Physician Engagement in Improvement Work at Brigham and Women's Hospital

Abstract

The United States currently spends over $2.5 trillion on health care every year, more than one out of every six dollars of total national income1. Much of this money is wasted: the Institute of Medicine estimates that up to $750 billion in annual health care spending is unnecessary, a figure that eclipses even nation’s total spending on defense. Facing pressure to counter this trend, insurers are increasingly pushing providers to bear partial financial responsibility for reducing costs while improving quality of care. Over the last several years, Partners Healthcare has entered into multiple contracts with public and private payors that put it at economic risk for the cost and quality of care for a significant number of its patients. By the end of 2012, an estimated 58,000 of the approximately half a million patients BWH sees a year were covered under at-risk contracts, and this fraction continues to grow rapidly. The hospital and its affiliated physicians’ organization must therefore motivate their physicians to help reduce costs while improving quality of care. Bending the health care cost curve requires fundamentally changing the way care is delivered. Consistently reaching cost and quality targets requires mobilizing the entirety of BWH’s staff, an extremely difficult task for a large academic medical center with thousands of physicians and other staff across dozens of specialties and departments, and where payments are still primarily fee-for-service. Success will require the greatest possible degree of physician and staff engagement in learning and improvement work across all facets of care.