By Harris Meyer

HILLSBORO, Ore. — Peter Cady, who works 12-hour shifts on his feet at Intel’s plant here, occasionally suffers severe lower back spasms.

But he nearly gave up seeking medical help because in the weeks it took to get a doctor’s appointment and a referral to physical therapy, the pain usually subsided.

These days, however, Cady is much happier with his care.

Rather than waiting to see a doctor, Cady and other patients with routine back pain now see a physical therapist within 48 hours of calling, compared with about 19 days previously, Intel says.

They complete their treatment in 21 days, compared with 52 days in the past. The cost per patient has dropped 10 percent to 30 percent due to fewer unnecessary doctor visits and diagnostic imaging tests.

And patients are more satisfied and return to work faster.

“It’s a real bureaucracy buster that gets you right straight to someone who can take care of the problem,” says Cady, 47. “Before, the doctor wasn’t helping me or explaining anything. But the physical therapist educated me, gave me stretches and exercises to do, and cleared it up.”

The change came about through an unusual collaboration between Intel, two local health care systems, and a health insurer. Based on that success, the partners have developed similar improvements for hip, knee, shoulder and headache treatment.

Intel and its partners say the result has been $2 million in administrative savings this year, from reduced costs for patient scheduling and registration, for example.

The Hillsboro collaboration is one of a small but growing number of voluntary partnerships around the country to tackle the twin problems of unsatisfactory quality and rising health-care costs.

Similar programs are underway in Atlantic City, N.J.; Lewiston, Maine; Muskegon, Mich.; Sacramento, Calif.; San Francisco and Seattle. One is budding in Orlando.

All the efforts draw on quality improvement models developed in manufacturing and other industries. Physicians and hospitals share cost savings with the employers and insurers, and in some cases share losses if savings targets aren’t met.

Medicare has launched a similar program under the 2010 health reform law aimed at developing so-called accountable care organizations.

Tackling a cost crisis

The goal is to carve out health-care spending that’s wasteful and doesn’t help patients. Sometimes there’s an implicit threat that if a provider or health plan doesn’t participate, the large employer will buy health care from someone else.

“It all starts when leaders in a community say the current system is not sustainable and we’ve got to find a different model,” says Joe Damore, a vice president at Premier, a national alliance of 200 health systems focused on performance improvement. “Major employers are jumping on board because they see it as an opportunity to improve their employees’ health and reduce costs.”

Intel asked Providence Health & Services, Tuality Healthcare and Cigna to collaborate in 2009 because its employee health costs were rising by more than 10 percent a year, with costs projected to hit $1 billion companywide.

The Oregon Public Employees’ Benefit Board recently joined the effort, having its members participate in the redesigned Providence and Tuality care models, sharing its data with the collaborative, and working with the partners to come up with new ways of improving quality and reducing costs.

“Health care was the only area where we weren’t setting standards and managing our suppliers,” says Patricia McDonald, an Intel vice president who spearheaded the project. “Our employees were waiting for care and the quality was questionable.”

In Atlantic City, Unite Here Health, a hotel workers’ union health plan, persuaded AtlantiCare, a local health care system, to open a special, jointly funded clinic in 2007 to provide intensive outpatient care to high-cost patients with chronic conditions such as diabetes, obesity and heart disease.

The program, which the union is replicating in Las Vegas, achieved steep drops in patient smoking, blood pressure and diabetic blood sugar levels, according to AtlantiCare.

By keeping patients healthier, it has reduced hospital admissions by 41 percent and emergency department visits by 48 percent.

Collaboratives help physicians and hospital leaders see employers and patients as customers whose expectations, such as rapid access to care, must be met.

“I practiced for 30 years without knowing how long patients waited to see me,” says Dr. Robert Mecklenburg, who led the development of a collaborative effort at Virginia Mason Medical Center in Seattle, which started working with Starbucks and other employers in 2004.

After meeting with employers, he adds, “you realize how important it is to see patients when they need to be seen. Any wait is not OK.”

Roadblocks to collaboration

Some employers are reluctant to get directly involved in how health care is delivered. Critics warn about rationing of care.

And some physicians complain about interference with their professional autonomy, although Mecklenburg says most come around when they see better results for patients.

