On a recent long road trip with my old college roommate, we touched on all of the major events in our lives, but then he hit on something else. What do you like about healthcare reform Gulp. This drive had so much promise.

But I did think of an answer. I saw a recent talk by Richard P. Shannon, M.D., chair of the University of Pennsylvania Health System's Department of Medicine. He regularly speaks to groups about the dire need for healthcare quality improvements.

Shannon generally criticizes a culture of sanitized data coupled with benchmarking to explain how C-level executives stay detached from tragic consequences of poor quality care. He cited an example of the 5.1 line infections per 1,000 line days found at one point at Allegheny General Hospital, where he also chairs the Department of Medicine.

The vague numbers meant 37 patients had a total of 49 central line infections out of 1,753 admissions in a 26-bed ICU, he said. Worse: 19 of the 37 or just over 50 percent -- died.

The minute you say there is a goal other than zero [line infections], we create the inevitability that someone has to get one, Shannon said.

Shannon saw the same problems when he arrived in Philadelphia in 2007 at Penn Medicine. That year, there were 363 central line infections, and about one of every four of the patients involved died. That dropped to 13 line infections in 2010, in part through Shannon's leadership to enact a sweeping set of changes to get infections to zero. These included hand-washing, training 220 nurses on catheter placement, and asking front-line workers to help come up with solutions.

The changes at Penn Medicine and at Allegheny General didn't happen because of national healthcare reform. But an important tenet of reform is driving improved quality and outcomes through similar initiatives. Payers are getting on board including Pennsylvania's largest insurers, Highmark Blue Cross Blue Shield and Independence Blue Cross. Highmark paid $3.1 million in pay-for-performance bonuses to Allegheny Hospital over a two-year period as the result of a decline in central line infections, ventilator-caused pneumonia and MRSA infections. Independence Blue Cross paid $3.8 million for similar improvements at Penn Medicine.

Like these insurers, payers elsewhere are joining health systems and providers to pay more for this kind of quality, cost-saving care that results in patients spending less time in hospitals. My friend, the skeptic, was listening.

So, he says, how does he, as a small business owner who provides healthcare insurance, benefit. And is it worth it

Good questions. We still do not know how reform will play out, but we know this: If leaders like Shannon drive the dialogue, lives will be saved and hospitalizations will decline. That is where business owners, like my pal, should begin to see the rewards.

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