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Could a national database, populated with descriptions of innovative initiatives and their results, help to accelerate the pace of change in health care delivery reform? A trio of authors, writing in Healthcare: The Journal of Delivery Science and Innovation, thinks so, and lays out their proposed model in their March 2015 article, “Crowd-sourcing delivery system innovation: A public–private solution.” Wing of Zock spoke recently with corresponding author Craig Tanio, MD.
Tanio is chief medical officer of ChenMed. He leads a joint venture, GenCare, that assumes full risk on Medicare patients with multiple chronic conditions. GenCare has 38,000 lives at risk and serves patients at 26 clinics in five states in the Southeast. Since its inception, the venture, which practices a model of “high-intensity primary care,” has generated care delivery innovations that have allowed it to reduce the costs of care by 20 percent in the past two years.
“The four years I have been at ChenMed have served as a practical laboratory in how to generate innovation and scale it in pursuit of the Triple Aim,” says Tanio.
In writing the journal article, Tanio and his co-authors, Shantanu Agrawal and Christopher Chen, hope to inspire private-sector entities and public agencies to partner to create a knowledge management system to hold “a comprehensive set of delivery system improvement initiatives and innovations that institutions can contribute and tap into.” They note that some of the groundwork already has been laid, with increasing public adoption of and trust in crowd-sourced solutions, as well as the relative successes of the CMS ACO Learning Network, the AHRQ Innovations Exchange, and PCORI.
“There are certainly some groups that have started to do more effective collaboration, such as the Brookings Institution and certainly the Institute for Healthcare Improvement,” he says. “But I think there is a fundamental difference between a policy view of innovation, where the health services researchers are trying to figure out what works and what doesn’t work, versus a practical, business-oriented view, where you must have a multiyear approach and an ongoing pipeline of initiatives with varying time horizons.”
Tanio believes that innovation could be accelerated with additional work on infrastructure. Although he notes that venture capitalists might call him crazy—no one is going to share ideas that lend competitive advantage—he believes that there is enough of a collaborative perspective among public-sector officials around the world, and that people are looking at the value of population health in discrete areas; “it’s not a theoretical approach,” he says. “You have to have organizing principles around what matters; a set of initiatives to drive change; and a viewpoint on culture and organizational design.”
In the article, Tanio et al write that the proposed database would “emulate and expand” on the CMS and AHRQ examples cited above. But why, one wonders, could one of these existing systems not be altered to fill the needs the authors describe?
“The biggest gap is trying to get user input around what’s practical from those case studies, from the front lines. One of the pieces we debated is the fact that that is where the consultants of the world play, but they do that at a much higher price point. So what you have in many of those examples is a set of facts, and you can go and talk to people; you can network pretty quickly with people who are doing cool things. But the questions then become, What really works? What’s just hype? What’s been shown?”
Tanio suggests creating a kind of Cochrane Collaborative for delivery system innovations. It would be organized around initiatives, and geared toward health care system managers with operational or profit-and-loss responsibility for part of the enterprise. In the article, the authors propose four categories of innovations: business, care and utilization management, analytic and technology support, and organizational capacity and capability. As the database is curated, people would be likely to develop tools that fit within those initiatives.
Could academic medical centers participate? “As I’ve observed innovation, some organizations are very open by nature, which includes most academic medical centers,” Tanio says. “However, AMCs are less able to innovate in lowering costs, based on the track record. The center of the AMC universe is quaternary care and NIH research; the mindset is just different. However, the notion of collaborating increases the speed at which an organization can improve.”
A key to the success of the innovations database would be to not over-filter its contents, Tanio says, and to be very disciplined about evidence and impact. Another key would be to lower the barriers to inclusion.
In order to reform itself, the health care industry must create this collaborative spirit and space, Tanio says.
“If we’re going to depend on the publication process to share innovations, we will get an outcome bias to people who publish for a living rather than people who innovate for a living.”
Jennifer J. Salopek is founding editor of Wing of Zock. She can be reached at firstname.lastname@example.org, or follow her on Twitter @jsalopek.