We all know that innovators in health care face a unique set of challenges - from misaligned incentives to regulatory hurdles and truly life-or-death scenarios, the stakes are high. And with millions of Americans gaining access to health care through the Affordable Care Act, the need for innovative solutions that lower costs, increase quality, and improve patient outcomes, has never been greater.

To discuss the current challenges and opportunities in health innovation, we have invited a talented group of health innovators to share their expertise with the community next week, July 15 - 19.

Our panelists include:

     * Sam Basta, MD, MMM, FACP, CPE, Founder and President, Healthcare Innovation by Design; Senior Medical Director, Clinical Integration, Sentara Healthcare; and Associate Professor, Internal Medicine, Eastern Virginia Medical School

     * Karen Herzog, Director, Marketing and Social Media Strategy, Valley Design Group and Co-Founder and Executive Director, Sophia's Garden Foundation

     * Andrey Ostrovsky, MD, Co-Founder and CEO, Care at Hand, Resident, Boston Combined Residency in Pediatrics, Boston Children's Hospital, Boston Medical Center; Harvard Medical School, Boston University School of Medicine

     * Julien Pham, MD, MPH, Founder, RHINNO (Rapid Health Innovation); Faculty, Instructor in Medicine, Harvard Medical School; and Associate Physician, Renal Division, Brigham and Women's Hospital

This panel will be led by GHDonline moderator and Health for America co-founder, Kapil Parakh. Panelists will share their thoughts on:

     * The biggest challenges in health innovation
     * Opportunities for innovators and gaps to be filled
     * Valuable tools and methods for developing and implementing innovations
     * Success stories from the field

Please also join us on Monday, July 15th at 3pm EDT for a live-streaming video conversation with our panel, and share your questions and comments for the panel throughout the week - we'll also be sharing key points from the discussion on Twitter (@ghdonline) using the hashtag #ghdinnovation.

(Please note, the video conversation will be recorded and available for viewing immediately following the session at 3pm.)

As we begin our first Expert Panel as part of the US Communities Initiative, we ask for your input on a brief, 4 question survey that will help us understand the impact of our Expert Panels, and how we can improve these panels in the future.

Please take the survey now by visiting: https://www.surveymonkey.com/s/Q5ZNS9K

We hope you will join us in welcoming our panelists, and look forward to your questions and comments on this important topic.

 
Sam Basta, MD, MMM, FACP, CPE
Replied at 8:52 PM, 11 Jul 2013

Thanks Marie! Very much looking forward to the discussion.

Marie Connelly
Replied at 10:01 PM, 14 Jul 2013

Just a reminder that we will be closing our Expert Panel survey shortly, and would greatly appreciate your input before we begin the panel. You can take the 4 question survey by visiting: https://www.surveymonkey.com/s/Q5ZNS9K

If you have questions for our panelists, please add a reply to this discussion - we'll do our best to address as many questions as possible during tomorrow's live-streaming video conversation, and will be continuing the conversation here in the community throughout the week. You can also tweet questions to us @ghdonline, using the hashtag #ghdinnovation.

We're looking forward to a great discussion!

Sam Basta, MD, MMM, FACP, CPE
Replied at 2:34 PM, 15 Jul 2013

Hello everyone,

Per Marie's request, here is a quick biosketch in the way of an introduction.

I'm an internist with a passion for healthcare delivery and experience innovation. I founded Healthcare Innovation by Design (HIxD), a global network for healthcare innovators about 4 years ago. You can find us at http://www.healthcareinnovationbydesign.com or on LinkedIn http://www.linkedin.com/groups/Healthcare-Innovation-Design-2579818/about?trk...

I work at Sentara Healthcare, an integrated delivery system in Virginia where I am Senior Medical Director, Clinical Integration. My job involves developing and implementing integrated patient-centered clinical programs that achieve the triple aim: better health, better care and lower cost.

