Premier launches new hospital QI collaborative

Focus closely on creating a 'template' for reliability

Following closely on the heels of its successful Hospital Quality Incentive Demonstration (HQID) project with the Centers for Medicare & Medicaid Services, Premier Inc. is launching Quest (quality, efficiency, and safety, with transparency), a voluntary three-year program that will reward hospitals that achieve certain quality and efficiency measures and help them share best practices.

Performance will be measured in five areas:

  • Mortality ratio, which will be risk-adjusted, aimed at eliminating all avoidable deaths;
  • Appropriate care, which will measure the percentage of patients receiving "perfect care" as defined by national standards, raising the bar to suggest that all patients should receive appropriate care every time;
  • Efficiency, which will measure adjusted cost per discharge;
  • Harm avoidance, measures of which will be developed over time by the program, taking into consideration the multiple existing industry standards from the likes of the Agency for Healthcare Research and Quality and the National Quality Forum;
  • Patient satisfaction, which will utilize CMS's HCAHPS patient satisfaction measures as a metric to drive improvements in satisfaction.

As of this writing, 60 hospitals have joined the program, which Premier, of Charlotte, NC, expects to launch in October with 100 participants.

Beyond P4P

While it will clearly have a pay-for-performance component, the goals of Quest move beyond that single focus. "The rationale for Quest is to move us closer to our goal of improving the health of communities by establishing these dimensions [bulleted items above] and working on what we think are the measures that really matter to us as an industry," explains Meg Horgan, Premier's vice president of customer services and performance improvement. In other words, she notes, Premier is seeking a "template" for reliability.

With the Department of Health and Human Services moving toward value-based purchasing, Horgan notes that "the ability to test these measures will help us get there." However, she adds, "we have a primary goal of moving all hospitals into the top quartile of all these areas simultaneously. Many hospitals have pockets of excellence; we are looking to achieve reliable care for all these areas."

A logical extension

Horgan notes that Quest is "absolutely" a logical extension of HQID and other initiatives. "When you look at HQID, it was really a great start — focused on and achieving certain goals. The reward system helped, but we are looking for broader measures — not just for Medicare, but for all payers, and also broader populations — all patients. "

As for lessons learned from HQID, Horgan says, "We learned that the organizations that were successful really had established cultures of quality; their leaders were totally engaged; their efforts were data driven; there were systematic processes in place; clear accountability for results; and an understanding of and commitment to sharing best practices. These were the major drivers we continue banking on for Quest."

As for new directions, Horgan sites an expansion of measures and types of measures. "Also, we are looking at being able to influence the industry on what the right measures are," she says. For example, in terms of mortality, "we will be evaluating multiple models that are out there now for determining risk. Our goal is to test measures, to correlate process measures with outcomes and inform the industry about what measures matter as we build reimbursement around them."

Horgan is quick to note that Premier will not be creating new measures. "We will draw upon ones that are already out there," she explains. "But we will use industry experts and our charter members to come to some consensus on which ones they feel are the right ones to use."

Evaluating performance

Once Premier has the charter members use their data to determine a baseline, says Horgan, "our goal is to move 50% of them into the top quartiles for all the measures in three years." Premier will not be accepting any and all hospitals as participants, she emphasizes. "Qualifications include being able to use standardized tools, having a committed executive team, and demonstrating an alignment of organizational goals with Premier's goals," she says. "They also need to be willing to be transparent with their results."

Ideally, she says, data sharing would occur monthly. "Right now, most of our hospitals send us data quarterly," she says, "but we've learned that the faster they can get the data, the faster we can evaluate their performance and the faster they can improve and share results."

How will the rewards differ from, or be similar to, those offered in HQID? "The biggest difference is it will not be restricted to CMS or Medicare patients," says Horgan. "Also, it will not strictly be P4P, but rather rewarding those facilities that get into the top quartile." At present, she says, Premier is in talks with insurance carriers about setting aside funds for the reward pool. "That will be finalized in October," she predicts.

Finally, she says, Premier will be assisted in pursuing its "reliability" goal by the Boston-based Institute for Healthcare Improvement (IHI). "IHI will be providing technical assistance in terms of helping to build our internal capacity to spread new ideas and disseminate them broadly," Horgan explains. "They look upon will, ideas, and execution as essential elements for strategic improvement, and we are looking at hospitals developing a reliable system to be able to execute the right care all the time. It's the strategy around how you do this that makes it reliable, and we believe with their strategic guidance we will be able to do this successfully."

[For more information, contact:

Meg Horgan, Vice President of Customer Services and Performance Improvement, Premier Inc., 2320 Cascade Pointe Boulevard, Suite 100, Charlotte, NC 28208. Phone: (704) 357-0022.]