More for Less

Susan DeVore, incoming president and CEO of Premier, discusses the inroads to achieving patient safety, quality care and reduced costs

Susan DeVore thinks outside the box. In fact, she thinks well outside the walls of her office. When she comes to work each day, her goal is to improve healthcare for at least 310 million patients across the country. So far, so good.

In 2003, DeVore joined Premier Inc. as president of Premier Purchasing Partners, the organization’s purchasing and supply chain improvement arm. Three years later, she was promoted to chief operating officer, and recently as the incoming president and CEO. As COO she led three additional business units at Premier: Healthcare Informatics, which helps hospitals improve their quality of care while reducing the cost of care; Premier Consulting Solutions, with 60+ clinical and supply chain consultants; and Premier Insurance Management Services, Inc., a wholly owned subsidiary of Premier Inc., and reportedly one of the nation’s largest policy-holder-owned, hospital professional liability risk-retention groups.

Premier currently serves more than 2,100 not-for-profit hospitals nationwide and over 54,000 additional healthcare sites. Its annual contracting spend is $33 billion.

The Journal of Healthcare Contracting: What is your role at Premier?

Susan DeVore: In my role at Premier, I lead its most significant initiatives to improve the quality, safety and affordability of healthcare in America, including QUEST. I also lead the Perinatal Safety Initiative to eliminate preventable birth injuries and the South Carolina Healthcare Quality Trust to eliminate preventable healthcare-associated infections.

Through these initiatives, Premier is leading the effort to create national models that can be used by hospitals across the nation to improve quality and enhance patient outcomes.

JHC: What is QUEST? How did it get its start? What are its goals and objectives?

DeVore: In the wake of the success of our Hospital Quality Incentive Demonstration (HQID) pay-for-performance project with the Centers for Medicare & Medicaid Services (CMS), a plethora of quality and cost improvement projects arose, but none of them addressed a comprehensive approach to achieving excellence. So, we reached out to our HQID top performers, our board members, the Institute of Healthcare Improvement (IHI) and our Quality Improvement Committee members. We learned that there was a need for a comprehensive approach to performance improvement that looked at the quality and cost, at patient safety and at the need for providers to have more influence in establishing consumer transparency via publicly reported data.

In August 2007, we brought a group of about 50 people to our offices in Charlotte, all from different organizations with very diverse backgrounds. For three days, these individuals participated in what we call an Accelerated Solutions Design Workshop. It was through their hard work and collective vision that QUEST was born.

QUEST is designed to help springboard hospitals to much higher levels of performance. The goal is to achieve improvements in quality, safety and cost of care. These improvements will stem from evidence-based results and real-world experiences that have been proven to provide the most benefits for patients. It’s about benchmarking, implementing, measuring and scaling innovative solutions to the complex task of caring for patients.

Ultimately, QUEST is designed to reliably deliver the highest quality, most cost-effective and most satisfying hospital experience for every patient. Its three-year performance improvement targets are to:

  • Save Lives. Reduce the risk-adjusted mortality rate to one that is at or below 83 percent of that predicted by patient severity and other factors.
  • Safely reduce the cost of care. Reduce inpatient costs per patient below the mid-point among participating hospitals of similar size and complexity.
  • Deliver the most reliable and effective care. Deliver 100 percent of appropriate evidence-based care for at least 84 percent of patients – a 13 percent increase from where we were when the program began. .
  • Improve patient safety. (Years 2 and 3 measure) Prevent incidents of harm in 30 categories, including healthcare-acquired infections, birth injuries, and other avoidable hospital-acquired conditions, such as decubitus ulcers.
  • Increase Satisfaction. (Year 2 measure) Dramatically improve the patient’s care experience.

Last December, we released an analysis that quantifies what these improvements could mean for the approximately 2.3 million patients treated annually by hospitals participating in QUEST. The analysis suggested that achieving these top performance goals could translate to 8,628 lives saved and 22,364 additional patients receiving all appropriate evidence-based care measures within this cohort each year.

JHC: How has QUEST evolved since it was initiated in 2007? How have its goals expanded?

DeVore: Though the original framework has not significantly changed since we launched the three-year program in January of 2008, the project is ever-evolving. Really, that is necessary as participants share their successes, achieved through QUEST and otherwise. Also, the program has evolved to define key drivers of the primary metrics and has discovered areas that cut across all measures. Instead of looking at each measure separately, QUEST is now attempting to impact those things that drive all the measures in an integrated way. In both of these activities – determining drivers and forming collaboratives to impact change – we have been heavily supported by our strategic partner, the Institute for Healthcare Improvement (IHI).

One example of the evolution of the project is the QUEST Comparative Innovation Program (CIP) (See sidebar on page 16). Through this, we have opened the project up to all medical device manufacturers, suppliers, pharmaceutical manufacturers and service providers, regardless of whether or not they are on contract with Premier Purchasing Partners.

JHC: How is QUEST different or unique from other organizations’ efforts to increase patient safety and reduce healthcare costs?

DeVore: QUEST is ahead of the curve regarding what the healthcare system can expect from Washington. For instance, QUEST is currently addressing all of the healthcare associated conditions such as adverse drug events and preventable events, for which hospitals may receive reduced Medicare payments in 2009 and 2010. And QUEST is a voluntary initiative; participating hospitals are not waiting for the government to tell them what to do. Instead, they are taking the initiative on the front line where they care for patients.

