ONC, healthcare leaders reflect on Beacon Community experience

As the three-year $250 million Beacon Community Cooperative Agreement Program embarks on its final year, the 17 participating communities are sharing lessons learned on their work to harness health IT and develop innovative approaches to healthcare delivery.

“Instead of tides being against these activities, now that tide is beginning to turn,” Farzad Mostashari, MD, ScM, national coordinator, Office of the National Coordinator for Health IT (ONC), said during an ONC videocast on May 22. “This is more profound, more exciting than anything we’ve seen in the five decades past. It’s time to start bringing those learnings together in a way that can be used more readily.”

To that end, he announced the release of the first of six Beacon Nation project learning guides, designed to assist other providers pursuing similar reforms. The first learning guide focuses on improved hospital transitions and chronic disease care management using admission, discharge or transfer (ADT)-based alerts.

“It has direct relevance to any hospital that cares about readmissions,” he said, reporting on one case in Indiana where the alerts drew attention to a girl who had visited the emergency department on ten occasions due to asthma complications. The data enabled the hospital to intervene and effectively help her family better manage her condition.

At the event, Mostashari spoke of the challenge of going against the status quo, citing successful efforts a decade ago in New York City to bring down smoking rates that at first faced heavy resistance. He said three years ago Beacon Communities faced similar hurdles in their reform efforts, but in the end they are improving healthcare in their communities. “We still need those brave souls, those who believe healthcare can be different,” he said.

When workers stressed the difficulty in changing workflows in delivery of care and other challenges, Asaf Bitton MD, MPH, division of general medicine, Brigham and Women's Hospital, Harvard Medical School Center for Primary Care, said he responded: “that means you are where you want be.” If it was easy, or just “safe incrementalism,” the efforts would not truly drive change, Bitton said.

“It’s a scaffolding program, which is not so sexy or catchy, but it’s scaffolding for serious community change and improvement,” he said.

To achieve structure, Beacon communities are advising others on the reform path to embrace governance early on, said Janhavi Kirtane Fritz, acting director, Beacon Community Program. Legitimacy of a trusting governance structure is required to really make progress, she said.

“If you don’t have governance figured out, you keep bouncing back to the starting line until you figure that out,” agreed Carol Beasley, MPPM, vice president, business development, Institute for Healthcare.

Patrick Gordon, director of government programs, Rocky Mountain Health Plans and program director, Colorado Beacon Consortium, also spoke to the importance of collaboration and leadership. “The learnings, the experiences, the networking and the trust fabric that has been built have been incredible,” he said of his experiences during the program.

Investment in human resources and skill development is crucial, the speakers also said.

“You need to bring learning and infrastructure up side by side, they can’t work in isolation,” said Beasley, stressing the importance of continual skill building.

“Technology is important, but development of the workforce is absolutely essential,” echoed Gordon. Criteria to achieve Meaningful Use Stage 1 served as a “very productive focal point” to align the Colorado Beacon community of providers, he said.

When data aggregation and collection became less of an abstract concept and more of something specific that workers could relate to, it accelerated adoption and benefits of population health and predictive modeling tools, he said.

Beasley also spoke of the critical importance of getting communities on board with the Beacon initiatives. “Change gets driven from the community. It is really hard to work in communities, but it appears impossible not to do that. So you have the choice between hard and impossible,” she said.

Working with schools, for instance, to keep children in the classroom and out of hospitals as much as possible, is an example of collaboration, she said.

In other comments, Mark McClellan, MD, PhD, director, Engelberg Center for Health Care Reform and senior fellow of Economic Studies and Leonard D. Schaeffer chair in health policy studies at the Brookings Institution, urged more focus on the business case for healthcare reform, but lauded the Beacon communities for blazing the trail to new payment models.

In a theme that emerged multiple times during the discussion, Bitton said failures should be treated as successes, as it is all a learning process.

Beasley elaborated on handling frustrations that come with change. “When things get bogged down, pick a patient, and walk through the workflow and find out where it is breaking down. It’s guaranteed to illuminate the system in ways that are novel and help you get past the bump in the road,” she said. The process is “bound to get messy and bound to have failures.”