Perhaps the biggest roadblock is the predominant fee-for-service system, which pays providers to deliver more services, rather than better, more efficient care. Health-care payers, including private insurers and Medicare, have been slow to change their payment models to reward outcomes rather than volume of care. That sometimes puts providers in the position of losing revenue by doing the right thing for patients.

Dr. Donald Storey, who worked on the Seattle collaborative as an Aetna medical director and now is a vice president at Premera Blue Cross, blames insurers’ reluctance to change on their having many different contracts with employers and providers. In addition, not everyone wants a more efficient system. “One man’s waste is another man’s income,” he says.

Some insurers have embraced collaboration. In Sacramento, Blue Shield of California, Catholic Healthcare West and Hill Physicians Medical Group have worked with CalPERS, the state public employee benefit system, to redesign care after they identified quality problems and high costs for 42,000 plan members.

Key areas were obesity-reduction surgery, hip and knee care, hysterectomies, and preventable emergency department visits and hospital readmissions. For example, Hill Physicians persuaded its OB/GYNs to perform more minimally invasive hysterectomies, which are safer and cheaper than open hysterectomies, when appropriate. Catholic Healthcare West hospital staff worked closely with patients on their medication instructions before discharge, to make readmissions less likely.

Redesigning care through a collaborative is “not easy to do. There’s a lot of investment of human resources, and we didn’t know if it would work or not,” says John Wray, senior vice president for managed care at Catholic Healthcare West. “But this was something we thought was important to try to learn from.”

It worked. Hospital length of stay and readmissions both declined 15 percent in 2010. That helped save more than $20 million, exceeding the $15.5 million target and allowing Blue Shield to keep CalPERS’ premiums flat in Sacramento for 2011.

The remaining savings were split among the three partners, who would have lost money if the target hadn’t been hit.

Now Blue Shield is working with its current partners and several additional provider organizations to improve care for 26,000 members of the San Francisco public employee plan.

It’s also starting partnerships in January for 38,000 plan members in California’s Orange and Stanislaus counties.

Mecklenburg hopes this partnership model will spread widely across the country. “We are creating a marketplace based on quality, where employers can use their purchasing power to bring out the best in both providers and health plans,” he says. “But up to now it hasn’t usually worked that way.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Virginia Mason has established a national reputation for its efforts to apply the super-efficient “lean production” system, developed by the car manufacturer Toyota, to health-care delivery.

The hospital says its application of the Toyota Production System’s approach to health care has significantly improved the quality of its care and the morale of its staff.

Treatment is more timely, delays are fewer and quality has improved, the hospital says.

At the same, time it “has meant less rework and frustration for staff” and helped control the cost of care, the hospital says.

The purpose of the new center is to evaluate the effectiveness of hospital’s improvement initiatives more rigorously and publish the results in medical journals and other publications.

Craig Blackmore, MD, MPH, will serve as director of the Center for Health Services Research.

“The role of the center will be to collect that data, apply the rigor of science and academic peer review, and publish it so that it can be scrutinized and applied by health care providers around the globe,” Dr. Blackmore said.

The Center for Health Services Research will also support the scholarly and publication efforts of Virginia Mason’s education programs that train medical residents, nurses, pharmacists and other health care professionals.

This is the sixth year in a row that Virginia Mason has made the Top Hospital List, and the second year in a row for Swedish First Hill.

This year sixty-five hospitals have earned The Leapfrog Group’s annual “Top Hospital” designation for delivering the highest quality care:

• by preventing medical errors,

• reducing mortality for high-risk procedures like heart bypass surgery,

• and reducing hospital readmissions for patients being treated for conditions like pneumonia and heart attack.

The 2011 Top Hospital list was culled from a field of nearly 1200 hospitals that voluntarily and publicly report their performance by participating in the Leapfrog Hospital Survey, which focuses on three critical areas of hospital care:

1. How patients fare
2. Resources used to care for patients
3. Management practices that promote safety and quality

In each of the three areas, Leapfrog asks hospitals to report on nationally standardized measures so healthcare consumers can compare hospitals in their community and across the country.

University and other teaching hospitals, children’s hospitals, and community hospitals in rural, suburban, and urban settings were all represented in the 2011 rankings.

