Engage Multiple Stakeholders in Spread Efforts

“Patients, purchasers, providers … we all have to actually be advocates for this kind of change in health care.” 
Veronica Goff, National Business Group on Health

The Million Hearts™ event was a unique opportunity to gather perspectives from various stakeholder groups on scaling and spreading innovative strategies for improving cardiovascular health. It was specifically designed as a forum to convene multiple stakeholders, and the sessions were conceptualized to maximize the opportunity to capture these perspectives. As a result, the event produced rich insights about the types of stakeholders, both traditional and somewhat unconventional, that should be engaged in the scaling and spreading of these innovations and their roles in catalyzing this process. Discussions also emphasized the importance of strategically crafting messages to appeal to the specific stakeholders’ interests and motivations, focused on how and when to engage stakeholders in innovation development and spread efforts, and explored potential ways in which public and private stakeholders can partner to spread innovations.

Identifying Stakeholder Groups and Roles

Learnings from the Million Hearts™ event, as well as previous scale up and spread efforts undertaken by the AHRQ Innovations Exchange, emphasize the need to engage multiple stakeholders to spread an innovation. Though the work of these groups sometimes exists in separate siloes, their purposes are inherently interrelated and their actions can also profoundly affect the scalability of an innovation. Meeting participants identified these stakeholders as having an important role to play in the scale up of innovations:

  • Hospital/Health System Leadership: Hospital and health system leaders often decide which innovations are generated or adopted within their organization or endorse the uptake of innovation through the allocation of resources or other support.
  • Providers: Providers have direct access to patients and many innovations affect, either directly or indirectly, how they deliver care. They are often at the genesis of an innovation and can champion (or resist) the adoption of innovation. Their acceptance of an innovation is crucial for it to spread.
  • Patients and Families: Patients and families have a role in both developing and disseminating an innovation. Their input can be critical to improving the quality and effectiveness of innovations, which in turn can help to build momentum for spread. They can also help market and create demand for innovations.
  • Communities: The successful spread of innovations requires deep knowledge of the community context in which the innovations are occurring, including demographics, culture and values, and health-related challenges.
  • Employers: Employers, whether small or large, fully insured or self-funded, have a stake in promoting the spread of successful health care innovations due to their vested interest in the health of their employees.
  • Insurers: Health insurers, both public and private, influence the spread of innovations through payment structures and the programs they offer to their beneficiaries.
  • Public Entities: Federal, state, and local governments can foster spread by changing payment methods, providing incentives, passing laws, and establishing regulations.
  • Private Funders: Private sector organizations such as foundations, venture capitalists, and others have a key role to play in spreading innovations by funding spread efforts and providing sources of capital and expertise at different stages of dissemination.
  • Connectors: “Connectors” can bridge different stakeholder communities and serve as intermediaries between innovators and adopters. Advisory boards and consultants can serve as connectors, making it easier for innovators to obtain multiple stakeholder opinions on their interventions, including the ways in which they need to be refined to speed adoption. Innovators can also tap connectors for help with forming spread teams and eliciting support from funders, insurers, and other key stakeholders.
  • Adopter Organizations: Adopter organizations are the ultimate target of spread activities. Depending on the nature of the innovation, the adopter organization may be very different ranging from a group practice to a hospital or from a health system to a state health department. This stakeholder category is broad and often encompasses a combination of many of the discrete stakeholder categories (e.g., providers, health system or hospital leaders, insurers). An adopter organization’s culture and willingness to attempt new innovations will create the demand for innovations (i.e., “pull”) or determine if dissemination efforts (i.e., “push” activities) are successful in stimulating the implementation of innovations.
  • Spread Organizations: Newly emerging and developing stakeholders, organizations such as state QIOs, the IHI, technical assistance centers, professional organizations, and others, are dedicated to large-scale dissemination and spread of innovations. Though the role these organizations play in the spread process is still forming and evolving, they represent an important and increasingly influential stakeholder group.

