Interview

Fifty Years of Health Care Quality Innovation

Jennifer P. Lundblad, PhD, MBA

Stratis Health

Please tell us how Stratis Health got started.

Stratis Health was established as the Foundation for Health Care Evaluation in 1971 by a group of Minnesota physician leaders. We are proud of our commitment to improving the health and care of seniors through our service as a federally designated Medicare quality improvement organization — the most longstanding of our programs. We changed our name to Stratis Health in 1997, when the Health Outcomes Institute merged into our organization. Our commitment to improving health and health care continues to grow with each passing year, and we have expanded far beyond our Medicare quality improvement roles to be a national leader in health improvement.

Your work with Medicare has been a foundational part of Stratis Health. What drove those early projects and how did they develop?

Our work in the early decades focused on quality assurance. As the field of health care quality evolved to embrace quality improvement and patient safety science and tools, so did Stratis Health. In our early days, the organization served as a Professional Standards Review Organization for Medicare, then part of the Health Care Financing Administration (HCFA). In the early ‘90s, HCFA introduced the Health Care Quality Improvement Program, adding a program with hospitals and physicians to improve the quality of providing care, in addition to the quality assurance case review role we played. As part of our Medicare improvement work in the 1990s and 2000s, we led projects which were laser focused on the conditions and needs of seniors – from better care for chronic diseases such as diabetes and heart failure, to improving how hospitals addressed surgical care and antibiotic stewardship, to building capacity in long-term care in areas such as pain management and infection control. This early improvement work paved the way to the Quality Innovation Network focus of today’s Medicare quality programs, which we lead in Minnesota, Wisconsin, and Michigan as part of Superior Health Quality Alliance.

To work in health improvement, it’s important to be an optimist.

Today Stratis Health is guided by what you call the Transformation Framework. What can you tell us about this?

The Stratis Health Transformation Framework depicts the foundations necessary for organizations to improve and sustain change in health care and the actions needed and desired between health care and the community. Core to the framework is addressing health equity and social determinants to achieve better care, better health, and lower costs.

Stratis Health has become very active in rural health initiatives. Please tell us about some of this work.

Rural health improvement has been an organizational priority for more than 20 years and is a large and growing part of the improvement portfolio for Stratis Health. Early efforts began in 1999 as the first of Minnesota’s hospitals transitioned to what was a new hospital designation at the time, the Critical Access Hospital (CAH) program, intended to preserve the safety net of access to hospital care in rural communities. We continue to work in partnership with the Minnesota Office of Rural Health and Primary Care to provide training and technical assistance in support of our state’s now 79 rural critical access hospitals to ensure access to high-quality health care that is aligned with community needs.

That early work in Minnesota established Stratis Health as rural and CAH quality experts and has evolved into national leadership roles in rural health improvement for Stratis Health. Since 2015, we have served as the Rural Quality Improvement Technical Assistance (RQITA) program lead for the Federal Office of Rural Health Policy (FORHP), helping the 1,300+ CAHs and rural clinics across the country better measure and improve the quality of care they deliver. Since 2012, Our Rural Health Value initiative, in partnership with the University of Iowa, has leveraged our extensive analytic and technical assistance capacity to understand how evolving health care delivery and financing systems affect rural communities and clinical and non-clinical health care professionals and actions needed to create and sustain high-performance rural health systems. In all our rural health work, we leverage national partnerships with organizations and people dedicated to improving rural health — a real asset for rural health organizations with limited resources.

In addition to these federally sponsored roles, our Rural Community-based Palliative Care initiative, which has been funded by health plans and private foundations, helps develop skills and capacity in rural communities to better deliver care and support for those with serious illness. We developed a groundbreaking model more than a decade ago to increase access to palliative care services in rural communities by using a customized community-capacity development approach. Stratis Health recently wrapped up its latest three-year project supporting the development of rural community-based palliative care teams and service across three states and building foundational resources, including developing an implementation toolkit designed to improve health and reduce disparities in access and services

Please tell us about the Partnership to Advance Tribal Health.

Funded by the Centers for Medicare & Medicaid Services, the Partnership to Advance Tribal Health (PATH) is a strategic partnership of organizations committed to improving health care for American Indians. The work focuses on supporting the 24 Indian Health Services (IHS) hospitals across the country in continuous improvement in the quality of care. The American Indian and Alaska Native people have long experienced lower health status in comparison to other Americans, the cause of which is often rooted in economic adversity, poor social conditions, and historical trauma. Stratis Health is part of a team building trusted relationships with IHS hospitals across the country to support continuous improvement by implementing best practices and providing performance improvement training and coaching.

