The San Francisco Bay Area is becoming something of an incubator for innovative, forward-looking health care delivery systems -- not really a surprise with Silicon Valley as the heart of technology and creative thinking.
Creating innovation-friendly "ecosystems" and fostering collaboration are woven into Bay Area strategies to encourage innovation and new ideas. Many of the same goals included in the Patient Protection and Affordable Care Act are echoed in Bay Area efforts to innovate -- using data to improve outcomes, managing health holistically, empowering patients, ensuring connectivity, lowering costs and delivering value.
The first -- and by many measures foremost -- of these Bay Area efforts is Kaiser Permanente's Sidney R. Garfield Health Care Innovation Center, a living laboratory of mocked-up clinical environments where new ways of delivering health care can be tested.
Kaiser launched the Garfield Center in San Leandro six years ago. The 37,000 square-foot facility may look like a Hollywood-style movie set, but its actors are very real physicians, nurses, patients, architects, engineers and technical experts.
They test technology, simulate the optimum patient environment and develop best practices in a living lab.
Preaching What You Practice
Jennifer Liebermann, director of the Garfield Center, is quick to point out that the center does not operate in a vacuum but has gathered input from organizations globally. "At the end of the day, we want our members to have a seamless experience resulting from cooperation among and input from providers and patients," she said.
The center features a mocked-up inpatient unit, an operating room and a home environment to address the entire spectrum of health care. It considers itself to be an "ecosystem of interoperability" that blends technologies and people to increase efficiency and improve health care.
The center's prototype patient rooms are colorful and include texture, subdued lighting and a welcoming "zone" for visitors to create serenity, while the operating room of the future tests user-friendly, interoperable technology.
Designs for a neonatal intensive care unit incorporate semi-private rooms, on-hand equipment for emergencies and a centralized nursing station.
Starting out as pressboard and duck tape, 2,000 square-foot micro-clinics have graduated from prototype to the real world. Clinics designed as a result of testing at the Garfield Center are now up and running in 18 Kaiser Permanente locations, designed to maximize efficiency with cutting-edge technology and treatment rooms in the middle of the clinic -- as per physician request -- for better access.
The next step for the center, Liebermann said, is looking at health and wellness outside the traditional health care setting, such as in the home where members can take advantage of personal technology tools to monitor their health.
Keeping Collaboration Alive
The Palo Alto-based Institute for the Future -- known for its forecasting -- plans to launch a hospital project later this year. It will leverage the expertise of professionals in and outside of health care to "crowdsource" innovation through a proprietary, online, brainstorming platform.
Participants will explore opportunities for hospitals to innovate and will reimagine the hospital for the next decade and beyond, said Bradley Kreit, research director with the Health Horizons Program at the Institute.
Not unlike the Garfield Center, the institute focuses on delivering care outside the traditional setting -- "where people are" -- and encourages interaction between multidisciplinary teams that might not regularly communicate, he said.
The project hopes to address immediate and long-term goals. In the near term, hospitals face many challenges and changes in adapting to the world of the Affordable Care Act. The project also will deal with long-term concerns, such as preparing for patients who want to manage their health needs in their homes and communities, rather than in a hospital, Kreit said.
Competition Generates Ideas
Through a series of prize-based competitions, Health 2.0, headquartered in San Francisco, uses a carrot approach to generate innovative ideas. Adapting to reform's provisions -- deploying technology and serving up patient-centered, preventive care -- has kept the Health 2.0 community on its toes.
Its agenda focuses on finding new sources of data, making information transparent and creating personal health tools.
Product development is girded by Health 2.0's Developer Challenges -- projects conducted by interdisciplinary teams building technology solutions to address health care issues, or one-day events stimulating rapid development of new applications and tools to improve health care. Many are coming to fruition.
"When we started, we wondered which apps would do for health care what Facebook did for social connections -- bringing the power of easier-to-use, lightweight technology to enhance services and communications," said Indu Subaiya, co-chair of Health 2.0. "But, it's clearly gone further than that."
The Office of the National Coordinator for Health Information Technology has put some of its grant money behind the Developer Challenges to reward innovations. One winning team created a universally accessible, text-messaging system that expands access to healthy food and information.