Before joining Sentara, I was an academic internist at Eastern Virginia Medical School (EVMS) for 10 years. During my time there, I focused on evidence-based medicine, quality improvement and patient-centered care. I was Chief Quality Officer for my last two years at EVMS. I also completed a Masters in Medical Management (MMM) at Tulane University during that time.

I'm very much looking forward to interacting with all of you during the Hangout and later in this discussion board.

Andrey Ostrovsky
Replied at 3:01 PM, 15 Jul 2013

Also per Marie's request, my biosketch is available here: http://www.linkedin.com/pub/andrey-ostrovsky-md/7/367/44b

Marie Connelly
Replied at 3:04 PM, 15 Jul 2013

Hi everyone,

We've begun the broadcast of our GHDonline Expert Panel - please join us in the discussion by visiting: http://www.ghdonline.org/innovation/discussion/expert-panel-principles-and-ch...

The video is embedded at the beginning of this discussion and should be streaming now. Please share your questions and comments for the panel here.

Marie Kenerson
Replied at 4:03 PM, 15 Jul 2013

Very interesting discussion. good job!

Julien Pham
Replied at 4:09 PM, 15 Jul 2013

This was great.
rhinno.partners.org
www.linkedin.com/in/julienpham

Looking forward to connect with innovators in the community!

Kate Long
Replied at 4:13 PM, 15 Jul 2013

Thank you to all the panelists for sharing their thoughts and experiences with all of us. I'm curious to know how each of you found the right mentor(s) along the way? Also, if you could go back in time, and tell yourself one thing about the process of innovation or building a start-up, what would it be?

Marie Connelly
Replied at 5:14 PM, 15 Jul 2013

Many thanks to our panelists and moderator Kapil for such a great discussion this afternoon! If you weren't able to join us for the live conversation, a recording of the video is embedded at the beginning of the discussion and can be viewed by visiting us online at: http://www.ghdonline.org/innovation/discussion/expert-panel-principles-and-ch...

I wanted to share a few resources that our panelists mentioned during the discussion.

When talking about resources and tools that have been most helpful, Andrey Ostrovsky shared a link to The Lean Startup, by Eric Ries. Sam Basta mentioned Macrowikinomics by Don Tapscott and Anthony D. Williams, as well as The Power of Pull, by John Hagel, John Seely Brown and Lang Davison. Karen Herzog mentioned Drive, by Dan Pink, along with Business Model Generation, by Alexander Osterwalder and Yves Pigneur. Kapil also shared a link to a discussion he had with The Next Web about bringing the Lean Startup approach to healthcare.

In our discussion of resources for innovators around regulations in the health care space, Andrey shared a link to Rock Health's FDA 101 slidedeck, as well as an insightful blog post he worte on Disrupt Healthcare outlining the risks faced by Hospital-based Startup incubators.

Sam also shared a favorite TED Talk by Derek Sivers on How to Start a Movement, and I've included a short animated version of Dan Pink's talk on Drive at The RSA which might be of interest (thanks to Kate Long for bringing that to my attention!)

Links to all of these can be found below. I hope our members, and panelists, will continue to share articles, videos, books, and other resources that they've found particularly helpful when it comes to health innovation!

Attached resources:

    Link leads to: http://theleanstartup.com/

    Link leads to:

    Macrowikinomics: Rebooting Business and the World

    ~ Anthony D. Williams (author) More about this product
    List Price: $27.95
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    Link leads to:

    The Power of Pull: How Small Moves, Smartly Made, Can Set Big Things in Motion

    ~ Lang Davison (author) More about this product
    List Price: $27.50
    Price: $18.04
    You Save: $9.46 (34%)

    Link leads to:

    Drive: The Surprising Truth About What Motivates Us

    ~ Daniel H. Pink (author) More about this product
    List Price: $16.00
    Price: $10.18
    You Save: $5.82 (36%)

    Link leads to:

    Business Model Generation: A Handbook for Visionaries, Game Changers, and Challengers

    ~ Yves Pigneur (author) More about this product
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    You Save: $11.54 (33%)

    Link leads to: http://thenextweb.com/entrepreneur/2013/04/20/bringing-the-lean-startup-approach-to-healthcare/

    Link leads to:

    Link leads to: http://www.disrupthealthcare.org/2013/02/risk-faced-by-hospital-based-startup.html

    Link leads to:

    Link leads to:

Marie Connelly
Replied at 5:25 PM, 15 Jul 2013

One question I had for the panel that we didn't quite have time for today was around motivation and staying engaged for the long haul.

