As major payers tweak their reimbursement policies in search of higher-value care delivery, opportunities for transformative innovation get lost because clinical operations naturally resist change. An opinion piece in JAMA suggests that adjusting federal funding policies could help drive more effective change.
The Agency for Healthcare Research and Quality's current research grant application process is not well suited to drive health systems toward innovative care delivery, according to Andrew B. Bindman, M.D., of the University of California, San Francisco; Peter J. Pronovost, M.D., Ph.D., of the Johns Hopkins University School of Medicine, Baltimore; and David A. Asch, M.D., of the Perelman School of Medicine.
“The creation of new health system innovations, and even the implementation of existing evidence within health systems, takes place in highly pragmatic and naturalized environments where even good ideas typically undergo substantial revision to fit operational realities,” they wrote.
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Demonstration projects funded by the Centers for Medicare & Medicaid Services, on the other hand, offer adequate flexibility, but lack the scientific rigor necessary to generate the best evidence-based practices needed for broader adoption across the industry.
The authors posited a funding strategy that would seek out and support existing research teams with a track record of innovation design. Ideally, those investigators would be paired with organizations that have made a substantial commitment to experimenting with and evaluating novel care delivery systems. Without organizational leadership that allows for the flexibility necessary to engage in an iterative, nimble process, investigators would face significant difficulties in driving rapid change.
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Such funding would provide financial incentive for healthcare organizations to become “learning systems,” constantly striving to improve their care by scrutinizing every interaction between physicians and patients. A simple shift in reimbursement incentives won’t be enough to make that happen, the authors wrote.