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Highlights from the Care Innovation Summit: Afternoon sessions

March 3, 2014

    Dan Diamond, Managing Editor

    While Kathleen Sebelius and Jeffrey Brenner mostly focused on how to transform care delivery, several other afternoon sessions addressed the politics of care innovation.

    A bipartisan discussion between the White House's Chris Dawe and the Podesta Group's Steve Northrup—billed as "beyond the beltway: understanding the intersection of innovation and public policy"—was striking for its lack of partisanship, despite Dawe's affiliation with the Obama administration and Northrup's background as a GOP lobbyist. Their conversation featured general agreement that the Obama administration was making progress by focusing on accountable care.

    Dawe also suggested that the White House is focused on long-term care as a path toward reducing health spending.

    A conversation moderated by the Aspen Institute's Elliot Gerson, former Senate Majority Leaders Bill Frist and Tom Daschle also dealt with the poltical challenges of reform, coupled with the practical hurdles in making transformations—like the shift toward the home as the center of care—real and lasting. Daschle stressed that the move to change incentives in the health system is happening too slowly.

    What HHS and a hotspotter can teach us about care innovation



    Sebelius: Transforming 'lazy data' is the key

    In her address, which was the keynote speech of the Summit, Sebelius said that the industry has undergone rapid transformation in just the past few years. Take electronic health records, the secretary said. In 2009, only 1 in 8 hospitals was using a basic EHR; by 2012, that figure had more than tripled. There's a continued shift away from fee-for-service and toward pay-for-outcomes. The health care cost curve continues to bend.

    But it's not enough.

    When it comes to health care, we "live in a 21st century world with a 20th century delivery system," the secretary said. And "if you were to give our nation a grade on health innovation, at best I'd say we'd get an incomplete," noting that visiting a physician today is not much different from doing so 40 years ago.

    Sebelius said the federal government can play a key role: Share its data with the public. Especially because so much of that data is "lazy"—it's stored in various databases, far from the providers and entrepreneurs who are dying to make it "active" and use it to transform elements of the health system.

    "What we're finding," she said "is if we make data open and accessible, the private and nonprofit sectors use it to start innovating."

    For example, one participant in an HHS "Datapalooza" came up with the idea to put a GPS device on an Asthma inhaler, which Sebelius said has helped patients better track and manage their asthma.

    "It’s been described as “hacking the inhaler” to give patients and their doctors the information they need to control their asthma, she added. No small fix, given that medical expenses associated with asthma have increased to about $56 billion.

    That’s why even those kinds of simple innovations, Sebelius argues, can lead to lasting improvements in health care delivery and spending.


    Brenner: Making population health real

    The Camden Coalition's experience, meanwhile, is the story of a more complex intervention.

    In his talk, Brenner—a MacArthur "genius" award winner—discussed how he used hospital billing data to identify the highest cost patients in Camden, N.J., theorizing that they were receiving the worst care.

    Working with a small team that's steadily grown over the years, Brenner targets these "super utilizers," builds personal relationships with them, and institutes interventions centered on the patient and designed to keep them out of the hospital.

    And it's working. When detailing Camden Coalition's success in the New Yorker, Atul Gawande wrote that the coalition's cohort of patients "averaged 62 hospital and [ED] visits per month before joining the program and 37 after—a 40% reduction," He added, "their hospital bills averaged $1.2 million per month before and just over a half a million after—a 56% reduction." 

    And the group isn’t afraid to try unique interventions. For example, Camden Coalition identified a subsidized, senior housing building as a "hot spot"—the residents had been racking up more than $1 million a year in hospitalizations and ED visits for about a decade. To better meet the needs of residents, and keep them out of the hospital, the coalition and one of its partners opened a clinic in the apartment building.

    The Camden Coalition story celebrates the power of data—the initial idea stemmed from how New York City police used "hot-spotting" to identify the most crime-ridden areas of their city. Although like Sebelius, Brenner bemoaned the lack of easy-to-use data throughout the health care system.

    "Capitalism doesn't fly blind," he ruefully said, "but health care still does."


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