Innovation Networks
Authors: Peter Margolis, Neal Halfon
Journal: JAMA (2009)

UPGRADING PRIMARY CARE IS KEY TO REALIZING THE promise of health care reform to improve access and quality while reducing costs. Promising models, such as the patient-centered medical home and new measurement systems for detecting better population outcomes, require primary care clinicians to develop innovative ways of organizing care. Because new and improved approaches are not easily transplanted directly into practice, transforming primary health care will be virtually impossible without a system for innovating, testing, and providing what works. Primary health care innovation networks can accelerate primary care transformation by harnessing the collective intelligence and motivation of the medical community. Collaborative networks of primary care practices can enhance the capability of individual practices, as well as the capacity of local primary care systems, to improve health outcomes. One example is the Cincinnati Children’s PhysicianHospital Organization, which is a network of 40 independently owned and operated practices that have developed a shared infrastructure led by a board of practice leaders. The Cincinnati Children’s Physician-Hospital Organization provides centralized technical support for quality improvement and a shared registry for population management. Novel payfor-performance approaches were implemented that focused on improving population-level outcomes for children with asthma that created incentives for improvement within and across practices. These efforts contributed to substantial improvement in care delivery for 13 000 asthmatic children, including use of written self-management plans, controller medications, and influenza vaccinations. Although large organized health care systems like Cincinnati Children’s Physician-Hospital Organization, the US Department of Veterans Affairs, and Kaiser Permanente have the resources and power to accomplish such changes, more than two-thirds of care in the United States is delivered by practices that are not part of such systems. Providing policy and practice supports for these primary care practices poses an enormous challenge. Most research on primary care improvement has focused on practice-level improvement and has involved relatively small numbers of practices. Advances necessary to transform primary care will require a better understanding of how to align improvements across practice, community, health plan, and regional levels of the health care system. Engineering such improvement and understanding of what strategies are likely to work across diverse local contexts will require participation of large numbers of practices and communities. Research needs to go beyond simply describing and analyzing the barriers to providing better care, and do much better at finding creative solutions, experimenting to determine what works, and understanding what it takes to spread and scale new effective care strategies. Ways to promote active involvement of clinicians in innovating and adapting new ideas are needed by harnessing the collective intelligence and motivation of individual clinicians, organizations, and communities to transform care.