Gail R. Wilensky is the senior fellow at Project HOPE and a member of the Peterson Center on Healthcare’s Advisory Board.
On December 4, the Peterson Center on Healthcare, created by the Peter G. Peterson Foundation with an initial commitment of $200 million, announced three major initiatives to advance its objective of transforming health care in the United States to a system that delivers high-quality care at lower costs.
The center is focusing on identifying strategies that already “work” (that is, they produce high-quality health care at lower costs), validating the strategies, and then replicating them. The center aims to identify effective strategies that are already in existence and to give them additional momentum, rather than to fund research to create new activities that are not currently being undertaken.
The three initiatives that received initial commitments of funding are (1) identifying high-performing primary care practices (through a grant to Stanford University’s Clinical Excellence Research Center); (2) tracking the performance of the U.S. health care system (through a grant to the Henry J. Kaiser Family Foundation [KFF]); and (3) improving data transparency and usability (through a grant to the National Quality Forum).
The aim of the grant to Stanford’s Clinical Excellence Research Center, for the first initiative, was to identify and validate high-performing primary care practices in the United States. Based on an analysis of commercial insurance data and using forty-one Healthcare Effectiveness Data and Information Set (HEDIS) measures, researchers found that fewer than 5 percent of the 15,000 practice sites reviewed ranked in both the top quartile for quality as well as in the lowest quartile for spending (on a risk-adjusted basis).
They also found that ten features seemed to distinguish these practices from other practices. These features included the following: the practices are always “on-call,” follow quality and clinical guidelines, solicit patient feedback, “in-source” tests and procedures, keep in close contact with specialty referrals, engage in patient follow-up, encourage staff to work to the top of their licenses, promote open work environments, balance compensation incentives (that is, physicians are not paid just by the volume of services and revenue they individually produce), and invest in staff, according to a press release.
What was perhaps most interesting is that these “positive outliers” for cost and quality are not nationally known practices. They include such places as Banner Health Clinic in Phoenix, Arizona; Family Physicians Group in Kissimmee, Florida; and St. Jude Heritage Medical Group in Yorba Linda, California.
The focus of the grant to the KFF, for the second initiative, is a new digital platform focused on the performance of the U.S. health care system, including an analysis of its performance over time and also its performance relative to other countries. This partnership between the Peterson Center and the KFF launched the Peterson–Kaiser Health System Tracker on December 4. Measures of cost and quality and information on how these measures are trending over time are included. The platform will also indicate how different parts of the country are performing relative to other parts of the country, in line with the continued interest in geographic variations in cost and quality of health care and supplementing Stanford’s analysis (for the first initiative),which looks at critical factors influencing cost and quality in individual clinical practices.
In the third initiative, the Peterson Center supports and is collaborating with the National Quality Forum to bring together leaders from both the public and private sectors to agree on data and analytics that need to be made available to support systems improvement in health care. The proliferation of metrics on quality and efficiency has been a source of frustration to clinical and institutional providers. The goal of this grant is to enable the National Quality Forum to make progress in reducing this frustration and to identify actions that will make data and analytics more uniformly available to support performance improvement systems.
The theme that is present in all three initiatives is the need to improve data transparency and usability and to disseminate best practices—associated with high-performing primary care practices, metrics, and health data.
The Peterson Foundation may supplement its $200 million in funding for its Center on Healthcare with more funding if the results of the initial grants suggest that additional efforts would produce useful results.
It is also hoped that these results will serve to attract additional capital to these efforts. The $1 million contribution by the Bill & Melinda Gates Foundation to the Peterson Center on December 4 is the first of what is hoped will be many future contributions.
———————————————————–
Editor’s note:
Three current or soon-to-be foundation leaders are on the Peterson Center for Healthcare’s Advisory Board: Harvey Fineberg, board chairman, who soon will be president of the Gordon and Betty Moore Foundation; Drew Altman, president and CEO of the Henry J. Kaiser Family Foundation; and Bill Gates, cochair of the Bill & Melinda Gates Foundation.
