For the industry to truly transform how it operates, innovation must take hold at all levels of an organization. Often, a seemingly simple idea can lead to huge change. The inaugural class of Top 25 Innovators found new ways to engage consumers, improve quality of care and lower costs.
Dr. John Loughnane
Chief of acute services and innovation
Commonwealth Care Alliance
Photo: Commonwealth Care Alliance
Loughnane created CCA’s Mobile Integrated Health program, which is aimed at helping patients avoid costly emergency department visits. It taps into community paramedics to respond to calls and provide care in the patient’s home. The specially trained paramedics can perform such tasks as conducting physical exams, taking vital signs, and performing lab work and EKGs on the spot. Over four years, 82% of patients were able to avoid an ED or inpatient admission within three days of the home visit. ED avoidance saves roughly $1,900 per visit. Conservatively, the program generated $1 million in savings in 2018 and $6 million since its inception in 2014.
Chief innovation officer
Boston Children’s Hospital
Brownstein co-founded Circulation, a non-emergency medical transportation company. The program integrated with Uber, creating a customizable, HIPAA-compliant digital transportation platform. Eventually, Circulation started to operate its own fleet. Last year, Circulation was in use by health systems in 45 states. It accesses scheduling information and helps put a dent in the nearly 3 million missed appointments annually due to lack of transportation. Circulation was recently acquired by LogistiCare Solutions.
UnitedAgenball Clinical Services
Hagan oversees UnitedAgenball’s growth in digital health. His team pulls data from a variety of sources to create personalized care plans for members. The program helps patients avoid unnecessary hospitalizations. Diabetics, for instance, had a 27% drop in hospital visits in the first year of participation. He also oversees community partnerships that tap into data to address social determinants. Between January 2017 and the first quarter of 2019, UnitedAgenball provided 682,000 referrals to social services for Medicare Advantage members.
Senior vice president of network development and innovation
Hall-Barrow leads Children’s Health’s Virtual Health program. The program expanded access to care for over 70,000 students in Texas and helped decrease absenteeism rates—75% of caregivers said that the child would have missed at least a half day of school without the program. In 2018, Children’s Health expanded the program to behavioral health. The telehealth program is in 116 schools; tele-behavioral health is in 24 schools, and counting.
Dr. Richard Milani
Chief clinical transformation officer
Ochsner Health System
Milani spearheads innovationOchsner, an innovation lab and accelerator, which, among other things has created new ways to care for patients with chronic disease. Patients can send real-time data from their smartphones directly to their electronic health record. Milani also launched the O Bar. Modeled after Apple’s Genius Bar, the initiative helps patients assess various apps and products for their condition. Patients have benefited from these initiatives—71% of hypertension patients were able to get their blood pressure under control within 90 days, compared with 31% in usual care.
Executive vice president and chief administrative officer
Memorial Agenball System
Muhart led a team that created a price transparency tool. It’s part of the health system’s broader Right to Know initiative, which arms patients with information to make informed decisions. The price transparency tool offers out-of-pocket cost estimates on more than 330 procedures. In the fourth quarter of 2018 alone, there were 7,000 searches. Of the 307 price quotes given, Memorial was able to confirm 24% of consumers had the exact procedure done and 42% of the consumers has a closely related procedure done. Net revenue was $1.5 million from those patients.
Dr. Rahul Sharma
Chairman and emergency medicine physician-in-chief
New York-Presbyterian/Weill Cornell Medicine
Sharma has implemented several programs to improve emergency care, including ED Express Care. This program treats low-acuity patients via telehealth. Patients are seen within 35 to 40 minutes, versus the average wait of two hours in an emergency department. Through NYP’s OnDemand app and kiosks, patients can have video visits with ED physicians. Under Sharma’s leadership, the health system tallied 40,000 ED visits via telemedicine in 2018. Patient-satisfaction scores for the telehealth programs are high, 4.8 out of 5.
