Helen Macfie
Chief Transformation Officer
MemorialCare Health System, Fountain Valley
MemorialCare concentrates on delivering the best value to patients, employers, health plans, clinicians and communities through exceptional quality, patient experiences and bending the cost curve. Our laser-like focus on value, system integration, population health and growth creates an environment of innovation and esprit de corps—allowing us to deliver high-quality, accountable care while reducing costs in the face of tighter reimbursement.
To create value, our physician-led best practice teams have focused for decades on improving outcomes through evidence-based medicine that identifies and expands optimal diagnostic, treatment and prevention guidelines for virtually every medical condition. We’ve also adopted lean management principles to reinvent how we provide care from the inside out, improving customer experiences through decreased wait times and easier access while removing steps that don’t add value to patients.
We’re integrating care by bringing our services together across the region for a seamless environment. For example, we united our cardiac programs through MemorialCare Heart and Vascular Institute, spreading best practices and ensuring access to cutting-edge medical and surgical care, like transcatheter aortic valve replacement, a minimally invasive procedure for those with aortic stenosis considered high risk for standard valve replacement surgery.
Our population health programs are improving health in our communities. MemorialCare’s customized, innovative service and accountable care organization networks of physicians, hospitals, outpatient services and other healthcare providers help employers control health benefit expenses and ensure high quality, coordinated care for their workforces. These include direct-to-employer customized partnership contracts like the one (recently signed) with Boeing (see story, page 14) that offers better benefits and lower costs for employees and their families. Businesses also benefit from our Vivity health plan offering with Anthem and six other leading health systems, as well as Anthem, Aetna Whole Health ACO and multiple other options. And we’re the region’s first to voluntarily participate in innovative bundled payment care improvement and next-generation accountable care organization pilots to better care for Medicare beneficiaries.
We’ve diversified to an integrated healthcare delivery network, giving patients a unique advantage. With five hospitals and over 200 outpatient physician, urgent care, imaging, kidney dialysis and surgery center sites, we can provide consumers the best care in the right location, with the right services and at the right price. Thanks to numerous technological advances, for example, many surgical patients now receive care in easily accessible outpatient centers without costly hospital overnight stays.
