Case Studies

Denver Health, a comprehensive and integrated medical system that is Colorado's largest health care safety-net provider, has a national reputation as a high-performance organization. Members of The Commonwealth Fund Commission on a High Performance Health System observed Denver Health during a site visit in March 2006, to assess its operation and determine whether it might serve as a model for other public and private health care systems around the country. The Commission concluded that Denver Health is indeed a "learning laboratory." It has succeeded at providing coordinated care to the community, promoting a culture of continuous quality improvement, adopting new technology and incorporating it into everyday practice, taking risks and making mid-course corrections, and providing leadership and support—and accepting accountability—both at the top and throughout the organization. Moreover, it has accomplished these objectives and others in straightforward ways that could be adapted elsewhere.  — View Case Study

Under the leadership of a quality-focused CEO, Flowers Hospital in Dothan, Ala., climbed from average to exemplary in Centers for Medicare and Medicaid Services (CMS) process-of-care, or "core" measures, across four clinical areas (heart attack, heart failure, pneumonia, and surgical infection prevention) in just two years.  — View Case Study

Adherence to evidence-based practice guidelines, perfomance benchmarking and feedback, multidisciplinary committees engaged in root-cause analysis, and strong leadership combined to produce near-perfect compliance with evidence-based process-of-care ("core") measures in four clinical areas at Gaston Memorial Hospital, near Charlotte, N.C.  — View Case Study

Gundersen Lutheran Health System is a physician-led, not-for-profit integrated delivery system serving more than 550,000 people in Wisconsin, Iowa, and Minnesota. Gundersen Lutheran has increased efficiency, improved patient care, and achieved the high performance associated with large urban institutions by: 1) using clinical and financial outcomes to set benchmarks and targets for improvement, to increase transparency, and to drive improvement among physicians; 2) investing in primary care and disease management programs; and 3) hiring engineers to improve operations. It offers leadership training programs that encourage cross-training and partnership within the institution and uses external collaborations to improve community health and extend its models of care and service to outlying communities. Gundersen Lutheran’s physician compact outlines the organization’s expectations of physicians and ensures that its medical staff remains committed to the organization’s mission: to distinguish itself in patient care, education, research, and community health  — View Case Study

HealthPartners is the nation's largest nonprofit, consumer-governed health care organization, providing health and dental care and coverage to more than 1 million individuals in Minnesota and surrounding states. Key factors driving HealthPartners' performance are a consumer-focused mission; a regional focus, scale, and scope integrating a broad range of services; strategic use of electronic health records to support care redesign; and a culture of continuous improvement. A comprehensive model for improvement includes setting ambitious targets for health system transformation; measuring what is important in order to optimize care; agreeing on best care practices and supporting improvement at the clinic level; aligning incentives with goals; and making results transparent internally and externally. HealthPartners' experience suggests that a nonprofit health plan market oriented to physician group practice--supported by collaborative measurement, improvement, and reporting structures--creates a community environment that helps each participant achieve objectives more effectively.  — View Case Study

Henry Ford Health System is a vertically integrated health care system in southeastern Michigan whose leadership is committed to systemic integration, clinical excellence, and customer value through the core competencies of collaboration, care coordination, and innovation and learning. Henry Ford’s care innovation initiatives are multidisciplinary, team-led projects that target improvements in quality measures and evidence-based standards through problem-solving and the identification of common metrics to build consensus. The collaborative approach, fostered by shared vision and values, facilitates transformation throughout the system. Moreover, Henry Ford’s integration of care delivery and coverage facilitates quality monitoring, measurement, and improvement activities.  — View Case Study

Kaiser Permanente--comprising the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and Permanente Medical Groups in eight regions--is the largest nonprofit integrated health care delivery system in the United States. The successful evolution of this organizational structure in a competitive marketplace has required a close partnership between managers and physicians supported by a culture of physician group accountability for quality and efficiency. An overarching agenda for achieving excellence focuses on high-impact health conditions, provides goal-oriented tools to analyze population data, proactively identifies patients in need of intervention, supports systematic process improvements, and promotes collaboration between patients and professionals to improve health. Central to this effort is KP HealthConnect, a comprehensive health information system that integrates an electronic health record with the tools to support physicians in delivering evidence-based medicine, coupled with a robust online patient portal that enhances members’ access to and involvement in their care.  — View Case Study

