Health Care Innovation Advancement Framework

Health Care Innovation Advancement FrameworkOptimizing Ecosystems to Support Impactful Innovation

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Point B, Inc. is a consulting company dedicated to helping organizations with critical initiatives in the areas of customer engagement, growth investments, workforce experience, and operations excellence. We achieve sustainable success for our customers by focusing on the humans at the center of change. Point B is a national company, with 13 U.S. locations and global reach via our partnership with Nextcontinent. Our company is 100% employee-owned and is regularly recognized as an exceptional place to work.

About usCambia Grove is a health care innovation hub focused on advancing innovation in health care across the country. Cambia Health Solutions, which was founded a century ago in the logging camps of the Pacific Northwest and is driven by a mission to transform the way people experience health care, launched Cambia Grove in 2015 to connect with like-minded changemakers to create solutions that advance Cambia’s Cause to create a person-focused and economically sustainable health care system.

AcknowledgementsThank you to the many organizations and individuals who have helped develop this report. Transforming the health care system is a community endeavor and we look forward to working with communities around the country to advance innovation.

There are countless opportunities to transform the health care system through innovative solutions. Yet the key foundational elements to support innovation — infrastructure, incentives and culture — have yet to be optimized. As a result, changemakers face systemic challenges as they work to advance transformative change.

In response to this challenge, Cambia Grove created a holistic model for driving transformation towards a more person-focused and economically sustainable health care system, titled the Health Care Innovation Advancement Framework. Cambia Grove commissioned Point B, Inc. to put structure to the framework by establishing a metrics-based approach to analyze and track the optimization of each critical element of state-based ecosystems.

Welcome

This work builds on similar reports commissioned by Cambia Grove in 2015 (Washington) and 2019 (Utah), and will be used as a reference for state-based ecosystem analysis in the future.

3HEALTH CARE INNOVATION ADVANCEMENT FRAMEWORK

This report seeks to answer:What are the challenges before us as we look at health care innovation ecosystems?

How can we drive toward an ecosystem in which health care innovation can thrive?

What role does Cambia Grove play in advancing health care innovation?

The health care innovation ecosystem is defined by the actors within the ecosystem, and the elements that influence their actions.

The challenges before usThe Health Care ChallengeA recent study conducted by Humana, Inc. and the University of Pittsburgh School of Medicine, and published in the Journal of the American Medical Association (JAMA) found that “The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP).” The study also highlighted that approximately 25% of health care spending in the US health system is wasteful. This amounts to between $760 billion and $935 billion annually.1

Unfortunately, this spend has not always led to equitable health outcomes for Americans. One analysis by the Kaiser Family Foundation of data published in The Lancet shows the extent of the systemic disparity. Among comparable wealthy Organisation for Economic Co-operation and Development (OECD) countries, the United States ranks last on the Health care Access and Quality (HAQ) index, which measures the rates of death considered preventable by timely and effective care.2

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1 Shrank, W. H. (2019, October 15). Waste in the US Health Care System. Retrieved April 14, 2020, from https://jamanetwork.com/journals/jama/article-abstract/27526642 Sawyer, B., & McDermott KFF, D. (2019, March 28). How does the quality of the U.S. healthcare system compare to other countries? Retrieved April 14, 2020, from https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/

https://jamanetwork.com/journals/jama/article-abstract/2752664


https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/

https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/


https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries

The Innovation ChallengeWhile the health care system faces many well-known challenges, the role that innovation can play to solve many of these challenges has yet to be realized at scale. In order to advance innovative efforts to support system-wide health care transformation, we must first define the health care innovation ecosystem.

As the visual on the next page indicates, changemakers working to advance innovation in health care can be found within the health care system (the 5 Points of Health Care™) and across Aligned Stakeholders. Not all individuals who work in the health care ecosystem are


changemakers, but changemakers can be found throughout the health care ecosystem. They may be small startups operating out of basements, well-resourced R&D labs of major corporations, within payer and provider organizations, or somewhere in between. What unites them is a desire to improve the health care system.

To transform the health care system towards one that is person-focused and economically sustainable, the efforts of changemakers must be supported by optimizing health care innovation ecosystems in which their work can thrive.

