The Democratization of Digital Health: Using Big Data for Big Ideas
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1 The Democratization of Digital Health: Using Big Data for Big Ideas How We Create Impact: A Venture Philanthropy Overview Better Health East Bay March 2016
2 Executive Summary Better Health East Bay (BHEB) is a philanthropic foundation that enables donors and social impact investors to participate in the redesign of our local health care system. By connecting donors to the people physicians, caregivers, researchers, technologists and the programs they are creating, together we can deliver better patient care to the more than 3 million people we serve throughout the East Bay. Better Health East Bay leverages Sutter Health s integrated health system assets across Northern California, including fundraising capabilities and health sciences research expertise to foster and fund "big ideas. We are taking on the challenge of health care system reform by raising funds for initiatives that will transition our outmoded facilities-based care model to an inter-connected model focused on patient empowerment, outpatient services, and community and wellness-based care. We are making a big bet in Oakland that can have national implications. By combining existing health care data and common social network design concepts, we want to create a first-of-its - kind virtual safety net of care for some of our sickest, most vulnerable, and most expensive patients in the East Bay. In effect, a well-coordinated, dedicated, hard-wired system that knows about these patients and organizes County-wide resources in a way that makes taking care of them easier. And, as part of this redesign, we are implementing digital health tools to help these patients and their families take better care of themselves at home. Central to our approach is collaboration with non-profit and for-profit innovators. Only through disruption of the current facility-based model with a technology-enabled, community wellness and self-empowerment strategy will we be able to achieve sustainable and cost-effective change.
3 Our goal is simple: Change the future of community health in the East Bay. In 2014, Alta Bates Summit Foundation Sutter Health s largest fundraising foundation in the East Bay joined with Eden Medical Foundation and Delta Memorial Hospital Foundation to become Better Health East Bay. As a nonprofit philanthropic organization based in Northern California, BHEB has: Partnerships with Sutter Health s research and innovation teams; and, a local care and social service ecosystem to test and introduce new care modalities Access to big data, including regional health care databases and research consortia Affiliations with an integrated health care system that incorporates the full continuum of community-based, inpatient, home health, and end-of-life care A broad-minded approach to collaboration with nonprofit and for-profit innovators A balance sheet of $90 million in charitable assets A fundraising, communications, and business development team dedicated to creating long-term value for partners, communities, and care delivery networks Business Model BHEB raises impact investment and charitable donations to fund our philanthropy. We invest endowment income to provide "seed funding" to develop and pilot new models of care to improve patient and community health and well-being. We are at the forefront of enabling philanthropic partners to make a fundamental difference in community health. Our approach shifts the priority from in-patient clinical settings to focusing on how we support individuals to be healthier in their everyday lives, homes, and communities.
4 The Better Health East Bay Difference: How Partners Enable Systemic Change Better Health East Bay provides a differentiated philanthropic approach for partners who want to invest in systemic change and large-scale impact. With their charitable dollars, Better Health East Bay partners have the opportunity to: Collaborate with an integrated, efficient organization capable of scaling new ideas throughout its East Bay network and affiliated research partners Influence Sutter Health s research and innovation priorities to support programs that address the most pressing needs of the East Bay s diverse ethnic and socio-economic patient population, impacting how care is delivered throughout Northern California and beyond Advance the work of nationally renowned research leaders by putting proven methods of translating health services (e.g., population health management, behavioral health, epidemiology, and population-based genomics research) into practice Health Care Innovation Today Health care systems in this era of system reform are pivoting from reactive, episodic and frequent emergency care to data- and technology-enabled population health management. With this shift, the focus also changes to become more proactive, continuous, and preventive, with home and community-based care at the core. As the catalyst for innovation in community health and population health management-based approaches, health care philanthropy can create more rewarding and innovative opportunities for impact investors and philanthropists seeking to make a material change in the lives of patients, caregivers, and the overall well-being of their local communities. Too often the ideas and resources people offer to solve a problem focus on one institution or community and are not replicated or adapted for greater impact. BHEB provides a new pathway for donors to co-create better patient care programs and experiences. We believe health care philanthropy is valuable not only for building the physical environment of care but also for redesigning how patient care is delivered and then scaled and spread to other communities.
5 Our Progress to Date Using hotspotting to improve access to care for the underserved. BHEB is using health care data and geographic information systems (GIS) tools to identify and address disparities in the delivery of care, form community partnerships, and implement financially sustainable solutions that expand access for those who do not have health care options. In addition, this work pinpoints the neighborhoods that experience disproportionately high incidences of episodic care or struggle with chronic diseases. Named a member of the Camden Coalition s National Hotspotting Toolkit Advisory Group. Led by MacArthur Genius-award winner, Dr. Jeffrey Brenner, The Camden Coalition guides participating entities in creating visualizations of utilization patterns mapped to community resources, and gaps therein. Through this partnership, BHEB has gained actionable insights including enhanced understanding of the causes of ED overutilization such as lack of primary care access. Formed East Bay/Camden Cross-Site Learning Curriculum Workgroup that supports participating systems in developing and testing super-utilizer intervention models. As a first step in population health management, BHEB initiated a collaborative care model test network with participation from the largest private and public hospital systems and Federally Qualified Health Centers (FQHCs). Raised seed funding to develop a first-of-its-kind county-wide hospital care coordination and research consortium as the foundation of a virtually integrated system of population and community health in the East Bay. The system development starts with focusing on shared pain points of frequent Emergency Department (ED) utilizers in Alameda County. Selected PreManage ED software as the proven data-sharing and community careplanning platform for frequent ED utilizers.
