Pioneering Ideas

Talking About Project ECHO...

Last month, Pioneer awarded a new three-year, $5 million grant to Project ECHO; the New Mexico based program that uses evidence-based medicine and interactive technology to deliver specialty care to patients in remote, rural areas of the state. Project ECHO is an exciting and innovative project that has made a real impact in New Mexico’s underserved, high-risk population. 

 

While we’ve written about the project on Pioneering Ideas in the past, including a recent post by Dr. Sanjeev Arora, we’re not the only ones talking about the recent grant announcement.  We encourage you to check out the posts below:

 

Philanthropy News Digest – RWJF Awards $5 Million to Expand Rural Healthcare Project

"Through Project ECHO, we are treating very sick people who couldn't otherwise get care, and we are extending the capacity and reach of the healthcare system by engaging more colleagues in highly needed specialties," said Project ECHO director Sanjeev Arora. "We believe that this approach can help bring best-practice specialty care to millions more Americans."

 

The Daily Tell: Robert Wood Johnson Foundation Awards Three-Year Grant for Project Echo to Begin New Washington-based Initiative

"The ECHO model teaches us that we can leverage our existing health care resources to provide safe, effective care to patients in their communities, regardless of where they are,” Nancy Barrand, Pioneer Program Officer.

 

Medgadget.com: Project ECHO Brings Specialists Virtually Out to the Farm

A YouTube video of the project in action. If you have a blog or a Twitter account, we hope you’ll consider sharing it with others.

A Model for Equity in Specialty Care, Part IV

The Pacific Vision Foundation, with support from the Pioneer portfolio, is piloting a new clinic in Northern California that will provide the same level of specialty care and other services to all patients regardless of ability to pay, while maintaining sustainable profit margins. Over the last week, David Green and David Roe, two of the project’s leaders, joined Pioneering Ideas to discuss the inspiration and behind their work and the challenges and implications. Below, find out why they believe the Pacific Vision Foundation might serve as a valuable model as the national health reform dialogue plays out.

 

What do you see as some potential long-term implications for health care?

David Roe: One of our marching orders was make this work within the existing system, not assuming or banking on any change from health care reform.  Within the existing system, the implication of success in ophthalmology would be that the same approach could work in other medical specialties – particularly ones that use repetitive procedures that take lots of expensive equipment – so that the more patients you put through, the higher the efficiency you can get. Cardiology, for example, certainly comes to mind. And of course, if health care reform does increase support for low-income patients, the economics of this approach will only get better.

 

A Model for Equity in Specialty Care: Part III

Last week, in Part I and Part II of our series, David Green and David Roe discussed the business model for the Pacific Vision Foundation, a self-supporting eye care center in San Francisco that will provide equal service to paying and non-paying patients. Today, they join us to discuss some of the challenges they face let us know when they expect this operation to be up and running.

What have been some of the major challenges in moving this forward?

David Green: In India, there are many procedure-oriented specialties or subspecialties in medicine that have a self-financing model, where it’s basically the same procedure performed over and over again, where you have para-medicals trained to do just a few things rather than many, and that helps bring the cost down. So how do you have the right clinical and business model combined with more affordable consumables in a procedure? It all adds up to how you source your goods, how you train your people, how you acquire and organize your patients.

David Roe: Given the legal differences and the very different regulatory structure for medicine between the United States and places where this has worked before, as well as the very different income expectations, it was natural to question whether this can work here in the U.S. The answer is, while there are some serious challenges, nothing in the law, business structure, or medical regulations stands squarely in the way. The big obstacle is the notion that since it’s never been done here, it can’t be – the intellectual inertia, or gut inertia. You can’t point to this city or that city and say, “There’s your example.” A lot of our work is to help overcome that inertia. Once you’ve done one, then it’s much easier to recognize that it’s doable.

Mozart, Superbugs and Antibiotic Resistant Infections

Last month, the Annals of Internal Medicine published a report suggesting that Wolfgang Mozart may have died from a strep infection. This discovery may turn out to be more than just an interesting historical fact. What if Mozart’s death could teach us something about the antibiotic resistant infections of today? That is exactly the question that Maya Sequeira of Extending the Cure, a Pioneer grantee, looks at in her post, “What Killed Mozart.” Check it out and then come back here and let us know what you think.

Equity In Speciality Care: The Aravind Eye Care System

If you have been reading our interview series with David Roe and David Green about a project in San Francisco to create equity in specialty care, then you know at least a little bit about the project that inspired them – the Aravind Eye Care System.  

Like Aravind, this new pilot project is being designed to accept and treat paying patients and non-paying patients exactly the same.  For over three decades, Aravind has been successfully providing care to paying patients and using the profits to offer free care to those who cannot afford it.  

This past Wednesday, the NewsHour with Jim Lehrer featured a piece on Aravind – now the largest provider of eye care services in the world – and their successful model.  Check it out and then come back to Pioneering Ideas and check out the rest of our series with David Roe and David Green.

A Model for Equity in Specialty Care: Part II

Yesterday, David Green and David Roe discussed the inspiration and history behind their work to create a self-supporting eye care center in San Francisco that will provide equal service to paying and non-paying patients. Today, they join us to discuss the business model of this project. Visit Pioneering Ideas again on Tuesday to learn about some of the challenges they face and when they expect this operation to be up and running

 

What is the business model for the new clinic you are creating?