• Misalignment of incentives that prevent the adoption of truly innovative solutions that promote health equity and/or reduce the overall cost of care

• Difficulty accessing necessary data to identify challenges, develop solutions, and test and scale them

• A mismatch between the length of time needed for players in the health care system to adopt and pay for a solution and the funding window entrepreneurs typically have

Common themes and challenges that innovators face have emerged to shape this report:• A health care system that can be resistant to change with a shortage of dedicated champions to guide changemakers and pull their ideas forward

• Difficulty articulating the value proposition of new solutions, linking those solutions to a known person-focused challenge, and lack of experience navigating the health care system to bring a solution from idea to impact

The Health Care Innovation Ecosystem

Ecosystem Elements

Infrastructure

Culture

Incentives

Researchers/ Academics

Non-profit/ Community-based

Organizations

Vendors (non-startups)

Professional Service Providers

Others

Startups

Innovation Hubs

Aligned Stakeholders

5 Points of Health CareTM

Policymakers

Payers

Providers

Purchasers

Patients

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The Ecosystem ChallengeAs with ecosystems found in nature, the health care innovation ecosystem is defined by the actors within the ecosystem, and the elements that influence their actions. In the health care innovation ecosystem, the key actors are the 5 Points of Health CareTM and other Aligned Stakeholders. Their interactions are numerous, with the uniting factor being a focus on the needs of the patient.

The key elements that influence their actions are infrastructure, incentives, and culture and the predominant challenge is that these elements are not currently optimized to support innovation. The primary reasons for this include the numerous and varied actors in the ecosystem, the complexity of their possible interactions, and their diverse objectives and interests, with no clear north star to drive alignment.


Policymakers: Elected officials and departments within local, state and federal governments responsible for crafting and implementing health care policy

Purchasers: Organizations responsible for purchasing health benefits for a population of people (e.g., employers or government entities)

Definitions of each of the 5 Points of Health CareTM:Patients: Individuals who receive health care

Providers: Individuals or organizations responsible for providing care to patients (e.g., doctors, nurses, hospital/clinic administrators, etc.)

Payers: Organizations responsible for issuing or administering payment for the care received by a population of people (e.g., insurance companies)

Impactful Innovation

The Triple Aim

Problem Idea Solution Adoption Impact

Optimized Ecosystem Elements

Incentives

Infrastructure

Culture

Health Care Innovation Advancement Framework

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Impactful Innovation:How to think about innovation and its impacts on improving the health care system

Optimized Ecosystem Elements:Which ecosystem elements must be optimized to support impactful innovation

The Triple Aim: How to measure and balance improvements to the health care system


3 Overview: IHI. (n.d.). Retrieved from http://www.ihi.org/Topics/TripleAim/Pages/Overview.aspx

As stated previously, innovation in health care is critical yet challenging. To address this challenge, and to provide an overarching model for driving meaningful change, we have developed the Health Care Innovation Advancement Framework, visually depicted on the prior page. This section will break down each piece in turn:

How to measure improvements to the health care system

How to think about innovation and its impacts on improving the health care system

Which ecosystem elements must be optimized to support impactful innovation

The Triple AimThe established standard in thinking about improvements to the health care system is the Triple Aim, developed by the Institute for Healthcare Improvement (IHI) in Cambridge, Massachusetts.3 The Triple Aim remains the dominant paradigm for improving health care delivery. In the Triple Aim, progress towards a better healthcare system is defined across three dimensions, or “aims”: reducing per capita cost, improving the experience of care, and improving population health.

The three aims together provide a balanced picture of our goals for the health care system. As the IHI states, “In most health care settings today, no one is accountable for all three dimensions of the IHI Triple Aim. For the health of our communities, for the health of our school systems, and for the health of all our patients, we need to address all three of the Triple Aim dimensions at the same time.” It is by combining the three aims and looking at them together, that we can start measuring value in the health care system.

http://www.ihi.org/Topics/TripleAim/Pages/Overview.aspx

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Impactful InnovationTo achieve lasting change in health care, innovation must be impact-driven. As outlined on the following page, Impactful Innovation is the culmination of five steps, leading to impact. This sets a high bar that is met only when the solution is directly tied to a challenge the end-user is facing. The solution must be tied to the goals of the Triple Aim. While each solution need not solve for all three of the triple aims simultaneously to be impactful, it must use the Triple Aim as the rubric for measuring impact. Any solution that makes progress on one or more of the aims must not do so at the net expense of the other aims.


Problem Idea Solution Adoption Impact

Typical activities

• Exploration of challenge via discussions with impacted stakeholders

• Research on size of challenge, potential impact, and existing solutions

• Identification of multiple potential ideas to address identified challenges

• Creation of business and/or project plan, including identification of key resources needed

• Narrowing multiple ideas to small number of prototypes

• Creating something that can be reacted to

• Early adopters from the stakeholder group to test solution

• Commitment of resources (e.g., time, energy, money, attention) to implement the solution

• Understanding and realization of benefits that can accrue from adoption of solution

• Change in behavior, processes, or actions, driven by solution

Intended outcomes

• Deep understanding and vivid description of challenges the end-user faces

• Several “on paper” ideas to address end-user challenge

• A product, idea, policy, or service that can be evaluated by an external party

• Implementation of the solution by the market and scaling beyond a test environment

• Short-term: Improvement of challenge faced by end-user

• Long-term: Improvements to the Triple Aim

Indicators of work underway

• End-users and innovators build collective understanding of challenge

• Key stakeholders collaborate on potential solutions

• Solutions shared with the market and valued by impact on end-users

• Stakeholders executing new solutions

• Stakeholders see measurable results

Please note: While the process may appear linear, progress frequently happens in an iterative fashion, and the five stages sometimes occur simultaneously.