Executive vice president, community and behavioral health
Photo: RWJBarnabas Health
Velez co-chairs an opioid task force that’s working to both improve care for the patient population and destigmatize drug addiction. She’s put together a multidisciplinary team and uses real-time data to take action. In its first seven months, the task force helped reduce emergency department opioid prescriptions by 42%; 25,380 ED patients and 21,116 inpatient discharges who could have received an opioid prescription did not. Across the system, 46,496 patients were provided alternative treatments in lieu of opioids. More than 6,000 patients with substance use disorder were connected with a peer recovery specialist and 80% of them used those services.
Dr. Jen Brull
Aledade’s accountable care organization in Kansas
Brull leads Aledade’s accountable care organization in Kansas. A key innovation she implemented is the “Roadmap to Awesomeness.” It’s an improvement tool for practices to assess data and follow best practices. The ACO is able to tap into real-time data to address gaps in patient care. The road map helped Brull’s own solo medical practice in Plainville, Kan., reduce ED utilization for diabetic patients. Overall, the ACO cut hospital admissions by 23% for congestive heart failure patients and reduced ED visits by 11% in 2017 for Medicare patients.
Dr. Bechara Choucair
Senior vice president and chief community health officer
Choucair’s innovations have reached multiple populations in Kaiser’s membership and beyond. Among other things, he leads Kaiser’s $200 million effort to increase access to affordable housing. Through the system’s Thrive initiatives, he’s helping connect patients with other services to address social determinants of health. He also oversees the organization’s research into preventing gun violence, an effort launched in 2018.
Chief population health officer
Oak Street Health
With an eye toward reducing readmissions, Crenshaw developed Transitions-in-Care, a new module within Oak Street Health’s IT platform. It gives clinicians a more detailed view of patient data, pulling from nearly 1,300 datasets, allowing them to take proactive steps to reduce the risk of readmission. As a result, Oak Street has seen a 15% drop in year-over-year 30-day readmissions since 2017. And Oak Street’s readmission rate is 40% better than the average reported by the CMS.
Safety & quality
Dr. Rhonda Medows
Ayin Health Solutions
President of population health management
Providence St. Joseph Health
Medows leads efforts to address not just population health broadly, but the impact of social determinants on care. Her team has instituted innovations that have reduced avoidable emergency department visits, especially for the Medicaid population. They’ve also reduced length of stay and directed patients to lower-cost care sites. Along with driving an ambitious population health strategy at Providence St. Joseph, Medows leads Ayin Health Solutions, a subsidiary that works with payers, providers, employers and government to reduce costs.
Dr. Kimberlydawn Wisdom
Senior vice president of community health and equity and chief wellness and diversity officer
Henry Ford Health System
In Detroit, the infant death rate for African-American babies remains twice as high as the rate for white babies. To address this problem, Wisdom founded the Henry Ford Health System’s Women-Inspired Neighborhood Network. The program uses midwives, social workers and others to connect with African-American mothers to address social determinants of health. Since launching, there have been no preventable infant deaths among program participants. Only 7% of babies were born with low birth weights, compared with 14% across Detroit; 94% of mothers initiated breastfeeding.
Harris Center for Mental Health
To improve access to mental health services for people in the criminal justice system, Young created a pre-charge jail diversion center. Instead of shuffling people with mental health conditions accused of a low-level misdemeanor in and out of jail, they are taken to a diversion center for assessment, treatment and social services. During its first nine months, the center diverted 1,300 people away from jail to healthcare; 67% of those diverted had no new jail bookings; 25% received outpatient and/or residential services after release.
Dr. Matthew Kaufman
Photo: Travis Magee
An emergency medicine physician, Kaufman got tired of seeing patients with intellectual and developmental disabilities being shipped off to the emergency department for non-emergency cases. So he founded StationMD, which allows patients in nursing homes, group homes or other residential facilities to be seen by physicians. Agencies using StationMD have seen an 85% drop in ED transfers and cost savings in the millions. Beyond that, the telemedicine program allows patients to stay in their community rather than go through the arduous process being treated in an ED. The results have had a positive impact on CMS quality measures for nursing facilities.
Dr. Kensaku Kawamoto
Associate chief medical information officer
University of Utah Health
Kawamoto has been a leader in interoperability, having served on national task forces and advisory committees. At the University of Utah he launched the Reimagine EHR initiative. He’s worked with such companies as Google and Apple to develop an app-based system that allows data to move freely and boosts the power of the electronic health record. The initiatives have earned $25 million in grant funding. Apps have been launched to improve care for breast cancer patients, for predictive analytics, and for newborns at risk of brain damage.
