比较有意思的是
1）以医院为中心整合的社区医疗服务模型能够多大幅度的降低医疗成本；
2）Lean带来的组织文化变化；
3）统一的电子病历系统带来的效益；
4）以病人为核心设计医疗服务系统；
Source: Kaiser Health News
http://www.kaiserhealthnews.org/Checking-In-With/Checking-In-With-Patricia-Gabow.aspx
Checking In With Denver Health CEO Patricia Gabow On A "Model" Health Care System Topics: Health Reform
By Andrew Villegas
Aug 14, 2009
President Barack Obama's trip Saturday to Grand Junction,Colorado is meant to highlight an efficient, high-quality health caresystem, one with "integrated care." That phrase has become a popularterm these days as Congress and policy gurus contemplate how thenational health care delivery system can be refined.
Butthe idea is not so new. Denver Health, just a few hundred miles east ofGrand Junction, began its own evolution into an integrated care systemin 1949 with the opening of Denver General Hospital. Over the years, arange of services and facilities has been brought into the network. Itnow serves 150,000 people, one of every four Denver residents and oneof every three children.
CEO Patricia Gabow credits much ofDenver Health’s efficiency and quality to the "lean" model ofintegrated care, which is based on Toyota's production system. Hers isone of the first health systems to adopt "lean" in an effort tostreamline processes and provide better patient care. Healthinformation technology is at the core of this approach.
Gabowhas testified before Congress about the Denver Health model. Sherecently spoke with KHN's Andrew Villegas and detailed how thiswide-reaching, inter-connected network can serve as a useful examplefor lawmakers and health systems to consider as they puzzle over how toexpand access to quality care while keeping costs under control. Editedexcerpts follow.
Q: What does integrated care mean to Denver Health?
A: It'snot just a hospital -- but it has a hospital, all the community healthcenters that are federally qualified in Denver, all the school-basedclinics and public health department, the 911 system, the callcenter and correctional care. All of those pieces create a variety ofpoints of entry and a continuum of care for patients. That's theintegrated model.
[The model] has been built up over 149 yearsof Denver’s history. Whenever a new component to a health care modeloccurred, it was added to Denver Health, which is very different than[what happens] in most cities. In most cities, public health is notlinked to personal health. Other cities have… developed silos andnobody wants to change. We were lucky that our city never let thosesilos happen in the first place.
Q: What is your "lean" model of integrated care?
A: LEANstarted about four years ago when we asked ourselves the question 'Howdo you really get it right and perfect the patient experience?' Wedecided that if you want to get it right, you need five rights -- theright physical environment, built for quality and safety and to supportemployees, patients and families; the right person in the right job;the right communication and culture; the right processes; and the rightrewards. We called this our puzzle and all the pieces had to fittogether. They were held together by our IT system. To date, since2006, we have saved $27 million by eliminating waste and making all theprocesses better. We did that without laying off anyone or cutting anycare to the uninsured.
Q: How do you balance using electronic medical records and the goal to keep such records private?
A:Obviously you have to protect the patient's privacy. But health care isa knowledge-information business. And if you don't have any informationon the patient at the time you see them, you aren't giving good care.Twenty percent of all the tests ordered in America by doctors arebecause they don't have the data when they see a patient.
Wehave a single electronic record. It's across all our system -- everyprovider has access to all the data when they see the patient. It's…critically important for cost and safety. I think we have to protectprivacy, but I personally think this has been put out of proportion.Our electronic record is much more secure than our paper records everwere. We used to drive the records around the city in the back of atruck.
Q: How will health care reform affect Denver Health?
A:I think it's too soon to know. My one concern… is that it might not bebold enough. We don't even know what's included. But I think that,basically, if the only focus is on coverage, that won't be adequate. Wemust address all three issues facing us concurrently: access, cost andquality. And we have to address the delivery model as well as thepayment model if we're going to achieve access, cost control andquality. Right now there's been very little discussion about meaningfulcost control or meaningful delivery system change. That has to happen.You see, in Massachusetts they started out with coverage. But nowthey're realizing they have a cost issue. So if the country is alreadyspending twice as much as any other industrialized nation and leaving46 million to 48 million people without insurance, if you're trying tobring those 48 million in and you don't lower your costs, there's aproblem.
Q: If Congress incorporated one part of Denver Health's model into its reform plans, what should it be?
A:I do think they need to push payment models towards the development ofintegrated systems of care. The more we can create multiple points ofaccess for patients that covers them across the continuum of theirlives and across the continuum of their disease – that is the way we'regoing to get high-quality, low-cost [care].
Q: How much savings can be wrung out of things like integrated care?
A:There is a lot of money to wring out. We're a very efficient systemalready. … But to give you an idea: Forty-six percent of our patientscan't pay us. We have a very low subsidy. (Last year it was $27.9million to cover $318 million of uninsured care.) But we're in theblack every year and we've put $320 million into informationtechnology. We're one of the most sophisticated IT systems in thecountry. It shows you that this can be done.
Our chargesare lower than the average metropolitan charges … Our Medicaid chargesper stay are about 30 percent lower than the metropolitan peerhospitals … Medicaid is our single biggest payer, which is classic forthe safety net. And we are the largest Medicaid provider for the stateof Colorado.
Q: If it's so great, why aren't more hospitals integrating care?
A:They're ingrained in their ways and I think the reason that there'ssuch a push back against health care reform is what it always comes to:money. It's a $2.2 trillion industry. Somebody's waste is somebodyelse's profit. |
发表于 2009-8-18 22:22:28
