This article first appeared in the June/July 2008 issue of the newsletter "States in Action."

The Greater Detroit Area Health Council (GDAHC), based in Detroit, Michigan, is a broad coalition of more than 70 organizations representing health care purchasers, providers, insurers, and consumers working to try to improve health care quality, enhance access to care, and reduce health costs in southeastern Michigan. In addition to major corporations, unions, and advocacy organizations, members include state and local public entities, including the Michigan Department of Community Health, which administers Medicaid.

"The majority of the state's population is in our area, so any improvement realized will directly benefit Medicaid and the state as a whole," says Jan Whitehouse, senior vice president of GDAHC.

GDAHC's current focus is its Save Lives, Save Dollars Initiative (SLSD). First implemented in 2005, its goal is to achieve 100 percent adherence to selected evidence-based clinical practice guidelines, and to save $500 million over three years or reduce health care cost growth by 1 to 3 percent. Its main strategy is to encourage all regional stakeholders to adopt standard performance measures and pay providers based on those metrics. So far in 2008, the largest commercial payers in southeast Michigan agreed to pay incentives for several SLSD recommended measures, including meeting generic prescription drugs rates and cancer screening rates. However, payers are not limited to providing incentives only for these measures. Payers are testing a measure for management of lower-back pain, which is likely to be implemented for differential payment in 2009. Payers also agreed to establish incentive programs around a set of principles concerning quality improvement.

A key component of the SLSD initiative is a Health Care Performance Report Web site that provides comparative information on hospital quality and health plans. Performance reports on physician organizations are expected to be available this summer. GDAHC is also working through its Web site to build consumer engagement in using comparative performance measures.

GDAHC officials say that the public reporting and other coalition efforts appear to be having a positive impact: hospital and health plan performance on recommended measures has improved in recent years. Several SLSD stakeholders report overall health care spending has been trending downward over the past year or two, but it is not known how much of this can be attributed to GDAHC's efforts given the difficulty attributing changes in service utilization or spending growth trends to any particular factor. "We think financial savings will be longer-term in nature," says Whitehouse.