Spread efforts will require these stakeholders to venture beyond their familiar worlds to recognize and actively leverage their complementary roles, though these roles may differ depending on factors such as the nature and setting of the innovation, the maturity of the spread effort, and the scope of the scale up and spread plan.

Tailoring Message to Various Stakeholders

“Everybody is tuned into that station ‘what’s in it for me,’ and that’s just human nature.” 
Paul Plsek, Paul E. Plsek & Associates, Inc.

For an innovation to spread, its benefits must be communicated in a targeted, compelling way to stakeholder audiences. It is critical to thoughtfully identify what the benefits are for each stakeholder and articulate them in a manner that resonates with the different groups. In addition to his quote above, Paul Plsek asserted that “there has to be a sense of tapping into intrinsic motivation … to do this because I can see a benefit for myself and for others.” Similarly, Barry Bunting, American Health Care, indicated that his experience with spreading his Medication Therapy Management innovation revealed that “what really flips the lever to activate someone to become at least modestly passionate about this is the personal connection of why this matters to them.” Fashioning the “sell points” of an innovation to address the key motivating factors for each stakeholder group was recurrently emphasized as necessary to convince stakeholders that an innovation would be worthwhile to implement or support on a larger scale. This concept spurred a wealth of suggestions from participants, which ranged from specific recommendations for the innovations discussed at the meeting to more general points of interest or considerations to emphasize when approaching the various stakeholder groups.

In presenting the case to decisionmakers in adopting organizations, arguments must be brief and memorable—they have to be brief enough to be an “elevator speech” or fit into “bumper stickers.” As noted by MaryAnne Elma from the American College of Cardiology: “If it can’t be said on a bumper sticker, you’re not going to remember it.” Making succinct points about a program is not easy; innovator Hali Hammer articulated the difficulties of doing this by stating, “It would be hard for me, even in an elevator speech much less a bumper sticker, to tell people why I’m so excited about health coaching for self-management support and medication adherence.” However, the participants from the event all agreed that a brief and memorable message is important for an innovation to spread.

For illustrative purposes, the following section describes key concepts of interest to the following stakeholders: providers, hospital/health system leaders, employers, patients, and insurers. These groups represent only a subset of the stakeholders mentioned in the previous section, but they were selected because the meeting discussions focused on strategies to appeal to their interests and increase the chances they are willing to adopt or champion an innovation.

The Provider Pitch

“It’s not clear that the benefits will be that visible always to those who are actually doing the work, and that is always, I think, a critical factor in enabling spread.” 
Bruce Siegel, National Association of Public Hospitals and Health Systems

As noted by MaryAnne Elma from the American College of Cardiology, “To make [an innovation] meaningful, you have to connect it to what people are really feeling and dealing with. Otherwise it is going to feel like an addition to what they’re doing versus an improvement.” This rings especially true for providers, who are often on the sharp end of an innovation. These providers are challenged to do increasingly more with less time and resources, all while trying to deliver the best patient care. As Bruce Siegel (National Association of Public Hospitals and Health Systems) commented, providers are not as concerned with cost savings. Instead, they are interested in the benefit to their workflow and patients. He stated, “When I see the benefits cast in terms of dollars, that may mean a lot to the CFO, and that’s great, but I wonder about the benefits to those on the front line.” This reasoning argues that in presenting an innovation to providers it is important to position the idea in terms of benefits to the patient and efficiencies and improvements in how they deliver health care versus dollars and cents.

The experiences of two innovators support this approach. Barry Bunting shared how he avoided push-back from community physicians when spreading the Asheville Medication Therapy Management innovation by reaching out to them prior to rolling it out to explain how the innovation would work and how it would assist them and their patients in reaching their goals. Hali Hammer, San Francisco General Hospital Family Health Center, pointed to the importance of highlighting provider satisfaction when championing the spread of the Health Coaches innovation, stating, “We need people to continue doing primary care, and working with a health coach is incredibly satisfying [for the provider]. You really feel like you provide better care and are not spending a lot of time repeating the same messages over and over again.” These anecdotes suggest that these types of messages particularly resonate with providers and enhance the likelihood of securing their buy-in.

