Innovation Nation July 12, 2012 Presented by Kathryn Alexandrei. Overview. Understanding what is meant by innovation in behavioral healthcare Developing an Innovation Framework Becoming conversant with new models like Accountable Care Organizations (ACOs)
July 12, 2012
Presented by Kathryn Alexandrei
Developing an Innovation Framework
Becoming conversant with new models like Accountable Care Organizations (ACOs)
Next Steps – Your Innovation CycleLearning Objectives
Sustaining Innovations (correction ribbon, lighted refrigerator, bucket seats)
allow you to make incremental changes in order to do what you’ve been doing more efficiently
or to produce a better outcome doing it.
Also allows you to maintain market share.
Disruptive Innovations (NetFlix, Craigslist, Amazon)
fostered by outsiders who want to upend markets and the way things are done
totally transforming the business modelWhat is Innovation?
Lower-cost financial model
Value Network is economically coherent (mutually reinforcing)Elements of Disruptive Innovation
Source: Clayton Christensen
Value-Add Process – assembling solutions of higher value (retailers, auto-makers). Charge for value of assembled products and services. Focus on treatment after diagnosis.
Facilitated Networks – models wherein people exchange things with one another (insurance, mutual funds, eBay and WebMD are examples). WebMD has begun building communities of people with certain chronic conditions like diabetes. These models harness vast amounts of data and technology architecture.Progressive Innovations
Source: C. Christensen
Health information technology (EMR, HIE, MU, PHR, etc.)
Internet and facilitated networks
Pharmaceuticals and medical devices
Medical education (behavioral medicine)Examples of Health Care Innovations
Personal Spending Accounts (debit cards)
Hospital and Provider Cost & Quality Comparisons online
Personal Health Records (PHR)
Coverage, Treatment and Cost Advisors
Health Risk Assessments with Incentives ($)
Disease Management Programs
Choice of Networks
Exclusive Provider Networks
Prevention Benefits and Services
Accountable Care Organizations
Patient-Centered Medical Homes
Value-Based Insurance Design (VBID)
2. Care Management, Data Analytics, and Informatics.
3. Health Insurance Exchanges and Individual Markets.
4. New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.)
5. Bending the Cost Curve.
6. Medicare and Medicaid.
7. Health Information Exchanges and EMRs.
8. Consumer\'s Role in the Modernization of Healthcare (social networking, incentives, CDHP, etc.)
9. Reform Uncertainties.
10.Payer / Provider Interoperability.Top 10 Issues/Opportunities2011-2014
(Source: Managed Care Executives Group, March, 2011)
Source: Congressional Budget Office (CBO)
Focus on coordination between primary care and specialty care:
Educating the Public
Medication Assisted Treatment
Accountable Care Organizations (ACO)
Patient-Centered Medical Home and Health Home Models (PCMH) – Focus on Primary Care IntegrationWhat are the Opportunities for Innovation in the Market Today?
“Blending and Braiding” Systems of Care
Joint Ventures and AffiliationsWhat are the Opportunities for Innovation in the Market Today?
What is an Accountable Care Organization (ACO)?
A group that would include a hospital, primary care physicians, specialists, and possibly others involved in coordinating care for shared (Medicare, Medicaid, or other insurance) patients.
The ACO\'s goal would be to ensure that the care provided meets or exceeds quality benchmarks within the fee-for-service structure.
ACO members would share in resulting cost savings.
Use Lower Cost
Hospitals & Specialists
ER Visits &
Testing & Referrals
Revised Capitation (Global Payment Systems or Comprehensive Care Payment Systems)
Episode of Care Payment System
ACOs must develop a process for:
identifying patients who have complex needs (multiple chronic conditions)
or those who are at high risk of developing such needs
and provide them with wellness and prevention programs,
and complex case management, as needed
ACOs must make available or support providers’ use of electronic prescribing, electronic health records systems, registries, and self-management tools
Reporting Infrastructure – Interface with Case Managers, Primary Care, and Care Coordinators
Performance Management – Access to disease-specific dashboards, baselines, benchmarks and adherence to best practices
Data Aggregation – Data warehouse, clinical decision support, and disease registry capabilities
Health Information Exchange – Interoperability and Meaningful UseACO Readiness and Capabilities
Data Analytics and Predictive Modeling
Disease and Case Management Software ApplicationsEstablishing Readiness and Capabilities for Market Innovations
Develop a strategic plan, business plan, and *especially* a marketing plan that enables innovation based on knowledge of market forces and market structural changes
Commit capital, develop a budget, and/or find investors or partners if you need them
Address staffing and the need for periodic expertise where innovation is concerned
Align innovation with your IT plans
Commit to Performance Mgmt frameworkNext Steps
Executives set the course and the mood
Establish and measure your expectations
Keep distractions and competing priorities to a minimum
Hold people (including yourselves) accountable
Align efforts so time and energy are not wasted
Provide reinforcements, encouragement and rewards (recognition)Next Steps
Become Learning Organizations (there is a lot to learn!)
Recruit, retain and train the right people in administrative as well as clinical areas
Leverage your Core Competencies
Encourage some risk-taking, experimentation and tolerate mistakes. Ask “What if…?”ALOT
Conduct market research – what you don’t know can hurt you
Invest in your brand image and dress the part of innovator
Use thoughtful scenario-based business modeling and business case methods to pilot your innovationsNext Steps