InfrastructureThese include formal and informal arrangements, key resources needed to enable innovators to implement their work and execute their strategy, as well as the right technical and physical systems to connect solutions with end users. The infrastructure must be encouraging of systemic changes to support innovation.

CultureThese include the predominant beliefs and norms that define and drive behavior in the ecosystem. There must be an open, inclusive and equitable culture to ensure that the solutions being created match the problems that exist.

IncentivesThese include both carrots (e.g., financial and non-financial rewards, recognition, and positive impact), and sticks (e.g., fines and penalties) to drive behavior. The right incentives, and alignment of incentives across stakeholders, must be in place for sustained change.

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Optimized Ecosystem ElementsThe Advancement Framework highlights the three elements of a health care innovation ecosystem necessary for impactful innovation to thrive. It is the optimization of these elements that creates the engine for impact across the health care innovation lifecycle. The hypothesis is that if these elements are optimized and balanced, as each leg would need to be on a three-legged stool, innovation will have a greater chance to occur, succeed, and be accelerated into adoption and ultimate impact on the Triple Aim. A lack of accountability and inability to see the elements work with or against each other and within the ecosystem is a critical challenge.

We have identified a baseline of key enablers of innovation and the available metrics that will be used and built upon as we continue to study and measure the ability for state-based ecosystems to advance impactful innovation. It is important to note that these elements are not mutually exclusive. For example, a collaboration space can be an enabler in both culture and infrastructure. Regardless of the grouping, we see these as the critical ingredients necessary to advance innovation. Below is a summary of what it means for each of the ecosystem elements to be optimized.


Ecosystem element Key enabler Available metrics*

Infrastructure • Collaboration spaces (physical or digital) to support testing and iteration

• Reward commensurate with risks along the process, not just big payoff at end

• Key needed resources: money, education system to produce necessary talent, data, leadership, and tools

• Technical infrastructure (e.g., broadband internet, information technology), such as to support interoperability

• Marketplace for discovery of solutions

• Mechanisms to roll out and scale solutions, and capture/ provide feedback

• Private capital investments

• Availability of funds to sustain innovators along the process (e.g., Series A and B funding)

• NIH awards directed towards university and primary research

• Interoperability/EHR adoption metrics (e.g., hospital health IT adoption)

• Broadband internet services deployment

• Legal support and regulatory requirements

• STEM education data (while STEM degrees are not the only ones that lead to innovation, it is a measurement to track the technical capabilities needed to catalyze innovation)

Incentives • Alignment of incentives to spark and support impactful health care innovation (e.g., value-based care)

• Public or private recognition (money, fame, impact)

• Innovation-friendly legal/regulatory/tax requirements

• Lack of or limits on non-competes

• Personal inspiration for patients to be healthy, depending on their own goals

• Policy and tax friendliness level (e.g., state innovation waiver, total tax burden, R&D tax credits)

• Split of value-based care vs. fee-for-service models (e.g., Medicare Advantage adoption), and programs to support the transition (e.g., SIM, DSRIP)

Culture • Collaboration & information-sharing on key challenges and ideas

• Leadership and talent in the health care system that promotes inclusivity and equity

• Focus on person-focused challenges, and frequent validation that solutions are solving their needs

• Risk tolerance and acceptance of failure

• Evangelizers and champions to “pull” ideas and create willingness to change

• Trust between the health care sector as represented by the 5 Points of Health Care™ and industries such as information and communications technology, life sciences, and advanced manufacturing

• Motivation from experienced innovators to mentor others

• Performance of the health care innovation industry (e.g., jobs creation, payroll, number of establishments)

• Diversity of leadership in medical field and state legislature

• Rate of technology transfer from academia

• Number of health and health tech accelerators and incubators

*Please note: available metrics outlined in the above table may evolve as state-level landscape reports are conducted and additional metrics are created or discovered.

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We believe innovation is key to a path toward creating a health care system that serves everyone equitably. We ask all innovators to take up the mantle of the Health Care Innovation Advancement Framework and create solutions that will drive realization of the Triple Aim.”