Subaiya said the challenges have common features:
- A focus on user behavior;
- Use of data from multiple sources that generate intelligent decisions; and
- Solutions that are part of an integrated process.
"People in the Bay Area just have innovation in their DNA and embrace the start-up spirit," she said. Not to mention, she added, capital resources, experience and a health-conscious attitude.
Up to the 'linkAges' Challenge
Health 2.0 and the Bay Area's incubator spirit have influenced the Palo Alto Medical Foundation in its quest for new care delivery models.
The foundation's David Druker Center for Health Sytstems Innovation invited the Silicon Valley community to participate in developing new ways to help seniors deal with changes brought on by aging.
The center's linkAges Developer Challenge -- a contest pitting new ideas against each other -- was designed to promote successful and graceful aging in the elderly population. Ideas ranged from preventing health complications to providing adequate support.
LinkAges is representative of breaking out of the traditional mold of health care even if ideas sometimes seem off the wall, said Albert Chan, medical director of the David Druker Center for Health Systems Innovation.
To Chan, linkAges is an ecosystem -- one linking across generations. "It supports solutions by integrating already existing social services, caregiver support, and professional health care teams to access necessary resources and improve quality of life," he said.
LinkAges' emphasis on partnerships among people to deliver ideas is reminiscent of the philosophy of other Bay Area companies in the health care delivery space.
The goal of linkAges is detecting significant signals that can uncover behavior (mail piling up or missed medical appointments, for example) and ultimately assist caregivers and providers in staying abreast of older adults' mental and physical status. Chan said that the winning solutions are all practical. "We don't believe in creating a hammer looking for a nail," he said.
Three winners emerged last month from brainstorming sessions:
- Similar to the Smart Meter concept, the Meter Made relies on a sensor to monitor use of household utilities to detect any deviations from normal use -- a red flag for behavior changes in older residents;
- Team SunHatPig's idea for resource-sharing among community caregivers of the elderly promotes collaboration and reduces stress: and
- Team JEDi's mobile application allows service providers, such as postal carriers and Meals on Wheels drivers, to provide health updates on the seniors they serve.
Stanford Moves Innovation to Health Care
In the tradition of Stanford University's Center for Social Innovation, Stanford's Clinical Excellence Research Center opened in August 2011.
"It trains a new breed of health care affordability innovators to design new care delivery models that lower the complexity and cost of health care, while improving outcomes and the patient experience," said Arnold Milstein, a longtime health care consultant in the private sector who heads the new center.
The center identifies top performers in high-cost clinical areas, analyzes their performance, and designs fresh care models, which the center alpha tests with a few delivery system partners, followed by beta testing in dozens of sites to confirm reproducibility.
It then works with health care improvement organizations and high-technology companies to simplify and disseminate the innovative care models nationally.
The goal, Milstein said, is to create models that reduce annual per capita health spending by as much as 50% for specific conditions.
During its first year, the center targeted two chronic diseases -- late-stage cancer care and late-stage chronic kidney disease -- and two procedures -- colonoscopies and low-risk bariatric surgery -- taking into account the 10 to 15 years of total health care spending after these procedures.
Plans for the second year include developing care models for children with severe chronic illnesses and patients with impending strokes.
Milstein said the new center's success rides on deep understanding of unmet patient and provider needs; learning firsthand what ideas work; enlisting contributors from various disciplines; reaping the benefit of younger, more "laterally thinking" research fellows; and targeting clinical areas absorbing high levels of U.S. spending.
Failure Breeds Success
A common thread among Bay Area organizations is a stalwart approach to failure. Prototyping and experimenting may breed some initial failures among the efforts of the Garfield Center, but that translates into successfully finding out what works and what doesn't, Liebermann said.
Kreit shares Liebermann's philosophy about successes arising out of the dust of failures. "It shows you are ambitious," he said. "You get a new idea, test it and refine it, and if the idea doesn't work, learn from your mistakes early and move on."
"Take enough risk that you actually have a chance of failing," suggested Carol Bartz, the recently ousted Yahoo! CEO, in an article in the San Francisco Chronicle.