With the fate of the landmark Affordable Care Act hinging upon outcome of the fall elections, some health care observers are closely watching an historic public–private collaborative launched late last year with the potential for improving hospital health outcomes on a grand scale.

The Centers for Medicare and Medicaid Services (CMS) Innovation Center announced its Hospital Engagement Networks (HENs) project in December 2011 through its Partnership for Patients program. The program awarded $218 million in contracts to 26 hospital organizations that have formed HENs, representing 4,100 U.S. hospitals. Those HENs have pledged to work together to cut 10 hospital-acquired conditions, such as pressure sores and catheter line associated bloodsteam infections (CLABSI), by 40 percent and to reduce unnecessary hospital readmissions by 20 percent by the end of 2013.

HENs are learning collaboratives for hospitals that have committed to improving patient safety by sharing of best practices, training and educational initiatives. They will provide technical assistance to help their hospital members achieve the CMS’ quality measurement goals and to track their progress. In turn, the CMS will monitor the HENs’ work. The initiative represents the CMS’ largest hospital quality effort to date and its greatest financial commitment to improving hospital patient safety.

The CMS estimated that if the HENs achieve their goals, it could save 60,000 lives over three years and translate to 1.8 million fewer injuries to hospital patients. Today, 2.6 million Medicare patients are readmitted within 30 days of hospital discharge, according to the CMS, which predicted the HEN project could save $30 billion over 10 years. More importantly, health care policy experts said if successful, the project  would establish a framework for disseminating and applying best practices that America’s health system previously has lacked.

Anne Rooney, vice president of Global Consulting Services for the Oakbrook, Ill.-based Joint Commission Resources (a division of the hospital accreditation organization, the Joint Commission) said JCR received a $3.1 million HEN contract. Rooney, who oversees the HEN, called the program “a big project that poses big challenges.”

Rooney said the greatest test facing everyone will be in helping organizations understand the root causes of their problems and building solutions. “We’re committed to making a difference,” she said. “But hospital leaders have to be in the forefront in providing leadership and inculcating a safe culture. If they have not already grasped the impact of errors on quality and financing, then they really need to be at the table understanding what’s happening.”

Karen Adams, vice president of national priorities for the National Quality Forum, said the Partnership for Patients is a way to implement safety goals through a national quality strategy. “HENs are the mechanism to get us there,” said Adams.

Arnold Milstein, M.D., medical director for the Pacific Business Group on Health and director of the Clinical Excellence Research Center at Stanford University, called the HEN project “a terrific idea and a real gift to patients and the Medicare program in particular.”

“There is no question that its goals are technically feasible; the question is will hospital leaders have the will to execute and implement these best practices,” Milstein said. “But it is absolutely doable.”

The HENs and the contracts they received vary in size. The American Hospital Association’s Health Research and Educational Trust (HRET) received the largest at $75.8 million. The AHA said it will distribute to 33 subcontractor state hospital associations representing 1,900 hospitals.

Maulik Joshi, president of the AHA’s HRET and AHA senior vice president of research, said the association’s approach is to partner with state hospital associations while providing great local and national support and educational activities. “We’re engaging leadership because we know that is critical to improving hospital progress.”

He said the AHA HEN is partnering with experts throughout the country in various hospital-acquired condition topic areas to bring that knowledge into hospital toolkits and to support local implementation. “Our job is to harness best practices and spread them. We’re not creating new work, but taking what is working already and broadcasting it. We are very focused on results.”

Joshi said the hospitals will submit data on their results, which the HEN will collect, aggregate and analyze, then report to the hospitals. “This gives us an opportunity to test and learn—to unleash the innovation,” he explained. “In two years, if we do our work well, we’ll be able to show dramatic improvement. We are not in this alone. This is not about competition, but collaboration.”

