Optimizing Quality and Cost

Premier seeks to prove that good patient care can be delivered safely and cost-effectively.

Premier stands at the “nexus of quality and cost,” and it intends to use data to help it stay there. As a national GPO, San Diego-based Premier remains concerned with the price and quality of the products for which it contracts. But the organization kept its focus on the quality of patient care at this year’s “Breakthroughs” Conference in Orlando, Fla.

In fact, if there was a “breakthrough” idea at the conference, it was that patient care can be improved on a broad scale – among hundreds if not thousands of hospitals – in a rapid, consistent, sustainable way, and that care can be delivered safely, efficiently and cost-effectively. It is an idea that Premier tested with the Centers for Medicare and Medicaid Services in their pay-for-performance Hospital Quality Incentive Demonstration Project (HQID), the first phase of which concluded in January. At the conference, Premier announced its intention to launch a similar project on a broader scale, called “QUEST: Higher Performing Hospitals.”

Group purchasing
President and CEO Rick Norling announced that purchasing volume now stands at $29 billion annually. He said the GPO had validated member savings over the past three years of $2.27 billion.

Meanwhile, Premier Purchasing Partners President Mike Alkire noted the continuing importance of product utilization in hospitals’ efforts to cut overall costs. Good information systems can help IDNs track not just product prices, but more importantly, product utilization, he said. Both he and Premier COO Susan DeVore called on the industry to adopt a unique-product-identifier system to make it easy for providers to track usage. By sharing utilization data, providers can compare their facilities’ statistics with those of their peers. Using clinical benchmarking tools, they can relate their usage to clinical outcomes. Alkire also spoke about Premier’s new ValueAdvisor tool, which helps providers walk through the technology assessment process in a thorough, standardized way.

Premier used the conference to demonstrate the SpendAdvisor automated tool, particularly, a new component called “My Spend,” which it has been pilot-testing for a couple of years. Providers who buy the My Spend module transmit their purchase order data (and, if they wish, pricing on locally or regionally negotiated contracts) to Premier. After their data is cleansed, they can then view their total spending, on- and off-contract spending, and savings opportunities using national or local contracts for the same products or functionally equivalent products.

QUEST grabs the spotlight
QUEST generated the most buzz in Orlando. QUEST (which is an acronym standing for Quality, Efficiency and Safety, with Transparency) is the direct descendant of the 3-year-old HQID. In that study, 260 participating hospitals tracked their quality of care based on their delivery of 30 standardized care measures to patients in five clinical areas – acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia and hip and knee replacement. Hospitals scoring the highest were rewarded economically. In fact, CMS awarded $8.7 million in incentive payments to the top-performing hospitals. That study was conducted because of a Congress mandate that Medicare make plans to implement “value-based purchasing,” that is, reimbursement tied to quality of care and other outcomes.

QUEST will take the program one step further, according to Stephanie Alexander, senior vice president, Premier Healthcare Informatics. For one thing, it will involve more hospitals. For another, it will also call for more collaboration (in terms of information-sharing) than competition for the highest payouts. (That said, Premier has seeded a reward pool, and is seeking other organizations to add to the fund.) Alexander said that QUEST will help Premier facilities position themselves for what the organization feels are inevitable developments – growing scrutiny on the part of state and federal governments of hospital-acquired infections, continuing calls for “value-based purchasing,” and more experiments with pay-for-performance.

Hospitals that agree to participate make a three-year commitment, during which time they will have to share their data with Premier and the other participants. “We will be laser-focused on results,” said Alexander. Hospitals’ data will be scrutinized with a number of automated tools, including Premier’s SafetySurveillor (acquired through its acquisition of Cereplex), which provides automated surveillance of hospital-acquired infections and antibiotic usage; and CareScience, a clinical data-mining tool, which Premier acquired in April 2007.

QUEST will help hospitals look not only at the “what” but the “how,” said Regina Berman, executive director of performance improvement for Hackensack (N.J.) University Medical Center (one of the top performers in the Premier/CMS study), speaking during a panel discussion. By that, she meant that Premier members will not only be able to learn what procedures and practices lead to better and safer outcomes, but how individual members actually performed them. Meanwhile, Allan Korn, M.D., chief medical officer of the Blue Cross and Blue Shield Association, Chicago, pledged that the Blues would support the QUEST program.