'Shark Tank' pitches fuel care innovation

When Brigham and Women's Hospital ventured into risk contracts a couple of years ago, analysts dove into big data hoping it would guide them to the best ways to reduce excessive spending while improving healthcare outcomes.

The data revealed a lot, but it did not provide a clear path to better population health. So clinical leaders at the hospital decided to step out of the data pool and into the tank.

Inspired by the venture capital approach and pitch competitions as depicted on the TV show “Shark Tank,” the hospital and Brigham and Women's Physicians Organization launched BCRISP, the Brigham and Women's Care Redesign Incubator and Startup Program, in 2013.

The approach has yielded encouraging results. Its leaders say the 24 pilot projects funded have saved about $4.5 million in annual medical expenses and have provided measurable quality improvements. Last year, the program was selected as one of six winners—out of more than 60 submissions—in the Massachusetts Hospital Association's inaugural Accountable Care Compass Awards.

One initiative, devised by a team from thoracic surgery and medical oncology, developed a process to speed up and improve the diagnostic timeline for patients with potentially cancerous lung lesions. The focus was on “vulnerable” patients—racial and ethnic minorities, disabled individuals and others—who were more likely than other patients to lose contact with the hospital either before they received a diagnosis or follow-up care.

The initiative relied on the use of a “clinical strategist” to improve logistical coordination, ensure only necessary diagnostic interventions were administered and function as a resource and advocate for patients. During the nine-month pilot, the approach reduced the average diagnostic wait period from 175 days to 15. Treatment wait times dipped from an average of 194 days to 31 while the number of average physician appointments was cut to two from six. Organizers also estimate that using this model saved about $19,000 per patient.

Other pilots have yielded similarly promising results. An initiative aimed at curbing elective cesarean section births saw the rate of vaginal birth after C-section increase from 14% to 27%. In another project, clinicians worked with costly emergency department “super users” to address the medical and nonmedical issues that kept them coming back. Yet another successfully cut hospital readmissions by one-third for complex patients who had been discharged to a long-term acute-care rehabilitation facility.

The program is the brainchild of Dr. Karl Laskowski, associate medical director of the Brigham and Women's Physicians Organization. Laskowski runs BCRISP with Dr. Jessica Dudley, chief medical officer of the Brigham and Women's Physicians Organization and vice president for care redesign at Brigham and Women's Health Care.

BCRISP is based on the premise that strong clinician engagement is necessary for value-based payment models.

“Historically, clinicians have been good at describing the clinical value of care redesign proposals, but cost has typically been an afterthought—if it's considered at all,” Laskowski and Dudley wrote in an October 2015 article in the Harvard Business Review. “By requiring contributors to calculate the expected ROI of their proposals, we encouraged a new cost-focused mindset while also identifying proposals that were most likely to be sustainable.”

Clinicians appear to be taking the bait and responding to the pitch format. BCRISP received 42 proposals in 2013, 67 in 2014 and 56 in 2015. To kick things off, organizers release a request for proposals and publicize it across the hospital. Anyone can submit an idea, but the project leader needs to be a clinician. Proposals are often from interdepartmental teams, said Jessica Desrosiers, a senior project manager with Brigham and Women's Physicians Organization who helps run BCRISP.

Once all the applications are received, an advisory board of senior hospital leaders and subject-matter experts evaluates the ideas, trimming the field—in 2015, there were 17 semifinalists. Those teams are then invited to the pitch competition, which determines which ones get funding for their program.

The competition is designed to quickly identify what works, another aspect that appeals to clinicians.

Dr. Yolonda Colson, director of the Women's Lung Cancer Program at Brigham and Women's Hospital, who is the lead for the lung cancer initiative, said it helps to “test new healthcare models in low-cost small sizes to see if there is potential to really improve care and then advance to larger-size studies.”

“I think it is very usable by other hospitals,” Colson said. “BCRISP has kept the investigators very accountable to progress so that the project has to keep moving and the questions get answered quickly.”