The Harvard Contest That’s Trying to Improve Health Care Delivery
In the fall of 2014, the HBS-HMS Forum on Health Care Innovation launched the inaugural Health Acceleration Challenge — a “scale up” competition that focuses on compelling solutions to problems in health care delivery that have already been implemented at a small scale and have the potential for wider dissemination.
The contest produced some useful innovations. Many of them are easily adoptable by other organizations, proving our assertion that there is no shortage of innovations in health care; rather the problem is that they take too long to be adopted by others.
There is a large body of research on the factors that make the diffusion of new innovations difficult in the health care industry, including:
How the innovation is perceived (e.g., Does it represent incremental change or require a large shift in thinking? Does the idea come from an established leader or an “outsider?”)
The characteristics of the individuals who do or do not adopt the innovation (e.g., Are potential adopters risk averse or penalized for change?)
The contextual and managerial factors within the organization(e.g., Is the innovation supported by leadership, management, incentives, and communication?)
The conventional wisdom is that it takes far longer for many potentially beneficial innovations to be widely adopted in health care than in other industries, especially consumer markets. An oft-cited example is the iPhone — more than 700 million have been sold since the first model went on sale eight years ago. By comparison it can take 10 to 20 years for a new health care practice to go from development to widespread adoption, according to some estimates.
The goal of the Health Acceleration Challenge is similar to that of this HBR-NEJM Insight Center: to serve as a platform to share proven innovations in health care in order to help encourage adoption across geographies, systems, and care-delivery settings.
Application questions focused on potential impact (e.g., What positive outcomes would occur if the innovation were disseminated more broadly?), evidence (e.g., What data exist currently that demonstrates success?), and the strength of the dissemination plan.
Altogether there were 19,965 visitors to the Challenge website who wrote 2,671 comments and provided 478 applications. These applications came from 29 different countries and 43 U.S. states. Approximately 60% were from for-profit companies, while the remaining 40% were from not-for-profit organizations.
More than three-quarters of the applicants were focused on provider-facing innovations, as opposed to those that directly addressed payors or patients. Of the provider innovations, 38% were aimed at acute care or hospitals, 14% on self-care, 10% on physician offices, 10% on telemedicine, 8% on home health care, and 20% on multiple or other settings.
To narrow down the 478 applications to 18 semi-finalists, we assembled a panel of 50 judges with wide experience in the field. The judges evaluated the applications based on potential impact, evidence of success, and the strength of the dissemination plan. Four finalists were ultimately selected. A winner will be selected in April 2016. (Click here to receive updates about this competition and the next Health Acceleration Challenge, which will begin in the spring.)
The four finalists represent a mix of for-profit and not-for-profit organizations, provider- and patient-facing innovations, and clinical and operational solutions. Each addresses a different problem in the health-care-delivery value chain and offers a unique approach that has been tested in the marketplace.
Bloodbuy. This Dallas-based company offers technologies that connect hospitals and blood centers nationwide to ensure the efficient flow of lifesaving blood products to patients in need. By providing on-demand access to a diversified base of premier blood centers, Bloodbuy ensures that hospitals avoid overpaying for blood products or encountering supply shortages. At the same time, Bloodbuy enables blood centers to reach and serve a broader base of hospitals and blood centers across the country, thereby increasing inventory turns, eliminating waste, and accelerating growth.
To date, Bloodbuy has produced average per unit cost savings of 20% on platelet orders, 24% on leukoreduced-red-blood-cell (LRBC) orders, and 27% on orders for fresh frozen plasma (FFP), when compared to the incumbent processes. On a blended basis, this equates to a net reduction of 22% in total blood spend. Bloodbuy has recently been featured on NPR’s Marketplace segment.
I-PASS Institute. A collaboration of over 50 faculty across the country, the mission of the I-PASS Institute is to improve patient safety by standardizing provider communication, with a specific focus on improving care transitions between provider shifts within the hospital. The institute’s members include Boston Children’s Hospital, Intermountain Primary Children’s Medical Center, and Oregon Health and Science University. The institute consults and trains clinicians to use the I-PASS Handoff Bundle, an evidence-based, standardized approach to teaching, evaluating, and improving handoffs. The I-PASS Hand-off Curriculum includes teamwork and communication training, simulations, a mnemonic to standardize handoffs, oral and written hand-off improvements, faculty-engagement tools, and an institution-wide sustainment campaign. The I-PASS mnemonic (Illness severity, Patient Summary, Action list, Situation awareness, Synthesis) serves as the cornerstone for the handoff protocol.
The I-PASS Handoff Process has been associated with a 30% reduction in injuries due to medical errors in nine hospitals. Medical professionals transmit vital information at every change of shift and whenever a patient changes locations.
Medalogix. People aren’t dying the way they want to in America. Although 80% say they’d prefer to die at home, surrounded by loved ones, far away from needles and breathing tubes, only 25% get their wish. Not only is this terrible for patients and their families, it is also costing the health care system billions of dollars. In 2011, Medicare spent 28%, or about $170 billion, on patients’ last six months of life — and much of the spend not only did not extend patients’ lives, in many cases, it shortened them.
Nashville-based Medalogix has developed a technology, Medalogix Bridge, which leverages predictive analytics to identify hospice-eligible patients. Once identified, Bridge incorporates a workflow that helps clinicians better manage patients through the hospice-decision and transfer process. Medalogix offers solutions that use a combination of predictive analytics, workflow analysis, and business-intelligence engines to improve quality and reduce costs. Its products help decrease transfers to inpatient facilities as well as identify patients who would benefit from an additional care episode. In addition, its tools help identify and inform patients who would benefit from hospice care. You can watch the Tedx Nashville talk of Dan Hogan, Medalogix’s president and CEO, here.
Twine Health. This company is an MIT Media Lab spin-off with a population-health platform that enhances collaboration between patients and clinicians and empowers patients to take the lead in their care. The platform allows individuals with chronic conditions to co-create personalized care plans that serve as common ground for continuous collaboration with their care team: their own providers, their family and friends, and a coach (e.g., nurse, pharmacist, health coach). Care teams provide timely support through tightly integrated communication tools and can efficiently monitor key data and events from their population, allowing them to focus care on the right patients at the right time.
Randomized controlled trials have shown that patient engagement increases and clinical intervention time decreases with the use of this application. For example, results show that three times the number of patients reach their outcome targets in a quarter the time of standard care with fewer office visits when using the Twine Collaborative Care Platform.
All of these projects have stirred new thinking in the health care field. While we wait for the winner to be announced, we hope the discussion about innovations and how to speed their adoption will continue.