To learn more:

• A complete list of 2011 Leapfrog Top Hospitals and the survey results for all participating hospitals are posted on a website at www.leapfroggroup.org.

Polyclinic introduces clinical research department with international HDL study

Seattle’s Polyclinic has launched a clinical research department with a study sponsored by Oxford University. The study, called REVEAL, will test whether new drug Anacetrapib can boost levels of the “good cholesterol” HDL in patients 50 years or older with a history of heart attack, coronary artery disease, or type I or II diabetes. “The only currently available therapy with an effect on HDL is niacin, which raises levels by 20% to 30% but can cause uncomfortable side effects,” the medical group says. Press Release.

Virginia Mason and Wenatchee Valley Medical Center to Begin Cardiac Affiliation

Virginia Mason and Wenatchee Valley Medical Center have formed a “cardiac affiliation” in which physicians from the two medical centers will collaborate on patient care and share best practices. Activities include:

• Weekly Grand Rounds
• Consultation on cases requiring technology and techniques not available in Wenatchee
• Development of cardiology order-sets and clinical protocols
• Weekly cardiac catheterization conferences and collaborative case reviews
• Shadowing opportunities
• Continuing medical education
• Site visits
• Community outreach events

To learn more read the full press release.

Merck for Mothers and PATH to collaborate on project to reduce maternal deaths

The pharmaceutical company Merck has awarded a grant to the Seattle global health non-profit PATH to “evaluate more than 30 promising technologies at various stages of development that address the two leading causes of maternal mortality—post-partum hemorrhage and preeclampsia—as well as family planning.”

The initiative is part of Merck’s “Merck for Mothers” program.

“The partnership, valued at $2.5 million and extending through Fall 2012, will integrate private- and public-sector expertise to help evaluate affordable and easy-to-use maternal health technologies that work in resource-poor settings.” Press Release.

PRESS RELEASE MATERIAL

Polyclinic introduces clinical research department with international HDL study

SEATTLE, Wash. – The Polyclinic is participating in a major international clinical research study aimed at raising HDL (good cholesterol) levels. As an entirely new department at The Polyclinic, clinical research opens up an additional arm of medicine for patients and physicians alike. The Polyclinic recognizes clinical research as an enhancement to its mission of providing high-quality, comprehensive, personalized health care.

“Patients who participate in clinical research studies are ultimately contributing to better health care,” said Polyclinic Chief Medical Officer Michael Tronolone, MD, MMM. “It leads to new discoveries that improve quality of life, and also the lives of future generations.”

Having grown significantly since its creation a year ago, the department aims to focus on research studies addressing significant unmet medical needs. Polyclinic physicians welcome the addition of the department, as it increases patients’ options for treatment and their ability to participate in research.

“Not all patients achieve optimum health with currently available medications,” said Dr. Tronolone. “The Polyclinic clinical research department can now play a part in improving outcomes.”

This international HDL study, now enrolling participants, will test whether new drug Anacetrapib can boost HDL levels in patients 50 years or older with a history of heart attack, coronary artery disease, or type I or II diabetes.

The study, entitled REVEAL and sponsored by Oxford University, will include 30,000 individuals worldwide with 180 sites in the United States.

The only currently available therapy with an effect on HDL is niacin, which raises levels by 20% to 30% but can cause uncomfortable side effects.

“Although we have excellent methods of treating heart disease, current therapies have plateaued and further progress is needed,” said Dr. Kier Huehnergarth, Polyclinic

cardiologist and principal investigator for the REVEAL study. “By participating in this research, The Polyclinic hopes to provide patients with even more protection against a future heart attack.”

Patients who qualify for this study will attend five clinic visits in the first year and biannual clinic visits thereafter. They will also receive a stipend for each visit as well as lab tests and study medication at no cost. The study will continue to enroll throughout the next several months.

The Polyclinic clinical research department studies are open to anyone who meets the criteria, regardless of their status as a Polyclinic patient. Other studies currently enrolling are focused on lupus, overactive bladder, nocturia (nighttime urination), and HIV. Each study is administered by a Polyclinic physician who acts as the principal investigator and is assisted by the staff of the research department.

For more information about the REVEAL study and other clinical research studies at The Polyclinic, or to find out if you qualify, visit www.polyclinic.com/clinical-research or call 206-860-5433.

