Region-Based Healthcare Transformation

by Julie Gray
Quality Quest for Health of Illinois

The best strategy to reduce costs and improve health can be found where healthcare is delivered: at the regional and community level.

According to the 2012 Greater Peoria Economic Scorecard produced by The Heartland Partnership, healthcare is the “region’s second largest and fastest-growing industry.” The region in the scorecard covers five central Illinois counties: Marshall, Peoria, Stark, Tazewell and Woodford. Increasingly, healthcare costs are making businesses uncompetitive, and health problems are making their workers unproductive. In the future, those regions and communities that can provide more affordable healthcare and healthier, more productive workers will be magnets for both new businesses and new residents. Efforts to control healthcare costs and improve quality should be included in central Illinois’ economic development strategy.

Healthcare Happens Regionally
Every region of the country is different in terms of the number, types and relationships of healthcare purchasers, payers and providers. Some regions have primarily small physician practices, while others have large group practices. One region may have multiple hospitals, while another has just one. Large, integrated delivery systems exist in some areas, but not others. A number of regions have delivery systems that are viewed as national models for cost-effective care, while others do not. Some regions have a dominant private insurer that is locally-based; others are primarily served by multiple national insurers competing for business. Some areas experience high rates of utilization or poor outcomes for certain kinds of procedures; others do not.

How Does The Peoria Area Compare?
There are several national organizations that gather health indicators to produce online scorecards or rankings which provide an overview of a population’s health and information about the regional healthcare system. These websites are valuable tools for employers and healthcare policymakers because they compile the most relevant statistics in one place, highlighting key indicators for assessing the overall health of a state, region or county over time.

For the purpose of this article, examples from two websites that use a Hospital Referral Region (HRR) to measure an area’s healthcare performance are provided. An HRR is a regional market area for tertiary medical care that has at least one hospital that performs major cardiovascular procedures and neurosurgery. The Peoria HRR includes the following hospitals:

  • Advocate Eureka Hospital, Eureka
  • Cottage Hospital, Galesburg
  • Graham Hospital, Canton
  • Hopedale Medical Complex, Hopedale
  • Illinois Valley Community Hospital, Peru
  • Methodist Medical Center of Illinois, Peoria
  • OSF Holy Family Medical Center, Monmouth
  • OSF Saint Francis Medical Center, Peoria
  • OSF Saint Mary Medical Center, Galesburg
  • OSF Saint Elizabeth Medical Center, Ottawa
  • Pekin Hospital, Pekin
  • Proctor Hospital, Peoria
  • St. Margaret’s Hospital, Spring Valley
  • St. Mary’s Hospital, Streator.

The Dartmouth Atlas
The Dartmouth Atlas of Health Care website provides data and information on “how medical resources are distributed and used in the United States.” The project tracks the performance of individual hospitals and their associated physicians, as well as regions and states in caring for Medicare patients. Variations in care arise from local, regional and state patterns of medical practice: how often patients see physicians, how often they are referred to specialists, how often the hospital is the site of care for patients with chronic illness, how many days patients spend in intensive care, and other measures. According to the Dartmouth Atlas:

“Much of the variation among regions in per capita resource inputs, utilization and spending has proven to be unwarranted; it cannot be adequately explained on the basis of differences among regions in prices, illness rates, patient characteristics, patient preferences, or the dictates of evidence-based medicine. Much of the variation relates to differences among providers… Of particular importance is the evidence that populations living in regions with greater levels of spending and greater use of physician visits and hospitalizations do not experience better healthcare outcomes or better quality of care.”

The Dartmouth Atlas has comparison data on topics such as the cost of care for chronically ill Medicare patients in the last two years of life, Medicare reimbursements, hospital use, medical discharges, surgical procedures, quality/effective care, end of life care, and physician and hospital capacity. As an example, the national average for the cost of a chronically ill Medicare patient during the last two years of life from 2003 to 2007 was $53,441, while the Illinois average was $55,729 per enrollee. Additional details can be found on the Dartmouth Atlas website.

The Commonwealth Fund Scorecard

The Commonwealth Fund is a “private foundation that aims to promote a high performing healthcare system that achieves better access, improved quality and greater efficiency.” Among its many resources, the Commonwealth Fund website has a Health System Data Center that allows visitors to interact with data from four different scorecards: State Scorecard, Child Health Scorecard, Long-Term Scorecard and a Local Scorecard.

The Local Scorecard looks at four areas of health system performance: access, prevention and treatment, costs and potentially avoidable hospital use, and health outcomes. As another example of variation among Illinois Hospital Referral Regions, the following chart shows hospital readmission percentages among Medicare patients in 2012. These are readmissions within 30 days of discharge as a percentage of all admissions. The median average for all HRRs across the U.S. is 17.7 percent.

Aurora............19.8%
Bloomington....15.5%
Blue Island......22.3%
Chicago...........24.7%
Elgin...............20.5%
Evanston.........19.3%
Hinsdale..........18.8%
Joliet..............21.2%
Melrose Park....20.2%
Peoria.............19.1%
Rockford..........19.1%
Springfield.......17.7%
Urbana............18.2%

The Commonwealth Fund has a comprehensive report available online entitled Rising to the Challenge: Results from a Scorecard on Local Health System Performance, 2012, which compares 43 indicators across all 306 Hospital Referral Regions in the country. The report’s findings “clearly show that where you live matters for healthcare access and care experiences.”

The Regional Health Improvement Collaborative
The only effective and sustainable way to reduce and slow the growth in healthcare costs is to fundamentally restructure healthcare delivery and payment systems, and that can only be done at the regional and community level, where healthcare is delivered. Similarly, the only way to truly engage citizens in improving their health is to address the barriers to healthy living in each community. The most effective federal strategy for reducing costs and improving the health of a population is to support regional and community strategies involving all stakeholders changing all aspects of the way care is delivered.

Enter Regional Health Improvement Collaboratives. RHICs have three key characteristics:

  • They are non-profit organizations based in a specific geographic region.
  • They are governed by a multi-stakeholder board composed of healthcare providers (physicians and hospitals), payers (health plans), purchasers (employers), and consumers.
  • They help regional stakeholders identify opportunities to improve healthcare quality and value and facilitate planning and implementation of strategies for addressing those opportunities.

Quality Quest for Health of Illinois is the RHIC for central Illinois. We are a neutral forum where different healthcare stakeholders convene to address challenging issues, as well as an independent source of unbiased information on local healthcare. Our goals are better patient outcomes and higher value for the money spent on healthcare. We achieve our goals by:

  • Identifying best practice standards
  • Measuring provider performance, providing analysis and reporting results
  • Sharing data with providers, payers and patients
  • Working to ensure delivery of the best healthcare value.

The result of this work is lower healthcare costs and healthier communities. Learn about the projects and public reporting of Quality Quest for Health of Illinois at QualityQuest.org. iBi

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