Disruptive Innovations in Health and Health Care: Solutions People Want

    • April 17, 2008


"Disruptive Innovations in Health and Health Care: Solutions People Want" was the second of three online competitions seeking innovative solutions to social problems that were sponsored in 2007 by the Robert Wood Johnson Foundation (RWJF) and Changemakers, an initiative of Ashoka.

The "Disruptive Innovations in Health and Health Care" competition was based on a concept coined by Harvard Business School Professor Clayton Christensen. "Disruptive innovations are technologies, processes or business models that bring to market products or services that are more affordable and simpler to use than what is currently available. It enables more consumers in that market to afford and/or have the skill to use the product or service. The change caused by such an innovation is so big that it eventually replaces, or disrupts, the established approach to providing that product or service."

As an example, Christenson points to the "Minute Clinics." What makes this innovation "disruptive" is that the Minute Clinic business model uses a nurse practitioner in a walk-in office located in convenient, high-traffic stores to diagnose and treat a limited number of routine conditions that make up the bulk of primary care visits, such as ear infections and strep throats. The nurse practitioner can prescribe generic drugs that can be obtained at that same store. The innovation is disrupting where and when consumers seek health care. As a result, many more people may be able to obtain care because it is more affordable and more convenient than the alternative.

The competition sought innovative, "disruptive" solutions to health care challenges such as:

  • Improving access to care
  • Lowering costs
  • Promoting greater efficiency
  • Delivering higher-quality services in ways that empower consumers.

The competition was aimed not at new "start-up" ideas, but rather at existing programs that were ready for expansion, scale-up or replication elsewhere.

As with each of the Changemakers competitions, "Disruptive Innovations in Health and Health Care" evaluated entries along a Mosaic of Solutions™—a map of the most promising and innovative principles transposed against the underlying factors that drive a particular social problem. In the case of health and health care, the barriers included:

  • Health care is not consumer friendly
  • Patients are not empowered
  • Medicine is expensive and complex
  • Knowledge is held in monopolies.

The "insights"—new standards for intervention arising from practical solutions—included:

  • Democratizing access
  • Simplifying through technologies
  • Centering the consumer in the business model
  • Pushing work down the chain of command.


The "Disruptive Innovations in Health and Health Care" competition received 306 entries. Of these, 15 were selected by a panel of judges as finalists, and the online Changemakers community selected three winners in an "open-source" voting process. (In November 2007, RWJF invited 11 of the 306 entrants to compete for a total of $5 million in grants.)

The winners of the "Disruptive Innovations in Health and Health Care" competition were:

Project ECHO
Sponsored by: University of New Mexico Health Sciences Center

Project ECHO (Extension for Community Healthcare Outcomes) is a collaborative partnership of an academic medical center with a network of rural health clinics, the U.S. Public Health Service, and the New Mexico Department of Corrections. The project delivers health care and clinical education in the management of complex, common and chronic diseases in underserved areas, using hepatitis C virus (HCV) as a model.

The key component of the ECHO model is a disruptive innovation called a "knowledge network." In a "one-to-many" knowledge network, a single specialist shares his or her expertise with several primary healthcare providers, each of whom sees numerous patients, and the primary healthcare providers provide information on their patients to the specialist.

Telemedicine and internet connections connect specialists with primary care providers in prisons and rural areas to promote the use of best practices, enabling co-management of patients with HCV infection and increasing the capacity of rural clinicians to provide treatment for HCV.

Since June 2004, Project ECHO has conducted 205 HCV "knowledge network" clinics and provided 2,316 consultations for HCV patients. Some 21 HCV Centers of Excellence have been established around New Mexico, and thousands of high risk patients have been screened for the disease.

In a survey of 24 participating providers, almost all have reported moderate or major improvements in their knowledge and self-efficacy about a variety of treatment issues, particularly knowledge about HCV management and treatment, which had a 96 percent improvement rate.

