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Taking Collaborations to Scale to Improve Population Health

This document discusses scaling collaborations to improve population health. It provides an agenda for a workshop on the topic, including framing the issue using Doug Engelbart's concept of Networked Improvement Communities. It then outlines two key efforts - the CDC's 6|18 Initiative and the 100 Million Healthier Lives Movement. The document discusses key elements of spreading and scaling up initiatives, providing examples from the field. It poses questions to prompt discussion around interesting ideas and activating whole-of-nation efforts through local action.

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Taking Collaborations to Scale to Improve Population Health Ahmed Calvo, MD, MPH | Marianne McPherson, PhD, MSPH | Laura Seeff, MD #PPBMeeting
Learning Objectives At the end of this workshop, you will be able to:  Discuss technical methodologies and adaptive, relationships-based approaches to achieving spread and/or scale  Apply principles of taking collaborations to scale to your local context
Workshop Agenda  Framing: Doug Englebart’s Networked Improvement Communities  Overview of CDC’s 6 |18 Initiative and 100 Million Healthier Lives  Key elements of spread and scale up, with examples from the field  Workshopping your spread & scale-up insights: Innovation disco - breakout groups – and sharing out to a conversation-of-the-whole
Questions-to-run-on How we would like you to listen and engage: • What is the one most interesting idea that popped into your brain as you heard the presentations as applicable to your work? • How do you activate a “whole-of-nation” effort with action at the local community?
5 Ahmed Calvo Taking Collaborations to Scale to Improve Population Health Framed Using Doug Engelbart’s Concept of Networked Improvement Communities (NICs) A Network-Centric Approach leverages the People-Centered Internet (PCI) and Information-Communication-Technology (ICT) Ahmed Calvo,MD,MPH Director,National Health Leadership and Public Service Fellowship Haas Center for Public Service,Stanford University Senior Fellow,Thought Leadership and Innovation Foundation Senior Medical Officer,Health Resources and Services Administration U.S.Department of Health and Human Services
Taking Collaboration to Scale After framing for this interactive session, we will focus on two key efforts: •CDC’s 6/18 Campaign •100 Million Healthier Lives Movement, convened by IHI – Laura Seef, MD – Director, Office of Systems Collaboration – Centers for Disease Control & Prevention (CDC) – Marianne McPherson, PhD, MSPH – Senior Director of Implementation, 100 MLives – Institute for Healthcare Improvement (IHI)
Key Principles For Success • Spread and scale-up happen at the speed of trust – And takes place via a network process (AKA net-centric method). • Technical and strategic components are important – particularly for cross-sector collaboration • But solid trust relationships are the true secret ingredient • We will frame these principles for spread and scale-up – using a variety of networked insights
Key Definitions • Doug Engelbart – concept of “networked improvement communities” – two co-evolving improvements of both IT systems and human systems – “Augmented Intelligence” (AI) concept in Augmentation Research Center laboratory at SRI International (Stanford Research Institute) – and of “bootstrapping” as start-up method for a network or center. • FQHCs (Federally Qualified Health Centers) – sites of Community Health Centers (CHCs); over 9,000 FQHCs with active patient volume of ~ 23 million patients and over 90 Million patient-visits/yr – 170,331 staffers (2014 UDS numbers). Funded by HRSA (Health Resources and Services Administration) – an agency in the US Department of Health and Human Services (HHS).
Breakthrough Series (BTS) Collaborative Model Drawing on a napkin by Paul Batalden over 20 years ago – from Don Berwick, Institute for Healthcare Improvement (IHI)
HRSA Health Disparities Collaboratives added ICT support to learning process – as key needed infrastructure (1998) Select Topic Planning Group Identify Change Concepts Participants Pre-work LS 1 P S A D P S A D LS 3LS 2 Rudimentary ICT Supports E-mail Visits Phone Assessments Senior Leader Reports Time for setting aims, allocating resources, preparing baseline data leading to the first 2 day meeting. Action period 1: Adapt and test the ideas for improved system of care Action period 2: further develop the system of care at the pilot site and spread the system to other sites
Evolved Perspective of the HRSA Health Disparities Collaboratives as a National Framework for Change (1998-2008) Establish National Agenda National FACULTY Identify Measures, Priorities Evidence-Base Developed by Partners Pilots Evolved ICT Infrastructure www.healthdisparities.net ° Regional Infrastructure ° www.hdnr.org ° Phone TA ° Monthly Measures and Senior Leader Reports ° National Faculty Consultants ° Topical Conference Calls/Webinars Small scale pilots for the purpose of developing the change package to facilitate rapid deployment of a new evidence-base Adapting Evidence Base -- Chronic Care Model, Model for Improvement Supporting National Learning Community For Best Practices Population Health Mgt. •Registry •Reporting Executing National Health Policy •Partnerships National Vision For Healthcare Transformation