Sam pointed out that we are really only a few years in to a decade-long process of massive systemic change in US health care, and I was reminded of the fact that this really is a marathon, not a sprint.

Often when we think of "innovation", I feel like we have this perception of things happening very quickly - the only rule of technology is that it changes, right? Our panelists certainly highlighted many of the ways it's possible to iterate and "fail fast", even in the healthcare space, but I would love to hear thoughts on how we motivate ourselves and each other, to keep pushing the field forward when, as Sam pointed out, we're really just at the tip of the iceberg now.

Andrey Ostrovsky
Replied at 10:29 AM, 16 Jul 2013

In response to Kate Long's comment, mentors in the innovation space can be a little challenging to find within academic centers because their perspective on innovation is limited. For a broader perspective, check out startup incubators. A great one that I found an incredible resource is startuphealth.com. Also, put yourself out there by participating in events like meetups for innovation or startups (meetup.com).

Corinne Abalos
Replied at 11:29 AM, 16 Jul 2013

It seems that at the forefront of innovation in the US healthcare system are questions about strengthening primary care delivery.

In developing nations, community health workers have proven a very elegant way of supporting the healthcare system in case finding, treatment delivery, and patient follow-up. To what extent might the model of community-based care be useful in promoting health care delivery in the US and more developed nations?

Nick Cuneo
Replied at 11:29 AM, 16 Jul 2013

I am interested in hearing more about any mechanisms that have been included in the Affordable Care Act (ACA) that incentivize the development or scaling of innovative models of healthcare delivery. It is my understanding that the ACA has mandates for better data collection standards, for example -- how will these data be harnessed to both inform and drive innovation?

Aneth Dorah Lutale
Replied at 11:32 AM, 16 Jul 2013

Does anyone have innovate way/s on how would we integrate traditional healers, spiritual(religious) healers into modern mental health care delivery?

Davis "Mac" Stephen
Replied at 11:32 AM, 16 Jul 2013

Hello :) This is Mac and Busi from the GHD summer intensive course at Harvard School of Public Health. We have both observed that as a physician-in-training and current physician (in S. Africa), relatively few of our colleagues share an appreciation of the non-clinical, socially-imbedded aspects of health in our patients. We feel that if this perspective were made more visible early in medical training, more would pursue innovative projects to address underlying gaps in delivery that result in poor health outcomes. Are there examples of such attempts that could be more broadly applied both domestically and abroad?

Aneel Brar
Replied at 11:33 AM, 16 Jul 2013

Following Corinne's remarks -- I'd also like to know how primary care could be affected by changing incentives for MD's working in primary care. Also, how could incentives for nurse practitioners and other health professionals one step up from the community health level be altered to shift the balance of care more towards prevention and early treatment.

Jonathan Lawson
Replied at 11:33 AM, 16 Jul 2013

Following up on Marie Connelly's question about how we motivate ourselves and each, I would be curious to hear thoughts on how we can envision a common goal for innovation in health care knowing that there are unique stakeholders with varied, and at times, competing interests, and if our destination will be a result of aggregate, independent individual behaviors or if some vision consensus might be possible and how we might reach it.

June-Ho Kim
Replied at 11:35 AM, 16 Jul 2013

Online tools like Google are able to "bubble up" the most important links so that, out of countless pieces of information, the most relevant topics are surfaced. As evidenced by GHDonline, there are so many experts with ideas and experiences, but it is difficult to filter and "bubble up" the innovations that are practical and/or scaleable. How can we maintain the scale and breadth of the conversations that occur on GHDonline and other forums without suffering from "information overload" (similar to alert fatigue in the EMR system) and with the ability to quickly identify best practices?

