Jan. 26th, 2012 CARE INNOVATIONS SUMMIT - WASHINGTON DC

In late January 2012, I was priviledged to attend the inaugural Care Innovations Summit in our nation's capitol, Washington DC, co-sponsored by the Center for Medicare & Medicaid, West Wireless Health out of La Jolla, CA, and HealthAffairs, a pre-eminent medical journal.  The event website is www.hcidc.org .  As promised, the Care Innovations Summit delivered on its mission:

"Transforming healthcare delivery by invigorating the marketplace of ideas

1200 participants from all walks of life in healthcare were at the conference - doctors, nurses, social workers, medtech and pharma, government, CMS's Innovation center, etc. as well as 2400 people viewing some of the proceedings via Webcast.  As one participant said in the lobby between talks, "this meeting feels like a tipping point" in our nation's work to reform our healthcare system for better access, higher quality, and LOWER COST. 

The Center for Medicare and Medicaid Innovation is co-hosting the first ever Care Innovations Summit, an HCI-DC event, on January 26, 2012, in Washington, DC in collaboration with the Office of the National Coordinator at HHS, The West Wireless Health Institute, and Health Affairs to facilitate dialogue and drive action towards the three-part aim:

Better care and better health at lower cost through continuous improvement."

Atul Gawande, Surgeon and Health Researcher at Brigham and Women's Hospital, Writer for the NYT and author of 3 books.
Dr. Gawande kicked off the content session of the meeting with excellent, humorous commentary from his perspective as a physician as well as a writer.  Dr. Gawande opened with the observation that our healthcare system was designed during the time of Lewis Thomas, pre-penicillin, where the model was predominantly Dr., RN, prescription.  Now we have 13,600 conditions and service lines, and 6000 drugs.  In 1970 it took 2 caregivers to take care of a patient in the hospital; in the 1990's, 15.   He shared a particularly insightful analogy by saying that doctors are used to being cowboys, but now we need pit crews instead of heros.  We need systems, not components.  "What we have how is a pile of expensive junk that doesn't go anywhere."

Clinicians can't handle it all on our own, and we are baffled by cost. There is hope, though, in that Dr. Gawande notes that when you look at the bell curves of results vs. the bell curves of costs generated by various health institutions for care, the curves don't match - THEREFORE high cost does not equal high quality.  We don't necessarily need to spend a lot of money to produce great outcomes.  These observations, in my mind, point again to the fact that our HC system needs a MANUFACTURING OVERHAUL, with technologies that are designed to EXPEDITE THE PROCESS of healthcare, in order to improve quality as well as reduce cost.

Dr. Gawande continued by exploring the system skills that are required:

1. Data for recognizing success and failure - now in healthcare it's like we're driving a car with a speedometer that tells us the speed of cars around you 4 years ago
2. Identify key area of failure and find solutions.  Look to other industries such as the airlines.  Use checklists for surgeons and other procedures (see his book "The Checklist Manifesto," where he is famous for introducing the concept that surgeons and teams should introduce themselves before each surgery as part of the checklist.)  Checklist values: humility, because everyone makes mistakes; discipline to do things the same way every time; and teamwork.
3. Implement discoveries - overcome cultural resistance. 

What about the $?  Define great performance - great care - and then define the financing behind it.  This is the soul of American healthcare.  Achieve what we mean by great care by innovating towards it.

Rick Gilfillan, Director if CMS Center for Innovation
Dr. Gilfilla, as a former MD and now in charge of Innovation at CMS, made a few pointed remarks that I took note of:

• With diabetes care, we can pay $300/month for good care or $xx,xxx for an amputation - which would you prefer, as both a patient and a payor?
• The journey we are on today to tomorrow has 3 parts: Better HealthCare, Better Health Outcomes, and Lower Cost.  Data driven by EHR's will help us get there - Meaningful Use, Partner with Patients, Bundled Payment, Primary Care, and ACO's.
• Innovation Value?  "People will not adopt innovation unless they see VALUE in it."

Todd Park, CTO, U.S. Dept of Health & Human Services
A high-energy guy, Todd opened his discussion with "at CMS, DATA is the ROCKET FUEL for innovation.  With data, we can identify the problems and opportunities, set goals, and measure achievement."  CMS is working on unleashing its data to improve healthcare. Work examples:

1. VA system - Blue Button for patients to Download my Data, launched Jan. 2011.  Includes claims and EHR.  500k patients have used it.
2. Data for ACO's & claims data for patients.
3. Performance measurement.
4. Health initiatives warehouse for U.S.

Care Delivery / PCP and Cancer Case Studies
The conference included two panels on the above topics as well, with some key discussion and dialogue from amazingly visionary people on the types of change we need to improve healthcare:

• With restructuring towards ACO's (Aetna's of this world) will ensure the survival of the most adaptable.
• Significant change required for physicians to be effective - ChenMed practice:
• invest in patients up front
• have a physician culture of transparency to deliver outcomes
• technology to support goals
• Capitation, subcapitation, compete for business
• Give Dr's time - the doctor doesn't want to manage the visit, they just want to take care of patients
• Communicate electronically
• Rewire the system so incentives are aligned
• Culture shift to outcomes - Protocols - EHR-directed care pathways
• Get people to care more about their well-being.  50% compliance for FREE drugs post-AMI; why don't people take responsibility for themselves?

IGNITE Talks also challenged the audience to participate in competitions for new solutions, with prizes - look at the agenda for the players in these.

West Wireless Messaging
West Wireless, which has the mission of lowering healthcare costs through wireless technology, also announced their new policy center in DC with brochures sprinked around the lobby. Key messages included:

Clearly West Wireless has a thorough vision for where America can innovate to transform healthcare, and I personally apprecitate their leadership with our federal government to make healthcare great for all of us.  Join us in the journey!

All in all, the most significant, relevant conference I have been blessed to attend in a number of years.  We are living in exciting times.  Get on the healthcare reform through innovation bandwagon!