Federally funded "beacon" communities are tackling the problem of hospital readmissions and other tough healthcare challenges by testing the effectiveness of multiple treatment strategies simultaneously instead of taking the traditional approach of testing one treatment at a time, according to the program's director.
The model communities, which have already embraced electronic health records and information exchange, are working to determine which specific treatments best improve patient outcomes for their region's healthcare goals. They plan to share the results with other communities.
"No one specific intervention in each community is designed to be the thing that will lead to improved health goals," said Aaron McKethan, director of ONC's Beacon program in the Office of the National Coordinator.
"There are a lot of things happening in service to a specific aim in each of these communities," he said at an Oct. 19 conference on innovation sponsored by the Brookings Institution.
For instance, the beacon in the North Carolina Piedmont region around Charlotte is focused on identifying effective strategies to reduce emergency room visits and complications of children with asthma, he said.
And the Indianapolis beacon community, made up of public and private providers, insurers and employers connected via the Indiana Health Information Exchange, is trying to reduce readmissions of people with chronic conditions by tele-monitoring their status after hospital discharge.
ONC has funded 17 beacon communities around the country
The effort engages payers to use incentives as a tool to advance healthcare goals, set up care management and physician reporting and performance feedback systems, McKethan said.
At the same time, it is difficult to evaluate the effectiveness of each line of action taken by a beacon community. "It's not clear whether it was the care manager working in the hospital calling the patients to make sure they had their meds reconciled upon discharge or some other activity that led to the results," he said.
However, beacon participants have developed a comfort level with research designs that call for mounting multiple clinical and administrative strategies at the same time. "We are not going to incrementalize our way into substantial improvements in performance, quality, cost and population health," McKethan said.
Also, data on intervention failures often can be as useful as successes, he noted. When a plan of action is tested, measured and found not to be effective, the data will provide a sense of how to make course corrections that will lead to other more successful approaches, he said.
Achieving each community's healthcare objective is a coordinated process, with clear goals and performance measures to back them up, and a range of steps and treatments to accomplish it.
The missing piece is ensuring that the payments are aligned with quality improvement activities in the community. Beacons can still find ways of reducing hospital readmissions, "but doing so without payments that back it up makes it really difficult," he said.
"We view the beacon communities as on a glide path to improvements where financing ultimately becomes a key part of reinforcing the performance improvement gains," McKethan said.
As part of the beacon program, ONC is also helping communities to prepare for accountable care organizations and other payment models designed to reinforce quality improvement activities.
McKethan hopes the beacon communities will eventually be part of a broad network contributing population data, analytics and timely information for Medicare, Medicaid and private payers.
