As President and CEO of Quality Quest for Health, Gail M. Amundson, MD, FACP, leads the organization’s mission to achieve exceptional patient service and outcomes by catalyzing healthcare transformation. Quality Quest helps foster a strategic partnership between Caterpillar, Inc. and OSF HealthCare which is transforming healthcare in central Illinois.
Dr. Amundson’s main goal is to promote partnerships between physicians and patients, dramatically enhance the quality and efficiency of healthcare delivery, and improve the health of the community in central Illinois. Dr. Amundson was given the Minnesota Community Measurement’s inaugural 2007 Leadership in Measurement Award and was asked to present to the Institute of Medicine Committee that wrote “Performance Measurement: Accelerating Improvement,” a report published in December 2005. She serves on several national committees, including the National Quality Forum Consensus Standards Approval Committee and the American College of Physicians Performance Measurement Committee.
Dr. Amundson commutes to work in Peoria from her home in St. Paul, Minnesota, while her youngest daughter, Julia, finishes high school. Her husband, Dr. Peter Rothe, MD, FACP, is an internist and geriatrician in Minnesota. Their son, Aaron, just graduated from the University of Minnesota, where his brother, Karl, is a freshman. In her spare time, Dr. Amundson reads, gardens and spends time outdoors with her family—they love to hike, bike and camp!
Talk about your career path that led you from molecular biology to medical school to your current position at Quality Quest.
I grew up on a dairy farm in central Wisconsin. My parents encouraged me to follow my interests and strongly supported education. It was my interest in science, especially biology, and math that led me to pursue a career in medicine. I received my bachelor’s degree in molecular biology from the University of Wisconsin-Madison. That degree was one step down the road to becoming a physician.
After graduating from medical school, also at the University of Wisconsin-Madison, I completed a residency in internal medicine at the University of Minnesota and then went into private practice with my husband, also an internist, in a small town in northern Wisconsin We practiced in Tomahawk, Wis., for two years before returning to Minnesota.
My other passion is art. As a youngster I imagined becoming an artist. I focus my creative energy on improving the quality of healthcare.
What initially inspired you to strive for quality healthcare at more affordable costs?
When I returned to practice in Minnesota, I joined the Group Health Clinic. I thoroughly enjoyed seeing patients, and my practice grew quickly. I also took on administrative responsibilities as the chief of professional services at my clinic. The clinic was friendly, my partners were excellent doctors and I learned a lot from them, as well as my patients. We strove to provide great patient care, working hard and putting in long hours. But it was a challenge to see everyone who needed appointments, and some of our processes seemed inefficient. I found myself thinking patients deserved better.
In the early ‘80s, HealthPartners introduced Continuous Quality Improvement methods—CQI for short. Readers may be familiar with Six Sigma and Lean Production methods; CQI is similar. I got excited about the potential of CQI to improve patient care and took all of the classes that were offered. I read a lot of books on the subject and just couldn’t get enough. I led several CQI project teams and eventually went on to get more training in quality improvement.
In 1995, I scaled my practice back and took the job of medical director for quality improvement at HealthPartners. That was a wonderful learning experience and a great opportunity to use my CQI skills in new ways. I helped develop HealthPartners’ quality measurement and pay-for-quality programs. Both were, and still are, ahead of their time. HealthPartners won the National Quality Forum’s 2007 National Quality Healthcare Award, and jurors called the program “the wave of the future.”
I also helped start Minnesota Community Measurement—a statewide collaboration that reports on the quality of physician practices in Minnesota at www.MNHealthcare.org. Minnesota Community Measurement was honored to be the organization chosen as the site where President Bush signed the executive order on healthcare transparency last year.
Explain the strategic alliance between Caterpillar and the OSF HealthCare System. Is it unique or patterned after another partnership?
This unique alliance is the state’s first regional healthcare improvement coalition. Together, our vision is to become the community of the healthiest people with the highest value healthcare.
