A QUEST to Improve Healthcare Cost and Quality

Where Congress fails, can the healthcare industry succeed?

It can, and it already is.

While the president started 2009 with a promise to reform healthcare, that process seems as though it's on life support. I've detailed many times in this space the shower of good ideas for improving quality and cutting cost in healthcare that have hit the cutting room floor as the healthcare reform debate devolved into an exercise in trying to cover the uninsured—a laudable goal, but definitely not healthcare reform. Now, thanks to a yearlong process that has disillusioned voters, even that goal has seemingly been discarded as a legislative attempt to solve healthcare's many woes seems as far away as ever. Not that covering the uninsured isn't a laudable goal, but healthcare reform should be about sustainability.

That's why the Quality, Efficiency, Safety, with Transparency (QUEST) program, a joint project with the Institute for Healthcare Improvement and the Premier Healthcare Alliance, is a ray of light in the darkness. QUEST helps hospitals to do what they have trouble doing alone by establishing a framework and data center that allows hospitals to compare themselves against each other, and a way to collect data and pool knowledge in such a way that sustainable cost and quality improvements can be made more quickly than if they were attempted by a bunch of hospitals operating individually.

Even though Premier has more than 2,000 hospital members, it's owned by a group of about 200. Many of those 200, including Arlington-based Texas Health Resources, have become guinea pigs for QUEST, which benchmarked participating facilities using data from Premier's clinical database to determine the "baseline" level of performance in cost, mortality, and evidence-based care delivery. Its goals are to:

• Save lives: Eliminate avoidable hospital mortalities.
• Safely reduce the cost of care: Reduce the costs for each patient's hospitalization.
• Deliver the most reliable and effective care: Ensure that patients receive every recommended evidence-based care measure.
• Improve patient safety (year two measure): Prevent incidents of harm in more than 30 categories, including healthcare-acquired infections and birth injuries.
• Increase satisfaction (year two measure): Improve the patient's overall care experience and loyalty to the care providing facility.

Twelve of THR's 14 hospitals are participating in QUEST, with the goal of reducing unnecessary deaths and cutting costs.

"We believe this is helping us set metrics that focus specifically on how our hospitals can reduce the cost of care and deliver more reliable evidence based outcomes," says Doug Hawthorne, THR's president and CEO, and a former board chairman at Premier. Hawthorne says the QUEST program alone, through its focus on evidence-based medicine guidelines and its cost metrics, has saved its participants $800 million and saved 8,000 lives in its first year (QUEST is now in its second year). Hawthorne says those results are credible based on what he's seen in cost savings in his own 12 QUEST-participating hospitals.

Participating in QUEST helps standardize patient care protocols as well as equipment and supplies, he says, helping THR's strategic goal of achieving "systemness." That means he's able to present data to insurers that convey THR's story across the system, rather than by individual hospital. He also says QUEST indirectly will help THR save $8 million over the next few years through process improvement exercises that allow THR to contract as a system for electricity and gas, for example, and to pursue the viability of long-term strategic possibilities like an integrated health campus model as opposed to a hospital-centric one.

Put simply, it helps hospitals—even those under the same corporate umbrella—to work more closely together. It makes sense. If two heads are better than one in helping solve a problem or group of problems, 200 are even better. More than 30 new hospitals joined the QUEST program recently.

What are the other few thousand waiting for? An act of Congress?