Nadege Belizaire
Replied at 11:35 AM, 16 Jul 2013

Are there any innovations out there that connect physicians to community health workers that can show a value added measure for to prevent complications in resources poor settings?

Jafet Arrieta
Replied at 11:35 AM, 16 Jul 2013

Hello everyone,

We would like to comment on the use of the Model for Improvement developed by the Associates in Process Improvement as an innovative way to plan, design, test and implement strategies to effectively deliver health care in resource-poor settings and as a mean to move from small scale to large scale improvement. This model has proven effective to improve the way health care is delivered in hospitals and different health care systems, but there is very few literature available about it being used in resource-poor settings. We've been using this model at PIH Mexico to improve the quality of health care in rural communities, particularly, to improve mental health. So far, we have promising results that allow us to think of it as a good tool as we plan on expanding the project.

We would like to know what you, as experts on innovation in health care, think about whether or not this is a good model to be used in this context?

Jafet and Price

Attached resource:

George Baison
Replied at 11:38 AM, 16 Jul 2013

One thing that I have noticed that limits innovation adoption among providers is the enormous amounts of new ideas that are tried and tested everyday. Many of these innovations end up "failing" leading to provider fatigue or lack of faith in new ideas. In what ways can we either incentivize providers to continue to adopt new innovations among this fatigue or in what ways can we implement innovations such that we minimize "failed" ideas?

Avik Chatterjee
Replied at 11:39 AM, 16 Jul 2013
Yesenia Risech-Neyman
Replied at 11:42 AM, 16 Jul 2013

Are there any examples of innovations designed in developing countries which have been successfully implemented in resource poor settings in developed countries like the US? So often we see innovations flow in the other direction, with limited success.

Yesenia and Radwan

Kapil Parakh
Replied at 11:52 AM, 16 Jul 2013

Great point. I have been loosely involved with the Johns Hopkins Aliki initiative which has shown effectiveness both as an educational tool as well as in improving patient outcomes. I would look into this as a starting point and here are some links:

https://www.mededportal.org/publication/9098

http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=487035

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304041/

Hope this helps.

Siniva Sinclair
Replied at 11:53 AM, 16 Jul 2013

Hi, we have been wondering about experiences of sharing effective ways of delivering services that particular communities have developed for themselves in one setting, with similar groups in other settings e.g. immigrant communities and those in their home countries, or indigenous communities facing similar issues in different countries. Appreciate any thoughts about how important lessons can be shared and built upon.
Many thanks,
Siniva, Billiameen and Rajan - Global Health Delivery Summer Intensive

Susan Driscoll
Replied at 6:14 PM, 16 Jul 2013

Yesenia and Radwan and all,
I have had similar questions myself and would very much like to start an effort to provide cervical cancer screening, diagnosis, and treatment services through VIA/Cryo to women that may benefit here in the U.S. It has been widely used in India, Africa, and South and Central America as a less time consuming/less expensive option. Its sensitivity and specificity have been found to be comparable to the Pap Smear in several research studies and the method is mandated by the WHO. I know that many women in the U.S. would benefit from this screening/treatment method and it would save substantial amounts in provider, lab, and cryo treatment costs. If anyone is familiar with people translating standards of care from low resource countries to the U.S. I would be very interested or if you know of anyone that has done VIA/Cryo in the U.S. I have been told that the economics and politics involved would be difficult to overcome in the U.S., but I would like to try. Any thoughts or examples that have been successful?
Susan Driscoll MPH, MSN, ANP

Sam Basta, MD, MMM, FACP, CPE
Replied at 10:35 PM, 16 Jul 2013

@jonathan
On the personal level, health is a very private matter and what motivates each of us to be "healthy" and the way we go about achieving it are hugely varied. At the organizational and societal levels, healthcare is a multi-trillion industry with enormous intrenched interests. In my opinion, seeking consensus or common goals is a suboptimal use of energy and resources. A more effective approach is for governments to create the right environment for innovation and for educational, NGO and non-profit organizations to spread the tools and methodologies of innovation and let each one of us and each organization innovate for their own unique reasons and interests. The only way to find the few amazingly innovations is by looking in the huge piles of not-so-great ones :)

Sandeep Kishore
Replied at 11:45 PM, 16 Jul 2013

@ Mac and @ Busi -- !

