First HHS Innovation Fellowships’ Meeting Focuses on New Measures of Quality in Healthcare

December 10th, 2012
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In its quest to find ways to reduce healthcare costs but boost healthcare quality, the U.S. Department of Health and Human Services (HHS) launched its first fellowship program in September. For the next year, I’ll be a technical advisor on the part of this program that focuses on quickly developing ways to measure clinical quality under the new healthcare act.
I’ll be working on a team with Mindy Hangsleben, an innovator in Lean technology at Intel in Portland, Oregon. We’ll be examining the challenge presented by the Affordable Care Act, which aims to move reimbursements from “fee for services” to” fees for performance.” Our questions are: “how do you measure performance? How do you pay for it?” Some aspects of health care delivery are easier to measure; e.g., what percentage of the relevant population gets a mammogram. But basing performance upon a more holistic measure of patient outcomes is tricky because all patients are not equal, and a comparison and ranking of outcomes is not easy. In addition, we’ll be looking at ways to determine the role played by various electronic health records (EHRs) in the capture of these performance parameters, as required under the new Health Information Technology for Economic and Clinical Health (HITECH) Act.
The other HHS Innovation Fellowship projects include:


  • Finding ways to quickly determine Medicaid or CHIP eligibility for people. This is going to be very important under the new healthcare law because a significant percentage of the 30 million new health-insurance eligible people will be covered under Medicaid.  It will take a sophisticated infrastructure to make sure people know about the coverage they are eligible for and are getting the care they need, at the right time. Could a combination of the fulfillment ability of Zappos with the innovation of Apple show the way to some solutions?
  • Optimizing services in the event of disaster. Preparing for disasters is problematic because disasters are rather rare—but as “Superstorm”/Hurricane Sandy showed, the need for care is acute when these types of natural disasters occur. This team is looking at ways to optimize devices and services for rare disasters and that may have collateral benefits for routine events. While only an advertising line, Motel 6’s “We’ll leave the light on for you” hints at ways to provide a constant state of comfort, if not readiness.
  • Developing electronic tracking and efficient transport for the nation’s organ transplant system. Could the logistics expertise of United Parcel Service (UPS) provide new avenues, for example?

The fellowship program was spawned when HHS met with other federal agencies to determine issues that might require some outside help (very much like the Defense Advanced Projects Research Agency). For the first round of the program, the teams assembled make for an extremely varied group, which should foster fresh ideas and perspectives, some of which are readily borrowed or repurposed from other industries.
What do you see as some of the biggest challenges facing healthcare with the ACA in place? Are the ones outlined above “it” or are there others that HHS might consider next? How would you develop a fee-for-performance system, perhaps borrowing ideas from other industry segments? Are there specific ideas you’d like to share with me as an advisor in this effort? Let me know your thoughts.

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About the Author:

I founded Popper and Company with Ken Walz more than ten years ago to address inefficiencies in health care by helping life science companies develop and commercialize new technology. Today, the members of our growing team leverage their extensive knowledge of the tools and trends shaping all aspects of health care and its participants. Send me an email.

4 Responses to “First HHS Innovation Fellowships’ Meeting Focuses on New Measures of Quality in Healthcare”

  1. Stephanie Krieger says:

    Hi Caroline,

    I am so happy to hear of this Fellowship that measures quality of healthcare. Coordination of care is indeed an important element as I witnessed first hand as an E.D. of a non-profit prescription clinic in needy areas.

    I would like to find out how more I can be involved or contribute to the question at hand of fee for performance. Thank you for your contributions to the healthcare industry as I look forward to working with you.


    Stephanie Krieger

  2. leslie garson M.D. says:

    Ms Popper; very interesting question as to how one measures ‘pay for performance’. I’ve spent some time thinking about this. currently, a lot of the P4P metrics are really nothing more than ‘pay for process’, which clearly don’t necessarily equate to performance- or perhaps another way of stating this, ‘outcomes’. In considering the complexity of patient variability, the number of factors outside a physicians control, currently untested genomic polymorphisms, i believe it would be very difficult to come up with ‘ a metric’, or even a few metrics, upon which to base physician payments. What i would propose is a system of desired outcomes for commonly managed illnesses; diabetes, CAD, Asthma, etc. these outcomes being a combination of subjective outcomes ( I feel better now than 3 months ago), biomarkers (HgA1C for diabetics) and physiologic markers (BP currently is 136/74, 3 months ago it was 158/92), and give the outcomes a weighted score- devise an algorithm utilizing these weighted scores, and then provide a scaled payment to providers linked to the summated score derived for that patient. The beauty of such a system is that it is infinitely scalable, new metrics can be added in (or others removed) at any time, it is not an ‘all or none’ payment system, and the metrics utilized can be subject to expert review. I’ve worked on such an algorithm for a pharmacogenomic decision support software and it is very robust. I’d be happy to discuss in more detail any time if you believe this idea has merit.
    Les Garson M.D., M.I.H.M.
    Newport Beach, California

  3. You’re embarking on a very interesting and important project. Not sure if you will focus on what primary care providers are doing, and how to help them change what they are doing, but supporting primary care would probably offer the best bang for the national buck.
    I’m reading Daniel Pink’s Drive and thinking about the medical clinic that I used to manage. Hope you come up with suggestions that leverage and enhance the front-line clinicians’ intrinsic motivation.

  4. joan justice says:

    Hello Caroline,
    This is indeed an interesting project. We have a series on HWC called High Quality, Low Cost HealthCare Video Interview Series. I have interviewed a number of people on thoughts about how to reduce healthcare costs while maintaining quality of care. Do you think you could give me an interview? I would love to have your ideas about this fellowship program and how it can help. Please send me an email with your thoughts. Thanks, joan