For providers, who delivers the message is perhaps as significant as its content. The messenger is part of the message. Mark Smith of MedStar Health observed that a strength of the Medication Therapy Management innovation was that the message was coming from a fellow provider. He indicated that this approach likely resonates better with physicians and comes across as more relatable, as opposed to coming from a managed care organization or State entity, which may be perceived as being too intrusive or designed to interfere in the way the provider practices medicine.

Beyond these factors, providers may also be influenced to adopt or participate in innovations through the use of incentives. René Vega of Aetna described how his company offered free continuing medical education credits to physicians for completing cultural competency training as part of his innovation. Though some participants questioned if continuing education credits were enough of an incentive to secure and sustain provider participation, this is another example of using targeted strategies to influence provider behavior.

The Hospital/Health System Leader or Administrator Pitch

“Within your own setting how do you justify [the innovation] to your own CEO or CFO? What are the things that they aren’t going to do in order to do this, and how do you say this is more important?” 
Foster Gesten, New York State Department of Health

As this quote reveals, hospital and health system leaders weigh different factors when deciding to support or adopt an innovation. These leaders often have an eye toward the bottom line and are faced with decisions that pit one program against another, as finite resources require tradeoffs among which innovations the organization prioritizes and pursues. They are primarily interested in programs that improve performance while achieving efficiency and also reducing costs. For example, David Magid from Kaiser Permanente Colorado explained the need to underscore the productivity features of the Heart360® innovation when approaching health system administrators, stating that “instead of talking about how the innovation improves blood pressure or patient satisfaction, we actually say, well, this is more efficient and we can take care of more patients.”

These leaders also respond to economic analyses that address the cost effectiveness of the innovation and its likelihood to produce a return on investment (ROI). Participants viewed this information as being powerful and persuasive to organizational decisionmakers. Herbert Smitherman, Wayne State University & Health Centers Detroit Foundation, Inc., spoke about his experience using cost-related data to make the case for an innovation: “Economic analysis helps me more when I work with the medical school or with the health system administrative leadership. We talk about investment, and it helps if I can at least have an economic case to bring to the table because ultimately if it doesn’t make economic sense, those who have the resources are not going to invest in it.” From a practical standpoint, Barry Bunting described how ROI projections for the Asheville Medication Therapy Management innovation differ depending on the nature of the medical condition. Early positive ROI, usually within the first year, was obtained for the diabetes program, whereas the positive ROI trends for the hyperlipidemia and hypertension programs do not emerge until the second or third years. Though this comment alludes to some of the challenges associated with calculating ROI and other cost-centric outcomes for health care innovations, it is evident this type of information plays a prominent role in spreading an innovation and is crucial to include and present to health system stakeholders.

Finally, another recommendation was to look beyond cost savings in isolation and consider the larger potential impact of an innovation from a systems perspective. Bruce Siegel summarized this concept, asking, “Is it better to think about [the innovation] perhaps, not only as a cost saver, but as something that can improve access, something that can reduce crowding in the family health center, something that can free up beds that can be used for patients who really need to be in those beds, something that can decompress the emergency department and overall just take work out of the system, work we can’t afford to support anymore?” Depending on the scope of the leader’s influence or authority, this systems- focused positioning could also be a convincing sell point.

The Employer Pitch

“That will help, I think, sell the idea … knowing that people are actually not spending a half day going to see the doctor for a checkup.” 
Veronica Goff, National Business Group on Health

Participants also considered the need to engage employers in the spread of innovations. This stakeholder group received particular attention since two of the featured innovations (the Aetna Disease Management and the Asheville Medication Therapy Management programs) were employer-based programs. Similar to the health/hospital leader perspective, the key points identified for employers related to efficiency and cost savings. Barry Bunting stated that he typically reports back to employers to “indicate bottom line dollars and cents.” This involves looking at per-person costs before and after enrollment in the program, with a particular focus on the net costs (payments to the care managers and pharmacist coaches, costs of the incentives, cost of administering the program) and bottom line ROI. René Vega of Aetna explained that he views the employer as a client and indicated that interactions should focus on what the employer is trying to achieve around improvements in clinical quality and health care costs. By understanding what programs are currently in place, we are then able to work with the employer to identify benefit solutions to best meet the needs of the employer’s employees and dependents. In addition, we work with the employer to develop approaches to monitor and track the effectiveness of the innovation that is implemented.

