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

1. Prepared by:
Chukwuma Onyeije, M.D.
Atlanta Perinatal Associates
Morehouse School of Medicine

2. CMS Health Care
Innovation Challenge
Grant.
Sponsored by:
LINK: http://www.innovations.cms.gov/initiatives/innovation-challenge/

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. 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
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5. What is the Role of the CMS Innovation Center?
Better care
and better
health at
reduced costs
through
improvement.
LINK: http://innovations.cms.gov/ 4

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.
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7. Measures of Success
Better health care - Improve individual patient
experiences of care along the IOM 6 domains of
quality: Safety, Effectiveness, Patient-Centeredness,
Timeliness, Efficiency, and Equity
Better health - Focus on the overall health
outcomes of populations by addressing underlying
causes of poor health, such as: physical inactivity,
behavioral risk factors, lack of preventive care, and
poor nutrition
Reduced costs - Lower the total cost of care for
Medicare, Medicaid and CHIP beneficiaries by
improving quality of care and patient experience
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8. Transforming Health Care
INNOVATORS 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.
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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.
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10. Objectives of the Health Care
Innovation Challenge
Engage a broad set of innovation partners to identify and
test new care delivery and payment models that originate
in the field and improve quality while lowering the total
cost of care.
Support innovators that can rapidly deploy care
improvement models within six months of the award
through new ventures or expansion of existing efforts.
Identify new models of workforce development, training
and deployment that support new models either directly or
through new infrastructure activities.
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11. Nature of Innovation Challenge Grant Funding
$1 billion to fund innovative service delivery and payment models
to support those innovative models
Successful 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 workforce
Proposals 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
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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.
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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
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14. OUR PROPOSAL

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.
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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
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17. OUR AREAS OF INTEREST:
GESTATIONAL DIABETES
OBESITY AND POSTPARTUM WEIGHT LOSS
PATIENT EDUCATION AND ENGAGEMENT

18. Gestational
Diabetes
UP-
OBESITY
CIP
& EDUCATION/
WEIGHT ENGAGEMENT
LOSS

19. Gestational
Diabetes

20. GESTATIONAL DIABETES:
• Background
– http://prezi.com/z89fo9gxmwka/gestational-diabetes/
• 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.
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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.
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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.
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23. A Template for
Success:
For details see: http://mobihealthnews.com/15116/medicaid-patients-reduce-hospitalizations-with-welldoc/

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
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25. GESTATIONAL DIABETES:
Our Proposal:
• Software solutions are already available
for FREE.
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26. INNOVATION: How our proposal changes the paradigm for
Gestational Diabetes Care for Patients?
• Emphasis on ongoing education
• Greater emphasis on patient participation
• Use of readily available technology
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27. INNOVATION: How our proposal changes the
paradigm for Gestational Diabetes Care for
Providers?
• 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
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28. COST SAVINGS: How our proposal assures
affordable 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.
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29. OBESITY
&
WEIGHT
LOSS

30. Obesity and Postpartum Weight Loss
• Background
– http://prezi.com/v9fgrfherwtr/obesity-during-
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
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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.
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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.
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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.
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34. Obesity and Postpartum Weight Loss:
OUR APPROACH:
Quantified Self Strategies
+
The Hawthorne Effect
+
Education / Accountability
=
Effective Interventions and Sustainable
Postpartum Weight Loss
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35. What is the
Quantified Self?
A community of
individuals
who share self
knowledge
through self-
tracking.
For more information: http://www.guardian.co.uk/science/2011/dec/02/psychology-human-biology

36. The Hawthorne Effect: Observation Changes
Behavior
Observation
Changes
Behavior
35

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.
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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
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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.
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40. Obesity and Postpartum Weight Loss:
Available Tools:
Internet enabled
scale
Weight management &
Food tracking software
Internet enabled
pedometer
Portable sleep monitor
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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.
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42. INNOVATION: How our proposal changes the
paradigm 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
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43. COST SAVINGS: How our proposal assures
affordable 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
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44. EDUCATION/
ENGAGEMENT

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.
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47. 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

48. EDUCATION AND ENGAGEMENT:
Our Proposal
• Utilize the previously described
interventions
• Document effectiveness prospectively
• Publish results
• Obtain insights to develop testable
hypotheses.
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50. 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
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51. Interested?
• Contact me by email: onyeije@gmail.com
• Indicate availability for further discussion /
planning
• Next CMS Webinar:
– Monday, December 19 , 2011 2-3pm EST
• CMS Resources:
http://www.innovations.cms.gov/initiatives/i
nnovation-challenge/
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