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CMS Health Care Innovation Challenge Grant - Preliminary Proposal


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A preliminary proposal for an application to the Health Care Innovation Challenge sponsored by CMS. Focus of this proposal include gestational diabetes, maternal obesity, postpartum weight loss, and as well as patient engagement / health literacy

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CMS Health Care Innovation Challenge Grant - Preliminary Proposal

  1. 1. Prepared by: Chukwuma Onyeije, M.D. Atlanta Perinatal AssociatesMorehouse School of Medicine
  2. 2. CMS Health Care Innovation Challenge Grant. Sponsored by:LINK:
  3. 3. An Overview of American Health Care in 2011• Greatest Acute Care in the World: – People come from around the world to be treated• HOWEVER – 46 million Americans lack coverage• OTHER PROBLEMS WITH CARE DELIVERY: • Uncoordinated – • Fragmented delivery systems • Variable quality • Unsupportive – of patients and health care practicioners • Unsustainable – Costs rising at twice the inflation rate 2
  4. 4. Components of a BETTER System• Affordable• Accessible – to care and to information• Seamless & Coordinated• High Quality – timely, equitable, safe• Person and Family-Centered• Supportive of Providers in serving their patients’ needs• Engaged with the community and fulfilling its population’s unique needs 3
  5. 5. What is the Role of the CMS Innovation Center? Better care and better health atreduced costs throughimprovement.LINK: 4
  6. 6. How will the CMS Innovation Center Improve Care?• Better health care: – Improving all aspects of patient care, (as defined by the Institute of Medicine).• Better health: – Encouraging healthier lifestyles in the entire population, including increased physical activity, better nutrition, avoidance of behavioral risks, and wider use of preventative care.• Reduced costs: – Promoting preventative medicine, better record keeping, and improved coordination of health care services, – Reducing waste, inefficiency, and miscommunication. 5
  7. 7. Measures of SuccessBetter health care - Improve individual patientexperiences of care along the IOM 6 domains ofquality: Safety, Effectiveness, Patient-Centeredness,Timeliness, Efficiency, and EquityBetter health - Focus on the overall healthoutcomes of populations by addressing underlyingcauses of poor health, such as: physical inactivity,behavioral risk factors, lack of preventive care, andpoor nutritionReduced costs - Lower the total cost of care forMedicare, Medicaid and CHIP beneficiaries byimproving quality of care and patient experience 6
  8. 8. Transforming Health CareINNOVATORS across the country are developing NEW & EFFECTIVE care delivery and payment models •These innovations offer us pathways to building a future health system that is more effective than the current system at improving health care, health, and lowering costs. 7
  9. 9. What is the Health Care Innovation Challenge?• The Innovation Center has received over 500 suggestions and ideas from across the country.• This initiative is an open solicitation to innovators across the country to identify and test innovative service delivery/payment models including infrastructure support.• This Challenge will strengthen the Innovation Center’s current menu of options and will address unique needs of communities and populations across the country. 8
  10. 10. Objectives of the Health Care Innovation ChallengeEngage a broad set of innovation partners to identify andtest new care delivery and payment models that originatein the field and improve quality while lowering the totalcost of care.Support innovators that can rapidly deploy careimprovement models within six months of the awardthrough new ventures or expansion of existing efforts.Identify new models of workforce development, trainingand deployment that support new models either directly orthrough new infrastructure activities. 9
  11. 11. Nature of Innovation Challenge Grant Funding$1 billion to fund innovative service delivery and payment models to support those innovative modelsSuccessful proposals will •Define and test a clear pathway to sustainability (higher quality and lower total system cost) •Demonstrate care improvement within 6 months of award •Support care transformation with enhanced infrastructure activity •Rapidly develop and deploy a health care workforceProposals are encouraged to focus on high-cost/high-risk populations •Including those with multiple chronic conditions, mental health or substance abuse issues, poor health status due to socioeconomic and environmental factors, or the frail elderly 10