QUEST is bringing all areas of the healthcare community together, including hospital clinicians and administration, manufacturers, industry experts and government officials. Not only do we have more than 160 of the nation’s top hospitals participating, but 20 of the country’s top healthcare experts are serving as advisors to the project [including] IHI’s Don Berwick, The Joint Commission’s Jerod Loeb, Janet Corrigan from the National Quality Forum and Allan Korn from the Blue Cross Blue Shield Association.

QUEST is about improving quality and costs across all disease states and the entire patient mix. It is not a zero sum game in which there are winners and losers. Our goal for QUEST is to get every single hospital involved into the “winner’s circle” of top performance in all dimensions. In fact, our internal Premier incentive goals are tied to the success of our member hospitals in this endeavor.

QUEST is using evidence-based results and real-world experiences to tie together quality improvement with a reduction in costs. A Premier analysis of 1.1 million patient records – 8.5 percent of all patients nationally within the five noted clinical areas over a three-year timeline – suggested that an estimated 70,000 lives per year could be saved and hospital costs reduced by more than $4.5 billion annually if all hospitals nationally were to achieve the three-year cost and mortality improvements found in the HQID project. Through the efforts of the HQID hospitals, we have developed the types of evidence-based measures that have been directly linked to success. Now, QUEST participants will use this knowledge to work toward substantive quality and cost gains across a wide range of areas.

JHC: What are your criteria for hospitals wishing to participate in QUEST? Are your doors open to new hospitals looking to join the program in 2009?

DeVore: QUEST is a voluntary project, and the current QUEST roster is comprised of all types of hospitals, including urban and rural, teaching and non-teaching, large and small, representing 31 states. So there really aren’t any restrictions, though participants must have a standardized set of clinical tools, which allow us both to measure and to impact change. To be successful and obtain the true value of participating, hospitals must be dedicated to working toward providing the highest quality care possible. Also, a commitment to transparency of results and sharing of best practices within the cohort is a must.

Due to the requests we have received from hospitals within our alliance and those outside of it to join QUEST, we have decided to open the door to a new group of hospitals to participate in another round of QUEST. We are happy to discuss participation with any hospitals, Premier member or not.

This 2009 QUEST membership will benchmark their performance against the baseline performance established by the current 160+ members, as well as establish future baselines and metrics for future measurement periods beyond 2010. They will work alongside that original group, which will serve as mentors to them, sharing what they have learned to date through QUEST.

JHC: What will be the impact of QUEST on IDNs in the next five years? What will it mean for IDNs who do, or do not, come on board?

DeVore: QUEST represents an opportunity for a change in American healthcare and a move beyond measurement and reporting to implementing and sharing quality, safety and cost-of-care improvements. We feel strongly that QUEST will serve as the roadmap for healthcare quality and cost improvements. In developing this roadmap, participating hospitals conducted systematic performance assessments to identify the reasons for quality gaps in the areas of costs, mortality, reliability of care, patient satisfaction and safety. Then, they developed specific action plans to address each one of these factors.

As patients demand information to help them make their care choices, and regulating bodies demand transparency, hospitals will need to provide the highest possible quality care or risk losing market share. Hospitals that do not participate in quality and cost improvement collaboratives will be challenged to make these improvements without the evidence-based information and collaboration that a project like QUEST provides.

JHC: What are the biggest changes we will see in the QUEST program in the next five years? How will it impact healthcare in the current weakened economy?

DeVore: The challenges we will face will likely mirror what the entire healthcare system will face: the credit crunch, reduced investment income and reimbursement rates; bad debt; and a need for increased transparency and reporting of such things as healthcare-associated infections. QUEST is addressing half of the current and prospective CMS healthcare-associated conditions that could lead to reduced reimbursement. And the HQID project has shown that by sharing best-practices, participants can work together toward quality and costs improvement.

JHC: How will QUEST provide a model for politicians in Washington and consumers across the country as they continue to debate healthcare and seek ways to improve outcomes?

DeVore: Central to overall health reform is the urgent need for our nation to improve the quality and affordability of care. Today, the United States spends far more on healthcare than any other nation, yet we don’t have the best outcomes. This frustrating reality signals the fact that we aren’t spending our resources wisely, and that patients don’t get what they pay for from the healthcare system.

With QUEST, we have identified the factors that lead to deaths, excessive spending, dissatisfaction and poor outcomes and developed a framework to tackle them all. Moreover, the program is showing that through collaborative execution, and with the proper support, real gains can be made quickly. I believe this is the model for healthcare improvement. Through QUEST we are making the improvements that everyone agrees are necessary to improve quality and safety, while at the same time reducing costs so that more Americans can get treatments at a price they can afford.

As the nation debates heath reform, we feel that QUEST stands out as a model for cost-effectively improving quality and patient outcomes. And in an era when lawmakers and healthcare providers are asking for evidence of clinical effectiveness, the QUEST CIP is designed to help identify and use technologies that can truly improve hospital performance on key measures.

About Laura Thill

Laura Thill is a contributing editor for The Journal of Healthcare Contracting.

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