ICT and Policy Change Infrastructure at HHS for ACA Implementation – a National Collaborative Framework (2009-2016) ACA Passed (Affordable Care Act) Networked National FACULTY Identify Measures, Priorities (NQF Contract) Evidence-Base Developed by Partners (e.g. PCORI) CMS Pilots Further Adapted ICT Infrastructure ° National Leadership Network shifted to CMS ° State Infrastructure ° www.heathycommunities.org ° Link with QIOs ° National Measures Massive use of Webinars – and maybe shifting to MOOCs Small scale pilots and demonstrations for the purpose of developing the change package to facilitate rapid deployment of a new evidence-base and massive scale-up via CMMI at CMS Community Adapting Evidence Base-- via foundations (private $$) Supporting National Learning Communities (Partnership for Patients) EHRs-HIEs Pop Health Mgt. •Registries •Reporting •Analytics Nation’s NQS & NPS – With ONC Standards Incentives Going from Healthcare To Health - as a Vision
Envisioning Collaboration via the PCI -- A Collaborative NIC Framework (2017) Topic: Health – in a digital age Planning Group: US Citizenship Change Concepts: Community Action Evidence-Base Developed by Digitally Native Citizen-Partners (using: PCI, smart phones, apps) Pilots Further Evolved (Decentralized) ICT Infrastructure ° Evolved Leadership Network ° Evolved Infrastructure ° ° New Metrics ° Massive use of Webinars – and MOOCs ° Small scale pilots and demonstrations for the purpose of developing detailed change package to facilitate rapid deployment of a new evidence-base for massive scale-up Community Adapting Evidence Base-- via foundations (private $$) Supporting Learning Communities -- as “going concerns” -- already in action Better ICT: - PCI - Collaborate.org - EHRs •Registries •Reporting •Analytics US Culture Of Health Going from Healthcare To Health - in context of new realities
Culture of Health Entities exist already working in the private sector: •100 Million Healthier Lives Movement •Communities Joined in Action (CJA) •New Breakthrough Collaboratives (Foundations) •Healthy Communities Collaborative for America, the AIMM Collaborative, and PCI •Wellbeing in the Nation (WIN) Initiative •Creating Wellbeing Leadership Group •Collaborate.org
Centers for Disease Control and Prevention 2nd Annual Practical Playbook Meeting - Improving Population Health: Collaborative Strategies That Work Scaling Collaboration For Greater Impact - CDC’s 6|18 Initiative: Accelerating Evidence into Action, June 1, 2017 Laura C. Seeff MD Director, Office of Health Systems Collaboration CDC Office of the Director
Opportunity Knocks: The Transforming Health System  Increased health care coverage  Payment reform: volume  value  Clinical care models more patient- centered/comprehensive  More opportunities to deliver prevention 46% 19% 13% 8% 10% Employer Medicaid Medicare Other Uninsured “Other” Insurance Coverage: • Other Private – 6% • Other Public – 2% About 90% of All Americans are Insured as of 2014 "Health Insurance Coverage of the Total Population." State Health Facts. The Kaiser Family Foundation, Juliette Cubansk; Barbara Lyons; Tricia Neuman; Laura Snyder; Anne Jankiewicz; David Rousseau. (2015). Medicaid and Medicare at 50. The Journal of the American Medical Association, 314(4), 328. doi:10.1001/jama.2015.8129
Another Major Trend: Public Health Evolution  Recession cuts unrestored – 52K fewer jobs  48% locals reduced public health services in 2012  29 states decreased public health budgets in 2012
6 18High-burden health conditions | Evidence-based interventions that can improve health and save money  Establish sustainable cross-sector partnerships between public health and health care purchasers, health plans, and providers to address shared health priorities www.cdc.gov/sixeighteen; Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton 2015. CDC’s 6|18 Initiative: Accelerating evidence into action. National Academy of Medicine, Washington, DC. http://nam.edu/wp-content/uploads/2016/02/CDCs-618- Initiative-Accelerating-Evidence-into-Action.pd Collaboration between public health, health care purchasers, payers, and providers to promote adoption of evidence-based interventions  Improve health and control costs using specific evidence-based interventions
6 18High-burden health conditions | Evidence-based interventions that can improve health and save money www.cdc.gov/sixeighteen; Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton 2015. CDC’s 6|18 Initiative: Accelerating evidence into action. National Academy of Medicine, Washington, DC. http://nam.edu/wp-content/uploads/2016/02/CDCs-618- Initiative-Accelerating-Evidence-into-Action.pd Collaboration between public health, health care purchasers, payers, and providers to promote adoption of evidence-based interventions Example
High- burden Preventable Scalable Purchasers & payers Costly
Eighteen Evidence-Based Interventions
State Medicaid – Public Health Department Implementation Launched February 2016:  Early Progress – Baseline data being collected – State Plan Amendments – Managed Care Organization contractual negotiations – New scope of practice legislative authority – Member and provider education tools and training  Upcoming – Staged expansion – Shared learning platform CO SC MI LA MA RI MN GA NY GA 3 Focus Areas: Tobacco, Asthma, & Unintended Pregnancy Prevention Action Plans State Medicaid Agency & Public Health Programs Teams9
Evaluation and Theory of Change State readiness to change payment Payment change for 18 services Increased provider delivery and patient utilization of services Improved health outcomes Decreased costs
– Payer-specific/multi-payer initiatives – Initial focus: DPP, HTN & asthma control – Shared learning platform – Added issues: behavioral economics, provider engagement, targeted member engagement Expanding 6/18 to commercial payers
Public Health and Health System Complementary Roles PUBLIC HEALTH  Contributed condition- specific subject expertise  Translated epidemiologic evidence into benefits for coverage  Developed awareness campaigns targeting providers and patients  Promoted linkages with community services MEDICAID AGENCY  Developed a business case for chosen interventions  Utilized available policy levers to improve coverage and promote increased uptake of services  Engaged with Medicaid managed care plans to enhance benefits  Engaged providers and members
