New center to deliver research-based solutions to rising health care costs

In response to rising national health care costs, the Indiana University School of Medicine and Indiana Clinical and Translational Sciences Institute have launched a new center to increase efficacy and reduce costs at four major health care providers across Indiana.

The newly designated Center for Innovation and Implementation Science, or CIIS -- formerly the Innovation and Implementation Science Initiative -- will oversee four specialized research and discovery units managed by IU School of Medicine researchers at Indiana University Health, Riley Hospital for Children at IU Health, Eskenazi Health and the Richard L. Roudebush VA Medical Center in Indianapolis. The center's mission will be to tackle problems with the potential to reduce costs or generate new revenue estimated at $5 million per year or greater.

"This center will be one of the first such dedicated centers in the nation," said Malaz A. Boustani, M.D., associate professor of medicine at the IU School of Medicine, who will serve as chief operating officer of the center. "It will leverage the country's focus in health care reform to transform the IU School of Medicine's health care partners into laboratories of discovery that improve the health of our population and the quality of their care, and reduce costs."

The center is also a direct response to an influential Institute of Medicine report that called for U.S. health care systems to transform into highly adaptive, learning health care systems, he added.

Support for CIIS comes from the IU School of Medicine and the Indiana CTSI. Additional funds from Strategic Research Initiative, a joint $150 million commitment from the IU School of Medicine and IU Health to fund innovative health care research projects, will fuel the recruitment and training of additional implementation scientists to IU School of Medicine. Initial support for the center, when it was the Innovation and Implementation Science Initiative, included $700,000 from the IU School of Medicine, Regenstrief Institute and Indiana CTSI.

The research and discovery units, including directors and staff members, will be funded by the health care delivery systems in which they are located. Dr. Boustani will oversee the unit at IU Health as chief innovation and implementation officer, the first such position in the nation for a large health system. He will also oversee three CIIO positions at other participating health care systems and hospitals.

Although research and discovery units are common across the biomedical industry, Dr. Boustani said the CIIS is the first center where a Clinical and Translational Science Award-funded center and a school of medicine will oversee such units embedded within commercial and other health care systems. Over the next five years, CIIS expects to hire 10 to 20 implementation scientists, as well as support staff, across the IU Health, Eskenazi Health and Roudebush VA systems.

"The United States and Western countries have been innovating for years within a rich, unlimited resource environment," Dr. Boustani said. "Yet innovation thrives when faced with limited resources and other challenges. I strongly believe that new restraints on resources will actually improve our ability to innovate in America."

The additional CIIO positions will be held by:

• At Eskenazi Health, William M. Tierney, M.D., president of the Regenstrief Institute, associate dean for clinical effectiveness research and Sam Regenstrief Professor of Health Services Research at the IU School of Medicine.
• At Roudebush VA Medical Center, Michael Weiner, M.D., director of the IU Center for Health Services and Outcomes Research, director of the Center of Excellence on Implementing Evidence-Based Practice at Roudebush VA Health Services Research & Development and associate professor of medicine at the IU School of Medicine.
• At Riley Hospital, Stephen M. Downs, M.D., Jean and Jerry Bepko Professor of Pediatrics at the IU School of Medicine.

"The goals of the CIIS fit perfectly with the mission of the Indiana CTSI," said Anantha Shekhar, M.D., Ph.D., director of the Indiana CTSI and associate dean for translational research and Raymond E. Houk Professor of Psychiatry at the IU School of Medicine. "The Indiana CTSI aims to break down barriers to safely and effectively translate new discoveries into new treatments and therapies. CIIS will provide a partner within the state's top health care systems focused on ways to quickly and efficiently implement innovations and ensure that they reach patients and transform our health care practices."

The center will also provide a platform to attract federal funds to Indiana through special government programs focused on health care innovation, including the Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Initiatives, a U.S.-based non-governmental institute created in response to the Patient Protection and Affordable Care Act. The first of these grants was a $7.8 million CMS Innovation Award earned by this initiative in August 2012 to fund the rapid expansion of the Healthy Aging Brain Care Program, a dementia care management system, to 11 community health centers at Eskenazi Health and IU Health Arnett Hospital in Lafayette.

Other projects implemented by the IISI include a computerized "dashboard" to objectively measure operating room quality, safety and efficiency at IU Health Methodist Hospital; in- to out-patient care system changes to reduce hospital stays for chemotherapy patients at the IU Health Simon Cancer Center; and a strategy to provide special mental health interventions to IU Health Plan members with chronic conditions and depression to lower costs and improve care within the system.

"The IISI's achievements over the past year have been remarkable," said David S. Wilkes, M.D., executive associate dean for research affairs and August M. Watanabe Professor of Medical Research at the IU School of Medicine. "The energy and enthusiasm that Dr. Boustani has poured into ushering this initiative to center status is a testament to his ability to translate theory into practice at a lightning-fast pace, and representative of what the IU School of Medicine expects this center to achieve across our partners in the local health care system."

Implementation science is uniquely situated to solve difficult health care problems due to its data-driven focus on efficacy and scalability, said Nadia Adams, executive director of the CIIS. The discipline puts a strong emphasis on evidence-based solutions to "real world" problems with methods such as controlling limited budgets through resource management; managing human factors through organizational psychology, behavioral psychology and behavioral economics; and correcting "failed solutions" through strong project evaluation methods.

"Implementing a solution is a dynamic, never-ending process which takes place within an ever-changing environment," Adams said. "Some scientists feel that after they publish a study, they should simply move onto the next challenge. We're saying more thought needs to be applied to how the ideas in journal articles can go on to impact thousands, or millions, of lives -- not only the number of patients in a research study."

Dr. Boustani added that the center aims to strike a balance between the strengths of both academic medicine and corporate health care.

"Over the next five years," he said, "our goal is no less than to transform our health care partners into truly adaptive health care systems that constantly provide excellent value to patients -- and their communities."