Even when an innovation is not employer-based, employers can still be influential in the adoption process. In addition to the efficiency and cost saving arguments put forth in the section above, an innovation’s impact on employee productivity was thought to be a powerful positioning statement. In the case of David Magid’s pharmacist-led, home blood pressure monitoring program, Veronica Goff (National Business Group on Health) observed that by promoting home blood pressure monitoring, individuals were able to avoid more frequent visits to their physician’s office for hypertension management. Using this innovation as an example, the impact on worker absenteeism and productivity is a noteworthy outcome from the employer standpoint, and presenting this information to employers could spur interest in the innovation and prompt them to advocate for its adoption.

The Patient Pitch

“For patients, we know that zero copayment, lower burden, 90-day prescriptions, simpler regimens, once a day, all of these are critically important.” 
Thomas Frieden, CDC

The patient, a critical stakeholder in successful implementation of innovations, has a central role in spreading and scaling innovations. Successful innovations depend on patient participation. For patients to participate actively in innovative programs, participation must be simple and easy.

Innovations that have built-in convenience benefits for patients facilitate their participation. For example, the Heart360® home blood pressure monitoring innovation helps individuals save work time by avoiding doctors’ visits. As Veronica Goff pointed out, this benefit for individual participants, as well as for their employers, can be emphasized in efforts to spread the innovation. Bruce Siegel echoed this concept, contending that this innovation could have a “huge potential for low-income populations who are in working families, who can’t take off a day or half a day to go to the doctor, and perhaps wait longer than they’d like to actually see the physician.” He suggested that publicizing this benefit can inspire uptake. This idea relates to limiting the burden of health care on patients, a concept coined “minimally disruptive health care” by Dr. Victor Montori of the Mayo Clinic9 and reflected in Thomas Frieden’s comments, quoted above. Patients are interested in health care innovations that not only improve their care, but also decrease the extent to which a health condition interferes with their daily lives. Often, managing health conditions, especially chronic conditions, entails complex medication regimens that require many appointments with multiple providers and specialists. This can be extremely time-consuming, taking a toll on patients and severely affecting their work and home lives. Thus, innovations that minimize the time and effort required of patients can be pivotal in making these innovations attractive to patients and their families.

It is also important for innovations to avoid unintended costs to patients, which may discourage their participation. David Magid spoke about the added expense for purchasing a blood pressure cuff with a USB adapter, which allows remote transmission of blood pressure readings, a component of his innovation. He stated that patients would not want to spend the extra money for a more expensive, technology-enabled blood pressure cuff, requiring a health plan or other payer to bear the cost difference or subsidize the price of the equipment for patients. This anecdote is an example of how meaningful increased out-of-pocket payments can be for patients. Considering this, the cost benefits, or at least the cost-neutral benefits, of an innovation could be a significant message for patients.

The discussions above suggest ways in which innovations can be structured in order to encourage patient participation. Yet, even with well-structured innovations, financial incentives may still be needed to promote patient involvement. Two of the featured innovations (Aetna’s Disease Management program and the Asheville Medication Therapy Management innovation) included a financial incentive component for the patient, both of which were designed to increase patient participation. As an innovation spreads and grows, some participants questioned whether patient incentives were financially feasible or sustainable. Yet, patient incentives were recognized as a useful way to spur patient engagement and show an appreciation for their time and involvement in their care.

