Beacons' bold experiment
'We recognized that we needed those brave souls.'
National Coordinator for Health IT Farzad Mostashari, MD, launched his talk about the Beacon Communities at a meeting last May by talking about Thomas Frieden, MD, a former colleague in New York City, now director of the Centers for Disease Control.
He spoke about Frieden’s personal crusade as a public health official in New York City to save as many lives as possible – a goal he achieved by cutting in half the number of smokers in the city through a series of initiatives that many thought could not be done. As Mostashari tells it, Frieden met with naysayers every step of the way, yet he persevered.
Mostashari saw similarities with the ONC’s Beacon Community Program.
"We recognized that we needed those brave souls – those people who believe that healthcare can be different," he said. "Those people who could mobilize that belief in their community, and that they could help illuminate the path for everybody else."
The comment describes the Beacon Community Program in a nutshell. The program includes 17 communities that three years ago, with a total of $250 million among them, went to work on helping to transform the U.S. healthcare system. The goal was that they would pave and light the road to transformation for communities everywhere across the country.
The intent, as Mostashari put it: "What are we going to work on as a community so that’s it’s greater than each individual organization doing their own initiative, and it resulting in white noise. It’s time to start bringing these learnings together in a way they can be used more readily."
The status quo is untenable, says Asaf Bitton, MD, of Brigham and Women's Hospital and Harvard Medical School Center for Primary Care.
As he sees it, the Beacon Communities have built scaffolding for serious community change and improvement. It’s an audacious move, he says, and is one to be commended.
In Colorado, Patrick Gordon (pictured at left), director of government programs for Rocky Mountain Health Plans and program director of the Colorado Beacon, has found that data plays an essential role in the transformation that the beacons are working to effect.
"Data empowers leaders," he says. "Data allows entities who might not otherwise be able to find common ground to share in joint efforts and to achieve in joint outcomes."
The Colorado Beacon Program provided an impetus for development, he says. It encouraged teamwork and even changed culture.
"It created a structure that could make collaboration into a cultural affinity for working together much more productive," Gordon says.
Carol Beasley (pictured below right), vice president of business development at the Institute for Healthcare Improvement in Cambridge, Mass., observes that the flow of information with patients is opening up possibilities that were imagined, but not yet achieved.
After talking with several Beacon Community leaders, she has formed a vision of what "Beaconville" might look like. To her it’s a place where priorities are driven from the community, where community assets are included, where the commitment and the skills continuously improve and innovate around care and are highly developed, where the piping and plumbing and "all that information system stuff" form a strong structure.
"We need to bring the learning and infrastructure along side by side," she says. "They can’t be working in isolation."
Gordon agrees, and he notes there are significant challenges ahead.
"As coverage expands, as healthcare becomes more individualized and personalized, as costs continue to rise – even in low cost communities like Western Colorado – the rate of inflation is simply not sustainable."
He says the Colorado Beacon work was aided by Stage 1 meaningful use and by a focus on skills development in understanding how measurement plays a role in improvement and also by creating awareness of population as a whole – not just at the community level, but at the practice level and at the point of care.
"Those are fundamental changes, and it’s easy to get frustrated at the slow rate of progress sometimes," he says. "But the only path forward is through consistent development and learning."
Gordon says Stage 1 played a useful role in creating alignment within the community. "We know that there needed to be a measurement focus," he says. "We know that it needs to be shared. Yes, we wanted to account for every segment of the community. There are many segments that we know need to be measured that are not measured today. Meaningful use 1 was a very productive focal point."
One thread that connects all discussions about beacon communities and their place in healthcare transformation is sustainability.
"How do we fund all this stuff?" asks Beasley. "I think the beacons are convinced that we can fund it out of the value created," she says. "There is value to be liberated in this clunky, crazy system of ours. We’re starting to see that value be made real."
The work of the Beacon Community Program to date indicates that big change does not come easy, Beasley and others note.
If it were not hard, Bitton says, you’d know you’re working on the wrong problem. "We have a limited amount of time right now to seriously structure how we deliver care, the way we prioritize patients, the way that we value providers and certain types of care within our systems, and that current status quo is untenable."
Bitton credits ONC for cutting through the noise – the "blah, blah, blah" – and changing the terms of the debate.
"Four or five years ago, we were having this really stale, kind of boring – mostly annoying – discussion about whether – whether – it was a good idea to use health information technology in healthcare,” he says. “Now the terms of that discussion have changed. It’s about why and when."