A little more than four years ago, CMS and private industry came together to create what was basically a partnership aimed at reducing hospital-acquired conditions and readmissions. In order for this initiative, termed the Partnership for Patients, to succeed, competitors had to become collaborators and hospitals had to agree to participate. The first phase of the project established 27 Hospital Engagement Networks (HENs) and approximately three-fourths of the nation’s acute care hospitals took part.
The results have been impressive.
“When you look at what’s happened in HEN (1.0 and 2.0) over the past four years, it’s been probably one of the most successful federal initiatives to date in health care. We have traditionally seen improvement in scores in the quality arena by a little less than 2 percentage points per year. Over the first three years of the initiative, the 27 HENs and their participating hospitals were able to triple that to six percentage points’ improvement per year,” said Keith Kosel, PhD, MHSA, MBA, senior vice president, government affairs for Vizient. “And when you think of the $20 billion and 87,000 lives saved, along with the 2.1 million harm events that were avoided over the four years of the initiative, the impact the HEN has had on patient care is staggering.”
CMS intends to keep the momentum going with their recently announced Hospital Improvement Innovation Networks (HIIN). The new HIINs will run through September 2018 (with an additional option year through 2019 possible) and will build upon the work done through the previous HENs. Vizient has again been selected to lead a network, making it one of only two organizations – the other being the Iowa Healthcare Alliance – to have both a HIIN and a Transforming Clinical Practice Initiative (TCPI) contract.
The HIINs, like the HENs before them, are focused very clearly on improving patient safety and quality within the hospital. The learnings from that program are now beginning to branch out into the ambulatory space through TCPI.
“Having HIIN and TCPI really provides great opportunities both for Vizient and our members. We have begun to build linkages between the acute care world of safety and quality and the ambulatory world where these competencies are not as well developed," said Kosel. “These programs are really doing great things. They work very well and there’s no cost to the hospitals.”
What’s new in the new HIIN
While the new HIINs will continue work to reduce overall patient harm and 30-day readmissions, their scope is expanding to address such areas as disparities of care and person and family engagement (PFE). Providers have observed that certain populations had worse outcomes but they didn’t have data to clearly identify why. Through the work of the previous HENs, hospitals began collecting Race, Ethnicity and Language (REAL) data for certain procedures to help better understand the disparities. Both the HIIN and TCPI are collecting and reviewing data to help guide their patient care protocols. Also, there is evidence linking lower harm rates with strong PFE, so an increased focus in this area will include tools and approaches to help engage patients, families and caregivers and improve communication, trust and shared decision-making.
Another new angle for the HIINs will be an integration of the work from the Quality Improvement Organization-Quality Innovation Network (QIO-QIN) programs. According to Kosel, the QIO-QINs are in a great position to help the HIINs and their participating hospitals achieve their improvement goals. These organizations are made up of performance improvement experts – nurses, doctors, allied health professionals – who work in the very communities where the hospitals and their patients are located. Working with the QIO-QINs will foster cooperation and leverage complementary skills to help our members improve their safety and quality measures.
Hospitals need to get in the game
While the HIIN and TCPI are voluntary programs, Kosel strongly recommends all hospitals participate. Sitting on the sidelines only invites CMS to move the program from voluntary to mandatory status, with potential reimbursement implications. The Bundled Payment for Care Improvement, BPCI, and its evolutionary sibling, the Comprehensive Care for Joint Replacement (CJR) initiative, is the perfect cautionary tale.
“CMS had a voluntary bundled payment program for providers to join. Very few did, so they mandated participation for hips and knees. Recently they announced a new mandatory demonstration program for select cardiovascular procedures and there are others in the pipeline,” said Kosel. “The new HIIN program has moved from a full-fledged demonstration project being run through the Center for Medicare & Medicaid Innovation to a mainline program now funded through the Medicare Trust Fund. The implications of this transformation are substantial in that the program no longer has to prove its worth before being incorporated into mandatory participation model under IPPS.”
Kosel says he tells every hospital leader he talks to the same thing about HIIN and TCPI, “You need to participate and of course we prefer that you choose our program, but regardless of who you partner with, you need to be in the game. These programs help providers take the steps necessary to deliver better care, be smarter about the dollars that are spent and show improvement quickly. A key advantage Vizient offers is linking the work and the learnings on the inpatient side (HIIN) with the outpatient side (TCPI) to give you safety and quality competencies across the health care continuum.”