WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Integrating Physical and Behavioral Health

Date: July 25, 2013

Featuring:

• Benjamin Miller, PsyD, Assistant Professor and Director, Office of Integrated Healthcare Research and Policy, University of Colorado Denver
• Brenda Reiss-Brennan, PhD, APRN, CS, Mental Health Integration Director, Primary Care Clinical Programs, Intermountain Health Care
• Mara Huberlie, MA, Director of Project Implementation & Continuing Education, Greater Nashua Mental Health Center
• Melissa Merrick, LCSW, CDC I, Administrator/BHC Clinical Supervisor - Medical Services Administration, Southcentral Foundation

 
The road to recognizing the impact of mental illness on the lives of patients and families, and society as a whole, has been an uneven one in the US. Even as battles are being won for benefit parity, and medications can now alleviate some of the worst suffering, the stigma of suffering from depression or some form of psychosis still has a lot of staying power. And most experts agree the supply of mental health professionals doesn’t begin to match the numbers of people in need of therapy and treatment. Against this backdrop, a new approach is emerging to bring mental health “in from the cold.”

This WIHI showcases leaders and organizations that are at the forefront of redesigning care for patients and populations in need of primary care and mental health services. By offering both, often in the same location, providers are more likely to help their patients connect the dots between body and mind, and improve underlying health problems in a more holistic fashion. Research has begun to demonstrate that this approach leads to improved chronic conditions and fewer trips to the ED.

However, just because something makes a lot of sense doesn’t mean there’s the infrastructure, the clinical training, or the payment system to effect these changes. That’s where places like Intermountain Health Care, Southcentral Foundation, and Greater Nashua Mental Health can be especially helpful: they’ve forged ahead with new models and hope that others can learn by their example. WIHI host Madge Kaplan leads the discussion of new ideas and thinking with Ben Miller, who has that big picture, and the expertise of Brenda Reiss-Brennan and Mara Huberlie.

WIHI: Slowdown in the Growth of US Health Care Spending

Date: July 11, 2013

Featuring:

• Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement; Former Administrator, Centers for Medicare & Medicaid Services (CMS)
• David Cutler, PhD, Otto Eckstein Professor of Applied Economics, Harvard University, Harvard Kennedy School of Government, Harvard School of Public Health
• Amitabh Chandra, PhD, MA, Professor of Public Policy and Director of Health Policy Research, Harvard Kennedy School of Government; Member, Congressional Budget Office’s Panel of Health Advisors

 

Is the rate of growth of health care spending slowing in the US? And, if so, to what do we attribute this momentous development? Momentous because a lot of health economists and policy makers believe there’s something to the decline besides the impact of the recent US recession. And, for the first time, there are indications that pressure from both public and private payers, reinforced by reimbursement reforms rolling out in the Affordable Care Act, may be making a dent in the growth of the country’s health care spending. It’s way too soon to cheer, but it isn’t too soon to gather some smart people together to try and tease out what’s going on.

Guest Don Berwick talks about some of the initiatives he helped shape and enact while at the Centers for Medicare & Medicaid Services (CMS), designed to move the system toward global budgets and shared responsibility for populations. Are these shared-savings programs starting to have a slowing effect on the growth of health care spending? Well-known economist David Cutler discusses his recent findings that there could be a $770 billion windfall coming for Medicare and Medicaid over the next decade, that wasn’t foreseen and wasn’t part of cost projections. Amitabh Chandra is watching recent spending trends closely, too, and helps us think through whether any of them are linked to greater efficiencies, less waste, and better ways to deliver care.

WIHI's Communications Coordinator John Gauthier highlighted some of the key questions that listeners posed here in a blog post. Take a look and then listen to the broadcast to hear what our guests had to say.

WIHI: The Ground Game of the Partnership for Patients

Date: June 27, 2013

Featuring:

• Ann Hendrich, RN, PhD, FAAN, Senior Vice President, Clinical Quality and Safety; CNO; Executive Director, Patient Safety Organization (PSO), Ascension Health
• Deborah Morris Nadzam, PhD, RN, BB, FAAN, Project Director, JCR Partnership for Patients Hospital Engagement Network
• Katherine Luther, RN, MPM, Vice President, Institute for Healthcare Improvement
• Libby Hoy, Founder and Chief Executive Officer, Patient & Family Centered Care Partners (Long Beach, CA) 

When it comes to patient safety and reducing harm, one of the biggest challenges US hospitals face day-to-day is how to maintain a relentless focus on everything that needs to be improved and worked on, simultaneously. Building reliable systems, engaging leaders, insisting on a team-based culture, and ensuring that staff has the necessary improvement skills have become essential underpinnings at every organization. So has joining up with something larger — to keep the pressure on, commit to stretch goals, and benefit from coaching and continuous learning. 

