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The East African : Jul 12th 2015
The EastAfrican 34 Employe≥-led health ca≥e ≥evolution COMMENTARY PATRICIA A. MCDONALS, ROBERT S. MECKLENBERG AND LINDSAY A MARTIN “The need to accelerate the transformation of health care is urgent.” I n the years leading up to 2009, Intel tried a number of approaches to tame its soaring health care costs. To encourage employees and their families to be more involved in the purchase of their care and aware of its cost, the company implemented “consumer-driven health care” offerings such as higher-deductible plans with lower premiums. To save employees time and improve access, it opened primary care clinics at Intel work sites in Oregon, New Mexico and Arizona. While those programmes gen- erated improvements in employee engagement and accountability, it had become clear by 2009 that they alone would not enable Intel to solve the problem, because they didn’t affect the root cause — the steadily rising cost of the care that employees were receiving. Intel projected that expenditures for its 48,000 US employees and their 80,000 dependents would hit $1 billion by 2012 — triple the amount it spent in 2004. Intel’s leaders wanted to protect the bottom line, but were reluctant to shift more of the cost to employees. One of us (Patricia McDonald) suggested another option: Intel could use its purchasing power in markets where it had operations to influence health care players — care providers, insurers and other employers — to work together to redesign the local health care system. Specifically, the company would use its expertise in supply chain management to reduce costs in local health care enterprises while putting the needs of their customers — patients — at the centre of everything they did. Intel would urge the health systems to standardise work by adopting best-practice clinical processes. In this case, the source would be Virginia Mason Medical Centre, a health system based in Seattle. It was one of several providers in the US that employed a version of the Toyota Production System to make its processes “lean” — in other words, strip them of activities that did not add value. Intel would pay for the clinical processes and Virginia Mason’s expertise in installing them and would train people at the local health systems to use Intel’s version of TPS to adapt them. Finally, Intel would enlist its health plan administrator, Cigna, to contribute the claims data required to track progress. Intel’s pilot Healthcare Mar- ketplace Collaborative was launched in metropolitan Portland, Oregon. Over five years, it successfully implemented new clinical processes for treating six medical conditions and for screening patients for immunisation status. Although assessing the HMC’s full impact was BUSINESS JULY 11-17,2015 to focus on an aim that would be in the interests of all stakeholders — providing the right care in the right place at the right time and the right cost for Intel employees and families and all other Portland-area health care users. 3. Don’t reinvent the wheel The HMC’s two health sys- tems accepted Intel’s proposal to start out by acquiring proven clinical content and work processes. 4. Make it flexible No two health care providers are exactly the same in terms of size and structure. Recognising this, the collaborative agreed at the outset that Providence and Tuality would each decide whether or how to adopt each of the new clinical processes. 5. Prioritise on the basis of impact and difficulty Intel combed through Cigna’s claims data and chose which medical conditions to focus on initially — those whose improvement would most benefit its employees, their dependents and the company. About two years into the effort, the medical directors at Providence and Tuality selected additional conditions. not easy, the results that could be measured were significant: The HMC reduced the direct costs of treating three of the conditions by 24 per cent to 49 per cent. The HMC also emphasised ev- idence-based care (clinical decision-making backed by validated research), eliminated unnecessary care and generated high levels of patient satisfaction. The need to accelerate the transformation of health care is urgent. We have seen some hopeful signs that the tide may be turning: Thanks to the Affordable Care Act, the proportion of adult Americans without health care coverage fell to 12.9 per cent in 2014 from 18 per cent in 2013. And the rate of increase in US health care spending has recently slowed. We believe that other large employers should follow Intel’s example. Let’s take an in-depth look at the elements that were critical to the success of the Healthcare Marketplace Collaborative. 