Another suggestion from the meeting centered on the need for a patient champion who would influence other patients to participate in the program. The idea of a patient champion in the spread of innovations is a new counterpoint to the more typical endorsement for a clinical or provider champion for the innovation. During the Medication Therapy Management fishbowl, the discussants agreed that the best champion to ensure participation in the program is not a clinician or a purchaser, but a patient. As Paul Plsek stated, “An untapped resource that would cause more spread to happen is the patient voice, getting patients the word of mouth … demanding these kinds of services.” A patient champion who is respected and trusted by other patients can make patients more open to participating in the health innovation and potentially lead to the marketing of the program to other patients.

Barry Bunting further provided an example of patients motivating other patients: “At least 50 percent of the individuals who enrolled after the first two years enrolled because a participant in the program who they worked with encouraged them by saying this has helped me. ‘You just mentioned you have diabetes, are you in the program?’ ‘No.’ ‘Well you need to be. It really helped me, plus you can save money.’ Never underestimate the value of word of mouth. I wish we could bottle that.” David Magid, Kaiser Permanente Colorado, also touched on this point and further connected patient involvement and engagement to program sustainability. “So unless there is an engagement of the member to the process and the program, there won’t be any sustainability, so we have to keep our members engaged, interested in their own health and the responsibility to themselves.”

The Insurer Pitch

“I think one of the things that could potentially be most useful to convince any payer, even the largest of payers, is simply recognizing that you’re already paying.” 
Barry Bunting, American Health Care

An axiom in health care is if you are not going to get paid for a service or innovation, it is not going to happen. This premise has direct implications for the spread of innovations and inherently relates to the willingness of a health insurer to reimburse for an innovation. The role of payment in spreading innovations is explored in more detail in the section entitled, Spreading Innovations in a Changing Health Care Environment, but generally this makes the sell to insurers especially critical.

One of the challenges with getting insurers on board with spreading an innovation is that the positive effects are sometimes not realized until much later. This point was expressed by David Magid who stated, “The benefits and the long-term benefits of preventing heart attack and stroke and so forth, while it’s clearly very important to the people here at this meeting, it’s hard to argue that the organization that implements that will really ever see that benefit themselves.” To counter this concern, Adam Zavadil, Alliance of Community Health Plans, proposed that it is important to focus on other short-term benefits, such as increasing efficiency or improving patient satisfaction. “You’ve got to bring the payers in by showing them not just the savings that are going to come in the long term, but what else can you bring to the table that will maybe get rid of some overuse and still keep that other part of the triple aim around a good patient experience.” Adam Zavadil continued, emphasizing the need to convey a realistic projection of how the innovation will work for the insurer, “There is a bigger issue. Purchasers are told over and over again—if you invest in this, we get more, and you’ll get the savings later. And yet every year, every purchaser is faced with … the bill going up, and it doesn’t stop, and there’s never the savings. Even if a program works well, the problem is that there’s other things that are coming in that are replacing that spending with something else. I think to make these kinds of proposals [to insurers] work best, what we found in our community, is come with both a give and a get of what’s going to happen.”

Barry Bunting also shared insights about garnering the attention of health insurers from his practical experience working with insurers to spread the Asheville innovation. These experiences have shown that insurers are concerned with the cost impact and value proposition. He said, “The people that really need to hear the message are the payers. Those that are currently paying for the care that we all acknowledge is not great, but okay … we need to show them that paying for something else makes sense … what they’re really interested in is the bottom line.”

Representing a large insurer, Aetna, René Vega offered a thoughtful perspective about the factors typically weighed by his organization in determining the merits of pursuing or adopting an innovation. He indicated that Aetna looks for information that addresses the needs of both external customers and internal stakeholders, stating, “We want [our external customers] to understand that we are looking for the members’ best interest in terms of outcomes. We can look at the customers’ employee base, look at the data that are there, build an employee health profile, and then we can look for evidence-based solutions to address those issues and concerns … the internal stakeholders want to develop a program that will improve health care for the population. It is about doing the right thing, doing the appropriate research, adding to the research base, and then as a by-product of that being a differentiator in the market.” Drawing from this statement, one can conclude that the extent to which an innovation can hit the “pain points” of an insurer’s customer base as well as the mission-oriented and business-focused needs of the insurer will likely increase its appeal to this stakeholder group.

