The Better Care Plan: a blueprint for improving America's healthcare system.

The United States falls far short of its potential for delivering care that is effective, efficient, safe, timely, patient-centered, and equitable. We put forward the Better Care Plan, an overarching blueprint to address the flaws in our current system. The plan calls for continuously improving care, moving all payers to risk-adjusted prospective payment, and creating national entities for collecting, analyzing, and reporting patient safety and quality-of-care outcomes data. A number of recommendations are made to achieve these goals.

Another Use for Lean.

The Lean principles and tools that hospitals use to transform care delivery, transparency and cost can also help to manage population health.

ACO model should encourage efficient care delivery.

The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance.

Improving the value of healthcare delivery using publicly available performance data in Wisconsin and California.

The healthcare industry must change in order to provide higher quality care and lower costs for patients; one method to improve both cost and quality used in Wisconsin and California is leveraging publicly reported claims and costs data. Wisconsin has been building comprehensive, publicly available clinical and administrative data sets: the Wisconsin Collaborative for Healthcare Quality (WCHQ) established in 2003 and the Wisconsin Health Information Organization (WHIO) established in 2009. The WCHQ and the WHIO allow physician groups to compare themselves with one another on cost and quality across 920 distinct episode treatment groups (ETGs). The ETGs include all components of care for a specific disease during a defined period. Since 2002 California has developed public reporting of quality data for physician groups and health plans through its Integrated Healthcare Association (IHA) and since 2008 its Right Care Initiative (RCI). In both states these data are used to identify best practices and opportunities for improvement, enhance care outcomes, and increase value for patients.

A management, leadership, and board road map to transforming care for patients.

Over the last decade I have studied 115 healthcare organizations in II countries, examining them from the boardroom to the patient bedside. In that time, I have observed one critical element missing from just about every facility: a set of standards that could reliably produce zero-defect care for patients. This lack of standards is largely rooted in the Sloan management approach, a top-down management and leadership structure that is void of standardized accountability. This article offers an alternative approach: management by process--an operating system that engages frontline staff in decisions and imposes standards and processes on the act of managing. Organizations that have adopted management by process have seen quality improve and costs decrease because the people closest to the work are expected to identify problems and solve them. Also detailed are the leadership behaviors required for an organization to successfully implement the management-by-process operating system and the board of trustees' role in supporting the transformation.

Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs.

Patient-centeredness--the idea that care should be designed around patients' needs, preferences, circumstances, and well-being--is a central tenet of health care delivery. For CEOs of health care organizations, patient-centered care is also quickly becoming a business imperative, with payments tied to performance on measures of patient satisfaction and engagement. In A CEO Checklist for High-Value Health Care, we, as executives of eleven leading health care delivery institutions, outlined ten key strategies for reducing costs and waste while improving outcomes. In this article we describe how implementation of these strategies benefits both health care organizations and patients. For example, Kaiser Permanente's Healthy Bones Program resulted in a 30 percent reduction in hip fracture rates for at-risk patients. And at Virginia Mason Health System in Seattle, nurses reorganized care patterns and increased the time they spent on direct patient care to 90 percent. Our experiences show that patient-engaged care can be delivered in ways that simultaneously improve quality and reduce costs.

The promise of Lean in health care.

An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations.

Leadership lessons from lean.

Inspired by nearby manufacturing plants, ThedaCare adopted Lean to standardize quality.

Using sterics to promote reactivity in fac-Re(CO)3 complexes of some 'non-innocent' NNN-pincer ligands.

Two new redox active ligands based on di(2-(3-organopyrazolyl)-p-tolyl)amine have been prepared in order to investigate potential effects of steric bulk on the structures, electronic properties, or reactivity of tricarbonylrhenium(I) complexes. Replacing the hydrogens at the 3-pyrazolyl positions with alkyl groups causes significant distortion to the ligand framework due to potential interactions between these groups when bound to a fac-Re(CO)(3) moiety. The distortions effectively increase the nucleophilic character of the central amino nitrogen and ligand-centered reactivity of the metal complexes.

Connecting statewide health information technology strategy to payment reform.

OBJECTIVE: To develop an effective way to link statewide healthcare information technology strategy to payment reform. STUDY DESIGN: Investigation of what Wisconsin did to develop and publicly share provider performance data and then use those data to drive payment reform. METHODS: We examine 2 statewide organizations (Wisconsin Collaborative for Healthcare Quality and Wisconsin Health Information Organization) and 1 integrated health system (ThedaCare) to evaluate how they pool data and use those data to measure provider performance. RESULTS: When aggregated data regarding health outcomes are shared, a clearer picture emerges of provider performance baselines and improvements with which payment models can be developed. CONCLUSIONS: Aggregating commercial and Medicare claims data will help states to better measure provider performance and to compare providers on quality and cost. The ability to compare performance using broad databases is necessary if the current payment system in the United States is to be reformed.