The Innovation Investment Process IIP: A Call for Good Ideas

1

• The Innovation Investment Process (IIP) A Call
  for Good Ideas

2
Overview

• Background
• Part of QDR Medical Transformation Roadmap
  Initiative 11 for performance-based financing
• Establishes a Board of Directors that will select
  and approve investment initiatives for
  implementation
• Vision
• Corporate-driven effort to expeditiously generate
  large-scale innovations with sound return on
  investment that support the Military Health
  System (MHS) mission, do no harm to medical
  readiness, and and positively impact
• Resource efficiency
• Quality of care
• Beneficiary and provider satisfaction

3
Goals

• Positively impact the MHS through
• Leveraging private sector best practices and
  methodologies to produce MHS benefits and further
  the medical mission
• Responding to and mitigating impact of increasing
  health care costs on overall MHS and DoD
  operations
• Demonstrating to the Congress and other key
  stakeholders that the MHS is pursuing a
  comprehensive agenda of sound and responsive
  fiscal management

4
Approach

• Develop a sustainable process to identify and
  fund innovative initiatives that reduce MHS costs
  with sound return on investment without
  compromising medical readiness, quality of care,
  and access to care
• Encourage corporate-level innovation
• Apply accepted economic evaluation criteria and
  methods tailored to the MHS

5
Structure
The IIP project structure combines the
collaboration and creativity needed to foster
innovation with discipline and accountability
required to make sound investment decisions
6
Initiative Plan Development Process
The IIP utilizes an iterative process to
identify, qualify and develop the most promising
opportunities into detailed initiative plans for
Board review and approval
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Progress Idea Generation
Examples of concepts in the IIP Pipeline

• Utilization of direct and purchased care services
• Resource utilization
• Medical, Case and Disease Management
• Customer Service
• TRICARE as a secondary payer
• Telemedicine
• IM/IT

• Pharmacy utilization and channels
• Access to care and specialty services
• Clinical service utilization (e.g. ER, Surgery)
• Clinical quality improvements
• Supply chain

• Over 150 ideas have been triaged to date from
  across the MHS
• Services
• HA/TMA

• MHS Leadership
• Private Sector parties

• Contractor experience
• IIP Website

8
Progress Proposal Development

• Eight proposals completed in year one
• Four approved by the Board
• Four on hold pending executive sponsorship
• One proposal currently in coordination
• Five additional proposals currently under
  development

• Year 2 focus will be more on direct care than
  corporate initiatives
• Increased focus on quality, and beneficiary and
  provider satisfaction in addition to ROI

9
Progress Initiative Plan Development

• Two initiative plans completed and approved for
  implementation
• Pharmacy Fraud Waste and Abuse
• Driving Home Delivery
• Total combined projected savings of 260 million
  at full implementation
• One initiative plan not moving forward due to
  NDAA language (Piloting Federal Pharmacies)
• One initiative plan currently in coordination
  with a business case for quality versus strong
  ROI (ARMD)

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Pharmacy as a First Focus Area

• Large-scale problem, large-scale opportunity
• Pharmacy costs are among the most pressing MHS
  budgetary concerns
• Enterprise-wide implications and impact
• Pharmacy issues are systemic, and warrant a
  corporate-level set of solutions
• Speed of implementation and return on investment
• Significant elements (though not all) of the
  pharmacy cost problem can be addressed in the
  near-term
• Executive sponsorship
• TMA Pharmacy Operations Directorate and Service
  Pharmacy leaders bring critical leadership,
  expertise and energy
• Applicable private sector experience
• Proven approaches and solutions can be adapted
  and applied
• Matched set
• There are clear logistical advantages to bringing
  a set of related issues and proposals to the Board

