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Outlook from the Summit

By Dr. David C. Pate, News and Community
February 27, 2012

We just concluded our annual two-day St. Luke’s Health System Summit. More than 250 people participated, including physicians, board members, and leadership from around the System. Nearly a third of the attendees were physicians.

Gay Simplot, a member of the St. Luke’s Boise/Meridian board of directors, and Tony Park presented a check to MSTI from the Killebrew-Thompson Memorial Golf Tournament for $350,000! We’re very grateful for the generosity of tournament organizers and participants, who have raised millions over the years to help us better treat cancer.

I then presented an update on how we’re moving toward accountable care, highlighted the past year’s successes, including those of our Healthy U program, and announced that St. Luke’s Health System will apply to take part in the Medicare Shared Savings Program.

I reported that we have had more than 10,500 readers of this blog since we launched in December. And I reported on the importance of the myStLuke’s electronic medical record, and how it will help to lay the foundation for clinical integration and accountable care, help us be more patient-centered, and permit patients to view their own medical records.

Next up was our guest speaker, Dr. Don Berwick. Dr. Berwick is a national physician leader in quality and patient safety. He was the president and CEO of the Institute for Healthcare Improvement and most recently, the administrator of the Centers for Medicare & Medicaid Services.

Dr. Berwick was very impressed with the work we are doing to provide accountable care and with our physician leadership. He talked about the scientific approach to quality improvement: method, capacity, context, and new ways to deal with challenges. He also observed that systems are perfectly designed to achieve the results that they get. If you want to change the results, you need to change the system.

Dr. Berwick underscored this disturbing fact: There is no evidence that the more we spend, the better the quality we achieve in health care, and that just the opposite is true. In the United States, the highest-quality areas are also the lowest-cost areas. Race and ethnicity should not impact outcomes, yet they do. We have significant health inequality in this country and people who are not Caucasian have worse health outcomes, so much so that the best predictor of life expectancy is race.

Dr. Berwick also emphasized a point that I have previously made on this blog: If we can’t deliver on the Triple Aim, which for St. Luke’s is better health, better care, at lower cost, what kind of health care (or the lack of health care) awaits our children and grandchildren?

He also confirmed another point that I have made repeatedly: It is almost immaterial what happens as the U.S. Supreme Court deals with the constitutionality of the health care reform law this spring and what happens in the elections later this year. The problems remain. We must fix health care or we will continue down the road of financial disaster.

"With Dr. Don Berwick, who commended St. Luke's efforts to transform health care and said our process improvement and sepsis intervention and mortality efforts were news worth spreading."

The answers will not come from Washington, D.C., anyway. The solutions will come from health systems like St. Luke’s, systems that are bold enough and determined enough to figure out how to create and provide accountable care. Dr. Berwick was excited to see, from our plans and progress thus far, that we are on our way to being a national leader that will help to solve the problem.

And why should physicians and hospitals work to solve the problem?

Because if we don’t, Congress will merely continue to deal with it through reimbursement cuts to providers. And at some point, the cuts will reduce physician access for patients and cause hospitals to close.

There are bright spots out there. The Nuka System of Care in Alaska has improved access to care and quality of care and reduced costs through the use of telemedicine and non-physician providers. And Dr. Berwick indicated that St. Luke’s results in reducing mortality from sepsis ranked with Kaiser Permanente’s performance as best in the country. Dr. Berwick also applauded our implementation of Lean through our St. Luke’s TEAMwork process improvement approach and our commitment to taking waste out of the System.

Dr. Berwick is thinking about “waste wedges” these days, those areas of opportunity that St. Luke’s and other health care systems can focus on for improvement. It has been estimated that at least 20 percent of the cost of health care is wasted spending, and Dr. Berwick thinks that to be successful, we must focus on

  • Overtreatment.
  • Failure to coordinate care.
  • Reduction of errors and injuries.
  • Excess overhead costs.
  • Excessive health care prices.
We also heard from St. Luke’s Chief Transformation Officer Tony Tomazic on different types of innovation. How do you innovate? Step 1: Set up the problem. Step 2: Understand your customers and what they want. And Step 3: Brainstorm ideas. Tony’s presentation was followed by an outstanding panel discussion from Marc Chasin, M.D., Martin Durtschi, M.D., Randy Billings, and Laura McGeorge, M.D.

Dr. Chasin, our chief medical information officer, reported on the early results from our first wave of the mySt.Luke’s implementation. We already have 1,400 patients accessing their own medical records on line! Dr. Durtschi reviewed our amazing quality improvement over the past couple of years. Our complication and mortality rates are only 60 percent of the rate that would be expected, meaning that 40 percent more patients were surviving than would be expected and 40 percent of patients escaped having a complication that would have been expected. Fantastic results!

Randy Billings, our vice president for provider and payor relations, explained our strategy for clinical integration: lower costs through a coordinated, leaner, and standardized delivery of proven high quality care. And Dr. McGeorge reviewed the accountable care initiatives to provide better care and lower costs, specifically, our care for high-risk patients with diabetes in conjunction with the Humphreys Diabetes Center and our Care of Patients at Risk program with Regence Blue Shield.

From the feedback we have already received, most attendees felt that this was the best Summit ever. Many thanks go to Matt Bell for coordinating such a significant event. It was bittersweet, as it was Matt’s last day with us, but we know that he is going to do great things as he moves on in his career, and we are so very grateful for all he has done for St. Luke’s.

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.