Exemplary quality scores at Luther Midelfort Mayo Health System in Eau Claire, Wis., are the result of a long-term commitment to building quality and safety into systems of care. Since joining the Mayo Health System in 1992, Luther Midelfort has advanced a culture that supports staff in their efforts to test new ideas and improve care. Although work focused on Centers for Medicare and Medicaid Services (CMS) core measures began recently, the newer efforts follow the philosophy and strategy established years earlier. In a recent analysis by The Commonwealth Fund, Luther Midelfort achieved the third-highest score in the country on a composite of 22 process-of-care measures that all hospitals report to CMS.  — View Case Study

Marshfield Clinic is a not-for-profit, physician-governed multispecialty group practice serving residents of rural Wisconsin through a regional ambulatory care system, an affiliated health plan, and related foundations supporting health research and education. Marshfield has engaged its physicians and staff in a program of clinical performance improvement aimed at enhancing patient access, coordination of care, and efficiency of clinical operations. An internally developed electronic health record acts as a care planning tool for delivering preventive care and managing chronic diseases. A telemedicine network expands access to care for patients living in rural and remote areas. Marshfield Clinic’s experience shows how an organized group of physicians can improve patient outcomes and reduce costs by undertaking a population-based approach to ambulatory care management supported by robust information technology. It also suggests that group-level performance incentives that are aligned with an organization's strategic goals have the potential to enhance population health management.  — View Case Study

The Mayo Clinic is the world’s oldest and largest integrated multispecialty group medical practice, combining clinical practice, education, and research at the regional, national, and international levels for the benefit of individuals with routine as well as complex health care needs. Mayo’s model of integrated care is one of multidisciplinary practice with salary-based compensation that fosters team-oriented patient care and peer accountability, a supportive infrastructure allowing physicians and other caregivers to excel at clinical work, and a physician-led governance structure promoting a patient-centered culture. Full integration of the hospital and clinic and the use of a shared electronic medical record across inpatient and outpatient settings also have been critical to realizing efficiencies and promoting clinical excellence. Mayo fosters a learning environment in which teams of medical professionals use information technology and systems engineering to learn from each other and improve care in tandem with clinical practice.  — View Case Study

In 2007, NorthShore University Health System achieved 97 percent compliance with Centers for Medicare and Medicaid Services (CMS) process-of-care measures, a 12-point increase from just one year before. With high-level endorsement, NorthShore pursued the following improvement strategies: a system-wide staff education initiative led by the quality department, including the essential engagement of medical staff, pharmacists, and nurses; promoting physician buy-in by encouraging them to contact CMS with questions about the care standards; use of an electronic health record (EHR) system as a tool in education, care management, and performance tracking; and use of real-time data for concurrent review of patient care, made possible by exporting data from the EHR.  — View Case Study

Since 2002, Oklahoma Heart Hospital has consistently demonstrated high adherence to process-of-care or "core" measures and high patient satisfaction. Key strategies behind their excellent scores include: physician leaders' commitment to quality; physician offices housed within the hospital, providing greater access to nurses and patients; flat organizational structure that allows quick implementation of operational changes; highly experienced nurses and high nurse-to-patient ratios; and more.  — View Case Study

Under pressure to improve performance on indicators of financial well-being, patient satisfaction, and clinical quality, St. Mary's Health Center leadership made a deliberate decision to focus on Centers for Medicare and Medicaid Services process-of-care measures, or "core" measures. They set in motion a series of activities that resulted in striking improvement. The main strategies were: clear communication of the new directive by the hospital's president and Board of Directors; physician-led committees taking responsibility for performance improvement; intensified efforts to standardize clinical processes through order sets; dedicating a full-time staff member to data abstraction and initiating a system of concurrent and post-discharge review of medical charts; continuous measurement and analysis of performance data; providing feedback to staff; and sharing successes, lessons, and tools across hospitals in the health system.  — View Case Study