It is important to note that discussions focused primarily on private insurers, and the perspective of the public insurers should be explored in the future.

Exploring New Partnerships

“We all know we have to do something different. Now the question is how we go about it.” 
Bruce Siegel, National Association of Public Hospitals and Health Systems

Breaking down the comfortable limits of stakeholders and creating systems or collaborations across these groups represent important steps in the spread process—it takes a village of stakeholders to spread an innovation. Partnerships between more conventional, commonly identified stakeholders in spreading health care service delivery innovations are crucial for spread activities to flourish, but they should not be the stopping point. Meeting participants challenged each other to look beyond these “usual suspects” and generate ideas for new, innovative partnerships that could also serve a meaningful purpose in expediting spread activities.

One possible approach to forming new partnerships is to identify existing organizations that have a potential investment in an innovation but are not typically viewed as spread partners. For example, Adam Zavadil suggested that pharmaceutical companies could play a role in spreading the Asheville Medication Therapy Management innovation. Since increased use of prescription medications by promoting patient adherence is a component of the innovation, Adam speculated, “Is there an incentive for a pharmaceutical company … to come in and say, we’ll take on some of the risk for you, health insurer or large employer. If you don’t end up making the money that you thought you were going to on this, then we’ll take some of that risk on.” Lisa Simpson, AcademyHealth, spoke about exploring opportunities for spreading the Heart360® innovation to retail settings, stating, “The other thought about the expansion is … the increasing presence in the marketplace of large pharmacies such as Wal-Mart, Target, Walgreens, and other retail clinics. They’re seen as sort of the new wave of primary care providers and being able to leverage them even more, is that another way to diffuse this?” Another participant applauded efforts to create partnerships with electronic health records (EHR) or health information technology vendors, noting that both the Federal and State governments are “often meeting with [EHR] vendors locally to try to get them to be responsive to specific projects like Million Hearts™, Patient-Centered Medical Homes, and so on.” Partnering with these types of vendors to ensure the products they create support the data collection and process improvement needs of these national initiatives could be a fruitful approach.

Non-traditional partnerships may also entail creating new roles for traditional players. For example, Barry Bunting advocated possible spread functions for insurance consultants or brokers. These individuals advise health plans, often presenting ideas for improvements and prospective innovations to their health plan clients, and could partner with innovators to help spread their innovations. New types of organizations may also be part of new partnerships. Marilyn Laken, Medical University of South Carolina, described her work with the Outpatient Quality Improvement Network in South Carolina, stating that they “take the ICD-9 codes off the back ends of whatever EMR a practice has … and come out with audit and feedback reports that go back to the providers. Our job is to, as Tom Frieden was saying, gather the data, take a look at the metrics, and give each provider feedback on how they are doing.” Dr. Laken stated that the network then uses grant funds from the CDC to hire nurse practitioners to spread and support innovations through rapid cycle quality improvement.

Partnerships with business coalitions were also frequently cited as a unique but promising approach to promote the spread of innovations. Specifically, one audience member representing a business group on health described a business venture that was developing a structure to support employers in implementing and sustaining innovations. His experience indicated that employers can “provide accountability, systems, and resources, but [they] don’t know how to do it or don’t have the time and energy to find and implement these programs.” He explained that his business group is “designing a plan where a coalition becomes the gatherer of the data…to show the employer that proven practices and technologies implemented within their organization are having an impact for health and productivity.” Another suggestion was that business coalitions join together with payer coalitions to provide an alternate source of funding that can be a source of sustainability for spread efforts. Teresa Titus-Howard, CMS, spoke about her experiences with a coalition of employers that came together to form a trusting network and share data both among the participating employers and with other public health partners, indicating that these types of partnerships are not only feasible but can serve a distinct role in the spread process.

