November 13, 2020

Adaptation: Proven Solutions Crossing the U.S. Border

Health systems around the world, including in the United States, struggle to balance affordability, quality, and access to care. In many low‐ and middle‐income countries (LMICs), urgent health needs within resource‐challenged settings are driving the development of promising new technologies and models of care.

At this year’s Annual Forum, we featured a panel discussion, Adaptation: Proven Solutions Crossing the U.S. Border, to highlight the experiences and perspective of organizations that have successfully adapted models, are planning for adaptation, or have funded adaptation projects in the United States. Innovations in Healthcare has emphasized evaluating innovations with the potential to address challenges faced by developed healthcare systems, including in the U.S., as policy makers and healthcare leaders increasingly recognize the potential of internationally developed solutions to improve cost efficiencies, access to care for rural and vulnerable populations, patient engagement, and other key challenges. Participants in this panel discussion offered up their thoughts on the challenges and opportunities of these adapting health solutions to the U.S. context.

The Innovator Perspective

Abner Mason described the adaptation of the MedicallHome model to the U.S. MedicallHome—a subscription-based telemedicine program connecting patients throughout Mexico by phone with doctors in a Mexico City call center—was launched in the United States in 2014 as ConsejoSano, connecting Hispanic residents in the US to the same doctor-staffed call center in Mexico. Although doctors serve as health advisers, rather than physicians, to U.S. customers, they fill an important gap in the supply of health care providers for the fast-growing Spanish-speaking population. The ConsejoSano model is being marketed to U.S. consumers and companies as a way to streamline—not replace—existing patient-physician relationships, reflecting responsiveness to consumer demand for convenience-driven healthcare services. Mason describes the approach as an “all you can eat” 24/7 plan that empowers users to access culturally competent health advice on their own terms. 

Richard Dougherty discussed how the BasicNeeds model leverages existing resources in new ways to increase access to and effectiveness of mental health services. Through a holistic and community-based approach, BasicNeeds provides medical treatment as well as opportunities for social and economic inclusion to people with mental health challenges. To date, BasicNeeds has helped a half million people in 12 low- and middle- income countries.  BasicNeeds is currently planning to pilot the model in U.S., marking the organization’s first attempt to replicate in a high-income setting. Dougherty is optimistic that there is indeed a U.S. market for the program, and believes that the model can provide strategies for both health plans and the government to better address the broader factors that influence those living with mental illness.The macro perspective:

Thomas Bollyky from the Council on Foreign Relations shared key insights from his 2015 paper - New, Cheap, and Improved: Assessing the Promise of Reverse and Frugal Innovation to Address Noncommunicable Diseases. This study, which focused on emerging problems related to chronic diseases in LMICs, found these threats are increasing much faster in much younger populations than we have seen in higher-income populations. Bollyky noted that the study’s findings reflect large potential for south-to-south opportunities, particularly with respect to information and communications technology-enabled healthcare; and community health workers and peer networks, particularly around mental health support. He also noted the need for more donor investment for chronic disease, which is currently “pitifully low,” about 1% of global health aid internationally.

US provider perspective:

Donald Goldmann discussed how the Institute for Healthcare Improvement is creating a large network of providers in the U.S. who are open to solutions from outside the US. Implementing and spreading these ideas is where “rubber meets the road” – and lots of money can be wasted at this point of the journey if there isn’t vision. Goldmann noted that that there is a tendency to first look for the ‘pain points,’ and then design a solution for a given problem, but argued that this approach is flawed. He maintains that that the proper way to look at innovation is to create the logic model for the outcome you want to achieve – by doing this exercise, you will identify many areas requiring innovation, but many innovations will actually fall outside of the logic model, and therefore may not be the right solution. Context does matter – payment systems, informatics structures, etc. differ – and there is much skepticism and significant intrinsic bias (and sometimes blatant biases) toward innovations that come from other places. At a corporate level, there is a lack of enthusiasm for the careful prototyping necessary before you replicate innovation in a new context. Many large health systems likely aren’t going to put the resources behind such testing, unless they see for themselves through firsthand site visits how it works in another health system.

Philanthropic perspective:

Deborah Bae spoke about how the Robert Wood Johnson Foundation (RWJF) is approaching the concept of adaptation, and how the Foundation’s adaptation work aligns with its mission to improve the health and health care of all Americans.  RWJF’s current focus on “building a culture of health” has led the Foundation to think about how countries outside of the U.S. are achieving quality health outcomes at a lower cost.  Deborah shared the Foundation’s experience of looking at Medicc -- an organization that strives to use lessons gleaned from Cuba’s health care system to improve outcomes in four medically underserved communities in the United States--to address social determinants of health. She also noted that RWJF has provided funding for a feasibility assessment for US implementation of the BasicNeeds model. She also highlighted the current open call for proposal inviting people in and out of the US to apply for a grant to take a lesson from abroad and apply it to the US. The call, Global Ideas for U.S. Solutions, is part of RWJF’s search “globally for ideas to help us build a Culture of Health in the United States, where everyone has the opportunity to live healthier lives, no matter who they are, where they live, or how much money they make.”

We are so thankful to all who participated in this rich panel discussion at our Annual Forum!