Pioneering Ideas

Innovations in Integrated Health

Posted by RWJF Blog Team
BY DR. JASON HWANG, Executive Director of Healthcare, Innosight Institute

Jason Hwang, MD, MBA is an internal medicine physician and executive director of healthcare at Innosight Institute, a nonprofit social innovation think tank he co-founded with Harvard Business School professor Clayton Christensen, the world’s foremost authority on disruptive innovation. Through a grant from the Pioneer Portfolio, Dr. Hwang has worked to apply the principles of disruptive innovation to the health care delivery system. Disruptive innovations occur when new business or delivery models displace overly complex and costly, expertise-intensive models. Highlighting work from the Pioneer-funded studies, Dr. Hwang recently described the need for innovation in health care in a post on CNBC.com and was featured in a Human Ingenuity series on Forbes.com.

Why have select integrated health systems outpaced their peers across nearly all quality and cost measures? More than one year ago, Innosight Institute–a nonprofit think tank co-founded by innovation expert Professor Clayton Christensen of Harvard Business School –set out to answer this question by identifying the critical factors and decisions that led to successful, integrated health systems.

Our findings are documented in the paper "Disruptive Innovation in Integrated Care Delivery Systems," which is the culmination of research on seven different organizations representing a wide spectrum of health systems around the country. Major observations and findings include: 

• Successful innovations that may be incorporated into today’s ongoing integration efforts, including mergers, accountable care organizations, and virtual assemblages being formed to participate in bundled payment programs and pay-for-performance contracts;
• The importance of expanding the scopes of practice of various clinical staff, including nurse practitioners and physician assistants, to ensure access to quality care through disruptive delivery models;
• Best practices in the use of electronic health records and health IT that should be implemented across all health systems as stimulus funds promote their widespread adoption.

Identifying these success factors is a crucial step forward in paving the way for similar organizations to be cultivated elsewhere and ensuring that one day every American will have access to high quality, affordable care.

Innosight Institute is also pleased to release its latest case study in conjunction with this project, which documents the experience of Sentara Healthcare in Virginia as it prepares for significant changes in how health care will be delivered and priced in the future. Pilots focusing on chronic disease management, bundled payments for procedures, and a patient-centered medical home are underway, yet Sentara is also acutely aware of the challenges these new delivery models pose to its successful, hospital-led health care system.

Not content with simply reacting to change, Sentara also created a test bed for wellness initiatives by targeting employee health with a program that includes a $500-per-employee rebate and has resulted in a return on investment of $6 for every $1 invested in the program. Meanwhile, the organization’s health plan, Optima Health, has sought to grow its consumer-directed, high-deductible health plans by first developing information and pricing tools for patients.

I invite you to read about Sentara and our other case study subjects: HealthPartners, Lancaster General Health, Presbyterian Healthcare Services, Group Health Cooperative, Grand Valley Health Plan, and Baystate Health (forthcoming).

Finally, I offer my special thanks to Robert Wood Johnson Foundation’s Pioneer Portfolio, whose financial support made this work possible.

What Do We Really Need from mHealth?

The December 5-7 mHealth Summit is approaching and I’m pleased and excited to be moderating the special session: What I Really Need from mHealth: Five Perspectives on Value.

Pioneer has been involved with multiple aspects of mHealth since very early on and has seen interest grow into what sometimes seems to me to be an “irrational exuberance,” to borrow a phrase from Alan Greenspan. I’m concerned that we’re on the way to another bubble that’s in danger of bursting with unfortunate consequences. The fact is we often don’t know what “works,” and even what “working” means. And that’s why it’s so important that we discuss the different ways value needs to be demonstrated in mHealth.

This mHealth Summit panel will talk about value from the perspectives of the individual, the provider, the payer, the regulator and the researcher. These can be different, but from time to time they converge. Rather than having a number of separate presentations, experts will engage in discussion around a hypothetic but realistic scenario of a mobile health device and what’s needed to provide enough “value” for each to adopt, approve, purchase, share, fund and embrace this as a tool for better health. It is sure to be a lively and informative discussion.

I hope that you’ll be able to join us either in person in Washington, D.C. or electronically to help us shape the dialogue.

Follow the conference discussion through #mHS11, leave a comment below, or follow me on Twitter to join in the conversation.

Discovery Channel Documentary Highlights Project ECHO

For some years now, health care innovators have been using emerging health information technologies to transform everyday clinical care. But Pioneer grantee Project ECHO applies these technologies in an entirely new and revolutionary way:  to spread medical knowledge throughout the health care workforce, and, in the process, form collaborative practices, build new professional skill sets and exponentially expand the capacity of the entire health care system.