Engagement Preparation Identify Evidence-Based Intervention  Significant disease burden  Strong health & cost evidence associated with intervention  Fills current gap Identify key purchaser-payers  Assess likely receptivity  Align with purchaser-payer priorities  Match burden of condition and insured population  Prepare customized case Consider  Provider engagement & provider supply  Level of support from key decision makers  Measurability Likelihood of success  Readiness for rapid change  Resources required for success
CO SC MI LA MA RI MN GA NY GA NC AK TX NV UT MD District of Columbia Los Angeles County Health Department Expansion (spread and scale) to New Localities
Visitthe6|18Website CDC.gov/SixEighteen Evidence Summaries Detailed summaries of the 6|18 interventions, based on scientific studies and expert consultations FAQs Answers to common questions about the 6|18 Initiative including goals,strategy, and the intervention selection process Coming soon! Additional Tools: Readiness checklist How to be a 6|18 Partner
Taking Collaborations to Scale to Improve Population Health 2017 Practical Playbook National Meeting ~ June 1, 2017 Spread and Scale Up: Lessons from 100 Million Healthier Lives Marianne McPherson, PhD, MS Senior Director, 100 Million Healthier Lives Institute for Healthcare Improvement, Cambridge, MA mmcpherson@ihi.org @MariannePhD
Mission Improve health and health care worldwide Vision Everyone has the best care and health possible Strategic Approach IHI applies practical improvement science and methods to improve and sustain performance in health and health systems across the world. We generate optimism, spark and harvest fresh ideas, and strengthen local capabilities. How We Work • Convene • Innovate • Partner for Results Health Equity What We Do Joy in Work Safe & High Quality Care Health of Populations Value Improvement Science Institute for Healthcare Improvement (IHI)
How We Work 31 Convene Bring people together to build skills, learn from one another, and bring energy to accelerate change Foster creative solutions to complex problems Drive system level results for the individuals, populations, and communities we serve Partner for ResultsInnovate www.ihi.org
IHI’s Triple Aim System designs that simultaneously improve three dimensions: – Improving the health of the populations; – Improving the patient experience of care (including quality and satisfaction); and – Reducing the per capita cost of health care. Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, Health, And Cost. Health Aff. 2008;27(3):759-769. doi:10.1377/hlthaff.27.3.759. Whittington JW, Nolan K, Lewis N, Torres T. Pursuing the Triple Aim: The First 7 Years: Pursuing the Triple Aim: The First 7 Years. Milbank Quarterly. 2015;93(2):263-300. doi:10.1111/1468-0009.12122. 32
The 5000:1 reality of chronic disease management In the U.S., at least 1/2 all adults—117 million people— had at least 1 chronic health condition. Leading causes of death in the US; projected 57% global disease burden by 2020 Among the most common, costly, and preventable of all health problems. 5000-to-1: person’s hours of self-management to health care contact • Asch DA, Muller RW, Volpp KG. Automated Hovering in Health Care — Watching Over the 5000 Hours. New England Journal of Medicine. 2012;367(1):1-3. doi:10.1056/NEJMp1203869. • Ward BW, Schiller JS, Goodman RA. Multiple Chronic Conditions Among US Adults: A 2012 Update. Preventing Chronic Disease. 2014;11. doi:10.5888/pcd11.130389. • World Health Organization: The Global Burden of Chronic Disease: http://www.who.int/nutrition/topics/2_background/en/. 33
Health care determines only 10-20% of overall health Social circumstances 15% Environmental exposure 5% Behavioral patterns 40% Health care 10% Genetic predisposition 30% Proportional Contribution to Premature Death "Health Policy Brief: The Relative Contribution of Multiple Determinants to Health Outcomes," Health Affairs, August 21, 2014. http://www.healthaffairs.org/healthpolicybriefs/ Graphic adapted from McGinnis JM, Williams-Russo P, Knickman JR. The Case For More Active Policy Attention To Health Promotion. Health Aff. 2002;21(2):78-93. doi:10.1377/hlthaff.21.2.78. Interaction Intervention possibility slim
Identity: An unprecedented collaboration of change agents pursuing an unprecedented result: 100 million people living healthier lives by 2020 Vision: to fundamentally transform the way we think and act to improve health, wellbeing, and equity. Equity is the “price of admission.” Convened by the Institute for Healthcare Improvement as a partnership 100 Million Healthier Lives www.100mlives.org
Our theory of change Unprecedented collaboration Innovative improvement System transformation 100 Million People Living Healthier Lives by 2020
1. Develop healthy, equitable communities 2. Create bridges between health care, community public health and social sector 3. Create a health care system that is good at health and good at care 4. Scale up peer to peer supports 5. Develop new culture and mindsets 6. Create enabling conditions 100 Million Healthier Lives: 6 Core Strategies 37
A growing movement: >1100 members in 27+ countries worldwide www.100mlives.org/map Interactive Map: www.100mlives.org/map
1. Join us by signing up 2. Create an action plan 3. Start measuring 4. Learn more & stay connected Join us! www.100mlives.org
Spread & Scale-up Key Concepts and Elements 40
Spread and Scale-Up Different yet complementary concepts Spread Scale- Up 41
Applying the Science of Improvement to Spread and Scale Up Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. doi:10.1186/s13012-016-0374-x. Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. Jossey-Bass; 2009. Image Credit: IHI,“Getting Results at Scale”Seminar, 4/7/2016.
