A new, broad-based group of Rhode Island health-industry and business leaders hopes to give employers a voice in the debate over the quality and costs of the state’s health-care system.
Atty. Gen. Sheldon Whitehouse recently disclosed plans for a “Quality Institute,” which he says will serve as a “central command and control area for improving quality” in the state’s hospitals.
“If you’re an employer, you have some kind of say in virtually all your major expenses, whether it’s your raw supplies or personnel or whatever,” Whitehouse said during a recent interview.
“But what I sense from the business community is a very high level of frustration that they have no voice in health care,” he said. “They pay money to the insurer, but in terms of controlling the debate in the health-care arena, they’re basically shut out.”
John Gregory, president of the Northern Rhode Island Chamber of Commerce and a participant in plans for the Quality Institute, said rising health-care costs have been a top issue for chamber members in recent years.
“We had been taking a traditional approach, trying to figure out how we minimize the health-premium increases,” Gregory said. “But eventually we started thinking about other ways to minimize these costs, like educating employees.”
That same sort of progression led to the formation last year of the Leapfrog Group, a national consortium of Fortune 500 companies and other large health-care purchasers. The group – which includes Textron Inc. – is dedicated to improving patient safety while lowering costs.
Although the plan for the Quality Institute is not modeled after the Leapfrog Group, Whitehouse said the goals are the same: better-quality health care with greater efficiency and less cost.
The idea for a local Quality Institute surfaced more than a year ago, during unsuccessful discussions of merger between Lifespan and Care New England health systems. Officials had proposed an institute that would have monitored the effectiveness of treatment at the state’s hospitals.
The proposal has been revived, although details of its structure and role are sketchy. Organizers are crafting a mission statement, developing by-laws and narrowing down exactly what aspects of care the group initially will focus on.
Eventually, there will be a board of directors, an executive director and – most importantly, officials say – a medical advisory board of doctors and other health-care professionals who work on the front lines of health-care quality issues.
The institute has garnered the attention of many of Rhode Island’s leading business groups and health organizations.
A partial list includes top executives from four chambers of commerce, the Rhode Island Public Expenditure Council, Lifespan, Care New England, the Hospital Association of Rhode Island, Blue Cross & Blue Shield, Rhode Island Quality Partners and Brown University. They have met several times since January to discuss details of the Quality Institute, Whitehouse said.
The Rhode Island Foundation has coordinated the effort, with $100,000 from various participants. Laura Adams Consulting of Boston was hired to spearhead the institute’s formation.
Organizers admit that virtually every entity in the health-care spectrum has its own quality-improvement programs, from hospitals and nonprofit health groups to insurers and state and federal agencies. An ongoing performance-measurement program overseen by the Rhode Island Department of Health, for example, is geared toward prompting hospitals to improve certain aspects of care.
But Quality Institute organizers say the group will serve as a central hub for those pursuits, whereby quality initiatives can be prioritized, coordinated and standardized across the state’s hospital system.
“We know that there are a lot of competing quality initiatives out there right now, but most of them target the same goals,” said Quality Institute consultant Laura Adams. “The institute’s role would be to coordinate and capitalize on those.”
One possibility: developing standardized clinical protocols, aimed at improving safety. For instance, individual hospitals might have different protocols for treating pneumonia patients.
“This is going to be the forum where they get together and say ‘Hold it, we can’t have all these different protocols kicking around,'” Whitehouse said. “They’ll work out what the best one is with the expert assistance of Quality Institute staff.”
The institute, Whitehouse said, is aimed at changing what Whitehouse and other call the “perverse economics” of health care.
The theory: As hospitals roll out quality-improvement initiatives, expenditures increase in order to implement new programs. But as those programs take effect and treatment improves, it effectively cuts the hospital’s business, because patients come back less frequently with infections, for example.
The end result of trying to improve quality, Whitehouse said, is reduced revenues.
“By just yelling at the hospitals, you’re never going to get them to make the right level of investment in quality because the money isn’t there and the incentives aren’t there,” Whitehouse said. “You need to involve the people to whom the savings flow, who are the insurers and, mostly, the employers.”
Eventually, the institute should provide a venue for employers to shape health-care policy at the state and national level, according to Michael Follick, president and CEO of Abacus Group in Cranston, which conducts measurement and research of health-care quality initiatives.
“Employers aren’t connected anywhere in the health-care delivery system,” Follick said. “Providers and (insurance) carriers have been at war with each other for years, and you have this disconnect with the actual purchasers of health-care services.”
Follick uses the example of mandated health benefits, which are laws passed by state governments requiring coverage for certain health-care services.
“Special-interest groups influence the creation of these mandates, and employers are never at the table,” he said. “But the employers are the ones who will bear the cost of those.”
Organizers say the Quality Institute also will provide revenue possibilities for providers by serving as a clearinghouse for quality-initiative grants from federal agencies and nonprofit foundations.
“There’s plenty of money available for quality initiatives, and if the group can demonstrate the strength of the leaders behind the initiative, it garners a lot of attention from grant-makers,” Adams said.
