Carnegie Mellon Teams with Health Insurance Provider to Accelerate Healthcare Innovation

Health care is fertile ground for disrup- tive innovation-there are innumerable opportunities to improve delivery and reduce costs through both technical and service innovations. But health insur- ance providers and other participants in the overall healthcare system have sometimes resisted innovation. A new initiative is partnering one of the na- tion's top research universities with a national health insurance provider to remove traditional barriers to disruptive innovation in health care.

Carnegie Mellon University's Disrup- tive Health Technology Institute (DHTI), created in partnership with health in- surance provider Highmark, aims to use data mining to spur disruptive innova- tion for healthcare improvements and cost reductions. With an initial invest- ment of $11 million building on a $2.5 million grant from the Heinz Endow- ments, the Institute will use Highmark's de-identified aggregated data to target areas where the university's consider- able research power and expertise can be applied to increase affordability, sim- plicity, and accessibility of health care. The aggregated Highmark information- data that researchers can use to track issues across time, organizations, pa- tient populations, or other variables- contains no identifications or personal information about patients. The partner- ship is giving the insurance company an uncommon seat at the innovation table and researchers unusual access to data that can help steer their innovation work.

DHTI is focusing on seven key areas that correspond to healthcare areas ripe for innovation and Carnegie Mel- lon's particular areas of expertise. These include six areas related to patient treatment-accessibility of medical di- agnostics, behavior change, chronic disease management, endoscopy, diag- nostic ultrasound, and infection pre- vention. The institute will also work to build on the University's expertise in data mining by developing more effi- cient and effective ways to harvest and analyze data, to improve both research and patient care.

Executive Director Lynn Brusco says the ability to use real and direct input from Highmark's administrators and cli- nicians allows a new approach to dis- ruptive innovation in health care. "Typically, innovators come to investors with an idea and say, 'This is my idea and I think that it will solve this prob- lem,' and then an investor has to decide whether they want to give the idea backing," she said. "We are coming at solutions differently. We are getting thought leaders together with the right data, sitting down with them discussing real issues and doing horizon mapping to identify where the problems are for healthcare delivery and patients. Re- searchers are then aligning their work and innovative ideas to provide solu- tions to these unmet needs."

Brusco said the DHTI approach seeks to replicate the successes attained when the search for safer motor vehicles led to data mining of automobile insurance information. As Brusco describes it, "What is exciting is that we are looking at problems and letting the brightest minds of Carnegie Mellon come up with solutions rather than innovating an idea and then seeing if there is a market for it. We have more than 100 faculty and clinicians doing horizon mapping." The horizon mapping has already resulted in more than 50 spe- cific proposals for targeted innovation, according to Brusco. She declined to specify their nature but said to expect significant announcements about ad- vancing the projects by fall 2013.

Thought leaders in disruptive innova- tion have long identified the innovator- to-investor step as the first of a set of resistive barriers in health care. As disruptive innovation theory pioneer Clayton M. Christensen put it in a 2000 Harvard Business Review article coauthored with physicians Richard Bohmer of Harvard and John Kenagy of the University of Washington, "Powerful institutional forces fight simpler alter- natives to expensive care because those alternatives threaten their liveli- hoods." The article details the chain of formidable barriers facing innova- tors looking for approval and invest- ment to bring new healthcare ideas to the marketplace: regulators who with- hold approvals, professionals who create the licensing standards those regulators enforce, and insurance com- panies that approve reimbursements only for established procedures and technologies.

Dr. Jason Hwang, an internist and co- founder of the Innosight Institute (now known as the Clayton Christensen In- stitute for Disruptive Innovation), a not-for-profit think tank, focused on in- surance companies when he told Man- aged Care Magazine, "Payers must shift payment models to begin rewarding pre- cision diagnostic tests and precision diag- nostic abilities of providers to begin to create a more rational system." In team- ing with Carnegie Mellon, Highmark has taken the unusual position of looking for a way around the traditional barriers to innovation in health care and potentially addressing the inefficient payment mod- els Hwang noted.

One of the participants is Dr. Alan Russell, a pioneer in the science of re- generating damaged or diseased hu- man tissue. Russell was appointed to the new post of Highmark Distin- guished Professor in the College of Engineering'sInstitute for Complex Engineered Systems. He will oversee DHTI and work with faculty research- ers to address research goals.

At DHTI's launch, Russell spoke of Carnegie Mellon's "innovation ecosys- tem" and said it can be deployed to ad- dress problems in the US healthcare system. "The US healthcare tab reached $2.8 trillion last year, but we believe our new institute will help reduce those costs and improve quality for all consumers," he said in a university news release.

CMU may be riding an early wave of interest in applying data mining to healthcare innovation. In early Au- gust, the National Institutes of Health (NIH) announced its intent to fund the exploration of ways to use "big data" to improve national healthcare outcomes to the tune of $96 million over four years. NIH has plans to establish six to eight big data centers of excellence that will train researchers and students in data science and testing to create tools, methods, and software to improve health- care processes.

NIH officials say they believe big data has strong potential to revolution- ize the healthcare industry by develop- ing new processes and products and by establishing new standards for health- care policy. However, they also note a growing skills gap among biomedical researchers who may not be familiar with the new forms of data collection and integration that the new centers will seek to address.

Dr. William Winkenwerder, Jr., High- mark's president and CEO, is looking for his company's partnership with CMU to have a measurable effect on US health- care costs, which are estimated to top $4.8 trillion by 2021. "Partnering with a worldwide leader like Carnegie Mellon will open the door to the ideas and in- novations that we need to improve healthcare delivery for the betterment of our patients and the community," he said.

Gerrill Griffith, Contributing Editor

Pittsburgh, Pennsylvania

[email protected]