Individualized data: RHI's Earl Steinberg applies evidence-based guidelines to each patient to improve quality, reduce costs

Sometimes to move ahead, you may have to take a few steps back. That certainly was the case for Earl P. Steinberg, MD, MPP, president and CEO of Resolution Health Inc. (RHI), a healthcare data analysis company that offers quality improvement and cost-reduction services to health plans, employers, PBMs and disease management companies.

Dr. Steinberg comes to his current position well prepared. He majored in psychology while an undergraduate at Harvard College, Cambridge, Mass., where he developed an interest in behavior change. While attending medical school at Harvard, he took a leave of absence and spent two years at the Kennedy School of Government, where he received a master's degree in public policy. After completing medical school, he trained in internal medicine at Massachusetts General Hospital. Dr. Steinberg then spent the next 12 years at Johns Hopkins University in Baltimore as a professor of medicine and of health policy and management.

"I left in 1994 because I was frustrated by the lack of progress that was being made in having healthcare delivered in a fashion that was consistent with evidence-based guidelines and the results of outcomes research," he says.

"It was certainly a difficult decision to walk away from a successful career at a prestigious institution, but one that made perfect sense," he continues."Rather than spending another 10 years writing another 100 papers, I decided it made more sense to try to focus on the development of practical tools to facilitate compliance with what we already knew to be the right thing to do."

Dr. Steinberg then went to RHI to try to improve the quality and cost-effectiveness of healthcare delivered to individual patients. At RHI, Dr. Steinberg has access to claims data that provide insight into the care being delivered to large numbers of people. By applying hundreds of computer algorithms to that claims data, RHI identifies discrepancies between the care being delivered to individual patients and what is known to be "best clinical practice."

Through its Care Monitoring Service (CMS), RHI sends messages to patients' physicians, as well as disease and case managers, regarding specific quality improvement opportunities for particular patients. In collaboration with Blue Shield of California and the University of California at Berkeley, RHI conducted a randomized, controlled trial on the effectiveness of sending patient-specific alerts to physicians. The study, for which Blue Shield of California received a 2005 Best of Blues Award, showed that RHI messages to physicians increase compliance with evidence-based guidelines by 15% with an ROI to the health plan of 2 to 1. RHI also sends electronic files that include the results of its evidence-based guideline "gap" analyses to disease management companies and PBMs, to guide the work of their nurses, pharmacists and case managers.

Q How do these initiatives encourage physicians to provide care that is based on evidence-based guidelines?

A The targeted clinical messages RHI sends to physicians are based upon widely accepted, evidence-based clinical practice guidelines or well-documented concerns regarding the safety of particular drugs in particular situations. Messages are accompanied by citations to specific organizations, clinical practice guidelines and published studies.