Blumenthal, more on breakthroughs, frugal innovation

BOSTON--“Incremental innovation is vital and may be sufficient but we’re asking, is there something more?” said David Blumenthal, MD, MPP, president of The Commonwealth Fund, speaking at the National Healthcare Innovation Summit.

This new experimental program focuses on breakthrough opportunities, which he said have two approaches. One starts with a compelling vision and uses a deductive approach to identify what will be needed to achieve those goals. “We are all trapped in the status quo and the most important breakthroughs may lie outside healthcare.”

The other is inductive, which involves a proactive scan of the environment for potential new ideas and concepts.

The Commonwealth Fund is working to develop a modeling process to create plausible scenarios about the probability of impact, he said. This effort is a modest part of the organization’s portfolio, he said, but “we are learning a lot about the difference between innovation and breakthrough.”

Blumenthal said he is convinced that the wiring of the U.S. healthcare system will be a breakthrough. “Data are not yet liberated but they are increasingly in digital form and capable of liberation.”  Wiring is potentially disruptive because outside forces are bearing down on institutions, which creates tension for change. It can be disruptive both economically and psychologically, he said, because it doesn’t require the participation or support of people who are part of the status quo.”

Molly Joel Coye, MD, MPH, chief innovation officer at UCLA Health, discussed the creation a year ago of the Global Lab for Innovation, which focuses on frugal innovation for sustainable healthcare. Nobody has defined sustainable health and while she said she’s looking forward to the rules of thumb, it means it’s not just affordable but the community thinks it’s a worthwhile investment of social resources.

The center’s first round was a domestic scan for high-value innovations that will radically reduce costs and improve access. “We work to de-risk the selection of high-value innovations in order to accelerate their spread.” To that end, they offer a virtual platform for people interested in seeing the range of innovations with a standardized way of characterizing for apples-to-apples comparisons. They also developed an innovation scorecard, which features a checklist of an effort’s most important features.

When the group identifies innovations that meet their savings criteria they are categorized as hitting either the 20 percent or the 2 percent threshold. “Sometimes just 2 percent savings can be quite radical.” Simple innovations deliver the savings within one year and complex realize savings within three years. “If it doesn’t happen in three years, we ain’t interested” because that is the same lifecycle of most political and healthcare leaders, she said.

The heavy hitters, Coye said, have been nurse extenders/clinical aides and ethnographically designed patient self-management kits, which they discovered in a scan. “We were blown away at first and had to be assured this really had the effect described.” Simple innovations include eReferrals, home palliative care, home-based acute care and community paramedics.

The global lab has conducted a beta launch of a website to establish a virtual platform with open access to anyone. “Come in and nominate an innovation,” she said. Every innovator is asked to provide two cases of where the innovation has been replicated with results as good or better than the index case. Most don’t have published articles or the results of randomized controlled trials but “we want to know this has been taken somewhere else and gotten the same results.” The plan is to validate reference cases and then reward a green button for sustainable frugal innovation to “those that are going to help us solve problem of affordable accessible care.”

The top-of-mind innovation priorities are cost reduction (65 percent) followed by patient satisfaction and care coordination, according to a survey, said Leslie Wainwright, PhD, chief strategy officer for Avia, the provider-formed innovator network.

The expectations, according to the survey, for ROI are relatively quick with 28 percent saying just one to two years.

Organizations, however, are “in a tough situation when no money is earmarked for innovation.  Something else will always win out.” Innovation can’t be sustainable if there isn’t some way to earmark it, she said. Leadership is important as is creating a culture of innovation.

Strategy and ability matter to achieve sustainability, Wainwright said, and Avia is studying that process. Avia studies the work published in other industries to learn more about high performance and sustained innovation. Successful innovators, she said, know where they’re going and articulate that well and have some discipline around it. They also have the ability to make good on that in terms of culture, senior leadership’s commitment and business capabilities.

Avia also is working to lay more of a quantitative foundation to transfer knowledge more broadly. “We want to give everyone access to key learnings so they can hit the ground running and learn from all who come before them.”