Column: Groping our way to better care

Albert Einstein once was asked, “How do you work?” He said, “I grope.” In today’s healthcare there is a lot of groping going on. (Did I really say that?) Actually, the groping that is being done is in the form of a proliferation of pilot projects, also called demonstration projects. Healthcare in the U.S. is becoming one large mass of pilot projects. And that is as it should be. 

Pilot projects in healthcare have been around for decades. What is different now is that society is demanding higher clinical outcomes and higher levels of patient satisfaction at a lower cost. Policy wonks call it “bending the trend.” Will it be achieved by some master plan? No, it is too complex and we are not smart enough. It can, however, be achieved by the constant development, tweaking and selective implementation of what has been learned from the many pilot programs that are out there. Some of the more intriguing include:

•  The Medicaid Incentives for Prevention of Chronic Diseases Program’s goal is to “test and evaluate the effectiveness” of providing “financial and non-financial incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes, including adoption of healthy behaviors.” Or put another way, “Eat  carrots, get a reduced deductable.”

•  Patient check-in times at South Lake Hospital in Orlando, Florida have been reduced to less than two minutes. How? By having the patient use a pre-programmed iPad to enter in their personal information. It’s called MASH: Manage, Analyze, Sustain and Harness information.

•  Slated to begin January 2012, a three-year pilot project called Independence at Home will attempt to provide better, more cost-effective care to 10,000 Medicare enrollees by using physician house-calls. To be eligible for the project, patients must have multiple chronic conditions and be unable to perform normal daily activities. They must also have been hospitalized or needed other high-cost care in the past year. Participating healthcare organizations will not receive any money upfront. Instead, the groups share in savings if and after they succeed in cutting treatment costs by five percent, improve health outcomes and get positive patient reviews. This is not a simple proposition and has as many doubters as supporters.

•  The California Telemedicine Pilot Project will use state-of-the-art video, audio and medical technologies to provide physician-patient consultations without requiring an in-person visit.

•  Geriatric specialists at Mount Sinai School of Medicine and Johns Hopkins have created the Medicare Innovations Collaborative or Med-IC. The program aims to develop a portfolio of innovative geriatric care models by working with hospitals at six national health systems that have a track record of providing excellent geriatric care. These “learning laboratories” will then be made available to other hospitals and healthcare systems.

Much is happening in our own state, as well. For example:

•  In a recent interview with Seattle Business magazine, Governor Gregoire said that she is talking with U.S. Health and Human Services Secretary Kathleen Sebelius about finding a new way to deliver health care as a pilot state. She stated, “As a pilot state, we could stop looking at fee-for-service and instead pay based on outcome. We could have people pay more if they are not willing to take care of themselves and pay less if they are willing to take care of themselves.” There’s that carrot and stick model of healthcare again.

•  Looking more expansively, the Washington Global Health Alliance Ambassadors program, funded by the Bill & Melinda Gates Foundation, is an educational program designed to engage and inspire high school students and teachers about the challenges and opportunities to address critical health needs worldwide. Teachers from four pilot schools in Washington are working with researchers and practitioners to develop a curriculum focused on four diseases: influenza, malaria, tuberculosis and cholera. 

These are just a few of probably hundreds of pilot projects in play across the country. Some will fail, many will succeed and most will fall somewhere in between; we will learn from each one of them.  Let’s hope it results in a bending of the trend.

Randy Scheel is the associate administrator of Fort Vancouver Convalescent Center. He is also the co-owner of Caretiqe and The Park Lido. You can reach him at