  12. 12. Nature of Innovation Challenge Grant Funding• Priority will be given to projects that rapidly hire, train, and deploy new types of health care workers• Focus on improved care coordination, prevention, and care process re-engineering,• Serving high-risk individuals with complex health care needs using infrastructure such as electronic health records, telemedicine, and medication reconciliation systems. 11
  13. 13. Nature of Innovation Challenge Grant Funding• Awards will range from $1 million to $30 million over three years.• No non-federal “matching” requirement.• Each approved project will execute a cooperative agreement with CMS, will be subject to monitoring of quality and costs based on a standard minimum data set of performance indicators, and must cooperate with independent evaluators to be contracted by CMS 12
  14. 14. OUR PROPOSAL
  15. 15. OBJECTIVES• Quantifiably reduce morbidity due to major drivers of adverse perinatal outcome in low income women over a three year period.• Utilize cutting edge technology to enhance patient education• Introduce the concepts of self tracking, participatory medicine and community support to low income women.• Enhance health literacy. 14
  16. 16. OBJECTIVES• Use quantifiable data to drive care decisions and improve outcomes.• Allow patients to use emerging social technology to improve communication about health and build lasting communities for continued care in a non-medical context• Reduce cost by improving outcome via the use of inexpensive and readily available technology 15
  19. 19. Gestational Diabetes
  20. 20. GESTATIONAL DIABETES:• Background –• Scope of the problem – Affects up to 4% of pregnancies. – Increased risk for perinatal complications – More common in African-American, Hispanic and Low income patients. – 45 percent risk of recurrence with the next pregnancy – 63 percent risk of developing type 2 diabetes later in life. 19
  21. 21. GESTATIONAL DIABETES: What can be done?• Introduce a mobile health component to current care protocols• Allow patients to record values for instant / ongoing interaction with care givers.• Allow patients to interact with similar patients. 20
  22. 22. GESTATIONAL DIABETES: What can be done?• Provide clinicians with tools to rapidly assess glucose control and institute timely interventions.• Reduce delays in care seen in current care plans• Reduce cost of current care plans• Reduce hospitalization for diabetes. 21
  23. 23. A Template for Success:For details see:
  24. 24. GESTATIONAL DIABETES:Our Proposal:• Provide patients with smart phones equipped with diabetes management software.• Phones can be rented to patients or subsidized via grant funding.• Software solutions will track blood sugar, dietary choices, maternal weight, mood and subjective assessment of compliance.• Tracked values and parameters will provide input for patients to self-adjust their care• Software will allow for patients to share useful practices and concerns with clinicians and other patients• Software will automatically track and provide clinicians with summaries and detailed information of outlying values.• Similar programs have reduced the need for hospitalization in patients with diabetes.• Intensive care of diabetes has been shown to reduce perinatal complications and health care cost• Economies of scale and new technology make this management feasible and afordable 23
  25. 25. GESTATIONAL DIABETES:Our Proposal:• Software solutions are already available for FREE. 24
  26. 26. INNOVATION: How our proposal changes the paradigm forGestational Diabetes Care for Patients?• Emphasis on ongoing education• Greater emphasis on patient participation• Use of readily available technology 25
  27. 27. INNOVATION: How our proposal changes theparadigm for Gestational Diabetes Care forProviders?• Access to empirical data to quantify and monitor effectiveness of intervention in real-time• Open Source communication across the country to similar programs• Rapid iteration and change in protocol based on input from all stake holders 26
  28. 28. COST SAVINGS: How our proposal assuresaffordable innovation for Gestational Diabetes• Reduced need for hospitalization• Reduction in utilization of outpatient acute care resources• Re-useable technology• Techniques to allow patients to sustain techniques after pregnancy is completed• Program is reproducible in a variety of clinical settings. 27
  30. 30. Obesity and Postpartum Weight Loss• Background – pregnancy-a-teachable-moment/ – Identification of Obesity during pregnancy represents a “Teachable Moment” – Effective interventions for postpartum weight loss can reduce the burden of chronic illness 29