A major driver of Quality Quest for Health’s founding partners is the fact that Caterpillar and OSF HealthCare account for over 45 percent of the lives covered in central Illinois. With the health of so many employees, retirees and dependents at stake, there is a substantial opportunity to have a huge impact on the region.
Like much of the country, central Illinois relies on a healthcare system that is fragmented, focused on acute rather than chronic care, driven by treatment rather than prevention and based on rewarding volume rather than quality. Leaders from both Caterpillar and OSF HealthCare simply believe “we can do better than this.”
Quality Quest for Health’s mission is to achieve exceptional patient service and outcomes by catalyzing healthcare transformation. Our goal is to become a leader in collaborative transformation. We aim to identify affordable and sustainable solutions, to develop and share replicable strategies, to continually enhance value, and to stimulate quantum-leap improvements in the Institute of Medicine’s six aims—patient-centeredness, effectiveness, efficiency, equity, safety and timeliness.
Quality Quest for Health was formed from Caterpillar and OSF HealthCare’s joint recognition that the healthcare status quo was undesirable and unsustainable. What have been the major obstacles for people in making better health choices?
It is true that healthcare is becoming increasingly unaffordable. Our country spends 16 percent of our gross domestic product (GDP) on healthcare. Experts predict that by 2010 the US will spend about one of every five dollars on healthcare. If US quality results were the best in the world, this might be understandable, but they are not. In fact, US results are some of the lowest in the developed world. Caterpillar, Inc. and OSF HealthCare System believe we can do much better.
The most important health choices are those each of us makes every day about eating, exercising and not smoking. These choices have the biggest impact on how long we live and how well we function as we age. As one looks around, it is easy to tell that making healthy choices has become more difficult in recent years. We are in the midst of a galloping obesity epidemic which needs to be headed off, but no one has all of the answers. Working toward this end, Quality Quest for Health’s vision is to have the healthiest people. It is extremely important that we work together as a region to find solutions.
Then there are choices about healthcare. Today there is very little information to help people make wise healthcare choices. One of Quality Quest for Health’s strategic objectives is to provide reliable information about the cost and quality of healthcare to physician practices and to consumers.
What wellness programs have Caterpillar and OSF HealthCare System implemented since this program began?
Caterpillar and OSF are working together to improve colorectal cancer screenings. They are also working together to assist individuals in improving their diabetes results. Both programs have been successful.
Colorectal cancer is preventable in most instances. Because of the new screening program, over a hundred people have had pre-cancerous polyps identified and removed. Removing these pre-cancerous polyps prevents them from causing cancer later on. In addition, two treatable colon cancers were found early.
The diabetes program has focused on helping individuals make sense of what can seem like a complicated and frustrating condition. Even so, it’s a handful of things that make the biggest difference. If an individual doesn’t smoke, takes a daily aspirin and keeps their numbers—blood pressure, blood glucose (A1c test) and cholesterol—on target, the likelihood of staying healthy increases dramatically. The number of people in the program who are now meeting all of their targets has more than tripled since the program started.
Has there been any pushback from physicians for this strategy?
Quality Quest for Health aspires to transformational change. Change can be challenging. We are early in the program, but I am impressed by the personal commitment to excellence among the physicians and nurses in our community.
How much of a typical worker’s day is being spent (or should be spent) on employee health and wellness programs?
There are a number of different yardsticks to guide us. Most experts would recommend adults walk a minimum of 10,000 steps every day, including time spent at work and at home. That’s about five miles. If people with office jobs are like me, they will be shocked at how far off that target one is at the end of an eight-hour day. Spending at least 30 minutes exercising every day pays off big in better health—almost immediately. It’s a must!
Can you give some examples of how you provide patients and clinical care teams with support to help achieve the best possible outcomes?
Support to achieve the best possible outcomes comes in many forms. For physicians, having an electronic patient record is an important support that has only recently become common practice. Having reminders built into the electronic record system is another support that helps physicians deliver better patient care. Sometimes we don’t stop to think about human limitations. Pilots wouldn’t think to take off without having completed a checklist. Doctors and nurses are human. We can’t, and don’t, remember every thing every time; automatic reminders help.
