Projects
The MacColl Institute for Healthcare Innovation's recent work has included developing regional collaborations between health care systems, local governments, and purchasers in improving the delivery of care, as well as a continued focus on fostering the implementation of innovative strategies in integrated health systems. Recent MacColl projects show the range of work in:
- Regional improvement
- State initiatives
- Patient-centered care
- Innovation at Group Health
- Practice change and coaching
- Cancer care strategies
Regional improvement
The Institute of Medicine's 2001 report, Crossing the Quality Chasm calls for a coordinated effort to align measurement, incentives, and concerted improvement to fix American's broken health care system. Coalitions are a promising structure for effecting this change. The MacColl Institute has offered a new model, The Framework for Creating a Regional Health Care System, and an introductory look at public and private stakeholders currently working together to improve health care in many regions of the country.
State initiatives
- Technical assistance for Prescription for Pennsylvania: Prescription for Pennsylvania (Rx for PA) is Governor Rendell's comprehensive health care reform initiative to address the access, affordability, and quality of health care in that state. Rx for PA is a set of integrated strategies to eliminate inefficiencies in the health care system, better manage chronic conditions, eliminate health facility-acquired infections, implement common sense insurance reforms, and offer access to affordable health care insurance to the uninsured. Embedded into Rx for PA is the Chronic Care Model. Since Rx for PA was rolled out in January 2007, it has been recognized by The Henry J. Kaiser Family Foundation, The Robert Wood Johnson Foundation, and Families USA for its reasonable approach to health care reform.
- California Improvement Network: The MacColl Institute is providing ongoing technical assistance to The California Improvement Network. First established in 2005 as a social network to share ideas about improving care delivery, the Network has sponsored training for more than 600 health care professionals in specific quality improvement skills and has evolved into an organization of partners who care for some 20 million Californians and actively work with more than 1 million patients who have one or more chronic conditions. The Network partners work with clinicians from a broad range of outpatient settings in California. They include statewide organizations as well as regional groups, and represent private commercial medical groups, public and private community clinics, public hospitals, a county health department, and a Medi-Cal managed care health plan.
Patient-centered care
In 2008, supported by The Commonwealth Fund and in partnership with Qualis Health, the MacColl Institute embarked on a major demonstration project assisting 50 safety net practices in selected regions in becoming high-functioning Patient-Centered Medical Home (PCMH) sites. The PCMH concept promotes the delivery of patient-centered care to achieve better health outcomes through care coordination and improved access and payment. This is urgently needed not only by providers and systems engaged in primary care quality improvement efforts, but by purchasers and policy makers in search of a vehicle for payment reform. A key feature of the PCMH is providing patients with more access to their personal care physician and clinical teams.
Innovation at Group Health
In the spring of 2007, The MacColl Institute summarized Group Health's current and future plans around innovation, and proposed a role for Group Health Center for Health Studies (CHS) in this work through the newly formed Partnership for Innovation, comprising leaders from the Group Health care-delivery system, the Group Health Foundation, and CHS. MacColl's report emphasized the importance of a common and precise definition of innovation that distinguishes it from quality improvement or other initiatives. The report proposed a framework to identify innovations, review and test them with reference to Group Health priorities, and make recommendations for the care-delivery system to adopt. Implementation of report findings began in 2008.
Practice change and coaching
In 2006 the Agency for Healthcare Research and Quality issued a contract asking the MacColl Institute to develop and test a strategy that would help safety-net practices implement the Chronic Care Model along with complementary changes to business systems designed to assure sustainability. Safety-net practices provide health care regardless of patients' insurance status, ability to pay, or immigration status. The strategy involves a toolkit supported by a practice coach to help practices redesign their care systems in a way that is less time- and resource-intensive than participation in traditional health care quality improvement collaboratives.
The goals of this ongoing project are to:
- Offer a sequenced approach to implementing the Chronic Care Model while integrating efficiency, revenue enhancement, and productivity
- Reach small health care practices
- Provide ready access to tools and concepts outside a formal quality improvement initiative
Cancer care strategies
The MacColl Institute has an ongoing commitment to studying the organizational factors related to the delivery of cancer care in health systems. MacColl Director Ed Wagner, MD, MPH, has served as the principal investigator of the HMO Cancer Research Network (CRN) since its inception. CRN consists of the research programs, enrolled populations, and data systems of 14 health maintenance organizations nationwide.
The overall goal of the CRN, and of the National Cancer Institute initiative under which it was funded, is to use this consortium of delivery systems to conduct research on cancer prevention, early detection, treatment, long-term care, and surveillance.