A type of partnership that received particular attention during the meeting was that between public and private entities. Despite their differences in scope, influence, responsibilities, and regulatory functions, public and private organizations have strengths that complement each other and have great potential, through partnerships, to be a powerful force in promoting the spread of innovations. Private sector organizations have expertise and resources for determining what products and services appeal to specific markets, and they have well-established conduits for moving products and services to various populations. The public sector has a wealth of population health data and regulatory influence to prompt adoption among a large audience. One participant contrasted the differences in stability and control that typifies the two sectors: “On the public side there’s much more external control and influence over strategic direction and in some cases a 4-year cycle where you know that things will change … there is much more internal control and flexibility on the private sector side. You might find more stability theoretically in the private sector.”

When combined, these entities together not only possess wide sway over key stakeholder groups and a potent arsenal of information and skills, but also hold the potential, from a macro- to micro-level, to affect the many factors that contribute to an innovation’s spread. This may be especially true in the case of the Million Hearts™ campaign, where both public and private entities also have a significant stake in achieving the goals outlined in the initiative. As an audience member keenly reflected, “The challenge that was put before us … is not a different challenge for the public or the private sector. They’re the same people … It’s the same problem … Health costs are killing us. They’re killing the public sector, and they’re killing the private sector … We’re essentially talking about the same issue.” This confluence of a shared problem may represent a unique opportunity to rally public and private partners around the Million Hearts™ campaign in an effort to leverage their complementary roles and spread innovations that improve cardiovascular health.

Beyond the theoretical merits of public-private partnerships, audience members cited examples that could be integrated into a possible roadmap for advancing the spread of innovations through public-private partnerships. According to the meeting participants, the work of the Beacon Communities surrounding Meaningful Use of EHRs is one successful model of a large-scale public-private partnership, where the government provides the incentives and standards, and private organizations focus on the implementation and products.

Meeting participants advocated that spread efforts should concentrate first on exploring existing partnerships or entities as a vehicle for spread, instead of developing new public-private partnerships. As one audience member stated, “Trying to find existing frameworks for folks who are working together to [spread innovations], I think, is one approach to try to figure this out, versus reinventing new structures in which public and private come together.” State QIOs were one such example of an existing structure for spread offered by the audience. With representation nationwide in every state, the QIO contractors were viewed as having current projects and missions that pair nicely with the Million Hearts™ campaign and related spread efforts. Other recommendations included The Robert Wood Johnson Foundation Aligning Forces for Quality10 and various programs involving the patient-centered medical home. Pursuing these and other synergistic efforts has the potential to increase the endurance, reach, and sustainability of Million Hearts™ innovations.

One function that might be conducted best under the auspices of public-private partnerships is data sharing. However, this collaboration often faces formidable challenges because of differing perspectives on data ownership. One meeting participant observed, “One of the largest barriers in our community with getting government and private institutions together is whatever the activity they’re involved in, ultimately there is going to be some release of some data. The public sector wants to be extremely open about releasing all of this data to the public, and the private sector goes ‘no way’.” The sync (or sometimes disconnect) between public policies and private institutions is another factor shading the perception of the utility of public-private partnerships. As one participant stated, “Usually the [public and private] intentions are shared, but the way policies play out, I think oftentimes slows the ability to work together and make progress.”

Overall, the Million Hearts™ meeting underscored the need for both public and private participation in an initiative of this magnitude. The public sector can provide the impetus and resources, while the private entities can incorporate changes into their infrastructure and processes that are not as much endangered by administration or political changes. Engaging both public and private partners in the adoption process and integrating this initiative into the government, communities, health care systems and practices, and ultimately the lives of Americans, is necessary for achieving enduring impact.

9 Link to presentation from the IHI 13th Annual International Summit, March 2012, http://app.ihi.org/tv/default.aspx#video=2f2c56f9-5a27-4b45-9f53-4e0c0906b192.

10 Robert Wood Johnson Foundation Aligning Forces for Quality. http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2010/07/aligning-forces-for-quality.html


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