"They did not meet the appropriateness standards," she says. "When you use these methods, you weed out unnecessary care. You can do that analysis with many surgeries. Variation in medical practice is such that in those cases, physicians inadvertently do not add value."
3. Embrace transparency and data
Anderson says the foundation of Virginia Mason's ability to draw large employers to its system is transparency and data help physicians change the way they practice, based on appropriateness of care and likely good outcomes.
It's also how they're able to offer guarantees of good outcomes to their employer customers in areas such as joint replacement surgery.
4. Create partnerships and collaborations with key people and organizations that help advance quality
When Virginia Mason was first contracting with Walmart, Walmart's executive team told Virginia Mason that the company didn't want to spend a dime less on care than it was already spending, but that it wanted to spend money on healthcare that was highly likely to bring about positive outcomes, says Anderson.
That was a revelation to Virginia Mason's team, who knew they could deliver on that.
Even if Virginia Mason rejected invasive interventions such as back surgery based on predictive modeling, it could make up that loss by serving a larger population with guaranteed good outcomes based on data, says Mecklenburg.
"Volumes don't suffer, because more people are sent here," he says.
Philip Betbeze is the senior leadership editor at HealthLeaders.