Rising healthcare costs have driven both the government and the private sector to seek cost-saving innovations in health care delivery. The Center for Medicare and Medicaid Innovation (CMMI) is leading this charge from a federal level, with burgeoning efforts coming from universities and private foundations. The Stanford Clinical Excellence Research Center (CERC) was established in 2010 with the mission better health, less spending by means of designing cost-saving care models, partnering with health systems for implementation, and disseminating innovations through peer-reviewed publications.
Purpose:
As health care payments moves from traditional fee-for-service to value-based payments, a new generation of healthcare innovators and leaders is required with unique training in systems design and healthcare finance. To meet this need, CERC has created a novel educational model for training early-career postdoctoral scholars in value-based care through the mentored design of care models that achieve the triple aim.
Description:
Scholars are recruited for a one year fellowship from a myriad of backgrounds including clinical medicine, psychology, systems engineering, and economics. They are divided into small, multidisciplinary teams of three and assigned health topics that are significant drivers of US health care costs. Prior topics have included cancer, stroke, critical care, back pain, and end-stage renal disease, among others. The fellowship begins with six weeks of intensive didactics taught by leading healthcare executives, economists, health service researchers and technology entrepreneurs and funders. Fellows receive training in human-centered design from the Stanford d.school and complete coursework in implementation science. A literature review follows to identify drivers of total cost in the topic area and countermeasures to combat them. The fellows then spend two months traveling nationally and sometimes internationally to visit high-performing centers, completing an ethnographic and operational analyses of care delivery. This culminates in the design of an innovative care model, supported with an economic cost analysis. The finalized models are pitched to incentivized health care systems and contracts are established for implementation.
Conclusions:
In the first 6 years, the health systems design fellowship has been successful in academic dissemination, publishing in high-impact journals. Prior models are being piloted in 15 health care systems across the country. Graduates have pursued a wide variety of careers with success in academia and healthcare administration. The CERC fellowship is an innovative training program that educates young leaders in value-based care.