Integrating Research and Practice Health System Leaders Working Toward High-Value Care: Workshop Summary (2015) / Chapter Skim
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3 Continuously Learning Health Care: The Value Proposition
3 Continuously Learning Health Care: The Value Proposition
Pages 31-44
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From page 31... ...
• "What we want to do is fail forward fast," Thomas Graf said. "The concept is if you are not failing, you are not doing enough." Graf added that what is important is to learn some thing from failure, to fail forward, and then keep iterating to the best design possible.
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From page 32... ...
Session moderator Sarah Greene, senior program officer at PCORI, began this discussion with a proposal for how to create a value proposition for a continuously learning health care system. Three panelists -- Thomas Graf, chief medical officer for population health and longitudinal care service lines at the Geisinger Health System; Rita Redberg, professor of medicine and director of women's cardiovascular services at the University of California, San Francisco (UCSF)
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From page 33... ...
process of continuous learning is the model that can help achieve the triple aim of better care, lower costs, and improved health and to address other goals that are important to health system leaders. The important elements of a value proposition, Greene explained, are focused on the needs of the customer; they include a promise of value to be delivered and a belief by the customer that value will be experienced, according to factors that are important to the customer.
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From page 34... ...
It is not automatic. There need to be some sustaining features." Some of those sustaining features can be found in three organization conditions that support learning: time allocated to exploration, discovery, and learning; a physical and social environment that enables one to be a "student"; and core values that appreciate learning in its own right and encourage curiosity, knowledge, and discovery.
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From page 35... ...
. the stakes have never been higher." Greene predicted that PCORnet is going to trigger such a change and said, "What I have seen already is that PCORnet is creating this climate of trust and humility from the outset and that it is purposely uniting the perspectives of CEOs, researchers, and patients to develop a compelling value proposition." INCREASING EFFICIENCY AND ELIMINATING WASTE To provide context for his comments, Thomas Graf began by explaining that the Geisinger Health System is a 1,000-physician medical group that owns 6 hospitals and a 400,000-member health plan.
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From page 36... ...
The bottom line, Graf said, "is that we have created a compelling model that creates better care for patients, which is a value proposition that we need to adhere to, and easier care for medical professionals." He added that his one complaint about the triple aim is that it omits any mention of health professionals. "If we reduce total cost of care, we improve quality, and we improve patient experience, but we do it on the backs of the health
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From page 37... ...
Achieving the triple aim plus requires taking an unreliable chaotic practice and reducing the variability of care by eliminating the 30 to 40 percent of what patients experience that adds no value to the patients. Automation plays a role, and so does better delegation across all members of the health care team, including doctors, nurses, front desk staff, and even patients.
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From page 38... ...
She said she believes that the use of "report cards" that provide feedback data on the usage of common testing has the potential to help physicians choose wisely without adding significant burden. Switzerland, she noted, now issues report cards that show doctors how they compare with other physicians on a variety of measures.
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From page 39... ...
The challenge is to disseminate the knowledge needed to determine value in the most effective manner. The Blue Cross Blue Shield Association's Center for Clinical Practice spends time working with all of the 37 Blue Cross Blue Shield plans to identify leading practices with some measure of validation and to disseminate it quickly.
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From page 40... ...
Haywood suggested that reward does not have to be strictly monetary and that it could be in the form of social capital. Fihn's question prompted Robin Wittenstein of the Penn State Hershey Health System to ask the panelists if they had any ideas on how to develop knowledge markets so that learning can be disseminated more rapidly to the eclectic mix of people who have to be involved in researching, understanding, and then implementing new ideas.
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From page 41... ...
Krishnan also commented that as systems become known for their research and improved quality, it should give them a competitive advantage; thus an effort to understand how to place a value on that advantage could help support the infrastructure needed to generate new knowledge, he said. Lorraine Johnson, a patient representative for PCORI, said that the question of how patients value research is context dependent and depends on balancing risk and reward for each patient.
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From page 42... ...
trial that Susan Huang discussed in the workshop's R opening session are straightforward enough that they should be applicable across health care systems, but for a PCMH it is likely that each health system will have to develop and test its own unique implementation that takes into account local factors, patient mix, institutional culture, and other factors. "I think there can still be a learning experience from sharing," she said, "but you do need more granular data for complicated interventions such as PCMH." Graf agreed, but wondered if it would be possible to look across PCMH models and draw some conclusions about core elements that are critical for successful interventions.
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From page 43... ...
I think we are a little ways away from that." Summarizing the discussion, Greene listed the many incentives that she heard during the session that could feed into the value proposition. These included social capital, reputation management, ease and speed of information gathering, making it simple and easy, monetary savings, better care, and lower anxiety.
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