Pursuing Innovation Across the Curriculum

The University of Arkansas for Medical Sciences (UAMS) is pursuing innovation and transformation aggressively, with nine different initiatives underway, including applications for grants from CMMI and the Patient-Centered Outcomes Research Institute (PCORI); an electronic health records system; a telemedicine program; and an NCQA-certified Patient Centered Medical Home (PCMH).

Guest poster Pavithra Vijayakumar, a sophomore at Princeton University, recently spoke with Paula White, Chief Operating Officer for the Faculty Group Practice at UAMS and Assistant Dean for Clinical Finance at UAMS College of Medicine, about the benefits and challenges of these multiple initiatives.

The AAMC tracks many of its member institutions’ initiatives to transform care. UAMS has the largest number of initiatives underway with nine. Which projects have you been involved with at UAMS?

White: Prior to coming into the dean’s office, I was the department administrator for the Department of Family and Preventive Medicine. We were the first in our state to receive NCQA recognition as a Level 3 PCMH. As we read through it, a lot of their standards matched our standards and what we already thought was important. We had used electronic medical records in the department for many years. We felt we had a jump start on other institutions, and as one of our senior faculty said, this was just getting back to the roots of family medicine.

We also saw that there would be a real opportunity with the Arkansas Payment Improvement Initiative. And we do have a  Translational Research Institute (TRI). We are innovative, and we look for those opportunities, like PCMH, where we can continue to improve the care that we deliver, and then teach the next generation how to be forward-thinking. I’ve been in this business for many years myself, and I think it’s going to continue to change at a very rapid pace.

UAMS is progressive with its participation in the CMS Bundled Payments for Care Improvement initiative, but we understand UAMS actually started on the initiative before the state. How and why?

Our dean of the medical college is very progressive and she was planning on attending the first national bundled payment summit. Something came up and she asked me to go in her stead. I saw some things coalescing: That was about the same time we were hearing things about bundled payment initiatives in the state — we really did not want to just watch things happen. We wanted to be proactive and leverage our strengths. We have multiple missions: research, clinical care, education — if we’re training the new care givers of the future, they need to understand that new care model — and community. Participation in the initiative is important to us and is what we do for our state.

Our hospital CEO, College of Medicine Dean, and CFO of the campus came in and listened to the initial webinar from the AAMC, which had applied to serve as a facilitator–convener in the bundled payments initiative. We all said, “Let’s go for it.” We wanted to tap into the experience of the other institutions. Equally important to us was getting the data from Medicare, because it allowed us to see the whole picture. We might know medically that our patients are discharged back to their community, but what’s happening to the immediately after? Are they getting readmitted to their home hospital for something related? Everyone is really hungry for this information on the physician side, and hungry to get this kind of data.

Have there been any significant challenges to managing so many innovations?

We are stewards of our state and of the people’s resources. The challenge has not so much been resistance to change — change is difficult, we recognize that — but a realistic picture of our resources. We are not a large state, we are mainly rural, and we’re the only academic medical center in the state, so we really have to make sure we deliver the care now. It’s the analogy of flying the plane and building it at the same time; we must continue to exist in the fee-for-service world, while taking care of our patients, training our residents, and meeting the needs of our community. We have thoughtful discussions about this at the highest levels of the organization. It’s not all about change for the sake of change. It’s important to be innovative, but I think we’re selective in what we pursue, and part of that selection process is thinking about what our focus is, what the state needs, and what we should do to meet our mission.

Is there a central convening point for everyone working in innovation to discuss different projects and decide which to pursue?

We have a Clinical Enterprise Leadership Council (CELC), which is led by our chancellor. In our TRI, researchers can tap into what others are doing — it’s how we gain synergy. When it gets down to the funding at the CELC, we have to look at how many new projects we can continue. We have a Bundled Global Payment Project, a steering committee comprised of physicians and hospital leaders getting together and talking about what are we going to focus on. Those recommendations then follow through to our CELC.

There’s a governing structure in place to address these issues, but we’re still learning how to ensure that there are no barriers to innovation. Communication’s always a challenge, and you cannot over-communicate. For example, our Dean and I started creating talking points after each meeting. After I meet with the billing office, we send the talking points to all levels of the organization, so the frontline customer service rep is hearing the same thing the same way at the same time as all the levels above. The innovations aren’t necessarily all about the pilots and the research — some of the techniques we’re using ourselves are also innovative.

What advice do you have for leaders at other academic medical centers that want to innovate in all these different ways?

We’ve had people who’ve had vision, and you certainly can’t discount all the creativity and innovation at the individual level. I also think we have a mission that encourages innovation and that’s critically important. Your organization also has to be willing to make tough calls, because you can spread yourself too thin and then not be successful. Leadership role modeling is also critically important. Whatever you decide is your mission, it’s important that leaders model those behaviors.

We’ve also got to make sure that everyone’s at the table. Someone must ensure openness and bring in various constituents, and that may be someone outside of your organization. Where we involve our patients, we’ve seen progress. For example, for the work that we did in the community for the ANGELS telemedicine program, there was a vision and there was a need. But when we got people on board who said, “This is important to us,” it just spread. We were thinking of a solution for them, and we involved them to make sure they wanted it and saw the need.