ORLANDO — Every hospital CEO is aware that health care reimbursement is on the verge of an unprecedented squeeze, as policymakers and commercial insurers alike rethink fee-for-service and consider dramatic reductions in overall payment. But how can health care providers deliver better results in an era of austerity?

During the opening session of the Institute for Healthcare Improvement's National Forum Tuesday, IHI CEO Maureen Bisognano acknowledged that the challenges of the next decade — and not just in the United States — are going to force quality advocates to work ever harder to reach their goals.

"What I'm hearing around the world is that we're going into a different time with
cost constraints and new challenges," Bisognano said.

Bisognano argues that providers must stay ahead of possible "draconian" cuts to reimbursement and the addition of millions of new patients via the Affordable Care Act by quickly developing and spreading best practices much faster than in the past.

Bisognano balanced that sobering message with stories of hope, including today's news, reported in the New York Times, that childhood obesity rates are declining in several U.S. cities. At last year's meeting, Bisognano introduced Swedish patient Christian Farman, who developed a self-dialysis technique during his care journey. Today, Bisognano said, she's seen self-dialysis units modeled on Christian's innovations across the world. And in Scotland, a 10-year-old effort to reduce hospital mortality rates is yielding ever-stronger results, with reductions in mortality rates moving from 1.4 percent a year at the beginning to 4.2 percent in 2010.

For providers, Bisognano said, the key challenge is accelerating the pace of quality improvement and quickly translating best practices from the unit to the floor to the entire institution.

"It's my dream that all of you will go back home, and stand in front of graphs and spread examples reliably," Bisognano said. "It's my dream that board members will have reports on the number of improvement cycles and degree of spread."

She cited the challenges of Jeffrey Brenner, a Camden, N.J. physician who used a hot-spot model to improve care for high-utilizers in his impoverished city. At the beginning, he worked with a small group of 5 patients, and was able to quickly adapt and build on improvements. By the time he moved to 25 patients, he needed a team to reach the same results. And at 125 patients, he needed physical space and other key assets to do that.

"It's about learning from five patients, building to 25 and thinking about the infrastructures you need to make to get that to scale," Bisognano said.

At the root, though, that work should start with homegrown solutions, Bisognano said, citing the work of Bellin Health CEO George Kerwin in Green Bay, Wis. After realizing that Bellin's insurance costs for its own employees were rising faster than anything else on the budget, Kerwin launched a small wellness program targeted at first to senior Bellin executives. Gradually, the project spread to willing employees, and ultimately to the entire organization, yielding major reductions in health care costs.

As it happens, I spoke with Kerwin on Monday about Bisognano's major theme — namely, how providers can innovate in spite of major changes in payment. Kerwin also believes that the only way to stay ahead of that is to move quickly:

Check this space tomorrow and Thursday for more reports from the IHI's 24th National Forum.