Michael AlkireAfter this fall's disastrous flooding in Colorado, it's easy to forget that, like many areas in the West and Southwest, the Denver metro area is just coming out of one of the worst droughts in its history. Indeed, notwithstanding the recent historical rainfall, Denver's climate is basically semiarid, and the area's propensity for drought demands continued vigilance in protecting water resources.

Prior to the recent downpours, experts noted that to meet its water requirements, the Denver metro area needed to save at least 16 billion gallons of water in the next year, with no certainty of whether future precipitation will be sufficient to meet that need. The good news is, Denver is prepared.

About a decade ago, the Denver Water Department launched the "Use Only What You Need" program to reduce water waste. The department collaborated with area schools on educational programs and partnered with appliance manufacturers to provide incentives for the use of water-saving equipment. Penalties for improper water use were also implemented.

Advertisements on billboards and sidewalk benches featured phrases, such as "CNSRV" and "B STNGY," that omitted unneeded materials and letters.

And it worked. Water usage dropped 30 percent in just one year, and citizens consume 20 percent less water to this day, despite a 10 percent population increase.

Health care is facing its own drought. Provider margins are depleting at a time significant investments in technology, labor, and other resources are necessary to transition to new care delivery models. And our industry is enduring a shortage of physicians and other clinicians while an increasing number of the aged and people with multiple chronic conditions require additional care.

But like the Denver Water Department and its community, care providers have been preparing for this situation for years. 

Building a Pathway to Change

Over the past decade, a number of hospitals and health systems have pioneered a pathway to change that has proven successful. They've focused on nationwide collaboration, sharing what works—and what doesn't—to improve care quality, cost and satisfaction.

It started with collaboratives, such as the Centers for Medicare & Medicaid Services (CMS) Physician Group Practice demonstration and CMS’s collaboration with Premier healthcare alliance on the Hospital Quality Incentive Demonstration value-based purchasing program. More-recent efforts focused on accountable care include CMS's Medicare Shared Savings Program, Bundled Payments for Care Improvement Initiative, Partnership for Patients Program, and Pioneer Accountable Care Organization (ACO) Model Program.

Each of these collaboratives has documented cost and quality successes among its participants. Now, we're seeing the affect they’re having on the industry as a whole.

A recent report shows healthcare inflation rising at the slowest rate in nearly 50 years. It's premature to think this trend will continue, and clearly the recession and other economic factors played a role in this decline. But an article in Health Affairs argues the slowdown "preceded the recession," and that spending "slowed more than the drop in income in the most recent recession would predict." And Harvard researchers directly associate a portion of the slowdown with the implementation of value-based purchasing and accountable care organizations. I couldn't agree more.

Delivering Care in the Right Setting

One thing is clear: To reduce healthcare waste, patients must get the right care, at the right time, in the right place. But a traditional care setting isn't always necessary.

University Hospitals (UH) Rainbow Babies & Children's Hospital created the UH Rainbow Care Connection—one of the country’s first pediatric ACOs—to improve care and overall health for children while lowering costs.

The program targets children with chronic and behavioral health problems. Focusing on patients who under- and over-utilize the care system, the ACO offers alternatives to high cost EDs, where about 70 percent of visits shouldn't require emergency care.

Nurses and physicians are available via phone 24/7 to prescribe medications, and provide care advice. Children and their families also have direct access to medical teams with their personal health information. And state-of-the-art telemedicine stations, monitored by a physician, consult on minor issues such as colds and earaches.

Though in its early stages, UH Rainbow Care Connection will impact 200,000 children in Northeast Ohio, one-third of them Medicaid enrollees.

Last year, in Chicago's inner city, Mount Sinai Hospital’s Sinai Urban Health Institute (SUHI) launched a program to educate citizens about preventing and managing diabetes.

Community health educators go door-to-door in area communities hit particularly hard by the disease, some having a diabetes rate three times the national average. Among the major reasons for the high rate of diabetes is a lack of access to healthy foods—the overall area covered by the program is known as a "food desert," with only one grocery store serving it.

SUHI partnered with that store to offer healthy shopping and food preparation classes, as well as free health and dental screenings. Opportunities now exist for parents to enroll their children in wellness programs at local schools, day-camps, and other youth programs.

Through 2012, health educators had canvassed well over 1,000 homes, working with 300 individuals with diabetes. They have increased their outreach in 2013, and plan to partner with Wal-Mart to expand their wellness program.

Preparing for Tomorrow Today

There's no quick or easy fix to solve health care’s drought. But it's clear that significant progress is being made. Pioneering health systems have taught us that we can be ready for today’s issues and tomorrow's challenges. Collaboration centered on education and innovation is an oasis for replenishing health care's resources and promoting future success. 


Michael Alkire is COO, Premier Healthcare Alliance, Charlotte, N.C.

Publication Date: Tuesday, September 24, 2013