Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Q&A: Creating an Innovation Hub in the Safety Net

IMPORTED: www_commonwealthfund_org____media_images_newsletters_quality_matters_dec_jan_2014_praveen_b_headshot_h_115_w_100.jpg   IMPORTED: www_commonwealthfund_org____media_images_newsletters_quality_matters_dec_jan_2014_headshot_h_115_w_100.jpg IMPORTED: www_commonwealthfund_org____media_images_newsletters_quality_matters_dec_jan_2014_syed_headshot_h_115_w_100.jpg San Mateo Medical Center, a county-funded public hospital and clinic system based in Northern California that provides 250,000 outpatient visits per year, operates in a community in which more than a third of residents are foreign-born and nearly half speak a language other than English at home. In September 2013, the medical center was awarded a $100,000 grant from the Center for Care Innovations to form an innovation hub, which will help vet new technologies and care processes that may benefit other safety-net institutions in the United States. Many of the innovations come from early-stage health technology companies in nearby Silicon Valley.


Quality Matters: We’ve heard that technology companies tend to favor the “worried well,” perhaps because not focusing on disease management allows them to avoid having to go through the F.D.A. regulatory process—and because the worried well tend to have disposable income to purchase health products and apps. In your discussions with entrepreneurs, do you see that changing at all?

Michael Aratow: I do see more interest in serving high-cost or high-need patients. Part of it is that the Center for Care Innovations is doing a good job advocating for that space around here and so is the California HealthCare Foundation. They are raising awareness that the safety net is a significant market force, which I think resonates with entrepreneurs. I reinforce this point by saying to them that if their product can work here, it can work anywhere. You’re not going to find a more challenging environment—financially, educationally, socially. This is a real stress test for them.

Quality Matters: Are the companies willing to provide funds to cover the cost of piloting products and gathering data to demonstrate their effectiveness and/or refine them?

Aratow: At the moment, there is no money changing hands, but we are exploring ways of charging them for the value of having a test bed—perhaps using a tiered approach. For example, for very early-stage companies with limited resources, there would be a minimal test bed encounter that didn’t involve significant feedback from medical center employees, no extensive metric collection, and no data interchange with our systems. At the highest tier, which could cost an order of magnitude more, there would be significant feedback from subject matter experts, study design and manuscript preparation assistance, return on investment analysis, interface to clinical systems, and acting as a reference site. We estimate we can save early-stage companies up to seven figures and about 12 to 18 months in their development cycle, depending on the product and type of engagement with us.

Quality Matters: What might that be worth in dollars? Or would you ask for some other form of reimbursement—perhaps equity?

Aratow: A first tier might start in the tens of thousands range, but we are still working out the business model.

Quality Matters: It seems as though safety-net institutions have significantly fewer IT staff and resources than other health care organizations and have to devote those to higher priorities—and thus innovation has to take a back seat. Are you finding the early-stage companies are willing to provide IT staff support?

Aratow: They do offer help. But a lot of times even though they offer resources it takes time to train those people to help them understand our systems. Sometimes our people say it is just not worth it. We try to work around this issue by focusing on patient-facing projects that can produce feedback loops that don’t heavily rely on internal IT systems.

Quality Matters: Can you give us an example of that?

Aratow: We’re piloting a smartphone or feature phone app that sends patients scheduled for a colonoscopy guidance on their prep and alerts to remind them when to drink the prep solution. It has animations and allows them to ask questions. We’re analyzing the data now, but anecdotally we’ve heard it’s reducing no-show rates and increasing patient preparedness, which is a big issue because patients have to be turned away if they are unprepared, leaving a gap in the schedule. It has the potential to increase our revenue by ensuring those slots are used and improve outcomes for at-risk patients.

Quality Matters: What other products are you testing now?

Aratow: Like the two other innovation hubs in the CCI programs, we’re testing a product that provides pictograms and video with easy-to-follow medication instructions for patients with low literacy levels. We’re also working with a local company that has a point-of-care predictive analytics tool that provides descriptive and predictive analysis based on the individual patient to identify gaps in care, missed diagnoses, and nonoptimal utilization of diagnostic tests. We’re also looking at disease management platforms and a biometric device company that will allow us to collect patients’ blood pressure, pulse, respiratory rate, and temperature at once, which can improve workflow and makes care outside of the clinical setting more accessible to our patients. We’ve only been around for a year or so, but we are moving pretty quickly given the fact that we only have four people working on this and none of us are devoting our full time to it.

Quality Matters: What do you find most challenging about this work?

Basaviah: One challenge is the contractual process. There’s significant back and forth to have contracts written up and agreed upon and small changes compound this. For instance, if the location of a server needs to be changed or if the technical specifications are tweaked to bring the costs down, then we go back to the drawing board. And when you have multiple stakeholders—hospitals, vendors, physicians, patients—it takes considerable time.

And of course there are HIPAA issues around personal health information. So everyone needs to be very careful about how we are transmitting data. We are lucky that we have passionate people at the hospital who work on the IT side to help us with data or business analytics and we have a friendly executive leadership that is on board with getting pilots running.

Quality Matters: Given these challenges, does it make sense to have multiple innovation centers—wouldn’t it be better to have ones that specialize in piloting and testing?

Basaviah: No. I don’t think you can have enough innovation test beds. Piloting takes time away from patients, it takes training, and it takes people who are comfortable using new technologies. Even if they are extremely savvy, they may be foreign to certain types of technologies. For instance, there may be people who are uncomfortable using a smartphone and you have to help them adapt. There is always going to be a limit to how much people are willing to put up with, and how many pilots the same providers and the same patients would participate in. We are very new, so I’m curious to see how we progress and grow over the year—for example, in the next few years will we eventually hit a cap of how many of our providers will engage in pilots, and if so, what solutions can we come up with so that we can sustain the quantity and quality of pilots to ultimately benefit patients’ health.

Quality Matters: What then?

Basaviah: We are hoping we can train other hospitals to become their own test beds, so they can take what we learned and develop their own in-house capacity to both pilot technologies and help spread innovation across the safety net. Another reason it’s important to do this is to be able to pilot technologies in—and spread them to—a great number and diverse array of patient populations and geographies. They are all unique and complex in their own ways and we need to be able to offer input to these vendors and technologies on other populations and regions.

Quality Matters: What strategies do you use to get providers on board?

Syed Khan: We pilot with single teams in early tests and we look for a showcase provider—someone who believes in it and is able to sell to other providers. We need persuasive people not only for our organization but for our hub. There are some providers that like to try new technology and some that are still hesitant. One of the challenges of spreading their use is that it requires wholesale cultural change. We have to demonstrate to them that the technology can not only make their workflow easier but also help them deliver uber patient care.

Quality Matters: What advice would you give policymakers and others who want to promote innovation?

Basaviah: We need to better incorporate training in innovation and design thinking, innovation processes, and understanding how technology works in health care within students’ curricula, especially in public health and global health graduate programs. This extends into government circles as well. I was formerly a member of the Presidential Advisory Council on HIV/AIDS, helping to inform policy in line with the National HIV/AIDS Strategy under President Obama and Secretary Sebelius. The Council was concentrated with brilliant, forward-thinking, and highly impactful experts from the HIV/AIDS sector; nonetheless, only a small part of the conversation was about using technology to combat HIV. There are also so many innovative health practices and initiatives going on in other countries—particularly in India, Southeast Asia, and Sub-Saharan Africa. They have really complicated patient populations and brilliant, dedicated thinkers and practitioners. If we are going to solve problems in the U.S. health care safety net, we need to have greater relationships, collaborations, and learning exchanges with the international health care community.

Publication Details