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Can Utah innovation lead the way on health care?

Premature babies often need assistance that typically comes in the form of expensive medical treatments and devices.
Premature babies often need assistance that typically comes in the form of expensive medical treatments and devices.

SALT LAKE CITY — American Fork Hospital delivers its share of babies, some of whom come earlier than planned.

As medical teams rush to care for the premature newborns, they have developed a system that saves lives and money, but also chips away at their own bottom line.

"Better care is nearly always cheaper," said Dr. Brent James, chief quality officer and director for the Institute for Health Care Delivery Research at Intermountain Healthcare, based in Salt Lake City. He said in order to reduce costs in health care, medical providers and insurance organizations "have to continue to do things that support those with the greatest needs in society."

Quality care, he said, depends on more than regulations and government policy and policy-makers can do more for health care reform by investing in public health programs, including mental health treatment, and education than anything else.

"Someone is going to figure this out and when they do, they're going to change the world," James said.

An example of change

As the lungs are one of the last organs to fully mature, premature babies often need assistance with breathing and that assistance typically comes in the form of expensive medical treatments and devices. The babies could die without immediate care.

Instead of transporting the little ones to a nearby, better equipped hospital with an intensive care unit, involving invasive intubation en route, doctors now utilize a simple breathing machine, allowing the babies lungs to expand and compress normally until they are strong enough to work on their own.

The "major improvement in a clinical outcome," James said, has curbed the intubation rate at the hospital, from 78 percent to 18 percent of the 110 babies born between 33 and 37 weeks of gestation each year.

But efficiency and better care has also led Intermountain to a more than $5 million profit margin loss, which is money insurance companies can then count as savings. Both add up to savings for the system and improved outcomes help the community as a whole.

"There are more efficient ways to do what we're already doing," said Jason Cooke, Utah Health Policy Project's Medicaid Policy fellow. He said stakeholders, albeit those who have been most competitive in the past, must come together to do things smarter, resulting in cost savings, but also better community health.

The Utah Health Policy Project hosted the Better Care Conference Friday, including provider groups and insurers from across the state, looking for an information exchange that might lead to better practices in the health care system.

"This lays the foundation for community collaboration that we need to implement facets of the Affordable Care Act in Utah," Cooke said. "We need to work better and more efficiently, figure out ways to arrive at the same goal and be a model for the rest of the country."

Such innovation, he said, is not just about the potential savings, but primarily about a better system of delivering health care.

James, who spoke at the conference, said Intermountain has been using various tools to measure quality within its system for years. The most beneficial methods, he said, are not financial incentives, which government-run plans seem to favor, but those that involve the patient in their own care, and also keep providers up to date on a patient's treatment.

"The best tools are those that blend into the background so providers don't even know they're following any sort of protocol," James said.

Through an aggressive detection and treatment program at Intermountain, providers have decreased the number of in-hospital sepsis-related deaths by more than 14 percent in the past three years. Sepsis is one of the main causes of hospital deaths, specifically among those admitted through emergency rooms, and the condition remains unabated in certain hospitals in the country.

Focus on the individual

Access to health care plays about a 5 percent role in a person's overall health, while public health programs make up 25 percent, genetics, 30 percent, and the remaining 40 percent is based on personal behaviors, James said. So there is much that can be done for health within the community.

Better education, he said, also leads to better health, in conjunction with better incomes and greater access to insurance programs.

"No two patients are the same," James said, adding that genetics, levels of exposure, responses, preferences, circumstances and values differ among individuals. "You have to adapt treatments to the individual."

Regulated protocols, he said, will never lead to better outcomes, but cutting waste from current procedures can and will.

To come up with a more efficient health care system, James suggested stakeholders need to better align practices, slash high rates of inappropriate care and preventable injury and death, "do what we know works," and get rid of the huge amounts of waste within the system.

The conference showcased health care leaders from various states that have implemented changes in their systems, including Oregon, which brought together historical competitors and let them battle out their own solutions — ultimately a collaborative, coordinated care organization.

In Utah, Medicaid providers are moving ahead with accountable care organizations, which will take health care delivery from a fee-per-service model, to quality-based reimbursements. The process aims to facilitate a healthier population, one that is more involved and less inclined to accrue higher costs through multiple unnecessary treatment.

"Health care is rapidly evolving," James said. "Despite what you might think, the current system is the best health care the world has ever seen."

High standards of education, strict requirements for professional licensing, medical practice founded on science and internal organizations for hospitals has led to better care delivery throughout the years, building on research and discovery.

Such delivery is proven by advances in health care, including a massive stretch in the average life expectancy. In 1900, individuals could expect to live to age 49. In 2000, that age had been extended to 77. James said health care "redefined what it meant to be a human."

He said such innovation does and must continue today.

"It is the task of every generation to take the next step ahead," James said.

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