Support for patients can take many forms. Understandable information is one important support. Readers can expect better support to develop over the next several years. Imagine being able to email your doctor, look up your health records online or be able to track your weight, blood pressure or blood sugars online. Imagine being able to share results with everyone on your care team—even those who are in another office, such as a dietician or counselor.
Physicians and insurers have historically focused on illness models rather than preventive models of healthcare. Is education of the consumer a major key to changing that?
It certainly is. It bears repeating that what choices we make as individuals about eating, exercising and not smoking have the biggest impact on how long we live and how well we function as we age. Not drinking alcohol or drinking in moderation is important too. Believe it or not, the impact of these choices is greater for most people than the impact of the healthcare system.
What changes will we see in the medical community in terms of physician specialty practices if more companies embrace a wellness model?
We will always need specialty physicians. But I believe we will see specialty physicians doing more to promote healthy lifestyles because it helps improve patient results. For example, quitting smoking helps broken bones heal. So, orthopedic doctors play a role in helping people kick the habit. Children who live with smokers have more ear infections. So, ear, nose and throat (ENT) doctors have a role in helping parents quit smoking. Physical activity helps depression, heart disease, diabetes and many other conditions. Specialists who see patients with these conditions have a role in encouraging exercise. As you can see, embracing wellness is good patient care.
Will physicians and hospitals use more holistic treatments in the future? More dietary supplements, non-invasive treatments, such as physical therapy, pain controllers, etc.?
I expect that evidence-based treatments will become more common. Evidence-based care standards are guidelines or care protocols developed by teams who spend a great deal of time reading the scientific literature on a topic and developing best-practice recommendations.
New scientific findings need to be sorted out and translated into practice in order for patients to benefit. In the past, it was expected that each physician would read the scientific literature to keep up with current findings. That is a problem, however. Medical science expands so rapidly that reading 24/7 doesn’t do the job. Delegating the review to teams who synthesize scientific findings to create a best practice guideline is the only way to go.
A team of clinical leaders is reviewing all evidence-based care standards and will select the best set for our region. The standards may include holistic treatments, dietary supplements, physical therapy and pain controllers. Quality Quest for Health will be using the guidelines the Evidence-Based Care Standards team identifies as the best.
In your opinion, should pharmaceutical companies be better regulated as to what and how they can advertise new drugs and incent physicians to prescribe drugs?
Yes, I do believe we need better patient safeguards. We need a better system to monitor drugs and we need more openness of information.
In particular, we need to take a hard look at pharmaceutical company advertising. Advertising works, and free samples are a popular form of advertising. But free drug samples aren’t really free. Their costs are included in the prices everyone pays for their medicines. Generic medicines are often the best choice because they are affordable and have long track records based on the success of their name-brand predecessors. But generic samples aren’t available. This means they are often overlooked in favor of more expensive brand name samples when a new medicine is started.
How does focusing on the care of individuals improve the health of the overall population you serve?
That is a good question. It means measuring how closely each patient’s care follows best-practice standards, even though each patient is unique. It means redesigning healthcare processes with perfect patient care as the end in mind. My previous practice, for example, measured how many patients had all of the preventive care they needed. That led the clinic to redesign patient visits to include a scan of preventive care recommendations at every visit. Fewer important screening tests were missed, immunization rates went up and patients appreciated the attention to detail.
You are currently commuting between Minneapolis and Peoria while your daughter finishes high school. How do you manage to balance that?
I have a very supportive family who shares my belief in the importance of this work. I travel to St. Paul Friday evenings and return to Peoria Monday mornings. We miss each other during the week, but it’s a manageable challenge.
What would you like our readers to know about yourself or Quality Quest that we haven’t asked?
Quality Quest for Health aspires to transformational change in central Illinois healthcare—change that puts the patient at the center of the system. It won’t be easy, it won’t be fast, but it is very, very important. We can do it, if we do it together. TPW