The flurry of new overlapping opportunities and incentives (ACO, value-based purchasing, public performance reporting, P4P, PCMH, CCTP, etc.) has unintentionally created a kind of paralysis in many health systems trying to sort it all out and prioritize their next moves. The choices are now more varied and the environment is far more complex than ever; especially when you layer in the stronger effort of stakeholders jockeying for ‘dollar one’, the uncertainty about the ROI under many initiatives, the need to develop stronger working relationships with community-based service organizations, the multiplicity of payers, the lack of upfront funding for organizational retooling, and an unstable policy and regulatory environment.
Some would argue that the multiplicity of innovation offerings is not really a problem, but rather a benefit, because it offers more choice and because all of these initiatives point in the same ‘general direction’ of better care at lower cost. But this ignores an understanding of the real work and money required to operationalize significant new processes or programs with reliability and resilience, and the tight specificity with which they must be designed to be effective.
It is likely that recent, well-intentioned efforts to stimulate health care innovation may backfire and instead impede it. Many an experienced system thinker has watched countless ‘direct’ and ‘targeted’ interventions produce counterintuitive results – the harder the push, the worse the results. The big aims are right, the intention is good, and a laissez-faire, do nothing approach is worse. But we must raise our level of systems thinking and actively encourage and support regional collaborative design forums – smaller than a state, larger than a single health system – focused on the long-term health outcomes of the population. This could help simplify the complexity in a given region, by encouraging providers to collectively select one, or at most a few, large scale redesign initiatives to work on. Those regions that come up with a consensus approach could be afforded extra support as a reward. Such an approach would emphasize our need to think first of the populations we serve and help CMS learn more confidently and efficiently what models work. No doubt we can and must learn to improve our approach to offering new initiatives to spur innovation within a very complex system.
It is likely that recent, well-intentioned efforts to stimulate health care innovation may backfire and instead impede it. Many an experienced system thinker has watched countless ‘direct’ and ‘targeted’ interventions produce counterintuitive results – the harder the push, the worse the results. The big aims are right, the intention is good, and a laissez-faire, do nothing approach is worse. But we must raise our level of systems thinking and actively encourage and support regional collaborative design forums – smaller than a state, larger than a single health system – focused on the long-term health outcomes of the population. This could help simplify the complexity in a given region, by encouraging providers to collectively select one, or at most a few, large scale redesign initiatives to work on. Those regions that come up with a consensus approach could be afforded extra support as a reward. Such an approach would emphasize our need to think first of the populations we serve and help CMS learn more confidently and efficiently what models work. No doubt we can and must learn to improve our approach to offering new initiatives to spur innovation within a very complex system.