  31. 31. Obesity and Postpartum Weight Loss• Scope of the problem – Obesity is America’s newest and fastest- growing epidemic – Obesity fuels a multitude of other diseases – Children of obese parents have a strong tendency toward obesity and a multitude of resultant complications. – Preventive measures are straightforward and simple but have not been implemented widely or effectively. 30
  32. 32. Obesity and Postpartum Weight Loss: What can be done?• Incorporate cost effective and proven methods of prolonged fat loss into prenatal care. – Weight watchers, Quantified self, ----• Provide patients with methods to track weight loss and tools to self assess personally effective strategies• Utilize incentives to facilitate compliance• Allow patients to record values for instant / ongoing interaction with care givers. 31
  33. 33. Obesity and Postpartum Weight Loss:What can be done?• Allow patients to interact with similar patients.• Use low cost readily available technology to allow clinicians to monitor progress BETWEEN clinical visits• Reduce delays in care seen in current care plans• Reduce cost of current dietary interventions for weight loss.• Provide early identification of patients with problematic weight loss profiles. 32
  34. 34. Obesity and Postpartum Weight Loss: OUR APPROACH: Quantified Self Strategies + The Hawthorne Effect + Education / Accountability =Effective Interventions and Sustainable Postpartum Weight Loss 33
  35. 35. What is theQuantified Self?A community of individuals who share self knowledge through self- tracking.For more information:
  36. 36. The Hawthorne Effect: Observation Changes BehaviorObservationChangesBehavior 35
  37. 37. Obesity and Postpartum Weight Loss:Our Proposal:• A 6 month intensive, physician guided, educational program modeled after successful nutritional strategies for sustained weight loss• Offered to low income women following pregnancy.• Identify patients while still pregnant• Hit the ground running on day of delivery. 36
  38. 38. Obesity and Postpartum Weight Loss:Our Proposal:• Incorporate weight loss as a part of ongoing neonatal and postpartum care.• Classroom instruction, Telephone/Telemedicine consultation, Online Educational resources 37
  39. 39. Obesity and Postpartum Weight Loss:Our Proposal:• Connect educational resources to patient’s chosen social media – (Facebook, Twitter, Google+)• Emphasis on increased activity (walking), dietary modification and self-tracking. 38
  40. 40. Obesity and Postpartum Weight Loss:Available Tools: Internet enabled scale Weight management & Food tracking software Internet enabled pedometer Portable sleep monitor 39
  41. 41. Obesity and Postpartum Weight Loss:Our Proposal:• Provide patients with tracking tools at low cost or no cost defrayed by grant funding.• Instruct patients regarding self tracking• Monitor with “Multiple Eyes” to exploit the Hawthorne Effect – Patient – Family members – Fellow patients – Health care providers• Make individual adjustments in care based on data obtained. 40
  42. 42. INNOVATION: How our proposal changes theparadigm for Postpartum Weight Loss• Patient empowerment• Low cost tools• Intensive education and monitoring• Exploit the “Teachable Moment” and the Hawthorne Effect• Constant contact between clinical encounters 41
  43. 43. COST SAVINGS: How our proposal assuresaffordable innovation for Postpartum Weight Loss• Sustainable interventions• Small changes compounded by repeated execution• Tracking of effective interventions with rich data• Publish success and build evidenc for what works 42
  45. 45. EDUCATION AND ENGAGEMENT:• Background: – Improved compliance with medical care can be achieved with improved health literacy• Scope of the Problem: – Health literacy is a barrier to optimal care in low income communities. – Health literacy affects all aspects of clinical care – Few studies documenting methods to improve health literacy in low income women. 44
  46. 46. EDUCATION AND ENGAGEMENT:What can be done?• Encourage participation• Use multiple methods to address comprehension• Leverage low cost technology• Enlist churches, community and civic organizations 46
  47. 47. EDUCATION AND ENGAGEMENT:Our Proposal• Utilize the previously described interventions• Document effectiveness prospectively• Publish results• Obtain insights to develop testable hypotheses. 47
  48. 48. NEXT STEPS:• Letter of intent to CMS is due: December 19th, 2011 at 11:59 PM• Discussion and modification of this proposal• Identification of resources and support staff• Creation of final protocol• Cost analysis• Final grant proposal due: January 27, 2012• Purchasing / Staffing / Implementation upon selection 49
  49. 49. Interested?• Contact me by email:• Indicate availability for further discussion / planning• Next CMS Webinar: – Monday, December 19 , 2011 2-3pm EST• CMS Resources: nnovation-challenge/ 50