Research: The Key to Improving Care and Lowering Costs

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Intermountain Healthcare, a community-based system is in the process transitioning from a fee-for-service to a fee-for-value care system. In a nutshell, the fee-for-value model focuses more on the patient by taking a holistic approach to each patient’s condition from onset, to treatment, and beyond. The fee-for-value model is reimbursed by payers for improving patient outcomes and lowering costs in contrast with a fee-for-service system that is reimbursed on the quantity of services provided.

How does research support a fee-for-value model?

Research is generally considered a public good funded by researchers seeking financial support through outside agencies and taking up to 17 years before discoveries reach the patient’s bedside. At Intermountain, we are investing in research that will have a rapid impact on care delivery performance, focused on achieving the best medical result at the lowest necessary cost. 

For example, a team of Intermountain researchers are testing a clinical decision support (CDS) tool to more accurately diagnose patients suspected of pulmonary embolism and to ensure more patients are treated with low-tidal volume ventilation such as in patients with acute respiratory distress syndrome. The tool, is intended to help patients avoid the inconvenience (and costs) of hospitalization without increasing their risk of a safety event related to their blood clot.

Translating science into better care

A recent Intermountain article published in Quality Management in Healthcare outlines how Intermountain is advancing the translational science process through the organization of teams and governance.

Lead author, Andrew J. Knighten, PhD, CPA notes that “delivering evidence-based discoveries consistently across the Intermountain system remains a challenge given our system size and complexity. Defining the principles and processes by which we will govern enterprise research activities is an important first step in promoting research, including both clinical discovery and implementation science, that translates into better outcomes for the patients we serve. A clearly defined governance structure and management processes will work to ensure that all research at Intermountain remains mission driven, aligns with our enterprise research objectives, and provides necessary transparency and accountability of our research investments.”

Principles that advance clinical discovery

  1. Strong linkage between research leaders and investigators, clinicians, and executive leadership to improve transparency and communication.
  2. Coordinated alignment across research teams that include capabilities of embedding systems engineering, bioinformatics, health services research, and implementation science capabilities alongside existing clinical research.
  3. Balanced approach to measuring and reporting the value of our investments in research. Measurements include:
  • Patient impact
  • Reputation and stature
  • Operational productivity
  • Financial stewardship

Implementation of principles

The first step was the organization of the Research Guidance Council responsible for creating governance of research activities. The council is in charge of identifying and aligning the enterprise research projects with the goals of individual research groups. Members from 13 major clinical areas are represented in the council including Cardiovascular, Pulmonary and Critical Care, and Oncology. It also includes PhD-led researchers such as Bioinformatics and Care Delivery Science. Pediatrics was also included, as members of the affiliated physician group.

In the fall of 2017, the council defined Intermountain’s research purpose statement: Intermountain Healthcare Research uses our model healthcare system to advance clinical investigation and improve patient outcomes and healthcare quality through innovation, discovery and implementation science.

The council has coordinated large grant opportunities across work streams and is currently in the process of formalizing investigator tracks for career advancement, standardizing research processes, identifying opportunities to improve financial stewardship, and adopting a more data driven approach to governing research.

“All of the changes made by the Research Guidance Council are being done to align Intermountain resources and investigators across the care delivery system, in order to better serve our patients and community”, says Dr. Srivastava. “The goal of research at Intermountain is to conduct research that has a rapid impact on improving patient care, focused on achieving the best medical result at the lowest necessary cost.”

Clinical discovery and implementation research are critical to identifying and advancing evidence-based treatment. Community-based health systems have an obligation to ensure research is helping examine the overall effectiveness of technologies, and innovations across our care delivery system.