Spread Scale- Up
Elements of Spread Spread 1. Shared values & identity 2. Creating trust & relationships as first principle 3. Setting culture & practice up front of not being terminally unique 44
1. Shared Values & Shared Identity  Examples of tools for creating: • Touchstones • Ways of Being • Core Principles  How they’re used • Shared, reflected up on at regular intervals (virtual & in-person) • Co-created whenever possible • May be revised as spread happens, shared identity evolves 45
Example questions for use at a meeting: As you review the touchstones, reflect upon: 1) What’s one touchstone that you feel like you’ve “got” / is a strength for you? 2) What touchstone is a growing edge for you, either in general or for today’s meeting? 46 Example: 100 Million Healthier Lives Touchstones for Collaboration
Example: SCALE Initiative, Ways of Being 47
Example: 100 Million Healthier Lives Core Principles http://www.100mlives.org/approach-priorities/
2. Creating Trust & Relationships as First Principle  Culture of knowing one another as human beings • Story of your name, story of your community • “Speed dial” in the network  Culture of failing forward, being vulnerable  Creating regular times when people are interacting with one another • Large groups example: Leadership academies • Smaller groups: Peer Community Teams, bright spot site visits 49
3. Setting culture & practice up front of not being terminally unique  Calling out bright spots & useful tools for the field  Tools and exercises where communities / network members get used to solving one another’s problems • Example: UFO exercise
51 Spread Scale- Up
1. Key Components of scale-up 2. The scalable unit 3. 5x scale-up thinking Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. 52Scale Up: 3 Main Ideas
1. Key Components 1. Use a clear sequence of activities needed to take interventions to scale, 2. Articulate the context and environmental factors that will foster scale-up of best practices 3. Describe the infrastructure that is required to support scale-up 53 Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. doi:10.1186/s13012-016-0374-x
2. Scalable Unit  It is the smallest representation of full scale that supports the patient journey, and  Includes components of a self-contained functional unit (i.e., the people, processes and structures) that produces an output that is representative of the whole.  Questions to consider: • Does it include all the elements that need scaling up? • Is it representative enough of the whole system? • Can it be scaled up? Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. doi:10.1186/s13012-016-0374-x 54
3. 5X Scale-Up Thinking What are the systems issues to address as you move up by multiples of 5? Image credit: Pierre Barker, IHI Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. doi:10.1186/s13012-016-0374-x 55
Workshopping Your Spread & Scale Up Issues & Challenges Breakout Groups
Set-Up  Take 2 minutes to write on an index card the most interesting idea that popped into your head as you heard the presentations – and that you want to share with group - ONE - or a scenario/innovation you are working on – relative to spread/scale-up.  Please write legibly!
Time to disco  For the next five minutes while the music plays, walk around the room, switching cards with people as you go.  When you get a new card, read the scenario on it and think about whether you are: • Not interested • Somewhat interested • VERY interested in discussing the scenario on that card  If you are VERY interested in discussing that scenario, draw a star on the card.  Repeat as many times as you can while the music plays! 58
Getting into breakout groups  3 groups based on the 3 cards that received the most stars • 1. • 2. • 3.  Each facilitator will be at one breakout table  Self-select based on what you’d like to discuss  Jot down notes about what your “report-out tweet” will be (or tweet in real time): #PPBMeeting 59
Real Time Twitter & In-Room Report Out  Use #PPBMeeting to share your key takeaways from the small group discussions. Thank you for joining us today! 60

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Taking Collaborations to Scale to Improve Population Health

  • 1.
    Taking Collaborations toScale to Improve Population Health Ahmed Calvo, MD, MPH | Marianne McPherson, PhD, MSPH | Laura Seeff, MD #PPBMeeting
  • 2.
