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Not Your Mom’s Health Care

“What we heard today… it’s not what people think of when they think about the pace of health care.” That was Roy Rosin, MBA, chief innovation officer at Penn Medicine, who earlier this month gave closing remarks at a unique event in which eight teams of health care professionals from Penn Medicine presented the initial results of innovative programs aimed at improving patient care in the hopes of receiving future support to expand their ideas. 

In an age where our uber driver is only minutes away and any more than 15 seconds of buffering on our latest Netflix stream is unacceptable, the health care industry – with its clipboards and paper forms – stands out among the rest as being exceptionally resistant to change, especially when it comes to adopting new technology. It is this resistance, in large part, that perpetuates the industry’s reputation as being slower than the Slowskys. And beyond the inconvenience to patients, the inefficiencies in the way health care services are run comes at financial costs to hospitals and health systems.

Changing this slow and obstinate reputation – and ultimately providing a more efficient system that leads to improved patient care and better outcomes – is the driving force behind the Penn Medicine Center for Health Care Innovation’s Innovation Accelerator Program, a fast-track grant program that provides seed money and mentors to Penn Medicine teams with promising ideas so they can develop, test and implement new approaches to care.

Teams were originally selected and given their initial round of funding – $10k each – back in October 2015. They then had three months to create and test hypotheses – and in many cases, go back to the drawing board to reassess their approaches. Then, earlier this month, representatives from each team presented seven-minute pitches detailing their process, findings, and the future direction of their program to an auditorium of their colleagues, peers, and members of Penn Medicine’s senior leadership.

Many of the projects worked to address problems that have been present in health care for a long time. By being open-minded and persistent, the teams were able to bring a fresh perspective toward addressing them.

One example of these long-time issues being addressed with a fresh perspective is The Bridge Project, an initiative working to improve the link between patients and their follow-up appointments. Unfortunately, it’s not uncommon for patients to miss follow-up appointments after they are discharged from the hospital. Since effective transitions of care for patients being discharged from the hospital are critical, this is an issue that providers have long been working to solve. Leaders of The Bridge Project used their Innovation Accelerator Program funding to test new patient scheduling and engagement strategies aimed at reducing no-shows and cancellations, streamlining care coordination, and improving the patient experience. After first investigating several reasons why patients might be missing their appointments, they had their “a-ha” moment.

IMG_4423“When we looked at an average copy of discharge instructions given to a patient, finding the post-discharge follow-up appointment information was like playing a game of I Spy,” Rahul Banerjee, MD, a resident physician in the department of Medicine, said during his Pitch Day presentation. “Even the box labeled 'Important Discharge Instructions’ on the first page doesn‘t include follow-up appointments. We realized the system is not conducive for anyone to remember their follow-up appointments, let alone patients who have recently been hospitalized.”

After implementing a series of strategies specifically aimed at helping patients remember and keep their appointments (including having dedicated nurses to review follow-up appointment information with patients prior to discharge, manually adding appointments to take-home calendars or patient smartphones, and giving patients the option to opt-in to a personalized communication system that would send text messages to them or their loved ones with important appointment information), the team began to see staggering results.

During the three-month test period, patients enrolled in the project kept their appointments 80 percent of the time, compared to just 43 percent of the time for patients whose units did not offer the reminders. Further, patients who opted into the text reminder system had a 100 percent attendance record at their follow-ups. By using the text system, one patient was even able to reach out to the team to let them know about transportation difficulties he was having. The team was then able to coordinate transportation assistance for the patient so he could keep his appointments.

For the Bridge team, the ROI is clear. 

“In this first stage, the project required about 20 hours of work per week divided between two team members and two discharge nurses, and the cost of some paper and pens, a printer, and a phone,” Banerjee said. “And in return, we’re providing a service that drastically increases the rate at which patients are able to attend appointments, which ultimately leads to healthier and more satisfied patients, and very likely reduces the number of preventable readmissions.”

Though Banerjee’s team won’t know for another week or so if their project will get the funding it needs to continue moving forward, the team already has a clear direction. Having piloted the program with only one test unit within the Hospital or the University of Pennsylvania, with additional support, the team hopes to expand the program to other units and floors in HUP.

Additionally, having learned from the experience of the patient who used the text system to reach out about his transportation troubles, they plan to eventually transform the automated reminders into actual conversations whereby patients can communicate more directly with staff who can provide transportation or other assistance to those who may have trouble making it to their appointments.

This concept of a “pitching competition” is not completely unheard of and is actually making more of a presence in health care markets. But, let’s not get Effie Trinket on the phone just yet. This isn’t the Penn Medicine Hunger Games. In fact, what makes the Innovation Accelerator Program different from pitch competitions is the absence of the “big check” presentation, proverbial or literal. 

“There is no big check because there isn’t one ‘winner’,” said David A. Asch, MD, MBA, executive director of the Penn Center for Health Care Innovation. “Unlike other programs that use a similar pitch-style approach, this isn’t winner-take-all. There are many ways Penn Medicine can improve health and health care.  Our goal is to continue supporting as many of these programs as we can.”

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