Archive for: November 2011

Innovations in Integrated Health

Nov 30, 2011, 12:28 AM, Posted by Pioneer 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?

Nov 29, 2011, 1:04 AM, Posted by Al Shar

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

Nov 23, 2011, 11:20 AM, Posted by Pioneer Blog Team

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:

Converging Ideas at the 2011 mHealth Summit

Nov 22, 2011, 9:55 AM, Posted by Al Shar

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

Nov 18, 2011, 1:51 AM

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.