First Plenary SessionTAKING STOCK OF THE LEARNINGHEALTH CARE SYSTEM: WHAT HAVEWE ACHIEVED AND WHY DOES ITMATTER?

Moderator

Penny Mohr, MAPatient-Centered

Outcomes ResearchInstitute (PCORI)

Washington, DC, USA

Taking Stock of the Learning Healthcare System:What Have We Achieved and Why Does It Matter?

Penny Mohr, MASenior Program Officer, Improving Healthcare Systems, Patient-Centered Outcomes Research InstituteMay 18, 2015

Caught Between Scylla and Charybdis

$2.6 Billion Cost toBring a New MolecularEntity to Market

Tufts Center for DrugDevelopment, 2014

Increaseddemand forPhase IVStudies andReal-worldEvidence

The Learning Healthcare System

Efforts aremade to learnfrom everyclinical

encounter*

Findings areimplementedto improvepatient care * Accomplished by closely

integrating observational andexperimental clinical research into

clinical practice

Evidence based Draw on the best evidence to provide care Learn through the delivery of care Discovery is a natural outgrowth of care

Value-driven Deliver the most value Retain incentives for innovation Emphasize prevention and health promotion

Patient-centered Provide the care most appropriate for each patient Facilitate collaborative choices between patient and provider

The Vision

The Building Blocks

Investment and Incentives

BD2K

Electronic Health Record Adoption byPhysicians Offices in the United States, 2001-13

>

The Optimists

Evidence BasePoint of care clinicaltrials represent apromising newmethod forconducting clinicalresearch.DAvolio et al. J Am MedInform Assoc. 2012

Value-drivenResults from thePioneer ACO Modeldemonstrationevaluation areencouragingNyweide et al., JAMA 2015

Patient-centerednessPatients are engaged andwant to participate.Martin Coulter CEO,PatientsLikeMe, iHealthbeat 2014

The healthcare system isnow positioned to finallyjoin other industries as anenterprise of continuouslearningVictor Dzau, CEO, Duke UniversityHealth System, IOM 2015

The Critics

Evidence-Basedthe aggregateresearch capacity isvery thin, and theproducts fallsubstantially short ofthe need.IOM, Learning What Works:Infrastructure Required forCER 2010

Value-drivenOne persons waste isanother persons income

Brent James, InterMountainHealthcare, Managed Care 2013

Patient-centerednessPatients frequentlypreferred restrictingprovider access to theirEHRs.Tierney et al. JGIM 2015

How do you learn ina formal, defensibleway?

SpeakersTAKING STOCK OF THE LEARNING HEALTH CARESYSTEM: WHAT HAVE WE ACHIEVED AND WHY DOES ITMATTER?

Sarah Greene, MPHPatient-Centered

Outcomes ResearchInstitute (PCORI)

Washington, DC, USA

Lewis G. Sandy, MD,FACP

UnitedHealth GroupMinneapolis, MN,

USA

Sachin H. Jain, MD,MBA

CareMore/AnthemCerritos, CA, USA

Moderator

Penny Mohr, MAPatient-Centered

Outcomes ResearchInstitute (PCORI)

Washington, DC, USA