Chris Trimble is on a mission. A Dartmouth adjunct professor for the Master in Health Care Delivery Science and MBA programs, Trimble is well-known for his expertise on innovation inside established organizations. He's traveled the world speaking to organizations ranging from healthcare systems to Fortune 500 companies that touch on healthcare, like General Electric.
Trimble, co-author of the New York Times bestseller Beyond the Idea: How to Execute Innovation in any Organization (AAPL, 2013), and more recently his sixth book, How Physicians Can Fix Health Care: One Innovation at a Time (AAPL, 2015), spoke with Orlando Medical News about resource allocation, key steps to take, opportunities to seek, pitfalls to avoid, and why full-time transition teams are necessary.
Medical News: Taking a clue from your book, How Physicians Can Fix Health Care, what major aspects of healthcare need fixing?
Trimble: So many. We focus on care redesign, changing the care model, and innovation initiatives that take the form of small, but full-time teams that redesign care for a very particular patient population.
For senior executives in particular, innovation resources are being allocated in a way that overlooks a huge area of opportunity. And I'd like to describe that a little bit, because there's a pretty solid history of investment in quality improvement work in healthcare systems. That's all very good, but quality improvement work tends to constitute initiatives that can be squeezed into people's slack time on the job, and also into their existing job descriptions.
On the other end of the spectrum, we're investing in high-tech innovations - new cell phone apps to improve health, new wearable devices. It's fun to be on the cutting edge, but a whole category is sort of in the middle. And in the middle, we're typically working with common sense, very straightforward ideas, like doing a better job of coordinating care, keeping high-risk patients healthy, or helping patients consider consequential medical decisions very carefully.
It's best done beyond the reach of quality improvement programs and specifically by commissioning small but full-time teams of three or four people to improve care for a very particular patient population. That full-time piece is so critical.
Medical News: Businesses are designed for ongoing operations, not necessarily innovation, which exposes deep, fundamental conflicts between the two. Tell us about the complexities of originating and managing these teams inside established organizations.
Trimble: It's difficult because those teams are inevitably going to experience conflict with existing ways of doing business. And yet, to get anything done, they can't really isolate themselves. They have to engage. There are always people involved in the initiative part-time with supporting roles so there must be a healthy relationship between those working on the initiative full-time and the supporting cast. It's a delicate balance that's tricky and counterintuitive. The core of my latest book is a step-by-step guide for physician leaders of these initiatives so they may avoid many mistakes their peers made in other organizations.
Medical News: Have you come across any sort of formula that gives a good ratio of number of people needed on a full-time team to the number of patients the organization has under its care?
Trimble: Wouldn't it be nice if there was such a guideline? But there's not because it depends so heavily on the type of patient population. For example, what about children with complex medical conditions, their families and families' needs? In that case, it was a full-time team of four that served 600 families.
On the other end of the spectrum, we have examples of initiatives to maximize the throughput and to maximize the providers' delivery of services. The best example is the high volume joint replacement center where the idea, again, is just the opposite: to spend as little time on each patient as possible in a way consistent with high quality.
Medical News: Physicians seem to have been taken out of the equation for providing input into these decisions. Tell me what you see as their place in innovating these teams and innovating an organization.
Trimble: The physician's role is so crucial. In the past, under fee-for-service, it's been nearly impossible to do with a pitiful few exceptions where the incentives just happen to work for a variety of quirky reasons. By and large, the fee-for-service stands in the way of the kind of work we're discussing.
The most powerful reason to feel optimistic about the future of healthcare in the United States is the steady transition to accountable care and value-based payments. There's no going back. While physicians initially may be anxious about the fee-for-service transition to accountable care, they'll find it's also extremely liberating. Once fully implemented under accountable care, fee-for-service payers won't be telling physicians what they can and cannot do, how much time they may spend with each patient, or what they can and cannot bill for. Instead, payers are saying: send us the results. If they're good and costs are low, we'll reward you financially. That's the way it should be.
Medical News: Are you encouraged by the number of ACOs that have been growing the last few years?
Trimble: Yes. In a couple of isolated cases, people have lost money by perhaps being a little bit too aggressive too quickly. But the overall trend seems very positive, and I'm very encouraged by the targets that CMS has set about the number of patients that will be under some sort of value-based payment by 2018. It bodes extremely well for U.S. healthcare.