# # #

PRESS RELEASE MATERIAL

Virginia Mason and Wenatchee Valley Medical Center to Begin Cardiac Affiliation

SEATTLE – (Dec. 5, 2011) – Virginia Mason and Wenatchee Valley Medical Center have entered into a new cardiac affiliation. This affiliation represents two outstanding health care organizations, who share similar values, formalizing a relationship to provide the residents of North Central Washington with access to high-quality, efficient and cost-effective health care. This is an opportunity for two like-minded organizations to further dedicate themselves to transforming health care, with a focus on improving the patient experience and value of care.

As part of the arrangement, physicians from Wenatchee Valley Medical Center and Virginia Mason will collaborate on numerous aspects of patient care and share best practices with one another. Some of the activities include:

• Weekly Grand Rounds
• Consultation on cases requiring technology and techniques not available in Wenatchee
• Development of cardiology order-sets and clinical protocols
• Weekly cardiac catheterization conferences and collaborative case reviews
• Shadowing opportunities
• Continuing medical education
• Site visits
• Community outreach events

“We look forward to this affiliation with Wenatchee Valley Medical Center, as our patients and providers throughout the state will ultimately benefit from what these exceptional organizations have to offer,” says Sarah Patterson, Virginia Mason executive vice president and chief operating officer. “Virginia Mason has served many eastern Washington patients over the years, and we are excited to build on this service as our partnership with WVMC takes shape.”

“This affiliation is a tremendous opportunity for Wenatchee Valley Medical Center and the patients it serves to have organized access to and interaction with a high quality health care organization that shares our values of patient-centered value-based care,” says Peter Rutherford, MD, CEO and Chairman of Wenatchee Valley Medical Center. “We will be able to learn from each other and improve patient care for all.”

# # #

PRESS RELEASE MATERIAL

Merck for Mothers and PATH Collaborate to Identify Innovations that Save Mothers’ Lives

Alliance is Key Step in Bringing Sustainable, Affordable Technologies to the Mothers Who Need Them Most

Whitehouse Station, N.J. and Seattle, W.A., December 5, 2011 – Merck (NYSE: MRK), known as MSD outside the United States and Canada, awarded a grant to PATH, a global health nonprofit, to identify game-changing technologies with potential to save the lives of women during pregnancy and childbirth in low-resource settings. Spearheaded by top scientists from Merck for Mothers and PATH, this unique alliance will evaluate more than 30 promising technologies at various stages of development that address the two leading causes of maternal mortality—post-partum hemorrhage and preeclampsia—as well as family planning. The partnership, valued at $2.5 million and extending through Fall 2012, will integrate private- and public-sector expertise to help evaluate affordable and easy-to-use maternal health technologies that work in resource-poor settings.

“PATH is excited to collaborate with Merck to make measurable reductions in maternal mortality,” said Dr. Michael J. Free, vice president and senior advisor for technologies, PATH. “Combining our capabilities will allow the most effective technologies to enter the market, without the usual barriers that come from the lack of private-sector incentives. This is an opportunity to advance needed technologies and make a great impact on maternal health around the world.”

“There are many promising, life-saving maternal health innovations that, left to current market forces, would not reach the mothers who need them, when they need them, at a price they can afford,” said Dr. Naveen Rao, who is leading Merck for Mothers. “By collaborating with PATH, which has deep expertise in developing solutions for the world’s greatest health problems, we will help bring important technologies to countries where women are dying at some of the highest rates.  By doing so, we will fulfill a key part of the commitment of Merck for Mothers to advance product development in post-partum hemorrhage, preeclampsia and family planning toward achieving United Nations’ Millennium Development Goal 5.”

Merck for Mothers is a new 10-year, half-billion-dollar initiative to create a world where no woman has to die from preventable complications of pregnancy and childbirth (merckformothers.com).  Drawing on the company’s history of discovering innovative, life-saving medicines and vaccines, Merck for Mothers will apply Merck’s scientific and business expertise—as well as its financial resources and experience in taking on tough global healthcare challenges—to reduce maternal mortality around the world.  As part of its focus, the program will seek to accelerate access to proven solutions; develop game-changing prevention, diagnostic and treatment technologies; and support public awareness, improved policies and broader private-sector engagement in the area of maternal health. The collaboration with PATH is a key step in Merck for Mothers’ rapid development of game-changing technologies in maternal health, and the company will leverage the learnings to build an investment strategy for accelerating the development of these technologies.

