Private Payer Initiatives for Quality Improvement

Abstract

With evidence for wide variation in the quality and cost of inpatient surgery in the United States, payers and policy makers have increasingly pursued strategies to improve the cost-effectiveness of surgical care. Payer-funded collaborative quality improvement (CQI) efforts represent an innovative and effective means of enhancing surgical care across a large population. Unlike more top-down approaches, such as pay-for- performance measures, CQI programs engage multiple stakeholders, foster knowledge sharing, and rely on cooperative efforts to drive quality. Most are centered around a robust clinical registry which provides data to allow for benchmarking of outcomes, identification of problem areas, and evaluation of quality improvement efforts. Payer- funded CQI efforts such as the Michigan Bariatric Surgery Collaborative have led to substantial reductions in unnecessary procedures, adverse events, and costs following surgery. The CQI model has proven to be an effective vehicle for advancing innovations in care and reducing unwanted variation across providers. Efforts to replicate this model on a national level will require the participation of both public and private payers and face many challenges. Ultimately, however, partnerships between payers, hospitals, and surgeons can be a win for all, especially for our patients.