Project leader Sanjeev Arora, MD, of the University of New Mexico Health Sciences Center, developed the ECHO model to break down medical “knowledge monopolies” so that doctors, nurses and other clinicians can deliver better care to more people who need it, right in their communities. Project ECHO uses video communications technology to create real-time virtual networks for sharing the best medical practices and knowledge between specialists at a university medical center and local primary care teams. 

A new Discovery Channel documentary, Health I.T.: Advancing Care, Empowering Patients, features ECHO amongst a handful of innovative efforts using technology to transform patient care. The segment tells the story of a primary care physician living in rural New Mexico who uses technology in a new way to address her patient’s condition. View the program online or watch it on the Discovery Channel this Saturday, November 26, at 8:00 a.m. ET.

For more information on Project ECHO:

• Read a research evaluation published in the New England Journal of Medicine
• View our Facebook infographic

Converging Ideas at the 2011 mHealth Summit

Sometimes things just come together. We funded the first mHealth Summit because it was interesting and pioneering, and it seemed to have a connection to a few of our Project HealthDesign grants. Then came our involvement with and support of Quantified Self, Open mHealth, the Stanford Mobile Health 2011 conference and the mHealth Evidence meeting. Other programs, like our national program Health Games Research, Games for Health Conference and the Reality Mining meeting that we funded at MIT in 2009, also have strong mHealth associations.

This is more than just coincidence--rather, mHealth focuses on many of the qualities that make Pioneer “pioneering.” mHealth has the potential to radically change the way health and health care is delivered, it is inherently oriented to the individual, and it is an area not yet burdened with the organizational and bureaucratic complexities of traditional health care. mHealth is a place where something radical can happen.

It is therefore particularly gratifying to see that Pioneer will be well-represented at the 2011 mHealth Summit on December 5-7 in Washington, D.C., with grantees featured in sessions on Open mHealth, The Evolution of Gaming and its Effect on Prevention and Wellness, and Wireless Patient Monitoring in Care Facilities: The Future of Wearable mHealth Applications, Devices, and Sensors, and with a  Pioneer-sponsored session, What I Really Need from mHealth: Five Perspectives on Value. This session builds on a discussion that began in August at a Pioneer co-sponsored workshop on mHealth Evidence.

I hope that you’ll be able to join us at the conference, tweet me at @alshar using #mHS11,  and help frame what I’m sure will be a very important discussion.

Why We Have to Start Cutting Back on Antibiotic Use

Up to one million antibiotics are prescribed unnecessarily every year, often for colds and other viral infections that they can’t even cure.  This overuse is a serious public health threat because it significantly reduces antibiotics’ effectiveness to combat all sorts of infections, including life-threatening ones caused by microbes like MRSA and E. coli.

As part of a national effort to reduce improper use of antibiotics, the Centers for Disease Control and Prevention (CDC) and its partners are promoting Get Smart About Antibiotics Week, a campaign to educate consumers and health care providers about appropriate antibiotic use in hospitals and throughout the community.

Pioneer grantee Extending the Cure (ETC), a partner in CDC’s campaign, also released new data this week on antibiotic use trends.  These findings are the focus of a guest blog post on CDC’s Safe Healthcare blog, where Ramanan Laxminarayan, ETC director, describes a pattern of high antibiotic consumption in the Southeastern United States, particularly in West Virginia and Kentucky.  USA Today ran a story about the new research on Wednesday.

Laxminarayan also authored an op-ed in the McClatchy Tribune, calling on public health officials to put in place strategies that address these worrisome trends, such as broader flu vaccination. The new research comes to us from ResistanceMap, an online mapping tool developed by ETC that illustrates the growing problem of antibiotic resistance. This new map provides a look at antibiotic use across the U.S. 

Also this week, ETC released a paper describing a new “Drug Resistance Index” that allows policymakers and hospitals to track changes in antibiotic effectiveness over time using a single measure.  The index, similar in concept to the consumer price index, appeared in Monday’s edition of the British Medical Journal Open.

Extending the Cure is working to change how we as a society think about antibiotics, encouraging us to think about these drugs as a shared resource—just like water, trees or oil reserves—that we rely on and should preserve so they maintain their effectiveness. 

Let us know what you think:  Do we, as a society, use antibiotics too often?  What strategies should we use to ensure a future with plenty of powerful antibiotics?  Leave a comment here or tweet @PioneerRWJF #SaveAbx and @CDDEP to tell us what you think.

