After the Michigan Bariatric Surgery Collaborative (MBSC), a group of 40 hospitals partnering with Blue Cross Blue Shield of Michigan, implemented their recommendations both readmissions and emergency department visits were reduced by 35% over a 3 year period. Forming partnerships with insurance companies is somewhat new, but as more health systems are venturing into a teamwork role, impressive improvements are being seen.
How the collaborative works:
In the MBSC 77 physicians met regularly to discuss problems, studies and issues occurring in their hospitals. From sharing thoughts and presenting new data published in the field, the physicians were able to suggest innovative solutions such as implementing filters on bariatric surgery patients to prevent lung blockage. While there were concerns of patient privacy, it was made clear that neither Blue Cross nor the hospitals could see numbers tied to individual patients.
The results have been so dramatic that Blue Cross Blue Shield of Michigan is investing $20 million annually in 12 quality collaborative initiatives. As health systems begin migrating to a payment system based on quality, this model stands a good chance of being adopted by other hospitals and insurers, possibly the nation’s largest insurer, Medicare.
Collaborating with Medicare:
Medicare is proposing a payment model along similar lines linking reimbursement to efficient care. Expected to hit the healthcare system by 2014, Medicare will judge hospitals by two means: how patients’ spending compares with other hospitals and how the hospitals’ spending compares to prior years.
With a stricter sense of accountability of care, hospitals are in a state of urgency to find solutions to streamline tests, treatments, follow-up care and other services provided during admission and 30 days post discharge fearing lower reimbursements. However, using the groundwork MBSC has laid, Medicare and health systems nationwide could benefit from the improved quality and cost reductions.
Issues may still exist over the right leadership, the amount of time taken to gather data and more importantly, how to use that data meaningfully. To me though, the notion of embracing a communal effort to enhance quality of care is one that requires acceptance, but one that has great potential.
James Ellis, CEO, Health Care Realty Development Company, is a nationally recognized successful real estate investor and developer of medical office properties with a comprehensive knowledge of sophisticated real estate transactions, cost effective designs, and efficient property management.
Aaron Razavi is Associate Marketing Director at Health Care Realty Development.
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