These are spot-on comments. I'm completing medical studies -- just now in the clinical portion -- and couldn't agree more
re: exposure to the social and structural determinants of health '(the causes of the causes' of ill-health) as well as inroads on compassion/emotional intelligence in 21st century education. In my training (in the USA), there has been little to no protected, core curricular time on these critical topics; very little social medicine, if you'd like. The courses on the non-biomedical and non-clinical determinants that we have jumpstarted have been (www.ghcurriculum.info), to this time, elective -- that is to say non-core (which signals that many curricular directors may still believe these topics are non-essential, or at least not as important as the existing curricular offerings). This is in and of itself a structural determinant that stifles health delivery innovation! It is time to make the extracurricular the curricular --

In my view, re-unification of the public health and clinical medicine worlds needs to happen in training itself -- and from what I see with global curricular
innovations, I think the world's current students + faculty could begin to re-marry these topics into core curricula.

To help nudge this along, we've started a google docs with a curation of examples by a global network of (from the University of Colombo to the University of Oxford) of student/faculty movements to provide exposure, sensitization as well as curricular credit for a deep -dive into these topics.

See: https://docs.google.com/document/d/1sQx1ZYDXKR6hwh5KrShnS33p60RCSjKKKg_ITo9Dg...


The Institute of Medicine has a terrific workshop on health professional education in the 21st century. I was delighted to sculpt and moderate a session for the IOM on the shared social contract for the next generation; on building a cohesive/ inclusive social contract with health providers, community members and patients that stands up for justice and equity.

See: http://www.iom.edu/Activities/Global/InnovationHealthProfEducation/2013-MAY-1...

Finally, a write-up on the Health Care blog written with colleagues from TEDMED who are both students and residents on the question of designing the new health provider -- and having the emerging cohort engage the issue rather than let the model of the new health provider be defined for us!

See: http://thehealthcareblog.com/blog/2013/04/14/designing-tomorrows-doctor/

All to say, the more students that demand the courses you speak of, the more likely we are to get to a global tipping point on curricular innovation. My email is if you'd like to f/u; very keen to learn of innovations in med education in S. Africa!

Warmly,

Sandeep

Julien Pham
Replied at 6:18 AM, 17 Jul 2013

@George.

This is a great question. There are several ways one can think of failure. There is failure from the user side and failure from the developer side. My opinion on this is the following: For users/consumers like we all are, we become accustomed to failure. When a product stops working, we fix, replace, or get rid of it. Sometimes the failures can be more drastic and impactful, and it becomes more complicated to fix/replace/get rid. We each have different ways to deal with failures as users, many we've learned from experience (hopefully non-threatening ones).

What I find interesting is indeed this failure as a creator/builder, or a developer. We may take this more personally because there was a personal investment put into it.
If you think of ideas as the initial spark that leads to innovation, it is just a spark. Sure, ideas fail before getting anywhere but that's the point. If all ideas turned into reality, we would surely be overwhelmed with choices. But what I think you imply is those ideas who get a little bit somewhere but fail, maybe at the prototype or pilot stage.
In the Lean Startup (see above for references), Eric Ries advocates the concept of "failing fast" by the creation of an MVP (minimal viable product) that allows you to capture early metrics to test your hypothesis and see whether you should 1) pivot or 2) persist.

