PMID: 8608332Nov 1, 1995Paper

Collaborating outside the box: when employers and providers take on environmental barriers to guideline implementation

The Joint Commission Journal on Quality Improvement
J L Reinertsen

Abstract

In 1992 15 employers in Minneapolis/St Paul, operating as the Business Health Care Action Group (BHCAG), combined their self-insured plans. To successfully bid for the BHCAG contract, three competing group practices and a health plan cooperated, operating functionally like a fully integrated care system to measure outcomes, develop practice guidelines, and meet other BHCAG requirements. To accomplish this, a new organization, the Institute for Clinical Systems Integration (ICSI), was conceived. PROVIDERS AND EMPLOYERS COLLABORATE: To reduce costs ICSI has implemented 16 of 80 planned guidelines. Teams including members from clinics and BHCAG develop best-practice algorithms. Each guideline is then reviewed and piloted before being implemented in all ICSI clinics. The guideline on cystitis in healthy women eliminated two costly practices-obtaining a urine culture and visiting the doctor. Yet many physicians and the clinics were afraid of losing significant revenue because they were reimbursed by BHCAG on a fee-for-service basis. In turn, BHCAG's hands were tied. If they changed to a capitated payment system, they would face onerous state insurance requirements. The solution lay in collaborating at a higher level. ICSI and BHCAG ...Continue Reading

Citations

Mar 8, 2008·Journal of Nursing Management·Caroline Marchionni, Judith Ritchie
Sep 1, 1996·Postgraduate Medicine·G Mosser, J L Reinertsen

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