Introducing Innovations for Health: Solutions that Cross Borders

At RWJF, we’re focused on solving the most intractable health and health care challenges in the United States, but we recognize that innovations come from all over the world and that many effective health solutions are emerging with the potential for immediate adaptation, replication and impact. That’s largely because, despite their differences, many countries throughout the world face a surprisingly similar set of health care challenges.

In today’s interconnected world, we have an important opportunity to learn from each other – especially when a new idea has the potential to make a difference in a big way. For example, the New York Times recently released a special section, “Small Fixes,” which focused on low-cost health care innovations to improve global health. The small fixes ranged from simple, self-adjusting eyeglasses for those who don’t have access to optometrists to the sophisticated, Gates-funded “postage stamp” paper to detect liver disease nearly instantaneously—the samples don’t have to be sent to a laboratory to be processed.

The innovation that most caught my interest in this article was one in Mozambique that organized patient groups to take turns picking up their medications, thereby forming strong social bonds, reducing stigma and increasing adherence to antiretroviral drugs. The organized patient groups also reduced the burden on health care workers while increasing patient engagement and self-management of care. Some consider this “small fix” a potential game changer for HIV care.

What’s striking about many of these solutions is that they highlight the universality of health problems faced throughout the world, such as lack of preventive care, provider shortages and rising health care costs. And, while most of the solutions are geared towards solving health problems outside of the United States, with some imagination, I believe many of these fixes could easily improve people’s lives in our country.

It’s this desire to accelerate change by tapping into unconventional thinking around the globe that led the Pioneer team to partner to launch the Innovations for Health: Solutions that Cross Borders competition with Ashoka Changemakers. We’re looking to find solutions to these universal health care issues, and are most interested in those that have potential to:

• Increase capacity and training for health care workers and providers;
• Scale low-cost interventions to increase access to medical, preventive, or dental care;
• Reduce barriers to health information and services;
• Provide high-quality care in non-traditional settings; and
• Engage patients directly in their care, particularly those managing chronic illnesses.

We’re thrilled to seek these global health care solutions and hope you’ll check out the competition, learn more about the three $10,000 prizes, and share the link with your network of pioneering thinkers. And why not submit an entry yourself, nominate an organization to compete, or comment on the submissions? We can’t wait to see what ideas you might have.

OpenNotes Hints at Great News to Come

Pioneer grantees Tom Delbanco and Jan Walker, the creative and scientific minds behind OpenNotes, this week published an opinion piece in Modern Healthcare championing the need for patients to easily and securely access their doctor’s notes online and discussing early results from their project. The piece says, “We are learning that patients are overwhelmingly interested in gaining rapid access to their notes and that many doctors appreciate the potential for open records to improve care.” Check out “e-Patient” Dave deBronkart’s take on the Modern Healthcare story.  He calls the early results, “A hint of great news to come, for lovers of participatory medicine.” We couldn’t agree more, and can’t wait for an update coming later this year and final results due out later in 2012.  Stay tuned!

The Potential to Solve Perplexing Health Problems

In October, RWJF’s Pioneer portfolio laid down a challenge. Recognizing that good health behaviors often require behavior change, but that making those changes is usually easier said than done, we asked the pioneering world of behavioral economics to come up with solutions—innovative ideas to help people make the “right” decisions for their health.

The results were unbelievable. We’re excited to announce that Robert Wood Johnson Foundation’s Pioneer portfolio received more than 330 responses—a plethora of ideas drawing on behavioral economics to address tough health problems—in reply to our recent call for proposals.

We received applications from a variety of institutions, including universities, business schools, schools of public health, medical schools, clinics, non-profits, and research organizations. Our hope was to discover new interventions and insights that have potential to transform health and health care. In particular, we stated an interest in experiments that test innovative solutions to the challenges of obesity and consumer engagement. More than 50 percent of the applications we received focus on problems involving obesity. Nearly one-third involve consumer engagement. We are eager to dig into these as well as the investigator-initiated topics and invite those with the most pioneering ideas to submit a full proposal later this month.

RWJF’s Pioneer portfolio supports unconventional approaches to difficult problems—visionary solutions that have the potential to change the way we think about health and health care. We are the only RWJF team that accepts unsolicited proposals; however, when we target an area that we think deserves more attention, we are often humbled and excited by the caliber of the results.  I extend my warmest thanks to those scientists, economists, physicians and big thinkers who submitted your pioneering ideas as an answer to this call and to all those in our network who helped spread the word.