David Green: The notion that this kind of specialty care can be provided in a self-sufficient business model is very attractive and compelling, but also sounds impossible. I think the main obstacle is that by serving low-income people, doctors initially think that somehow they’re going to make less money. What actually happens in practice is that they make more money as the practice becomes more like a hybrid model, where the volumes are higher, costs are lower, and margin is greater per surgery. I’ve seen many instances where the work to reach lower-income strata helps to bolster overall profitability and also the amount of money going into the pocket of those involved. It’s quite counterintuitive to think that if you serve low-income people that somehow you’re going to make more money, but that’s in fact what’s been going on. 

A Model for Equity in Specialty Care: Part I

In San Francisco, the Pacific Vision Foundation is piloting a new model of specialty clinic that is designed to be able to accept and treat paying patients and non-paying patients exactly the same: offer the same procedures, by the same doctors, under the same roof, while maintaining sustainable profit margins. While seemingly implausible in the U.S., this model, which is being developed with support from the Pioneer portfolio, has hundreds of successful examples overseas.

 

Below is the first of a series of interviews with two of the project’s leaders: David Roe, who trained as a lawyer and has 30 years of experience in public interest strategy and environmental and human rights advocacy; and David Green, an Ashoka fellow, vice-president and a recipient of the MacArthur “genius” award, who helped to create an eye care model in southern India that has been replicated in several other countries. Check back over the next three days to find out what needs to happen for this model to work in the U.S., what opportunities could emerge through health reform, and the potential for replication in other locations and other forms of care.

 

What is the history and inspiration behind this project?

David Green: Through my work and the work of the Aravind Eye Care System in southern India and other training centers, we have helped maybe 250 eye-care programs become self-financing, where the volume is high and revenues cross-subsidize care for those who can’t pay. (Editor’s note: Last year, the five Aravind eye hospitals performed approximately 250,000 eye operations – 53% of them for free, 22% at two thirds cost, and 25% paying well above cost – and realized a substantial profit.) I’ve been involved with four or five programs in India and two in Nepal. I worked in Bangladesh, in China. In Egypt, we set up the largest eye care program in the Middle East. It now is basically self-financing, where revenues from paying patients support care for those who can’t pay. So it’s a well-proven model.

A Model for Equity in Specialty Care: Introduction

Paying patients and indigent patients in the United States frequently have separate treatment options and receive care from separate sources and doctors, with quality and comprehensiveness that too often vary with the patient’s income. This country is in chronically short supply of publicly supported services for people who cannot pay, and even more so with specialty care than with primary care.

 

The Pacific Vision Foundation– a foundation closely affiliated with the eye department at California Pacific Medical Center– is piloting a new model of specialty clinic that is designed to be able to accept and treat paying patients and non-paying patients exactly the same: offer the same procedures, by the same doctors, under the same roof, while maintaining sustainable profit margins. 

 

While seemingly implausible in the U.S., this model, which is being developed with support from the Pioneer portfolio, has hundreds of succesful examples overseas. Over the next four days, Pioneering Ideas will feature a series of interviews with two of the project's leaders, David Roe and David Green.  

 

David Roe trained as a lawyer and has 30 years of experience in public interest strategy and environmental and human rights advocacy. David Green, an Ashoka fellow and vice-president and a recipient of a MacArthur “genius” grant, helped develop an eye care model in southern India that has been replicated in Nepal, Malawi, Egypt, Guatemala, El Salvador, Tibet, Tanzania and Kenya.

 

Visit Pioneering Ideas over the next four days to learn about what inspired the project, what needs to happen for it to work in the U.S., opportunities that might emerge through health reform, and the potential for replication in other locations and other forms of care.

 

The H1N1 Flu Prediction Market

As kids across the country are starting to go back to school this month, parents, health officials and school administrators are wondering whether or not we will see a resurgence of H1N1. While no one can forecast the future, we asked Phil Polgreen and Forrest Nelson, the directors of the Iowa Electronic Health Markets, to explain what they’ve learned so far from their H1N1 market, a pilot prediction tool, and discuss what their expert traders believe will happen in the fall. The Iowa team has been running prediction markets for avian influenza (bird flu) and for seasonal influenza for several years.

On Friday, April 24, some of the first news reports about a frightening new influenza virus surfaced here in the United States. That news prompted us to re-tool our prediction market for the bird flu in order to develop a market for this new strain. We immediately started working on the questions for the new market and recruiting traders.

We had already assembled a group of microbiologists, doctors, public health officials, epidemiologists and others that had inside information about influenza, including trends in seasonal and bird flu. We gave those experts $100 in virtual money (makeshift dollars that can be used to buy and sell shares on the market) and asked them to start trading. By April 28, the H1N1 market was up and running.

Right off the bat, most of our traders predicted that by the end of May, there would be more than 1,101 cases across the U.S., with a low the mortality rate. As it turned out, they were right: As of June 1, the Centers for Disease Control and Prevention had reported 10,053 cases of swine flu in all 50 states and the District of Columbia with 17 deaths at that time.

What’s remarkable about the forecast is that in late April, news reports played up the danger factor, reporting that the virus was killing young, relatively healthy people in Mexico. The fear was that H1N1 would spread rapidly in the U.S. too and be a formidable killer. Our expert traders didn’t buy into the hype, betting instead on a future that resembles the course actually played out by H1N1. In fact, the market predicted that H1N1 would spread widely and quickly but the mortality rate would be less than 1 percent during the first few weeks of the outbreak.