HealthPartners, Allina form a 'lab' for health reform

An unusual partnership in the northwestern suburbs of the Twin Cities is claiming early progress toward the Holy Grail of health care reform: better treatments, lower costs and more satisfied patients.

In its first year, the joint effort between rival health systems HealthPartners and Allina Hospitals and Clinics was able to shave $6 million from medical costs for patients in Anoka and Sherburne counties, compared with what had been projected.

As the nation wrestles with polarizing issues of health care reform, the results offer a sliver of evidence from the front lines that doctors and hospitals can achieve savings without sacrificing patient care.

"We see this as a litmus test for the future of health care," said Dr. Penny Wheeler, Allina's chief clinical officer. "Here are two competitors collaborating for the common good. It's unique across the country."

As part of a seven-year "learning lab," Allina and HealthPartners agreed to pool resources, share electronic patient records and mine insurance claims data for a group of about 26,700 people with private insurance.

Tactics ranged from simple steps, such as giving heart patients a $12 scale to weigh themselves, to wholesale changes that required everyone from receptionists to physicians to change how they work.

More time was spent talking with patients and their families before they left the hospital. Urgent-care options were expanded to reduce emergency-room visits. Doctors were told to prescribe more generic drugs and avoid antibiotics. Women in the uncomfortable late stages of pregnancy who asked to be induced into labor were sent home.

"It's the exact direction reform has to go if we're going to keep private care affordable," said state Rep. Jim Abeler, a Republican who is chairman of the Health and Human Services Finance Committee and who represents Anoka County. "Rather than sitting around a table thinking up ways to do things differently, they're in the clinics and hospitals doing things differently."

Wheeler said the region was a natural testing ground for the collaboration, known as the Northwest Metro Alliance, because there's so much overlap of care between the two health systems.

Allina operates Mercy Hospital plus five medical clinics; HealthPartners provides health insurance and operates four medical clinics. Together, they treat about 300,000 people in Coon Rapids, Andover, Anoka, Elk River, Champlin, Coon Rapids, Elk River and Ramsey.

Allina and HealthPartners wouldn't discuss how much they spent on new technology or staffing, but leaders of the organizations said the long-term view will benefit patients and, eventually, the bottom line.

But by taking steps to keep people healthier and out of the hospital or doctor's office, they also don't get paid as much, highlighting a challenge of the current system that only pays caregivers for giving treatments.

Federal reform efforts to address this are often grouped together under a concept known as accountable care organizations, or ACOs. The idea is to encourage doctors, hospitals and insurers incentives to provide smarter care by allowing them to share in the cost savings.

Allina and HealthPartners consider the Northwest Metro Alliance an example of how an ACO could work. Others in Minnesota also have been adjusting their businesses to prepare for the new world of ACOs.

Fairview Health Services and Medica have been exploring ways to make systemwide changes in payment and health care delivery since 2008. Park Nicollet Health Services has been part of a five-year federal project aimed at reducing Medicare costs for chronic diseases such as diabetes, high blood pressure and heart failure.

Dr. Brian Rank, medical director of HealthPartners Medical Group, said the alliance wanted to eliminate the "white spaces in care" in favor of a continuous stream of health care support.

Patients often are overwhelmed with instructions from multiple doctors in different locations. Assigning a team of caregivers to those with complex conditions helps patients stay on track with treatment regimens and ward off potential problems. For doctors, being able to call up medical records on the computer provides a more complete picture of care at other clinics, which can avoid ordering duplicate tests.

Dr. Amin Rahmatulla, a cardiologist at Mercy Hospital, said that forcing the nearly two dozen cardiologists to coordinate care of heart failure patients has reduced the hospital readmission rate from about 25 percent in 2008 to 18 percent in 2010.

That's significant, he said, because heart failure accounts for the highest tab for Medicare costs, at about $393 million a year. At Mercy Hospital, and elsewhere, about a third of those readmitted to hospitals within a month of discharge have bounced back because they didn't take the medication properly or had side effects.

"A cookie-cutter approach doesn't work," he said, noting that patients often are dealing with multiple issues, including diabetes, kidney failure or chronic lung disease. "Giving these patients personalized care decreased errors and improved patient satisfaction tremendously. Their quality of life has been improved."