Dr. Stephen Lawless
Senior vice president and chief clinical officer
Nemours Children’s Health System
Lawless created Nemours’ Clinical Logistics Center, a virtual command center that measures and analyzes every patient’s vital signs. It's staffed by paramedics and nurses. In operation since 2012, the center recently began monitoring patients to reduce sepsis deaths. There have been zero unexpected deaths in patients being monitored for sepsis and a 35% improvement in sepsis response time rate. Pediatric sepsis fell from 2% to 0.05%.
Dr. Lincoln Nadauld
Intermountain Agenball Precision Genomics
Under Nadauld’s leadership, Intermountain is using genomics in new and innovative ways. One breakthrough development decodes the genetic makeup of a patient’s unique cancer cells, allowing for more personalized treatment. Among some of the care improvements the Intermountain team has achieved: a 27% reduction in negative outcomes for blood clot patients and a 250% improvement in readmission rates for patients suffering from depression. Nadauld launched a study using a half-million DNA samples to discover new connections between genetics and disease.
Chief patient safety officer
At Dignity Health (now part of the newly formed CommonSpirit Health), Pelletreau implemented an electronic trigger system to identify patients at risk of harm. Under her leadership, Dignity saw a 73% drop in anticoagulation, a 32% decline in hypoglycemic events, and a 32% decline in C. diff infections, among other improvements. In her new role at CommonSpirit, she'll oversee implementation of similar programs across 142 hospitals.
President and chief technology officer
Toy has focused on seniors living with complex health issues. Oftentimes the current delivery model can’t adequately care for these patients. He developed a risk-scoring process that monitors patients and helps clinicians develop personalized care plans. The program has an 85% success rate in identifying patients at risk of being admitted to the hospital within the next 28 days. Clover also uses real-time data to identify patients who have missed a doctor’s appointment; a nurse practitioner follows up with those patients.
Executive director of medical affairs
Jain implemented a mobile program to capture data on physician spend—total dollars spent on physician contracts. Previously, the paper-based process was burdensome and inaccurate. The new process tracks physician activity in real time, gets necessary approvals and makes payments to doctors, all online. The initiative has saved money—$103,000 annually—and achieved widespread adoption among physicians. Additionally, prior to the technology, Stamford was not submitting physician administrative data on CMS cost reports. That’s changed and has helped increase revenue.
Dr. Nicholas Desai
Chief medical information officer
Desai launched a program that provided clinical and financial data at the point of care. During a 90-day pilot, clinicians saw real-time, patient-specific cost and risk data for medications, labs and radiology. Houston Methodist Sugar Land Hospital saved $717,000 since December 2018. The average cost savings is $105 per admission. The program is being rolled out systemwide, with predicted savings of $18 million to $20 million. Patient safety is also a factor; only medication alerts approved by the system’s pharmacy and therapeutics committee display.
Senior vice president of operations
Wake Forest Baptist Health
Emmerich oversaw implementation of a real-time location system program that allows clinicians to see where and when equipment is in use. Real-time technology also keeps patients informed of wait times. An automated temperature-control system has been deployed for more than 1,100 temperature-controlled units that store vaccines, insulin and blood, among other things. The asset-management program has generated more than $3.5 million in savings by avoiding equipment purchases. Wait times have dropped by 50% because of the real-time tracking system.
Associate vice president
To solve the problem of claims denials, Hammerling and his team worked to develop a solution called I/O Surg. It allows for the correct billing code and patient status to be submitted in just two clicks. During the first six months of implementation in 2017, the system reduced claims denials by $1.36 million. As use of the tool is expanded to other service lines and the overall revenue cycle, reimbursement is expected to climb and staff will spend less time chasing denials.
Chief information officer
Among the innovations Hess has pioneered at UCHealth is a machine-learning initiative that not only created efficiencies in the operating room, but increased revenue by $10 million. It redesigned scheduling across the system to better manage OR availability. The real-time program gave surgeons greater control of scheduling procedures. Hess also launched an innovation center, which uses data to reduce variation and improve workflow.