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According to the Institute for Healthcare Improvement, more than 40,000 incidents of medical harm occur daily in the United States. Many of these adverse events could be prevented with more attention directed to patient safety and the coordination of care. To address these issues, The Trust funded the Colorado 5 Million Lives campaign that encouraged hospitals to adopt up to 12 interventions to improve care. These interventions include rapid response at the first sign of patient decline, ensuring that patients receive the right medications, implementing best practices known to prevent hospital-acquired infections and providing leadership support and training to sustain these efforts. There are few incentives to better coordinate services, improve the health care delivery system or provide care that is responsive to patients' individual preferences and cultures. Typically, Colorado health care providers are paid based on the number of services they provide rather than the quality of care. Yet, payment-per-service encourages providers to respond to missing test results by ordering additional testing, rather than investing in improved information sharing. Ironically, medical complications and poor outcomes often result in higher payments. The providers who "do the right thing" and coordinate care for their patients (provide a true "medical home") are largely uncompensated for providing integrated medical care, even when their efforts result in better health for patients and savings to the system. Public and private payment policies need to be reformed to reward quality and value, and remove incentives to provide more care than necessary. For example, The Trust supports the Colorado Clinical Guidelines Collaborative (CCGC), a multi-payer, patient-centered medical home initiative that aims to reward value. CCGC provides technical assistance to help medical practices implement clinical guidelines, health information technology and enhanced payment to 17 medical home pilot sites across the state. Through a rigorous evaluation, the project's findings have the potential to improve local and national payer reimbursement for primary care. Measuring quality is a challenging endeavor due to expense and a lack of consensus about appropriate indicators. Data that would be useful to pinpoint the problem areas are frequently trapped in paper files or stored in many separate and often propriety databases. Data on quality of care are increasingly available for health plans and hospitals, yet few private physician offices collect quality data on their patients due to prohibitive costs and the limited availability of technology. However, provider-specific data are often necessary to better understand the reasons behind poor outcomes observed in a larger health system, such as the fee-for-service Medicaid programs. |
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