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Blazing a trail toward lower costs and better care
Insurer-hospital collaborative yields 'phenomenal' results
A few years ago, a handful of Michigan hospitals were using filters on bariatric surgery patients, expecting to prevent blockage in their lungs. Instead, studies found that the filters were causing postoperative complications and sending patients right back to the hospital within 30 days.
A group of 40 hospitals, in conjunction with the state's largest private insurance company, had formed the Michigan Bariatric Surgery Collaborative. Seventy-seven physicians were meeting regularly to chew over issues, and they knew to pounce on the problematic filters. By sharing data and their collective know-how, the collaborative reduced readmissions by 35 percent over the course of three years and decreased emergency department visits by 35 percent.
"It was an incredible climate of respect and trust, and they changed things," says David Share, M.D., executive medical director at Blue Cross Blue Shield of Michigan, which has funded and championed the collaborative. "If you just put that information out as a research article in a journal and put it in people's mailboxes, it would have taken many years for that learning to disseminate into real practice. It was really a stunning example of the power of the model."
BCBSM is blazing trails in the Great Lakes state, where the insurer is investing about $20 million annually in 12 collaborative quality initiatives focused on sharing data in certain areas and convening physicians to discuss the findings. In April, Blue Cross released the findings from the four initiatives that are furthest along — general, bariatric and cardiovascular surgery, along with angioplasty. The results have been staggering: $232.8 million saved over three years, with significant reductions in surgical-site infections, readmissions and lengths of stay.
While providers are sometimes hesitant to share data with insurance companies, worried that it might be used in contract negotiations, Arthur Carlin, M.D., says the results have been impressive. In fact, the American Society for Metabolic and Bariatric Surgery is looking to emulate the bariatric program nationally.
"Initially, I would say there was quite a bit of skepticism, but it has been phenomenal," says Carlin, head of general surgery for Henry Ford Hospital in Detroit. "It's pretty much transformed bariatric surgery, not just in my institution, but throughout the state."
Share says they were able to quell fears from surgeons, and all of the 70 institutions taking part in the 12 initiatives, by making it clear that the data is owned by the consortium, and that neither BCBSM nor any hospital can see numbers from each individual hospital. Other states, such as Tennessee and Florida, are looking to tackle similar collaborations, Share says, and those involved in Michigan believe the model could provide the Centers for Medicare & Medicaid Services with important lessons in improving quality and reducing costs.
Sam Watson, senior vice president of patient safety and quality for the Michigan Health & Hospital Association, says BCBSM is using a powerful model, but there will be obstacles to conquer to spread it nationwide, including the time it takes to gather data, figuring out how to use it meaningfully and putting supportive leadership in place at the physician and C-suite levels.
"We're all learning a culture that's an extremely important part of this work," Watson says. "It's not something that people gravitate to immediately because it's not in a journal; it's not the 'evidence.' But the culture of accepting how we can prevent harm and make care better is a critical part of making this sustainable over the long term."
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