Prepared by:

Chukwuma Onyeije, M.D.

Atlanta Perinatal Associates

Morehouse School of Medicine

CMS Health Care

Innovation Challenge

Grant.

Sponsored by:

LINK: http://www.innovations.cms.gov/initiatives/innovation-challenge/

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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

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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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What is the Role of the CMS Innovation Center?

Better care

and better

health at

reduced costs

through

improvement.

LINK: http://innovations.cms.gov/

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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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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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Transforming Health Care

•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.

INNOVATORS across the country are developing NEW & EFFECTIVE care delivery and payment models

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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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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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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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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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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

OUR PROPOSAL

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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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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

OUR AREAS OF INTEREST:

GESTATIONAL DIABETES OBESITY AND POSTPARTUM WEIGHT LOSS

PATIENT EDUCATION AND ENGAGEMENT

UP-CIP

Gestational

Diabetes

EDUCATION/

ENGAGEMENT

OBESITY &

WEIGHT LOSS

Gestational

Diabetes

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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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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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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.

A Template for

Success:

For details see: http://mobihealthnews.com/15116/medicaid-patients-reduce-hospitalizations-with-welldoc/

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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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GESTATIONAL DIABETES:

Our Proposal:

• Software solutions are already available for FREE.

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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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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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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.

OBESITY &

WEIGHT LOSS

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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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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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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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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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Obesity and Postpartum Weight Loss:

OUR APPROACH:

Quantified Self Strategies

+

The Hawthorne Effect

+

Education / Accountability

=

Effective Interventions and Sustainable Postpartum Weight Loss

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

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The Hawthorne Effect: Observation Changes

Behavior

Observation

Changes

Behavior

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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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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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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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Obesity and Postpartum Weight Loss:

Available Tools:

Internet enabled

pedometer

Internet enabled

scale Weight management &

Food tracking software

Portable sleep monitor

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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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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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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

EDUCATION/

ENGAGEMENT

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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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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

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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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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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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/