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Alven Weil, Premier Inc.
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Premier healthcare alliance launches comprehensive project to improve hospital quality, reduce costs

Premier, leading hospitals launch QUEST: High Performing Hospitals; Premier, the Blue Cross and Blue Shield Association working to develop incentives for top-performing hospitals

CHARLOTTE, N.C. (July 26, 2007) – The Premier healthcare alliance and a group of healthcare leaders today launched a comprehensive project called “QUEST: High Performing Hospitals” to improve patient safety and quality in the nation’s hospitals while safely reducing healthcare costs.

QUEST is a three-year program through which participating hospitals will report data to Premier on a set of clearly defined performance measures encompassing aspects of quality, efficiency, safety and patient satisfaction. Premier will analyze the data, facilitate sharing of best practices, and provide incentives for top-performing hospitals.

“This is an exciting partnership involving the Premier healthcare alliance, leading organizations in the healthcare quality movement and a large number of hospitals, reflecting our mutual desire to transform American healthcare,” said Richard A. Norling, Premier’s president and CEO. “QUEST High Performing Hospitals will move us closer to the day when we can say that America has the most effective, efficient and caring healthcare system in the world.”

QUEST is based on many of the same principles used in the Hospital Quality Incentive Demonstration Project – or HQID - a highly successful pay for performance initiative overseen by Premier and the Centers for Medicare and Medicaid Services.

“The success of that project led us to believe that similar principles – clearly defined performance measures, incentives for high performance, transparency, sharing of best practices – can accelerate improvement in other aspects of hospital performance,” Norling said.

QUEST also builds on the momentum of hospitals focused on harm reduction in the Institute for Healthcare Improvement’s (IHI) 5 Million Lives Campaign, a voluntary initiative to protect patients from five million incidents of medical harm over the next two years (December 2006 – December 2008). IHI is offering technical assistance and improvement expertise to the QUEST program.
“To accomplish our shared goal of transforming healthcare, we have to help hospitals improve multiple dimensions of performance simultaneously,” said Rashad Massoud, M.D., M.P.H., senior vice president of the Institute for Healthcare Improvement (IHI). “The ultimate goal of projects such as QUEST and the 5 Million Lives Campaign is to enable hospitals to reliably deliver the best outcome for each patient clinically and financially, and for each patient to be satisfied with the hospital experience.”

The QUEST recruitment period is open until September 30, 2007. Announced only several weeks ago, a number of hospitals to date have already signed up for the program, including Geisinger Health System of Danville, Pa., Kettering Medical Center Network of Dayton, Ohio, and North Mississippi Health Services of Tupelo, Miss., a 2006 Malcolm Baldrige winner. In QUEST, the QUEST measures focus on Quality, Efficiency, Safety, with Transparency.

“As a QUEST member hospital, North Mississippi looks forward to working with other leading hospitals and healthcare organizations to develop a program that will truly measure cost and quality performance,” said Ken Davis, MD, chief medical officer at North Mississippi Health Services, the first hospital system to join QUEST. “Our goal is to be a top quartile performer in all QUEST categories, all the while learning new ways to better serve our patients while safely reducing the cost of care.”

QUEST will be guided by an oversight committee comprised of leaders from IHI, the Premier healthcare alliance and charter member hospitals. QUEST will also benefit from the advice of an Advisory Panel which will guide issues around policy and advocacy. The panel will include Blue Cross and Blue Shield Association (BCBSA) and CMS (Figure 1).

“We believe in the effectiveness of P4P as tested in projects such as the Premier, CMS demonstration, and we applaud Premier and its member hospitals for taking this giant step forward in working to improve the quality of care and reduce costs,” said Allan Korn, M.D., senior vice president and chief medical officer, Clinical Affairs, BCBSA. “The Blue Cross and Blue Shield Association is working with Premier to determine the best ways to support and provide incentives to hospitals participating in the QUEST program."

It is anticipated that the performance measures developed through QUEST will be of significant interest to these organizations.

“QUEST hospitals will be engaged in developing and testing performance measures that will help guide future models of quality measurement and reimbursement,” said Stephanie Alexander, Premier senior vice president. “Participating hospitals will be ahead of the curve related to changes that are clearly coming in reimbursement landscape.”

The five measurement areas for QUEST are (Figure 2):

Mortality Ratio, which will be risk-adjusted, to attain the goal of eliminating all avoidable deaths;
Appropriate Care, which will measure the percentage of patients receiving "perfect care” – using nationally-recognized evidence-based measures.
Efficiency, which will measure severity adjusted cost per discharge, including all of the costs associated with each episode of acute care.
Harm Avoidance measures will be developed over time by the program. By harm avoidance, we mean the prevention of such things as healthcare associated infections and adverse drug events. Many measures exist today in this area. The participating hospitals will evaluate a number of these measures to identify those that have the greatest impact for use in QUEST.
Patient Satisfaction, which will utilize the CMS Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction measures. In addition to the obvious purpose of improving the patient experience, we will also study how patient satisfaction can relate to cost, quality and safety.

The initial phase of the program will focus on mortality, appropriate care and efficiency, with harm avoidance and patient satisfaction the focus in Year 2.

The QUEST recruitment period is open through the end of September. Approximately 60 hospitals have already indicated their intent to participate in the project. Sr. Carol Keehan, DC, president and CEO of the Catholic Health Association of the United States, said she expects significant participation by Catholic hospitals.

"We have a large number of Catholic hospitals participating in Premier's HQID project, and we are looking forward to a continued partnership to improve the quality of care for patients through the new QUEST project,” Sr. Keehan said.

In the end, the most important aspect of QUEST is the impact it will have on patients, Alexander said.

“Ultimately, QUEST is about reliably delivering the most efficient, effective and caring hospital experience for each patient,” Alexander said. “As important as QUEST is for hospitals in meeting the challenges they face, it will make an even greater difference for patients.”

Statement from the American Hospital Association (Figure 3).

About Premier, 2006 Malcolm Baldrige National Quality Award recipient
Serving 1,700 hospitals and more than 46,500 other healthcare sites, Premier is the largest healthcare alliance in the United States dedicated to improving patient outcomes while safely reducing the cost of care. Owned by not-for-profit hospitals, Premier operates one of the nation's largest healthcare purchasing networks and the most comprehensive repository of hospital clinical and financial information. Premier Insurance Management Services, Inc., a wholly-owned subsidiary, operates one of the largest policy-holder owned, hospital professional liability risk-retention groups in healthcare. Headquartered in San Diego, Premier has offices in Charlotte, N.C. and Washington. For more information, visit www.premierinc.com.