The Partnership for Patients, launched by the US Centers for Medicare & Medicaid Services (CMS) in April 2011, is attempting to be that “something larger” for some 3,700 hospitals that have signed on to reduce nine hospital-acquired conditions by 40% and hospital readmissions by 20% by December 2013. What does this sprint look like from the vantage point of the 26 Hospital Engagement Networks (HENS) that form the backbone of the initiative? On this WIHI, we check in with two HENS — Ascension Health and Joint Commission Resources, Inc. Ann Hendrich and Deborah Nadzam are our invaluable informants, along with Libby Hoy, who’s playing a crucial role embedding patient engagement into every hospital’s safety work. IHI’s Kathy Luther also shares her perspective on what we’re learning about reducing harm from this ambitious initiative. 

At one level, the Partnership for Patients is about doing all the right things to protect patients from a list of hospital-acquired conditions and avoidable readmissions. But as you’ll find out on this WIHI, if the improvements are going to be lasting, hearts and minds have to change, too.

WIHI: Large-Scale Change Across a Country: Learning from Scotland

Date: June 20, 2013

Featuring:

• Maureen Bisognano, President and CEO, Institute for Healthcare Improvement (IHI)
• Jeffrey D. Selberg, MHA, Executive Vice President and Chief Operating Officer, IHI
• Derek Feeley, Director General for Health and Social Care, Scotland; Chief Executive, NHS Scotland; Incoming Executive Vice President, IHI
• Carol Haraden, PhD, Vice President, IHI

In September 2013, IHI will welcome one of Scotland’s most well-regarded health system improvement leaders to its executive ranks. Derek Feeley is currently Director General for Health and Social Care in the Scottish Government and Chief Executive of NHS Scotland. In this capacity, he has overseen and steered Scotland’s ground-breaking Patient Safety Programme. At IHI, Mr. Feeley will have executive-level responsibility for driving IHI’s strategy across five core focus areas: Improvement Capability; Patient Safety; Person- and Family-Centered Care; Quality, Cost, and Value; and the Triple Aim for Populations. His role will be international in scope, helping to steer IHI’s ongoing work on six continents in support of our mission to improve health and health care around the world. 
 
How can the experience of Scotland and the leadership of Derek Feeley move this agenda forward? We explore this on WIHI. Along with Mr. Feeley, our guides include IHI President and CEO, Maureen Bisognano; IHI COO, Jeff Selberg; and IHI Vice President Carol Haraden, who has first-hand experience working with clinical and quality leaders in Scotland and England to drive significant change across both countries. In Scotland, hospital standardized mortality ratios (HSMR) have fallen by nearly 11 percent since 2008.
 
What went on in health care delivery in Scotland to achieve these results? How is Scotland sustaining the gains and exporting the learning to other countries, including the US? How does Scotland now intend to change the health trajectories for infants and young children? WIHI host Madge Kaplan hopes leads the discussion to answer these questions. 

WIHI: Measure Up, (Blood) Pressure Down: 80% by 2016

Date: May 30, 2013

Featuring:

• Jerry Penso, MD, MBA, Chief Medical and Quality Officer, American Medical Group Association
• Phil Yphantides, MD, Hypertension and Diabetes Physician Champion, Sharp Rees-Stealy Medical Group
• Ola Akinboboye, MD, MPH, FACC, Associate Professor or Clinical Medicine, Weill Medical College of Cornell University; Medical Director, Queens Heart Institute; President, Association of Black Cardiologists
• Bob Mathews, President and CEO, MediSync

 

In order to improve health outcomes and slow health care spending in the US, much of which is fueled by millions of people with poorly managed chronic conditions, health care providers are rethinking how they engage with patients who are most at risk.

Hypertension is a case in point. Left untreated, individuals are on track to develop heart disease, strokes, and more. Yet the US Centers for Disease Control and Prevention (CDC) estimate that 30 million Americans with high blood pressure aren’t receiving the proper care. The reasons are complex and multifaceted. That’s why the American Medical Group Foundation decided six months ago to harvest the best hypertension interventions and innovations from leading medical group practices, and spread the learning via Measure Up, Pressure Down, a three-year national campaign. This WIHI looks at how the initiative is progressing.

Each guest has a unique perspective on the issues surrounding hypertension, as well as experience transforming group practices to deliver the right care to the right patient at the right time. Our guests agree that access to primary care is an important factor in untreated high blood pressure, but they assert that this tends to obscure other defects in the system. That’s why the campaign planks, described in a detailed toolkit, focus on eliminating “dropped balls” and map out ways medical groups can more reliably and accurately engage with the patients with high blood pressure they do see.