1. Make explicit what each player is bringing to the effort Intel initially invited Cigna; Providence Health & Services, a multistate health care system; and Tuality Healthcare, a small local system with two community hospitals, to join the collaborative. On Providence’s recommendation, two state agencies, Oregon’s Public Employees’ Benefit Board and the Oregon Educators Benefit Board, were asked to participate in 2010. Each organisation that joined the collaborative brought capabilities that the others lacked. It was important that each group’s unique value be recognised. 2. Establish a shared aim The HMC’s members agreed The HMC chose simple metrics that addressed the aim of better, faster and more-affordable care. Picture: File 6. Choose simple metrics and goals The HMC chose simple met- rics that addressed the aim of better, faster and more-affordable care. And it set audacious goals for each. In virtually all regions, at least some employers, providers and health plans will be able to transcend narrow self-interest and co-operate to develop new business models that result in the best health outcomes for individuals at lowest cost. Patricia A. McDonald is Intel’s vice president of human resources and the director of the Intel Talent Organisation. Robert S. Mecklenburg is the medical director of the Centre for Health Care Solutions at Virginia Mason Medical Centre. Lindsay A. Martin is the executive director of innovation and an adviser at the Institute for Healthcare Improvement. B≥ussels Ai≥lines exits Nai≥obi as Lufthansa makes a ≥etu≥n By ISAAC KHISA The EastAfrican BELGIUM’S FLAG carrier Brussels Airlines will concentrate on West African markets after dropping the Nairobi route in favour of its code share partner Germany’s Lufthansa. Sebastiaan Spijkers, the airline’s country manager in Uganda and South Sudan, told The EastAfrican that Brussels Airlines, using Airbus A330-200 aircraft, will unveil four weekly flights to Accra, Ghana, extending to Lome, in Togo, replacing the current twice weekly triangular Brussels-Abidjan-Lome route, starting October 26. Mr Spijkers said the new move is part of the realignment strategy by Lufthansa Group — which owns 45 per cent of Brussels Airlines — to have its airlines collaborate closely in their operation in Africa. “Our observation is that the majority of the passengers from Nairobi are destined for Europe and the United States, and we think they can be well served with Lufthansa Airlines via Frankfurt in Germany,” he said. Brussels Airlines will stop its flights to Nairobi starting October 24, as Lufthansa resumes flights from Frankfurt after nearly 16 years of absence, starting with four weekly flights using Airbus A340300 aircraft and later five weekly flights from December 17, to cater for increased traffic during the festive season. Brussels Airlines has been flying to and from Nairobi since the start of its operations in 2002. Lufthansa has relied on codeshared flights with partners Swiss and Brussels Airlines to connect its passengers to Nairobi. Its subsidiary Lufthansa Cargo, however, continued to offer four weekly flights from Nairobi, moving fresh flowers, horticultural products and fish destined for Europe. Brussels Airlines, which currently 16 yea≥s serves 15 destinations in West Africa, also plans to strengthen its capacity in the region with the increase in frequencies on the Brussels to Cotonou (Benin) route via Abidjan in Ivory Coast and Brussels to Ouagadougou in Burkina Faso via Abidjan to Europe from two to three weekly flights. However, the airline will retain flights out of Entebbe, Bujumbura and Kigali in the East African region. Brussels Airlines’ expansion Time in which Lufthansa has been away from the Nairobi route plans in West Africa comes at the time when its main rivals Emirates, British Airways, Air France and KLM are yet to lift suspension of their flights out of West Africa to serve travellers destined to Europe through their hubs. The suspension was occasioned by the Ebola outbreak, which claimed over 10,000 lives with more than 24,000 cases reported in Sierra Leone, Guinea and Liberia last year. Brussels Airlines’ planned moves in West Africa are expected to give travellers destined to Europe more alternatives instead of relying on Ethiopian Airlines and Spanish carriers — Iberia and Vueling Airlines — on the routes. Brussels Airlines chief commercial officer Lars Redeligx said the new flights to West Africa will link the continent with the United States, the UK, Denmark, Germany and France via Brussels Airport. “This is an important investment in our African presence,” Mr Redeligx said.
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