1. Members Meeting Leadership 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
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 learning Learning-linked payments
Financing
Care access-linked payments
Proven-care payments
Patient goal-linked payments
Continuity-linked payments
Accountable health communities

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 reported functional 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