Learn about an effort that promises to impact both health care delivery and population health.

WIHI: Reliable Practices for Responding to Natural Disasters: Lessons from Long Island Jewish and Hurricane Sandy

May 16, 2013

Featuring:

• Mark P. Jarrett, MD, MBA, Chief Quality Officer, North Shore-LIJ Health System
• Mark J. Solazzo, MBA, Executive Vice President and Chief Operating Officer, North Shore – LIJ Health System 
• Joseph Cabral, MS, Senior Vice President, Chief Human Resources Officer, North Shore-LIJ Health System
  
  

Hurricane Sandy first struck the Caribbean and then the entire East Coast of the United States at the end of October 2012. The storm smacked into New York and New Jersey especially hard, impacting millions. The story of how the largest health care system in the region, North Shore–LIJ, operated throughout to ensure patients and staff were protected and supported, under fierce circumstances, is one that communities and hospitals everywhere can learn from. This WIHI features three leaders from NS-LIJ who were responsible for every kind of decision imaginable before, during, and after the storm.

Some of the decisions included transferring hundreds of nursing home residents out of harm’s way, taking in patients from other hospitals, assisting at area shelters, buying up fuel for ambulances, and opening up a resource center for hospital staff whose homes and neighborhoods had been torn apart and flooded. One of the back stories to NS-LIJ’s response is the degree to which it was built upon critical lessons learned during Hurricane Irene, a year before. In 2009, there was the H1N1 outbreak. In each instance, the health system did things well, and saw where it fell short; now that Hurricane Sandy has come and gone, this same type of assessment continues.

Health care organizations and first responders must prepare for many types of crises and disasters. Reflecting on the recent Boston Marathon bombings, which killed three and seriously injured over 200 (NEJM, April 24, 2013), authors Arthur Kellermann and Kobi Pelag write, “The best way hospitals can prepare is to base their response on a strong foundation of daily health care delivery.” So, routine and reliably safe practices, guided by continuous quality improvement, is lesson one for emergency planning. WIHI host Madge Kaplan invites you to learn more in this timely discussion.

WIHI: Home for Life, Aging, and Aging in Place

Date: May 2, 2013

Featuring:

• Sharon King, Principal, Starfield Consulting Ltd.
• Mimi Toomey, MA, Director of the Office of Policy, Analysis and Development at the Administration for Community Living (ACL),  US Department of Health and Human Services

 
With the aging of the population in many countries, where are the best ideas going to come from to help older people remain in their communities, and among the friends and families — and other seniors — they know best? How can we shift mindsets and models from ones that include endless and expensive health care interventions to a vision that factors in the role that supportive people and support services can play further upstream — to reduce isolation and loneliness, to ensure good nutrition and management of chronic health issues, to prevent avoidable hospitalizations?

This WIHI takes a stab at some answers. In South Georgian Bay, a community along the Severn River in Ontario, six organizations have come together to create a web of resources called Home for Life, focused on the growing population that’s over 65. Anchored by volunteers, a 211 system to initiate and engage services, and a “back to the village” vision that also includes empowering older individuals with computers and new technologies, Home for Life isn’t just another in a long string of well- intentioned social service initiatives. WIHI guest Sharon King, one of its creators, believes Home for Life should be studied, measured, and monitored for its effectiveness. She’s hopeful they’re on to something in Canada that can be adapted elsewhere.

How does this look to Mimi Toomey from her perch at the US government’s Administration for Community Living? With over 25 years of experience developing policies to support aging populations, is this the kind of “break the mold,” more cost-effective experimentation that communities in the US need to tap into, too? Do we have similar examples popping up that we need to learn more about? Probably so. If we’re going to get out from under headlines and reports that focus exclusively on aging as unaffordable for society most of all, we need fresh ideas and compassionate innovation.

WIHI: Engaging Patients in Safety — Live from London and the International Forum on Quality and Safety

Date: April 18, 2013

Featuring:

• Susan Hrisos, Senior Research Associate, Institute of Health & Society, Newcastle University (UK)
• Jane O’Hara, MSc, PhD, Senior Research Fellow, Yorkshire Quality & Safety Research Group, Bradford Institute for Health Research
• Martin Hatlie, JD, CEO, Project Patient Care; President, Partnership for Patient Safety; Co-founder, Consumers Advancing Patient Safety

It’s easy enough to say patients need to be engaged in all levels of their care, including being aware of best practices and anything that could inadvertently result in harm. But what does this actually look like day-to-day, especially in the high-stakes, busy environment of today’s highly complex hospitals? And what good does it do for patients and families to notice and speak up about things if there’s no one on the receiving end trained to respect and act upon the information? 