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– Maura Little, Executive Director, Cambia Grove


Putting it all together Over the years, while the goals of the health care system have evolved, the elements to support the implementation of health care innovation have lagged. For example, goals for the health care system have moved from acute care to include prevention and care for chronic conditions. There is increasing acknowledgement that social determinants of health, behavioral health, and health inequity can drive health outcomes, and patients are demanding greater personalization and individualization of care. Unfortunately, the health care system was not designed to take on these challenges, nor has it evolved to embrace innovation that supports or aligns these goals for individuals or our communities. Moreover, our nation faces systemic discrimination against marginalized communities and subsequent health inequity. Recent focus on these issues increases the sense of urgency to enable impactful innovation.

As the demand on our health care system shifts, innovative solutions must be incorporated as part of the solution to help meet evolving needs. To enable innovation, more must be done to strengthen ecosystems to advance health care innovation around the country. It is in society’s best interest to nurture ecosystems that support health care innovation with an equity lens — as outlined in the Health Care Innovation Advancement Framework — wherever it occurs, at whatever scale it occurs. Fostering an ecosystem that enables health care innovation will better drive toward a person-focused and economically sustainable system for everyone for years to come.

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Convene Stakeholders:

We will continue to convene, nurture and expand a community of health care innovators through education and connection. We will engage diverse perspectives to make sure communication siloes are broken down.

Identify Barriers:

By listening to the community, we will continue to identify common barriers to innovation in health care. We will outline detailed problems, categorize common themes across stakeholder groups, and prioritize opportunities for improvement.

Catalyze Solutions:

Finally, we will continue to catalyze solutions to support system-wide transformation by creating an ecosystem in which innovation can thrive. We will continue to build and maintain programs and resources to support the creation and adoption of health care innovation.

Identify CatalyzeConvene

Cambia Grove’s role

As part of our mission, we believe our efforts can best be put to work in developing and optimizing ecosystems that will enable changemakers to make improvements in the health care system. We do this by convening key stakeholders, identifying barriers preventing innovation, and catalyzing solutions to enable innovation to be adopted throughout the health care system.

While the challenges may seem daunting, we believe there are also tremendous opportunities ahead. Our philosophy for this report therefore is “progress not perfection.” Multiple small steps in the right direction can add up to a significant, sustainable impact. As we develop future reports, we will track the directionality and status of key indicators supporting the Health Care Innovation Advancement Framework. Specific metrics to analyze ecosystem enablers may evolve as our work progresses, but the goal — to optimize infrastructure, incentives, and culture to support innovation — remains the same.

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We believe impactful innovation comes from both within the 5 Points of Health Care™, and from other Aligned Stakeholders (see Health Care Innovation Ecosystem visual). Regardless of the source, we ask all innovators to take up the mantle of the Health Care Innovation Advancement Framework and create solutions that have an impact on the Triple Aim.

We are here to help.

To support the development of ecosystems (as outlined in the Health Care Innovation Advancement Framework) in states across the country, we have compiled a list of commonly used assets on our website. Our goal is to connect innovators with an extensive network of key organizations, businesses, and resources that are specifically curated to support health care innovation. We hope health care innovators will be able to build off the work others have already done, and find solutions to commonly faced challenges. This asset library can be found at https://www.cambiagrove.com/innovation-assets and will be updated periodically.

Additionally, we have built the Impactful Innovation Exchange, a comprehensive platform to search for emerging and/or proven innovations that solve health care problems. It can be found at https://www.cambiagrove.com/impactful-innovation-exchange.

Finally, we ask that if you would like to get involved as we build ecosystems to support impactful innovation, please join us as a Member. Members are individuals who believe that the health care system must change and are willing to both receive support as well as lend support to likeminded changemakers around the world. More on our Membership can be found at https://www.cambiagrove.com/cambia-grove-membership.

Ongoing monitoringOur vision is to develop state-level assessments for all states, and to create interim refreshes for each state. Our work will be guided by these findings, our metrics may be built further as we progress along this journey, and we hope each state will learn and share best practices. As we collect this rich tapestry of data, our long-term goal is to identify the key levers that drive impactful health care innovation, finding causal relationships between these key levers and improvements to the health care system. We look forward to sharing our findings with the community, and we invite all readers to engage with us in conversation and action.


https://www.cambiagrove.com/innovation-assets

https://www.cambiagrove.com/impactful-innovation-exchange



https://www.cambiagrove.com/cambia-grove-membership

https://www.cambiagrove.com/cambia-grove-membership

To learn more visit us at:https://www.cambiagrove.com/innovation-landscape-reports or contact Cambia Grove via https://www.cambiagrove.com/

@CambiaGrove

https://www.cambiagrove.com/innovation-landscape-reports

https://www.cambiagrove.com/

Documents

Health Care Innovation Advancement Framework