    Learning Objectives At theend of this workshop, you will be able to:  Discuss technical methodologies and adaptive, relationships-based approaches to achieving spread and/or scale  Apply principles of taking collaborations to scale to your local context
  • 3.
    Workshop Agenda  Framing:Doug Englebart’s Networked Improvement Communities  Overview of CDC’s 6 |18 Initiative and 100 Million Healthier Lives  Key elements of spread and scale up, with examples from the field  Workshopping your spread & scale-up insights: Innovation disco - breakout groups – and sharing out to a conversation-of-the-whole
  • 4.
    Questions-to-run-on How we wouldlike you to listen and engage: • What is the one most interesting idea that popped into your brain as you heard the presentations as applicable to your work? • How do you activate a “whole-of-nation” effort with action at the local community?
  • 5.
    5 Ahmed Calvo TakingCollaborations to Scale to Improve Population Health Framed Using Doug Engelbart’s Concept of Networked Improvement Communities (NICs) A Network-Centric Approach leverages the People-Centered Internet (PCI) and Information-Communication-Technology (ICT) Ahmed Calvo,MD,MPH Director,National Health Leadership and Public Service Fellowship Haas Center for Public Service,Stanford University Senior Fellow,Thought Leadership and Innovation Foundation Senior Medical Officer,Health Resources and Services Administration U.S.Department of Health and Human Services
  • 6.
    Taking Collaboration toScale After framing for this interactive session, we will focus on two key efforts: •CDC’s 6/18 Campaign •100 Million Healthier Lives Movement, convened by IHI – Laura Seef, MD – Director, Office of Systems Collaboration – Centers for Disease Control & Prevention (CDC) – Marianne McPherson, PhD, MSPH – Senior Director of Implementation, 100 MLives – Institute for Healthcare Improvement (IHI)
  • 7.
    Key Principles ForSuccess • Spread and scale-up happen at the speed of trust – And takes place via a network process (AKA net-centric method). • Technical and strategic components are important – particularly for cross-sector collaboration • But solid trust relationships are the true secret ingredient • We will frame these principles for spread and scale-up – using a variety of networked insights
  • 8.
    Key Definitions • DougEngelbart – concept of “networked improvement communities” – two co-evolving improvements of both IT systems and human systems – “Augmented Intelligence” (AI) concept in Augmentation Research Center laboratory at SRI International (Stanford Research Institute) – and of “bootstrapping” as start-up method for a network or center. • FQHCs (Federally Qualified Health Centers) – sites of Community Health Centers (CHCs); over 9,000 FQHCs with active patient volume of ~ 23 million patients and over 90 Million patient-visits/yr – 170,331 staffers (2014 UDS numbers). Funded by HRSA (Health Resources and Services Administration) – an agency in the US Department of Health and Human Services (HHS).
  • 9.
    Breakthrough Series (BTS)Collaborative Model Drawing on a napkin by Paul Batalden over 20 years ago – from Don Berwick, Institute for Healthcare Improvement (IHI)
  • 10.
    HRSA Health DisparitiesCollaboratives added ICT support to learning process – as key needed infrastructure (1998) Select Topic Planning Group Identify Change Concepts Participants Pre-work LS 1 P S A D P S A D LS 3LS 2 Rudimentary ICT Supports E-mail Visits Phone Assessments Senior Leader Reports Time for setting aims, allocating resources, preparing baseline data leading to the first 2 day meeting. Action period 1: Adapt and test the ideas for improved system of care Action period 2: further develop the system of care at the pilot site and spread the system to other sites
  • 11.
    Evolved Perspective ofthe HRSA Health Disparities Collaboratives as a National Framework for Change (1998-2008) Establish National Agenda National FACULTY Identify Measures, Priorities Evidence-Base Developed by Partners Pilots Evolved ICT Infrastructure www.healthdisparities.net ° Regional Infrastructure ° www.hdnr.org ° Phone TA ° Monthly Measures and Senior Leader Reports ° National Faculty Consultants ° Topical Conference Calls/Webinars Small scale pilots for the purpose of developing the change package to facilitate rapid deployment of a new evidence-base Adapting Evidence Base -- Chronic Care Model, Model for Improvement Supporting National Learning Community For Best Practices Population Health Mgt. •Registry •Reporting Executing National Health Policy •Partnerships National Vision For Healthcare Transformation
  • 12.
    ICT and PolicyChange Infrastructure at HHS for ACA Implementation – a National Collaborative Framework (2009-2016) ACA Passed (Affordable Care Act) Networked National FACULTY Identify Measures, Priorities (NQF Contract) Evidence-Base Developed by Partners (e.g. PCORI) CMS Pilots Further Adapted ICT Infrastructure ° National Leadership Network shifted to CMS ° State Infrastructure ° www.heathycommunities.org ° Link with QIOs ° National Measures Massive use of Webinars – and maybe shifting to MOOCs Small scale pilots and demonstrations for the purpose of developing the change package to facilitate rapid deployment of a new evidence-base and massive scale-up via CMMI at CMS Community Adapting Evidence Base-- via foundations (private $$) Supporting National Learning Communities (Partnership for Patients) EHRs-HIEs Pop Health Mgt. •Registries •Reporting •Analytics Nation’s NQS & NPS – With ONC Standards Incentives Going from Healthcare To Health - as a Vision
  • 13.
