Assessing Patient Safety Practices and Outcomes in the U.S. Health Care System

By Donna O. Farley; M. Susan Ridgely et al. | Go to book overview

APPENDIX B.
CASE STUDIES FROM THE COMMUNITY STUDY:
Indianapolis, Indiana

CONTEXT AND HISTORY

Market Composition and Competition

The highly competitive environment in Indianapolis has been feeding expansion activity in the four private hospital systems, which have all been expanding their facilities both within Indianapolis and into the surrounding suburbs. Clarian Health Partners led the charge into the suburbs, followed by Community Health Network, St. Vincent’s Health System, and St. Francis Hospitals & Health Centers. Wishard Health Services, a county-owned hospital and network of community clinics is the main safety net provider. An increased number of uninsured patients has caused Wishard to implement cost-cutting measures, such as increased copayments, staff reduction, and more aggressive bill collection from third-party payers.

As the insurer for several large Indianapolis-based companies, Anthem BlueCross BlueShield is the dominant health insurer in the market. Meanwhile, national insurers United Healthcare, Aetna, and Humana have been gaining membership at the expense of providerowned local insurers, such as M-Plan and Advantage Health Solutions.


Economic Environment in Indianapolis

The large employers in the Indianapolis region include Eli Lilly, General Motors, Marsh Supermarkets, and St. Vincent’s Health. They have struggled with containment of health care costs and are now shifting costs toward employees and focusing on developing tiered provider networks. The concern is that health care costs seen in Indianapolis and the state are higher than those in other regions in neighboring states, which may affect future business development.

In the following sections, we describe patient safety activities in the hospital, ambulatory and long-term care sectors, characterize the views of local stakeholders, and then conclude with key lessons learned from the Indianapolis experience.


CURRENT COMMUNITY COLLABORATIONS

Indianapolis Coalition for Patient Safety

The key patient safety initiative in Indianapolis is the Indianapolis Coalition for Patient Safety (ICPS), which operates within the hospital sector. Begun in 2003, the ICPS brings together the six major hospital systems in the metropolitan Indianapolis area. The systems are Clarian Health, Community Health Network, Richard L. Roudebush VA Medical Center, St. Francis Hospitals & Health Centers, St. Vincent Health, and Wishard Health Services. What grew into the ICPS began in 2001 as discussions between the chief executive officers (CEOs) of the major health systems. The CEOs were motivated by To Err Is Human, the Institute of Medicine (IOM) report. The ICPS currently is considering expansion to include the hospital systems in the suburban ring around Indianapolis.

Major overarching goals of the ICPS include making Indianapolis the “safest city (for patients) in the country,” “not to compete on safety,” and to bring a high degree of standardization to practices across all participating health systems. The last goal was crucial,

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