By doing rapid iterations on the "idea" (think prototype/product), and by using feedback from users to guide product development, you are removing risk from what you are building. In other word, you are building something that you know your customer/user is asking/wanting. As you tweak your idea further, it is important you do so as "experiments" with small hypotheses in mind, and what Eric Ries describes as "innovation accounting" to measure. In other words, as you set new hypotheses about your innovation, you want to build-measure-learn quickly but on a small scale, by developing your idea into the prototype that users want you to build (not the one you think is what they need - here again, be "empathetic" rather than "paternalistic"), assign metrics as you test/validate your idea further and understand why you fail, and if possible get to that pivot or persist decision quickly so you don't waste time and resources, then learn and iterate again.

That is one part of the question.
The next part is how do we incentivize or avoid failure. I think we should NOT avoid failure. As developers/creators/builders, we should embrace failures and turn them into opportunity.
This is a fun read http://www.geekwire.com/2012/instagrams-billion-dollar-idea-wasnt-photos/
as it tells the story of how Burbn, a geo-location, social-networky app that was full of features was so bloated and lost focus on what users wanted. The founders realized (probably through good metrics and testing) that what users really liked was the photo uploading feature, and particularly the photo filters. They made the decision to wipe everything else to focus on that one specific feature, and Burbn turned into the Instagram we know today that really disrupted how we take and share photos.

Finally, "idea fatigue". I think we get to idea fatigue because too many ideas were created without the user in mind. And maybe among users, there is not yet a strong culture of beta-testing. To prevent this fatigue, one needs to create an innovation accounting platform that the organization becomes aware of, and fair rules to better "scout" and organize ideas and figure out how to best vet those ideas in each context. Each organization/group has a different culture. That's really the challenge, to figure that culture and what works in that context, then slowly influence users that it is ok to be a beta-tester before products are mature.

In general, making things simple, testing your hypothesis quickly to get to the next bifurcation of your product's evolution in order to make that pivot or persist decision, based on customer/user feedback, and building a strong analytics (innovation accounting) platform is one way you can ensure you minimize failure or turn failure into opportunity to progress.

Jessica Taylor
Replied at 5:41 PM, 17 Jul 2013

Hi Mac & Busi,
.
I was thinking a lot about your post and how to encourage interest in the care of underserved patients early on in medical training. I wanted to share an OpEd piece, "Haiti" (attached below), that was written by the Dean of Students of Mount Sinai School of Medicine in NYC and speaks powerfully to the need for training in this area, whether one goes on to practice in the US or abroad.
.
One of the biggest factors in developing my own career interests was the opportunity to work with underserved and undocumented patients beginning in my first year of medical school. Our school had a free, student-run and faculty-supervised primary care clinic where junior students were involved in interpreting, helping patients apply for insurance, connecting them with community resources, helping them navigate our hospital's (very complex) charity care system, and completing prescription drug assistance program applications. Many students "know" that impoverished patients face barriers, but, in my experience, working through social obstacles with a patient firsthand creates a sense of ownership over the problem of inequitable access to care.
.
Student-run clinics require a tremendous investment by medical school administration and faculty, but I do think they offer a model to engage students in advocacy. Our clinic also provided mentorship and helped create a culture where working with marginalized populations was an encouraged career direction. A few related websites:
.
Society of Student Run Free Clinics: http://www.studentrunfreeclinics.org
.
Mount Sinai School of Medicine's EHHOP Clinic: http://icahn.mssm.edu/education/medical-education/east-harlem-health-outreach...
.
Would be interested to hear other ideas on this topic!
.
Jess

Attached resource:

Amol Navathe
Replied at 12:20 AM, 18 Jul 2013

@Nick. Good question. There is actually quite a bit in the ACA as well as some pre-ACA legislation (ARRA, i.e. the stimulus bill) re: scaling innovations. First point that's important to note is that the ACA created a new center within Medicare called the Center for Medicare and Medicaid Innovation (CMMI). Check out the website. One of the most important features of the legislation CMMI is after they test a delivery innovation, the Secretary of Health and Human Services has the authority to scale it up to the entire Medicare program without going through Congress (but she must go through the Medicare Actuary!). The idea here is to make Medicare more "nimble."

