How Will We Do That?™ was a joint initiative of the Institute for Healthcare Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, the Harvard School of Public Health, the Engelberg Center for Health Care Reform at Brookings. Financial support was provided by the Peter G. Peterson Foundation and the Fannie E. Rippel Foundation.
In May 2010, IHI and its partners brought together 13 regions committed to redesigning health care to achieve the IHI Triple Aim: better care for individuals, better health for populations, and lower per capita costs. The communities came together with the belief that if even one region in the US could achieve sustainably low-cost, high-quality care, it would be a model and an inspiration for the rest of the nation. These sites have set ambitious goals; as they work to bend the health care cost curve locally, they will be an important source of testing and learning for the country as a whole.
The How Will We Do That? meeting held in May 2010 was a successor to an event that was held in July 2009, when IHI and our partners examined the performance of ten US Hospital Referral Regions (HRRs) with relatively low Medicare costs and above-average health care quality. The event focused broad attention on regional differences in cost effectiveness, and showed that, even without national reform, some regions were doing better on cost and quality than the country as a whole.
Since that first meeting in July 2009, we assembled a more complete set of data, including that from commercial health plans. We are seeking to generate a deeper and more action-oriented discussion about what regions are doing, and will do, to advance health and quality while controlling cost. If even one region in the US could achieve sustainably low-cost, high-quality care, this would be a model and an inspiration for the rest of the nation.
The goal for the May 2010 meeting and subsequent efforts is to build awareness among the public and policy makers that successful models for achieving high-quality care at significantly reduced cost already exist in many regions and in many forms throughout America. With a deeper understanding of how these communities have achieved success, the conditions for better, less costly health care for the country as a whole ― and a reform agenda that will protect, value, and spread best practices ― can be identified.
Models of Low-Cost, High-Quality Health Care in America Do Exist
The US Congress, the White House, and the American people are currently engaged in an unprecedented discussion and debate about the best way forward for the US health care system, beginning with the pressing needs of insuring all citizens and reforming the system in ways that make universal coverage affordable. As the scenarios most likely to gain support unfold, it remains critical to keep focused on ways to contain costs, improve health, and improve the patient experience with the health care system.
Several American communities are already achieving impressive results for patients, at significantly reduced per capita cost, supported by their culture, careful planning, and a high level of coordination among leading health care institutions (both outpatient and inpatient).
Aims of How Will We Do That?™
In May 2010, four health care improvement experts ― Drs. Donald Berwick, Elliott Fisher, Atul Gawande, and Mark McClellan ― invited health care leaders from a select group of high-performing regions of the US to share their experiences at a gathering in Washington, DC.
Called How Will We Do That?™ Building Low-Cost, High-Quality Health Care Regions in America, the meeting brought together teams from 13 high-performing regions to explore openly the local, regional, and national factors ― including culture, financing, infrastructures, and more ― that underlie the mechanisms for delivering health care in their communities.
The aim for this meeting was to convene regions committed to taking the lead on redesigning health care to provide lower cost (or cost growth) with better health and health care for their communities.
Each team represented a broad cross-section of health care stakeholders. These differed across regions, but, included health care providers, employers, health plans, patient advocates, civic leaders, public health agencies, social service agencies, and others. Some regions had already established multi-stakeholder coalitions that served this purpose. IHI left it to each region to convene a team that is committed to improvement at the regional level, and is capable of leading that improvement. We also asked that there be some commitment to reconvene, or otherwise share actions and results, in the future.