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Redesigning the health care system around these attributes will not be easy. In fact, it will require changes at every level, including:

• Environments, such as insurers, purchasers and regulators;
  
  
• Organizations, such as hospitals and medical groups;
  
  
• Micro-environments, such as office practices and hospital units;
  
  
• Individual clinicians;
  
  
• And, at the center, the patient.

To meet the STEEEP challenge, some key changes must begin with purchasers and insurers.

In one major recommendation, the IOM said payments for care should be redesigned to encourage providers to make positive changes to their care processes. Ideally, this shift will begin with purchasers and insurers, and filter down through the delivery system to help encourage improvements at all levels.

In response to this challenge, a group of employers, physicians, health plans and patients have come together to create Bridges to Excellence. Guided by three principles, its purpose is to create programs that will realign everyone's incentives around higher quality:

• Reengineering care processes to reduce mistakes will require investments, for which purchasers should create incentives;
  
  
• Significant reductions in defects (misuse, underuse, overuse) will reduce the waste and inefficiencies in the health care system today;
  
  
• Increased accountability and quality improvements will be encouraged by the release of comparative provider performance data, delivered to consumers in a compelling way.

Three programs guided by these principles are already underway: Physician Office Link, Diabetes Care Link and Cardiac Care Link.

Physician Office Link enables physician office sites to qualify for bonuses based on their implementation of specific processes to reduce errors and increase quality. They can earn up to $50 per year for each patient covered by a participating employer or plan. In addition, a report card for each physician office describes its performance on the program measures and is made available to the public.

Diabetes Care Link enables physicians to achieve one-year to three-year recognition for high performance in diabetes care. Qualifying physicians receive up to $80 for each diabetic patient covered by a participating employer and plan. In addition, the program offers a suite of products and tools to help diabetic patients get engaged in their care, achieve better outcomes and identify local physicians that meet the high performance measures. The cost to employers is no more than $175 per diabetic patient per year with annual projected savings of $350 per patient.

Cardiac Care Link enables physicians to achieve three-year recognition for high performance in cardiac care. Qualifying physicians are eligible to receive up to $160 for each cardiac patient covered by a participating employer and plan. In addition, the program offers a suite of products and tools to help cardiac patients get engaged in their care, achieve better outcomes, and identify local physicians who meet high performance measures. The cost to employers is no more than $200 per cardiac patient per year with annual projected savings up to $390 per patient.

Better quality costs less. The savings are there for the taking. Purchasers everywhere must work together to create the mechanisms to reap them.

In an age of rapidly rising health care costs, combined with little or no system accountability, there is a greater risk than ever for purchasers, patients and providers to find their interests at odds. This can lead to intractable gridlock and the creation of few, if any, solutions to systemic problems.

Taking the steps now to encourage better performance and reduce inefficiencies will erase this gridlock and pave the way for a better system of care - one that meets the goals of purchasers, providers and patients alike. Implementing systems to support physicians is a great place to start. We hope you will join us in this effort.

The Bridges to Excellence coalition is a not-for-profit organization created to encourage significant leaps in quality of care. Bridges to Excellence participants include large employers, health plans, the National Committee for Quality Assurance and MEDSTAT, among others. The organizations are united in their shared goal of improving health care quality through measurement, reporting, rewards and education.

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