    Envisioning Collaboration viathe PCI -- A Collaborative NIC Framework (2017) Topic: Health – in a digital age Planning Group: US Citizenship Change Concepts: Community Action Evidence-Base Developed by Digitally Native Citizen-Partners (using: PCI, smart phones, apps) Pilots Further Evolved (Decentralized) ICT Infrastructure ° Evolved Leadership Network ° Evolved Infrastructure ° ° New Metrics ° Massive use of Webinars – and MOOCs ° Small scale pilots and demonstrations for the purpose of developing detailed change package to facilitate rapid deployment of a new evidence-base for massive scale-up Community Adapting Evidence Base-- via foundations (private $$) Supporting Learning Communities -- as “going concerns” -- already in action Better ICT: - PCI - Collaborate.org - EHRs •Registries •Reporting •Analytics US Culture Of Health Going from Healthcare To Health - in context of new realities
  • 14.
    Culture of Health Entitiesexist already working in the private sector: •100 Million Healthier Lives Movement •Communities Joined in Action (CJA) •New Breakthrough Collaboratives (Foundations) •Healthy Communities Collaborative for America, the AIMM Collaborative, and PCI •Wellbeing in the Nation (WIN) Initiative •Creating Wellbeing Leadership Group •Collaborate.org
  • 15.
    Centers for DiseaseControl and Prevention 2nd Annual Practical Playbook Meeting - Improving Population Health: Collaborative Strategies That Work Scaling Collaboration For Greater Impact - CDC’s 6|18 Initiative: Accelerating Evidence into Action, June 1, 2017 Laura C. Seeff MD Director, Office of Health Systems Collaboration CDC Office of the Director
  • 16.
    Opportunity Knocks: TheTransforming Health System  Increased health care coverage  Payment reform: volume  value  Clinical care models more patient- centered/comprehensive  More opportunities to deliver prevention 46% 19% 13% 8% 10% Employer Medicaid Medicare Other Uninsured “Other” Insurance Coverage: • Other Private – 6% • Other Public – 2% About 90% of All Americans are Insured as of 2014 "Health Insurance Coverage of the Total Population." State Health Facts. The Kaiser Family Foundation, Juliette Cubansk; Barbara Lyons; Tricia Neuman; Laura Snyder; Anne Jankiewicz; David Rousseau. (2015). Medicaid and Medicare at 50. The Journal of the American Medical Association, 314(4), 328. doi:10.1001/jama.2015.8129
  • 17.
    Another Major Trend:Public Health Evolution  Recession cuts unrestored – 52K fewer jobs  48% locals reduced public health services in 2012  29 states decreased public health budgets in 2012
  • 18.
    6 18High-burden health conditions |Evidence-based interventions that can improve health and save money  Establish sustainable cross-sector partnerships between public health and health care purchasers, health plans, and providers to address shared health priorities www.cdc.gov/sixeighteen; Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton 2015. CDC’s 6|18 Initiative: Accelerating evidence into action. National Academy of Medicine, Washington, DC. http://nam.edu/wp-content/uploads/2016/02/CDCs-618- Initiative-Accelerating-Evidence-into-Action.pd Collaboration between public health, health care purchasers, payers, and providers to promote adoption of evidence-based interventions  Improve health and control costs using specific evidence-based interventions
  • 19.
    6 18High-burden health conditions |Evidence-based interventions that can improve health and save money www.cdc.gov/sixeighteen; Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton 2015. CDC’s 6|18 Initiative: Accelerating evidence into action. National Academy of Medicine, Washington, DC. http://nam.edu/wp-content/uploads/2016/02/CDCs-618- Initiative-Accelerating-Evidence-into-Action.pd Collaboration between public health, health care purchasers, payers, and providers to promote adoption of evidence-based interventions Example
  • 20.
  • 21.
  • 22.
    State Medicaid –Public Health Department Implementation Launched February 2016:  Early Progress – Baseline data being collected – State Plan Amendments – Managed Care Organization contractual negotiations – New scope of practice legislative authority – Member and provider education tools and training  Upcoming – Staged expansion – Shared learning platform CO SC MI LA MA RI MN GA NY GA 3 Focus Areas: Tobacco, Asthma, & Unintended Pregnancy Prevention Action Plans State Medicaid Agency & Public Health Programs Teams9
  • 23.
    Evaluation and Theoryof Change State readiness to change payment Payment change for 18 services Increased provider delivery and patient utilization of services Improved health outcomes Decreased costs
  • 24.
    – Payer-specific/multi-payer initiatives –Initial focus: DPP, HTN & asthma control – Shared learning platform – Added issues: behavioral economics, provider engagement, targeted member engagement Expanding 6/18 to commercial payers
  • 25.
