By Julie Murchinson. While many have argued that health reform and other federal regulatory posturing has left true innovation in health improvement for consumers and patients nearly impossible, the “innovation” concept seems to be the buzz word du jour across the health care industry. This post focuses on innovation as it relates to how health care is delivered and paid for.   

Some organizations like Kaiser Permanente have been threading innovative approaches through aspects of their work for years with the Innovation Consultancy, the Innovative Learning Network and the Garfield Innovation Center, a living laboratory where ideas and solutions are tested in a real-world simulation.  The rest of the industry is seeing new life forms start to take hold that are inspiring and organizing innovation. For example, Health 2.0 and other conferences are showcasing and tracking the latest and greatest innovations in web-2.0 ideas and iphone apps for health care.  The California HealthCare Foundation recently started an Innovation Fund “to support entrepreneurs with business concepts that have the potential to significantly lower the total cost of delivering care or to substantially improve access to care”.  The federal government is even joining the movement through its establishment of the CMS Innovation Center to test new payment methods through new models of health care delivery, the creation of the Community Health Data Initiative that is making publicly available data more accessible and by creating financial and non-financial challenges like the VA Innovation Initiative to create new solutions around new data availability or a specific goal/problem.

So, the question is…how well are these innovations being designed for and absorbed into the current health care marketplace to actually improve the efficiency and/or effectiveness of the health care system?

One indication the industry is attempting to absorb innovative technologies and solutions is the emergence of executive-level accountability for innovation among health systems, pharmaceutical companies, health plans and other health care companies.  Following in the footsteps of Fortune 500 companies in other sectors, many large health care companies and organizations are establishing an Innovation Officer role, presumably to improve their brand and increase revenues in this time of incredible change and uncertainty.  According to 2009 research conducted by Accenture’s Innovation Performance Group, establishing an executive as an innovation leader increases a company’s chances to drive higher innovation performance and capabilities than those who do not establish such a role. This is mostly because they do not let as many new ideas languish without the proper structure and internal champion and, better yet, manage innovation as a business process.  The question is…will these innovation seekers believe the value of solutions professed by the innovators mentioned above and manage innovations well to a fruitful result or will the same macro issues stalling progress in health improvement for consumers and patients prevail? 

Innovation may be a proxy for many things, but these two ends of the spectrum demonstrate the existence of significant new idea generation with an increased focus on transforming the business of health care with new, revenue-generating or brand-enhancing ideas.  If innovation is the marriage of ideas that drive revenue with purchasers who can put them to work, then we may just be on to an opportunity to move progress in health improvement forward.  That said, it requires the ideas to prove their value and purchasers to be comfortable with a potentially non-linear, longer-term road to the new nirvana.

By Julie Murchinson. The Robert Wood Johnson Foundation-funded program, Project HealthDesign, is pursuing the identification, interpretation and integration of observations of daily living (ODLs). As defined by Project HealthDesign, ODLs are sensations, feelings-thoughts-attitudes, and behaviors that occur in the course of everyday life – such as sleep patterns, diet, exercise levels, pain episodes, and mood – that are not typically part of one’s clinical record, but are critical to managing an individual’s health and guiding their treatment.

During the recent Project HealthDesign workshop, I was struck by the question of what ODLs have the potential to do to engage patients in their health. Will ODLs be the patient’s true representation of issues they own and manage as part of their health or will they be factoids about patients that doctors use but patients don’t truly own? Will ODLs management come naturally or will managing them be an arduous task for the unfortunate individuals who may “need” to manage them? Will doctors be able to synthesize ODLs into clinical practice or will they be too overwhelmed to incorporate another set of information they may not know how to handle or not be remimbursed to pay attention to?  Will ODLs evolve with medical research such that they will be taken into consideration as part of future discovery or will ODLs always be an afterthought left to discovery at the point of care?  Much remains unknown about the fate of ODLs, but there is strong potential for ODLs to be the patient engagement hook in the years to come.

Three big “ah-ha’s” came this week as I listened to grantees develop, describe and integrate ODLs into their research project plan.

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The following guest post on the subject of drug adherence is written by Julie Murchinson, Founder, Health 2.0 Accelerator and Managing Director with Manatt Health Solutions.

The tools are coming! The tools are coming! For a while now, tools to manage drug adherence have been developed, many designed to enable the patient to self-manage in the context of and in collaboration with the health care system from a specifically designed device or heavy application. Patient adoption, however, has been slow and the vision for self-management of drug adherence not yet reality. But recently from the budding Health 2.0 space, we are seeing tools built on more accessible web and mobile platforms that allow patients to manage when and where they want to with their mobile device (e.g. iPhone, Blackberry, cell phone). So, in much the same way many people’s lives have changed as a result of being able to use Facebook or Twitter, or read the Washington Post from their phones on the bus or out at lunch, patients who have previously required proximity to their home device or desktop to log medications taken can now not only track on their phone what they take from their pill box, but also take advantage of glow cap or smart label technologies that can technically interact with a phone-based mobile application.

It was one thing when the Brazilian government was sending text messages to remind women to take their birth control pills (which, by the way, has been highly effective), but we are in a new age of both passive and active patient engagement with mobile platforms. There are iPhone accessible apps like Polka and TheCarrot.com that enable patients to schedule and track their medications taken along with a number of other health topics including sleep, exercise and mood, among others. Medic8Manager provides an iPhone solution that goes a few steps deeper on drug adherence for managing scheduled medications with reminder functionality, refill tracking, missed dose alerts, as-needed meds and discontinued medications. A similar application in development from Informediq even uses the tagline, “enabling healthcare anywhere”. While some products are typically used solely by patients without involvement required from a physician or other caregiver, we are starting to see more user-friendly tools that originate from the physician-patient care process, while allowing for more consumer-friendly adherence tracking, a good example of which we are seeing from the new AdhereTx product. The next step in innovation can be seen from eMedMobile which facilitates a phone working with “smart labels” on prescription medication bottles that store drug data and send alerts to caregivers when a drug is missed.

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Today’s guest post by Julie Murchinson, Executive Director, Health 2.0 Accelerator, is the final installment in the Disruptive Women Comparative Effectiveness Research smackdown.

Stay Tuned: We will be creating and widely distributing a CER e-book.

The HHS Federal Coordinating Council for CER research posted its report to Congress and the President on Monday describing federal activities on CER. Another report with actual priority suggestions is due to Congress by the end of July. On Tuesday, the Institute of Medicine released their sage advice about the top 100 priorities as well as a report on CER. I found one line, in particular, of extreme importance from the report to Congress:

“National Institutes of Health (NIH) diabetes prevention trial demonstrated that lifestyle change was superior to metformin and placebo in preventing onset of type 2 diabetes.”

Although an extremely complex and closely watched effort across the private sector, this line is the crux of the issue of success for such an endeavor. Of the entire IOM report, I found the following meaningful:

“Compare the effectiveness of traditional behavioral interventions versus economic incentives in motivating behavior changes (e.g., weight loss, smoking cessation, avoiding alcohol and substance abuse) in children and adults.”

How do we know how much the patient – their genomic and proteomic make-up, their lifestyle choices, their home environment, the food they eat, the exercise they do, the sangria they drank last night, the choices they make, the levers that influence their behavior – impacts our ability to understand the health outcomes and economic value of clinical interventions such as medications, procedures or clinical delivery system strategies as proposed by comparative effectiveness research? (more…)