# Source: How Intermountain Trimmed Health Care Costs (Health Affairs, 2011)

**Type:** source
**Status:** Useful
**Confidence:** High
**Source Type:** peer-reviewed
**URL:** https://doi.org/10.1377/hlthaff.2011.0358
**Publisher:** Health Affairs (Project HOPE) — James BC, Savitz LA, 2011;30(6):1185–1191
**Updated:** 2026-08-11

## Summary

The paper in which Intermountain's own quality leadership — Brent C. James and Lucy A. Savitz, both
then at Intermountain Healthcare in Salt Lake City — set out the method behind the health system's
clinical quality-improvement program and its cost claim, in a peer-reviewed policy journal rather
than in a press release. *Health Affairs* 30(6):1185–1191, June 2011; DOI
`10.1377/hlthaff.2011.0358`; PubMed **21596758**.

It is the load-bearing citation for the wiki's claim that Intermountain applied industrial process
management to care delivery from the late 1980s onward, and for the specific mechanism it used:
measure clinician-level variation, understand it, then manage it, on the Deming premise that the
cheapest care is the highest-quality care.

## Useful Claims

- The program dates to **1988**, when Intermountain began applying W. Edwards Deming's process
  management theory to health care delivery — the paper's own dating of the work, and the reason the
  wiki describes this as a late-1980s beginning.
- The stated mechanism is variation management: savings came from "measuring, understanding, and
  managing variation among clinicians in providing care," supported by data systems and management
  structures built to increase accountability.
- The paper's worked example is obstetric: a new delivery protocol reduced rates of elective induced
  labor, unplanned cesarean sections, and newborn-intensive-care admissions.
- That single protocol is claimed to save an estimated **$50 million** in Utah each year, and about
  **$3.5 billion** annually if applied nationally. Both are the authors' estimates, not audited
  figures — see Reliability Notes.
- The framing is national policy, not local operations: the authors present "organized care" as
  potentially central to containing the cost growth that could undermine coverage expansion under
  the Affordable Care Act.

## Verbatim

The published abstract, quoted exactly:

> Since 1988 Intermountain Healthcare has applied to health care delivery the insights of W. Edwards
> Deming's process management theory, which says that the best way to reduce costs is to improve
> quality. Intermountain achieved such quality-based savings through measuring, understanding, and
> managing variation among clinicians in providing care. Intermountain created data systems and
> management structures that increased accountability, drove improvement, and produced savings.

— Abstract

> For example, a new delivery protocol helped reduce rates of elective induced labor, unplanned
> cesarean sections, and admissions to newborn intensive care units. That one protocol saves an
> estimated $50 million in Utah each year. If applied nationally, it would save about $3.5 billion.

— Abstract

## Reliability Notes

Primary tier: a peer-reviewed article, cited by DOI, retrievable by that DOI regardless of what
happens to any publisher URL. That is why this page carries no archive snapshot.

Three cautions, and they matter more than usual here. **The authors are the program's owners.**
James and Savitz ran the work they are evaluating; the paper is a credible insider account of method
and an interested party's account of results. **The savings figures are estimates, and the paper
says so** — "an estimated $50 million," "about $3.5 billion" — extrapolated from one protocol, not
measured against a control arm. Repeat them as the authors' estimate, attributed and dated, never as
an audited number. **The full text is paywalled**, so the claims above are limited to what the
published abstract carries; anything from the body of the paper needs a legitimately obtained copy
before it is quoted here.

One detail the wiki asserts is *not* in this abstract: the 1996 extension of "active management" to
prioritized clinical processes, and the count of processes brought under it. The abstract dates the
program to 1988 and does not enumerate processes, so that claim still needs its own citation.

## Related Pages

- [Intermountain Clinical Quality Improvement](intermountain-clinical-quality-improvement.md)
- [Source: Integrated Team-Based Care at Intermountain (JAMA, 2016)](intermountain-team-based-care-jama-2016.md)
- [Source: Intermountain Health (Wikipedia)](intermountain-health-wikipedia.md)