One of the earliest demonstration projects has been the Pioneer ACO program, which has been an effort to see how we can pay differently for care. Check out the recent article in the WSJ that describes early results.

Regarding data standards and how data can be used, this is a huge and still emerging field. You may have heard of "Big Data" as a buzz word. Many startups are trying to make strides in this space. For example, check out http://www.humedica.com/ (it was recently acquired). There are an amazing amount of applications, operational improvements in delivery is one, but comparative effectiveness research, safety and surveillance, are a couple of others to name a few.

Attached resources:

Amol Navathe
Replied at 12:32 AM, 18 Jul 2013

@Jonathan.

Tough question. On one hand, there are policy interventions (like global budgets or readmission penalties) that are explicitly designed to start aligning incentives. On the other hand, you are right that in a market based economy we will never align all competing interests and there will always be some ways to game the system.

Designing smart policy is one way to address as much of this problem as possible. Another area will be for organizations (either for profit or non-profit) to find collaborative ways to align missions. Some places have aligned delivery and research missions, for example, take http://www.regenstrief.org/. There are also multiple initiatives aimed at developing common standards for health data (see http://www.healthdataconsortium.org/). We will have to see how this plays out!

Heidi Behforouz, MD
Replied at 11:05 AM, 18 Jul 2013

Hi, everyone!
Thanks for the invitation to participate in this great discussion re our phenomenal opportunity to ride the health reform wave and improve health care and health in the United States.

My name is Heidi Behforouz. Im a primary care doctor and a member of the Division of Global Health Equity at the Brigham and Women's Hospital. Up until very recently, I was running the Prevention and Access to Care and Treatment (PACT) Project- the domestic adaptation of Partners In Health's "accompagnateur" model- in which we helped recruit community members to become community health workers and accompany struggling AIDS patients in Boston's inner city to better health at reduced cost to Medicaid.

I'm a strong believer in the health home model where the seat of power for good health is in the community and with the patients as opposed to in hospitals/clinics and with the delivery system. Only by engaging community and capacitating them can we truly address the psychosocialeconomicohistoricocultural determinants of health and achieve more patient-centered equitable care that is focused on wellness rather than disease management.

Feel free to read more re http://www.ssireview.org/articles/entry/realigning_health_with_care

We face many barriers in shifting the power structure and more fully integrating patients and community into our health care solutiosn. We've encountered many of these barriers (fiscal, cultural, legal, logistic) as we've provided training and technical assistance to delivery systems, communities, and payors who wish to integrate CHWs into their care teams. We are hopeful that we can participate in large scale demonstrations to further prove that this can be done and the Triple Aim be achieved...but there remains a lot of competition and push back from traditional biomedically trained providers and no mechanism for sustainable CHW reimbursement. We have a long way to go but feel the opportunity for doing this kind of work has never been greater.

Kate Long
Replied at 5:16 PM, 18 Jul 2013

Wonderful discussion!

I wanted to share a link to a report summarizing a forum hosted last year by Harvard Business School and Harvard Medical School on the topic of Healthcare Innovation.

One statement that emerged from the forum was: “The big idea is that there is no big idea”. Instead, attendees developed five key imperatives that they felt were the key drivers of future innovations.
1. Making value the central objective
2. Promoting novel approaches to process improvement
3. Making consumerism really work
4. Decentralizing approaches to problem solving
5. Integrating new approaches into established organizations

I've also attached an image from the report which highlights some opportunities for innovation that attendees felt would have a strong impact on quality, while controlling costs. Those opportunities include alternatives to fee-for-service, non-physician personnel, disease management, data analytics, and process improvements.

Would love to hear everybody's thoughts on these priorities, and the opportunities highlighted.

Attached resources:

Marie Connelly
Replied at 6:24 PM, 18 Jul 2013

Many thanks to all of our panelists and members for sharing such insightful questions and comments in our Expert Panel this week!

