A look at value-based purchasing in action

It took four years for the Dallas-Fort Worth (TX) Business Group on Health (DFWBGH) to become a familiar and sought-after partner in the area’s health care community. Its calling card was giving its corporate members value in return for their health benefits dollars. (See cover story, "Cost and quality share top spot on corporate shopping lists" for additional details on this cooperative venture.)

Marianne Fazen, PhD, executive director of DFWBGH describes the evolution this way:

Year 1 — Relationship-building with the administrative and medical leadership of each hospital, the medical society, and individual physician groups.

Year 2 — Refining definitions of quality outcomes on which to base standardized data reports.

Year 3 — Trial runs of quality data.

Year 4 — Data reporting.

"We’ve gotten the hospitals and doctors to sit up and listen to us and to realize that we’re trying to improve quality through collaboration instead of a punitive approach," she says. "They are much more understanding of employers’ interests and more open than ever before."

The hospitals have agreed on quality and outcomes measures for two areas of care:

1. Maternity and neonatal

Indicators — vaginal birth after cesarean, length of stay, and cesarean rates.

2. Cardiovascular

Indicators — admission rates, infections, readmissions, and beta-blocker use.

Data collection and reporting highlights

• Participating hospitals (39) pay for extra data handling and reporting. Expenses include centralized data scrubbing and warehousing.

• Hospitals have these reporting requirements: Each field on the form is filled accurately according to the standardized style. Data are collected within a specified time window and submitted on time.

• Each hospital receives its own data un-blinded, as well as blinded comparative data from other hospitals in the marketplace.

• DFWBGH has received one blinded report to date and anticipates the receipt of unblinded versions of that report in the near future.

• The burden of data collection and reporting is mitigated by cooperation between area hospitals and the state’s hospital council.

Annette Rowton, vice president of clinical outcomes at Presbyterian Healthcare System in Dallas, explains that for a single fee, the council manages data for several reporting requirements. It’s worth the expense, she says, given the extensive use of the data. In addition to DFWBGH reports, the fee covers reports for the Oakbrook Terrace, IL-based Joint Commission on Accredita-tion of Healthcare Organizations, as well as others. "We have been analyzing and utilizing the reports internally with our ongoing quality groups," she says. "Also, it’s a source of local comparative data from other hospitals in the marketplace."

Additional outcomes from the four-year effort:

• Increased collaboration among area hospitals and physician groups. The DFWBGH is a regular participant on projects, notes Fazen. In fact, "They’re asking our blessing on more and more programs."

• The quality commitment has taken on a life of its own, beyond DFWBGH requirements. Hospitals and physicians have become far more involved in measuring quality across the health care continuum.

• Discussions are under way within the DFWBGH board to analyze claims data from the large employers. Although the statistics would not be severity adjusted, they could reveal a pattern of costs for procedures at individual hospitals. For example, the per-day cost of delivering a baby could be linked to pharmaceutical and other clinical charges, he says. "It would not be an apples-to-apples comparison, but it would give us a more complete picture of each hospital’s performance. And it might give us a sense of which hospitals are really good at taking care of high-risk maternity cases." The DFWBGH has not budgeted for the project, but Fazen says he might seek a grant to fund it.

• Standardized patient satisfaction measures are still to come. Such measures are currently on hold as the coalition and providers tend to other priorities, he explains. (For contact information for Fazen and Rowton, see box, p. 40.)