Lessons From Ice Hockey: How Gainsharing Fits Into a Population Health Strategy
I was a big Philadelphia Flyers fan in the heyday of their Stanley Cup Championships in the 1970s. One of the saddest events I can recall is when Flyer Hall of Fame goalie Bernie Parent’s career ended in February 1979 when an errant stick hit him in the eye, finding an unprotected area through his fiberglass mask. Now
a little history…the fiberglass goalie mask was a significant innovation in hockey, used in a game for the first time only in 1959. Prior to 1959, goalies did not have anything on their face! The mask changed a lot during those 20 years. While a “cage type mask” (think of an old-time baseball catcher’s mask) was considered, it was never widely adopted by goalies. Parent’s 1979 injury marked the beginning of the demise of the face hugging fiber glass mask. The cage mask briefly made a resurgence, but was not felt to provide enough protection, and also left some blind spots for the goalie.
By the 1990s, a fiber glass mask with a cage attached near the eyes became the standard and provided the best protection against eye injuries as well as performance. Hockey goalies are safer, and hockey fans can cheer their heroes longer.
It’s not always an either-or strategy that works best. In healthcare, I think the same approach applies. For example, population health strategies are those that focus on improving the health of our patients while lowering the overall cost of care, usually by ensuring that patients receive higher quality, more efficient treatment, and a better patient experience, by providing the right care in the right place at the right time. Patient Centered Medical Homes, Integrated Care Management Programs, Accountable Care Organizations, and programs are all approaches that can bend the healthcare cost curve.
But what happens when a patient comes into a hospital? No matter how well population health strategies are carried out, some events require hospitalization. Once a patient comes into the hospital, clinical management strategies need to be implemented to lower costs. Gainsharing provides the infrastructure for reducing variations in patterns of care, avoiding unnecessary duplication and expense of resources such as pharmacy and imaging, and reducing length of stay and intensive care services. It does this by aligning physicians and hospitals…so that they are both on the same page with the same incentives.
By integrating a proactive approach to population health management with a gainsharing strategy for improving the efficiency of inpatient costs, overall medical costs can decrease. Kind of like combining a cage and a fiber glass goalie mask.
Title: Healthcare Policy Advisor, Public Speaker and Writer
Mr. Anthony Stanowski’s statement comparing fiberglass goalie masks and quality evidence based medicine is most clever because it strikes at the heart of what American Medicine is all about. The basis of quality medicine is to, above all, protect patients from harm so that in the future they can live productive lives. So the analogy of a protective hockey fiberglass goalie mask and the practice of delivering safe and skilled medicine to patients is most appropriate.
Title: Long-time hockey-playing healthcare executive
I was thinking ice hockey has a long history of incremental, sometimes unpredictable, changes that have resulted in better play and lower injuries. I like Anthony’s example of goalie masks, but I’ve got a couple more.
Goal nets were originally unmounted, and play would get interrupted by a net dislodged from its home position. Someone then designed fixed goal post mounts or anchors, which succeeded in keeping the nets from moving and interrupting play. But the fixed mounts generated many injuries through player collisions with the immovable nets…or worse with the mounts in the ice when the nets became dislodged. One of the worst injuries came to Hall of Famer Mark Howe in 1980, when he played for the Whalers. This injury was the turning point for the design of a magnetic mount that detached when a certain collision load was applied. Injuries were reduced, but the right sensitivity was difficult to define, and most found the nets dislodged too often due to low speed collisions or bumps. I believe they have now landed on flexible fiberglass pins that the posts rest upon, achieving the right balance between injury prevention and play continuity.
Another example is the protective glass/netting around the perimeter of the risk. From no crowd protection at all, chain link fencing was added to rink ends where pucks were most likely to enter the spectator area. Chain link fencing protected the crowd, but injured players and created odd puck deflections that affected play. The fencing also interfered with some spectator sightlines. Fixed Plexiglas started to replace chain link, which improved crowd sightlines but increased player injuries due to the unforgiving nature of the boards and glass. A tragic injury to a young girl in 2002 cause the NHL board to require protective netting behind the goal area. Today we have a combination of flexible boards, glass and netting that delivers better outcomes to both players and spectators.
Healthcare is evolving the same way as different approaches are tried and then redesigned based on the need to cut costs and improve quality. I’m confident we can figure it out. Gainsharing certainly seems like an approach that is worthwhile to consider. Well, enough on healthcare. Can’t wait for the new season to start. Go Maple Leafs!
Greg Lawrie
Long-time hockey-playing healthcare executive.