Some thoughts from Dr. Claire Neely
As the year draws to a close, ICSI prepares to close its doors. This of course has led to a great deal of reflection on our history, our accomplishments, and the legacy we leave after nearly three decades of our pursuit to improve healthcare in Minnesota. One clear theme, an overarching principle really, always floats to the top of my mind. That is there has always been, and always will be, a pressing need for collaboration to improve healthcare and systems. It’s been our primary driver here at ICSI, from inception to the end.
The spirit of collaboration has motivated leaders from both healthcare delivery and health plans across Minnesota and the region to gather together to solve problems and quite simply – make things better. As a result of our work, ICSI gained a reputation as a high-integrity, neutral convener, helping these collaborators navigate obstacles safely while providing expertise in evidence-based care and quality improvement.
We are all proud that over the course of our history, ICSI was always a place where healthcare systems could tackle tough problems together. It’s hard to summarize 30 years of work in one short letter here, but in a nutshell our accomplishments have included:
- Pioneering the use of evidence not only for clinical decision-making but also for system policy development, choosing effective care models, and implementation of the needed care processes
- Embedding the disciplined use of quality improvement methods to improve outcomes, including measurement and the comparison of systems performance to drive ongoing change.
- Developing collaborative leadership skills and establishing processes for working together. ICSI helped shape healthcare leaders who truly understand the value of collaboration, and how to leverage collaboration to solve complex problems.
While our history will live on in the minds of everyone who worked here, and those we worked with over the years, I think it important to remember a bit of our storyline here as well.
ICSI was established in 1992 through a planning process that involved 70 people from medical groups, hospitals, health plans, and employers providing healthcare insurance to their employees. The primary delivery organizations were what is now HealthPartners, Mayo Clinic, and Park Nicollet Clinic. Without these amazing healthcare leaders, ICSI would never have gotten off the ground. By 2005, there were 55 member health care delivery organizations and all six health plans were sponsors.
ICSI was the first regional healthcare improvement collaborative and provided an organizational model that has been emulated across the country in Massachusetts, Pennsylvania, California, Oregon, and Michigan, to name a few.
Recently, the ICSI-activated MN Health Collaborative was created to address the more complicated problems of the opioid epidemic, mental health care and social needs, creating public-private partnerships and other new partnerships needed to both understand and address these challenges. The work done to address the opioid epidemic by improving prescribing and pain management is being used across the US. The work done by our surgical community in post-operative pain management is ground-breaking, as is the novel work done to better understand the experience of those with chronic pain and the clinicians who care for them. Our emergency departments have made substantive changes in working with those who attend the ED with mental health concerns, especially those at risk of suicide. Primary care efforts to integrate behavioral health into primary care are redoubled.
The pandemic changed our focus, too. Understanding what healthcare staff were/are facing during the ongoing pandemic led to shared strategies to support the mental health and wellbeing of all of us working in these difficult conditions. Using our skills at evidence assessment and review, we provided clinicians with the best of the everchanging knowledge about COVID-19 vaccines, updated weekly. This page on our website was viewed over half a million times.
Use of Evidence
As you probably remember, ICSI initially focused on the development of clinical practice guidelines through work groups engaging not only specialists from member organizations but primary care providers, operational experts and health plans in reviewing evidence and crafting recommendations and creating implementation supports. A pioneering effort at that time, sixteen guidelines were developed in the first year, eventually expanding to about 60 guidelines developed and updated regularly. The guidelines were shared without charge with any care delivery organization and used throughout Minnesota, the rest of the US, and in several other countries, especially Mexico and Brazil. (Were you one of the hundreds who carried the pocket guidelines or had them on your PalmPilot?)
As a result, it may be hard to remember that clinical guidelines were once derided as “cookbook medicine” and that clinical decision-making used to be solely based on the authority of prominent physicians or on established custom. Using available evidence to guide clinical decision-making, assess new technologies, spread to the use of evidence for choosing organizational models for clinical care, and for choosing methods for changing clinical processes so that actual practice matched guideline recommendations. As a result of ICSI’s work, using available evidence is now the accepted standard for health care in our state.
Continuous Quality Improvement
In time, ICSI members identified the need for more support in implementing guidelines.
Through training and shared membership requirements, ICSI established continuous quality improvement (CQI) as a routine activity in Minnesota medical groups and hospitals. Although CQI practices were already embraced by some, ICSI’s work lead to an expansion of this approach to improving care processes. ICSI developed quality improvement training for members as they sought to embed this in their organizations. (Remember the tractors for the Cultivating Quality series?)
Understanding that organizations could be more successful when learning together and from each other, led ICSI to develop state-wide improvement projects (Action Groups) focused on specific shared challenges. (Did you “embrace” the challenge of working down backlog to implement Advanced Access?) The desire to implement innovative models of care and test strategies for financial sustainability led to other state-wide collaboratives. (Do you remember what the DIAMOND acronym means?) Health plans and care systems working together created decision support for high-tech diagnostic imaging that saved millions of dollars. (And, for clinicians, avoided 1000s of calls for prior auth.)
Our annual quality improvement colloquium which drew about 400 attendees from Minnesota and many other states, supported the spread of successful practices and highlighted innovations.
As with guideline implementation, ICSI promoted sharing healthcare performance data among the member organizations in these collaborative efforts. ICSI demonstrated the effectiveness of sharing performance data in motivating medical groups and hospitals to improve their care. Our internal performance data sharing set the stage for formal public reporting of healthcare performance in Minnesota, which has been led by Minnesota Community Measurement since 2004.
While only rarely providing overt leadership training, many healthcare leaders experienced collaborating with others at the ICSI table. Without a political or regulatory agenda, ICSI became trusted by healthcare delivery organizations, health plans, and other stakeholders. Being a reliable, available resource for activating healthcare improvement endeavors across organizational boundaries showed leaders that collaboration is a way to solve some problems-those that are too complex to be solved by a single organization working alone. The ongoing development of new collaboratives and with new stakeholders is a testament to what our leaders have learned.
While our doors are closing, our legacy is sure to continue. First and foremost, ICSI uniquely demonstrated the feasibility, effectiveness, and need for healthcare organizations working together to improve healthcare, even though they were competitors in the same marketplace. I know that spirit of collaboration will continue.
On behalf of all of us who have worked at ICSI over the years, I thank you for your trust, your hard work, and most importantly, your spirit. Our work will live on in the work of dedicated Minnesota’s healthcare leaders like you who have always been, and always will be, an example of how to do it right.
Claire Neely, MD, FAAP