We look forward to continuing the conversation over the next day or so, but as many of our members may have missed the live-video session on Monday, I wanted to share a few key themes that came from that discussion:

* Empathy should underscore much of our approach to health innovation - it facilitates the development of innovations that are truly patient-centered and empower stronger relationship between patients and providers

* Systems are changing - perhaps more slowly than we might wish, but as reimbursement models begin incentivizing quality over quantity, we are able to move towards an approach that looks at providing value across the continuum of care, instead of in “short bursts” of interactions between patients, providers and systems.

* Focus on sustainability, both financial and regulatory - when developing innovative approaches to care delivery, consider early on how these will be supported over the long term, and commit to rigorous testing. Documentable successes can enable wider adoption and implementation in a conservative health care landscape.

* Collaborate - we don’t innovate alone. Building communities of innovators in healthcare, finding colleagues and collaborators with similar interests and complementary skill sets is instrumental in developing, testing, and implementing innovations.

Please share any additional questions or comments you have for our panelists - are there challenges we haven't addressed in this discussion, opportunities that are being overlooked? We look forward to hearing your thoughts!

Kapil Parakh
Replied at 7:53 PM, 18 Jul 2013

@Yesenia

There certainly are innovations designed in developing countries that have
been brought to the US (and other developed countries). This concept has
been termed "reverse innovation." A famous example is a EKG machine
developed by GE for villages in India that made its way to the US. Here is
a Harvard Business Review article on this:

http://www.antoniovidigal.com/drupal/cd/sites/all/PDFs/how_ge_is_disrupting_i...


There is also a book on the subject:

http://www.amazon.com/Reverse-Innovation-Create-From-Everywhere/dp/1422157644

Hope this helps.

Kapil Parakh
Replied at 7:59 PM, 18 Jul 2013

@June-Ho

Information overload is indeed a challenge as is finding the right experts.
Twitter is a good tool to focus in on an area of interest and engage with
experts. Evernote is a good tool to organize information. White papers and
reviews can provide some insights into best practices. However, there is a
substantial amount of nuance in health and the specific circumstances have
to be taken into consideration. Therefore, even when you do find the right
expert and information, it has to be placed into context.

Aaron Beals
Replied at 4:33 PM, 19 Jul 2013

Sam, Karen, Andrey, Julien, thank you all for sharing your experience with us through this panel.

I wanted to share this relevant blog post from the past week on HBR, which addresses a common challenge faced by many innovators trying to effect change within a large organization: commitment to the initiative in voice but not resources, which they call the "soft yes".

Aaron

Attached resource:

Marie Connelly
Replied at 2:57 PM, 22 Jul 2013

I'd like to thank all of our panelists and colleagues here in the community for such a rich and engaging Expert Panel this past week. The comments and questions shared throughout our video conversation and online discussion were incredibly thought-provoking, and highlighted a number of key challenges and opportunities in health innovation.

We will be working to summarize some of those key themes into a Discussion Brief (to learn more about GHDonline Discussion Briefs, please visit: http://www.ghdonline.org/discussionbriefs/) and will notify the community as soon as this summary is available.

In the meantime, we hope everyone will take a few moments to fill out a brief, 10 question, follow up survey, that will help us understand the impact of our Expert Panels, and how we can improve these panels in the future.

Please take the survey now by visiting: https://www.surveymonkey.com/s/YXR8TJQ

Many thanks again to our panelists, moderators, and everyone here in the community, for such an interesting discussion!

Marie Connelly
Replied at 4:26 PM, 2 Aug 2013

Just a reminder that our Expert Panel survey will be closing on Monday afternoon. Your feedback in these surveys is incredibly important to us, as it helps us to evaluate the impact of GHDonline Expert Panels and identify areas of improvement for future community events.

The survey has only 10 questions and will take less than 5 minutes of your time: https://www.surveymonkey.com/s/YXR8TJQ

Thank you for your feedback!

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