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Pharmacy Initiative Plans

• Prescription Drug Fraud, Waste Abuse
  Contracting with a pharmacy-specific, data-driven
  vendor to identify and recover costs attributable
  to fraud, waste and abuse
• Driving Home Delivery Leveraging new mail order
  program enhancements and opportunities for
  targeted beneficiary outreach in order to shift
  maintenance medication fills and refills from the
  retail network to a more cost effective and
  convenient channel
• Piloting DoD/Other Federal Pharmacies Piloting
  vendor-managed pharmacy outlets on Federal
  installations in locales with high retail
  utilization currently underserved or unserved by
  MTF pharmacies

Implementation in progress Approved by the Board
on 8/1/2007
Implementation in progress Approved by the Board
on 9/26/2007
Initiative Plan on hold due to NDAA language
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Anesthesia Reporting and Monitoring Device (ARMD)

• The Anesthesia community recognizes ARMDs as
  quickly becoming the standard of care and aims to
  provide the best quality of care available. They
  formed the Anesthesia Reporting and Monitoring
  Device Leadership Organization (ARMD-LO) and
  initiated discussions with the IIP
• ARMD-LO leveraged the IIP in order to
• Quickly gain visibility amongst senior leadership
• Expedite the process of initiative approval and
  implementation
• Obtain credibility and resources of industry
  recognized leaders within Military Healthcare
  space
• ARMD-LO gathered executive-level support across
  TMA and the broader MHS for the ARMD initiative,
  which will ensure system-wide standardization of
  anesthesia recording practices and technology
• The ARMD initiative is expected to be presented
  to the IIP Board of Directors in the upcoming
  weeks

The views expressed in this article are those of
the author(s) and do not necessarily reflect the
official policy or position of the Department of
the Navy, Department of Defense, or the United
States Government.
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IIP Partnership with Anesthesia Community

• Contributions of the Anesthesia Community
• Coordinated Tri-Service involvement
• Raised awareness of initiative and need for
  automated electronic record keeping
• Oversaw business case to validate clinical
  assumptions
• Provided guidance to ensure initiative not only
  has clinical necessity and validity, but also has
  merit as a sound business decision
• Present initiative to the IIP Board of Directors
  for approval
• Contributions of the IIP team
• Developed business case model and implementation
  plan
• Solicited industry input and vendor interest
  through a Request for Information (RFI)
• Conducted information-gathering interviews at all
  levels across MTFs
• Leveraged critical private sector views and
  leading practices
• Through a successful partnership between ARMD-LO
  and the IIP, the ARMD initiative has been
  transformed into a solid business case which has
  gained executive-level support and is positioned
  for approval by the IIP Board of Directors

The views expressed in this article are those of
the author(s) and do not necessarily reflect the
official policy or position of the Department of
the Navy, Department of Defense, or the United
States Government.
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Continuing the Call for Good Ideas

• What
• Any idea that has broad application across the
  MHS with a sound financial business case and
  positive impacts on Access, Quality,
  Provider/Beneficiary Satisfaction
• Who
• Anyone can submit an idea to the IIIP team
• How
• Go to http//iip.fedworx.org
• Register and submit your idea (attach document or
  fill in Concept Form)
• Ideas and information submitted will only be
  visible to IIP personnel
• If you have an idea with cross-service agreement
  and believe that IIP could be a support vehicle,
  please contact Rachel Foster directly at
  Rachel.Foster_at_ha.osd.mil

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• Backup Slides

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Pharmacy as a First Focus Area

• Large-scale problem, large-scale opportunity
• Pharmacy costs are among the most pressing MHS
  budgetary concerns
• Enterprise-wide implications and impact
• Pharmacy issues are systemic, and warrant a
  corporate-level set of solutions
• Speed of implementation and return on investment
• Significant elements (though not all) of the
  pharmacy cost problem can be addressed in the
  near-term
• Executive sponsorship
• TMA Pharmacy Operations Directorate and Service
  Pharmacy leaders bring critical leadership,
  expertise and energy
• Applicable private sector experience
• Proven approaches and solutions can be adapted
  and applied
• Matched set
• There are clear logistical advantages to bringing
  a set of related issues and proposals to the Board