Grant renewed for Alliance for Health

May 27, 2011
| By Pete Daly |
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A $650,000 annual grant from the Robert Wood Johnson Foundation for the Alliance for Health — one of three federally designated Chartered Value Exchanges in Michigan — has been extended, according to Lody P. Zwarensteyn, president of the Alliance.

“We just got it renewed as of May 1 for the next two years, and we’re very happy with that,” said Zwarensteyn.

The Alliance, a West Michigan nonprofit organization set up more than 60 years ago to encourage high-quality health care for all at the lowest cost, enjoys the dual prestige of being one of the first 14 designated Chartered Value Exchanges and a recipient of one of the Aligning Forces for Quality grants from the RWJF, the nation’s largest health foundation.

“On the other hand, it’s sobering because if we don’t do well, the eyes of the nation are on us. We want to make sure that we can perform,” said Zwarensteyn.

Performance, in this case, “requires everyone to partner in this effort,” he added, but that’s not always a cinch.

The Patient Protection and Affordable Care Act, signed into law March 23 last year by President Barack Obama, required the Secretary of the Department of Health and Human Services to establish a national quality strategy that sets priorities to increase access to high-quality, affordable health care for all Americans and to develop a strategic plan on how to achieve it. The result is the National Strategy for Quality Improvement in Health Care, which, according to Zwarensteyn, pursues three broad aims:

  • Better care that is more patient-centered, accessible and safe.

  • Healthier people and healthier communities through proven ways to address behavioral, social and environmental determinants of health.

  • Affordable care through reduced cost of quality health care for all.

Zwarensteyn said there is “much waste and inappropriateness” in the American health care system, adding that “the feds are beginning to put into effect policies to make the system more focused and less costly.”

In West Michigan, the work of the Alliance has supported more widespread use of information technology, measuring physician and institutional performance and publicly reporting that performance, consumer engagement, specific quality improvement and a website, It is a consumer website that offers information on health care resources, including comparisons of performance ratings for West Michigan hospitals in certain categories, based on national averages.

The Alliance also has worked to allow medical records systems to include patient race, ethnicity and language, in order to better study and report quality measures as they pertain to each segment of the population.

Zwarensteyn said there is occasionally a glitch in cooperation by some individuals, organizations and businesses in the health care community. Sometimes hospitals fail to overcome their rivalry with others, and those situations can get in the way of fully participating and cooperating with each other, he said.

“In order to really make changes, we need some system-wide moves, and that means we all have to be committed in this region to doing better collectively. The rising tide has to lift all ships. It’s not like one party has a competitive advantage over anybody else, and yet we have some people who think they are so different that they don’t need to work with others, at times. At other times, they do. It changes by the day,” he said.

“We have insurance companies that will tell you ‘we’ve got a better product.’ We have hospitals that will tell you, ‘we’re better than the next guy.’ We have some doctors say, ‘I’m better.’

“The idea really should be that we want everyone to be better — not just one or two. You can’t have an island of quality in a sea of mediocrity. It just doesn’t work,” said Zwarensteyn.

The fact that the federal government now has “an agenda for quality” in American health care really is a first, according to Zwarensteyn. 

Improving health care quality “is a phased kind of thing,” he said. One project the Alliance has been working on for the last three years is getting patient information sorted by categories. An example of that is comparing procedures for heart failure and coronary artery bypass graft surgery. Taking it further, the Alliance got the hospitals to agree to break their data out by race, ethnicity and primary language.

A hospital could report it was in the 98th percentile in heart failure survival rates, but “that would leave room for a follow-up question: Are all your patients in the 98th percentile? Now, increasingly, we can answer that question. That’s good,” said Zwarensteyn.

Is it difficult to obtain cooperation from hospitals on sharing information such as patient data broken out by race, ethnicity and language?

“Oh no,” said Zwarensteyn. “Spectrum Health and Trinity Health, in Muskegon especially, were very cooperative getting their record system into such a condition that they could, in fact, collect race, ethnicity and language data. It meant changing record systems and reworking those.”

The Alliance is now trying to get patient records in physicians’ offices to reflect race, ethnicity and language, and he said physicians are providing that information, largely because they want to.

“Doctors have this scientific curiosity; they want to know if they are doing well,” he said.

However, there is still resistance from some health care providers regarding the proposed change to electronic patient records, due to questions about the time required, the cost, etc.

“Our approach here in West Michigan has been to say, let’s work on these questions jointly,” said Zwarensteyn.

“We’re hopeful that everybody is on board. We’ve had good cooperation to date. Periodically, there are little challenges, but we’re able to overcome them, to date,” said Zwarensteyn.

“We’d like to be able to hit a home run on behalf of the region,” he added. “We want to be in the top 1 percent of performing systems in the nation. We want to give a reason for people in other markets to come to West Michigan for their care.”

Making West Michigan a “health care destination” would add business to the region, while also bringing down the unit cost of medical care for the people who live here, he explained.

There are 24 Chartered Value Exchanges in the U.S., and only two states have more than one: Pennsylvania has two and Michigan has three.

There are 17 community coalitions like the Alliance for Health receiving the RWJF Aligning Forces for Quality grants.

Results achieved by the national Chartered Value Exchanges and the Aligning Forces for Quality communities, as well as several significant efforts around the nation, will be used to help form the National Quality Strategy. One such effort is Michigan’s Keystone Intensive Care Unit Project.

Because nearly one in every 20 hospitalized patients in the United States each year acquires a sometimes fatal health-care-associated infection, the Michigan Health and Hospital Association worked on ways to reduce blood stream infections in 100 intensive care units throughout the state. Known as the “Keystone Project,” it reduced the rate of these infections by two-thirds within three months. Over 18 months, the program saved more than 1,500 lives and nearly $200 million, according to Zwarensteyn.

These dramatic improvements were sustained for five years, and the Michigan approach is now being applied nationwide.

Zwarensteyn said health care professionals and hospitals can receive incentive payments when they adopt and use certified technology to improve care. Altogether, more than $27 billion in incentive payments is available to eligible providers and hospitals in the U.S. that meet these “meaningful use” objectives.

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