CASE 5 The Intermountain Way

INTRODUCTIONIntermountain Healthcare is often cited as a leader in high-quality, lower-cost care (Bohmer, 2009; Staines, 2009) and a model for others in the United States. It shares many of the characteristics of highly regarded systems, including many salaried physicians, strong information technology and accounting systems, and a consistent long-term corporate strategy for improving care. But Leonhardt (2009) has reported that some experts consider Intermountain Healthcare more advanced than most in terms of its use of evidence-based medicine and the extent of its deployment of quality concepts throughout the organization.

  • “It’s the best model in the country of how you can actually change health care,” Wennberg told me. I heard nearly the same argument from Anthony Staines, a health scholar and hospital regulator in Switzerland who recently completed a study of some of the world’s most-admired hospitals. “Intermountain was really the only system where there was evidence of improvement in a majority of departments,” Staines said. (Leonhardt, 2009, p. 3)

Leonhardt drew on interviews with such famous names in healthcare quality as Dr. John Wennberg at Dartmouth and Dr. Lucien Leape at Harvard. This case examines that internal quality, safety, and education system as it impacts clinical care.

Figure 5–1 Mission Critical Support for Performance Excellence

It describes experiences of Intermountain Healthcare with evidence-based (EB) care process models (CPMs) that have reduced costs while maintaining and improving quality of care delivered to its patients. Figure 5–1 outlines the three major supports that underlie Intermountain’s quality-improvement efforts:

  • Clinical integration;
  • Quality-improvement training; and
  • Information systems.

Background

Intermountain Healthcare (IH) is a community-owned, integrated, nonprofit healthcare system based in Salt Lake City, Utah. It was established in 1975 to own and operate 15 hospitals in Utah that had been established in local communities by The Church of Jesus Christ of Latter-day Saints, including LDS Hospital in Salt Lake City. The Church decided in 1975 that the operation of healthcare facilities was no longer critical to its religious mission. IH added an insurance arm, IHC Health Plans in 1983. In 2006, the insurance operations, which covered care to beneficiaries at both IH and other health organizations, were placed under separate management and renamed SelectHealth.

In early 2010, IH was the largest healthcare provider in the Intermountain West, with over 32,000 employees serving Utah and southeastern Idaho residents. Its resources included 24 hospitals, over 130 outpatient facilities, over 750 physicians and clinicians in the Intermountain Medical Group, a broad range of clinics and services, health-insurance plans from SelectHealth, and the Intermountain Institute for Health Care Delivery Research (IHCDR). The IH corporate Web site defines its mission as one of providing “clinically excellent medical care at affordable rates in a healing environment that’s as close to home as possible.” It serves approximately 60% of Utah’s population of approximately 2.8 million. Due to the low population density in the region, about half of its hospitals have less than 100 staffed beds. The system also includes Life Flight, a medevac unit with dispersed helicopters and fixed wing aircraft.Required:

This organization has a long and effective history of success of continuous improvement. What has led to that success?
What do they do that is transferable to other systems? What is not transferable?
What investment does Intermountain Health make to support clinical integration?