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LEBANON, NH – Six healthcare organizations and the Dartmouth Institute for Health Policy and Clinical Practice have announced a first-of-its-kind collaboration to share data on costs, outcomes and quality with the intention of improving clinical outcomes while reducing costs.
Tentatively named the High-Value Healthcare Collaborative, participating providers include the Cleveland Clinic, Dartmouth-Hitchcock, Denver Health, the Geisinger Health System, Intermountain Healthcare and the Mayo Clinic. As a group, the six serve a patient population of more than 10 million.
“We are focusing on high-cost, high-treatment variation conditions to start,” said James Weinstein, DO, director of the Dartmouth Institute. “These conditions are generally high-cost conditions nationally with lots of variation on how they are treated.”
The group will focus initially on eight diagnoses and has begun gathering data on total knee replacement surgery, which is performed more than 300,000 times a year and costs between $16,000 and $24,000. Other conditions to be studied are diabetes, heart failure, asthma, weight loss surgery, labor and delivery, spine surgery and depression, which together amount to hundreds of billions of dollars in direct medical costs each year.
“We find that even in our organization, which is very efficient, there is still a lot of waste, and this is true of the others in the collaborative,” said A. Marc Harrison, MD, chief medical operations officer of the Cleveland Clinic. “If we are the efficient ones and we still identify waste, how much is there to find in the whole system?”
The Dartmouth Institute will coordinate data sharing and analysis and report results back to the collaborative members to inform development of best practices. The intention is to create a website where any provider could come for the latest findings on best practices that reduce cost and improve outcomes.
"In my view, the most critical piece of this initiative is the transfer of knowledge to other health systems," said Glenn Steele, MD, president and CEO of the Geisinger Health System. "We need to aggressively implement a rapid learning network to disseminate our work and assist other systems in implementing these best practices, especially the highest cost systems."
Initial funding is being provided by the participating health systems, though Weinstein noted the group is preparing to seeking a grant from the Center for Medicare and Medicaid Innovation for roughly $300 million over five years. With 20 to 30 other health systems expressing interest in joining the collaborative, Weinstein estimates that would equate to roughly $2 million annually for each system.
“CMMI has a budget of $10 billion,” Weinstein noted. “This is a grassroots effort that will help move the country forward, so that doesn’t seem like a lot to ask.”
Harrison agreed that external funding would be needed for the long haul.
“The existing funds are enough to help with the data management, but I have a couple of people that are working significantly on this project so we are incurring additional costs,” Harrison said. “But we think this is important. This is the kind of thing that is a game-changer for how healthcare is delivered.”