The project team plans to expand the ECHO model of care to other common, chronic, complex diseases in rural New Mexico and prisons. For example, they intend to broaden another pilot program aimed at increasing access to chemical dependency treatment from its initial focus on opiate dependence (New Mexico leads the nation in deaths from heroin overdose) to include alcohol and other substance use disorders, developing 10 Centers of Excellence throughout the state for the treatment of substance abuse and associated behavioral health disorders.

Other ECHO clinics in various stages of implementation are:

  • HIV care
  • Arthritis and other rheumatoid conditions
  • Autism
  • Cardiac risk reduction
  • High risk pregnancy
  • Occupational health disorders
  • Childhood obesity
  • Prevention of teenage suicide.

Project ECHO also plans to partner with the government of India to use the ECHO model for expanding access to anti-retroviral treatment for HIV in rural India.

Family Coaching Clinics
Sponsored by: UCLA Semel Institute Global Center for Children and Families

Launched in 2006, Family Coaching Clinics work to reach families who might not have access to or seek out traditional mental health care. The goal is to locate clinics in convenient access points, such as area shopping malls, bringing a new level of accessibility to mental health care. Services are organized around a menu of specific child-rearing issues, making it feel easy and "normal" for families to seek and find support. The initial pilot clinic was located in a semi-retail area of Los Angeles' Westwood neighborhood. The project team sought funding to expand the program.

The philosophy behind the Family Coaching Clinics is that most child-rearing problems that families encounter are normal, predictable, and relatively easy to handle - if addressed early. According to the project team, research shows that small behavior changes have great power to increase family well-being over the long run.

Family coaches at the center provide a menu of services that identify common family challenges and offer simple ways to address them. Coaches are also trained to screen for serious childhood disorders that require referral for specialized treatment, such as:

  • Mood disorders
  • Anxiety
  • Conduct disorder
  • Attention deficit/hyperactivity disorder or other learning disorders
  • Autism and Asperger's syndrome.

During the pilot phase, the program worked with approximately 30 families, and collected anecdotal evidence suggesting that family child-rearing practices and mental health have improved as a result of participation in the programs.

Participating families have referred more families to the project as it scales up. The project team hopes to create three full-scale Family Coaching Clinics in existing retail outlets in different Los Angeles neighborhoods over the next three years. They also plan to continue to develop, test and refine their family coaching model—and ultimately roll it out on a nationwide scale.

Instant Birth Control
Sponsored by: Planned Parenthood of Columbia/Willamette, Ore.

In April 2004, Planned Parenthood of Columbia/Willamette (PPCW), became the first family planning provider in the United States to make prescriptions for birth control pills available online to qualifying Oregon women. The organization is located in Portland and provides services in 10 centers throughout Oregon and Southern Washington.

Patients who participate in Instant Birth Control, as the program became known, receive all necessary health screening and monitoring to ensure safe, quality care. After filling out an online health intake form similar to that completed at a clinic, patients read about and select a method of hormonal birth control.

A registered nurse or nurse practitioner reviews each patient's health history. Patients may have the prescription called in to a pharmacy, pick up medication at a Planned Parenthood health center or have medication mailed to them.

Instant Birth Control removes many traditional barriers to access to contraception, such as geographic barriers, busy work and family schedules, concern about privacy, and anxiety about pelvic exams.

Since April 2004, 2,363 Oregon and Washington women have accessed Instant Birth Control. An Instant Birth Control ad campaign, which ran in the fall and winter of 2006, raised awareness about the program, with over 17,000 people visiting the Web site in 10 weeks. Nearly 7,000 visitors clicked through to the Web site of Planned Parenthood of Columbia/Williamette, and sales of Instant Birth Control increased by 20 percent.

Planned Parenthood plans to expand the program, including:

  • Launching a second public awareness campaign.
  • Recruiting affiliates in other states to provide Instant Birth Control.