With at least a decade’s worth of ideas and initiatives on patient engagement with patient safety as a backdrop, new research on what is and isn’t working in the UK — with broad application to the US and elsewhere — is in the spotlight on this WIHI. WIHI listeners got a first peek at new analysis presented at the 2013 IHI-BMJ International Forum on Quality and Safety in Healthcare by leading researchers at Newcastle University and the Bradford Institute for Health Research in England, Susan Hrisos and Jane O’Hara. Martin Hatlie, one of the leading voices and experts on patient engagement in the US, comments on the research and describes new models for effective patient/provider collaboration around safety that are emerging in the US. 

Patient engagement in patient safety is here to stay. The only question is how this vital part of improvement can be more effective, and what skills patients and providers alike need to work together for the same goal. 

WIHI: Community Health Needs Assessments, Part 2: Lessons from North Carolina

Date: April 4, 2013

Featuring:

• Dorothy Cilenti, DrPH, MPH, MSW, Senior Investigator, North Carolina Institute for Public Health; Clinical Assistant Professor, UNC Gillings School of Global Public Health
• John Morrow, MD, MPH, Pitt County Health Director; Incoming President, North Carolina Association of Local Health Directors
• Craig James, MPH, President and CEO, Highlands-Cashiers Hospital

 

One of the reasons it’s so hard to transform US health care into something that’s safe, value-driven, and patient-centered, but also focused on improving the health of the local community, is that the responsibilities and the responsible parties have grown up completely separately. For example, it is not a naturally occurring event for the local public health department to coordinate its efforts with local hospitals… except in cases of disease outbreaks or disaster. So, imagine how rare it is to sit down together to craft overlapping goals for population health or to hatch new initiatives to keep residents from needing expensive acute care. It helps to have a convener to bring parties together… which is why we examined one such coalition that has formed in North Carolina on this WIHI.

WIHI host Madge Kaplan invites you to hear what’s been going on under the auspices of the North Carolina Institute of Public Health (NCIPH), and the leadership of Dr. Dorothy Cilenti and her team. They’ve brought together local health directors like Dr. John Morrow of the North Carolina Hospital Association and hospital leaders like Craig James; leaders from community health centers; and many more, to lay the groundwork for the future of health and health care in the state. The effort has become especially relevant and pressing because of new federal requirements for nonprofit hospitals to engage in robust community health needs assessments, with help and input from other groups and agencies. These new IRS rules, and how to make them meaningful, were the focus of the March 21 WIHI, which we invite everyone to listen to as background and context for the April 4 discussion.

One of the more intriguing dimensions to the work in North Carolina is its explicit mission to create multiple “community health systems” throughout the state to build and model best practices for population health. The collaborative driven by NCIPH is also working on analyzing return on investment and economic impact to “create the business case for working collectively on improving community/population health.” We’ve got a great case study to learn more about on in this show. Please listen, and make your own work on population health and community health needs assessments all the richer.

WIHI: Community Health Needs Assessments, Part 1

Date: March 21, 2013

Featuring:

• Sara Rosenbaum, JD, Harold and Jane Hirsh Professor, George Washington University, School of Public Health
• Kevin Barnett, DrPH, MCP, Senior Investigator, Public Health Institute
• Jean Nudelman, MPH, Director, Northern California Community Benefit Programs, Kaiser Permanente Northern California Regions

 

When a US hospital’s not-for-profit status is in the news, it’s usually not a good thing. It typically means someone (often a politician) is questioning whether the hospital’s federal tax exemption is deserved because of business practices, high executive pay, too little charity care, or a perceived lack of commitment to the local community. Sometimes the allegations and heightened scrutiny have been fair, sometimes not. Either way, America’s hospitals have a brand new challenge on their hands: to take newly revised IRS rules governing a hospital’s not-for-profit designation and turn them into meaningful plans to improve, in partnership with other organizations, a community’s overall health. 

WIHI held a timely discussion with three leading experts on the transformation of the decades-long “community benefit” law (largely focused on hospital support for indigent patients) into something more far reaching known as Community Health Needs Assessment, or CHNA. Section 9007 of the Affordable Care Act outlined the components of CHNA, chief among them a requirement for hospitals to conduct an evaluation every three years of the health status of the neighborhoods that surround their campuses, and then to use that information to develop strategies to reduce the community’s health risks. The new IRS rules also require greater transparency in the process and obligate hospitals to work in concert with community leaders and local public health experts. 

The trio of Sara Rosenbaum, Kevin Barnett, and Jean Nudelman exemplify the ways in which policy and public health expertise, access to community health data, and the experience of health care providers can combine in powerful new ways to meet the demands of CHNA — and, more importantly, to meet the demands of better health and better health care at reduced costs (yes, the good old Triple Aim).