Twelve state hospital associations have formed HENs. So, too, have Catholic, for-profit and regional health systems, along with specialty hospital associations representing public, teaching and children’s hospitals. Group purchasing organizations like Premier ($23.9 million) and VHA ($6.3 million) have also created HENs to serve their members.

While all of the HENs have committed to the CMS goals, their approaches, methods and tactics vary. Intermountain Healthcare’s HEN includes the Cleveland Clinic, Mayo Clinic, Baylor Health Care System and other quality leaders, working across state borders and health systems to collaborate on the best practices for improving patient safety and care.

Many of the HENs have been toiling in the quality improvement vineyards for years and the HEN project marks an extension of earlier efforts.

Hospitals must act swiftly, said Jim Battles, social science analyst for patient safety with the federal Agency for Health Research and Quality (AHRQ). Battles said escalating health care costs threaten the financial viability of the Medicare and Medicaid programs and the stability of America’s employer-financed private insurance system. “If we don’t get a handle on costs, this country will go bankrupt,” predicted Battles. “And the best place to start is to stop harming people. It is absolutely essential for survival of the U.S. health care system.”

Battles said the HEN project represents a unique opportunity for hospitals to gain and share knowledge, adopt best practices and improve the care of their patients. He said the project marks a substantive leap both philosophically and practically from earlier government quality improvement and patient safety programs.

“It takes an average of 17 years for an innovation or practice to get from the lab to the bedside,” said Battles, the son of a county agricultural extension agent. “That’s far too long. Here we have this huge investment in a gargantuan research engine, but almost nothing to create the infrastructure to transfer that knowledge from the research bench to the bedside. That’s because we’ve never had the boots on the ground to help hospitals implement the improvements.”

Battles said the HENs comprise that missing infrastructure. “We’ve known what to do and now we have the tools and resources,” he said. “We need to think about the network of HENs as the agricultural extension agents of HHS.”

In announcing the HEN contracts, HHS Secretary Kathleen Sebelius said many Americans will likely need hospital care during their lives. “And we need to be confident that no matter where we live, we’re going to get the best care in the world,” said Sebelius, who explained that the Partnership for Patients program is helping the nation’s finest health systems share their knowledge and resources to improve hospital care everywhere.

The Affordable Care Act required HHS to form a national strategy to improve the delivery of health care services, patient health outcomes and population health. The National Quality Forum convened the National Priorities Partnership, which included 51 leaders representing every health care sector. That partnership advised Sebelius on targeting those national health care priorities, which included setting achievable goals such as reducing unnecessary hospital readmissions, then devising strategies to accomplish those goals.

Still, some prominent health care researchers continue to harbor concerns about the HEN program, expressing doubts about the lack of standardized measurements and the HENs’ commitment to change hospital culture.

Peter Pronovost, M.D., professor of anesthesiology/critical care medicine and surgery
at The Johns Hopkins University School of Medicine, said one of the challenges facing HENs is that while there is an urgency to get going, there is no uniform way to keep score.

“This is funded with taxpayer money, a huge investment. These kinds of dedicated resources to improving quality are much needed and long overdue. But we don’t have the measures yet, though CMS is working on that.”

Pronovost said changing hospital culture is key to adopting best practices and making them stick. “We found culture is so important that I wouldn’t dream of trying to reduce one kind of harm without culture change,” he said.

Though Pronovost has apprehensions about the HEN program, he said it also possesses powerful potential.

“Galvanizing national attention on the problem is a huge strength,” he said. “And this kind of national collaboration between the HENs is pretty remarkable, that this kind of focus and level of resources are being devoted to preventable harm. Federal leadership should be applauded for shining a light on this problem. I hope these kinds of investments continue because we need them in research.”

Joseph McCannon, senior advisor to the CMS administrator and group director for learning and diffusion, said the Partnership for Patients is the first plank for gleaning the best quality performance practices and spreading them. “This is a really big goal,” McCannon said. “And the engine for accomplishing this is the HEN networks. I’m confident that this is possible.”