By Jane Eilbacher
In the post-Affordable Care Act world of health care and health policy, “innovation” is the ultimate buzzword. Between Medicare and CMS Innovation Center (CMMI) demonstrations and pilot programs such as accountable care organizations and payment bundling; new payment arrangements with commercial payers; state-based efforts; and patient safety and quality initiatives, providers are often overwhelmed with the myriad ways to participate.
In hearing from organizations around the country, there is excitement about participating, but it’s often accompanied by trepidation about how to operationalize innovation: How do we change culture and attitudes, create the necessary data and technology infrastructure to support new programs, and find a way to make care redesign financially palatable?
At the recent Care Innovation Summit, hosted by CMMI, Health Affairs, and the West Wireless Health Institute, speakers from CMS, HHS, and organizations across the country highlighted the challenge of aligning three key areas for innovation: developing a culture of patient-centered care; effectively utilizing and sharing data and developing more robust data collection platforms; and being adequately reimbursed for new care models.
In his opening remarks, Atul Gawande encapsulated these ideas, emphasizing that in this new world of innovation, we need “pit crews, not cowboys;” health care delivery must transition from components of care to systems of care. Systems are able to recognize success and failure, facilitated through access to and use of data. Systems are able to devise solutions, and never undervalue careful design. Last, systems are able to implement discoveries, promoting the values of humility, discipline, and teamwork. We need to define great care, then build the financing systems around it.
I thought about these concepts, and the interplay between them, throughout the day’s presentations. Three sets of case studies highlighted successes in primary care innovation, chronic disease innovation, and cancer care; while rapid-fire “Ignite” sessions presented a series of publicly and privately-sponsored challenges. I was particularly struck by a number of these proposals. For example, the Office of the National Coordinator announced a challenge to create an easy-to-use web-based tool for the scheduling of discharge follow-up appointments. Something we frequently discuss in our AAMC facilitator/convener bundling group is getting patients follow-up appointments soon after discharge to better guide care in the post-acute period. Would a web-based tool — functional across various platforms and accessible by providers, patients, and caregivers — be feasible and effective?
The case studies served as poignant examples of how organizations across the country are changing care for certain populations. Presenters emphasized the need to make more time for patients and to flip the current primary care model — quickly deal with patients’ acute conditions — to a model in which patients are seen regularly and acute conditions are prevented or at least anticipated.
While these organizations have found ways to improve culture, they still struggle with the components of data and payment adequacy. A key aspect of patient-centered care is understanding patient background and medical history. However, electronic health records do not typically capture all patient background information or include dashboards for each patient for a large patient panel.
The world of “innovation” is murky, with many moving parts for providers to grasp in order to undergo change. The Care Innovation Summit provided some amazing examples of organizations that have embraced the challenge to change, while still recognizing and admitting the difficulties. Accompanying this was a fantastic attitude and a room filled with excitement for the work to come.
— Jane Eilbacher is a Policy and Regulatory Specialist in Health Care Affairs at the AAMC. She focuses on regulatory and policy issues out of the Affordable Care Act, including Medicare demonstrations and pilot programs, health insurance exchanges, and following CMMI programs; she can be reached at firstname.lastname@example.org.