* Is paying smokers to quit their habit effective?
* Can “automated hovering” help patients remember to take their heart medication?
* Can a magic scale help get the weight off?
Question such as these are prompting some of the most mold-breaking thinking in American health care circles -- and it’s happening at Penn. The Center is the brainchild of Kevin Mahoney, Penn Medicine’s chief administrative officer, who believes that the best way to keep the organization advancing is by promoting the creative capacities of personnel within the health system and the university.
At the Center, staff members and associates with backgrounds in medicine, behavioral economics, business, engineering, design, software development, and hospitality develop and test fresh ideas for improving health care delivery. Additionally, the Center’s grant program funds Penn Medicine staff members with imaginative ideas for preventing hospital readmissions, improving the patient experience, and delivering evidence-based care.
David Asch, MD, MBA, executive director of the Center, says: “We’re called the Penn Medicine Center for Health Care Innovation -- not the Penn Medicine Center of Health Care Innovation. ‘For’ means we’re there for those with great ideas. ‘Of’ implies that all of the innovation takes place within our walls. And that’s not something we want.”
Innovation is hard work, says Asch. "We’re not just creating trendy smart phone apps. We’re keeping the patient in our sights, and we want to provide enduring value.”
Asch notes that most health-care financing in the US addresses hospitalizations and outpatient visits. But the Center emphasizes the 5,000 annual waking hours patients spend out of the doctor’s office or hospital. “These hours directly influence whether patients remain healthy,” says co-director Kevin Volpp, MD, PhD. “Deciding whether to take their medication regularly and not just when they feel ill, choosing what to eat and drink and whether to smoke, all greatly affect patients’ health. Most patients know what those choices should be; we just give them a little outside help.”
The Center has brought in entrepreneurial expertise to help it achieve its mission. Roy Rosin, the Center’s chief innovation officer and a college classmate of Volpp’s, came to Penn after serving as first vice president of innovation for Intuit, a global software company known for Quicken, QuickBooks, and TurboTax. But the apparent incongruity between health care and online mortgages and DIY income tax returns is just that: apparent.
Rosin, who oversaw Intuit’s innovation program, says, “My role was helping internal teams test new ideas. We’re following the same model here at Penn. Innovation -- and most science today -- isn’t about a lone genius having a ‘eureka’ moment. Instead it’s based on teamwork and learning early on and at low cost if you’re going in a viable direction.” Asch says this about Rosin: “After three minutes with Roy you know he can help you better understand what your real goals are, and get you on the path to achieving them.”
Way to Health
Much of the Center’s work is tied to Way to Health, a web-based IT platform developed at Penn and supported by an economic stimulus grant from the National Institutes of Health. (The name may ring a bell. It intentionally evokes Benjamin Franklin’s The Way to Wealth, a short guide to prosperity.) Asch calls it “a new pathway for care delivery.”
Way to Health supports what Asch, Volpp, and UPHS CEO Ralph Muller christened in a joint article in The New England Journal of Medicine as automated hovering: mixing behavioral economics -- such as paying people to perform healthy behaviors -- with biometric devices such as “smart” pill-bottle tops. The goal is to motivate patients to improve their health while keeping track of their progress and letting them know if they’re slipping behind. Way to Health helps researchers allocate participants in studies, send surveys and voice and text messages, and pay participants by transferring money into their bank accounts.
For example, at the Children’s Hospital of Philadelphia, employees hoping to lose weight were randomized to take part in monthly weigh-ins through Way to Health. They were given the goal of losing a pound a week for 24 weeks with 1) no financial reward, 2) $100 monthly for reaching their target weight, or 3) $500 monthly for groups of five employees who reached their target. Which would work best?
Participants weighed themselves on a Way to Health “magic” workplace scale. The machine sends weight information to a server, which calculates the applicable incentive. Payments are then transferred electronically to the participants’ banks. The results showed that the group-based incentive -- perhaps reflecting a positive form of peer pressure -- produced three times the weight loss as individual rewards. As a result of these findings, Asch and Volpp expect that employers will offer similar incentives to their own employees.
Another focus is on encouraging patients to take their medication regularly. One technique involves “smart” pill caps. A chip inside the cap sends information electronically to the Way to Health platform, indicating whether the heart-medicine bottle has been opened that day. Patients volunteer to have family members notified if they forget to take their medicine. “Imagine you’re a fifty-year-old male whose 19-year-old daughter will be told if you skip your pills,” says Volpp. “You certainly don’t want to get a call from her asking why you missed your medication.”
Through Center-based research, Volpp and colleagues found that smokers given financial incentives quit smoking at three times the rate of those not similarly rewarded. A program based on this approach was implemented for all 152,000 General Electric employees in the U.S. Volpp continues to assess how the model can be improved, noting that the incentivized quit-rate, while significantly better than the five percent of workers who weren’t given financial incentives, was still only 15 percent. That means 85 percent of smokers who want to quit still have a hard time doing so -- even with $750 in financial incentives.
DreamIt: IBX Partnership
Rosin leads Penn Medicine’s role in DreamIt Ventures, a partnership with Independence Blue Cross aimed at finding new ways to improve care and use resources effeciently.
An early result of the team-up is the first Philadelphia-based health care “accelerator,” which supports promising health care start-up companies. The accelerator provides cash, guidance from experienced health care executives (including members of the Center’s staff), and office space. Its four-month boot camp recently helped support ten new local health care startups, tackling such problems as hospital readmissions, patient communications, and cost transparency. The program culminated in a “demo day” with the 10 companies presenting their businesses to investors and potential customers, including major health-care organizations.
Penn is renowned for the kind of care that only a few places around the country can deliver. But it still has to make patients feel welcome and supported. Along with Emilie Bartolucci, who came to the Center from the Ritz Carlton Hotel, and Meera Gupta MD, a general surgery resident, Rosin developed a program for assessing patient feedback so hospital staff members can get a sense of what patients think of their care. It features a combination of new software (think private Yelp or Twitter for hospitals) and rigorous analysis.
And these are only some examples of what’s taking place at the Center. Results are already showing how patients can improve their health. While not every reader of Dr. Franklin’s Way to Wealth becamea well-heeled tycoon, those who hold fast to the findings of the Penn Medicine Center for Health Care Innovation can remain in the pink for a good long while.
Photo caption: (L. to r.) Roy Rosin, David Asch, and Kevin Volpp want to hear your best ideas to improve health care.