    Public Health andHealth System Complementary Roles PUBLIC HEALTH  Contributed condition- specific subject expertise  Translated epidemiologic evidence into benefits for coverage  Developed awareness campaigns targeting providers and patients  Promoted linkages with community services MEDICAID AGENCY  Developed a business case for chosen interventions  Utilized available policy levers to improve coverage and promote increased uptake of services  Engaged with Medicaid managed care plans to enhance benefits  Engaged providers and members
  • 26.
    Engagement Preparation Identify Evidence-BasedIntervention  Significant disease burden  Strong health & cost evidence associated with intervention  Fills current gap Identify key purchaser-payers  Assess likely receptivity  Align with purchaser-payer priorities  Match burden of condition and insured population  Prepare customized case Consider  Provider engagement & provider supply  Level of support from key decision makers  Measurability Likelihood of success  Readiness for rapid change  Resources required for success
  • 27.
    CO SC MI LA MA RI MN GA NY GA NC AK TX NV UT MD District of Columbia LosAngeles County Health Department Expansion (spread and scale) to New Localities
  • 28.
    Visitthe6|18Website CDC.gov/SixEighteen Evidence Summaries Detailed summariesof the 6|18 interventions, based on scientific studies and expert consultations FAQs Answers to common questions about the 6|18 Initiative including goals,strategy, and the intervention selection process Coming soon! Additional Tools: Readiness checklist How to be a 6|18 Partner
  • 29.
    Taking Collaborations toScale to Improve Population Health 2017 Practical Playbook National Meeting ~ June 1, 2017 Spread and Scale Up: Lessons from 100 Million Healthier Lives Marianne McPherson, PhD, MS Senior Director, 100 Million Healthier Lives Institute for Healthcare Improvement, Cambridge, MA mmcpherson@ihi.org @MariannePhD
  • 30.
    Mission Improve health and healthcare worldwide Vision Everyone has the best care and health possible Strategic Approach IHI applies practical improvement science and methods to improve and sustain performance in health and health systems across the world. We generate optimism, spark and harvest fresh ideas, and strengthen local capabilities. How We Work • Convene • Innovate • Partner for Results Health Equity What We Do Joy in Work Safe & High Quality Care Health of Populations Value Improvement Science Institute for Healthcare Improvement (IHI)
  • 31.
    How We Work 31 Convene Bringpeople together to build skills, learn from one another, and bring energy to accelerate change Foster creative solutions to complex problems Drive system level results for the individuals, populations, and communities we serve Partner for ResultsInnovate www.ihi.org
  • 32.
    IHI’s Triple Aim Systemdesigns that simultaneously improve three dimensions: – Improving the health of the populations; – Improving the patient experience of care (including quality and satisfaction); and – Reducing the per capita cost of health care. Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, Health, And Cost. Health Aff. 2008;27(3):759-769. doi:10.1377/hlthaff.27.3.759. Whittington JW, Nolan K, Lewis N, Torres T. Pursuing the Triple Aim: The First 7 Years: Pursuing the Triple Aim: The First 7 Years. Milbank Quarterly. 2015;93(2):263-300. doi:10.1111/1468-0009.12122. 32
  • 33.
    The 5000:1 realityof chronic disease management In the U.S., at least 1/2 all adults—117 million people— had at least 1 chronic health condition. Leading causes of death in the US; projected 57% global disease burden by 2020 Among the most common, costly, and preventable of all health problems. 5000-to-1: person’s hours of self-management to health care contact • Asch DA, Muller RW, Volpp KG. Automated Hovering in Health Care — Watching Over the 5000 Hours. New England Journal of Medicine. 2012;367(1):1-3. doi:10.1056/NEJMp1203869. • Ward BW, Schiller JS, Goodman RA. Multiple Chronic Conditions Among US Adults: A 2012 Update. Preventing Chronic Disease. 2014;11. doi:10.5888/pcd11.130389. • World Health Organization: The Global Burden of Chronic Disease: http://www.who.int/nutrition/topics/2_background/en/. 33
  • 34.
    Health care determinesonly 10-20% of overall health Social circumstances 15% Environmental exposure 5% Behavioral patterns 40% Health care 10% Genetic predisposition 30% Proportional Contribution to Premature Death "Health Policy Brief: The Relative Contribution of Multiple Determinants to Health Outcomes," Health Affairs, August 21, 2014. http://www.healthaffairs.org/healthpolicybriefs/ Graphic adapted from McGinnis JM, Williams-Russo P, Knickman JR. The Case For More Active Policy Attention To Health Promotion. Health Aff. 2002;21(2):78-93. doi:10.1377/hlthaff.21.2.78. Interaction Intervention possibility slim
  • 35.
