Learning Health System: Aligning Science, Informatics, and Culture for Continuous Improvement

1. Members MeetingLeadership Consortium for a Value & Science-Driven Health System March 21, 2019 • Vision  Research  Evidence  Effectiveness  Trials  IT Platform  Data Quality & Use  Health Costs  Value  Complexity  Best Care  Patients  Systems  Measures  Leadership The Learning Health System Series

2. Leadership Consortium Vision We seek the development of a continuously learning health system in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.

3. Approach • Making the case • Mapping the landscape • Facilitating the action

4. Challenges and Opportunities • Strategic silos: integrative, linked and informed strategies and perspectives • Fragmented decision nodes: agreement on guiding principles • Misplaced incentives: path to payment for personal and population health improvement • Opacity in choice and performance: transparency, engagement, accountability • Tragedy of the commons: basic commitment to equity and the common good

5. Supporting Policy Platforms • xFour surrogate candidates • Periodic publication of progress • Related stakeholder and NAM communication strategy • Related assessment of Collaborative projects

6. Collaborative Model • Digital Learning Collaborative • Clinical Effectiveness Research Innovation Collaborative • Value Incentives and Systems Innovation Collaborative • Care Culture and Decision-making Innovation Collaborative

7. Collaborative Obligations • Clarify compelling issues, strategies, and roles • Encourage and/or sponsor convening of key stakeholders to consider strategies on progress targets • Directly steward collaborative action on certain selected priorities • Undertake periodic progress assessment and communication

8. Strategic Initiatives • Digital Learning • Virtual Health Data Trust • Clinical Effectiveness Research • Real-World Learning Capacity • Value Incentives and Systems • Payment for Health • Care Culture and Decision-Making • Engaged People and Communities

9. Project Criteria • Importance of the problem targeted • Need for multi-organizational collaboration • Gap in strategic initiative • Clarity of stewardship advantage for NAM • Other considerations: • Practical utility of planned deliverable • Communication potential

17. Facilitating the Action • Projects: strategic collaborative projects • Development • Evaluation • First principles: identify cross-cutting first principles for stakeholders • Dashboard: indicators of national progress in domains of action

18. Dashboard Development • Four domains: digital, evidence, economics, culture • Priority indicator categories for each • “Ideal” indicators for each category • Available indicator surrogate candidates • Periodic publication of progress • Related stakeholder and NAM communication strategy • Related assessment of Collaborative projects

19. Possible Dashboard Issues • Engagement • Care match with patient goals • Voluntary health organization density • Multi-sector CHNA’s • Digital connectivity • Technology-enabled engagement • Core measures • Financing • Care access-linked payments • Proven-care payments • Patient goal-linked payments • Continuity-linked payments • Accountable health communities • Digital • Data security • Data reliability • Data compatibility • Data interoperability • Data access • Data use • Data trust integrity • Evidence • Care-embedded researchers • Collaborative study conduct • Open science practices • AI & machine learningLearning-linked payments

20. Engagement (example issues) • Care match with patient goals • Voluntary health organization density • Multi-sector CHNAs • Digital interoperability & connectivity • Level of technology-enabled engagement • Use of standardized multi-level core indicators

21. Digital (example issues) • Data security • Data reliability • Data compatibility • Data interoperability • Data access • Data use

23. e.g. Vital Signs Core measures Best available/surrogate Life expectancy Life expectancy at birth Well-being Self-reported health Overweight and obesity Body mass index Addictive behavior Addiction death rate Unintended pregnancy Teen pregnancy rate Healthy communities High school graduation rate Preventive services Childhood immunization rate Care access Unmet care need Patient safety Hospital-acquired infection rate Evidence-based care Preventable hospitalization rate Care match with patient goals Patient-clinician communication satisfaction Personal spending burden High spending relative to income Population spending burden Per capita expenditures on health care Individual engagement Health literacy rate Community engagement Social support

24. e.g. CMS Meaningful Measures Healthcare associated infections Preventable healthcare harm Care is personalized and aligned with patient's goals End of life care according to preferences Patient's experience of care Patient reportedfunctional outcomes Medication management Admissions and readmissions to hospitals Transfer of health information and interoperability Preventive care Management of chronic conditions Prevention, treatment, and management of mental health Prevention and treatment of opioid and substance use disorders Risk adjusted mortality Equity of care Community engagement Appropriate use of healthcare Patient focused episode of care Risk adjusted total cost of care