Imagine you are going in for a hip replacement surgery, knowing you could get hip Type A or hip Type B. You know there are differences between the two – one will last five years longer and cause less pain.

Wouldn’t you like to know which option that was?

A key challenge in redesigning care delivery is the lack of accurate, comparable information. Even in the age of electronic health records (EHRs), social networking, and other forms of information exchange, care providers and patients do not have access to accurate information to inform treatment choices.

Several of PBGH’s initiatives aimed at redesigning care include the creation and use of clinical registries to help provide this accurate information that is so often lacking. Registries are used widely in other countries and within some systems in the US to:

• Build knowledge base for comparative effectiveness on procedures and devices
• Drive towards common data definitions and outcomes metrics
• Leverage the power of current technology to engage patients in decision making and integrate patient self reported status into effectiveness research
• Identify high value providers and design benefits and offerings to reward the
• Increase multi-stakeholder collaboration

• Drive better outcomes and lower costs over time

Orthopedics:

PBGH is leading the development of a voluntary, statewide registry for total joint replacements, including knees and hips. Our partnership with the California Orthopedic Association and California HealthCare Foundation (CHCF) has enabled us to define outcomes data to be collected, select a technology platform, enroll three leading hospitals and their top notch orthopedic surgeons, and launch a pilot. The three hospitals participating are UCSF, Cedars-Sinai and Hoag Memorial, and collectively, they represent about 7% of the hip and knee replacements done in CA each year. We’ll keep you posted as we proceed with the pilot.

Births:

We’re also partnering with CHCF and the California Maternal Quality Care Collaborative (CMQCC) to build a statewide data repository that can drive quality improvement in maternity care. Almost 30% of the births in CA each year are c-sections, and we know that the outcomes for both babies and moms in c-sections that aren’t medically necessary are inferior. With this data, we will design quality improvement projects, patient information campaigns and reimbursement systems that encourage the right care.

A role for purchasers

As a leading coalition for purchasers of health care, PBGH staff are often asked: what can purchasers do to support your efforts? Purchasers can do a number of things to help support these efforts and others like them. Here I have listed just a few:

Design benefits that drive patients to high value providers.

• Offer commercial benefit designs that encourage patients to choose high quality, cost effective care and participate in their care planning.

• Tie reference pricing preferred "list" to registry participation.

Pay providers for value

• Develop episode payments that are linked to registry participation and reporting.

• Create incentives for patient engagement in shared decision making.

Invest in registry startup

Fund activities related to the development of registry infrastructure.

Publicly recognize providers who participate

List hospitals and physicians in “excellent” category on health plan provider directories and preferred provider lists. Require participation for inclusion in preferred programs.

Insist on the development of professional standards and guidelines that encourage appropriateness and identification

Tie payment to guideline adherence and reporting of appropriateness indications.

Choosing the right hip can mean several more years of better health and improved quality of life as well as lower health care costs. It is exciting to be advancing these opportunities and working with purchasers to support these and other strategies to advance care redesign.

Kate Chenok is a Director at PBGH, who focuses on PBGH's Redesigning Care strategy. She can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it