6 Upcoming Program Milestone In 2016, BHEB will launch a four-ed pilot of the PreManage ED super-utilizer registry with Alameda Health System s Highland Hospital in Oakland, CA and San Leandro Hospital in San Leandro, CA. Two EDs within Sutter Health s Alta Bates Summit Medical Center in Oakland and Berkeley, CA will also participate. This will represent a significant milestone for the East Bay and Bay Area as it represents a first step towards data-sharing and care collaboration between major health institutions in the Bay Area something that has never been done before. Future Initiatives We intend to raise funds to invest in three additional challenge areas in the East Bay: End of Life Care. Using a design thinking approach, Better Health East Bay will engage the community to create innovative strategies to organize, deliver, and finance community-based palliative care services. Coordinated care for complex medical conditions. We will support the development of new ways to coordinate care among Sutter East Bay hospitals, outpatient clinics, longterm and home care facilities, and other community providers. Our goal is to advance how appropriate, coordinated care is delivered at the right time, in keeping with each patient s needs and wishes. Community-based chronic disease management. We will explore the behavioral factors that can impact chronic illness and develop digital health-based tools and care models that will allow patients and physicians to monitor and manage their diseases together.
7 Leveraging Our Assets for Change Our Team and Advisors BHEB is led by experienced health care executive Jim Hickman, supported by a committed group of business sector volunteers and knowledgeable fundraising professionals, who share a vision for impact and change. Under Mr. Hickman s leadership, a new strategy, structure, and identity for Sutter Health s philanthropy for the East Bay was developed. Our health innovation initiatives will be guided by: Steve Lockhart, M.D., Chief Medical Officer for Sutter Health Chris Waugh, Chief Design and Innovation Officer for Sutter Health Walter Buzz F. Stewart, Ph.D., MPH, Vice President and Chief Research and Development Officer for Sutter Health and Director of Research, Development and Dissemination (RD&D). Our health innovation initiatives will be guided by Walter Buzz F. Stewart, Ph.D., MPH, Vice President and Chief Research and Development Officer for Sutter Health and Director of Research, Development and Dissemination (RD&D). Under Dr. Stewart s leadership, RD&D investigators are managing teams who will invent and launch new health care service models for testing and evaluation and then share these unique solutions to transform care delivery at the community level. Powered by Sutter Health No stand-alone hospital or fundraising foundation could achieve this vision alone. For innovations in one setting to be replicable in others requires both scale and diversity of providers and patients. This vision cannot be achieved in a lab or at a university research hospital, where research is isolated from the patient care setting. Known for its high-quality services, especially in the area of specialty care, Sutter Health is proud to be one of the nations leading health systems, with scores of quality awards, including honors from the prestigious Leapfrog Group. Sutter Health is a founding member of the High Value Healthcare Collaborative, a project of the Dartmouth Institute for Health Policy and Clinical Practice. Sutter Health is also recognized as a national leader in managing the cost of caring for chronically ill patients covered by Medicare.
8 As an integrated network of care with a significant presence in Northern California, we serve one of the largest and most diverse patient populations in the country. Our clinicians engage in more than 12 million patient encounters each year and deliver 40,000 babies annually, representing 1% of all U.S. newborns. Already, Sutter Health, using its electronic health record platform, can connect 5,000 doctors serving more than three million patients in 100 Northern California communities. Today, more than 1.2 million adult patients more than 64 percent of the adult patient population across the Sutter Health network connect to Sutter Health via My Health Online to partner with their doctors in managing their health. Here in the East Bay, Sutter Health has three acute care hospitals and 26 outpatient locations serving patients throughout Alameda and Contra Costa counties. Our patient population is unique in that it mirrors the demographic diversity and the health needs of the nation. Innovations that prove successful here have the potential to meet the personal, cultural, and ethnic preferences of patients nationally. Why We Need and Want Your Participation The wave of big data innovation is opening up new, affordable sources of information to help us better understand sub-populations of patients and their needs, and the community-based factors that influence their health and how they seek care. Health systems and researchers are now able to use this data to focus their attention tightly on critical interventions with the greatest potential to impact the community. This includes the development of an emerging array of digital health technologies that support better care coordination and patient and family navigation and engagement. Better Health East Bay is partnering with impact investors making strategic philanthropic investments in order to create better solutions for the community. Benefits for all partners include: Engagement in a focused leadership group with the opportunity to make a meaningful contribution towards improving the health and well-being of our community Access to researchers and clinicians who will seek your support and insights about the nature and direction of health care for the next generation of East Bay residents Inclusion in ongoing program updates, site visits and monographs This is an exciting time of redesign and opportunity in our organization s history. We look forward to speaking with you and sharing ideas for how you can contribute to this new vision of health care delivery in California and beyond. For more information, please contact James H Hickman at or HickmaJ@sutterhealth.org. To learn more, visit
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