    Identity: An unprecedentedcollaboration of change agents pursuing an unprecedented result: 100 million people living healthier lives by 2020 Vision: to fundamentally transform the way we think and act to improve health, wellbeing, and equity. Equity is the “price of admission.” Convened by the Institute for Healthcare Improvement as a partnership 100 Million Healthier Lives www.100mlives.org
  • 36.
    Our theory ofchange Unprecedented collaboration Innovative improvement System transformation 100 Million People Living Healthier Lives by 2020
  • 37.
    1. Develop healthy,equitable communities 2. Create bridges between health care, community public health and social sector 3. Create a health care system that is good at health and good at care 4. Scale up peer to peer supports 5. Develop new culture and mindsets 6. Create enabling conditions 100 Million Healthier Lives: 6 Core Strategies 37
  • 38.
    A growing movement: >1100members in 27+ countries worldwide www.100mlives.org/map Interactive Map: www.100mlives.org/map
  • 39.
    1. Join usby signing up 2. Create an action plan 3. Start measuring 4. Learn more & stay connected Join us! www.100mlives.org
  • 40.
    Spread & Scale-up KeyConcepts and Elements 40
  • 41.
    Spread and Scale-Up Differentyet complementary concepts Spread Scale- Up 41
  • 42.
    Applying the Scienceof Improvement to Spread and Scale Up Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. doi:10.1186/s13012-016-0374-x. Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. Jossey-Bass; 2009. Image Credit: IHI,“Getting Results at Scale”Seminar, 4/7/2016.
  • 43.
  • 44.
    Elements of Spread Spread 1.Shared values & identity 2. Creating trust & relationships as first principle 3. Setting culture & practice up front of not being terminally unique 44
  • 45.
    1. Shared Values& Shared Identity  Examples of tools for creating: • Touchstones • Ways of Being • Core Principles  How they’re used • Shared, reflected up on at regular intervals (virtual & in-person) • Co-created whenever possible • May be revised as spread happens, shared identity evolves 45
  • 46.
    Example questions foruse at a meeting: As you review the touchstones, reflect upon: 1) What’s one touchstone that you feel like you’ve “got” / is a strength for you? 2) What touchstone is a growing edge for you, either in general or for today’s meeting? 46 Example: 100 Million Healthier Lives Touchstones for Collaboration
  • 47.
  • 48.
    Example: 100 MillionHealthier Lives Core Principles http://www.100mlives.org/approach-priorities/
  • 49.
    2. Creating Trust& Relationships as First Principle  Culture of knowing one another as human beings • Story of your name, story of your community • “Speed dial” in the network  Culture of failing forward, being vulnerable  Creating regular times when people are interacting with one another • Large groups example: Leadership academies • Smaller groups: Peer Community Teams, bright spot site visits 49
  • 50.
    3. Setting culture& practice up front of not being terminally unique  Calling out bright spots & useful tools for the field  Tools and exercises where communities / network members get used to solving one another’s problems • Example: UFO exercise
  • 51.
  • 52.
    1. Key Componentsof scale-up 2. The scalable unit 3. 5x scale-up thinking Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. 52Scale Up: 3 Main Ideas
  • 53.
    1. Key Components 1.Use a clear sequence of activities needed to take interventions to scale, 2. Articulate the context and environmental factors that will foster scale-up of best practices 3. Describe the infrastructure that is required to support scale-up 53 Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. doi:10.1186/s13012-016-0374-x
  • 54.
    2. Scalable Unit It is the smallest representation of full scale that supports the patient journey, and  Includes components of a self-contained functional unit (i.e., the people, processes and structures) that produces an output that is representative of the whole.  Questions to consider: • Does it include all the elements that need scaling up? • Is it representative enough of the whole system? • Can it be scaled up? Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. doi:10.1186/s13012-016-0374-x 54
  • 55.
    3. 5X Scale-UpThinking What are the systems issues to address as you move up by multiples of 5? Image credit: Pierre Barker, IHI Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016;11(1):12. doi:10.1186/s13012-016-0374-x 55
  • 56.
    Workshopping Your Spread &Scale Up Issues & Challenges Breakout Groups
  • 57.
    Set-Up  Take 2minutes to write on an index card the most interesting idea that popped into your head as you heard the presentations – and that you want to share with group - ONE - or a scenario/innovation you are working on – relative to spread/scale-up.  Please write legibly!
  • 58.
    Time to disco For the next five minutes while the music plays, walk around the room, switching cards with people as you go.  When you get a new card, read the scenario on it and think about whether you are: • Not interested • Somewhat interested • VERY interested in discussing the scenario on that card  If you are VERY interested in discussing that scenario, draw a star on the card.  Repeat as many times as you can while the music plays! 58
  • 59.
    Getting into breakoutgroups  3 groups based on the 3 cards that received the most stars • 1. • 2. • 3.  Each facilitator will be at one breakout table  Self-select based on what you’d like to discuss  Jot down notes about what your “report-out tweet” will be (or tweet in real time): #PPBMeeting 59
  • 60.
    Real Time Twitter& In-Room Report Out  Use #PPBMeeting to share your key takeaways from the small group discussions. Thank you for joining us today! 60