Another more recent area of focus involves health care disparities. What does some of this work entail? 

Addressing social determinants of health is built right into our workflow as a key strategy to improve health equity and reducing health disparities, as guided by our Transformation Framework. We’ve discussed PATH and our rural health initiatives, but Stratis Health experts work on many projects designed to strengthen partnerships between health care and community organizations, reduce inequities, and harness data to uncover services or capacity that may be missing. For example, the collaborative Health Plan Performance Improvement Projects (PIPS) in Minnesota cover many health topics identified as priorities for improvement including preventive care, chronic illness management, and transitions in care, and currently focus on reducing disparities in maternal health and in diabetes. Culture Care Connection, developed in partnership with UCare, is an online learning and resource center to support clinical and non-clinical health professionals with tools and resources to build awareness skills and encourage action to help them be responsive to and supportive of the diverse patients and communities they serve.

What are some of the ways Stratis Health has worked with issues related to COVID-19?

Since April 2020, Stratis Health’s quality improvement work pivoted to address the extreme challenges presented by the pandemic. We have been continuously working with our funders to best use our programs, resources, and relationships in redirected ways to support health care organizations in addressing COVID-19. Deep fractures in the US health care system, including a lack of coordination between health care and public health, became impossible to ignore with the pandemic and the fallout due to the murder of George Floyd co-occurring. The re-awakening about health disparities, structural racism, and financial challenges put extraordinary pressure on all stakeholders. Stratis Health is comprised of experienced, trusted experts in developing and guiding health improvement and safety initiatives across the continuum of care that result in better health and care for all people and communities. We have been further galvanized to meet the monumental challenges posed by COVID-19 and social unrest and to do all we can to help stabilize our fragmented and inequitable health care system for the long term.

What are some of the most rewarding projects you have worked on since becoming CEO?

My daily reward is knowing that we make lives better. To work in health improvement, it’s important to be an optimist – to believe that things can be better and that our actions make a difference. At Stratis Health, I get to work with a smart and compassionate team of optimists who believe in our mission and work; and I have the opportunity to authentically engage with the communities and people we serve. As a result, it’s impossible to call out the most rewarding projects since I became CEO in 2006. While there are certainly hard days and difficult projects, I’m rewarded in the moment by whatever combination of initiatives we have in front of us on any given day and am always looking ahead to see how we can be even more relevant and responsive. My role is to continue to lead with vision.

When you find yourself in a non-professional social situation and you have to explain what you do for work, what do you say?

Stratis Health improves health through collaboration and innovation. We are an organization breaking down care delivery silos and building bridges between health care and community, often for vulnerable and underserved populations. As the president & CEO, it’s my job to ensure we maintain our results-driven culture and firmly support our dedicated staff and Board members who have guided the organization and implemented our work for the past five decades.

Improving health care quality is a vast and complex topic. What are some examples of how your work helps physicians provide better patient care?

Improving health care is indeed vast and complex! Physicians have a key role in care improvement, and it’s been our privilege to be working alongside physicians over the 50 years of Stratis Health. In the past, we have supported physicians in providing better care by accelerating the translation of research to practice such as the use of standing orders and re-designed workflow; facilitated efficient and effective adoption and optimization of electronic health records; and collaboratively established statewide standards and protocols to improve care transitions focused on such things as medication reconciliation and discharge planning. Today, we assist physicians to be successful in new payment programs that reward for quality through our MIPS Estimator tool and technical assistance, and to be able to understand and be responsive to the increasingly diverse patients they care for through Culture Care Connection. We lead the Minnesota Shared Decision-Making Collaborative to adopt and promote the routine use of shared decision-making in clinical practice, and launched the Minnesota Serious Illness Action Network last year to share new and emerging practices, tools, and resources relevant for front-line clinicians in the COVID-19 pandemic. And we are just getting started in new work to engage physicians to improve access to medication-assisted treatment for opioid use disorder in underserved communities in Minnesota. We are grateful to our physician partners and champions.

Jennifer P. Lundblad, PhD, MBA, is the President and CEO of Stratis Health, an independent non-profit organization that leads collaboration and innovation in healthcare quality and safety.