Researchers at Merck’s Development Center in Oss, Netherlands and PATH’s Technology Solutions Global Program in Seattle will work together to advance promising technologies in different stages of development, with an initial goal of identifying three to five maternal health breakthroughs in the next 12-18 months. The collaboration will evaluate technologies in the prevention, diagnostic and treatment areas for the different stages of pregnancy and childbirth and compare them across multiple parameters, such as commercialization potential, user and stakeholder acceptability and time to impact.

Potential technologies for assessment include:

• Treatments for the prevention of post-partum hemorrhage to assist women in the third stage of labor.

• Pre-natal preeclampsia screening tool to identify high risk women and significantly increase survival rates.

• Effective family planning interventions that are relatively easy to use to encourage higher adherence.

About Maternal Mortality

In the next decade, it is estimated that as many as three million women may die from complications of pregnancy and childbirth. The majority of these maternal deaths are preventable.

The United Nations’ Millennium Development Goals (MDGs) seek to address the world’s greatest development priorities, with MDG5 focused on reducing the maternal mortality ratio by 75 percent and creating universal access to reproductive health. However, several countries around the world run the risk of failing to meet this goal unless good-quality reproductive health services and well-timed interventions are supplied.

About PATH

PATH is an international nonprofit organization that transforms global health through innovation. PATH takes an entrepreneurial approach to developing and delivering high-impact, low-cost solutions, from lifesaving vaccines and devices to collaborative programs with communities. Through its work in more than 70 countries, PATH and its partners empower people to achieve their full potential. For more information, please visit www.path.org.

About Merck

Today’s Merck is a global healthcare leader working to help the world be well.  Merck is known as MSD outside the United States and Canada.  Through our prescription medicines, vaccines, biologic therapies, and consumer care and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions.  We also demonstrate our commitment to increasing access to healthcare through far-reaching policies, programs and partnerships.  For more information, visit www.merck.com and connect with us on Twitter, Facebook and YouTube.

Forward-Looking Statement

This news release includes “forward-looking statements” within the meaning of the safe harbor provisions of the United States Private Securities Litigation Reform Act of 1995. Such statements may include, but are not limited to, statements about the benefits of the merger between Merck and Schering-Plough, including future financial and operating results, the combined company’s plans, objectives, expectations and intentions and other statements that are not historical facts. Such statements are based upon the current beliefs and expectations of Merck’s management and are subject to significant risks and uncertainties. Actual results may differ from those set forth in the forward-looking statements.

The following factors, among others, could cause actual results to differ from those set forth in the forward-looking statements: the possibility that the expected synergies from the merger of Merck and Schering-Plough will not be realized, or will not be realized within the expected time period; the impact of pharmaceutical industry regulation and healthcare legislation; the risk that the businesses will not be integrated successfully; disruption from the merger making it more difficult to maintain business and operational relationships; Merck’s ability to accurately predict future market conditions; dependence on the effectiveness of Merck’s patents and other protections for innovative products; the risk of new and changing regulation and health policies in the United States and internationally and the exposure to litigation and/or regulatory actions.

Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Additional factors that could cause results to differ materially from those described in the forward-looking statements can be found in Merck’s 2010 Annual Report on Form 10-K and the company’s other filings with the Securities and Exchange Commission (SEC) available at the SEC’s Internet site (www.sec.gov).

“Hospital-industry leaders say they’re doing what patients want and what makes good business sense,” Ostrom writes, but critics say the free-standing emergency rooms are “cash cows for hospitals, strategically built in affluent areas to lure busy, well-insured patients and collect fat reimbursements.

Hospitals say the new ERs will streamline care and help reduce costs, but Ostrom points to research that suggests the opposite:

Last year, the Center for Studying Health System Change, a national research group, noted concerns that increased competition around Seattle could increase overall costs. It found hospitals invading one another’s turf with free-standing ERs and vying to provide big-ticket specialty procedures in cardiac, cancer and orthopedic care.

To learn more:

• Read Ostrom’s article: ER building boom is wrong prescription, critics say.